[The 2nd Japan Public-Private Dialogue Forum-A Multi-Stakeholder Dialogue on Universal Health Coverage for Cancer in Asia-Seeking an Approach to Asia Health and Wellbeing Initiative].

On 5 September 2018 the UICC-Asia Regional Office(UICC-ARO)convened the second Japan Public-Private Dialogue Forum at the House of Councilors Members' Building as a follow-up to the previous meeting held at United Nations University in Tokyo in April 2018. Senior representatives of government, academia and industry met to discuss the progress made since April, noting the significance of the Japanese government having included specific reference to cancer in its revised basic policy on the Asia Health and Wellbeing Initiative, which was adopted in July 2018. The meeting provided an opportunity for all stakeholders to discuss ways forward for improving access to cancer care, with the WHO Cancer Report and other global initiatives in mind.

[A Multi-Stakeholder Dialogue on Universal Health Coverage for Cancer in Asia - Seeking an Approach to Asia Health and Wellbeing Initiative].

UICC-Asia Regional Office(UICC-ARO)successfully convened a fruitful Multi-stakeholder Dialogue at United Nations University in Aoyama, Tokyo, which brought together parliamentarians, representatives ofthe WHO and Japanese government agencies and NGOs, senior executives ofpharmaceutical and other companies, and leading members ofJapan 's cancer research community. This meeting provided a valuable opportunity for stakeholders from all sectors of society to discuss ways in which Japan can develop a multi-sectoral approach that will promote access to cancer care and support initiatives for UHC for cancer in Asia. UICC-ARO Director Hideyuki Akaza and Haruhiko Hirate(Chair of International Affairs Committee, JPMA) co-chaired the meeting. At the outset it was noted that with cancer now firmly on the global health agenda with the adoption ofthe WHA Cancer Resolution, countries around the world are coming to grips with the necessity for concerted and cooperative action on cancer prevention and control. This dialogue marks the first step in efforts to pool resources and information, and noted that with various key international meetings due to be held in 2018 and 2019, now was the time to coalesce opinions and identify a concrete direction for action.

Joint Symposium of Korean Cancer Association & UICC-ARO-Cross-boundary cancer studies: cancer and Universal Health Coverage (UHC) in Asia.

On 16 June 2016, the Korean Cancer Association (KCA) and Union for International Cancer Control-Asia Regional Office (UICC-ARO) organized a joint symposium as part of the official program of the 42nd Annual Meeting of the Korean Cancer Association to discuss the topic 'Cross-boundary Cancer Studies: Cancer and Universal Health Coverage (UHC) in Asia.' Universal Health Coverage is included in the Sustainable Development Goals adopted by the United Nations as part of the 2030 Agenda for Sustainable Development. The objectives of UHC are to ensure that all people can receive high-quality medical services, are protected from public health risks, and are prevented from falling into poverty due to medical costs or loss of income arising from illness. The participants discussed the growing cost of cancer in the Asian region and the challenges that this poses to the establishment and deployment of UHC in the countries of Asia, all of which face budgetary and other systemic constraints in controlling cancer in the region. Representatives from Korea, Japan and Indonesia reported on the status of UHC in their countries and the challenges that are being faced, many of which are common to other countries in Asia. In addition to country-specific presentations about the progress of and challenges facing UHC, there were also presentations from WHO Kobe Centre concerning advancing UHC in non-communicable diseases and prospects for further collaboration and research on UHC. A presentation from the University of Tokyo also highlighted the need to focus on multidisciplinary studies in an age of globalization and digitization.

Significance of UICC Activities in Global Health Initiatives on Cancer Looking Towards the Future of Cooperative Networks for Cancer Care in Asia - A Dialogue with the Union for International Cancer Control(UICC).

At the 24th Asia Pacific Cancer Conference held in Seoul, Korea from 22 to 24 June 2017, a dialogue with Dr.Cary Adams, CEO of the Union for International Cancer Control(UICC)was held to discuss the significance of UICC activities in global health initiatives on cancer and pathways for cooperation on cancer control and care.UICC is engaged in a wide range of capacity building, advocacy and convening initiatives and is increasingly focusing on multi-sectoral approaches.In Japan activities are still predominantly focused on scientific and clinical research and this dialogue provided an opportunity to discuss the possibilities for expanding cooperation in Asia, using the UICC Asia Regional Office(UICC-ARO)as a platform.Discussion also covered UICC's new C/Can 2025: City Cancer Challenge, a new multi-sectoral initiative that has the potential to bring multiple stakeholders together.

