April 21, 2015

M8 Alliance Kyoto-Fukushima Statement

The World Health Summit Regional Meeting – Asia in Kyoto and Fukushima 2015

Meeting Emerging Challenges: Toward Responsive andResilient Health Systems
In 2011, the massive earthquake, tsunami, and subsequent nuclear reactor meltdowns
produced one of the most severe disasters in the history of Japan. Fukushima
Prefecture was the most severely affected by this ‘triple disaster’. The impact of thetriple disaster on health and the health system was extreme, with adverse effects
continuing to be felt.
Hit by this severe natural disaster, the health system in Fukushima also faces a second
challenge: a hyper-aging society. A transformed health system is an imperative if
Fukushima is to be able to respond to future disasters and demonstrate resilience tothe rapidly emerging needs of the Japanese society. Lessons learned from Fukushima
provide an opportunity for the rest of Japan and other countries of the world to build
more responsive and resilient health systems that are key to sustainable development.
In this statement, we, the members of the M8 Alliance, consider ‘Responsiveness’and ‘Resilience’ as two critically important attributes of a sustainable health system.
We define responsiveness as the capacity of providers to respond to health needs of thepopulation in the event of a catastrophe (such as a natural disaster), rapid change (such as
emerging new infections) or cumulative effects of contextual changes (such as aging of itspopulation). We define resilience as the capacity of a system to sustain its activities andadapt to major changes it faces over time (population aging, epidemiological transition
leading to chronic illness and disability, economic crises, and migration, for example).
Sustainable health systems are a critical ingredient for sustainable development.
The aftermath of the triple disaster revealed societal cohesion, as well as the strengths
in the responsiveness and resilience of Fukushima’s health system. The societal
response and resilience to the disaster was exemplary: not only did the social fabricremain intact, the society was able to weave a stronger fabric to protect its members,
especially the vulnerable. Social violence, witnessed elsewhere with natural disasters,
did not emerge. Most health professionals remained in Fukushima after the disasterand they struggled to protect lives and health of people in Fukushima. Voluntarism wasevident – providing much needed additional human resources. Yet, the responsivenessof the health system was challenged, and its resilience is under pressure as the healthsystem tries to meet the ongoing needs of vulnerable populations, in particular theelderly. Responsiveness challenges included integration of community and hospital
responses, speed of communication, managing varied messages emerging from official
sources and the media, transport – with consequent adverse effect on supply chain
management for critical supplies – and the shortage of health human resources. Therewas strong public demand for transparency, timely communication and information
dissemination.
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Fukushima embodies the challenges faced by the health system in Japan and in othercountries globally. These health systems are subject to rapidly changing contexts, withexternal shocks such as natural disasters and economic crises as well shocks fromwithin the populations they serve, such as aging, rapid rise of chronic illness, growing
disability and emerging infections. Nothing less than a transformation is needed tocreate health systems in Japan and globally that are responsive and resilient to future
shocks and emerging contextual challenges, including the rapid aging of society. Sucha transformative change will require a set of actions we recommend below, not as aprescription but as a set of considerations to inform health system transformation.
Addressing emerging infections and disasters
Responsiveness
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Establish a framework for rapid decision-making and action in health systems.
Ensure timely information dissemination to the public and gathering intelligencefor rapid strategic responses.
Create sufficient reserves to rapidly mobilize and fill health system “gaps” thatemerge due to limited supply of critical resources and increased demand forthese resources immediately after a disaster.
Provide immediate access to transportation, communication, temporary shelter,
clothing, and food to assure individual and population health security needs.
Create just-in-time management systems to deploy mobile heath teams units andhealth workers in health systems.
Integrate medical and societal actions for a more comprehensive response.

Resilience••••

Monitor the long-term effects of disasters, including mortality, disability,destitution, and social welfare in different population groups, especially thevulnerable, to inform current and future policies.
Establish multi-sector action plans involving public agencies and the private sector.
Enable community mobilization through social networks and build social capital.
Allocate resources not according to historical burden, but to meet current and futureneeds.

Responding to the needs of a hyper-aging society
Responsiveness••••Emphasize healthy aging.
Transform the response paradigm from “find it and fix it” to “predict risk andprevent”.
Focus on proactive management of outcomes to enable reactive diagnosis andtreatment.
Focus on targeted services and support to maintain the health and functionalityof frail elderly, who often have multi-morbidities and would otherwise use adisproportionate share of medical resources.
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Resilience•••

Transform the health system from a hospital-centric to a community- andprimary care-centered model, where primary care physicians work within
multidisciplinary teams and play an important role in personal, public, andenvironmental health.
Establish more robust and comprehensive health information systems as afoundation for resilient healthcare systems.
Foster development of “hybrid doctors” who provide personal health care andsimultaneously manage population health.

Leadership and governanceStrong leadership and governance is critical for transforming health systems to be
more responsive and resilient. We recommend:
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Developing and strengthening leadership at all levels of the health system toimprove communication and decision making in the event of a disaster.
Establishing a multi-sectoral and inter-sectoral response that involves all parts ofthe government and non-health institutions in health systems planning andimplementation of strategic action plans.
Involving the private sector in the building of partnerships to design and apply
new technologies, information systems, and innovation.
Engaging medical academia and academic health science centers to foster
collaborative research, monitoring, and evaluation across disciplines to informand support health systems reform.
Introducing formal education programs into health care systems and healthprofessional training courses to address the acquisition of responsiveness andresilience knowledge and skills.

Looking forward
We must learn from responses to external shocks and rapidly changing contexts.
Building an evidence base through rigorous scientific research is critical for managing
emerging challenges and future crises that provide opportunities for transformativechange in health systems. Policy-makers, academics, and practitioners must
collaborate to maximize the societal benefit of fostering the health workforce,generating new evidence for policy-making, and designing health systems that bridge
gaps between primary care and specialized services delivered in hospitals. This call toaction is directed not only to policymakers and academics, but to the whole of society.

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