Message Greeting 50th Anniversary of CMAAO Conferences and Lectures

171 Pages·2009·21.76 MB·English

Vol. 51 No. 6 November-December 2008
Message
On the Occasion of the 50th Anniversary of CMAAO
Yoshihito KARASAWA...................................................................................................................................... 351
Greeting
50th Anniversary of CMAAO—Congratulations by the World Medical Association
Otmar KLOIBER.................................................................................................................................................. 352
50th Anniversary of CMAAO
Characteristics of Man in a Life Cycle in the Development and Allocation of
Medical Care Resources
Taro TAKEMI....................................................................................................................................................... 353
CMAAO’s Role and Future Tasks
Tai Joon MOON.................................................................................................................................................... 358
The Role of Medical Organization in Health Care Service
Somsri PAUSAWASDI........................................................................................................................................ 362
Confederation of Medical Associations in Asia & Oceania:
Past, present and the future
Keizo TAKEMI..................................................................................................................................................... 365
Memories of CMAAO’s 50-year History .................................................................................................... 372
Conferences and Lectures
The 44th CMAAO Midterm Council Meeting .......................................................................................... 374
COUNTRY REPORTS
Hong Kong Medical Association ............................................................................................................ 375
Indian Medical Association ....................................................................................................................... 381
Indonesian Medical Association ............................................................................................................. 384
Japan Medical Association ....................................................................................................................... 387
Korean Medical Association ..................................................................................................................... 389
Malaysian Medical Association ............................................................................................................... 393
Myanmar Medical Association ................................................................................................................ 400
New Zealand Medical Association ........................................................................................................ 407
Philippine Medical Association ............................................................................................................... 413
Singapore Medical Association .............................................................................................................. 416
Sri Lanka Medical Association ................................................................................................................ 420
Taiwan Medical Association ..................................................................................................................... 425
Medical Association of Thailand ............................................................................................................. 431
Contents
SYMPOSIUM: Global Warming, An Alarming Phenomenon, What Shall We Do?
[Hong Kong]
The Heat Is On ............................................................................................................................................. 436
[India]
Global Warming ............................................................................................................................................ 443
[Indonesia]
The Impacts of Global Warming ............................................................................................................ 446
[Japan]
Approaches to the Global Warming Problem, which Exerts a Huge Impact
on the Survival of Humanity .................................................................................................................... 451
[Korea]
Climate Change and Health .................................................................................................................... 454
[Malaysia]
Global Warming & Its Implications for Health & Society: What can we do? .......................... 462
[New Zealand]
A New Zealand Perspective ..................................................................................................................... 484
[Philippines]
Presidential Task Force on Climate Change ..................................................................................... 489
[Singapore]
Climate Change and Health .................................................................................................................... 495
[Sri Lanka]
Global Warming, An Alarming Phenomenon—A Sri Lanka Perspective ................................ 498
[Taiwan]
Global Warming, An Alarming Phenomenon, What Shall We Do? ........................................... 502
[Thailand]
Global Warming, An Alarming Phenomenon, What Shall We Do? ........................................... 508
From the Editor’s Desk
Masami ISHII......................................................................................................................................................... 512
Table of Contents......................................................................................................................................... 513
Message
On the Occasion of
the 50th Anniversary of CMAAO
Yoshihito KARASAWA*1
This year marks the 50th anniversary of the establishment of
the Confederation of Medical Associations in Asia and Oceania
(CMAAO). This issue provides a record of the CMAAO 50th Anni-
versary Celebration.
A former president of the Japan Medical Association (JMA),
Dr. Taro Takemi, and Dr. Rodolfo P. Gonzalez of the Philippine Medical
Association are said to have played leading roles in the establishment
of CMAAO.
The JMA joined the World Medical Association (WMA) in 1956 at the same time as the
German Medical Association. Dr. Takemi served as president of the JMA for 25 years from 1957,
becoming president shortly after the JMA joined the WMA. In 1959, the inaugural CMAAO
Congress was held in Tokyo, Japan. Dr. Takemi believed that it was very important that the opinions
of regions, particularly the Asia-Pacific region, be reflected within the WMA, and that this was
imperative for the formulation of a foundation for the WMA, an organization representing medical
associations around the world. Consequently, it is said that Dr. A.Z. Romualdez of the Philippines,
who was then WMA Secretary-General, also became involved in the establishment of CMAAO in
order to forge ties between the two organizations.
During the program of the 1st CMAAO Congress, Dr. Takemi said, “The emerging close and
rapid connecting of people around the world today through scholarship and culture is unprecedented
in the history of humankind. This could be called the ‘birth of a new world.’ I believe that this 1st
CMAAO Congress will create a core for this ‘birth of a new world.’”
