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The US and Japan as G7 Champions of Health and Democracy

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Trans-Pacific View | Diplomacy | East Asia

The US and Japan as G7 Champions of Health and Democracy

Washington and Tokyo can contribute conclusively to global governance in the service of peace, prosperity, and pluralism.

The US and Japan as G7 Champions of Health and Democracy

President Joe Biden meets with Japanese Prime Minister Fumio Kishida, Friday, January 13, 2023, in the Oval Office.

Credit: Official White House Photo by Adam Schultz

Japan hosting the G-7 presidency in Hiroshima next week signals a ripe moment for deeper, deliberate U.S.-Japan collaboration on promoting global health and democratic norms. The two areas are longstanding prominent features of both powers’ foreign policies anchored in their shared respect for human dignity. Scaled up, methodical cooperation in both areas would make an ever-stronger bilateral alliance also an axis for dignity.  

The U.S.-Japan alliance, which has been the bedrock for peace and security in the Indo-Pacific region for over 70 years, is as strong as ever today. Much can be attributed to Japan’s increasingly proactive efforts to strengthen its defense posture and the alliance as presented in the Kishida government’s “transformational” plans announced in December 2022. The two allies have also taken regional collaboration to a new level through the Quad (in partnership with India and Australia) based on the “Free and Open Indo-Pacific” vision set out by Japan under the late-Prime Minister Abe Shinzo’s leadership. Now is the time to build on the strength of this alliance to enhance their global collaboration, particularly to strengthen health security and democratic resilience. 

These two agenda items are in essence: access to healthcare and access to justice. They are central to the U.S. and Japan’s shared commitment to human dignity, which Mark P. Lagon and Anthony Clark Arend define as advancing the agency and equal social recognition of individuals worldwide through institutionalized means. Among the major, intertwined transnational challenges of the day — including violent conflict, climate change and involuntary migration — health and democratic norms are mutually reinforcing. As Thomas Bollyky and co-authors established, democratic systems advance positive health outcomes. Civil society participation and transparency to curb corrupt diversion of funding strengthen local healthcare in low- and middle-income countries (LMICs).

In alternate parlance for human dignity, Kishida has embraced Japan’s long legacy of a “human security” approach as a guiding principle in Japan’s 2022 Global Health Strategy and its Development Cooperation Charter. Japan’s focus on advancing universal health coverage (UHC) and strengthening health systems in LMICs reflects this approach, ensuring that all people have access to quality and people-centered healthcare. Consistent with its commitment, Japan was a leading donor to the multilateral response to COVID-19. Together with the U.S., Japan mobilized other world leaders to invest more in global health, such as by making its early and largest-to-date pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) ahead of the seventh replenishment conference hosted by U.S. President Joe Biden, tying that pledge to prioritizing LMICs’ health systems strengthening. As a champion of global health, Japan, including Kishida, identified global health as a priority issue in the Hiroshima G-7.

The U.S. has stood out as a leader in global health, particularly since launching the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003. PEPFAR made health the centerpiece of U.S. official development assistance (ODA). Based on OECD bilateral and multilateral aid data, the Kaiser Family Foundation’s Adam Wexler and Anna Rouw established that each year between 2011 and 2021 U.S. global health investment represented between 27 to 31 percent of its ODA. The U.S. global health budget has exceeded $10 billion since 2014. Addressing the COVID-19 pandemic, despite domestic divisions, the U.S. pioneered swift vaccine development and rollout, and under the Biden administration made significant vaccine donations in LMICs, and offered leadership in COVAX, in efforts to create the Pandemic Fund, in leveraging the Global Fund by hosting its largest replenishment, and in launching a Global Health Worker Initiative

COVID-19 prompted U.S. priorities in global health to evolve. The emphasis on the demonstrable benefits of “vertical” programs for single diseases to pandemic preparedness and UHC were embodied by a State Department reorganization plan giving PEPFAR responsibilities for global health security. Via PEPFAR and more generally, interest is growing in building “more resilient, accessible, equitable health systems,” in the words of the global health chief at the Department of Health and Human Services, Loyce Pace. This U.S. conception parallels Japan’s focus on resilient and sustainable systems of health, and offers important opportunities for strategic coordination. 

