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The ideal minister of health
  1. T Takano
  1. Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45 Bunkyo-ku, Tokyo 113-8519, Japan
  1. Correspondence to:
 Professor T Takano;

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Should be an outsider

The ideal minister of health needs to be a vigorous political or social leader, above all. The minister needs to be someone who knows political realities and can push their health policies forward. The minister should selflessly devote themself to serving the public. This person needs to be a visionary, a strategic thinker, a master of organisational skill, and a skillful communicator to the general public and with ministry of health bureaucrats.

Japan is now in transition to fundamental reform of its administration system. It is moving a large, rigid government bureaucracy to a system that favours deregulation, transparency, and smaller government. In this context, the work of Japan’s ministry of health is expected to change from a vertical approach to a comprehensive one that can act promptly and incorporate intersectoral collaboration. However, this change has not been progressing quickly enough.

Japan’s rigid bureaucratic system led health development through the entire country in the past through vaccination programmes, school health programmes, a public health insurance system, and so on. The compulsory and collective measures were effective. The system was also able to accumulate the experiences of professionals and create specialists who were experts in narrow fields. However, because of changes in society the old way doesn’t work anymore. In the past 10 years, there have been several important public health scandals: HIV infected blood products were allowed to be used, a severe lack of collaboration between the ministry of health and the ministry of agriculture helped increased contamination of BSE prions, and sufferers of Hansen’s disease had to wait far too long to be rehabilitated into society. The list of scandals continues. Ministry structure has basically continued unchanged even though superficial restructuring was carried out.

The ideal minister should be skilled at politics, but should come into the position from outside the ministry of health. This means that the minister could come from, for instance, the upper levels of an university, a large, transnational NGO, a large corporation, or a large organisation. A degree in medicine is not always needed. The minister does not need to be well known before assuming the position, either.

Japan’s citizens would now like to participate in health issues more subjectively. They want prompt and open measures against new health problems. They want leadership that has inter-ministerial collaboration. These positive potentialities have not yet been embraced by the ministry. An outstanding minister would be needed to make two large changes at the same time: change the ministry’s conventional structure and invite citizens into health administration in their communities. The ideal minister needs to be a very good listener and pay attention to outside academics, and the public. The minister needs to have the power to install the bureau chiefs of the ministry of health. In short, the ideal minister has to have a rare mixture of idealism and realism.

In addition to the above, there is one essential prerequisite for the ideal minister. S/he needs to be a long time reader of this journal!