Dr. Takemi emphasized the importance of taking an extremely global perspective. He stressed
the need to realize that diseases occurring on one’s own country do not exist in isolation and to
unceasingly seek connections with other areas of the world as to the diseases’ significance in terms
of global healthcare. Dr. Takemi formulated this approach—which we apply to the problems we
face today, such as avian influenza and other transnational medical issues and the impact of climate
change on healthcare—more than 30 years ago. This issue contains a paper by Dr. Takemi that
provides insight into his medical philosophy, so please take the time to read it.
It is my hope that this special CMAAO issue provides an opportunity to consider the future
of CMAAO, an organization that was established as a foundation for the work and achievements
of physicians in the Asia-Pacific region.
*1 President, Japan Medical Association, Tokyo, Japan ([email protected]). Council Member, WMA. Councilor, CMAAO.
JMAJ, November/December 2008—Vol. 51, No. 6 351
Greeting
50th Anniversary of CMAAO—
Congratulations by the World Medical Association
Otmar KLOIBER*1
When the Confederation of Medical Associations in
Asia and Oceania (CMAAO) was founded fifty years ago,
the world was deeply divided and actually at the brink of
a nuclear catastrophe. What is normal today—to cooper-
ate, act, even to legislate across borders—fifty years ago
was no more than a vision requiring courage and eager-
ness to make a change for the better. Building bridges was
the vision of a few for the benefit of all.
More than many other professions, medicine relies
on collaboration and exchange. Physicians migrate to
other countries to learn, teach and work. Patients migrate
to, or seek advice in, other countries. As a human family,
we not only share the same biology, we share the same pathology. Close international cooperation
in medicine is more than useful, it is absolutely essential.
CMAAO and the World Medical Association (WMA) helped to pioneer this kind of cross-
border cooperation, thanks to visionary leaders in the early days of our associations: Dr. Taro
Takemi (Japan Medical Association), Dr. Rodolfo P. Gonzalez (Philippine Medical Association)
and Dr. Romualdez of the Philippines. Today our partnership is more active than ever, with the
strongest representation of the Asian and Pacific region in WMA in our history. Civil engagement
in medical associations—both national and international—provides crucial advocacy opportunities
to benefit both patients and their physicians. Together members of CMAAO and WMA have shown
leadership in advocacy most recently with our Caring Physicians of the World Conference in Tokyo
in 2006 and our 2008 General Assembly in Seoul. We look forward to visiting Asia again with our
General Assembly in New Delhi, October 14–17, 2009. Our newest initiative—the Caring Physicians
of the World Leadership Course—has been very well received by our members from CMAAO
countries and we plan to bring this exceptional course even closer to the region.
The WMA offers its heartfelt congratulations to CMAAO, our steady and loyal partner for
fifty successful years. We wish you a bright future in support of physicians and the patients you
serve in your region and, indeed, across the world. We also hope this half-century of cooperation
is also a good incentive for the few CMAAO members who have not joined WMA to do so now.
*1 Secretary General, World Medical Association ([email protected]).
352 JMAJ, November/December 2008—Vol. 51, No. 6
50th Anniversary of CMAAO
Commemorative Lecture of the Late Dr. Taro Takemi
Characteristics of Man in a Life Cycle
in the Development and Allocation of
Medical Care Resources
JMAJ 51(6): 353–357, 2008
Taro TAKEMI*1
I have been involved with the work of the World grasped as an individual being, his economic life
Medical Association (WMA) since 1970. The has a very important meaning. At the same time,
duties assigned to me concerned primarily medical care must be considered as something of
socio-medical affairs. When the World Medical great fundamental significance.
Assembly was held in Tokyo in 1975 and I was When we examine the mechanisms of human
appointed WMA president, I proposed that the survival we must start with a consideration of
WMA take up the question of “the development in what form human beings are spread over the
and allocation of medical care resources.” For- surface of the earth. I use the ecological approach
tunately, my proposal was accepted, and it was and regard human life as a thin film covering
subsequently decided that the socio-medical the earth. During the age of agricultural society,
affairs committee alone would be inadequate very little development of natural resources was
to carry out this task. Therefore, it was decided carried out. There, human existence was found in
that the Japan Medical Association (JMA) under- terms of metabolism occurring in the surface
take to form a special committee to follow up on layer of the earth.
