AJISS-Commentary
The Association of Japanese Institutes of Strategic Studies
NPIRIPS

Nakasone Yasuhiro

The Japan Institute of

Research Institute for

Peace InstituteInternational Affairs

Peace and Security

Editorial Advisory Board:

No. 275

Akio Watanabe (Chair)
Ichiro Fujisaki
Masashi Nishihara
Kenichiro Sasae

27 September 2019

Editorial Committee:
Tsutomu Kikuchi
Fumiaki Kubo
Tsuyoshi Sunohara
Shujiro Urata andYasunori Nakayama

GLOBAL HEALTH DIPLOMACY TO
PROMOTE UNIVERSAL HEALTH
COVERAGE AT THE 2019 OSAKA G20
SUMMIT
Yasushi Katsuma

Editor & Online Publisher:
Kenichiro Sasae
President, JIIA・ As an outcome of the 2019 G20 Osaka Summitin June, the consensus on universal healthcoverage (UHC) among the leaders of powerful
economies is significant, as it will encourageother UN member states to treat UHC as anumbrella concept in achieving Sustainable
Development Goal 3 at the UN High-Level
Meeting on UHC in September 2019.
・ G20 finance and health ministers organized ajoint session for the first time, agreeing thatinvesting in health at an early stage ofdevelopment is important for sustainable andinclusive growth, which will be instrumental fordeveloping countries to justify mobilization oftheir domestic resources for UHC.
The views expressed in this piece are the author’s own and should
not be attributed to The Association of Japanese Institutes ofStrategic Studies.

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The Association of Japanese Institutes of Strategic Studies

・ The 2019 G20 Osaka Summit has served as one of the milestone events forJapan’s global health diplomacy to promote human security, in which Japan
took a whole-of-society approach in order to strengthen partnerships andengage in policy dialogues with G20 Engagement Groups.
The heads of state and government of the Group of 20 (G20) met inOsaka on 28-29 June in 2019, and adopted the G20 Osaka Leaders’
Declaration i , in which global health is one of the major issues addressed.
Paragraph 30 of the Declaration, the first paragraph in the section “GlobalHealth,” summarizes the consensus reached among G20 leaders on universal
health coverage (UHC). As an outcome of the 2019 G20 Osaka Summit, theconsensus on UHC is significant for the following five reasons.
First, G20 heads of state and government recall the commitment to the2030 Agenda for Sustainable Development and the Sustainable Development
Goals (SDGs) made by all member states of the United Nations (UN) in 2015,and have identified the urgent need to formulate a global health action plan sothat Goal 3 (to ensure healthy lives and promote well-being for all at all ages)
and Target 3.8 (UHC) can be achieved by all stakeholders in a harmonizedmanner.
Second, they have raised expectations for the UN High-Level Meeting(UN HLM) on UHC to be held in New York on 23 September 2019, by adopting abroader definition of UHC. In other words, UHC is treated not as just one of thehealth issues, but rather as an umbrella concept under which all health issues
related to Goal 3, including infectious diseases control and more robust
healthcare systems, can be tackled in a coordinated way.
Third, before the heads of state and government met, G20 finance andhealth ministers were convened to organize a joint session for the first time on 6
June 2019, and endorsed the G20 Shared Understanding on the Importance ofUHC Financing in Developing Countries ii. The finance ministers of powerfuli

https://g20.org/en/documents/final_g20_osaka_leaders_declaration.html [visited on 31 Augustin 2019]ii
https://g20.org/pdf/documents/en/annex_05.pdf [visited on 31 August in 2019]http://www.jiia.or.jp/en/commentary2AJISS-Commentary
The Association of Japanese Institutes of Strategic Studies

economies have agreed that investing in health at an early stage of development
is important for sustainable and inclusive growth, with evidence provided by theWorld Bank, and encouraged developing countries to mobilize their domestic
resources for UHC.
Fourth, Japan took a whole-of-society approach in order to strengthen
partnerships and engage in policy dialogues with G20 Engagement Groups.
AlthoughtheG20Summit

isaninter-governmental

process,many

non-governmental actors, particularly G20 Engagement Groups, were given
opportunities to provide the Japanese government with policy recommendations.
For example, the Civil 20 (C20) published C20 Policy Pack 2019iii, containing a
policy paper on global health prepared jointly by a number of civil societyorganizations, in April 2019. The C20 Global Health Working Group organized aroundtable in Tokyo on 19 April, inviting Japanese government officials from theMinistry of Health, Labor and Welfare, the Ministry of Foreign Affairs, and theMinistry of Finance, as well as some members of the Think 20 (T20) HealthWorking Group. A C20 policy paper on global health was presented, and views
on UHC, healthy and active ageing, and health security were exchanged among
the participants.
T20 is a research and policy advice network for the G20, and consists ofa number of Task Forces. Its Task Force 1 focused on the 2030 Agenda for
Sustainable Development, and published 11 policy briefs. The T20 Working
Group on UHC produced one of the policy briefs entitled Deliberate Next Steps
toward a New Globalism for Universal Health Coverage (UHC)iv in March 2019.
The policy brief consists of four proposals: 1) leaving no one behind; 2)prioritizing reliable domestic financing and cost-effective best buys; 3)
harnessing innovation and access to technology judiciously; and 4) supporting
common monitoring mechanisms, mutual learning platforms, and coordinatedinternational cooperation for UHC. A workshop was organized in Tokyo on 19iii

