Intended for healthcare professionals


The iron triangle of Japan's health care

BMJ 2005; 330 doi: (Published 06 January 2005) Cite this as: BMJ 2005;330:55

Another lesson from the Japan Medical Association

Editor-Kondo described one aspect of the Japan Medical Association (JMA) in its relation with Japanese politics (1). He emphasized the importance of transforming itself from a lobby group to an academically grounded professional association (1).

His article, however, is not showing JMA's international contributions. JMA has contributed to improve the quality of health professionals in the world through the Takemi program in the Department of the Population and International Health at the Harvard School of Public Health since 1984. In addition to this international health program, JMA initiated an international health project in rural Nepal to narrow the gap between the urban rich and the rural poor in 1992 through 2005: the School and Community Health Project (SCHP). I was a director of SCHP from 1996 to 2001 for five years and learned how communities could improve health systems in rural Nepal (2).

As a result of SCHP's activities in rural Nepal, the King Birendra awarded a Decoration to Dr. Eitaka Tsuboi, then JMA president, in 2000. Nepalese Ministry of Health has tried to institutionalize school health in Nepal since then; it is currently making a national school health policy in Nepal being supported by JMA in cooperation with other international agencies such as the Save the Children/USA.

Among the other world medical associations, only JMA has directly implemented international health activities in developing countries for more than a decade. This is something other medical associations around the world may learn from JMA. What is disappointing, however, is that JMA is terminating such an innovative work in developing countries this year and making it a history.

1. Kondo J. The iron triangle of Japan's health care. BMJ. 2005; 330: 55-56.

2. Jimba M, Wakai S. Learning from low income countries: what are the lessons?: Communities improve health systems. BMJ. 2004 ;329:1183.

Competing interests: I was a director of JMA's Nepal project from 1996 to 2001.

Competing interests: No competing interests

21 January 2005
Masamine Jimba
Assistant Professor
Department of International Community Health, University of Tokyo,Tokyo, 113-0033, Japan