"My own resolution didn’t seem so significant" ~ Way of thinking transformed by encounters with international students

Please tell us a little about your story so far.

Since my parents were prone to being sick, the impact of health on life and work was something that was very apparent to me from a young age. I’m sure this formative experience has led me to what I’m doing now.

After leaving university, I had the opportunity to work at Johnson & Johnson, and became involved in work related to prevention of medical accidents, which was a big turning point for me. The media tends to highlight the "human error" aspect of medical accidents, but I always got the sense that in the background there were so many systemic factors that can’t be handled by or blamed on one individual, whether it’s manpower or budgetary issues, or a culture where it’s hard to admit failure, or an organizational culture that makes it difficult to point out a potential error to your boss. So, I started to educate myself about these wider issues, and this led eventually to my decision to go overseas to study at the Harvard School of Public Health, which was at the forefront of the field at the time. After a few years of necessary preparation, I moved to the US with my family.

What did you learn during your time at Harvard School of Public Health?

For me, the biggest impact was undoubtedly on my own way of thinking. Before enrolling, I was if anything probably more interested in "micro issues" relating to prevention of medical accidents and management of medical institutions. By the time I graduated, however, I’d come to grasp things much more from a macro perspective in terms of healthcare policy and the like.

What changed your way of thinking?

There were two international students that I met. One was from Afghanistan, a female obstetrician in her thirties. We were neighbors in the student dormitory, and talked a lot about various things. She was set to graduate a year ahead of me, and when I asked what she planned to do next, she gave a very powerful response.

"I will become Prime Minister. I don’t think you can easily imagine the ‘pre-healthcare’ problems my country faces. With the civil war, there’s no gas, electricity, or running water, nothing’s functioning as it should. Kabul, our capital, is just a mountain of rubble, infant mortality is still very high, and many mothers die in childbirth. To help as many of our people as we can, we must improve the country itself before we can improve healthcare. That’s why I will become Prime Minister."

That really opened my eyes. In fact, she went on to become Afghanistan’s Minister of Public Health while still in her thirties, and has been the country’s Permanent Representative to the UN in Geneva for several years now.

The other student was a doctor in his twenties who had come from Thailand. Even in the midst of the demanding classes and coursework at Harvard, I would see him doing some kind of additional work of his own. When I asked what he was doing, I found he was intently studying the agricultural sections of Thailand’s equivalent of the Monthly Economic Reports published in Japan. When I asked why he was doing this on top of everything else he had to study, he explained: "There are many poor in Thailand’s rural areas, and so if agriculture, the key industry, is not good, it will have a great impact on the health of people there. Thus, the health of the people can’t be protected without developing agriculture. So, a doctor must also learn about agriculture." He was very earnest about this.

To see how seriously and fixedly they were looking at their respective country’s situation had a powerful impact on me. I had spent several years studying for entrance exams while also working full-time, and though I had a scholarship, going overseas with my family in my mid-thirties to study required a pretty high level of determination. However, compared to those who were committing their lives to carrying their countries on their backs, I felt humbled, and my own resolution didn’t seem so significant. Observing their approach, I also came to feel that I need to commit my time and effort to making society better for the benefit of the country and the people... So, in this frame of mind, on returning to Japan I became involved with the independent think tank, Health and Global Policy Institute, among other activities, and started to confront social issues.

"Aren’t we overdoing things now? As a country, as a planet, every one of us?"

Why then did you now decide to establish SustainaHealth?

First of all, after I returned to Japan, my experience of local political activity and my work with Health and Global Policy Institute made me acutely aware of the vital importance of "sustainability" as a theme in thinking about Japan’s future.

I’m originally from Mie Prefecture, and it’s an entirely different world there than you can imagine if you’re at the heart of the Japanese economy in central Tokyo. Clearly, the population’s declining, more and more stores are being permanently shuttered, the number of empty houses and marginal settlements is growing, and unused agricultural land is becoming wasteland... Seeing these things in my own hometown, I felt the urge to do something, and so I was wondering what exactly I can do.

At the same time, the number of people in Tokyo is clearly excessive. With so many people living in such a densely populated area, it seems very apparent that it’s unsustainable, and at the very least, at a personal level it’s something that I feel doesn’t suit me. I started to think that it would be ideal if we could get people to think more about, and wherever possible to pursue, the sustainable lifestyle that really suits them. In particular, the Covid-19 crisis has exposed the vulnerability of these densely populated communities, and I think many people are now questioning the value of a lifestyle where they’re commuting an hour or more each way on overcrowded trains to work from morning till night in the city.

A second point is that there are obviously going to be tremendous challenges in maintaining Japan’s health insurance system and financing at current levels. We’re now in an era of slow or stagnant economic growth, so we cannot expect to see any significant growth in tax revenues or insurance premiums, while expenditures are certain to continue climbing just from the fact that society is aging so rapidly, as well as the increasing sophistication, and cost, of medical technologies. Sustainable social security is something I’ve been thinking about for quite some time now, and in particular how to proceed with reforms in the healthcare sector. Needless to say, health cannot be protected through healthcare alone, and so there’s a great deal that also needs to be done with regard to nutrition and exercise, jobs, the economy, social infrastructure, energy, urban development, and so on.

