Asia Pacific Legal Culture and Globalization. Vancouver: UBC Press; University of Chicago Press [Distributor], 2023. xi, 280 pp. (Tables, graphs, figures.) US$90.00, cloth. ISBN 9780774867702.
The book Global Health Security in China, Japan, and India: Assessing Sustainable Development Goals is an essential contribution to the discipline of global health security, as it addresses global health crises and challenges faced by countries in achieving their sustainable development goals (SDGs). Health security is no longer a national issue; rather, it has become a global issue due to the threat it poses across borders. In seeking to understand global health security, this book looks into the actions taken by three Asian giants: China, Japan, and India. In attempting to highlight challenges, it focuses on three sets of goals (as per the SDGs): strengthening access to primary healthcare; protecting and promoting public health; and integrating global economic markets into the healthcare system (5). It also assesses health security standard perfomances in China, Japan, and India, as outlined by their respective SDGs (4).
It consists of nine chapters divided into three parts, each focusing on a specific issue. The first section outlines primary health care services and their role in achieving SDGs in China, Japan, and India. When it comes to healthcare services each country faces unique as well as common challenges. Though China has invested significantly in government healthcare services, Wenqin Lian and Ilan Vertinsky show how rising tension between access to medicine and market forces is posing challenges. China has adopted a price control system, to ensure affordability of generic drugs, but it has failed to address shortages in the supplies of these medicines. In response, it has encouraged foreign direct investment in pharmaceutical products which has facilitated production of unaffordable non-generic drugs, rather than cheaper drugs. Notably, Japan provides access to universal healthcare services, but it does not cover new or experimental drugs and healthcare services as per global standards. Yoshitaka Wada’s illustration shows that the elderly Japanese population is facing difficulties in accessing these services. Since the world is constantly evolving to develop and respond quicky to new diseases or health risks, it is important that up-to-date products are covered under national healthcare insurance. Wada proposes mixed billing which would allow patients to receive treatment after paying a partial amount of the cost, with the rest paid by the government. India is ambitious in its goal of achieving SDGs, but healthcare services are inadequately funded. Unlike China and Japan, the central government in India lacks leadership in this area.
In the second section addressing the protection and promotion of health, authors investigate and identify major barriers. Though China has set an example by meeting the health standards set out by the SDGs, it has failed to perform in the human rights index. Against the Millennium Development Goals, China is the best performing country as it has reduced poverty, enhanced primary education and maternal health, and reduced child mortality and HIV infections (106). However, China has not been able to develop an effective institutional structure to address mismanagement or malpractices within healthcare services. Lesley A. Jacobs sheds light on several cases of malpractice that authorities could not address because the institutional set up is not right. He also believes that epidemics like AIDS require containment of the virus along with fighting social vulnerability (105). Similarly, slow vaccination is keeping Japan below the global standard. Toshimi Nakanashi agrees with Japan’s cautionary approach for rolling out vaccination for all. Meanwhile, he also warns that if the precautionary principle was held in the true sense, Japan could not have rolled out the human papilloma virus vaccinations which eradicated acute poliomyelitis and reduced tuberculosis morbidity drastically (125, 136). Since pandemics like COVID-19 cannot be fought without vaccination, the author suggests that Japan must find the right balance between vaccination rate, herd immunity, and minimum threshold of mortality. In the chapter about India, Mariela de Amstalden examines curtailment of regulatory spaces to address food safety. Here the author delves into the inability of states to meet their health safety measures due to the technical standard set by the World Trade Organization (WTO). It discusses the WTO’s three-step criteria for invoking food safety measures which asks the following questions: Does the measure address public health concerns? Is the measure science based? Has the state conducted a risk assessment set?
In the last section, authors discuss the role of the market in promoting or threatening public health. Fang et al. analyze the impact of the China National Tobacco Corporation (CNTC) (167). As per the World Health Organization Mandate on Tobacco Control, member countries need to adopt measures to contain smoking. Since the CNTC produces 40 percent of global tobacco and accounts for 7–11 percent of state revenue, China has not discouraged its business; rather it has promoted it by domestic support in the form of tariffs and other incentives. After China became a member of the WTO, the CNTC faced global competition from British American Tobacco and Philip Morris International. As a result it went global. Although tobacco consumption is constantly threatening global health security, states have not devised a plan to ban smoking completely. In the following chapter Neil Munro and Ziying He write about the principal-agent problem. Within the Chinese healthcare system, unnecessary diagnostic testing, over-prescription of medicines, and bribes have been widely reported. Due to the prevalence of unethical medical practices, Munro and He investigate public attitudes, governments corrective measures, economic inequality, and regional disparity. The authors name the lack of critical, independent thinking, and ethical sensibility as major factors. In the last chapter, Hiroyuki Kojin analyzes Japan’s healthcare service exports. An increasingly elderly population has allowed Japan to excel in both healthcare services and its healthcare system. Due to an economic slowdown in 2008, Japan began to explore the export of healthcare services, especially targeting Japanese people living abroad. Since Singapore is a country that has a unique relationship with Japan and a sizable Japanese population, the two countries signed an economic partnership around healthcare. It allowed Japanese companies to set up healthcare services, not only in Singapore and India, but across the world. This book is an important contribution to the topic of health security challenges and provides an essential assessment of SDGs in China, Japan, and India.
This collection fills a gap in the literature by offering a comprehensive and comparative analysis of health security challenges and SDGs in China, Japan, and India. The chapters contribute fresh perspectives on specific areas like medical malpractice in China, vaccine hesitancy in Japan, and the impact of the tobacco industry on global health. However, greater coherence and potential policy solutions could further enhance the book’s impact.
Krishna Kumar Verma
Jawaharlal Nehru University, New Delhi