this theme. And the committee has met twice As industrialization progressed, however, man
since then. began extracting natural resources from the
It has been recognized that the theme of deeper layers of the earth. With further indus-
“the development and allocation of medical trialization, we entered the age of mass pro-
care resources” is of utmost importance because duction with these natural resources. The things
it includes the most fundamental problems of produced in this mass production stage were
medical care found in every country of the world. not recycled back to the earth after they served
It gives me great pleasure to be able to discuss the purpose for which they had been intended.
one of what I have regarded as central problems. This is the reason why we had the pollution of
Both medical science and economics are the the environment.
most important basic branches of learning to The industrial society developed during the
human survival and living. height of economic growth, and it is a fact that
I thought that a new survival order—which this brought about an elevation of the standard of
includes a new social order, economic order and living. It is also a fact that the allocation of indus-
medical care order—and a new ethics and science trial goods became a major economic issue.
and technology must be developed, bridging these In agricultural production, the metabolic cycle
two disciplines. Human survival and living must was very simple, and natural resources were
be examined from every angle, and man must be recycled locally in a very natural manner. In
grasped as an individual and groups and in his the industrial society, however, the situation was
relationship with his environment. When man is totally different. There was absolutely neither
*1 Former President, Japan Medical Association, Tokyo Japan ([email protected]). Former President, WMA (1975–76) and CMAAO (1959–61,
1965–67, and 1976–79).
This article was selected from a commemorative book “Socialized Medicine in Japan” published in 1982 which collects major articles written by
Dr. Taro Takemi, past President of the JMA who served president for 25 years. The text remains unchanged.
JMAJ, November/December 2008—Vol. 51, No. 6 353
Takemi T
Fig. 1 Man in a metabolic process in ‘cellular membrane’ on earth’s surface
Fig. 2 Demand side of medical care
economics nor technology for the recycling of and had very little to do with the development of
wastes—a fact responsible for a high degree of natural resources.
environmental pollution that occurred, threaten- In the case of medical care, the development
ing, in some local areas, the survival of man. of its resources is highly important, and I believe
What is called the economics of pollution is that interaction between the process of devel-
an economics that came into being after pollu- opment centering on medicine and the process
tion actually occurred. There was an element centering on economics is extremely important
of prediction of industrial pollution in medicine to the stable development of human survival and
and public health. But I don’t believe there was living. The improvement of economic life is inevi-
an economics of prediction. Economics had a tably accompanied by an increase in the demand
close relationship with ethics from its early stage for medical care. The proper and effective allo-
of development. This is the reason why it has cation of demand for medical care, I believe, is
attained a major development in its relationship possible through cooperation between medical
with the industrialized society as a survival order science and economics.
in term of air pollution, industrial accidents, For this, it is necessary first of all to establish
changes in working conditions, and improvement a goal in the development of medical care
in the standard of living. Yet, economics was resources, but this must be done in both medical
essentially a science of labor and consumption science and economics at the same pace.
354 JMAJ, November/December 2008—Vol. 51, No. 6
CHARACTERISTICS OF MAN IN A LIFE CYCLE
Fig. 3 Qualitative change in population structure by aging
Fig. 4 Supply side of medical care
Medical care must be developed by both indi- the natural and social environments. Participa-
viduals and groups as I said earlier. This means, in tion by medicine also becomes necessary.
a nutshell, the question of how an individual or a Demand for medical care must be considered
group responds to demand made by the human in terms of the various periods in the life of man
body. These may be mental, physical and group just as it is so with regard to health. For instance,
responses. And these three kinds of response health at the stages of growth in a person must be
must be considered in terms of total medicine. considered separately from health in the stage of
Then there is the important question of the his aging because of the qualitative changes that
selection of what kind of responses to make. This occur during the latter process. In the stage of
is where the question of individuality comes in. aging, geriatrics and gerontology become involved.
There are also the questions of the environment, As for the structure of aging, the ideal is “to
workplace and its surroundings, and the home age healthily” and therefore, demand for medical
and its surroundings. In every one of these ques- care in the aging period is totally different from
tions, economics must become involved with both that for the periods of growth.