The third point is the environmental context. Both for our individual lives and at the level of community development, isn’t it better for us to be living in a more natural way that’s more in harmony with the environment? Moreover, specifically within the healthcare sector, reduction of the environmental burden is a key issue for the future. From the standpoint of safety and guarding against infection, we use an excessive amount of disposable equipment and materials, and we need to be asking if that something we can really continue to do. This also relates to the system’s sustainability, and even though it’s the medical field, we need to get away from the mass consumption mode of thinking where our go-to strategy is simply to throw a large amount of resources at any problem we encounter.

So, these are all things that I’ve been thinking about deeply ever since I returned to Japan after my studies at Harvard. And this time, the conditions and timing felt right to start up full-scale activities to address these issues, and so the decision was made to establish SustainaHealth.

As it forms part of your organization’s name, please explain to us your concept of "Sustainability".

At the national level, global level, and at the level of the individual as well, it seems that we’re simply overdoing things now... To secure our current healthcare system and financing, to maintain the Earth’s resources, to pursue a lifestyle where we can live in good health, free from sickness... well, for all these things, we need to think from a longer term perspective, and from the standpoint of living in closer harmony with nature and the environment. And what I think of as "sustainability" is building a society that makes it possible for us to do that, to live in harmony with nature and the environment from a long-term perspective and without undue hardship.

Incidentally, I understand that the working style of SustainaHealth members is quite distinct.

Right now, we have around 10 people actively involved, and the majority are working on a part-time basis. In the areas of public health and health policy where SustainaHealth is active, there’s a host of hidden or unused talent in terms of people with relevant expertise who are not currently able to utilize that expertise after stepping away from their careers to have children or care for family members, or other such reasons. It really is a waste of a precious resource. To give a couple of examples, there’s someone studying on a doctoral program overseas who also wants to make use of their specialty to contribute to Japan, and someone currently focused on raising young children but who also wants to commit to working 5 hours a week. I want such human resources to be able to play active roles, and so I’m happy to take people on in a part-time capacity to make that happen.

In addition, due to the nature of SustainaHealth’s activities, not only do we need an extremely high level of expertise, but also we require a wide-ranging variety of specialties. To give an example, on a project for, say, "healthy community development", as well as medical and health policy specialists, we also need to involve a large number of experts in everything from energy and transportation to social infrastructure and preventive long-term care. Thus, even with a good number of full-time members, we would be unable to cover such a project. On the other hand, if members with the required expertise are able to participate on a project basis, we become capable of providing value by pooling the collective knowhow of a custom-made group of experts, while the individual members who participate are able to contribute their knowledge and skills regardless of time or place. In this way, it’s possible for us to create real "Win-Win-Win" outcomes that are fulfilling for all stakeholders.

It seems that you too have a workstyle where the time or place is of no matter.

Well, it’s not something that I regard as being especially difficult to do. It originated in the fact that, quite simply, I found big city life didn’t suit me [laughs]. One outcome of my pursuit of my own sustainable lifestyle is that I’m currently living among the fields in the suburbs of Chiba Prefecture. In fact, I rent a field from a local farmer, and in my spare time I’m growing mainly peanuts, sweet potatoes, and several varieties of bean.

At the same time, though, our clients are scattered all over the country, from foreign-affiliated companies in the heart of Tokyo to local medical institutions, so in addition to working remotely, I’m often traveling back and forth to different regions. To make sure I always have a quiet work space whatever my destination, I carry a foldable desk and chair in the back of my minivan, so I can hold a meeting or do some work from anywhere I can drive to. Of course, I can’t always choose the exact location, but if I’m near the coast, for example, I can drive up there and participate in a meeting while looking out at the ocean.

Our obligation to future generations

Finally, please share the driving force and motivation behind all these activities.

Essentially, almost everything we now enjoy or utilize as a matter of course, from our social security system to the water supply, roads, energy, the public peace, culture, you name it, was built with the effort and sense of duty of past generations. I think it’s important that we appreciate just how fortunate we are to have such a society and environment. Accordingly, isn’t it a natural responsibility of our generation to hand down these fruits properly to our children’s and grandchildren’s generations? And so, surely, steadily, we need to promote the creation of a sustainable society.

However, I understand that it’s difficult to spare financial resources for such long-term activities, and the reality is that not only are there few people tackling such issues but also there are few people actually capable of tackling them. We need people to act, and we absolutely need people to instigate and lead. Instead of waiting for someone else to act, instead of leaving it to the government, I said to myself "One action has greater value than a hundred comments or criticisms," and I decided to do something myself. Nobody asked me to do this, so in that sense, it may be a willful or even selfish mission in one way, but this is what’s driving me.