’ Health Promotion for Jusitice’・・・New name for New stage of the Health -Strategy to aim at the right to health

I am thinking about    new  name  for new stage of the  health -strategy to aim at the right to health　 that had been initiated by Amartya Sen's thought.

It is necessary to recognize that there is a historical transition in WHO's health -strategies.

The first stage was "Primary health care" PHC. This went out strongly a medical biology side, and ended in infectious disease control only (partial PHC). It can be said that it failed in the incentive-making of health- creation by resident's social participation.

The second stage is Health promotion HP.Though it almost completed in the idea,the clue of practice was not obtained, it fell  into  self-responsibility theory  and  overemphasis of   empowerment  individual lifestyle like Japanese "Healthy Japan 21"  and United States' "Healthy people 2000"   in  the large wave of neoliberalism globalization, and it failed .

The third stage is  on the epoch where the Health promotion discovered the direction of advancement along "Social determinats of health" SDH (→ 'solid facts') that is the maximum factor to decide health by obtaining arms of social epidemiology.

Michael Marmot  is the leading person of  this movement.

By it  health-strategy and the right  to health  hado become the acquisition targets with the scientific basis from the subjective effort target and the wish .

However, there is no name  for the third stage yet. The content is not reflected in "New Health promotion".

SDH Health promotion (HP-SDH)  can not catch a lot of people's hearts .

ComprehensiveHP(CHP)is too official.

Scientific HP is like the scientific socialism.

Might "HP for the justice"   be too passionate ?

The End of the receipt of the Western Europe culture by the east Asian nations and the border issue of Japan

Danger toward to the third World War caused by the capitalistic development  of  China and India  which demand  new  subdivision  of the global market has been pointed out already widely.

However, to realize it  will be the end  of the humankind history . The measures might conclude the reforms of the United Nations,and the formation of a regional community that follows EU.

And, only the latter,that is,the regional community formation to follow EU  becomes  the conclusion of the receipt of the Western Europe culture  by the east Asian nations including Japan since the 19th century.

　Ｔｈｅｎ，the Western Europe  culture receipt  by East  Asia for about 200 years　will be
completed  and the assumption of the global peace   will become  there. Afterwards, the problem of Western Europe culture  receipt by East Asia will not exist.

Shozo Fujii "Rojin - literature to live in east Asia" Iwanami-shinsyo 2011 sharply points out that Mao Zedong's or  Yosimi Takeuchi 's understanding  Rojin greatly wrong  in each way. Rojin-literature begins to be regarded as the common property that ties east Asia as a  literature that fought hard about the problem how the east Asian exceeds the Western Europe  cultre receipt.

Moreover,   2 articles in tha magazine "Sekai" Iwanami-syoten special  volume "East Asia of not new Cold War but live-and-let-live" 2011 become  good references .

Haruo Nishihara "Think about the future of east Asia in the flow of a big history" and Masaji  Shinagawa "Do not look at China by the United States' eyes" .

When I read these ariticles ,I think    the annoying border issue of Japan between China, South Korea, and Russia is a problem of not solving by the insistence of  hitorical rights  by Japan through all eternity .

A regional community foramation  will  eliminate the border from real life, and change  it into the fiction on the map.

You may say the border is lost again , because there was no border in the world from the beginning,and that it is historical inevitable from dialectic.

When ' a great state  of nuclear powe plant  'Japan became the root of the big misfortune of east Asia  that  disregardede the border  , thinking about disappearance  the border of east Asia will not be coincidence .
 

Let's tell the story of 'Justice' just now.

The House of Councilors election voted on July 11 ended by the result in which the the Democratic Party retreted and the Liberal Democratic Party recovered . The excitement and the expectation of the change of power by the general election on August 30 2010 also disappeared. Only  that two main political parties have agreed  to greatly  raise  the consumption tax rate is remained.

The alternation from Hatoyama Cabinet to  Kan Cabinet means a substantial end of last year's change of power and the revival of the Koizumi restructuring.

Hatoyama former Prime Minister's essence is neoliberalism. However, he was conscious best of whether last year's change of power was supported by what kind of people's expectations. Therefore, he aimed at the achievement of the policy such as the transfer of the Futenma base outside the prefecture or to foreign, child treatments, and  making public high schools'  fee  free  to the last minute.

