Kiyoshi Kurokawa's blog （en）

From Botswana -4

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Photos from Botswana are at; http://www.flickr.com/photos/whsaito/sets/72157623508216878/

I spent 5 full days giving advices in sessions with Botswana government on policy development and implementation..  It was a hard and exhausting task but rewarding at the same time as seen in local media.  However, follow-ups are equally important.  Botswana expects a lot from Japan so we - Japanese government, business sector, and universities - should all work harder together.  From here, the private sector, in part with our government, is expected to take leadership in developing partnership with Botswana government. Akita University has also begun collaboration with Botswana.  This is wonderful!

The advantages of Botswana is its huge land (1.5 times of Japan), rich variety of natural resource, highest level of maintenance of natural reserve and potential for wonderful tourism, existence of largest number of lions and elephants and other wild life, compulsive education being provided to all citizens, English as an official language, stable government, society in good order/security, GDP of USD$6,000/person, etc.  Its weak points are; population of only 2 million, diamond being the highest percentage (40%) of government revenue, about 20-30% of the population in poverty, HIV/AIDS still dominant though reducing, etc.  However, I think that the highest potential lies in the fact that this nation is located in the center of southern half of Sub-Sahara.

In this global age, how can Botswana take their advantages while managing their disadvantages?  This viewpoint is the basis of recommendations for policy making of Botswana.

‘Getting Health Reform Right; A Guide to Improving Performance and Equity‘： A monumental work.

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Health Reform is without doubt a great issue in any nation of the world.  In Japan and the United States, too, it is counted as one of the most pressing challenges in national political agendas.

In each country, there exist complicated elements – social, political, economical, cultural – unique  to each society and country, but on the other hand, medicine and health care technologies are developing faster in speed.  There is no such health system which fits to every society and country.  Developed nations are struggling on how to reform existing system, which is one of the greatest challenges for policy makers of today.   In the world where information spread with no time, the gap between expectation and perception of the society and actual reality of the health care as they see receive continues to widen.

Large numbers of books on health care system are available including those which illustrate the reform carried out in many countries.  Any universal model does not exist, so each ‘leaders/experts’ must learn as much as possible and speak from better perspective, not only from the value of one’s position.  As I often point out in this web-site and elsewhere (Ref.1, 2), it seems that too many leaders/experts in Japan speak only from their limited personal experiences or positions, thus tend to be less objective and not much perspectives, visions for a bigger picture or longer time frame.

This is one of weak points of ‘Tate shakai (Hierarchical society)’ of Japan where the great majority of people pursue their careers in a linear style (i.e. within the same organization and often seniority-based) within Japan.

Several days ago, ‘How to Realize Health Care Reform’was published from Nihon Keizai Shinbun sha.  This is the translation of ‘Getting Health Reform Right; A Guide to Improving Performance and Equity‘（2nd edition, 2008） by Professors of Harvard School of Public Health, Drs Marc Roberts, William Hsiao, Peter Berman, and Michael Reich.  Japanese students who were taught by the authors translated it.  Please search for this book at Amazon.

What makes this book unique from other books of the same theme is that the authors have rich experiences in many countries, understand the difference of social backgrounds of each country; they write not only about policies but also analyses of five ‘Controllers’, i.e. ‘Finance, Expense, Organization, Rules, Actions’, and discuss ethical, political aspects (of the policy) as well as the processes that explain how reform is possible.  The content is very rich and outstanding

The book also provides the analysis of issues and situations pertinent to Japan, how to make reform possible, how policies being developed and advanced on what basis…   Everything is so well thought-out; they encourage us to see the health policy from overall perspectives, stimulate our practical thinking.

I would sincerely like to express my deep appreciation and respect to the four Professors of Harvard University who had written such a wonderful book as well as those who planned and carried out the publication of its Japanese translation.  It was my pleasure and honor to be asked to write a ‘recommendation’（in Japanese ） in this book.

This is a book that I recommend strongly to anyone who cares about health policy.  The price seems a bit high (4,500 yen), but is well worth it.

Activities of Health Policy Institute and its ‘Surprising’ Evaluation

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Several years ago, I founded with a few friends a think-tank ‘Health Policy Institute, Japan (HPIJ)’ and have since been working with my colleagues who share the same vision.

