Hiroshi Nakajima was director-general of the World Health Organization from 1988 to 1998. He previously served as WHO's regional director for the western Pacific, and as chief of drug policies and management in Geneva, where he was instrumental in developing WHO's essential drugs programme, which serves to increase access to effective medicines, particularly in the developing world. It was an early achievement that he treasured as an important contribution to public health.
Nakajima was born in Chiba, Japan, the eldest of four sons, all of whom became doctors. His father, Ryosuke Nakajima, was the first of a long line of practitioners of traditional herbal medicine (‘kanpo’) to receive a Western medical education. His mother, Junko Nakajima, was one of Japan's early female nurses. Shortly after Nakajima was born, his father completed his paediatric training at Chiba University, and the family returned home to Maebashi, where his parents opened a paediatric clinic (now operating under one of Nakajima's nephews).
During the Second World War, Nakajima's education was interrupted when his junior high school closed and he was mobilised to work in a nearby aircraft factory. The factory ran out of materials and closed in 1944, and he was then admitted to Urawa High School in suburban Tokyo and later to Tokyo Medical College.
As a student he availed himself of free French lessons offered by a French-speaking church, and began to pick up small translation jobs at the French Embassy in Tokyo. This led to his winning a French government fellowship to study at the University of Paris in 1956. He remained in Paris until 1967, working at St Anne's Hospital and INSERM (Institut Nationale de la Santé et de la Recherche Médicale) as a clinical psychiatrist and researcher in psychopharmacology. He studied and worked under Robert Debré, Jean Delay, Pierre Deniker and Jean Thuillier.
In 1967 Nakajima was appointed as research director of Nippon Roche Research Centre, responsible for establishing, recruiting staff and operating the firm's new research laboratory in Japan. He held that position until he was recruited by WHO.
Nakajima's initiatives in executive positions in WHO included: the development of the DOTS (directly observed treatment, short course) strategy for diagnosing and treating tuberculosis; the promotion of artemisinin drugs, long lasting insecticide-treated bed nets and residual household spraying for malaria; the integrated management of childhood illness; programmes on health and the environment; the monitoring and treatment of the health effects of the Chernobyl nuclear accident; the introduction of the first rapid-reaction teams, designed to move quickly into the field at the outbreak of diseases and during humanitarian emergencies; the WHO annual report; enhanced vaccination coverage for children; the eradication of polio from much of the world; the preparatory work for the framework convention on tobacco control; and the establishment of the WHO Kobe Centre, in Japan, which, with its focus on urban health, captured a leading demographic trend in the developing world.
Nakajima was the first Japanese elected to head a UN agency. Throughout his WHO career he received strong support from the Japanese government, whose contributions, both assessed and voluntary, to WHO increased substantially during that period. He led the organisation with a pragmatic, non-ideological approach. His leadership style was not appreciated by some member states, and resulted in some serious challenges. Rather than evaluating the work of WHO under his leadership, criticisms levelled at him were mainly of his leadership and management styles, which reflected the institutional realities of WHO as an intergovernmental agency with a decentralised regional structure. This reality has not changed under his successors.
He considered himself to be the chief technical officer of WHO responsible for choices and transfers of technologies and health care strategies to developing countries, particularly the poorest countries and most underserved population groups. He fully supported the primary health care concept introduced by his predecessor, Halfdan Mahler, but his extensive field experience convinced him that much work needed to be done to implement the concept on the ground. All Nakajima’s initiatives were compatible with primary health care, and have survived and evolved over the 15 years since he retired from WHO.
Once he had left WHO, Nakajima headed a health research institute in Japan until 2002, when he retired to the French countryside near Poitiers. In retirement he was active in the commissions and working groups of the Academié Nationale de Médecine (French National Academy of Medicine) and accepted several invitations for conferences and speeches in Japan, China, Europe and Latin America. Until his last few years, he enjoyed good health and appreciated fine wine and food. By 2010 age-related macular degeneration prevented him from continuing his professional activities. He spent his last winters on the Costa del Sol in Spain and enjoyed visits from friends and family.
He had married Andrée Guillien, an Algerian-born French doctor, in 1962. They had two sons. Guillien died of cancer in 1981, and in 1984 Nakajima married Martha Ann DeWitt, an American foreign service officer, whom he met during his service in WHO's western Pacific regional office in Manila. He was survived by his wife, sons and two grandchildren.
Hiroki Nakatani
[The New York Times 28 January 2013; The Lancet 2013 381(9873) 1178]