The Fourth Intellectual Dialogue on Building Asia’s Tomorrow was held on March 16–17, 2002, in Kisarazu, Japan on the theme of “Health and Human Security: Moving from Concept to Action.” It had been stressed at previous meetings that in order to further advance the international debate on human security, more practical policy discussions were required and that this could best be accomplished by examining in-depth case studies of effective responses to specific human security threats. Accordingly, case studies were commissioned on one of the most serious and conspicuous human security challenges in East Asia: the lack of primary health care for the poor. These focused on Cambodia, Indonesia, and the Philippines, and were presented for discussion before approximately 40 health and human security experts and other leading Asian public intellectuals who took part in the conference.
The results of the conference were published as Health and Human Security: Moving from Concept to Action.
Opening of the Conference
Tadashi Yamamoto, President, Japan Center for International Exchange
Session I: Evolution of the Human Security Concept as an Operational Tool for Policy Formulation and Implementation
Tadashi Yamamoto, President, Japan Center for International Exchange
Keizo Takemi, Chairman, Committee on Foreign Affairs and Defense; Former State Secretary for Foreign Affairs; Member of the House of Councillors
Lincoln Chen, Member, Commission on Human Security; Professor, John F. Kennedy School of Government, Harvard University
Chalongphob Sussangkarn, President, Thailand Development Research
Akihiko Tanaka, Professor, Institute of Oriental Research, Tokyo University
Session II: Human Security as a Policy Framework for New Cooperation in Asia
Carolina G. Hernandez, President, Institute for Strategic and Development Studies, Inc., Philippines; Visiting Professor, Graduate School of International Cooperation Studies, Kobe University
Surin Pitsuwan, Member, Commission on Human Security; Member of the Thai Parliament; Former Thai Foreign Minister
Yoichi Funabashi, Chief Diplomatic Correspondent and Columnist, The Asahi Shimbun
Musa bin Hitam, Chairman, Human Rights Commission of Malaysia; Chairman, World Enterprise Institute; Former Deputy Prime Minister of Malaysia
Chia Siow Yue, Director and Chief Executive Officer, Institute of Southeast Asian Studies, Singapore
Session III: Human Security Approach in Primary Health Care Delivery for the Underprivileged—Case Studies in Southeast Asia
Chia Siow Yue
Mely C. Anthony, Assistant Professor, Institute of Defense and Strategic Studies
Prunawan Junadi, Chair, Health Administration and Policy Department, School of Public Health, University of Indonesia
Carlo Panelo, Medical Specialist III, Policy, Planning and Advocacy Division, Bureau of Food and Drugs, Department of Health
Noriko Fujita, Chief Advisor, JICA Cambodia Child and Maternal Health Project
Sann Chan Soeung, Program Manager, National Immunization Program, Ministry of Health; Professor, University of Health Science
Naruo Uehara, Professor, School of International Health, Tohoku University
Session IV: Human Security as a New Policy Framework for Cooperation in Asia—Implications from the Case Studies
Peter F. Geithner, Advisor, Asia Center, Harvard University
Lincoln C. Chen
Mely C. Anthony
After reviewing the history of the evolution of human security in Japan since the late 1990s and the cases of human security initiatives taken by the Japanese government, Mr. Keizo Takemi, a presenter in the session, observed that human security continues to grow its importance in Japan. Furthermore, Takemi stressed that Japan’s commitment to human security will remain strong. He added a cautious note on the possible mix up between human security and humanitarian intervention, which may provide an opportunity to developed countries to meddle in the internal affairs of developing countries through the back door.
The ensuing discussion in this session centered on four inter-related themes:
(1) Conceptual ambiguity of human security
Acknowledging the importance of the human security perspectives, a number of participants referred to the problem of its conceptual ambiguity, particularly concerning what is included and what is not. If one takes the broadest possible definition, virtually all human issues can be included, depriving the concept of its practical effectiveness. Particular attention was paid to the inclusion/exclusion of humanitarian intervention and international terrorism. Participants seemed to be in agreement that the former should not be included. While terrorism raises issues of “human security,” participants sensed that direct military attacks on terrorism should not be included in the definition of human security activities. An ASEAN participant, quoting the case of human rights being immobilized through the excessive expansion of the concept, warned against the inclusion of too many elements. Rather, he suggested that a concrete, small-scale project should be actually implemented on an uncontentious human security issue in order to avoid repeating the unfortunate history of human rights.
