Women leaders should take the lead in health care policy decisions in Japan. – The BMJ

Intended for healthcare professionals
Rapid response to:
At last, a prestigious prize for global health
Investing in public health systems is a global common good
To the editor,
In 2022, Japan’s gender gap index acknowledged its gender parity in education. However, Japan ranked 139th out of 146 countries regarding political participation.[1] Even though women make up about 52% of eligible voters, the ratio of men to women in the National Assembly as well as the cabinet of ministers has been poor. The proportion of women Diet members, including the Houses of Representatives and Councilors, is 15.5% (110/711); this is much lower than the OECD average. This situation is persistent in the House of Representatives. The first 39 women members of the House of Representatives were elected 76 years ago. However, there are still only 46 women members in the House of Representatives, an increase of only seven.[1] Factors contributing to this include the difficulty that women in Japanese culture experience when trying to balance their family life with running for office and serving in the Diet, the lack of opportunities for human resource development for political participation, harassment of candidates and politicians, and the gender-role division consciousness that prevails throughout Japanese society.[2] As in Clark and Dhatt’s argument, the lack of women law makers may explain why Japan has not produced evidence-based healthcare policy for improving health among Japanese.
This situation is not limited to Diet members in Japan. Only 4.2% of senior civil service managers overseeing policy interpretation and implementation are women.[2] The leadership roles at 82 medical schools (162 positions, including deans of medical schools and directors of university hospitals) are all men. It is implicit that women are not able to hold these top leadership positions.[3] Of the 449 board members at the 19 major medical societies, only 31 (6.9%) are women. These data suggest that the gender equality in the Japanese medical community is worse than the Diet members and cabinet ministers.[3] In the health system with few women leaders, Japan’s health policies have led to various problems, such as the increasing burden of medical costs on the elderly, low-level preventive medicine for suicide, overwork, and inadequate tobacco tax. Policies to counteract global warming, such as changes to clean energy, have been delayed.
Women cabinet members and Diet members are best suited to address these critical issues. Women leaders might also play an active role in addressing issues of environment, employment, job training, gender equality in childbirth, child-care, and education.[4] Women leaders are significantly better at health care quality and safety management than their male counterparts.[5] A growing body of evidence has demonstrated that women’s leadership in political decision-making processes improves women’s leadership overall.[6] It is urgent to set ethical numerical targets to enable women leaders to lead the initiative in health policy decisions.
1. World Economic Forum. Global gender gap report 2022, insight report. Geneva: World Economic Forum; 2022.
2. Gender Equality Bureau, Cabinet Office [Internet]. Current status and issues of women’s activities and gender equality; c2022 [cited 2022 Oct 25]. Available from: https://www.gender.go.jp/research/pdf/joseikatsuyaku_kadai.pdf
3. Watari T, Tokuda Y. Japan: reform clinical medicine leadership. Nature. Forthcoming 2022.
4. Inter-Parliamentary Union and UN Women (2021). Women in politics: 2021
5. Silvera GA, Clark JR. Women at the helm: Chief executive officer gender and patient experience in the hospital industry. Health Care Manage Rev. 2019 Jun 6.
6. UN Women [Internet]. Women’s Leadership and political participation; c2022 [cited 2022 Oct 25]. Available from: https://www.unwomen.org/sites/default/files/Headquarters/Attachments/Sec…
Competing interests: No competing interests


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