Lessons from Japan's T-Shaped Approach to TB

Interview with Keizo Takemi, Member, House of Councillors of Japan
December 15, 2015

On December 16, JCIE and the government of Japan held a conference on universal health coverage (UHC) and the new development agenda. The JCIE Global Health Special Series comprised four blogs that ran from December 12—also known as “UHC Day”—up until the start of the conference. This is the last of those blogs.

Several years ago, the global health field seemed destined to be divided into two camps: those in support of targeting investments to disease-specific vertical programs and those in support of targeting the broader goal of health system strengthening. But we soon came to the conclusion that this is a false dichotomy because the two are strongly interdependent.

After reflecting on Japan’s experience in addressing public health issues in the postwar period, I came to realize that the lessons learned at that time are highly applicable today. More specifically, I have begun to see the need for what I have been calling a “T-shaped” approach. In this approach, disease-specific approaches are important not only in relation to their core goal of fighting communicable diseases but also as entry points to strengthening health systems and promoting UHC. It is not a choice between vertical or horizontal or a compromise (diagonal) but rather two strong lines that depend on each other.

This approach is what we used in Japan to lay the groundwork for UHC in the 1950s, although it was not done deliberately. At the time, tuberculosis was the leading cause of death in Japan, so not surprisingly, a large portion of health expenditures was allocated to preventing, diagnosing, and treating tuberculosis. In 1951, we passed the Tuberculosis Prevention Act, which mandated that the government cover the cost of checkups and tuberculosis treatment for low-income people throughout the country. Health surveys were designed to track progress on tuberculosis control, and financial incentives were given to prefectural governments to encourage responsible efforts to contain the spread of disease.

The tuberculosis control program emphasized universal use of health checkups, and our health system continues to this day to place high priority on checkups and other preventive measures. The surveillance systems that were put in place formed a strong foundation not only for health surveillance more generally but also for the expansion of public health systems down to the community level. The public subsidies given to prefectures for tuberculosis control enabled the social health insurance system to expand primary care coverage, allowing us to achieve UHC in 1961.

As we move into the new development era, I believe Japan’s T-shaped approach to fighting tuberculosis offers a useful model. We need to make sure that we are not abandoning successful, life-saving programs focused on specific diseases, but rather are implementing them in such a way that they contribute to the expansion of UHC while continuing to make progress toward their specific mission.

Keizo Takemi is a member of Japan’s House of Councillors and a JCIE Senior Fellow.

JCIE Global Health Special Series

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