NEAT Working Group on
Enhancement of Regional Health in East Asia with Special
Reference to the Public Health and Universal HealthCoverage

Draft Final ReportTokyo
6th July 2016

1. Introduction
In East Asia, as exemplified by the institutionalization of ASEAN+3 (APT) in 1997
and East Asia Summit (EAS) in 2005, regional cooperation and integration have advanced
particularly in such areas as economy, finance, education, and disaster preparedness, etc.
Worthy to note is the burgeoning economic interdependence deriving from establishmentof an intra-regional supply chain in parallel with the rapid economic development. Under
the circumstances, the question of how to maintain and promote health of the people or
how to develop cooperation in healthcare appears to be an indispensable agenda forsustainable development in the region, let alone a common issue for humanity at large.
The international society has made efforts for health promotion including
improvement of the health condition of pregnant women, prevention of such disease as
HIV / AIDS and malaria, etc., as an integral development goal under the framework of theMillennium Development Goals (MDGs) established in 2000. The issue of healthcare hasbeen on the agenda of the summit meetings among major countries, leading to theestablishment of the Global Fund to fight AIDS, Tuberculosis and Malaria. These efforts
have resulted in many achievements, such as the significant decreases of such disease as
malaria and tuberculosis as well as the mortality of pregnant women.
However, the recent changes in people’s life habit along with economicdevelopment, have induced serious non-communicable disease, such as cancer, diabetes,and heart diseases. In addition, new infectious diseases, such as SARS and MERS, have also
emerged. Global disease structure has changed significantly as the vulnerability toepidemics along with globalization has been revealed, as seen in the case of the pandemicof Ebola. Furthermore, these diseases and vulnerability lead to other diseases, causing
multi-faceted issues. Hence, the international society requires a new approach to healthcare
including enhancement of comprehensive healthcare system, instead of traditional
approach based on individual disease.
Especially, Asia is a region inherent of many tropical and infectious diseases. The
region also has been facing various issues such as international health problems,environmental health, and aging which significantly change healthcare system of eachcountry. Thus, the region is in need of further cooperation and management in the field ofhealth.
Nevertheless, East Asian countries have not simply left the situation unaddressed.
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The APT, for example, has convened health ministerial meetings approximately every twoyear since 2004 and shared the recognition that the APT is facing two-folded issue ofcommunicable and non-communicable diseases and that it is important to enhancecollaboration in the region, which include cooperation in training health experts, as well asuniversal health coverage (UHC). As a result, the ASEAN+3 UHC Network was establishedin 2014 by the APT Senior Official’s Meeting on Health Development (APTSOMHD).
Future development of the regional UHC is expected.
As for Japan-ASEAN bilateral framework, "ASEAN-Japan Health Initiative" wasadvocated at the ASEAN-Japan Commemorative Summit Meeting in 2013 to make theASEAN a region of advanced regional health and longevity, which claimed the cooperation
to promote UHC, to manage infectious diseases, and to expand health services and medical
equipment for non-communicable diseases.
Hence, in the East Asian region, cooperation in the newly-developed healthrelated issues has already been initiated. Should the East Asian region be able to develop
cooperation in this field and achieve sustainable development, it would significantly
contribute not only to regional prosperity but also to the solution of issues in the field on aglobal scale. Therefore, there is no emphasizing enough significance of promoting regional
cooperation in this field.

2. Objective
With the background and awareness explained above, what is the “cooperation inthe field of health” to be focused in the East Asian region? Especially today, because
communicable and non-communicable diseases have appeared as multi-faceted issues dueto the changes in people’s living environment along with globalization and economic
development, it is necessary to consider how to promote comprehensively management ofpublic health care rather than an approach targeting individual disease. It is necessary to
clarify the public health issues in each country and to share ideas on how to promote
cooperation in the field of health care.
Also, as a concrete means to maintain health, securing impartial access to basic
medical services in each society would be indispensable and adoption of universal healthcoverage is thus an immediate task.
Besides, research and development in health related issues, including the2

management of emerging diseases, would be indispensable. Cooperation for technologicalinnovation and human resource development are also necessary.
Based on these backgrounds and awareness and with the understanding of thecurrent situation of regional cooperation in East Asia with a broad perspective, thisWorking Group aims to make concrete and detailed policy proposals for “Cooperation inthe field of healthcare in East Asia” and to submit the proposals to the APT Summit.