(2) Effective operationalization of the concept
While Japan’s commitment to human security was admired, concerns were voiced on the difficulty in translating this excellent concept into concrete policies and making it an operative tool. Personal commitments of the three Japanese prime ministers in this cause notwithstanding, some cautioned that there might be difficulty in convincing the rest of the world of the relevance of this concept. Some warned of danger of good intentions on the executive level being hampered by the bureaucratic division of labor and vested interests. It was also pointed out that the current discussion on human security lacks a very practical viewpoint on how much security should be guaranteed.
(3) Actors of human security enhancement
It was generally accepted that, unlike traditional national security, enhancing human security requires the improvement of various human conditions and it should, therefore, require the involvement of various non-state actors, including international organizations and civil society organizations. Some argued that an effective network among non-state actors and states would be a key to the mobilization of limited resources toward human security enhancement.
(4) Side effects of human security discussions on Japan
Several Japanese participants made a rather interesting observation on the unexpected effects of the human security discussions on Japan. It was pointed out that the discussions might have promoted internal internationalization of Japan by encouraging the Japanese to look into more global concerns, and away from the traditional, narrow one-country pacifism. Some argued that traditional national security evolved in tandem with human security in Japan; public awareness of their own stake in human security led to the reconsideration of the traditional national security framework. Human security, thus, may have provided a healthier ground for the national security debate in Japan.
Keizo Takemi concluded the session by claiming that Japan continues to try to use nonmilitary means to cope with new threats beyond national boundaries, and that it is high time to reformulate the vague conceptual framework of human security into a more practical operative framework, which calls for intellectual input and policy initiatives.
After the presentation by Mr. Surin Pitsuwan, the discussion centered on how to make the human security concept into an operable policy framework.
It was pointed out that in the eye of security traditionalists, such as President Musharaf of Pakistan, human security still looks like a sort of slogan rather than an operative concept which can be applied to places like Kashmir. It was generally agreed, therefore, that the first step must be to make the concept sellable or marketable.
(1) Issues to be tackled
Seen from the angle of marketability or practicability, some argued that potentially controversial issues, including heavily military and violent aspects, should be eliminated, at least initially. These issues were seen to be “nonstarters.” It was further argued that we should, therefore, concentrate more on social and economic aspects. Referring to the similarity between the human security concept and the comprehensive security concept, one participant cautioned that operationally we should not be comprehensive. Instead, he argued that we should be concentrating on a select number of issues.
An example suggested as a concrete issue that human security concept should be applied to in the Asian context was the problem of poverty and economic development in general, which may not constitute a sufficient condition but definitely a necessary condition for human security enhancement. Adding the importance of freedom from ignorance (on top of freedom from want and freedom from fear) to the goals of the human security concept, education—particularly toward the development of civil consciousness—was also suggested. Primary health care was also offered on the grounds that it is deemed to be crucial for the population in order for them to contribute to economic development.
On the other hand, others argued that we should not shy away from controversial issues. In fact, some found that even the health issue could be potentially controversial or, at least, not entirely uncontroversial. Human security problems emerge more from inequity within a society and between societies rather than simple poverty. Thus, addressing inequity could be highly controversial.
Regardless, it was found to be important to begin small and gradually evolve into a larger scope.
(2) Levels on which human security initiatives should be taken
Participants also exchanged views on what levels that human security initiatives should be implemented for the maximum effect. There seemed to be a consensus that it should be started on the regional/sub-regional level. ASEAN was seen to be an appropriate initial arena, but suggestions were also made to utilize the ASEAN Regional Forum (ARF) or ASEAN+3. Some argued that ARF should establish a caucus to discuss human security, inviting NGOs and other civil society organizations. The special role of the civil society was emphasized in this session again in light of the risk of dependence on government, which is likely to lead to conflict with bureaucracy. Similar skepticism was heard by a Southeast Asian participant who suggested that a wide-based national commission on human security should be established in each country in order to avoid domination by the bureaucracy.
