10th Ludwig Boltzmann Forum 2018, Tuesday 20 February 2018 at the Embassy of Austria in Tokyo
Welcome by the Ambassador of Austria, represented by Magister Konstantin Saupe (Embassy of Austria)
Gerhard Fasol CEO Eurotechnology Japan KK, Board Director GMO Cloud KK, Guest-Professor Kyushu University, former faculty Cambridge University and Tokyo University, past Fellow, Trinity College Cambridge “Entropy, Information and Ludwig Boltzmann“
Hiroyuki Sasaki Vice-President Kyushu University, Director of the Epigenome Network Research Center, Professor, Medical Institute of Bioregulation “Strategy and Serendipity in Science“
Wolfgang Kautek Professor for Physical Chemistry at University of Vienna, Member of Scientific Board of Austrian Research Associations, President of the Erwin Schrödinger Society for Nanosciences (ESG), Chairman of the Research Group “Physical Chemistry” of the Austrian Chemical Society (GÖCh) “Nanotechnology and Critical Raw Materials“
Chuck Casto Licensed Nuclear Power Station Operator. Was NRC regulator responsible for 23 nuclear power stations. Leader of the US Integrated Government and NRC efforts in Japan during the Fukushima nuclear accident in 2011. “Balance of Nuclear Power Policy in Post-Fukushima Japan”
Yayoi Kamimura INTEL, Global Account Executive, previously: NTT Docomo, Director and Head of Business Development & Investment “Innovation – A style in Japan”
We share data in space science, why don’t we share data and expensive equipment in medicine?
AMED. Our Vision: to fast-track medical R&D. Create catalytic systems to fast-track medical R&D for human’s quality of life (QOL)
AMED is financed by three Japanese Government Ministries with a total budget of US$ 1.4 billion in FY2015.
AMED not only offers budgets, but also officers and scientists with new mindsets.
In a way AMED corresponds to the tricarboxylic acid (TCA) cycle:
Amino acids / glucose / lipids correspond to the METI / MEXT / MHLW Ministries.
AMED catalyzes these 3 different substrates to galvanize medical R&D processes.
Brain/MINDS (Brain Mapping by Integrated Neurotechnologies for Disease Studies) project
Purpose of the Brain Mapping by Integrated Neurotechnologies for Disease Studies (Brain/MINDS) project is to map a primate brain to help understand brain diseases such as Alzheimer’s disease and schizophrenia. For an overview see:
Overcoming balkanization: patients’ needs vs physicians’s desire (e.g. to publish papers)
We need to overcome balkanization, and share ideas and data, e.g. we need to overcome the conflicts of interests between patients’ needs and the desire of physicians for example to publish scientific papers. We need to overcome balkanization of sequencers vs physicians, scientists vs bureaucrats, universities vs industry, and especially bureaucrats vs. bureaucrats (e.g. from a different Ministry) etc.
AMED: How to reform medical R&D systems?
make “inflexible and balkanized funding” flexible and unified
promote global alliances to facilitate data sharing
support ARO network in University Hospitals for activating clinical research
optimize peer-review in pilot projects: online in English (partly from FY2016), 5 all-English programs, database of all accepted proposals
overcome “ECG budgets” and promote PPP
social implementation of genomic medicine
Initiative on Rare and Undiagnosed Diseases (IRUD)
Homepage of AMED’s Initiative on Rare and Undiagnosed Diseases (IRUD):
Our aim is to overcome the “N-of-1 problem” by data sharing, i.e. we work to find patients with similar rare and undiagnosed diseases.
Why did we start from IRUD?
We want to improve 3 different types of life: life science, diary life and quality of life of patients and family.
We want to stop “research for budgets”, and empower “budgets for research”.
We want to encourage global data sharing, and overcome researcher’s inner biological behavior.
We want to overcome fragmentization of budgets and of expensive machines.
We want to overcome the phenomenon of “Darth Vader-type Professors”.
Data sharing not only for diagnosis, but also for drug discovery.
We respect front-line physicians who help patents who suffer from “diagnostic odyssey”, who are sent from test to test without hearing a valid diagnosis or treatment.
Our IRUD Regional Alliance includes 200 hospitals in Japan. We have more than 2000 registered families, and our program is showing first results with case matches of patients with similar rare diseases with foreign countries.
On 11 January 2016 we concluded a Memorandum of Cooperation between NIH and AMED.
SCRUM-Japan is a nation-wide, multi-centric cancer genome screening program with headquarters at the National Cancer Center in Kashiwa: http://epoc.ncc.go.jp/scrum/.
