Health reform for children in Japan's aging society: A paradigm shift for pediatricians*

Japan confronts a dilemma in reshaping its health care for children: the low birth rate is reducing the proportion of children in the overall population, while the health issues for children are becoming increasingly complex and connected to social behavior. The present paper reviews Japan's changing demographics and the declining proportion of children in the population structure. This change has important implications for how the government sets priorities in the health sector. Next, the paper considers how 'problems' are defined for health policy in society and how the agenda for health reform is determined. Attention is directed to the political dimensions of these two processes of problem definition and agenda setting. Two examples of health reform for children, in other countries, are discussed to show how these two processes have worked in practice. In the next section, the paper explores new health issues for children in Japan and the challenges to Japanese pediatricians in shaping the agenda for health reform.