For maximum effectiveness, it was suggested that we should start with the top. Most Asian governments, most notably ASEAN governments, are a more top-down type rather than a bottom-up type. Others argued, however, both top-down and bottom-up approaches should be tried rather than relying exclusively on one approach.
Session 3 centered around the three case studies on primary health care in Cambodia, Indonesia, and Philippines. After the three case study authors presented their respective drafts, which attempted to view health care conditions in these three countries from the angle of human security, participants discussed what should and can be done to improve the primary health care situations in these countries, as well as East Asia in general.
One participant found that the lack of political will was common among three cases and argued for consistency in the health project in order to promote political will on the part of the respective governments by convincing them that health is a priority. Another participant observed that political will has long been around, and it was more a matter of learning from the experiences of other developing countries where health has been a high priority.
Scarce resources for health care, financial as well as human, were generally found to be inefficiently and/or unwisely used. Some participants criticized governments for this phenomenon and underscored the importance of empowering the people and community. Some, on the other hand, pointed to the essential role of the public sector in such areas where the market mechanism does not work as primary health care. It was found imperative, therefore, to collaborate with governments to secure financial and human resources and to cultivate more cost effective measures.
In order to enlighten people on their unalienable right to good health and, in turn, enhance people’s consciousness on the issue, education was found to be a key element by several participants. In a similar vein, access to health-related information must be secured and regional coordination among micro/macro-level data on health must be promoted.
Summarizing discussions in this session, a Southeast Asian intellectual who was once a government leader observed that (1) the focus should be on primary health care for the poor and (2) a comprehensive package including not only the direct primary health care program, but also such basic infrastructures as road, bridges, water supply, and clinics should be implemented. This was based on his conviction that it is providers of health who should move to people, and not the other way around. He also predicted that a people-centered program would draw the attention of politicians, eventually contributing to the political will on the part of governments. Key actors on this level of primary health care would be medical assistants and assistant nurses instead of modern hospitals or even medical doctors.
On the other hand, another Southeast Asian participant was opposed to the concentration on primary health care of the poor on the grounds that it would look more like charity rather than exercising human rights. He contended that a good health care program should target both rich and poor and that efforts should be made to minimize the cost of health care.
The final session discussed what needs to be done to operationalize the human security concept as a policy tool. Suggestions made during this session can be grouped into the following five categories:
- to make the health human security everyone’s business
- to convince national governments of the importance of the concept
- to convince and mobilize regional and global institutions
- to rely on track 2
- to use the market mechanism
(1) Making the health and human security everyone’s business
Quite a number of participants emphasized the importance of making the health and human security issue everyone’s business, and they underscored the crucial importance of education and information in this process.
A Japanese participant pointed out that the health issue today is not only about the treatment of the sick, but it consists of the whole process of the health care system, i.e. (1) the first stage of health promotion for individuals based on individual responsibility; (2) preventative health care services, including health education; (3) early access to care; (4) early treatment and rehabilitation; (5) return to one’s routine life or into terminal care. Human security is a key word to convince people that the health issue should be a core and common agenda for everyone.
A Southeast Asian intellectual observed that there are many people who are still very much unconvinced that information, education, and services could be acquired; issues of health could be treated; and information about health could be found. Therefore, he went on to underscore the primacy of education and information.
Another participant from Japan stressed that we need to put more efforts into developing a strategy to make human security a domestic issue in each country as well as a global issue. In his judgement, it is difficult for the general public to imagine what this concept is all about in concrete terms. Therefore, he concluded that there must be efforts to take action in all corners of society to make human security a domestic issue.
A medical doctor participant referred to the securitization of health (or human securitization); he believes that health has been under-prioritized in the political and public allocation process and that a demedicalization of health is very important to remedy this situation. According to this participant, it is not just that health has low priority, but that it is too important to be left in the hands of doctors alone. Human security can help make health everybody’s business, which is an important part of the human securitization process.