SCRUM-Japan is a successful academia-industry cooperation program encouraging data sharing among pharmaceutical sectors. Many major pharmaceutical companies cooperate.
National Clinical Database
The National Clinical Database includes more than 95% of operation data of general surgery in Japan: http://www.ncd.or.jp/
AMED supports the application of the National Clinical Database (NCD) to post-market surveillance of medical devices.
Real World Data (SSMIX 1+2) – Science Information NETwork 5 (SINET5)
AMED will start investments from April FY2017
Data sharing in AMED: no trust – no sharing: no man is an island.
IRUD & SCRUM-J, using ToMMo with more than 4000 Japanese variants
NCD extension to clinical research
Clinical genomics data base (from FY2016): rare diseases, cancer, infectious diseases, dementia
Minoru Koshibe majored in protein crystallography with a Master’s Degree. He started work at a predecessor company in 1978, worked in processor engineering, and later in head quarters in corporate planning.
Mitsui Chemicals was established by merger in 1997. Minoru Koshibe in 2003 joined the fine chemicals division, was involved in the Sankyo Agro acquisition, in the establishment of subsidiaries/affiliates (JPS, HMCI, OPC, YK, JC and others), and in M&A (Acumen, KOC, Hereaus Kulzer)
Minoru Koshibe worked 17 years in manufacturing, basic chemicals, R&D, construction and production,
9 years in the function chemicals business sector, and
12 years in corporate planning, and business planning.
About the Mitsui Chemicals Group
Our corporate mission is:
Contribute broadly to society by providing high-quality products and services to customers through innovation and the creation of materials, while keeping in harmony with the global environment
And our corporate target is:
Constantly pursuing innovation and growth to become a chemical group with an undisputed global presence
Founded: 01 October 1997 by merger, however Omuta Works started operation in 1912, so including predecessor companies Mitsui Chemicals has over 100 years history
Paid in capital: YEN 125 billion
Subsidiaries and affiliates: 133 (55 in Japan, 17 in the Americas, 20 in Europe, 16 in China, 7 in Singapore, and 18 elsewhere
Employees: 13,600 (9,300 in Japan, 1,350 in the Americas, 1,100 in Europe, 800 in China, and 1,050 elsewhere
Basic materials (45%): gas pipes, bi-phenol, methyl methacrylate, PET resins, polyurethane
Origins and history of the Mitsui Chemicals Group:
1912. Contribute to solving food shortages caused by rapid population growth: manufacture raw materials for fertilizers from exhaust gas, a byproduct of coal business
1932. Contribute to preserve our indigo culture: achieve Japan’s first successful production of indigo dye by using chemical technology
1958. Contribute to industrial modernization. Construct Japan’s first petrochemical complex.
MCI 2025 Basic Strategies
Accelerate global expansion
Strengthen competitiveness of existing businesses
Strategy for our Healthcare Domain
FY2016: Operating income = YEN 15 billion
FY2025: Operating income = YEN 45 billion + new business
Creation of new products
vision: functional ophthalmic lens line-up
hygiene: new functional nonwovens
personal: new products for detergent and cosmetics
oral: 3D printers and laser milling machines
Strengthen existing businesses
vision: sales activities in North America, China and India
hygiene: high functional nonwovens
personal: licensing business
oral: periodontal disease treatment drugs, IoT and network solution business, denture and OSA mouthpiece business in North America
vision: electronic glasses (see in the photographs below: Mr Minoru Koshibe was wearing prototype electronic glasses during the keynote lecture)
personal: surgical materials, physical mobility
oral: new domains of dental materials
hygiene: specialized products
oral: dental business in India, ASEAN, Middle East and Eastern-Europe, dentures and OSA mouthpieces in Europe and Asia
Strategy for our healthcare domain: fusion of materials and IT, realization of personalized healthcare, open innovation
Super Aging Society is coming soon
As regenerative medicine technology advances, life expectancy might increase to 100 years age by the year 2050
Japan’s population has peaked around 125 million around 2010, and may decrease to around 50 million by 2100
When asked for their biggest regret in life, 70% of old people answer: Not to have taken on challenges:
Lets live to accomplish your purpose!
Lets make a meaningful life!
Lets change our thinking about aging: instead of seeing old age as a decrease in value, lets see old age as seniority, as increasing value through knowledge, challenges and experience!
Concern about Japanese Conglomerates
Over the last 20 years the “earning power” of Japanese companies decreased compared with other major countries.
