Since the UN General Assembly adopted the Sustainable Development Goals (SDGs) in 2015, the world has enhanced universal and transformative efforts on promoting an equitable and resilient society and a suitable planet. In the health sector, Universal Health Coverage (UHC) became a primary agenda in which people could access quality, accessible, equitable, affordable, and quality health services and no one should not be left behind. The concept for sustainability was initiated by the Roma Club's proposal “The Limits to Growth” in 1972. They argued that the planet's boundaries could terminate the growth of the human society and we must reflect on our way of development. The idea of sustainable development was proposed by the Brundtland Report in 1987. The sustainable development agenda was followed by the Rio de Janeiro Earth Summit in 1992 and the Copenhagen World Summit on Social Development in 1995. While poverty, the environment, gender, and the HIV pandemic became global issues, the UN Millennium Summit adopted the Millennium Development Goals (MDGs) in 2000. Economic disparity and health inequity became ultimate challenges for the sustainable development of global society in recent years. This is an urgent concern and the reason why the Sustainable Development Goals were established in 2015. Now all nations have shared responsibility to achieve equity and sustainability in the development agenda with the slogan “No one will be left behind.” While we are facing predicaments in this modern world, the most essential challenge is the mind-set of individual and social responsibility to contribute to our planet sustainably.

Achieving the Sustainable Development Goals (SDGs) is a mission for all member states of the United Nations, including Japan. In the “Expanded SDGs Action Plan 2019,” presented by the Prime Minister's office in June 2019, regional revitalization and development of sustainable communities are listed as major initiatives. On the other hand, a survey report indicates that the health issue, mainly related to Goal 3, is most significant for community residents. Thus, building a healthy community is expected to become a major pillar of promoting the SDGs.

In this article, we examine how to develop a healthy community with the SDGs concept, especially some effective local government approaches. In addition, by summarizing the results of monitoring the achievement status of SDG goals by country, we discuss the current status of the indicators closely related to health promotion in the SDGs.

Background: Smoking is one of the biggest health issues, and tobacco control measures are implemented in each country based on the WHO Framework Convention on the Tobacco Control (FCTC). Furthermore, from the perspective of the Sustainable Development Goals (SDGs), all SDG goals relate to tobacco control, including increased tobacco consumption, expanded tobacco leaf production, and environmental issues in developing countries.

Method: We reviewed the efforts of international organizations and tobacco control measures in each country and the achievement status of the SDGs based on literature.

Results: The International Union against Tuberculosis and Lung Disease (UNION) developed the Index of Tobacco Control Sustainability (ITCS) to be a tool to assess and guide national tobacco control programs to become sustainable in each country in relation to the SDGs. As of August 2016, the results of assessments in 24 countries have been published, but Japan is ranked 21st out of 24 countries and is assessed as “low” sustainability.

The World Bank has issued a report on “Tobacco Tax Reform” in connection with the promotion of the SDGs. The tobacco tax increase is stipulated in Article 6 of the FCTC and is indicated as the most effective tobacco countermeasure. In this report, tobacco tax increases are extremely effective as a powerful human development and poverty reduction measure that reduces poverty and at the same time increases public funds for development investment. It is noted that this policy measure remains largely underutilized, especially in low- and middle-income countries (LMICs).

Summary: In LMICs, tobacco is the source of poverty and disparity, and it is necessary to implement tobacco countermeasures, including tobacco tax reform, in order to unite various stakeholders and save human lives. Tobacco control is closely related to all the goals of the SDGs, and all countries, including Japan, need to implement tobacco control based on the FCTC as quickly as possible so that it reaches as many people as possible.

Among the 17 Sustainable Development Goals (SDGs), the health field is listed in Goal 3, “Ensuring healthy living and promoting welfare for all people of all ages,” toward 2030. Sufficient human resources in the health sector are also one of essential components for achieving Target 3.8, universal health coverage (UHC). Furthermore, regarding securing human resources in developing countries, is Goal 3.C, “Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States.” In order to provide high-quality health care services to all people with limited human resources, it is necessary to respond to the uneven distribution of health care workers, promoting task shifts and skill mix, as well as continual education and training systems. These are common issues in the world, in both developing countries and developed countries.

The ratification for achieving the goals on nutrition-related non-communicable diseases (NCD) in Sustainable Development Goals 2 and 3 and the United Nations Decade of Action on Nutrition had the following requirement contents:

“To resolve the ‘double burden of malnutrition (challenges of both under- and over-nutrition),’ it is important that each country analyzes and monitors their priority health issues and the underlying risk factors.”

In Japan, Z-scores, which indicate the relative position between prefectures, were calculated from local government health and nutrition-related data, from which priority health issues and risk factors were identified, and health personnel training and nutrition measures were developed and promoted.