(2) Convincing national governments
While various actors are expected to play major roles in the promotion of health care as a human security issue, some believe that the role of national governments should not be underestimated. One Southeast Asian scholar believes that the government remains to be one of the most critical stakeholders. As such, we need to convince the government of the critical importance of human security, and the strategy is to link human security to values that appeal to power holders. They are interested in political stability and legitimacy, and human security can address these two things.
Another participant from ASEAN sees it as imperative to make the concept (and resultant actions) acceptable to Asian countries. He believes that we will have to start with bureaucrats and governments, because in the Asian context, agreement and acceptance by upper levels are indispensable. He cautioned that we must be careful to plan well the presentation of human security.
A third ASEAN participant stated the importance of persuading donor countries that investing in human security is in their own interests. When people in all societies have a level of human security, he claims that it will prevent the future recurrence of incidents like the 9-11 attacks.
Quite a number of participants referred to the special role of Japan in promoting human security. A Southeast Asian participant stated that if Japan thinks that human security is an important tool, then Japan’s international cooperation community, including all the agencies involved, will have to adopt this idea as part of their operating procedure.
A Japanese participant also conceded that Japan should be more active in conveying the message that it is placing higher priority on human security through government-to-government dialogues on Japanese aid and ODA. It would also help the human security perspective gain more support from the Japanese public.
Another Japanese participant, in return, assured that the Japanese government is paying more attention to health issues as a common agenda for Asia.
(3) Mobilization of regional and global institutions
Some participants stressed the utility of using regional and international organizations to promote human security. An ASEAN political leader believes that it will be necessary to make this concept known and to try to sell this idea to the ASEN+3 entities. He cautioned, however, that the introduction should be conducted carefully and tenderly to ASEAN+3.
Another participant advocated an ASEAN audit on human security. He argued for an audit of all ASEAN countries on human security, for tracking progress, and for the advocacy of specific policy and operational improvements to move countries from where they are to where they want to be. It would not mount to imposing an outside measuring stick, but rather have countries audit themselves as to where they are in terms of human security. This auditing could involve financing and tracking the resources in human security.
Institutions with more global scope should also be mobilized. Particularly on health, one participant argued that we must communicate to WHO, World Bank and ADB that health has been appropriated as a dimension of human security in our communities, and accordingly, they could consider their own projects with this conceptual tool in mind so the idea could gain currency. If these institutions are convinced and adopt this conceptual tool, he predicts that we can gain the necessary momentum.
(4) Promotion of human security through the Track 2
Voices were heard mainly from ASEAN participants on the effectiveness of the track 2 in promoting human security in Asia. One argued that track 2 institutions could be used as a platform to broadcast and develop the idea, which will develop constituencies in every country based on intellectual skills. For instance, the human rights colloquium in ASEAN/ISIS can serve as a forum to discuss human security. Other track 2 devices such as ASEAN People’s Assembly and ASEAN Vision 2020 could also address human security themes. Through ASEAN/ISIS, linkages between government and civil society organizations could be facilitated. Thus, we must create a track 2 for human security
Another ASEAN participant called attention to the East Asian Development Network, which is a network of think tanks linked together with Global Development Network. Research could be done through these networks.
(5) Use of market mechanism: pros and cons
One factor over which participants did not quite agree among themselves was the wisdom of relying on the market mechanism. Some positively evaluated the potential role of the market, especially the corporate sector, in terms of building constituencies. He argues that there are aspects of health that are going to be marketized, beginning with the care of the elderly. He foresees increased opportunities for the corporate sector to work in the realm of health care, especially in China where one sees investment in old age homes by the private sector. He thus predicts that there is going to be a marketization of aspects of the health issue.
On the other hand, some were very cautious about an increased reliance on the market mechanism. One claimed that there are social and public responsibilities in health that must override market failures. His opinion was based on the past experiences of not being sufficiently successful in introducing universal access to health care with high quality and reasonable levels of efficiency, which in his judgment is an unfinished challenge for Asia.
Another participant from Southeast Asia also agreed that health must be taken out of the market system. For example, issues of drug production of, research, etc. must be not left to the market system.
