Introduction

East Asian countries undertake enhancing health systems through achievement of the universal health coverage. In each country, as it is necessary to take into account of the aging and a change in disease structure, it is important to respond flexibly to take measures for tackling these issues at the regional and/or the global level. In particular, as it is necessary to respond to emergencies such as occurrences of natural disasters and infectious disease outbreaks beyond the national level, it is necessary to establish a collaborative system between counties in this region from ordinal situation towards emergencies that enables countries to respond these issues. In order to tackling common issues within this region such as aging and changes in disease structure, countries may make use of the experiences of the efforts in Japan and Korea where are working on the issues ahead of other countries. For confronting these issues, therefore, it is necessary to construct a resilient network for health cooperation in East Asia.

In order to establish a health cooperation network in East Asia, it is necessary to adjust various conditions. In building a health cooperation network, it is essential to nurture and secure personnel who act actively in the network. Especially, it is necessary to secure and utilize health care experts in both ordinary time and emerging situation, as well as policy makers and bureaucrats who make health policies related to developing and enhancing health cooperation network. It is also essential to secure and expand various resources to operate the health cooperation network effectively. Specifically, it is important to maintain health information networks using ICT, and to secure and expand various healthcare resources, and to achieve optimal allocation. These will be achieved through health system development.

Building a health cooperation network in East Asia leads to enhancements in health systems in each country, contributing to the improvement of the global health led by WHO, and contributing to the development of global health governance. Furthermore, it is possible to establish a network of researchers in East Asian countries to improve health research capabilities through building a health cooperation network.

This policy recommendations are based on the discussions at the symposium "Towards Building a Resilient Network for Regional Health Cooperation in East Asia" (January 15, 2018, Tokyo) under the above-mentioned awareness of the issues for establishing and maintaining health cooperation networks in East Asian countries.

Recommendation 1: It is necessary to construct and expand a health care system considering disaster medical care from ordinal time and improve international cooperation system.

Responding to health care in large-scale natural disasters is an important issue to be addressed in each country as a part of achievement of universal health coverage. Especially, it is necessary to prepare the occurrence of disaster and the necessity of provision of disaster medical care from ordinal time.

For providing disaster medical care properly, it is important to train personnel in charge of disaster medical care. In particular it is necessary to develop curriculum for professional education of disaster medical care at medical schools in this region. As it cannot be said that there are enough resources to provide medical education for disastrous situations in East Asian countries, it is necessary to cooperate each other to establish and enhance of curriculum of disaster medical care. It is necessary to establish and maintain various human resources for disaster situations. For providing disaster medical care properly, it is necessary to have not only medical staff such as doctors and nurses who provide disaster medical care on site but also administrative officials and bureaucrats in charge of management at times of disasters, and information officials of gathering and disseminating appropriate information to the society and so on. Also, it is important to secure personnel engaged in disaster medical care throughout East Asian countries. For dealing with large-scale disasters, it is important to establish an international networks for providing disaster medical care among East Asian countries for enabling utilization of human resources beyond national borders, including improvement of the acceptance of international teams for the disastrous situations.

In the event of a disaster, it is necessary to respond promptly and appropriately. In addition to obtaining accurate information quickly, for example, it is necessary to dispatch medical staff to the disaster occurrence sites, to operate mobile hospital and hospital ship, to promptly improve the cooperation system with the military, the Self-Defense Forces, and other stakeholders. Also, at the time of the occurrence of a disaster and immediately thereafter, there may be a major shortage of primary medical resources in the area, then there may be intensive supply of medical resources in a short period of time. In order to provide disaster medical care appropriately, it is important to establish a system dealing with whole country or whole region. As various organizations such as UN, WHO and other international organizations, central and local governments, medical institutions, NGOs and others, sometimes not only from the East Asia region but from the whole world, involve in the disaster medical care with complex relationships. For dealing with the special situations at the time of disasters with diversified stakeholders and resources, it is important to develop appropriate infrastructure to manage them properly. Furthermore, it is important to collect and disseminate appropriate information at the time of a disaster and to develop an information network that combines various organizations including international organizations, national and local governments, and medical institution covering East Asian countries. It is also important to establish such a network at ordinal time to enable appropriate information gathering and communication during the disaster.