Market capitalization (corporate value) of Japanese corporations is falling behind compared to both Western countries and emerging countries:
The stock index FY2016 / FY1990:
Japan = 0.7
USA = 7
Germany = 7
India = 24
China = 24
Indonesia = 12
thus while the stock index has grown 7 times both in Germany and USA, and grown 24 times in India and China, it has actually fallen by 30% in Japan.
Market capitalization FY2015 / FY1990:
Japan = 1.7
USA = 8.1
Germany = 4.8
India = 5.4
China = 16
Indonesia = 5.3
while the market capitalization has grown 8.1 times in USA, 4.8 times in Germany, and grown 5.4 times in India and 16 times in China, it has only grown 1.7 times in Japan.
Capital markets are actually highly complex systems including the markets (stock exchanges) investors, intermediaries, are influenced by disclosures and governance rules. We need to improve the system as a whole, as well as its parts, to improve the performance of Japanese corporations.
In the past technology was made for people, e.g. airplanes and jets. In future more and more products will be made for robots, drones and other machines. Where is the place for people in such a world?
Lets build a society where technology (robots) and people can coexist!
20 years experience in open innovation, services alliance and JV with foreign companies
originally investment banker
promote innovation to customers with cutting edge Silicon Valley technology
Joint ventures and investments: PLDT, Sri Lanka Telecom, StarHub, Codelco, TT&T
Service alliances and collaborations: runtastic for docomo, Toyota, M-TV, SEGA
Anti-Fraud App: “hi its me” fraud crime exceeds US$ 400 million/year in Japan. Recently launched anti-mobile fraud app to protect the elderly population from these types of crime. The system monitors suspicious in-coming calls to the elderly, then sends alerts to their family
Snap shots: Macro view on Japan’s innovation landscape
R&D and patent applications
2016 R&D expenditure vs GDP
USA: GDP (PPP) = US$ 18,559 Bill, R&D 2.77% of GDP
China: GDP (PPP) = US$ 20,015 Bill, R&D 1.98% of GDP
Japan: GDP (PPP) = US$ 4,913 Bill, R&D 3.39% of GDP
Germany: GDP (PPP) = US$ 3,741 Bill, R&D 2.92% of GDP
Patent applications by Chinese companies have been sky-rocketing since 2000, while patent applications by US, Korean and European companies are steadily increasing, patent applications by Japanese corporations have peaked around 2000, and have been decreasing ever since 2000.
Japan is trailing in R&D efficiency, defined as total value add in the last 4 years / total $ spent for R&D between 8-6 years ago:
While R&D efficiency in USA and Germany is similar between 80-90 times during the last 10 years, R&D efficiency in Japan has dropped from 80 times in the 1990s to near 60 times currently.
Venture Capital and start-ups
With only 3.7% of the population, Japan has one of the lowest ratios of entrepreneurs in the world.
In countries like Zambia, Nigeria or Ethiopia the entrepreneur population is on the order of 40% of the population.
In China, USA, Canada, the entrepreneur population is on the order of 12-14%.
In Japan the entrepreneur population is only 3.7% – similar to France, Belgium, Germany.
Venture Capital Funding is shockingly low in Japan
VC Funding 2016:
USA: VC Funding US$ 60 billion
China: VC Funding US$ 20 billion
Japan: VC Funding US$ 2 billion
Japan does not appear in rankings of the “hottest start-up ecosystems” (source: Spark Labs Global Venture):
Start-up ecosystems require:
funding and exits
legal and policy infrastructure
government policy and programs
As a result of “Digital-Capital” mobile internet unicorns in Q1 2015, which include Facebook at the top, only three Japanese “unicorns” appear in the ranking: DeNA, GREE, and Cookpad.
USA has a large number of young companies, established since the 1970s with high market caps, e.g. Apple, Google, Microsoft, Facebook, Amazon etc.
Japan has only one single such company: SoftBank.
What can we change today?
