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1、MichaelR.ReichGlobalHealth&Population,HSPH26April2012ReflectionsonJapan’s50YearsofUniversalHealthCoverage“Reflections”NotafocusedresearchpresentationMoreofapersonalperspectiveJapanhashaduniversalcoveragesince1961,kokuminkaihokenseido(国民皆保険制度)=50yearsJapanhashadMichaelcoveragesince1971=40years

2、2FieldResearchinJapan,1971-74MePresentationBasedonLancetJapanSeriesLeadersoftheJapanResearchGroupProf.K.TakemiProf.N.IkegamiProf.K.Shibuya50YearsSinceAchievingUniversalHealthCoverageMajorimprovementsinhealthstatusinthepostwarperiodJapanesewomenhaverankedasnumberoneinlifeexpectancyfor25years

3、7LifeExpectancyofWomenForG7Countriessource:MHLW.Japan’sUnder-5Morality（1950-2008）9BoysGirlsMDG4:Reduceby2/3’s(1950-1965)92(1950)24(1965)Source:ランセット日本特集号PopulationHealthIn50YearsSinceAchievingUniversalHealthCoverageAlsoexcellentcontrolofnationalmedicalexpendituresinJapanTodayJapan’sNMErepre

4、sentonly8.1%ofGDP,placingthematnumber20amongOECDcountriesCostcontrolhascontinued,evenwithrapidagingofthepopulation10MedicalExpenditureamongOECDCountries(2005）source:MHLW.ReasonsforJapan’sSuccessesNoteasytoexplainPublichealthpolicies,Highliteracyratesandeducationallevels,Dietandexercise,Econo

5、micgrowth,andAstablepoliticalenvironment12PerryandhisBlackShips“Open”Japanin1853RecentHistoricalContext-1About3.2milliondeathsduringWW2HiroshimaaftertheBombRecentHistoricalContext-2UndertheOccupation,socialchangeanddemocratizationNewpublichealthpoliciesintroducedEffectivecontrolofinfectiousdi

6、seasesandtuberculosisFrom1947to1955,averagelifeexpectancyincreasedby14yearsSeriouspollutionproblemsin1960s15ExpandingCoverageJapan’sAchievements“GoodHealthatLowCostwithEquity”Fourmainpoints:UniversalcoveragewithincreasingequityCostcontainmentandservicequalityPoliciesforageingImpressivegainsin

7、populationhealth17GrowingSocialChallengestheriseofpart-timeandtemporaryemploymentforyoungworkersgrowingnumberofyoungwomenwhopostponemarriageandchild-bearingever-expandingnumberofelderlyincreasingsenseofwideningincomeinequalityanddiversityinva