https://civil-20.org/2019/wp-content/uploads/2019/08/C20-POLICY-PACK-2019-web2.pdf[visited on 31 August in 2019]iv

https://t20japan.org/wp-content/uploads/2019/03/t20-japan-tf1-1-deliberate-next-steps-toward-n
ew-globalism-for-uhc.pdf [visited on 31 August in 2019]http://www.jiia.or.jp/en/commentary3

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February 2019, and Japanese government officials invited, in order to present
the policy brief and exchange ideas on the recommendations.
In addition to the above official G20 Engagement Groups, two interesting
private initiatives were taken to advocate for UHC. One is the HealthProfessional Meeting (H20) organized by the World Medical Association (WMA)
and the Japan Medical Association (JMA) in Tokyo on 13-14 June 2019, in whichthe Memorandum of Tokyo on UHC and the Medical Professionv was adopted.
The other is the Biopharmaceutical CEOs Roundtable (BCR) organized by theInternational Federation of Pharmaceutical Manufacturers and Associations(IFPMA) in Tokyo on 3-4 June 2019. The IFPMA prepared a joint statementvi
signed by pharmaceutical manufacturers in Japan, the US and Europe, andpresented it to Prime Minister Shinzo Abe in anticipation of Japan’s leadership inaccelerating progress towards UHC, in resolving unmet medical needs, and intransforming to a new healthcare system utilizing various medical data.
Fifth and last, the 2019 G20 Osaka Summit has served as one of themilestone events for Japan’s global health diplomacy to promote human security.
The Government of Japan adopted Japan’s Strategy on Global Health
Diplomacyvii in June 2013. Based on a firm belief that health is indispensable inachieving human security, the Strategy presents a vision of prioritizing global
health in Japan’s diplomacy and mainstreaming UHC in the global agenda, while
extending international cooperation to developing countries, particularly in Africaand Asia.
After UHC was included in the SDGs as Target 3.8 in 2015, Japan
hosted the first UHC Forum with the World Bank, the World Health Organization(WHO) and the United Nations Children’s Fund (UNICEF) among others inTokyo on 13-14 December 2017 in order to further mainstream UHC in the global
agenda. The co-organizers adopted the Tokyo Declaration on UHCviii, calling forv

http://dl.med.or.jp/dl-med/wma/h20e.pdf [visited on 31 August in 2019]http://www.phrma-jp.org/wordpress/wp-content/uploads/2019/07/BCRJointStatement_EN.pdf[visited on 31 August in 2019]vii
https://www.mofa.go.jp/mofaj/files/000005946.pdf [visited on 31 August in 2019]viii
https://www.mof.go.jp/international_policy/others/uhc_20171214.pdf [visited on 31 August in2019]vi

http://www.jiia.or.jp/en/commentary4

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The Association of Japanese Institutes of Strategic Studies

greater commitment to strengthen global momentum towards UHC, toaccelerate country-led processes towards UHC, and to nurture innovation forUHC.
Japan also organized the Tokyo International Conference on AfricanDevelopment (TICAD) in Yokohama in 2013 and 2019, in which UHC wasdiscussed with the heads of state and government of African countries. AtTICAD 7 held on 28-30 August 2019, the Yokohama Declaration 2019ix wasadopted, in which the commitment to promote UHC agreed at the 2013 TICAD 6
was reiterated.
For the above five reasons, the consensus on UHC at the 2019 Osaka
G20 Summit is significant. The consensus reached among powerful economiesof the G20, as well as the strengthened partnerships with internationalorganizations and non-governmental actors, are expected to further accelerate
global momentum towards UHC in the forthcoming milestone events, including
the UN HLM on UHC in New York in September, the G20 Health Ministers’Meeting in Okayama in October 2019, the 2nd UHC Forum in Bangkok inJanuary and February 2020, and the Nutrition for Growth Summit coinciding withthe 2020 Tokyo Olympic and Paralympic Games.

Yasushi Katsuma is a Professor in the Graduate School of Asia-Pacific Studies (GSAPS) at
Waseda University, and Director of Global Health Affairs and Governance at the Institutefor Global Health Policy Research (iGHP) in the National Center for Global Health andMedicine (NCGM).
ix

https://www.mofa.go.jp/region/africa/ticad/ticad7/pdf/yokohama_declaration_en.pdf [visited on31 August in 2019]http://www.jiia.or.jp/en/commentary5