Global Health Governance and Japan’s Contributions:
Infectious Diseases as a Threat to Human Security 1

KATSUMA, Yasushi, Ph.D.
Director & Professor, International Studies Program
Graduate School of Asia-Pacific Studies
Waseda University

1.
2.
3.

From State Security to Human Security

Infectious Diseases as a Transnational Threat

Japan’s Contributions to Global Health through a Human Security Approach
4. The G8 Summit and the Global Health Governance5.

1Conclusion

From State Security to Human Security
The scope of the security concept has been expanded in the last decade and a half.
Moving beyond a traditional macro-level focus solely on the states, the concept of
security now includes an attention to the micro-level insecurity of individuals andcommunities. There is still no global consensus on a clear definition of this “humansecurity” concept, but there has been a general agreement on the necessity for a new
security paradigm, in which emerging threats to the security of individuals andcommunities are properly addressed in a globalizing world.
Although this paradigm shift in the security discourse is taking place more recently, themicro-level focus on the insecurity of individuals and communities is not entirely new.
For example, the security of people was mentioned in the Red Cross doctrine in the1

This article is based on an unpublished paper co-authored by Keizo Takemi, Masamine Jimba, Sumie

Ishii, Yasushi Katsuma, and Yasuhide Nakamura, and presented at an international symposium on “FromOkinawa to Toyako: Dealing with Communicable Diseases as Global Human Security Threats” held inTokyo on May 23-24, 2008, but modified and updated by the author.

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1860s, and its elements were later incorporated into international human rights andhumanitarian treaties of the 1940s, such as the Universal Declaration of Human Rights
and the Geneva Conventions.2 It shows that it has long been recognized that the state
security defending national borders from external threats imposed by other states would
not be sufficient to guarantee the security for people. In other words, if vulnerable
groups of people within the boundaries cannot survive other kinds of threats, the state
security does not make much sense for them. For example, internal armed conflicts,
particularly prevalent after the end of the Cold War, pose security threats to vulnerable
groups of people within the state. Also, in the era of globalization, infectious diseases
have become a transnational threat to the survival of people living in a global village.
1-1. Human Development Report 1994
In spite of the earlier concerns over the insecurity of individuals and communities, it
was only in the 1990s when the concept of “human security” began to take clearer shape,
being reappraised within the United Nations system. After the end of the Cold War, theUnited Nations started to shift its focus from inter-state wars and disputes to other typesof threats that devastate the lives and livelihoods of people around the world. As part ofsuch efforts, the United Nations Development Programme (UNDP) published its
Human Development Report 1994, which had a significant impact on the evolution of
the concept of human security covering seven domains: economic, food, health,environmental, personal, community, and political. This report made the connection for
the first time between the concept of human security and the dual freedoms from fear
and want that were originally outlined in the United States Secretary of State’s report on
the 1945 San Francisco Conference. To translate this concept into practice, the 1994
UNDP report also called for the establishment of a “global human security fund.” 3
In 1990s, a series of tragedies caused by internal armed conflicts posed serious security
threats to vulnerable groups of people within the state. For example, the genocides in
Rwanda (1994) and Bosnia (1995) graphically illustrated to the world that thetraditional concept of security as the protection of national borders was not sufficient for

2

Paula Gutlove & Gordon Thompson (2003). “Human Security: Expanding the Scope of Public Health”

Medicine, Conflict & Survival, Vol.19, No.1, pp.17-34.
3

United Nations Development Programme (1994). Human Development Report, 1994 (New York:

Oxford University Press).

2the United Nations to take the responsibility to protect the vulnerable people.
The 1997 financial crisis in East Asia provided another example, highlighting thevulnerability of some groups of individuals and communities to the transnational threat
beyond their control. Even in some of Asia’s more industrialized countries that had once
been praised as “East Asian Miracle4,” their economic growth created social exclusion
for some fragile groups. In the era of inter-connectedness of economies across theregion and the globe, the individual states in East Asia alone were not able to provide
security for the vulnerable groups severely affected by the financial crisis.
The above series of events in the 1990s provided justification for expanding the scopeof security to include individuals and communities. Furthermore, in this decade, theterrorist attacks in the United States on September 11, 2001, are often seen as a turning
point in how we define security in a globalizing world. There is a growing recognition
that we need to expand the concept of security if the world is to be a truly secure place
for people to live, while traditional security challenges and responses are still highly
relevant. In addition, the severe acute respiratory syndrome (SARS) outbreak in 2003
also shook the world, putting infectious diseases at the forefront of the human security
agenda. Now, we identify other transnational threats, such as avian and possible
pandemic influenza, as well as global warming.
1-2. Commission on Human Security
To urge the member states of the United Nations in the new millennium to take action
on the pressing needs of individuals and communities around the world, the second
influential report was published in 2003 by the Commission on Human Security,
co-chaired by Sadako Ogata and Amartya Sen.5 This report was presented to then UN
Secretary-General Kofi Annan on May 1, 2003, laying out a definition for humansecurity. The refined definition of human security in this report advocates protecting
individuals’ and communities’ freedom from fear, freedom from want, and freedom tolive in dignity.