3. Discussions on Enhancement of Regional Health in East Asia
Twenty three experts from ASEAN +3 member countries and the sponsoringorganization, the Japan Forum on International Relations (JFIR), took part in a working
group meeting in Tokyo on 5 – 6 July 2016 which was organized in three sessions.
In Session I “Trend on Public Health in the 21th Century”: the WG discussed
various issues and challenges related to the public health in East Asia, including secure
human and financial resources for providing appropriate public health services andachieving UHC. It is necessary for improving health among counties in East Asia toconsider further health systems reform with various options including to reduce
out-of-pocket payment, to expand coverage of national health insurance schemes, toimprove social protection, and to improve health governance. The WG discussed theimportance for considering similarities and differences of the determinants of healthamong East Asian countries for understanding and promoting health systems
strengthening. The WG also discussed the importance of a common analytical framework
for understanding health system in each country.
In Session II “Promotion of Public Health in the Age of Universal Health Coveragein East Asia”: the WG discussed various issues and challenges related to public health andhealth systems among East Asian countries, including the aging societies, increase burdenof non-communicable diseases etc. The WG discussed various options to tackle these issues
and challenges, including enhancing international collaborations among variousstakeholders, to promote health, to share best practices, to promote communicable andnon-communicable disease prevention, to enhance public/private mix, to improve quality
and coverage of health data, and to develop human resource for public health researches.
The WG also discussed establishing a public health research network in East Asia.
3In Session III “How to Further Enhance Regional Health in East Asia”: the WG
discussed about setting up regional priorities and the goals for enhancing regional health.
For doing it, it is important to understand the current status of health and health systemamong East Asian countries, to collaborate between countries including establishingresearch networks, setting up common framework for the monitoring and evaluation ofhealth systems and UHCs.

4. Policy Recommendations
Based on the discussions above, this Working Group on “Enhancement ofRegional Health in East Asia with Special Reference to the Public Health and Universal
Health Coverage” summarized the following policy recommendations:
1.

Strengthen health systems in East Asian countries to enhance regional health, reduce
health inequities, and promote health and achieve/sustain universal health coverage.
It should be done for each component of health system including financing,governance and human resource with appropriate transferability.

2.

Seek the possibility of financing public health facilities either from the viewpoint ofsocial development program at national level, or from that of basic infrastructuredevelopment program at regional level.

3.

Jointly advocate for the need of policy and program support among health andnon-health sectors to address social determinants of health that have strong impact on
the regional health priorities.

4.

Jointly promote health among East Asian countries for preventing and detecting bothcommunicable and non-communicable diseases at early stages, with equitableallocation of health resources, as well as to cope with the aging society, eventually, ifpossible, through establishment of a regional center or its equivalent under APT
framework.

5.

Establish a framework of cooperation and cross-sectoral information sharing among
the East-Asian countries in the areas of public health and health system.

6.

Enhance utilization of health data in collaboration with East Asian countries as well asother stakeholders such as international organizations, NGOs and communities. To
improve abilities of data collection, to improve quality of data, to develop and expand
4health database into 'big data' in each country, and to enhance capability of data
management and analysis.
7.

Strengthen health services research networks among research institutions in East Asia,and build a network of health services research specialists, eventually, if possible,
through establishment of a regional committee or its equivalent under APT
framework.

8.

Develop human resources for public health and health services research towards
evidence-based health policy.
[END]

List of Participants
Cambodia
IR PorChief of Technical Bureau, National Institute of Public Health,
Ministry of Health

China
WANG Yu
Director-General, China Center for Disease Control and Prevention
MIAO JiResearch fellow, Institute of Asian Studies, China Foreign Affairs University

Japan[WG Members]*Director of the WG
SATO Teiichi*Professor, International University of Health and Welfare
FUKUDA Takashi
National Institute of Public Health
IGARASHI Ataru
Associate Professor, the University of Tokyo
IKEDA Shunya
Professor, International University of Health and Welfare
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OGAWA Toshio
Associate Professor, International University of Health and Welfare
WATANABE Kozo
Deputy Director General, Japan International Cooperation Agency[The Japan Forum on International Relations]
ISHIGAKI Yasuji
Trustee, JFIRWATANABE Mayu
Executive Director, JFIRKIKUCHI Yona
Senior Research Fellow, JFIRYANO TakuyaResearch Coordinator, JFIR
HARADA Hiroyasu
Research Fellow, JFIRKorea
KANG MinahProfessor, Ewha Womans University

Laos
Phimmasone KOTSAYTHOUNE
Deputy Director General of Finance Department, Ministry of Public Health

Malaysia
LEE Kah Seng
Principal Assistant Director, Pharmaceutical Services Division, Ministry of Health
LIM Yen Wei
Principal Assistant Director, Pharmaceutical Services Division, Ministry of Health6Myanmar
San SHWE
Senior Technical Consultant, Myanmar Institute of Strategic and International Studies

Philippines
Ida Marie PANTIG
Supervising Research Specialist, Philippine Institute for Development Studies

Singapore
PHUA Kai Hong
Associate Professor of Health Policy & Management,
the Lee Kuan Yew School of Public Policy

Thailand
Wiwat ROJANAPITHAYAKORN
Director, Center for Health Policy and Management,
Faculty of Medicine, Ramathibodi Hospital, Mahidol University

Vietnam
Do Duy CUONG
Head of Infectious Department, Bachmai Hospital
In Alphabetical Order of Country Names

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