- Amphon Jindawatthana, Director, National Health System Reform Office, Thailand
- Mely C. Anthony, Assistant Professor, Institute of Defence and Strategic Studies, Nangyang Technological University, Singapore
- Abdul Razak Abdullah Baginda, Executive Director, Malaysian Strategic Research Centre
- Barnett F. Baron, Executive Vice President, The Asia Foundation
- Chalongphob Sussangkarn, President, Thailand Development Research Institute
- Lincoln C. Chen, Member, Commission on Human Security; Professor, John F. Kennedy School of Government, Harvard University
- Chia Siow Yue, Director and Chief Executive Officer, Institute of Southeast Asian Studies, Singapore
- Francois Fouinat, Executive Director, Commission on Human Security
- Noriko Fujita, Chief Advisor, JICA Cambodia Child and Maternal Health Project
- Yoichi Funabashi, Chief Diplomatic Correspondent and Columnist, The Asahi Shimbun
- Yoshitaro Fuwa, Senior Economist, Japan Bank for International Cooperation (JBIC) Institute
- Peter F. Geithner, Advisor, Asia Center, Harvard University, USA
- Yasuhiro Goto, Editorial Writer, Nihon Keizai Shimbun
- Han Feng, Deputy Director and Associate Professor, Institute of Asia-Pacific Studies, Chinese Academy of Social Sciences
- Sukehiro Hasegawa, Director, United Nations Development Programme (UNDP)
- Carolina G. Hernandez, President, Institute for Strategic and Development Studies, Inc., Philippines; Visiting Professor, Graduate School of International Cooperation Studies, Kobe University
- Ryokichi Hirono, Professor Emeritus, Seikei University
- Musa bin Hitam, Chairman, Human Rights Commission of Malaysia; Chairman, World Enterprise Institute, Former Deputy Prime Minister of Malaysia
- Toru Honda, Chairperson, Services for the Health in Asian & African Regions (SHARE); President, Horikiri Central Hospital
- Andrew Horvat, Japan Representative, The Asia Foundation
- Jon Ungphakorn, Member of Thai Senate; Secretary of the Board, AIDS Access Foundation
- Prunawan Junadi, Chair, Health Administration and Policy Department, School of Public Health, University of Indonesia
- Hideko Katsumata, Executive Secretary, Japan Center for International Exchange
- Jun’etsu Komatsu, Managing Director, Asia Center, The Japan Foundation
- Yoshihiko Kono, Senior Executive Director, Japan Bank for International Cooperation
- Makito Noda, Chief Program Officer and Director for Research Coordination
- Kensuke Onishi, Chief Executive Officer, Peace Winds Japan
- Carlo Panelo, Medical Specialist III, Policy, Planning and Advocacy Division, Bureau of Food and Drugs, Department of Health
- Sann Chan Soeung, Program Manager, National Immunization Program, Ministry of Health; Professor, University of Health Science, Cambodia
- Kenji Shibuya, Global Programme on Evidence for Health Policy, World Health Organization (WHO), Geneva
- Surin Pitsuwan, Member, Commission on Human Security; Former Thai Foreign Minister
- Keizo Takemi, Chairman, Committee on Foreign Affairs and Defense; Former State Secretary for Foreign Affairs; Member of the House of Councillors (Liberal Democratic Party)
- Akihiko Tanaka, Professor, Institute of Oriental Culture, Tokyo University
- Masami Tashiro, Senior Director, Administration Department and International Affairs Department, Keizai Koho Center (Japan Institute of Social and Economic Affairs)
- Kiyohiko Toyama, Member of the House of Councillors (New Komeito)
- Naruo Uehara, Professor, School of International Health, Tohoku University, Japan
- Koji Watanabe, Senior Fellow, Japan Center for International Exchange; Executive Advisor, Keidanren (Japan Federation of Economic Organizations); Former Ambassador to Russia
- Taizo Yakushiji, Profesor, Keio University; Executive Research Director, Institute for International Policy Studies
- Yuriko Yamakawa, Officer, Program Unit, Peace Winds Japan
- Tadashi Yamamoto, President, Japan Center for International Exchange (JCIE)
- Yap Mui Teng, Senior Research Fellow, Institute of Policy Studies, Singapore