UICC International Session: What are the implications of sharing the concept of Universal Health Coverage for cancer in Asia?

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC - Asia Regional Office organized an international session as part of the 74th Annual Meeting of the Japanese Cancer Association on the topic "What are the implications of sharing the concept of Universal Health Coverage for cancer in Asia?" Universal Health Coverage (UHC) is included in the United Nations' Sustainable Development Goals and aims to ensure that all people can receive high-quality medical services, are protected from public health risks, and are prevented from falling into poverty due to medical costs or loss of income arising from illness. The session discussed the growing cost of cancer and the challenges that this poses to the establishment and deployment of UHC in the Asian region, where countries face budgetary and other systemic constraints in tackling and controlling cancer. It was noted how sharing concepts on UHC will assist mutual learning among Asian countries and help in the formation of guidelines that can be adapted to national and regional realities. Presentations included a status report on UHC for cancer control in Thailand, and a report from the WHO Kobe Centre concerning prospects for collaborative research on UHC. Also discussed were the current status of cancer burden and control in China and Korea and Japan's progress in systemizing cost-effectiveness evaluation. The final presentation highlighted the importance of gathering social and economic data across Asia in order to build a picture of commonalities and differences in the region.

[Cancer Education for Children from the Perspective of International Cooperation for Cancer in Asia].

When considering how Japan can propose cancer prevention strategies for other countries in Asia and what would be the best format for such strategies, involvement in cancer education has the potential to make a significant contribution to cancer control measures in Asia. Such involvement would be effective not only from the perspective of promoting future research collaborations for cancer but also because many countries in Asia are coming to a turning point in their social structures as population growth declines and societies start to age. Cancer involves various stages, from prevention, early detection, early treatment, and treatment with advanced methods to prognosis and follow-up, and prevention of recurrence. In all of these stages, the daily lives of patients and the clinical environment are intricately interlinked on the same level. In addition, decisions on when and how to allocate medical resources that support the various cancer stages affect the health and quality of life of patients. Progress in prevention and early detection can reduce the consumption of medical resources. However, the tendency is to rely on self-help efforts and individual awareness in these areas. It is therefore thought to be necessary to re-appraise prevention and early detection in the context of a framework that aims to bring people together in a way that encourages mutual and public assistance. It would be ideal if children, who represent the future, could acquire awareness about such matters from an existing body of knowledge that has been formed through ongoing interpersonal interactions that have been nurtured through community and blood relationships. It is necessary to consider what cancer education means for individuals and society, and how it can change the way people go about their daily lives, particularly in the context of the changing social structure of Asia.

Union for International Cancer Control International Session: healthcare economics: the significance of the UN Summit non-communicable diseases political declaration in Asia.

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC-Asia Regional Office (ARO) organized an international session as part of the official program of the 71st Annual Meeting of the Japanese Cancer Association to discuss the topic "Healthcare Economics: The Significance of the UN Summit non-communicable diseases (NCDs) Political Declaration in Asia." The presenters and participants discussed the growing cost of cancer in the Asian region and the challenges that are faced by the countries of Asia, all of which face budgetary and other systemic constraints in tackling and controlling cancer in the region. The session benefited from the participation of various stakeholders, including cancer researchers and representatives of the pharmaceutical industry. They discussed the significance of the UN Political Declaration on the prevention and control of NCDs (2011) as a means of boosting awareness of cancer in the Asian region and also addressed the ways in which stakeholders can cooperate to improve cancer control and treatment. Other issues that were covered included challenges relating to pharmaceutical trials in Asia and how to link knowledge and research outcomes. The session concluded with the recognition that with the onset of a super-aged society in most countries in Asia and an increasing focus on quality of life rather than quantity of life, it is more important than ever for all stakeholders to continue to share information and promote policy dialogue on cancer control and treatment.

The eighth Asia cancer forum: seeking to advance the outcomes of the UN summit: 'global health as the key to a new paradigm in cancer research'.