JMAJ, November/December 2008—Vol. 51, No. 6 355
Takemi T
The development of medical care resources to establish prospective medicine because, for
must be carried out according to these demands. one thing, it is impossible to conduct an efficient
For this development of medical care resources, allocation of medical care resources without it.
there could be such varied targets as develop- Service in terms of the allocation of medical
ment by age bracket, for health improvement, care resources based on data obtained by predic-
for the prevention of disruption of health, etc. tive medicine must be provided in such a way as
For these purposes, economic rather than social, to secure the maximum propagation effect in the
bases are extremely important, and this is where long term. Unless the service is given on the basis
medical technology has a major role to play. of metabolic processes varying according to age
In short, the development of medical care groups, it would be wasteful. The concept of
resources, because it greatly differs from the timing in relation to this service must be thought
social development of inanimate objects, must be of as “time reference.” When the service is given
conducted toward a target established according just before it becomes necessary, it is likely to
to the survival process of man. As for industrial- have a long-term propagation effect.
ization, development must be carried out from We have accumulated a large amount of
the standpoint of industrial medicine with regard knowledge in relation to the problem of medical
to a large number of different types of occupa- care costs for the aged. What we have learned is
tions created by that process of industrialization that when medical attention, including that in
itself. Here, the development of the environment mental hygiene, is given to individuals from the
for man as a group also has a great significance. time when they are about 35 years old, medical
The setting of medical targets in the develop- care costs for the same individuals as they
ment of medical care resources and the method- become aged are very small—about one-tenth of
ology that makes this possible must anticipate what is normal.
many contributions from economics. Economics This seems to suggest that it is possible to
of today is a science concerned with the state of think of the provision of medical services for
“completed development.” And little attention human beings as an investment. In the past, medi-
has been paid to the combination of economics cal care was considered a form of consumption.
with the technology necessary for the develop- But when medical service is incorporated into
ment of the future. Through the systematic study a metabolic system, it makes now development
of the development and allocation of medical within that system, raising expectations in a
care resources that has been conducted, however, long-term propagation effect.
I have keenly felt the need or this. In other words, we must not think of counter-
The allocation of resources requires a large measures after a problem has arisen. Take the
number of processes. After the kind of develop- case of the prevention of contagious diseases, for
ment of medical care mentioned above has been instance. If all the countermeasures have been
achieved, it is to be supplied as a “professional put into effect, prevention could be achieved at
activity” (Fig. 4). Because the medical environ- a very low cost. When there are no counter-
ment is of extreme importance in this connec- measures in force, on the other hand, there is
tion, medical care resources, professional activity even the danger of a mass outbreak of a disease
and medical environment must be considered as with a serious threat to human life, and medical
parallel concepts. These three must be promoted care costs would be enormous. Measures in pro-
by comprehensive technology. spective medicine must be said to have long-term
Social management engineering, including propagation effects.
the management of risk factors, and patient con- Therefore, the supply side of medical care
trol also become necessary. Comprehensive tech- does not only include hospitals, clinics and physi-
nology includes medicine and the technologies cians. It requires many new branches of learning,
surrounding it. Another important thing is that for which it is necessary to select the most effec-
through this emerge prospective medicine and tive points of action. Welfare location theory,
its surrounding technologies. for instance, which considers welfare in terms
Prospective medicine today is still at a very of where to locate facilities, may be also impor-
infantile stage. To those who are on the side of tant. This means that when a medical care facility
supplying medical care, it is of great importance is to be established, we must think in terms of
356 JMAJ, November/December 2008—Vol. 51, No. 6
CHARACTERISTICS OF MAN IN A LIFE CYCLE
what is to be built where for a long-term propa- The development and the allocation of medi-
gation effect. cal care resources are the two sides of a coin.
On the other hand, early detection and diag- Only when they are considered in terms of life
nosis make major contribution to the preservation cycle will new bio-insurance become possible.
and promotion of health, and its relationship with In order to translate into reality the concept
social production deserves a serious assessment. of bio-insurance, it is necessary to think of the
As seen from the above, it is obviously neces- development and allocation of medical care
sary to think anew of the supply side of medical resources in highly rational terms. At the base of
care. Its development and allocation must be this rationality, there must be bioethics and bio-
considered simultaneously; placing emphasis medicine. To the evaluation of bio-insurance,
only on allocation is not adequate. economics will make a major contribution.
The health insurance system as a form of allo- In the scheme of bio-insurance, the insurer
cation of medical care has expanded enormously is people themselves, and the insurer under the
throughout the world. Essentially, however, present health insurance system will become
insurance is a system based on the idea of com- unnecessary. The Burden to each citizen in this
pensation for damages. In it the insurer collects scheme will be figured out by computer through
premiums to have the insured pay part of the the successive administrative levels of local
damages while he pays the remainder. Economic government, prefecture and state. Bills by physi-
measures of this kind, dealing with inanimate cians checked by the examination machinery of
matters are rather simple. But when we apply the medical association will be paid by the bio-
this idea to human society, we are compelled to insurance center at each city, town or village.
think of human life, not of inanimate things. As I When any of these local governments is short of
said earlier, human survival and living has many funds for payment, state funds will be used. If
extremely complex conditions and relationships the state center is in deficit, additional premiums
with the natural and social environments. will be collected from the insured.