In the public domain we need changes:
Education system, STEM: coding population, diversity, gender gap bridges
Public sector R&D: DARPA like organization, TAX breaks
Policy change: deregulation, promotion or open innovation, funds flow, capital markets
Universities and research agencies: more funds, clear goal set and PDCA
In the private domain we need changes:
Organization: double decker structure, CVC
Management: vision and target setting, acquisition & development rather than R&D / not NIH, start-up inclusion
Process: PDCA, SPEED, ROI monitoring
People: talent, skilled labor, IP and Legal, Standardization
We need entrepreneurs, especially those who can compete globally
We need many more coding population in face of the software defined economy, we need to rewrite our DNA
We need to expand the funds flow to startups, from public sector and from private capital markets
Japan is now facing big challenges and global competition to even keep the status quo in innovation
Both public and private level, we should rewrite our DNA and accelerate the rejuvenation our economy
Innovation happens where money is. We should be ready to invest in more riskier assets of start-ups, both on private and public level. And the money does flow where returns are sound
Build our ecosystems and gain the momentum to maximize innovation, producing next generations of Sony, Honda, Toyota… they were all ventures at their start
Large enterprises transform themselves and/or we welcome the rise of new generation entrepreneur players
Balance of Nuclear Power Policy in Post-Fukushima Japan
keynote talk given at 9th Ludwig Boltzmann Forum, Embassy of Austria in Tokyo, 16 March 2017
by Chuck Casto Licensed Nuclear Power Station Operator. Was NRC regulator responsible for 23 nuclear power stations. Leader of the US Integrated Government and NRC efforts in Japan during the Fukushima nuclear accident in 2011
The Fukushima nuclear disaster is not a triple crisis, as sometimes stated, but five crisis:
nuclear plants, including clean-up
All five crisis must be addressed, and a system solution must be found and implemented.
The Fukushima Dai Ichi nuclear disaster was caused by a system failure both of the Government and the Utility (Tokyo Electric Power, TEPCO)
The nuclear disaster was caused by a long list of failures and mistakes, not by one single factor:
the plant was constructed at the wrong place
the well known Tsunami history was ignored, land was lowered to near sea level to save money for pumping water, exposing the nuclear plant to Tsunamis
Lessons from Chernobyl were not learnt, incorrect venting procedures were used
Mistakes in emergency planning and crisis leadership: there was not enough planning for the case of accidents
Lessons from the US 9/11 terror attack were ignored, and US advice was rejected: no backup electricity was provided
A misalignment of values
Policy imbalance between power and responsibility
Instead of the prevalent “safety myth”, we must start from the position that accidents can happen.
The balance of power and responsibility
Which group has the legal power and who has the legal responsibility?
Misalignment of values held by (1) nuclear utilities, (2) the public and (3) the Government leads to distrust, and as a result doubt, uncertainty, fear, anxiety, insults, anger, and loss of trust in the system.
The values need to be realigned to create a system to protect public health and the environment.
We must have a clear legal basis for roles and responsibilities.
The utilities (electric power companies) need to be ultimately responsibly.
There is a public and government reluctance to give the utilities clear and sole responsibility.
Lessons from the Three Mile Island Accident
Before the Three Mile Island Accident we had an imbalance between:
the power of the utility (the nuclear plant operator)
the responsibility of state and federal authorities
This imbalance was corrected and rebalanced after the Three Mile Island accident:
the law was changed regarding risk: the law demands now a “reasonable assurance”
the regulator was strengthened
an industry excellence organization was formed
Similarly in Japan we need to rebalance the system of power, responsibility and accountability of all players:
The pyramid of power needs to be with the Government and the Diet on top:
Government and the Diet
Government agencies and ministries
Prefectures and Local governments
Nuclear utilities, nuclear plant operators
Public and non-governmental organizations
This power pyramid needs to be balanced with responsibility and accountability of:
Nuclear utilities, nuclear plant operators
Government agencies and ministries
Government and the Diet
Prefectures and nuclear utilities
Public and non-governmental organizations
Japan’s system failure needs a Japanese solution, not a US or EU solution
…and the cleanup of the Fukushima disaster zone is absolutely essential for a restart of nuclear power in Japan.
Nuclear crisis: the Fukushima disaster area must be restored for new land use, to prove that future accidents will be cleaned up, and to give hope to residents
Social crisis: public health communication is necessary
Policy crisis: Japan’s Diet (Parliament) needs to hold a national dialogue on nuclear power and risk, who should have the power, who should have the responsibility and what level risk is acceptable
Balanced regulatory oversight needs to be established, and the Nuclear Regulation Authority (NRA) needs proper oversight.
“Manyo-shuu” Voll.11 (2542)
Ever since I started to sleep on the hand of
my new wife as a pillow, soft as young grass/
It is no longer possible to be separated from
her over night/ How could I, when there is not
a speck of hate in my heart
Historical background in Japan
1603 – 1868, Edo period, Samurai era
We had a peaceful period in Japan, and Japan was a closed country.
In 1674 discovered the determinant, earlier than the discovery by Leibniz in 1683.
He discovered Bernoulli numbers independently around the same time as Jacobi Bernoulli.
derivatives and integrals (in the West: Newton, Leibniz)
but, there was no discovery of the fundamental theorem of Calculus.