To date, the Asia Cancer Forum has focused its efforts on creating a common concept for collaborative efforts in international cancer research with a focus on Asia, where cancer incidence is rising dramatically, and also sharing information and knowledge among cancer specialists about the importance of cancer as a global health agenda issue. The Eighth Asia Cancer Forum was held following the historic outcome of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases held in New York in September 2011, at which cancer was duly recognized as a global health agenda issue. Despite this significant development, however, the issue of cancer, one of the most intractable of all non-communicable diseases, still faces a variety of challenges if it is to be addressed on the global level. The Eighth Asia Cancer Forum sought to address these various issues, seeking ways to capitalize on the outcomes of the UN Meeting and take global collaborative studies and alliances in the field of cancer further. It was recognized that one of the main challenges for the Asia Cancer Forum is to formulate a proposal that demonstrates how middle-income countries can provide a good level of care using only their own limited medical resources. Given that the Asia Cancer Forum is one of the organizations that can provide assistance in working to further boost awareness about cancer research and the situation relating to cancer in Asian countries, discussion also focused on how to concretize activities in the future.

The 6th Asia cancer forum: what should we do to place cancer on the global health agenda? Sharing information leads to human security.

This forum discussed issues relating to the inclusion of cancer on the global health agenda, with the ultimate aim of achieving human security for all people. The forum discussed what methods are available to the cancer community in attempts to create a common data system for the rapidly growing Asian region. Discussions also focused on the preparations that can be made to consider and respond to the obstacles to the creation of an Asia-wide data and information network. It was also noted that in order to create a cancer information network, support would need to be provided to low- and middle-income countries and efforts made to ensure that data are comparable.

The 7th Asia Cancer Forum: from the perspective of human security, how can we collaborate as Asians in order to place cancer on the global health agenda? How can we fill in the gaps that exist among us?

This forum has continued to discuss the inclusion of cancer on the global health agenda, and specifically the Millennium Development Goals. The seventh forum presented an overview of activities to date, supplemented by reports from Korea, local governments in Japan and representatives from the pharmaceutical industry. Discussion focused on how to engage in measures to tackle cancer prevention and achieve early detection and effective treatment, using limited resources. It was recognized that with non-communicable diseases gaining increasing attention in international dialogue, it is now of the utmost importance to share an accurate recognition of cancer research and treatment throughout Asia and the wider world. Participants concurred that cancer issues are decoupled from the development aid agenda and that cooperation should be advanced on the basis of international cooperation without recourse to governmental development aid.

What should we do to raise awareness on the issue of cancer in the global health agenda?

Developing and emerging countries, including China and India, account for a large proportion of the global population, and as measures to address infectious diseases in these countries bear results, we are seeing a transformation in the nature of diseases that affect these countries. It is against this backdrop that cancer is presenting an increasingly serious threat in developing countries (WHO. The World Health Report 2008--primary health care: now more than ever.) 'Global health' has become an often-heard term in discussions on international health, and backed by a number of well-funded global initiatives, it is now positioned as one of the major agenda items for the international community (Reich MR, Takemi K, Roberts MJ, Hsiao WC. Global Action on Health Systems: A Proposal for the Toyako G8 Summit. Lancet 2008;371:865-9). However, cancer has not yet attained its rightful position on this global health agenda. This paper gives an overview of the discussions that took place at the 5(th) Asia Cancer Forum. Based on the challenges and outlook for placing cancer on the global health agenda, we conduct analysis that focuses on top-down mechanisms and bottom-up mechanisms.

The importance of clinical epidemiology for development of appropriate treatment modalities for Asian populations.

The Asian countries with their own particular cultural background and risk factors differ from the Western world regarding their disease burden, including the incidences of different cancers. The lack of awareness and effective screening programs in many parts of Asia means that the stage at presentation with a neoplasm is often more advanced than is typical elsewhere, with all the inherent associated problems in cancer control. In addition, the presence of racial variation in genetic polymorphisms may mean that different populations in Asia may not respond to chemotherapy or other treatment modalities in the same way as their counterparts in Europe or the United States. Therefore it is essential that research be conducted into the clinical epidemiology of efficacy of drug protocols in Asian groups, with an appropriate focus on influencing factors.

Cooperation partners in information sharing within the context of an Asian cancer network.