Yet, the health insurance system regards dis- Details are to be worked out by the govern-
ease as a form of damage. As far as I have ment of each country. In this system, the phy-
observed so far, this signifies the fact that medical sician and the patient operate an insurance
care resources have been thrown into the meta- plan without the intervention of a third party,
bolic process through medical service. They are constantly improving the system of allocation of
therefore, not a form of consumption nor a redress medical care resources.
for damages. Of course, we cannot expect a conclusion on
Unless we consider the human body in its such a large problem as this in a short time. But
context of the environment by ecological think- I have served as chairman of the socio-medical
ing and also in terms of age bracket, the health affairs committee of the WMA, and I am also
insurance system must be thought of as repre- president of the Japan Medical Association,
senting an entirely new mode of thinking and which is in charge of this committee.
a health insurance plan must be formulated pri- In lieu of greetings to you today, I have stated
marily on the basis of the concept of life. my views on the basis of what I have learned
This is what I call bio-insurance, which, to be in these capacities. This matter, however, will
sure, is not a system for compensation for dam- require further studies in the months and years
ages. Its supply system must be considered as a ahead because it includes many areas that will
form of investment. And effective investment in move forward through the progress of medicine
this system would be maximize its propagation and its collaboration with economics.
effect.
JMAJ, November/December 2008—Vol. 51, No. 6 357
50th Anniversary of CMAAO
Special Contribution
CMAAO’s Role and Future Tasks
JMAJ 51(6): 358–361, 2008
Tai Joon MOON*1
The 50th anniversary of Confederation of Medi- that of the WMA. It
cal Associations in Asia and Oceania (CMAAO) is dedicated to topics
is a momentous occasion for all national medical such as medical ethics,
associations in Asia and Oceania. To best mark alliance and friendship
this significant event, I would like to reflect upon building among medical associations in Asia and
my long time involvement in CMAAO and to Oceania and other medical issues common to the
summarize CMAAO’s history and share sugges- region. It aims to discuss and develop policies
tions for an even more meaningful future. necessary to protect the health of people in this
region, as stipulated in its Constitution. Coopera-
Birth and Development of CMAAO tion with other international organizations such
as WMA is also included in its Constitution.
After World War II, ethics and social responsi- From its very start CMAAO was fortunate to
bility of physicians became a topic of serious enjoy the outstanding leadership of Presidents
discussion by physician groups in Europe and Dr. Taro Takemi of Japan, Dr. C. Wu of Taiwan and
North America. This led to the launch of the Dr. Rodolfo P. Gonzalez of Philippines. These
World Medical Association (WMA) in Geneva in competent and respected leaders successfully
1947. WMA quickly gained widespread attention formulated and developed CMAAO’s systems
for its noble cause and impressive achievements, and procedures.
which generated a consensus in Asia for the need
to establish an umbrella organization of medical Structure and Operation of CMAAO
associations in the region that strive for similar
goals. In 1950, the 43rd Congress of the Philip- According to CMAAO’s Constitution, the Presi-
pine Medical Association (PMA) first officially dent, Vice President, President-Elect and Trea-
discussed the idea of an international medical surer/Secretary are to be appointed through
organization devoted to the Asia and Oceania election. Each member association is to dispatch
region. In 1954, the name of this organization was a councilor to the Council. Council meetings are
decided to be the Asian Confederation of Medi- to be presided by the Chair and the Vice-Chair.
cal Associations but in 1956, the 3rd Meeting The term for officers is 2 years with the possibility
of the South East Asian Medical Confedera- of re-election. The president of the national
tion revised the name to the current CMAAO medical association hosting the Congress has been
and adopted its Constitution and by-laws to elected automatically as the President of CMAAO.
complete the process of officially launching the The Congress has been hosted by different mem-
new organization. CMAAO’s historic first Con- ber associations in the region with almost all
gress was held in Tokyo in 1959 with 11 member members having had the honor of hosting the
associations attending including Japan Medical Congress at least once, which demonstrates the
Association (JMA) and Korean Medical Asso- strong unity among members. Currently, CMAAO
ciation (KMA). has 17 member associations from Australia, Ban-
CMAAO’s foundation purpose is similar to gladesh, Cambodia, Hong Kong, India, Indone-
*1 President Emeritus, Korean Medical Association, Seoul, Korea ([email protected]). Former Minister of Health and Social Welfare, Republic of
Korea. Former President, WMA and CMAAO. Current Advisor, CMAAO.
358 JMAJ, November/December 2008—Vol. 51, No. 6