As you may see in our web site, the Institute, as an independent, non-profit, non-partisan private think-tank, we have focused on three areas;  to provide platforms, basic data, and issues for policy discussion, to facilitate the participation of civil society groups and patients in the policy making process, to nurture leadership of the civil society, and Global Health.  I am happy to say that people with talents and commitments on our common goals have joined and are working with us, including young people who work with us as part of their career.  In short, our activities could be described as an effort to encourage Japan’s shift to civil society hence promoting the change of Japan of global world to a responsible civil nation.

We gather at a breakfast meeting once in every two months that function as an opportunity for communication with the members and supporters of our Institute.  It has become a custom for me to greet and speak to the participants at this meeting every January.  Each and every one of the members are committed to improve health care system in their own way.  So, this time, for a change, I suggested my session be primarily ‘Q&A’, but asked the audience to raise questions based not on their jobs and positions but from objective critical observation of their positions.  It might have been a bit difficult for them because this suggestion came up without prior notice.  However, I would like to stress the importance of making it a habit of seeing things objectively and from higher/broader perspective, outside from your background, expertise and position – especially in policy making.  I recommend that you always try to see objectively as much as possible as I stated in ‘Japan as seen from outside’ and elsewhere, and to think and comment on ‘A part of a big picture’.  I have written on this in a book review also. (3rd paragraph, in Japanese)

HPIJ just organized our annual ‘Health Policy Summit 2010’, a two days’ conference on February 10 and 11.  I will report about this in detail soon, but it was a very lively conference with presence of cabinet members of DPJ (Democratic Party of Japan; the administration party);  AKIRA NAGATSUMA, Minister of Health, Labour and Welfare, YUKIO EDANO, Minister of State for Government Reform (was appointed just February 10th), MOTOHISA FURUKAWA, Senior Vice Minister for Economic and Fiscal Policy, Science and Technology Policy, and Government Reform, and Parliamentary Secretaries including KEISUKE TSUMURA, in charge of Science and Technology Policy.  Representatives from DPJ legislators Ms YOKO KOMIYAMA, Dr MITSURU SAKURAI, and Dr SATOSHI UMEMURA.  Representatives from LDP (Liberal Democratic Party) legislators were Mr JIRO KAWASAKI (former Ministry of Health, Labour and Welfare) and Mr HIROSHIGE SEKO.  From New Komeito, another polictal party, include former Vice Minister FUKUSHIMA of Ministry of Health, Labour and Welfare.  Large number of people from health care sector, patient organizations, academia, business sector, mass media participated to join in vibrant discussions.

By the way, I would like to report to you a very good news, which came in such a no-better timing of our annual conference.  The University of Pennsylvania publish its annual report on the ‘Think Tanks’ of the world.   Evaluation of Universities is talked about in many occasions in recent years, but this is ranking of ‘Think Tanks’.  For 2009, the top think tank in the world was ‘Brookings Institution’, but in the category of ‘Health Policy’, 1. Harvard University School of Public Health; 2. Bloomberg School of Public Health, Johns Hopkins University… the list went on as expected…but in the 10th place our ‘Health Policy Institute of Japan’ ranked-in!  I was so surprised to see this, but at the same time thought that this was the result of everybody’s hard work.  Also the high valuation reflects our daily effort of making our activities visible to broader audience of Japan and the world involving various global partners through our website and other means.  ‘Think Tanks’ of governments may outnumber non-governmental ones in many countries including Japan, so ours was a great result.  For this yet young and small ‘Think Tank’, completely independent from the government, to receive such a high evaluation was certainly a great encouragement to us all.

From Davos -3

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On 29th, the 3rd　ｄay at Davos, I spent the morning in private meeting with a few VIPs. In the afternoon, I participated as a ‘Discussion Leaders’  in ‘Prepared for a Pandemic?’- a full two hour session with specialists on pandemics, academics, business enterprises, and insurance companies.  It was a highly informative session with discussions covering wide range; lessons from H1V1 since last spring, role of government, arrangements/preparedness of the companies, risks to be considered, insurance, financial loss, employees and their family, impacts on economy etc., etc.  I was impressed to know that the width of some business leaders thinking and also making effort to prepare themselves to the expected risks.  It is such learning and knowledge sharings that makes this sort of discussions with the leaders of diverse sectors enjoyable and meaningful.