4

World Bank (1993). The East Asian Miracle: Economic Growth and Public Policy (Washington, D.C.:

World Bank).
5

Commission on Human Security (2003). Human Security Now: Protecting and Empowering People(New York: Commission on Human Security).

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In order to ensure human security for all, first, it is argued that no one should have tofear pervasive physical violence, whether it is violence by other states, violence bysome groups within their own state, or violence carried out in their own communities orfamilies.
At the same time, it is acknowledged that for many people, their most significant daily
fears are not necessarily related to physical violence; instead, they worry on a daily
basis about how they feed their families, how they keep their families healthy, and how
they can ensure that their children receive the education necessary to survive andflourish in today’s world. These are among the sources of insecurity that a humansecurity framework also attempts to address.
Finally, the Commission’s report emphasizes the importance of allowing people to live
in dignity. In other words, the causes of insecurity go beyond physical needs to include
emotional needs. Through the process of empowerment, individuals and communities
are expected to enhance their own resilience to cope with current and future threats,rather than being dependent solely on external actors taking care of them.

2

Infectious Diseases as a Transnational Threat
The 2003 Commission report identifies ten immediate areas requiring concerted global
action, including the provision of basic health services. In many developing countries,
basic life-saving prevention and treatment are not readily available to large segments ofthe population, leading to unacceptable rates of preventable death.
2-1.

Health as a Global Challenge

Health has become a shared global challenge. First, the proliferation of information
allows us to see the suffering of people in many African and other poor countries. This
has instilled in many of us a moral determination to respond to this challenge forhumanity. Second, it has become increasingly clear that the health of one community
now has serious implications for that of other communities around the world. For
example, the outbreak of SARS in 2003 offers a vivid illustration of the way in which
infectious diseases can travel rapidly, ignoring national borders and socio-economic4differences. As SARS traveled across Asia and across the Pacific Ocean to North
America, we were reminded that health threats to people on the other side of the world
is our business, not only for moral reasons but also because it has the potential to affectus physically.
Health threats can also have significant economic impacts, particularly the spread of
HIV/AIDS, malaria and other infectious diseases. The impact of HIV/AIDS on
development is attributable to its ability to undermine three main determinants ofeconomic growth, namely physical, human and social capital. Current estimates suggestthat HIV/AIDS has reduced the rate of growth of Africa’s per capita income by 0.7
percentage points a year, and that for those African countries affected by malaria, thegrowth rate was further lowered by 0.3 percentage points per year.6
At the same time, the antiretroviral (ARV) treatment that can extend the lives ofHIV-infected people is often prohibitively expensive, so that few developing countries
are able to provide these life-saving drugs to this vulnerable group without external
assistance. Once an HIV-positive person starts taking ARV drugs, they have to continue
doing so for the rest of their lives. If they lose their access to the drugs, not only does itmean certain death for them, but it also means the emergence of drug-resistant strains ofHIV, which in turn leads to a collective cost for the rest of the world in terms of researchand development in search for new drugs.
Many of the private companies that depend on workforces and markets throughout thedeveloping world have found that their economic interests are greatly compromised as aresult of rapidly rising disease burdens. In some parts of Africa, for example, employers
have to hire and train three people for every job due to the devastation caused by
HIV/AIDS, such as high death rates among employees and growing absenteeism:
Employees are too ill to work, have to stay home to take care of sick family members,or have to take time off to attend funerals. Furthermore, private companies carrying out
large-scale building and extraction projects in areas where malaria is endemic havefound that the cumulative effect of individual employees having to take time off when
they or their family members suffer from malaria can have staggering costs because of6

Renel Bonnel (2000). “Economic Analysis of HIV/AIDS,” What Makes an Economy HIV-Resistant?

