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In today's highly globalised world, protecting human security is a core challenge for political leaders who are simultaneously dealing with terrorism, refugee and migration crises, disease epidemics, and climate change. Promoting universal health coverage (UHC) will help prevent another disease outbreak similar to the recent Ebola outbreak in west Africa, and create robust health systems, capable of withstanding future shocks. Robust health systems, in turn, are the prerequisites for achieving UHC. We propose three areas for global health action by the G7 countries at their meeting in Japan in May, 2016, to protect human security around the world: restructuring of the global health architecture so that it enables preparedness and responses to health emergencies; development of platforms to share best practices and harness shared learning about the resilience and sustainability of health systems; and strengthening of coordination and financing for research and development and system innovations for global health security. Rather than creating new funding or organisations, global leaders should reorganise current financing structures and institutions so that they work more effectively and efficiently. By making smart investments, countries will improve their capacity to monitor, track, review, and assess health system performance and accountability, and thereby be better prepared for future global health shocks.

Summary In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls—but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative strategies that address the national political economy context.

Japan has made its presence felt in the realm of power politics by focusing on the promotion of “human security” and sustainable development. At the core of both concepts lies the issue of health. As Japan prepares for the upcoming G7 Summit, Keizo Takemi examines the question of what sort of leadership role Japan should play in the critical field of health.

Summary The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.

To date, the Asia Cancer Forum has focused its efforts on creating a common concept for collaborative efforts in international cancer research with a focus on Asia, where cancer incidence is rising dramatically, and also sharing information and knowledge among cancer specialists about the importance of cancer as a global health agenda issue. The Eighth Asia Cancer Forum was held following the historic outcome of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases held in New York in September 2011, at which cancer was duly recognized as a global health agenda issue. Despite this significant development, however, the issue of cancer, one of the most intractable of all non-communicable diseases, still faces a variety of challenges if it is to be addressed on the global level. The Eighth Asia Cancer Forum sought to address these various issues, seeking ways to capitalize on the outcomes of the UN Meeting and take global collaborative studies and alliances in the field of cancer further. It was recognized that one of the main challenges for the Asia Cancer Forum is to formulate a proposal that demonstrates how middle-income countries can provide a good level of care using only their own limited medical resources. Given that the Asia Cancer Forum is one of the organizations that can provide assistance in working to further boost awareness about cancer research and the situation relating to cancer in Asian countries, discussion also focused on how to concretize activities in the future.

Over the past 50 years, Japan has successfully developed and maintained an increasingly equitable system of universal health coverage in addition to achieving the world's highest life expectancy and one of the lowest infant mortality rates. Against this backdrop, Japan is potentially in a position to become a leading advocate for and supporter of global health. Nevertheless, Japan's engagement with global health has not been outstanding relative to its substantial potential, in part because of government fragmentation, a weak civil society, and lack of transparency and assessment. Japan's development assistance for health, from both governmental and non-governmental sectors, has remained low and Japanese global health leadership has been weak. New challenges arising from changes in governance and global and domestic health needs, including the recent Great East Japan Earthquake, now provide Japan with an opportunity to review past approaches to health policy and develop a new strategy for addressing global and national health. The fragmented functioning of the government with regards to global health policy needs to be reconfigured and should be accompanied by further financial commitment to global health priorities, innovative non-governmental sector initiatives, increased research capacity, and investments in good leadership development as witnessed at the G8 Hokkaido Toyako Summit. Should this strategy development and commitment be achieved, Japan has the potential to make substantial contributions to the health of the world as many countries move toward universal coverage and as Japan itself faces the challenge of maintaining its own health system.

Summary Japan's premier health accomplishment in the past 50 years has been the achievement of good population health at low cost and increased equity between different population groups. The development of Japan's policies for universal coverage are similar to the policy debates that many countries are having in their own contexts. The financial sustainability of Japan's universal coverage is under threat from demographic, economic, and political factors. Furthermore, a series of crises—both natural and nuclear—after the magnitude 9·0 Great East Japan Earthquake on March 11, 2011, has shaken up the entire Japanese social system that was developed and built after World War 2, and shown existing structural problems in the Japanese health system. Here, we propose four major reforms to assure the sustainability and equity of Japan's health accomplishments in the past 50 years—implement a human-security value-based reform; redefine the role of the central and local governments; improve the quality of health care; and commit to global health. Now is the time for rebirth of Japan and its health system.

Summary The 2008 G8 summit in Toyako, Japan, produced a strong commitment for collective action to strengthen health systems in developing countries, indicating Japan's leadership on, and the G8's increasing engagement with, global health policy. This paper describes the context for the G8's role in global health architecture and analyses three key components—financing, information, and the health workforce—that affect the performance of health systems. We propose recommendations for actions by G8 leaders to strengthen health systems by making the most effective use of existing resources and increasing available resources. We recommend increased attention by G8 leaders to country capacity and country ownership in policy making and implementation. The G8 should also implement a yearly review for actions in this area, so that changes in health-system performance can be monitored and better understood.