Mr. Hatoyama called the uneasiness of the United States and  Japanese financial circles and the hard repulsions by them, and became the result of surrender to them finally and the retirements. Mr. Ozawa who had been aiming at the revival of the profit inducement politics of the Tanaka Kakuei  type was repelled by them at the same time,too. Therefore,  Kan Cabinet has become a pure neoliberalism political power.

The promise of Kan  Cabinet to  Japanese  financial  circles was   the consumption tax hike and the corporate tax reduction. Kan Cabinet promised the United States  deepening  of mutual agreement of between Japan　and the U.S..

Edano chief secretary directed the renewal of Constitution Research Council of the Democratic Party and stepped forward his foot in the direction of  Revision to the Constitution at the same time.

And, the result of the House of Councilors election is the worst. Non regular workes frightened to the dismissal and unemployment became with urban  businessmen in the higher classes whose profits are conflicted with non regular workers essentially , and supported neoliberalism parties,Democratic Party, Liberal Democratic Party, and "Minnnanotou " Party .

Recall Marx's writing "Brumaire18 of Louis Bonaparte " (1852). The constituent  may choose the  political power that suppresses and persecutes himself.

By  this reason  Koizumi Cabinet had become long-term political power.

Today's situation is more serious.

It is certain that medicine, nursing, welfare, and education will be further rounded down under the pretext of "Regional sovereignty" in the future.

Now,the book of Michael J. Sandel 's "Let's tell the story of 'Justice' in the future" (Hayakawa Publishing) is best-selling . It is citizens' common sense that talking about 'Justice' is necessary to oppose neoliberalism. We should also desperately talk about 'Justice' of the medicine,

nursing, and welfare.

the revised Organ Transplant Law enforced on July 17

A　 hospital in Kurashiki City asked  me an explanation of the revised  Organ Transplant Law enforced on July 17. My explanation was the following.

①Tachibana Takashi insisted as follows.
"The present brain death standard is a standard 'Not survived any longer', and not true criterion for brain death. "Not survived any longer" is quite different from " the person is already dead". The doctor must treat the patient in "Not survived any longer" state. For instance, if the patient is getting a stomach cancer, this is natural. It is wrong that the traumatic brain injury is an exception. Therefore, it is equal to the vivisection to remove internal organs by the present brain death standard. " This criticism has not been denied yet.

②Still, the standpoint  of Takashi Tachibana is "The brain death is the person's death". There is an insistence that denies "the brain death is the person's death" more plainly,. There are people who insist that "President of the United States bioethics council" mistaked .

③Moreover, the diagnosis "Only the organ transplant is an effective remedy" is also often uncertain. When the organ transplant is not done,  according to a certain investigation, the patient's passage is not too bad compared with the case to transplant . In addition, there is a person who has the doubt of organ transplant. A patient hoped his priority level went up as the colleague patient died. He got wounded deeply by that. l it was a testimony in the Diet.

④Nevertheless, the self-decision of the donor himself became unnecessary by revising this Organ Transplant Law, and less than 15-year-old infant came to be able to become a donor along with it. However, brain death criteria in less than six-year-old child do not exist.

⑤Moreover, the previous law had been decided, "The brain death = person's death" only in case of the organ transplant. It unconditionally put it away as "The brain death = person's death" in a new law. Therefore, treating the brain death person became equal to the treatment of the dead. Therefore, "The health insurance is applied to treatment to the brain death person for the time being" was decided. When the relative refuses the organ donation to final  after patient's declaration of brain death, treatment is not discontinued.

However, people's doubts grow.
When the doctor does the declaration of brain death besides the organ transplant purpose, and  diagnosed the brain death, is treatment done?

In the press report on May 21, the Democratic Party started the preparation for legalizing breaking off of the treatment of a clinical brain death to the patient.

Only this report might be the answer. The legalization of the right to die and euthanasia starts here.

Self-deciding the death at that time becomes a reason why the death is compelled. Moreover, Engelhardt's "Person theory" might play the role. It is  ranking of the  characters. ① free character,② subordination character , ③ imperfect character  that  can  only suffer pains ,④existence that should be protected within the range where load doesn't rest upon and and  societies .Such a rash insistencemight be performed as Global standard ,because  in Japan   it becomes  a reason  that   atheory is powerful in the United States .