Therefore, this study considered the possibility of applying Japanese the monitoring method to identify appropriate solutions for the comprehensive nutrition and NCD issues indicated by the WHO. The results showed that the methodology could be a useful resource. Therefore, Japan’s experience may be helpful in monitoring nutrition and NCD measures in the SDGs.

“Health Security” is a frequently used term, but there is no common definition that has been widely agreed on. This article examines “A series of measures such as prevention, preparation, detection, and response to protect the population as a whole from hazards that cause an acute health crisis, regardless of their origin.” Core capacity-building efforts mandated by the International Health Regulations (IHR) revised in 2005 are an important policy agenda for the international community in strengthening health security. The Sustainable Development Goals (SDGs) Goal 3.d also includes “early warning, risk reduction, and management of national and global health risks,” thus, core capacity-building based on international health regulations capacity-building is clearly correlated to SDGs. To reinforce health security, a new framework for monitoring and evaluation of IHR has been established, and efforts such as joint external evaluation are being promoted worldwide. Japan has already declared to the WHO that Japan had achieved its core capacity, but IHR joint external evaluation was conducted in February 2018. While highly regarded, various areas of improvements were pointed out. Efforts to make effective use of these recommendations are ongoing.

The National Institute of Public Health (NIPH) has contributed to strengthening domestic and global health security through research projects and training. The author participated in four JEE missions as an evaluator. In addition, to strengthen health security in the country, we published “Vulnerability Assessment Guidance for Emerging and Re-emerging Infectious Diseases Preparedness and Crisis Management” and advocate a joint assessment model using this guidance with external evaluators, which has been proposed for local governments. We also provide support for training and exercises. For human resource development, in addition to providing an infectious disease outbreak training course and disaster health crisis management assistant team (DHEAT) training in the short-term curriculum at the NIPH, we also support infectious disease crisis management specialist (IDES) training programs. Not only are the efforts imperative for strengthening health security at the national level, but also at the local level, including for human resource development.

Currently, we are making progress toward achieving the UN Sustainable Development Goals (SDGs) around the world. In this paper, we focus on human resources for health, which is an element of health systems, and we introduce the training courses conducted by the National Institute of Public Health (NIPH) for health personnel in Japan and abroad. In the joint training with JICA and NIPH, two training courses, “Health Systems Management” and “Health Policy Improvement,” are conducted for participants from about 10 countries around the world to achieve Universal Health Coverage (UHC), defined as access to safe, effective, quality and affordable essential health-care services, medicines and vaccines for all with financial risk protection. In joint training with the WHO Western Pacific Region (WPRO) and NIPH, we have two workshops, “Measures on Non-communicable Diseases” and “Promotion of Medical Quality and Patient Safety.” The two training courses introduced for domestic health personnel , AIDS countermeasures training and child-abuse prevention training, cover topics of the SDGs, and Japan is expected to promote these measures. Specially, it was pointed out by the UN that Japan needs to deal with prevention of child-abuse immediately. All training courses introduced in this paper provides participatory and mutual learning sessions that allow participants to learn what policies and mechanisms should be applied in the field and what we can do from their experiences. The National Institute of Public Health has the strengths to engage in human resource development from both a global perspective and a local perspective.

We will continue to contribute to human resource development by leveraging our strengths in line with changing social needs to achieve the SDGs

Introduction: Universal Health Coverage (UHC) is a system ensuring people to receive medical care at an affordable cost and is promoted by UN and WHO as a goal to be achieved by all member countries. As the first country to have achieved UHC in Asia, Japan provides technical assistance for Asian countries to achieve UHC as part of its international health diplomacy.

The “Social security system strengthening towards Universal Health Coverage (UHC) in Asia” course was organized by the Japan International Cooperation Agency (JICA) in collaboration with the National Institute of Public Health (NIPH) and was provided in three years (FY2013-15).

Contents: The participants were young bureaucrats responsible for the development of UHC in their countries. The course intends to provide technical knowledge and skills useful for UHC through a case study of Japan's experiences. The course also emphasizes practical aspects of the UHC operation to be learned from on-site visits.

The course is a two-week course, in which the first half is devoted for didactic lectures to provide basic understanding about Japan's UHC system and the last half is devoted for site visits to the three essential components of health insurance: insurer, provider and claims review/reimbursement organizations (CRRO).

In the end of the course, participants summarize what they learned to make them lessons for realizing UHC in their countries. Those lessons range from health economics to balance the patients' copayment and its inflationary effects on health expenditures to political negotiations to win supports from providers (such as favorable taxation on doctors' income derived from health insurance).

Achievement: In three years, a total of 39 participants from nine countries completed the course. The course was continued in FY2016 after expanding target countries from Asia to include Africa. Monitoring of the activities of the participants and the developmental process of UHC of participating countries will be next challenges to the future.