(Washington, DC: World Bank) quoted in United Nations Economic Commission for Africa (2000).
HIV/AIDS and Economic Development in Sub-Saharan Africa. African Development Forum 2000.

5

delayed production schedules.
As these examples illustrate, the inability to protect people’s health has become a major
global challenge, and no country can protect the threat to human security of individuals
and communities within its national borders on its own.
2-2.

Global Health for Human Security

In translating the concept of human security into practice, the health sector offers a very
useful entry point for several reasons. First, countries are generally more willing toaccept health-related assistance from industrialized countries because it is less likely to
be politicized. Even countries that strictly adhere to the principles of state sovereignty
and non-intervention in internal affairs are often willing to accept international support
to mitigate health threats within their boundaries. Second, diseases and severe
malnutrition are challenges that one can readily understand at an emotional level,
making it easier to rally people in industrialized countries to support health initiatives
for humanity. Third, the inter-connectedness between health and many other humansecurity challenges, such as education, are relatively clear. Finally, the SARS outbreakof 2003, avian and possible pandemic influenza, and other emerging infectious diseases
have provided stark illustrations of the fact that diseases do not stop at national borders,and have raised people’s awareness that good health in one country depends on good
health in other countries. In this context, the World Health Organization (WHO) used
the term “global public health security” to draw attention to emerging threats tocollective health of populations living across international boundaries, in its World
Health Report 2008.7
Beyond serving as an entry point, a strong international commitment to taking a humansecurity approach to dealing with global health has the potential to contribute toimproved health for all. First, as a “human-centered approach,” the focal point of humansecurity is individuals and communities. In the health sector, this does not mean thatoutside diagnoses of ailments and education on prevention and treatment of illnesses areunnecessary. Rather, as a complement to such external expertise, it is important thatpeople recognize their right to health and ask for health services that they deserve.

7

WHO (2007). World Health Report, 2007 --- A Safer Future: Global Public Health Security in the 21stCentury (Geneva: WHO).

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People’s proactive participation as the rights-holders will help strengthen the healthsystem that responds to their health needs.
Second, the human security approach highlights people’s vulnerability and tries to help
them build resilience to current and future threats. Those who face violent conflicts or
natural and/or manmade disasters find themselves even more vulnerable to healthchallenges, as their already-limited access to basic social services further deteriorates.
The purpose of human security, therefore, is to help people create an enabling
environment in which they can still protect their own and their family’s health even in
the event of conflicts or disasters. Therefore, it is important to look beyond the healthsector and take a multi-sectoral, comprehensive approach in which health is seen within
the context of various threats affecting health.
Third, the human security approach allows us to strengthen the interface between“protection” and “empowerment.” The “protection” strategy, through which basic social
services are provided, is of course crucial. Nevertheless, at the same time, the“empowerment” strategy is equally critical, so that people can take care of their own
health and build their own resilience to cope with various threats. It is also important tolook at the interface between these two strategies. Examples include strengthening
people’s ability to act on their own to secure access to services; relying on community
healthcare workers who are more embedded in the local communities and more awareof the various threats to the community members; and educating and mobilizing people
to focus more on the health of the community. In other words, it is imperative for those
who have political and economic power not only to provide vital services but also tocreate an enabling environment for individuals and communities so that they can havemore control over their own health.

3Japan’s Contributions to Global Health through a Human Security Approach
The Japanese who experienced firsthand the devastation resulting from the World War II
have driven the strong sense of pacifism that has characterized Japan for the last half acentury. However, as the generation of people whose pacifism is based on thatexperience is almost gone, Japan seems to be trying to develop a new motivation for
pacifism. At the same time, as Japan is trying to secure its position in an ever-changing
world, the concept of human security seems to offer Japanese politics a new framework

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for future-oriented pragmatic pacifism8. The evolution of the human security concept
into one of the pillars of Japanese foreign policy thus reflects Japan’s quest to solidify
its position in the international society as a “global civilian power.”
3-1.