Mathematics votive tablets (san-gaku) featuring mathematical puzzles, mainly Euclidean Geometry.
1868 – 1912, Meiji Period, opening of Japan
Social system, law were imported from Britain
Science, technology were imported from Germany
Culture and arts were imported from France
In pure Mathematics, Göttingen in Germany was the leading center, and pure mathematics was imported from Göttingen to Japan
Applied mathematics was much harder to import to Japan.
1926 – 1989: Showa period, from 1989: Heisei period
Japan’s period of fast growth.
Japan had many strong applied mathematicians before high performance computers were developed in the mid-1990s, but they were not regarded or valued as mathematicians.
After the introduction of high performance computers, applied mathematics decreased in emphasis in Japan.
The main reason for this weakness was found to be the weakness and decreasing numbers of applied mathematics, and applied mathematicians.
The report stated: “It is desirable to have the same percentage of workers in the private sector of research and development as the West, which is 65%. However, in Japan the percentage in the private sector is only 26%. This shortage and nearly 40% gap relative to the West must be overcome”
At the same time, there was a world-wide trend in favor of mathematics for industrial technologies:
As a consequence, MEXT commissioned an investigation project “Investigation and estimation of promotion of cooperation of mathematics and mathematical science with other fields – Toward a proposal for the 4th governmental science & technology master plan”
(October 2009 – March 2010)
Implementing organizations were:
Kyushu University (Main),
University of Tokyo,
Mathematical Society of Japan,
Nippon Steel Company.
And the representative was: Masato Wakayama (Kyushu University)
We investigated and estimated the activities of mathematics and mathematical science, and those of their cooperation with the other fields that have been implemented in Japan, and thereby gained ideas for making a proposal to the Japanese government for promoting mathematics and for strengthening cooperation with various fields surrounding mathematics.
As a consequence of this investigation project:
The 4th Governmental Science & Technology Basic Plan (2011) of the Prime Minister’s Council of Science and Technology Policy (CSTP) for the first time ever stated that Mathematical Sciences are important and should be promoted.
The Mathematics Innovation Unit was established in MEXT
The Committee of Innovation by and for Mathematics was established by the Committee of Science and Technology (2011)
MEXT organized 22 workshops in mathematics and 36 workshops in mathematical sciences and math-for-industry
Cooperations with Mathematics programs and several leading schools of mathematics
2016: The 5th Governmental Science and Technology master plan again emphasizes mathematical science
Some resulting research programs:
Alliance for breakthrough between mathematics and sciences (ABMS), leader: Yasumasa Nishiura (WPI Advanced Institute for Materials Research, Tohoku University) JST CREST/PREST 2007-2016
Modeling methods allied with modern mathematics, leader: Takashi Tsuboi (Graduate School of Mathematical Sciences, University of Tokyo) JST CREST 2014-
Collaborative mathematics for real world issues, leader: Hiroshi Kobuku (Dept of Mathematics, Graduate School of Science, Kyoto Univ) JST PREST 2014-
Meiji Institute for Advanced Study of Mathematical Sciences (MIMS), leader: Ichiro Hagiwara (Director Meiji University) 2007 –
The Casimir effect (https://en.wikipedia.org/wiki/Casimir_effect) leads to attraction between opposite mirrors in a vacuum, which are spaced a short distance apart, due to electro-magnetic wave fluctuations in the vacuum. The Casimir effect was first predicted in 1948 by Hendrick Casimir (1909-2000), and first measured by Steve K. Lamoreaux 1996.
An equivalent effect exists between ships which are spaced close to each other, see: SL Boersma, “A maritime analogy of the Casimir effect,” Am. J. Phys. 64, 539–541 (1996), http://dx.doi.org/10.1119/1.18150.
Derivation of the Casimir effect shows that the force between the two plates is directly related to Riemann’s zeta function, which again is directly connected with prime numbers.
keynote talk given at 9th Ludwig Boltzmann Forum, Embassy of Austria in Tokyo, 16 March 2017
by Gerhard Fasol CEO, Eurotechnology Japan KK, Board Director, GMO Cloud KK. former faculty Cambridge University and past Fellow, Trinity College Cambridge
We use Ludwig Boltzmann’s results every day. Here are some examples:
The definition of the units of temperature, Kelvin, Celsius, are directly linked to Boltzmann’s constant
The Stefan-Boltzmann radiation law tells us that the total energy emitted by a black body per unit surface area is proportional to the 4th power of the temperature, and allows us to measure temperatures at a distance. For example, the temperature of the surface of the sun can be measured using the Stefan-Boltzmann radiation law
Boltzmann’s formula S = k log W links the macroscopic Entropy with the probability (W = Wahrscheinlichkeit) of a macrostate
Boltzmann’s transport equations are used for many purposes, to simulate carrier transport in semiconductor devices, and to design airplanes, turbine blades and cars
Ludwig Boltzmann’s philosophy of nature contributes to our understanding of nature and our world
Ludwig Boltzmann was proposed several times for the Nobel Prize: 1903, 1905 and three times in 1906, the year he took his life in Duino, Italy.