⑥The WHO general meeting was decided to limit the making a passage organ transplant in May, 2010. Only the making a passage organ transplant  from  the poor country  to the advanced country is permitted.

We should  think about the Organ Transplant Law revision from the standpoint where the equality of the life is esteemed.

We should examine the right of health. It is necessary to examine the right of health from many fields, with the standpoint of medical ethics ,the standpoint of the human rights ,and  the standpoint of a social epidemiology.

Conclusion:As the issue of  right of health,
① social epidemiology must show  no existence of the self-responsibility of health,② human rights method　must  show  that self-decide of the patient  should be supported by the maximum level of the human rights esteem obligation of the nation , ③medical ethics　must show no permission for  ranking the characters.

Enforcement of the Organ Transplant Law revision

I noticed an important issue about the Organ Transplant Law revision enforced in this July.

What does it mean that the nation unconditionally decides that the brain death is the person's death?
It might be an enactment of "Right-to-die bill" that comes afterwards. The nation doesn't permit   living with an artificial respirator without expectation of recovering .
The execution is extremely easy if payment by the medical treatment fee is stopped, and it makes it to the  full self-load.

Then ,the treatment of the person of the vegetative state patient and the person in the state of the end is discontinued there if coming.

Grounds are the self-decisions.

We should not believe the fair name such as the self-decision. It is compulsion of the death by the nation  on the name of self-decision.

Grounds of the insistence of the nation  are "  being  healthy is people's obligation " that exists in "Health regime", that is, the self-responsibility theory of health. The nation  makes  the  people who became not healthy  voluntarily choose dying as a transgressor of their obligations.

On the other hand,  there is "Right of health"  that  denies completely  the self-responsibility theory of health.
And   "Right of health"  declares  the nation's responsibility  for the people's health  and  for the recovery when people's health is lost.

Up to now, I have thought about "Right of health" only by the route from a social epidemiology. It was an extremely powerful method of indicating the origin and the road
of  achievement of the right of health in a scientific manner.

However, it is necessary to explain "Right of health" from medical ethics.

Theclue must be in thinking about Organ Transplant Law.

Especially now, when neoliberalism blows again under the Kan  Cabinet , we should be serious.

Louis Bonaparte in 1848 , Hitler in 1933 ,Kan in 2010

Aｓ Watanabe　Osamu said、the Democratic Party is composed of three parts.
1st ,the head  for neoliberalism.
2nd, the body for  pork-barrel effect.
3rd,the hands and feet for social welfare business .

When the body that Ichiro Ozawa leads moves backward , the center of the political stage has been  occupied by a neoliberalist,Kan Naoto.

Kan is only a degenerated politician , a colleague of Walesa in Poland etc.

When Japanese workers support him, History will say that the victim often supports the assailant.

I can see Louis Bonaparte in 1848 , Hitler in 1933 ,and Kan in 2010

National Art Center ,Tokyo "Orsay Museum exhibition 2010".

　I  attended a  meeting that  made the asbestos damage problem cheif theme on June 12 and the 13th at Tokyo. Hearing the story how the diseases  related to asbestos   in  hospital patients are able to be discovered , and   how  young  lawyers  work vividly  on asbestos damage lawsuits,   I had a llittle sense of incompatibility and discomfort .

Because  I had   held mini-lectures as to the asbestos damage  at all cities in Yamaguchi Prefecture for these three years.,and there were no in-hospital patient,but retired workers only.

After the meeting , I decided to go to National Art Center  Tokyo  for enjoying Sunday afternoon of the slightly cloudy cool  weather. My purpose is to see  "Orsay Museum exhibition 2010. "

It was  packed with  many spectators in exhibition space. Moreover, by  the time of the airplane, I was possible to stay only for about one and a half hours.  I couid not have   a good  appreciation.

But   Gogh's "Star-spangled night" struck  my herat. Night sky, the Great Dipper,
a river, and city lights.  I liked   to cry  ahead of his  hope and his  sense of well-being by catching Gogh who died soon .

A fetal Minamata disease in Yamaguchi prefecture

A　45-years old patient　whom I had examined yesterday seemed to have gotten a fetal Minamata disease.

This person  was born after the  mother had migrated to Kansai area. The mother had already gotten Minamata disease .