Human Security and Japanese Foreign Policy

It first became clear, both domestically and internationally, that human security was
becoming a central pillar of Japanese foreign policy through a series of speeches given
by Keizo Obuchi during the year when he rose from the foreign minister to become theprime minister9. Then Foreign Minister Obuchi first used the term “human security”
during a speech, delivered in Singapore in May 1998, on Japan and East Asia in the newmillennium. 10 By describing “health and employment [as] basic ‘human security’concerns,” he expressed the idea that Japan should use its official development
assistance (ODA) to proactively tackle these challenges in the field of human and social
development. He made clearer reference to human security as a policy direction, at aconference in Tokyo, in the context of the Asian financial crisis.11 In his keynote
address, he argued that human security is the key to “comprehensively seizing all of themenaces that threaten the survival, daily life, and dignity of human beings and tostrengthening the efforts to confront these threats.”
Of particular interest in Obuchi’s speech was mentioning of his belief that “we mustseek new strategies for economic development that attach importance to human security

8

Keizo Takemi, Masamine Jimba, Sumie Ishii, Yasushi Katsuma, and Yasuhide Nakamura (2008).

“Human Security Approach for Global Health,” The Lancet, Vol.372, pp.13-14.
9

Nobumasa Akiyama (2004). “Human Security at the Crossroad: Human Security in the JapaneseForeign Policy Context,” Hideki Shinoda & Ho-Won Jeong (Eds). Conflict and Human Security: A
Search for New Approaches of Peace-building (Hiroshima: Institute for Peace Science, Hiroshima
University), pp.252-270.
10“Japan and East Asia: Outlook for a New Millennium.” speech delivered by then Foreign Minister

Keizo Obuchi on May 4, 1998. The full text can be found online atwww.mofa.go.jp/announce/announce/1998/5/980504.html.
11This was the first conference in a series entitled Intellectual Dialogue on Building Asia’s Tomorrow,

held on December 2, 1998. The conference was co-sponsored by the Japan Center for International
Exchange (JCIE) and the Institute of Southeast Asian Studies. A report on the conference was publishedunder the title JCIE (1999). The Asian Crisis and Human Security. (Tokyo: JCIE).

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with a view to enhancing the long-term development of this region.” He then went on todescribe global warming and other environmental issues, trafficking in drugs and people,
and other transnational crimes, poverty, the exodus of refugees, human rights violations,
HIV/AIDS and other infectious diseases, terrorism, antipersonnel landmines, andchildren in conflict, as the core threats to humanity. He further argued that we need astronger framework for dealing with these threats, all of which is embodied in theconcept of human security. Two weeks after the conference in Tokyo, Prime Minister
Obuchi announced at a conference in Hanoi his plans for the creation of a Trust Fundfor Human Security within the United Nations to be initially funded by the Japanese
government.12
The proposals outlined by Prime Minister Obuchi a decade ago in these speeches, whichcalled for human security to play a central role in Japan’s foreign policy framework,
reflected, on one hand, his personal character and the importance he placed on taking
care of people. At the same time, he carefully analyzed the new international
environment of the post-Cold War world and the impact of the financial crisis on Asian
countries, and then recognized that Japan has a unique responsibility as a major
economic power to play a more proactive role in addressing these common challenges.
This recognition of the new international environment and the desire to strengthen
Japan’s role in the world is reflected in the Prime Minister’s Commission on Japan’s
Goals in the 21st Century, a private commission launched by the prime minister inMarch 1999. The commission’s report argues that “security in the 21st century will need
to be a comprehensive concept, encompassing economic, social, environmental, humanrights, and other elements. And it will need to be pursued cooperatively by the public
and private sectors on the multiple levels of individuals, states, regions, and the entire
globe,” reflecting the idea of Japan’s role as a “global civilian power.”13
Based on the report of the Commission on Human Security, co-chaired by Ogata andSen, Japanese ODA policy also turned its attention towards human security, redesigningin 2003 the “grassroots grant aid,” administered by Japanese embassies in developing
countries, as “grassroots human security grant aid.” In August 2003, the ODA Charter

12

Japan’s total contributions to the UNTFHS have been ¥31.5 billion, and more than 170 projects havebeen funded by the fund so far (as of March 2007).
13

The Frontier Within: Individual Empowerment and Better Governance in the New Millennium (Tokyo:

Office for the Prime Minister’s Commission on Japan’s Goals in the 21st Century, 2000).