The G8 summit in Toyako off ers Japan, as the host government, a special opportunity to infl uence collective action on global health. At the last G8 summit held in Japan, the Japanese government launched an eff ort to address critical infectious diseases, from which a series of disease-specifi c programmes emerged. This year’s summit provides another chance to catalyse global action on health, this time with a focus on health systems. Global eff orts to improve health conditions in poor countries have embraced two diff erent strategies in recent decades, one focusing on health systems, the other on specifi c diseases. The interactions of these two strategies have shaped where we stand today. The fi rst strategy has emphasised systemic approaches to health improvement. In the late 1970s, the world embarked on a major eff ort to strengthen health systems from the bottom up, through the primary health-care movement. WHO and UNICEF launched this movement at the Alma Ata conference in 1978, which was attended by nearly all their member countries. The movement used an integrated multisectoral approach to health development, with special attention to disadvantaged populations in each country. This became known as a horizontal approach. This approach confronted many challenges. The problems were particularly severe in sub-Saharan Africa, because of “low fi nancing of health systems, bad governance, the human resources for health crisis, the high level of poverty of the people, the debt burden, the emergence of new diseases and the deterioration of the social system in many countries.” Today, with the 30th anniversary of the Alma Ata Declaration in 2008, calls have arisen for renewed attention to primary health care. Indeed, WHO’s annual report in 2008 focuses on primary health care and its role in strengthening health systems. The second strategy emphasised disease-specifi c approaches to health improvement. The last decade of the 20th century witnessed a rise in many diff erent single-disease control programmes. The Okinawa Infectious Disease Initiative, announced by Japan at the G8 summit in 2000, led to strengthened global eff orts on several diseases, in particular HIV/AIDS, tuberculosis, and malaria, but also poliomyelitis, parasitic diseases, and other neglected tropical diseases. These eff orts contributed to the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as other single-disease control programmes, ushering in a new era in global health cooperation. These programmes represent the vertical approach to health improvement. The disease-specifi c strategy has attracted substantial support in recent years and produced major results. Donors believe that this approach creates tangible products that can yield measurable improvements in health status. Development assistance for health is estimated to have grown from about $6 billion in 2000 to $14 billion in 2005. In addition to the Global Fund, collective eff orts to improve global health have included the GAVI Alliance, the Global Polio Eradication Initiative, the global health activities of the Bill & Melinda Gates Foundation and other private foundations, and various initiatives to develop new treatments for neglected tropical diseases. Various assessments suggest that these disease-specifi c partnerships have contributed to improvements in health conditions in poor countries around the world. However, the surge of disease-specifi c eff orts has also generated concerns about the unintended consequences of creating a fragmented array of uncoordinated programmes supported by multiple donors that recipient countries must struggle to manage. By focusing on specifi c performance measures, these programmes have sometimes not fully dealt with broader system failures. Yet such failures seem to lie behind the inadequate progress many countries have made on several key targets of the Millennium Development Goals (MDGs) for health—those related to child mortality (MDG 4), maternal mortality (MDG 5), and the prevention of HIV/ AIDS, malaria, and other diseases (MDG 6). Progress on these and other health improvements that depend on health system performance has been disappointing, especially when we consider the health status of poor and marginalised groups, for whom health status indicators (eg, infant mortality and maternal mortality rates) can be 50–100% higher than those of more advantaged population groups. The world is also facing the impending health threats of climate change. The potential consequences include enlargement of the geographical range of tropical diseases and massive fl ooding of low-lying inhabited areas, both of which would pose major challenges for health systems and disease control programmes in poor countries. Climate change could thus trigger negative interactions between poverty and health around the world, especially in poor countries. Addressing the health problems of poor countries can only move forward with a more balanced approach between specifi c-disease focus and system-based solutions; like weaving a piece of cloth, we need both the vertical and the horizontal threads to form strong fabric. Input-oriented approaches to health improvement (eg, Lancet 2008; 371: 865–69

The ex-perience of the health-related Millennium Development Goals (MDGs) has taught us, however, that to translate such a prin -ciple into reality, health systems must be strengthened. Key to such strengthening and to improving health service coverage and health outcomes is the availability of a sufficient, equitably distributed, skilled and motivated workforce.

Japan achieved universal health insurance coverage in 1961 and now has the longest life expectancy in the world. Japan’s strengths are, however, now becoming its weaknesses. Universal coverage is not the end but the beginning of new challenges—a rapidly ageing population, escalating health-care expenditures, and sustainability of universal coverage—that all countries will have to face in the future. How can Japan reinvigorate its health system to be more sustainable and equitable? On the occasion of the 50th anniversary of Japan’s universal coverage, The Lancet is producing a special Series on Japan’s health and health system in September, 2011. This Series is the fi rst country Series from a developed nation, and aims to stimulate scientifi c debate around the issue of health-systems reform while using experiences in Japan to provide national, regional, and global lessons. We seek submissions of original research from Japan or from research teams working on Japan, to publish in the Series. We are particularly interested in research that analyses key questions of health status, health policy, and health systems, both within Japan and within the Asia–Pacifi c region. The deadline for submissions is April 15, 2011, via The Lancet’s EES online submission system. Please state in your covering letter that the submission is in response to this call for papers.