At first I could not understand  why this person  have gotten Minamata disease.

The mystery was able to be solved when the mother told that she spent the time of pregnancy and birth in her hometown by the Yatsusiro sea. She had kept eating the fish every day  at that time.

I have helped a doctor who was investigating  the mercury damage of Tokuyama bay coast residents　in my school days. When that is recalled, it is not a coincidence that this patient had visited  me on this day .

At any rate, unhappiness exists universally like this.

Ikeda Masayuki 's lecture meeting was held.

Ikeda Masayuki,professor of School of Medicine Nagasaki University is a famous doctor who is showing a preeminent talent in various areas of the general practice, neurology, and the medicine effect judgment, etc.

We held Mr.Ikeda's lecture meeting respectively in Yamaguchi City and Ube City on June 5 and the sixth,2010.

We have already held Noguchi Yosinori's lecture meeting before the last year, and Yamanaka Katuo's lecuture meeting last year.

THis program was in a series for studying diagnostic reasoning .

Mr. Ikeda advocated the axis of the diagnosis by the story , the axis on doctor - patient relaionship , and the axis of society. Most of those axes are in the area "Examine in an interview".

And, the key word of the axis of the story is "What is embarrassed in patient's daily life?" imagining one house. With the bath ? In the bedroom ? In the rest room? In the kitchen ? In the living room ? When it is recorded  merely accurately, even though there is no knowledge of the disease, the correct diagnosis can be made by almost all doctors .

On the axis of doctor- patientrelationship, the doctor should be conscious that it is the patient who teaches and help him. And, the patient may be conscious of his contribution to actually serious and social by telling the doctor his experience. The patient if it can be thought, "It is depreciation of my life (Pile up internal reserves in the society through his doctor) to be sick, and to teach his doctor. Thus, a new dimension was added to the study of the diagnostic reasoning.

However, dissatisfaction might have somewhat remained in the teacher who had requested useful knowledge at once for the diagnosis and treatment.

Mr. Ikeda said in the start of the lecture. In master's behavior at being, it might be a free coincidence and information as the message be 0. However, if something was produced in the apprentice, the education has been splendidly approved as a result. "It is not contents but thought manners to want to tell. " *The diagnosis is the practical instruction of directionality for the treatment, not the game seeking for disease's name .

Had we made a mistake in the strategy?

There are three patterns to blame former Prime Minister Hatoyama.

One is that  he thoughtlessly promised , destroyed oneself, and  left the successor a heavy load . This attacks is from the right wing. It is  merely a  lesson for the art of protecting politician's  own interests .

Another is  that he challenged a matter to do  and made everyone embrace the dream , but betrayed  everyone  for his weakness of the character at last . This attacks is from the left wing.

About these two types,  the mass communication discusses confusedly.

However, the third pattern is the most interesting. We  can know it  from representation of Mr.Yukio Okamoto on Asahi Shimbun  on June 3. The importance of the deterrent of Marine Corps was slowly but steadily acquired by Mr. Hatoyama and he  had seemed to be gradually a  good leader. But his strength was insufficient. Successor's Prime Minister should  make the best use of the one that former Prime Minister Hatoyama learnt with great pains.

I  can guess easily that Yukio Okamotowa　is the teacher who taughut former Prime Minister Hatoyama  that the deterrent of Marine Corps is important.

Let us  remember that Secretary of Defense Mr.Gates stayed in Japan from 20th to 21st October, 2009, and he threatened one after another with Foreign Minister Okada, the Prime Minister Hatoyama, and Minister of Defense Kitazawa. Gates : "The Obama Goverment reached the conclusion that the current plan was the one of the best. I also want Japanese Government to advance the construction of the replacement facility in the Futenma base etc. steadily. ". 

Okamoto was a tutorial that the United States had sent along this line. He made Mr.Hataoyama's mind broken  with occult violence  of U.S. that could contain his (political) assassination.

Then, the situation could not been changed by 100,000 people's meeeting at Okinawa, after Prime Minister Hatoyama's mind had broken . 

What  was necessary to change the situation  was  an invitation Prime Minister Hatoyama to 100,000 people's meeeting  to give him encouragement to make  East Asia  safe  , before  his mind had broken.

I feel ,we could had made a mistake in the strategy for true resolution  of 'Hutenma Problem'.