I came across Mr. Bill Gates and had an opportunity to talk with him for a minute on several things such as our encounter in Jakarta in 2008.  In the evening at the main hall, I went to watch ‘Business Leadership’, ans‘The US Economic Outlook’ hosted by Charlie Rose, with Lawrence Summers, Director of the White House's National Economic Council for President Obama.  Charlie Rose, was wonderful in his soft ways of raising good focused questions in a very good timing and Summers’ response was also very persuasive and powerful. Please see them for yourself on the web.

In the evening, I stopped by at the reception of Harvard University and exchanged a few words with President Drew Gilpin Faust （President Faust is female - I suppose you know? ) I understand that she will be visiting Japan this March.  Since Minister Sengoku and three other Ministers were scheduled to arrive after midnight, Dr. Heizo Takenaka, Mr. Yoichi Funabashi of Asahi Newspaper, myself, with several others, had an opportunity to get together at a Chinese restaurant and talk about the new Administration, an opportunity we haven’t have had among ourselves for some time.  When I returned to the hotel, I came across Dr. Yunus of Grameen Bank at the lobby -just like we did last year.  I talked about the group of Japanese students who went to Bangladesh (Ref.1, 2, 3) (Ref.2 and 3 are in Japanese) this January and last year. They also had an opportunity to see Dr. Yunus several times at Bangladesh.  This year, Professor Seichiro Yonekura (Ref.1 in Japanese) of Hitotsubashi University, a leading expert on innovation, accompanied them to Bangladesh.  Dr. Yonekura is a wonderful role model as mentor/teacher and I admire his activities as Innovator (=Entrepreneur, Change Agent or ‘a nail that sticks out’) ; the way he supports young people, and make things happen.

 
Photo 1-3: ‘Toward an East Asia Community?’ Panel.

Next morning on the 30th, I checked out from the hotel to be at ‘Toward an East Asia Community?’  where Minister of Trade, Economy and Industry (METI), Mr. Naoshima were among the panelists.  The panel was moderated by Dr. Kishore Mahbubani (Ref.1), Dean of Lee Kuan Yew School of Public Policy, Singapore.  I was seated at the front raw with my friends, Hiroshi Tasaka-san and President Ninami-san of Lawson (Photo). 

 
Photo 4: From left, Mr. Ninami, Dr. Tasaka, and myself

Then, after listening to the former half of ‘Global Economic Outlook’ in which Minister Sengoku participated as a panelist, I left the venue and headed to Zurich airport to catch my return flight.  Please see this session on the web.  A well known columnist of Financial Times, Mr. Martin Wolf moderated the panel in his keen and insightful style.  In the afternoon, NHK hosted ‘The Great Shift East in the Global Agenda’ moderated by Ms. Aiko Doden, with Vice Minister Furukawa as a panelist.  Report on web  is available, and also TV broadcasts are scheduled on February 6 (Sat), and 13 (Sat) in Tokyo and elsewhere in Japan.

 
Photo 5: With Dr. Takenaka

From Zurich, I returned to Narita via Paris.  I was able to sleep only a bit during the flight, thus  a bit tired.  Somehow a feeling of concern about the future of Japan made me awake.  This theme appears repeatedly in my web-site, and I hear that‘Japan in Transition’ in the afternoon of 30th wrapped up the session in a comment like my view.

The web-site of Davos meeting is apparently quite packed with good information.  Please enjoy according to your interest.  Tons of information, backgrounds, interpretations, and thoughts are introduced and I am sure that they will open up your minds to the world.

From Harvard University

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I came to Boston on January 14.  It’s been a long time since I was here before.  The purpose of this visit is to attend a conference planned by Prof. Lisa Berkman, Director of ‘Harvard Center for Population and Development Studies’ of Harvard School of Public Health (SPH) for two days on 15th and 16th.

