February 21, 2023

Recommendations for the G7 Hiroshima Summit and Health Ministers' Meeting in 2023
– Establishing a more resilient system for providing healthcare to better realize UHC –Japanese Nursing Association
President Toshiko Fukui

The population of Japan is aging and birth rates are declining more than anywhere else in the world,
leading to fears that there will be weaker bases of social support and more complex inequality in the future.
Furthermore, regarding healthcare, the expansion and diversification of the population requiring care has
not only brought to light the increase in the quantity of needs, but also the increase in complexity in termsof quality. In response to this situation, the Japanese government is advancing "community-based
integrated care systems" as a national policy to support home care for the elderly. Discussions are also
underway regarding the creation of a social security system not only for the elderly, but for all generations,
including children, people with disabilities, people in needs, and healthy people with potential needs.
Japan is recognized as having achieved UHC relatively early in comparison to other countries. Therefore,
discussions based on real experiences revolving around system reforms aimed at sustaining andstrengthening UHC serve for realizing UHC more widely in other countries and regions around the world.
In addition, after three years of tackling COVID-19, we have reaffirmed the importance of social
infrastructure, and strongly shared this view with society as a whole. Above all, the healthcare system isan essential infrastructure of the highest priority, as it is directly linked to the lives and health of people
in the community. There is unanimous agreement that normal operation of the system must be madesufficiently stable and resilient so that it can be maintained and continue to function effectively under any
circumstances. Experience gained during the COVID-19 pandemic will provide specific suggestions thatcan be used in discussions regarding the healthcare systems upon which future UHC will depend.
In light of the above, we hope that the G7 Summit and health ministers' meeting in Japan will set anagenda that focuses particularly on the following perspectives, and provide an opportunity to holdJapanese Nursing Association
5-8-2 Jingumae, Shibuya-ku, Tokyo 150-0001 JAPANTEL: +81 3 5778 8559 FAX: +81 3 5778 5602,
E-mail: intl@nurse.or.jp URL: http://www.nurse.or.jp/jna/english/effective discussions, based on the experience and knowledge gained in addressing the challenges of aging
under UHC and in tackling the issues caused by the COVID-19 pandemic that we are currently facing.
Through these recommendations, the Japanese Nursing Association will, under the leadership of the G7,
work to further strengthen nursing efforts with the aim of sustaining and strengthening UHC in Japan,and achieving UHC in the rest of the world.

Recommendation 1: Secure the workforce for healthcare services in order to realize andstrengthen UHC
Healthcare services that form the foundation of UHC are knowledge-intensive services in the sensethat they are provided by professionals with specialized knowledge and skills in the area. Even withadvancements in technology, there remains a constant need for services involving interpersonalinteraction, which makes them considerably labor intensive as well.

Healthcare systems in countries around the world have encountered many challenges during theprolonged COVID-19 pandemic, and the principal contributing factor in maintaining these systems
has been the availability of healthcare professionals to provide services. We need to learn from thisexperience and take measures to guarantee a health workforce by ensuring a better working
environment, including protecting and advocating them.

All over the world, low birth rates and aging populations are issues that are rapidly becoming more
severe. As a result, the quantity of people requiring healthcare is expected to increase, and their needs
to become qualitatively more serious and complex. At the same time, it will also become moredifficult to secure new entrants into the healthcare field. It is therefore necessary to improve theproductivity of individual healthcare professionals, and there is also an urgent need to provide better
education in order to train more qualified healthcare professionals.

It is the responsibility of each country to ensure that healthcare professionals are effective insupporting people's health in terms of both quantity and quality, and to guarantee contributions topromote people's health. We look forward to discussions among G7 member nations that will drive
initiatives and lead to the formation of a social consensus.

The nursing profession is at the forefront of the healthcare system, as it is the largest professional
body within it. Securing a workforce of nurses and promoting their advancement are essential

Japanese Nursing Association
5-8-2 Jingumae, Shibuya-ku, Tokyo 150-0001 JAPANTEL: +81 3 5778 8559 FAX: +81 3 5778 5602,
E-mail: intl@nurse.or.jp URL: http://www.nurse.or.jp/jna/english/elements when it comes to strengthening healthcare systems around the world andrealizing/sustaining UHC.＊1

Recommendation 2: Establish more effective and efficient healthcare systems (promotion ofinnovation)
In order to realize and sustain UHC, it is also necessary to make healthcare systems more effective,efficient, and productive. In healthcare systems where doctors, nurses, and other healthcare
professionals work together, it is important to consider how to demonstrate the ability of eachspecialization while also considering the effectiveness and efficiency of the system as a whole(overall optimization).

Furthermore, as a result of the COVID-19 pandemic, more importance has been placed on healthmanagement and disease prevention than ever before. When discussing the effectiveness andefficiency of healthcare systems, it is important to also reflect this shift in society's values concerning
health.

Taking into account that it will be difficult to secure new entrants into the professions as birth rates
continue to decline, it will become more important than ever to discuss overall optimization of thesystem. From this point of view, we hope that the G7 member nations will engage in discussions topromote innovation that is not bound by existing frameworks, resulting in healthcare systems thatcan contribute better to society.

In addition, regarding the need to strengthen the healthcare systems that form the foundation of UHC
in societies with low birth rates and aging populations, it is clear that nursing is a profession that
contributes to the health of the entire population and drives overall optimization of the system, evenin response to the shift in society's values concerning health due to COVID-19. As the nursing
profession's approach takes perspectives of both medical care and living, it can be effectively applied
to wider populations in the community. Also, as locations for treatment and recuperation expand
through the community, the nursing profession can play an even greater role. It is therefore desirable
to hold more flexible discussions on regulations and the division of roles to allow nurses to do morewhile taking each specialization into account.

1According to a report by the U.K.'s All-Party Parliamentary Group on Global Health titled "Triple Impact: How developing

nursing will improve health, promote gender equality and support economic growth" (Oct. 2016), "Nurses are by far the largest
part of the professional health workforce and achieving universal health coverage globally will depend on them being able touse their knowledge and skills to the full. Yet they are too often undervalued and their contribution underestimated."
The report goes on to say that, "Increasing the number of nurses, and developing nursing so that nurses can achieve theirpotential, will also have the wider triple impact of improving health, promoting gender equality and supporting economic
growth." (http://www.appg-globalhealth.org.uk/home/4556655530)

Japanese Nursing Association
5-8-2 Jingumae, Shibuya-ku, Tokyo 150-0001 JAPANTEL: +81 3 5778 8559 FAX: +81 3 5778 5602,
E-mail: intl@nurse.or.jp URL: http://www.nurse.or.jp/jna/english/

Recommendation 3: Increase investment in healthcare to develop a better systemAs mentioned above, UHC depends on healthcare systems, and the heart of these systems is healthworkforce. Increased investment in healthcare is essential to ensure a health workforce quantitatively
and qualitatively, and to develop human resources with the capacity to promote innovation.

We trust the leadership of the G7 member nations in building a social consensus on the importanceof investing in healthcare, especially in specialists in these fields, in order to realize/sustain UHC.

We also hope that there will be discussions regarding increasing investment in nursing and thenursing profession, taking into account the fact that nursing is an essential element for realizing andsustaining UHC.

Japanese Nursing Association
5-8-2 Jingumae, Shibuya-ku, Tokyo 150-0001 JAPANTEL: +81 3 5778 8559 FAX: +81 3 5778 5602,
E-mail: intl@nurse.or.jp URL: http://www.nurse.or.jp/jna/english/