The second area of promoting democratic governance and universal human rights has been a core U.S. foreign policy priority from the Reagan era to the present day. A documented 17-year wave of authoritarianism, nationalism, and pressure on civil society now swelling to new heights intensifies the urgency of this mission — as Biden has emphasized. U.S. democracy domestically is challenged by structural racism, populism, and right-wing extremism. Biden has sought to bolster freedom and electoral legitimacy both abroad and at home. Within the past year and a half, his administration has framed support for Ukraine as a question of democratic norms and hosted two summits for democracy. Less astride the globe than in the “unipolar moment” of the 1990s, the U.S. needs great power partners to counter growing threats to democratic norms — a role which Japan is poised to fill.

Japan has become more vocal on anti-democratic trends and human rights abuses overseas in recent years. For example, Kishida appointed a Special Advisor on International Human Rights Issues in 2021 with the Uyghurs and Hong Kong in mind. Contrasted by its passive response to Russia’s annexation of Crimea in 2014, Japan quickly reoriented its policy to respond to Russia’s invasion of Ukraine in 2022 by imposing sanctions, supplying surveillance drones and other nonlethal equipment and providing more than $5.5 billion worth of financial support to Ukraine, and accepting Ukrainian refugees. While these actions against growing authoritarianism are often discussed in the context of geostrategic competition, what ultimately drives Japan’s approach is an acute interest in defending fundamental principles of rule of law, territorial integrity and civilian security, as shared by the free world.

Japan is aligning more closely with the United States on these issues, too, holding the first U.S.-Japan strategic dialogue on democratic resilience. At Biden’s second summit for democracy, Kishida vowed to “lead efforts to strengthen democracy,” pointing to Japan’s human resource development efforts in the Global South to underscore its focus on people as the “backbone of democracy. At home, Japan is beginning to respond to calls to address gender equity and social inclusivity on issues such as LGBTQ rights.

There is no more important pair of powers seeking to safeguard human dignity, in light of their mutual focus on global health and democratic norms, emphasizing social inclusion in both areas. Leveraging their longstanding efforts and recent initiatives, they should coordinate strategically to institutionalize greater agency and social recognition of all people in the healthcare and governance realms. As such, this powerful duo can advance the Sustainable Development Goals’ vision of “leaving no one behind.”

Such joint leadership would not just be about common values bilaterally, or universal values. The interests of the U.S. and Japan align closely with these ideals. Strengthening health systems and outcomes in LMICs reduces the threat of pandemics within the U.S. and Japan. Advancing democratic norms in turn advances stability and prosperity in countries where states are fragile, authoritarian, or socially exclusionary. And geopolitically, the two powers’ concerted action on health and democratic norms offers an attractive alternative model to LMICs as China spreads investment, influence and illiberal rule globally.

The world order desperately needs leadership. While the U.S. and Japan have recently been enjoying an economic resurgence, it is no longer the era of U.S. hegemony as a guarantor of a rules-based order nor of Japan eclipsing China’s economic vitality. But working together, they can contribute conclusively to global governance in the service of peace, prosperity, and pluralism. A very good place to accelerate this joint leadership is at the G-7 meetings Japan hosts. As India hosts the next G-20 and Italy hosts the next G-7 summit, Japan and the U.S. can lead by ensuring continuity and further advancing multilateral collaboration on health and democratic norms.

Guest Author

Kazuyo Kato

Kazuyo Kato is executive director of the Japan Center for International Exchange/USA. She held senior roles at the Japan Society in New York and the Sasakawa Peace Foundation in Tokyo and USA.

Guest Author

Mark P. Lagon

Mark P. Lagon is chief policy officer at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria and adjunct professor in Georgetown University’s Master of Science in Foreign Service Program. He previously served as president of Freedom House and U.S. Ambassador at Large to Combat Trafficking in Persons, and co-edited the book, Human Dignity and the Future of Global Institutions