On July 16, 2026, an international research team led by Tohoku University published two policy review papers that examine Japan's health system and global health strategy in The Lancet Regional Health - Western Pacific ― the Lancet group's first Japan-focused feature in about 15 years. Building on the world-leading healthy longevity Japan has achieved under universal health coverage, the papers argue that keeping the system sustainable to 2040 will take a full redesign, not just a small adjustment.
Japan's universal health coverage, which aims to provide everyone with necessary care without serious financial hardship, has helped build one of the longest-living societies on earth. However, new challenges are arising that may put a strain on Japan's healthcare system. By 2040, more than one in three people in Japan will be aged 65 or older, and medical and long-term care needs are shifting from short-term hospital treatment to years of daily support for older adults living with chronic illness, dementia and frailty. The papers argue that today's incentives, budgets and data systems were shaped for an earlier era, and that meeting these needs will require looking beyond cost containment to how well the system supports people's everyday lives. How can Japan keep universal health coverage fair and sustainable as its population rapidly ages?
A working group of 25 researchers and policy practitioners from Japan and the Western Pacific reviewed evidence and discussed what must change. The first paper describes a pattern in which widely recognised pressures have yet to translate into reform of the system's core architecture ― what it terms "institutional stagnation." It proposes that Japan moves from a hospital- and service-volume-centred system to one focused on people's lives, health outcomes and communities, with better links between medical, long-term care and welfare data; independent scientific advice; clearer evaluation of policy effects; and public spending decisions that consider broader social value, such as family burden and quality of life.
The second paper looks outward. Japan has delivered notable results at G7 and G20 summits. However, the paper's concern ― which it calls "strategic inertia" ― is connecting that momentum to everyday policy, multi-year budgets and skilled personnel. It argues that health should not be treated only as foreign aid; instead, Japan should make health a pillar of "human security diplomacy": diplomacy that protects people's lives, health and dignity while strengthening regional stability and economic security. The paper calls for stronger cross-ministry coordination, stable multi-year funding and common regional rules in areas such as infectious disease control, antimicrobial resistance, medicine quality and supply, health data, artificial intelligence and misinformation. It also calls for cooperation with Western Pacific partners in areas where common technical rules can be agreed.
The researchers suggest three main changes: from hospital-centred care to community-centred support; from aid to human security diplomacy; and from one-way knowledge transfer to mutual learning. The papers give particular weight to that third shift: Japan can share experience in areas such as universal health coverage, long-term care and disaster response, and can in turn learn from Asian partners in areas such as efficient payment systems, digital health tools and community-based care developed under tight resource constraints.
"The central question is not how Japan can protect the old system, but how it can redesign the social contract behind universal health coverage," says Shuhei Nomura, a professor at Tohoku University's International Research Institute of Disaster Science (IRIDeS).
The papers offer a 2040 roadmap linking domestic reform, regional partnership and preparedness for challenges such as population ageing, climate change, disasters and future health crises. Offered as a basis for dialogue rather than a prescription, the researchers hope this work can inform the policy choices ahead.