Ludwig Boltzmann achieved his Matura, Austria’s high-school examination required to enter University education at the age of 19 in 1863.
In 1865, at the age of 21, he published his first research paper entitled “Über die Bewegung der Elektrizität in krummen Flächen” (electricity in curved surfaces). It was the dawn of our electrical age, Maxwell created his Maxwell’s equations in 1861-1862, and on 15 February 1883, 20 years later, Tokyo Dentsu KK received the license to start its electricity business in Tokyo.
Among Ludwig Boltzmann’s teachers were Josef Loschmidt and Jozef Stefan.
Josef Loschmidt proposed structures for 300 chemical compounds including benzene, he determined the number of gas molecules in a given volume and the Loschmidt constant is named after him.
Jozef Stefan created the Stefan-Boltzmann Law with Ludwig Boltzmann, and used it to determine the temperature of the surface of the sun.
Ludwig Boltzmann traveled extensively, was in correspondence and discussions and scientific exchange with most major scientists of the time. He also moved professionally:
University of Vienna
1869-1873 Full Professor of Mathematical Physics in Graz
1873-1876 Full Professor of Mathematics in Vienna
1876-1890 Full Professor at University of Graz, Head of the Institute of Physics
1887-1888 Rektor (President) of the University of Graz
1890-1894 Professor University of München
1894-1900 Professor University of Vienna
1900-1902 Professor of Theoretical Physics University of Leipzig
1902- Professor University of Vienna
Ludwig Boltzmann supported and worked with women:
One of Ludwig Boltzmann’s students was Lise Meitner (November 1878 – 27 October 1968). Lise Meitner was part of Otto Han’s team that discovered nuclear fission, Otto Hahn was awarded the Nobel Prize. Lise Meitner was the second woman to earn a PhD degree in Physics at the University of Vienna. The Element 109, Meitnerium is named about Lise Meitner.
The first President of Osaka University (1931-1934), Nagaoka Kantaro (1865 – 1950) was Ludwig Boltzmann’s student in München around 1892-1893.
The unit of temperature, Celsius or Kelvin, is directly linked to Boltzmann’s constant k
One Kelvin is defined such that the temperature of the triple point of water is exactly 273.16 Kelvin.
For this definition to be reproducible, the water needs to be defined: its defined as VSNOW = Vienna Standard Mean Ocean Water.
While this definition may have been best at the time it was set, clearly its not sufficient for today.
keynote given at the Ludwig Boltzmann Forum on women’s development and leadership, Tokyo, Monday 16 May 2016
by Dame Carol Black DBE FRCP FMedSci, Principal of Newnham College, Cambridge University, and Expert Adviser on Health and Work, Department of Health and Public Health England
(Summary of Dame Carol Black’s keynote written by Gerhard Fasol)
Dame Carol Black DBE FRCP FMedSci
Principal of Newnham College, Cambridge University.
Dame Carol Black has held top positions in medicine and now holds high-level policy advisory positions on health and work in the United Kingdom.
Women in healthcare – Women in the British National Health Service
The gender imbalance in the National Health Service is reflected by the facts that 77% of the total workforce is female, while only 7% of female staff are doctors or dentists, ie only 5.4% of total workforce are female doctors or dentists.
41% of Chief Executives are women.
81% of non-medical staff are women.
Alison Wolf and the XX Factor
Alison Margaret Wolf, Baroness Wolf of Dulwich CBE, is a British economist, and the Sir Roy Griffiths Professor of Public Sector Management at King’s College London, see:
In her book “The XX Factor: How Working Women Are Creating A New Society” (Profile Books 2013), Alison Wolf writes that women are split into two groups: one group sacrificing family for rapid professional advancements, while the other group of women opts for having children at a young age, and remain in low level positions. As a result, inequality is growing faster among women than among men, and low status and low paid jobs are predominantly done by women:
97% of secretaries are female
92% of registered nurses are female
89% of nursing, psychiatric and home health aides are female
90% of maids and housekeeping cleaners are female
The fundamentals: what are the essential characteristics of “good employment”?
