From the Ministry of the Interior to COVID-19: Japan's Healthcare Paradox (Part 1 of 3)

Masahiro Kami, M.D., Ph.D.

President, Medical Governance Research Institute, Tokyo, Japan

Since 2022, I have been overseeing lectures at Rikkyo University in Tokyo. The subject at hand delves into the intricacies of gathering information. Specifically, I draw upon Japan's response to the COVID-19 pandemic as a case study.

A primary emphasis within my series of lectures is the importance of "learning from history." Both individuals and organizations possess their unique histories, fostering distinct intrinsic values. More often than not, the influence of founders is palpable.

My educational journey took me from the private Nada Junior and Senior High Schools in Hyogo Prefecture to the Faculty of Medicine at the University of Tokyo. Notably, the founders of Nada Schools were the Kanō family, who managed the prestigious sake brands Kiku-Masamune and Hakutsuru, and the Yamamura family, responsible for Sakura-Masamune. Both families have been sake producers, representative merchants of the Settsu (between Osaka and Kobe) area since the Edo period.

The management philosophy of Nada Schools is rationally aligned with merchant standards. During my school days (1981-87), the principal, Mr. Masami Katsuyama, imparted, "You are free. As long as you do not break the law, make your own judgments."

Many of Japan's prestigious preparatory schools trace their origins to Edo-period clan schools or related institutions. Interestingly, the philosophy in such schools often contrasts with the balanced approach of "scholarship and martial arts."

Recently, the weekly magazine Bunshun, one of the most influential magazines in Japan, reported on a scandal involving Yuji Kuroiwa, the Governor of Kanagawa Prefecture and an alumnus of Nada High School, in relation to his dealings with women. As politicians who are also alumni of Nada High School, Ryuichi Yoneyama, a member of the House of Representatives, and Teru Fukui, a former member of the House of Representatives, have been reported on for similar issues.

One might speculate that the prevalence of such scandals among Nada graduates is due to a belief that infidelity is not a crime. This is quite distinct from the culture of prestigious schools derived from old clan institutions where the culture of shame still persists. On the other hand, there are fewer instances of financial troubles among Nada alumni, which is in stark contrast to their issues with women. I believe this reflects the 'intrinsic values' of the merchant backgrounds of the Kanō and Yamamura families.

Such values seem incompatible with traditional Japanese values. Nada High School graduates often do not rise to prominent positions in government offices or major corporations. The situation is the same for the University of Tokyo's Faculty of Medicine, from which I graduated.

Since the University of Tokyo began its Science III entrance examinations in 1962, about 800 students from Nada High School have passed. This is more than twice the number from the second-ranking Kaisei High School, making Nada the indisputable leader for the most challenging medical school in the country. However, up to the present day, only a mere two have been appointed as professors in major clinical departments. Under normal circumstances, there should be more than ten times that number.

Nada High School is a sister school to Azabu Gakuen. The founder of this institution was Soroku Ebara. Born in 1842 (the 13th year of the Tenpo era), Ebara was a retainer of the Tokugawa shogunate. He pursued Western studies and swordsmanship, served as a professor at the shogunate's military training facility, and fought on the side of the shogunate during the Boshin War (1868-1869), a civil conflict between the ruling Tokugawa Shogunate and proponents of imperial restoration, resulting in the establishment of the Meiji government and the end of the samurai era.

Following the Meiji Restoration, he followed the Tokugawa family and relocated to Shizuoka prefecture. In Shizuoka, he dedicated himself to the education of former shogunate retainers. He was involved in the establishment of schools like the Numazu Military Academy and Suntō Girls' School (now Shizuoka Prefectural Numazu Nishi High School). Furthermore, he founded Azabu Gakuen in Tokyo, which is the present-day Azabu Junior and Senior High School.

Later, while serving as the District Chief of Suntō, Ebara participated in the Freedom and People's Rights Movement, an anti-government activity of the time. In the first House of Representatives general election, he ran from the Shizuoka 7th District and was elected. Among the graduates of Azabu Gakuen are Kihei Maekawa, former Vice Minister of the Ministry of Education, Culture, Sports, Science and Technology; Shigeaki Koga, a former bureaucrat of the Ministry of Economy, Trade and Industry; and Shinji Miyadai, a professor at Tokyo Metropolitan University.

Azabu High School graduates are often characterized by their integrity and unwavering principles rather than pandering to those in power. Notably, the criticisms directed at former Prime Minister Abe by figures like Maekawa and Koga were particularly severe. I believe these individuals have inherited the "Anti-Satchō" DNA of Ebara, the school's founder. Satchō is Satsuma and Chōshū domains, two powerful feudal domains that allied during the late Tokugawa period, playing a pivotal role in the overthrow of the Tokugawa Shogunate.

Inherent values are also crucial when considering medical administration. This is because the policy decisions of the Ministry of Health, Labour, and Welfare (MHLW) are heavily influenced by its origins. To understand the MHLW, one must recognize its predecessor, the Ministry of Health and Welfare, which was separated and became independent from the Ministry of the Interior in Showa 13 (1938). In essence, comprehending the MHLW requires a deep understanding of the Ministry of the Interior (To be continued).