9was revised for the first time in 10 years, and human security was included in the newCharter as one of Japan’s fundamental policy tools. The Midterm Policy on Official
Development Assistance, released in February 2005, also clearly placed human security
as a central policy tool for Japanese aid to developing countries.
The focus on human security is prompting Japan to expand the pool of actors who are
involved in policymaking, reflecting a trend that is taking place around the world. First,
we saw a transition of diplomatic framework from bilateral to multilateral diplomacy.
But at the same time, the framework is being further expanded to include otherstakeholders, such as NGOs and other civil society networks. This framework allows us
to view the individuals and communities not only as the end point of top-down policy
making but also as the starting point for a more bottom-up approach todecision-making.
3-2.

Japan’s Contributions to Global Health

The Okinawa Infectious Disease Initiative, announced by Japan at the G8 Summit inKyushu & Okinawa in 2000, led to strengthened global efforts to combat several
diseases, including especially HIV/AIDS, tuberculosis, and malaria, but also polio,
parasitic and other neglected tropical diseases. These efforts at the Kyushu & Okinawa
G8 Summit prompted the establishment of the Global Fund to Fight AIDS, Tuberculosis
and Malaria, as well as corresponding disease-specific programs, which is directly
linked to the Goal 6 of the Millennium Development Goals (MDGs).
The disease-specific strategy has attracted substantial financial support in recent years,
and has produced significant results, particularly in many of the world’s poorest
countries. These results are tangible inputs and outcomes that donors can use to measure
improvements in health conditions. In this context, during the first five years since the
Kyushu & Okinawa G8 Summit put infectious diseases on the international agenda, it isestimated that development assistance for health grew from about US$6 billion in 2000
to US$14 billion in 2005.
Eight years after the Kyushu & Okinawa Summit, in 2008, Japan again hosted the G8
Summit, this time in Toyako, Hokkaido, and global health was identified as one of thepriorities on the summit agenda. In his speech on global health and Japan’s foreign
policy, Japanese then Foreign Minister Masahiko Koumura clearly stated that “human10security is a concept that is very relevant to cooperation in the 21st century. That is tosay, it is vitally important that we not only focus on the health of individuals and protect
them, but also strive to empower individuals and communities through health systemstrengthening.”14 With this statement, he demonstrated Japan’s commitment not only tosupport global health but to do so through a human security approach.
At the same time, a group at Harvard University also advocated for global action on
health system strengthening as part of their proposal to the political leaders gathering
for the G8 Summit in Toyako in July 2008. Emphasizing the importance of the conceptof health security, they have proposed three principles providing a basis for global
action on health systems. First, health systems need to be improved to provide increased
protection for individuals, but in ways that empower the target communities.
Implementing this principle means developing community-based approaches that create
major roles in policy setting and implementation for the people who are meant tobenefit from a program. Their second principle entails enhancing the international
commitment to improving health systems in poor countries, not by creating a new fundbut by using existing organizations to develop a comprehensive approach creating abalance between disease-specific and system-oriented strategies. Their last proposed
principle is to encourage enhanced learning about health systems so that we have aclearer sense of what works and what does not work, where potential lies, and where weneed to strengthen our activities to save and improve lives.15
The renewed attention to the health systems seems to be derived from two factors. First,
it has become clear that the Goals 4 and 5 of the MDGs are not on track to be achievedby the year 2015, while some tremendous progress has been reported in relation to thedisease-specific Goal 6. Although annual deaths among children under five dipped
below 10 million in 2006, child mortality rates remain unacceptably high. Similarly, thehigh risk of dying in pregnancy or childbirth continues unabated in many countries in
Sub-Saharan Africa and Southern Asia.16 Therefore, it is increasingly recognized that
the Goals 4 and 5 cannot be achieved without accelerating health system strengthening.

14

Masahiko Koumura (2007). “Global Health and Japan’s Foreign Policy,” The Lancet, Vol. 26.

15

Michael Reich, Keizo Takemi, Marc Robert, and William Hsiao (2008). “Global Action on Health

Systems: A Proposal for the Toyako G8 Summit,” The Lancet, Vol. 371, pp.865–869.
16

United Nations (2008). The Millennium Development Goals Report, 2008 (New York: United

Nations).

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Second, in 2008, as we celebrate the 30th anniversary of the 1978 Alma Ata Declaration,
the concept of primary health care (PHC) has been revisited and re-interpreted in thecurrent context. WHO has proposed that countries should make health system andhealth development decisions guided by four inter-linked policy directions: universal
coverage, people-centered services, healthy public policies, and leadership.17
Hosting the G8 Summit in July 2008 provided Japan with the opportunity to put thehuman security concept into practice, and introduce the framework to the agendas ofsome influential global conferences.