The conference aims to discuss social determinants of health, which, in a sense, is a process for putting into actions the pertinent recommendations of the report of the WHO Commission for Social Determinants of Health （CSDH）(Ref.1). On the first day, we discussed what the major social determinants were, and on the second, we tried to identify issues and how to take them into account the situation as well as the determinants of each country.

Dr. Berkman, the host, Dr. Julio Frenk, the Dean, and Dr. Michael Marmot, the Chair of WHO-CSDH Committee delivered lectures which were all superbly done.

On 15th, we divided discussion groups by themes of; ‘Aging’, ‘Equity from the Start’, ‘Gender Equity’, ‘Health Equity in All Policies, Systems and Programs’, ‘Health People, Health Places’, ‘Political Empowerment’, and ‘Intergenerational Transfer and Social Protection’.

On 16th, we continued discussions by separating in the 8 participating countries of Brazil, China, India, Japan, Mexico, Uganda, United Kingdom, USA.

I served as leader for the Japan delegate consisting of Dr. Katsunori Kondo known for his work on studies of social determinants of health, Dr. Keizo Takemi, former Senior Vice Minister of Health, very productive in the field of global health policy,  and Dr. Soshi Takao; Professor Ichiro Kawachi,  who leads Harvard SPH Social Epidemiology. joined our discussion. We discussed issues of Japan by focusing on ‘Aging’, ‘Gender Empowerment’, ‘Suicide’, and ‘Poverty Index’.  Dr. Ikeda, a post-doc at SPH, served as Rapporteur; she has many years of study in US.

Eight countries participated in this new meeting which was apparently a new kind of effort in promoting CSDH, and I had a strong impression that the government of Great Britain had a clear commitment in drafting and executing policies on the basis of reliable data, the process which I was very envious of.  This process of UK was very much in contrast to that of Japan.

By the way, The Royal Society is celebrating its 350th anniversary this year and many events are being planned under the catchphrase of ‘The Home of Modern Science’.  I felt that Great Britain has rich history and tradition in the field of science (mind you, not ‘science technology’).

In the evening of 15th, we were invited for dinner at Loeb House of Harvard Yard (the center of the University.  Dorms where all freshmen stay, major libraries such as Widener Library, venue of the commencement ceremony are at this place).  Loeb House used to be (not for past many years) the residence of the President of Harvard University.

 

  
 
                    
Photos: From top, Widener Library, two scenes from Harvard Yard, and two photos of Quincy House, one of student dormitories outside Harvard Yard

On 16th, about 12 people - not only people in medicine whom I am familiar with, but also students, post-docs, and faculty at Harvard and MIT in the field of natural sciences and engineering - had dinner together at Legal Seafood (photo below), a restaurant located behind the Charles Hotel where I stayed; we all enjoyed dinner very much. Some of the people have appeared in this blog postings (Ref.1, 2).

Photo:At Legal Seafood

A graduate student in physics, a medical researcher who came back to Boston after post-doc for a few years in Boston then once returned to Japan etc.  They are all working with high spirits.  As always, we shared good time together.  Those who have spent more than 5 years in the USA seemed to be struggling about which country (US vs Japan) to build their further career, but at the same time had strong desire to contribute to Japan in one way or other.  I see great possibilities in them although they will face many challenges on their further career building  It is very important to support and encourage these young people.

Although I was anxious about the weather in Boston because of the season, but fortunately, we had bright sunny sky all through the 3 days.

Khalifa University, Abu Dhabi

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From Washington DC I took a flight to Dubai.  I was on the same flight 6 weeks ago, and flew to Dubai 3 weeks ago as well.  In total I flew to Dubai airport 3 times, once to visit Dubai and  twice to visit Abu Dhabi in the past 6 weeks.  Two of the return flights were from Dubai to Kansai Airport and another was to Singapore.

The purpose of visit is the same as my some previous ones; to support Khalifa University.  Dr. Elias Zerhouni, the former director of the National Institutes of Health joined our team starting from this meeting and his participation stimulated the discussion.  Dr. Zerhouni, originally from Algeria, moved to the United States after graduating from Medical School, worked at Johns Hopkins Univesity, then was appointed to the Directorship of NIH, the most distinguished and responsible position in medical research of US government.  I have had the privilege of knowing him for these years (in Japanese) and am quite impressed by his wonderful personality.