Good work: is stable and safe, allows individual control, is flexible, gives opportunities, promotes wellbeing, reintegrates sick or disabled people if possible.
Good workplaces: have visible senior leadership and well trained managers, enable staff engagement, empower employees to care for their own health
Good news for medicine, less good news for academic medicine
Generally we have achieved a good situation regarding gender equality in medicine. We have achieved meritocracy, and their are no reports providing evidence for systematic barriers against women’s professional advancement. Both intake and retention for women in medicine is high, and the pay scales are the same.
A study (Royal College of Physicians (RCP) Working Party 2009), investigated the female share of Consultants (= established Senior Medical Professionals in the UK), and showed the ratio of women is highest (38% – 49%) in “more plan-able” and “more people oriented” specializations such as general practice or paediatrics, while women’s share is lowest (8% – 23%) in “more technology oriented” and “more unpredictable” specializations such as anaesthetics or surgical specializations.
There is far less progress in academic medicine, and cultural stereotypes and bias remain, see:
Women’s advance into top leadership positions suffers from “cultural” prejudices, e.g. prejudices that women too kind, too caring, not logical or strong enough, or otherwise unsuited to lead.
Prominent leadership roles for women, Prominent medical leadership
Prominent leadership roles need investment in the “extras”, leads leadership dimension in each speciality, and requires career single-mindedness.
Prominent medical leadership requires investment of time “over and above” the ordinary duties, requires professional “stewardship contributions”.
The top 200 leadership positions will naturally go to those who pursue their career goals with a high degree of single-mindedness.
Women choosing the route towards prominent leadership roles need encouragement and support, they need:
Role models: Prominent women leaders in UK medicine
Una O’Brien, Permanent Secretary, Department of Health
Professor Dame Sally Davies, Chief Medical Officer
Dame Julie Moore, CEO, University Hospitals Birmingham, NHS FT
Claire Murdoch, CEO, Central and NW London NHS Foundation Trust
Professor Jane Dacre, PRC Physicans
Clare Marx CBE, PRC Surgeons
Dr Suzy Lishman, PRC Pathologists
Dr Maureen Baker, Chair, RC General Practitioners
Need to debunk leadership myths
Its important not to fall into the traps of common leadership myths, e.g. that leadership is inborn, that leadership is that of a lone genius, that they must inspire others to follow their vision, the leadership requires formal authority, or that all leaders have common personality features.
We need to avoid similar leadership myths in medicine, e.g. that men naturally make better leaders.
Dame Carol Black: From a shoe-making village in decline to Government Advisor
Dame Carol Black is born in the shoe-making village of Barwell, Leicestershire, went to Grammar School in Market Bosworth, were she became Head Girl, despite her working class background.
Dame Carol Black studied first History, then Medical Social Work and finally Medicine at the University of Bristol, specialized in Rheumatology research, focusing on Scleroderma. Later advanced to Medical Director, Royal Free Hospital, President of the Royal College of Physicians, Chairman of the Academy of Medical Royal Colleges, Chair of the Nuffield Trust on Health Policy, then advising Government as National Director for Health and Work, and now Principal of Newnham College, Cambridge.
A major step was Dame Carol Black’s advancement to Medical Director of the Royal Free Hospital, since this meant not just responsibility for an institution or a group or a department, but also responsibility for the health of a population.
Leading the Royal College of Physicians
The Royal College of Physicians was founded by Royal Charter by Henry VIII on 23 September 1518 with the aim to promote the highest standards in medicine.
The skills required were: understanding a wide landscape, consensual leadership, standing ground when necessary, negotiating with Whitehall (= British Government) and building trust.
Chairing all the Medical Royal Colleges – The Academy, 2006-2009
Dame Carol Black from 2006-2009 chaired this group of 21 independent organizations. As Chair, Dame Carol Black had no executive powers, needed to lead by persuasion and with consensus.
Dame Carol Black shared several of her experiences advising Government and highest ranking Government officials and Ministers.
Key was to become valuable in the eyes of Government officials by giving independent advice based on scientific evidence, in combination with remaining totally unpolitical.
Dame Carol Black became a champion for the “cause” of health and work, and kept totally out of politics, never revealing any political views or opinion, and wrote three major reports.
The Confidence Code – forget perfection…Striving for perfection can waste women’s time, and hold back the best from reaching the top
This UK House of Commons report finds some common traits which hold women back from reaching top leadership positions, including that women may perceive promotions as undesirable, wait until they meet all perceived criteria for promotion while men often take higher risks and may behave more speculatively, and women may think that “political” skills are required to reach the top.