Recommendation 2: It is necessary to construct a more robust infectious disease control network in East Asia.

As East Asia is known as one of the regions where emerging infectious diseases in the world, it is important to consider the countermeasures of controlling infectious diseases in East Asian countries. Regarding combating infectious diseases in this region, various countermeasures have been implemented by various organizations such as WHO, national and local governments, and donor agencies such as JICA. As a part of the countermeasures, various infectious disease control networks have been established such as Asia Pacific Strategy for Emerging Diseases (ASPED) developed by the WHO Western Pacific Regional Office and the International Development Program on Infectious Diseases Research (J-GRID) by the Japanese government. However, it is difficult to say that sufficient measures have yet to be taken.

For improving infectious disease control in East Asian region, it is important to expand international collaboration and to increase opportunities of the training of experts in infectious diseases. Although the international collaboration for the infectious disease surveillance is being implemented mainly by international organizations such as WHO in parallel with implementation in each country, it is necessary to construct a robust cooperative system to cover entire East Asian countries in order to collect and disseminate information quickly and accurately.

It is important to provide appropriate professional trainings for the experts in infectious diseases for strengthening infectious diseases control including expansion of infectious disease surveillance system. For achieving it, it is urgent to expand programs to train experts in infectious diseases in East Asian countries with the cooperation of educational institutions such as medical schools and schools of public health in each country. Moreover, it is important at ordinal times to construct an infectious disease control network that allows experts in infectious diseases to cooperate effectively for the occurrence of a epidemic and pandemic situation.

In East Asian region, some countries have not yet developed health systems for achieving proper infectious diseases control. The disparities of health systems development within the region make difficult to control infectious disease effectively. Therefore, it is important to enhance health systems and to reduce disparities of health systems development within the region for against infectious diseases.

Internationally it is recognized the importance of the measure against antimicrobial resistance (AMR) of infectious diseases. It is urgent to formulate guidelines concerning the proper use of drugs at national and regional level, and it is necessary to cooperate between countries for reducing AMRs. It is also important to prepare high quality vaccines for reducing infectious diseases in this region. Furthermore, it is necessary to establish a framework to survey occurrences of infectious diseases in this region and to consider measures for infectious diseases control suitable for the region based on the evidence.

Recommendation 3: It is necessary to construct a social and health systems adapted to the aging society.

As East Asian countries are reaching aging society with different progress between countries, it is necessary to make proper policies based on accurate analysis of the aging situation in each country. In order to respond to the aging society, it is necessary to construct a health system that can take measures against diseases peculiar to the elderly. Furthermore, it is important to build a social system that makes it easy for the elderly to live, and achieve Active Aging that aims at a society where healthy elderly is easy to live.

With becoming an aging society in East Asian countries, it is necessary to take measures against diseases peculiar to the elderly, such as lifestyle-related diseases, in addition to conventional infectious disease controls. Lifestyle-related diseases require long-term care and it is necessary to respond to changes in disease structure due to aging such as an increase in dementia. Therefore, in addition to providing health care services at health care institutions such as hospitals and clinics, it is necessary to expand various forms of care including home care to provide long-term care effectively. For providing various types of care, it is necessary to secure human resources to provide appropriate long-term care and to introduce technologies that can provide adequate and high-quality care at home using ICT or else. In addition, it is necessary to secure and utilize various resources for the treatment of lifestyle-related diseases, such as development of innovative medicines for cancer and cardiovascular diseases as well as utilization of traditional medicine. Furthermore, it is better to enhance the use of medical tourism for providing effective care of lifestyle-related diseases and effective usage of human resources.

In East Asian countries, it is important to expand preventive activities of lifestyle-related diseases. For achieving Active Aging, it is better to improve eating and exercise habits from young generations to lead to prevention of lifestyle diseases. For achieving it, it is necessary to clarify the causal relationship between lifestyle and diseases, then promote evidence-based preventive measures. It is also important to promote the development and utilization of medical technology for the early detection and early treatment. Aging is a common issue among East Asian countries. It is better to collaborate between countries for achieving more efficient measures by sharing experience of each country. Therefore, it is important to establish a health cooperation network related to the aging in East Asia for establishing a system within the entire region to address diseases related to aging including lifestyle-related diseases and dementia.