Khalifa University, which I have been helping, is one of important Projects of the government of Abu Dhabi. I have contacted Dr Zerhouni for his support since I thought that advice from a person at higher position, a person with distinguished and international reputation, who understands Arabic civilization and culture personally, would be very helpful.  It was a great joy when I received his immediate affirmative answer.

The meeting itself took place for only one day, but the discussion was very active and fruitful.  I firmly believe that participation of someone who is familiar with both Western values and Arabic values, who knows how to communicate with both sides is so very important and necessary for this kind of project.

Photo; At the lobby of the Emirate Palace, with Dr Zerhouni. 

Recently, The U.S. Department of State announced the appointment of Science Envoy for Middle East, and Dr Zerhouni was among the three, with Dr. Bruce Alberts, Editor-in-Chief of ‘Science’ and Dr. Zuweil, a Nobel Prize laureate in Chemistry, originally from Egypt.  This is another significant step forward of US Science Diplomacy.

Such rich variety of human resource (Ref.1) without doubt serves as one of the strong core assets of a nation in this global era.  I met Dr. Zuweil several times in the past, and deepened relationship with Dr. Alberts during these 10 years, since he was the President of the National Academy of Science of USA, through many international scientific community works or events, often related to SCJ (Science Council of Japan).

Toyota Cup (FIFA Club World Cup 2009) was being held at Abu Dhabi during my visit.  As I watched in TV later in Tokyo, it was again Lionel Messi (Ref.1) that brought triumph to his team, as you all may know.

‘Medicine and Art’ Exhibition Opens

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An exhibition‘Medicine and Art’ opened at Mori Art Museum. It is the fruit of nearly 2 years of planning, collaborating with Wellcome Trust  and will be exhibited until the end of next February.  Since I knew that Wellcome Trust is the largest foundation in the United Kingdom supporting medical research but is also making efforts to promote arts related to medicine, I was very happy to support this project - although there was not much that I could do to contribute.

Mr. and Mrs. Mori, the owner of Mori Art Museum, Mr. Nanjo, the Director of the Museum, and the museum staffs, His Excellency Warren, the Ambassador of UK to Japan, Mr. Kan Suzuki, Vice Minister of MEXT (Ministry of Education, Culture, Sports, Science and Technology), (in Japanese) attended the opening ceremony and reception.  I also gave a speech to congratulate the opening.

Among the exhibitions were several valuable drawings of anatomy by Da Vinci.  The words were written in ‘mirror writing’.  Also at display was a sketch by Michelangelo - a rare piece from the collection of The Royal Collection.  Since Michelangelo was a sculptor, he had a habit of burning sketches away one after another so only about 200 pieces are left, the fact which is unbelievable.  The paintings at the ceiling and the Last Judgment of Sistine Chapel in Vatican, are widely known as his masterpiece.  I remember having an opportunity of seeing some 90 of the sketches by Michelangelo in an exhibition 3 years ago (in Japanese).

A variety of special programs including lectures are offered at ‘Medicine and Art’.  I recommend you to visit this special exhibit.

Asia Health Forum in Singapore

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From Abu Dhabi via Dubai airport, I flew to Singapore to participate Asia Health Forum organized by EDB (Economic Development Forum) of Singapore Government; I was a part of its planning discussion session. The venue was a beautiful Cappella Hotel on Sentosa Island.

The member consists of some 15 leading world experts from medical, pharmaceutical, public health and a team of McKinsey, an excellent consulting firm. This one day session began with a welcome by the Health Minister of Singapore , Dr Khaw followed by nearly 40 min discussion session with the Minster. The Minister is fully knowledgeable of the principle, unique historical legacy of Singapore health policy, details of current Singapore health policy and its issues, nonetheless considered perhaps the best service in the world  despite spending only 4% of GDP.

I fully enjoyed the meeting and took a late night flight finally back to Japan after 12 days of around-the-world tour which started from Ottawa. 