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The G8 Summit and the Global Health GovernanceIn the context of these statements and discussions, the Japanese Presidency set up a G8
Health Experts Group. Building on the Saint Petersburg commitments to fight infectious
diseases, the G8 Experts produced “Toyako Framework for Action on Global Health,”
outlining the current situation, the principles for action, and actions to be taken on
global health.18
The principles for action on global health include the following. First, the G8 willcontinue to make efforts so that its previous commitments will be met, including the one
made at Heiligendamm in 2007, through coordinated and complementary action.
Second, the G8 will approach the health-related MDGs in a comprehensive manner.
Third, the human security approach, focusing on protection and empowerment of
individuals and communities, will be taken in addressing global health challenges.
Fourth, a longer-term perspective that extends beyond the 2015 deadline for the MDGs
is critical in supporting research and development. Fifth, the effective utilization offinancial and human resources requires the leadership and good governance ofdeveloping countries and the respect of their ownership consistent with the Paris
Declaration on Aid Effectiveness.

17

WHO (2008). World Health Report 2008 --- Primary Health Care: Now More than Ever (Geneva:

WHO).
18

“Toyako Framework for Action on Global Health: Report of the G8 Health Experts Group,” mimeo, 8July 2008.

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Among these five principles for action outlined in “Toyako Framework for Action on
Global Health,” the second and third principles will be discussed further in thefollowing sections.
4-1.

Comprehensive Global Health Framework

It is critical to develop a comprehensive global health framework integrating the two
strategies of disease-specific programming and health system strengthening. In otherwords, we need to move beyond the debate on vertical versus horizontal programming,and look at how these two strategies can be better integrated to provide maximum
benefit for health outcomes. The major infectious diseases threatening the world today
are costly to prevent and treat, and it is only by strengthening international
commitments to fighting their spread that we will be able to improve people’s health.
We are already seeing evidence of healthcare facilities and workers being freed up to
focus on a broad range of health issues as a direct result of large-scale successful
initiatives to prevent and treat HIV/AIDS and malaria. At the same time, these
disease-specific targets require a strong health system delivering basic social services,
particularly to some of the world’s most marginalized and vulnerable people. As a result,
it is no longer appropriate to look at these two strategies as separate enterprises
competing for a finite set of resources. Instead, we need to find ways in which they cancomplement each other for more efficient and effective action.
This integration needs to be done through careful coordination among existing actors
and activities, with active involvement of both donor and recipient governments, civilsociety and private sector stakeholders, and communities that are most affected by thehealth challenges we are trying to address. It is not clear, though, what institution or
institutions should play this role. It requires a convening capacity as well as global
legitimacy. The G8 leaders should strongly endorse the principle of integration, which
will provide more impetus for efforts within the field of global health to promote
coordination and alignment.
One of the reasons that disease-specific programs have been able to attract funding isthat the impact of the three major infectious diseases is very visible and has proven to
be directly detrimental to economic growth. In addition, it is relatively easy todemonstrate the direct positive impact of large-scale prevention and treatment programson the health of individuals, communities, and economies. On the other hand,13monitoring and evaluation of programs aimed at strengthening health systems has been
relatively weak, making it more difficult to convince people of the importance of healthsystem strengthening.
More fully integrating these strategies will require more systematic monitoring andevaluation of these efforts so that planning and implementation can be based on strong
evidence of what works and what does not. However, there are currently too many
actors engaged in their own systems of monitoring and evaluation, leaving us with a
confusing array of data, particularly on health systems, and imposing additional burdens
on implementing agencies and recipient countries that have to spend precious time andresources on multiple evaluations. Therefore, the G8 countries should make acommitment to developing common indicators and methodologies that they will accept
for monitoring and evaluating their bilateral and multilateral assistance for global
health.
4-2.