It would be a great mistake to analyze the health situation in Asia relying on the focus on individualism inherent in the sense of values of Europeans and Americans. Cooperation across fields is indispensable for effective control of the epidemic of disease we are facing in the 21st century. We need to concentrate efforts on bringing together specialists, not only within the various areas of medical practice, but also across such fields as economics, politics and information technology (IT). Asia differs from Europe and America in that it does not have any group political structure and therefore we must rely on voluntary integration of our efforts if we are to achieve the most effective application of our combined resources. Non-intervention in internal affairs is naturally a very important condition for success. Sharing of information while abiding by national regulations regarding medical data confidentiality does pose difficulties, but gentle persuasion to standardize processes with a shared commitment to overcoming problems should reduce opposition. Our common purpose in maintaining healthy societies, whether we be scientists, medical staff, economists, computer specialists or politicians, provides the bond. Ways and means by which this bond can be strengthened deserve our attention.

UICC-ARO Symposium at the UICC 2016 World Cancer Congress How Can We Mobilize Action to Realize UHC in Asia?

The 2016 World Cancer Congress, organised by UICC, was held in Paris in November 2016, under the theme "Mobilizing action ­ Inspiring Change." As part of Track 4 presentations on the theme of "Strengthening cancer control: optimizing outcomes of health systems," UICC-Asian Regional Office (UICC-ARO) held a symposium to discuss the issue of mobilizing action to realize UHC in Asia. Introducing the symposium, Hideyuki Akaza noted that universal health coverage (UHC) is included in the Sustainable Development Goals and one of the key issues for achieving UHC will be how to balance patient needs with the economic burden of cancer. Speakers from Japan and Indonesia addressed various issues, including the current status and challenges for medical economic evaluation in Asia, the importance of resource stratification, prospects for precision medicine, and the outlook for cancer control and UHC in developing and emerging countries in Asia. Key issues raised included how to respond to the rising costs of treating cancer as new and increasingly expensive drugs come to the market. Speakers and participants noted that health technology assessment programs are being developed around Asia in order to evaluate the cost-effectiveness of drugs in the face of budgetary constraints within increasingly pressurized national health systems. The importance of screening and early detection was also noted as effective means that have the potential to reduce reliance on expensive drugs for advanced cancers. The symposium was chaired jointly by Hideyuki Akaza and Shinjiro Nozaki (WHO Kobe Centre).

Roundtable discussion at the UICC World Cancer Congress: looking toward the realization of universal health coverage for cancer in Asia.

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC-Asia Regional Office (ARO) organized a Roundtable Discussion as part of the official program of the UICC World Cancer Congress 2014 in Melbourne, Australia. The theme for the Roundtable Discussion was - Looking Toward the Realization of Universal Health Care (UHC) for Cancer in Asia - and it was held on December 5, 2014. The meeting was held based on the recognition that although each country may take a different path towards the realization of UHC, one point that is common to all is that cancer is projected to be the most difficult disease to address under the goals of UHC and that there is, therefore, an urgent and pressing need to come to a common understanding and awareness with regard to UHC concepts that are a priority component of a post-MDG development agenda. The presenters and participants addressed the issue of UHC for cancer in Asia from their various perspectives in academia and international organizations. Discussions covered the challenges to UHC in Asia, collaborative approaches by international organizations, the need for uniform and relevant data, ways to create an Asia Cancer Barometer that could be applied to all countries in Asia. The session concluded with the recognition that research on UHC in Asia should continue to be used as a tool for cancer cooperation in Asia and that the achievement of UHC would require research and input not only from the medical community, but from a broad sector of society in a multidisciplinary approach. Discussions on this issue will continue towards the Asia-Pacific Cancer Conference in Indonesia in August 2015.

Japanese Cancer Association Meeting UICC International session--what is cost-effectiveness in cancer treatment?

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC-Asia Regional Office (ARO) organized an international session as part of the official program of the 72nd Annual Meeting of the Japanese Cancer Association to discuss the topic "What is cost-effectiveness in cancer treatment? " Healthcare economics are an international concern and a key issue for the UICC. The presenters and participants discussed the question of how limited medical resources can be best used to support life, which is a question that applies to both developing and industrialized countries, given that cancer treatment is putting medical systems under increasing strain. The emergence of advanced yet hugely expensive drugs has prompted discussion on methodologies for Health Technology Assessment (HTA) that seek to quantify cost and effect. The session benefited from the participation of various stakeholders, including representatives of industry, government and academia and three speakers from the Republic of Korea, an Asian country where discussion on HTA methodologies is already advanced. In addition, the session was joined by a representative of National Institute for Health and Care Excellence (NICE) of the United Kingdom, which has pioneered the concept of cost-effectiveness in a medical context. The aim of the session was to advance and deepen understanding of the issue of cost-effectiveness as viewed from medical care systems in different regions.