From San Diego to Abu Dhabi, Festival of Thinkers, and Bugatti

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From Toronto, I flew to beautiful and sunny San Diego, spending an overnight stay for two important meetings. One was on global clinical study called DOPPS, a major endeavor to valuate and compare clinical practice pattern of the world in the treatment of end-stage chronic kidney disease patients; the project began 10 years ago, almost the time when Google was founded, the fact I reminded to the participants indicating how fast the world has changed. Another meeting was consultative one for a pharmaceutical company with a few world leaders and a FDA consultant on a highly innovative medicine. After some time I felt at back home as a physician and a nephrologist or a kidney specialist. It is a good feeling.

Next day, I headed to Abu Dhabi, to participate Festival of Thinkers 2009; I participated previous one as reported earlier (Ref.1).  I was on the panel on Globalization and Culture and Language, the theme and the discussion I liked very much. The presence of Japan in this Festival was weak as you may imagine. It seems I was the only Japanese this time in contrast to the Festival of 2007..

Photos 1-7; Festival of Thinkers

Photos 8-12; Bugatti 1932

It arrived just one day after the final day of FI Grand Prix. Too bad, I missed the event. But in the lobby of Emirates Palace (Ref.1, 2) , the venue of the conference, about 12 F1 cars of old and current are on display. What lovely creatures they are. Let me share some of their beautiful bodies and mechanics.

Photos 13-18; Vintage Mercedez and newer F1 cars

One is Bugatti of 1932. For many years, I was intrigued by Jiro Shirasu, thus, when an opportunity arose I introduced books on him (in Japanese). Mr Shirasu studied at Cambridge University, owned a Bugatti and made an unbelievably crazy driving with his life-long friend Robin Byng, one of most notable families, to Gibraltar back to UK in two week through France, Spain, and other places, probably unthinkable speed particularly considering the roads of those days. Other cars on display include vintage Mercedez, Maserati, Ferrari and more recent models. Enjoy the photos.

The Gairdner Award

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The day of the award begins with a series of excellent lectures by 2009 Gairdner laureates, rich content of outstanding science with passion for science of those laureates who contributed and those who supported their work; each has his/her own beautiful stories to tell. Lucy Shapiro’s story was outstanding, of a bacterial 3 dimensional dynamic molecular mystery of her life work including collaborations of her husband, a physicist. I know her personally, and her one son is a urologist who worked recently for 3 years at US Naval Hospital in Okinawa, and her daughter-in-law is a marine officer just returned from Afghanistan. What a family she has!

Dr Mori’s story was also moving in that he left Japan from his tenured position because he felt what he was supposed to do then was something wrong and boring; he decided to venture to US; through a lot of struggles, but found a right career he loved as he told us. He was very grateful for his parents who are not wealthy, but supported him to go through university and let him go to US. He of course brought with him his parents, family, and several staff researchers, and it was good to congratulate his entire family.

Dr Yamanaka focused on how he came over through these years after 2 years of clinical training, graduate study in research in Japan, and moved to California for completely new research project. There, he encountered seemingly a totally failure, but hanged on to pursue what may be happening. From unexpected findings with full of struggles, he came back to Nara with three graduate students, then Kyoto, where he finally made his landmark discovery with a few graduate students and technicians in the last few years

Dr Sackett’s historical story of major errors made by excellent clinicians being observers, which includes William Osler. He told me personally, he was also surprised by his findings on Dr Osler.

All lectures reveal core personality of each laureate. The day was ended with unquestionably thoughts-provoking guest, Sydney Brenner, who talked about ‘Humanity Gene’ with his usual sense of humor, but a serious message.

 Photo 1：Honorable Ambassador Nishida and Mrs.Nishida
Photo 2: From left Dr. Pierre Chartrand, Vice-President, CIHR., Dr Peter Singer (Ref. １、２）

Photo:

In the evening, the award ceremony was held at the Royal Ontario Museum. Proud Ambassador Nishida was on the stage to accompany the ceremony of two Japanese laureates.

After return to the hotel, I had drinks in our hotel bar with Dr Yamanaka and his staff and Dr Mori just dropped by.

It was a very good few days in Toronto for me and for all Japanese science community. This year also celebrates Japan-Canada’s 80th year of Diplomatic Relation. As you may recall, earlier this year Emperor and Empress of Japan visited Canada (Ref.１ ）.

I will leave for San Diego early tomorrow morning.