Taking a Human Security Approach

Another principle for action is to take a human security approach to addressing thechallenges of global health. The human security approach focusing on protection andempowerment of individuals and communities is critical, given that the healthchallenges directly affect human dignity and the right to the highest attainable standardof health.
Although we generally talk about global health at the macro level, we should not lose
track of the fact that health strongly impacts and is impacted by many other factors in
people’s lives. Our approach to global health needs to be human-centered and to involvethe individuals and communities who are meant to benefit from health interventions inall stages of needs assessment, planning, implementation, and monitoring andevaluation. In doing so, we will be able to better understand how their vulnerability tohealth challenges interconnects with other challenges they face in their daily lives.
Focusing our efforts on individuals and communities requires a human security
approach, integrating protection and empowerment strategies, as health challenges crosssectors and national boundaries. Investing in health of our fellow human beings in thedeveloping world will also help to protect our own citizens from health-related threats,
particularly infectious diseases and other illnesses that travel across international

14

boundaries easily. We can also anticipate significant benefits in terms of economic
development and social stability emerging from healthier communities around theworld.
4-3.

Mobilizing More Resources

In order to translate the above principles into concrete action, it is necessary to mobilize
more resources for global health, from industrialized and developing countries, torespond appropriately to the overwhelming challenges.
Development assistance for health has increased from US$2.5 billion in 1990 to almost
US$14 billion in 2005. The government of the United States has committed to provide
US$15 billion for five years through the President’s Emergency Plan for AIDS Relief(PEPFAR) and to increase its support for malaria to US$1.2 billion over five years. The
Bill & Melinda Gates Foundation contributes around US$1 billion for development andhealth per year, and the Global Fund to Fight AIDS, Tuberculosis and Malaria intends toincrease the size of its funding to US$6 billion per year in 2010. The budget of the
WHO has increased to around US$2 billion per year, of which US$350 million isearmarked for the three major infectious diseases.19 Nevertheless, the magnitude of thechallenges we face in global health is staggering, and we need additional investments
for disease-specific approaches as well as for health system strengthening or amechanism that integrates the two strategies for maximum mutual benefit.
The dramatic increase in funding for specific infectious diseases, particularly
HIV/AIDS, tuberculosis, and malaria, has led to some concern that it is distorting thehealthcare sector in many countries with weak health systems. Another way of looking
at it, though, is that funding for infectious diseases has shown us what is possible when
the international community makes a strong commitment to fighting specific healththreats, and highlighted the areas where we have failed to make progress. Therefore,
rather than cutting back on those efforts, the lessons that have been learned throughdisease-specific funding over the past five years should be applied to the health sector
more broadly. And, we should be consistent in our message that creating more equity
within the health sector does not mean reducing funding for infectious diseases, but

19World Bank (2007). Healthy Development: The World Bank Strategy for Health, Nutrition, andPopulation Results (Washington, D.C.: World Bank), pp.149–150.

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increasing funding for other areas of the health sector that have not received as muchattention.

5

Conclusion
Moving beyond a traditional macro-level focus solely on the states, the concept of
security now includes an attention to the micro-level insecurity of individuals andcommunities. In the era of globalization, infectious diseases have become transnational
threats to the survival of people living in a global village. In translating the concept ofhuman security into practice, the health sector offers a very useful entry point forseveral reasons. Beyond serving as an entry point, a strong international commitment totaking a human security approach to dealing with global health has the potential tocontribute to improved health for all.
The concept of human security has become a central pillar of Japanese foreign policy.
Also, based on the report of the Commission on Human Security, Japanese ODA policy
also turned its attention towards human security. The Okinawa Infectious Disease
Initiative, announced by Japan at the G8 Summit in Kyushu & Okinawa in 2000, led tostrengthened global efforts to combat several diseases, including HIV/AIDS,
tuberculosis and malaria, which is directly linked to the Goal 6 of the MDGs.
In 2008, Japan again hosted the G8 Summit, this time in Toyako, Hokkaido, and global
health was identified as one of the priorities on the Summit agenda. The G8 HealthExperts produced “Toyako Framework for Action on Global Health,” outlining theprinciples for action, including a comprehensive global health framework and a humansecurity approach. It is critical to develop a comprehensive global health framework
integrating disease-specific programs and health system strengthening. A humansecurity approach, integrating protection and empowerment strategies, allows us tofocus our efforts on individuals and communities.
In order to translate the above principles into action, it is necessary to mobilize moreresources for global health. So far, there has been a dramatic increase in funding for the
strategy to combat specific infectious diseases. However, another important strategy tostrengthen health systems has not drawn sufficient attention of both industrialized anddeveloping countries. The G8 leaders, in consultation with partner countries, should

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look at how these two strategies can be better integrated to provide maximum benefit
for health outcomes, contributing to the MDGs.

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