Finally, to reach top leadership positions, we need:
staying motivated after failure
mentors, sponsors, role models
personal values aligned to organisational values
Summary of Dame Carol Black’s keynote written by Gerhard Fasol
by Kyoko Nomura, MD, MPH, PhD: Director, Support Center for women physicians and researchers, Associate professor, Department of Hygiene and Public Health, Teikyo University, School of Medicine, and Associate professor, Teikyo School of Public Health
In 2016, Japan’s elderly population, aged 65 years or older, comprises 26%, which is one-fourth of total population. By contrast, the younger generation, aged 0-14 years, comprises only 14%. Why so low?
Nowadays, the birth rate in Japan is estimated at 10.3 per 1,000 population, meaning that one woman bears only one child over her lifetime on average. The Japanese Health Ministry estimates that the nation’s total population will fall to 95.2 million by 2050. The aging of Japan is brought about by a combination of low birthrate and longevity.
Now we understand that Japan faces an aging society. Who is going to take care of this quickly growing aging population? Of course, younger people and women! This is the fundamental reason why women are encouraged to work as much as men to support the aging society.
However in Japan, our traditional gender roles that men should work outside and women be good house wives is strongly embedded in our mindset and hard to get rid of.
According to the Gender Gap Index by the World Economic Forum, Japan ranks at 105th near the bottom among 135 countries in terms of gender equality, mainly due to the underrepresentation of women in economic and political leadership.
In the medical area, Japan faces a physician shortage because the number of physicians per 1000 population is 2.2 which is lower than the average of OECD countries, 3.2 per 1000 population. This means, if you reside in a remote area and suppose you have a cancer, it is less likely to find a medical doctor who can treat your cancer in your neighborhood. Hence, Japan needs higher numbers of medical doctors to meet patients’ needs and definitely women medical doctors are expected to work more to take care of patients.
Actually the number of women entering into medicine is increasing and now constitutes 20% of total number of medical doctors. But this value is still low among OECD countries (actually it is lowest) and thus, we need to set up an urgent strategy to improve working conditions for women to work as much as male counterparts and pursue their potentials as well.
Dr. Nomura conducted a surveys of alumnae from 14 medical schools and found that 98% of men worked in full-time positions, but only 70% of women worked in full time positions, and that men work longer hours per week compared to women. In her another survey with colleagues, they also found that many women quit working at the time of life events like marriage and child birth or rearing; the retirement rate from full-time labour was 44％ in 5 yrs and rose up to 85％ in 10 yrs. To make matters worse, once they switched from full-time to part-time positions, only one third of these people will return to full-time work.
As a consequence, women are underrepresented in medicine. We have 80 medical schools in Japan and each has one dean but there are only 2 women and women constitute only 2.6% of full professors in medicine in Japan, which is far behind of USA (19%) and UK (16%).
Dr. Nomura and her colleagues have recently published an article to the international scientific journal “Surgery” in February 2016 and this epidemiological study based on 8,000 surgeons who are members of the Japan Surgical Society demonstrated that married men earn more than unmarried women after adjusting for covariates including working hours; as the number of children increases, annual income increases only for men but decreases for women.
In another study, she also demonstrated that the length of weekly domestic working hours is much longer for unmarried women than for married men and men do not work at home even if they have children (the average household working hours for men is only 3 hours per week).
These findings suggest that Japan’s stereotypical gender role, where men should work outside and women should be housewives still prevails even among highly qualified professionals like medical doctors.
Dr. Nomura has launched a women support center at her University in 2014 and provides various kinds of support to women researchers and physicians including
to provide a nursery for children including sick children
to provide social support like mentorship
to provide various seminars and workshops on research skills
to promote gender equality campaigns
With these efforts, Teikyo University has successfully increased the numbers and percentages of women faculty members. Dr. Nomura concluded by saying “in order to support women, environmental support at the workplace is not enough, but a combination of workplace support with educational intervention and career development works very well.”
Kyoko Nomura, Teikyo University, Profile
MD, Teikyo University School of Medicine, Tokyo, Japan, April 1987-March 1993
Master of Public Health: Quantitative Methods, Harvard School of Public Health, MA02115, USA, June 2001-June 2002
PhD: Dep. of Hygiene and Public Health, Teikyo University School of Medicine , April 1999-March 2003
Associate professor of Dep. of Hygiene and Public Health and Teikyo University School of Medicine, and Teikyo School of Public Health
Director of Teikyo Support Center for women physicians and researchers