Background
 In recent global health developments, attention has focused on health system strengthening (HSS). Behind this move is the realization that HSS is essential for the development of sustainable and effective health care activities required to meet UN Millennium Development Goals and eradicate poverty. Since the publication of the World Health Report (WHR) 2000, the World Health Organization (WHO) has made intensive efforts to promote HSS.
Progress
 This paper descibes recent global activities for HSS, based on official WHO documents and related issues, along with the following three phases: publication of the WHR 2000, follow up of feedback on the WHR 2000, and global trends for HSS after publication of the WHR 2003. In particular, we shall clarify progress made after the year 2003 with regards to policy, implementation, and scientific methodology. For policy, the principle of Primary Health Care has been introduced to HSS, and the participation of international agencies has been promoted. With regards to practice, training a health care workforce and financial assistance from global funds are addressed. Finally, for scientific methodology, we refer to instances such as the development of the WHO framework for health systems, the promotion of evidence-based health research, and strengthening of health information systems.
Conclusion
 To make vertical health care programmes for acute care, infectious diseases and chronic illnesse etc. more effective, HSS as the lateral foundation is an urgent global health care issue. It is surely necessary that Japan's basic strategy for supporting HSS is clarified as well as attempts to introduce concrete components for HSS into bilateral cooperation and NGO programmes.

BACKGROUND: Although fat accumulation in human organs is associated with a variety of diseases, there is little evidence about the effect of a fatty pancreas on the development of subclinical chronic pancreatitis over the clinical course. METHODS: We conducted a prospective cohort study from 2008 to 2014 of patients who underwent a medical checkup consultation for fat accumulated in the pancreas. Patients included in the analysis were divided into a non-fatty pancreas group (n = 9710) and fatty pancreas group (n = 223). The primary end point was the odds ratio (OR) for chronic pancreatitis associated with fatty pancreas, which was diagnosed using ultrasonography. We used a multiple logistic regression model to estimate the OR and the corresponding 95% confidence interval (CI). RESULTS: Ninety-two people were diagnosed with chronic pancreatitis, including both presumptive and definitive diagnoses. Twelve people were diagnosed with chronic pancreatitis by ultrasonography among the 223 patients with fatty pancreas, and 80 patients among 9710 were diagnosed with non-fatty pancreas. The crude OR was 6.85 (95% CI 3.68, 12.75), and the multiple adjusted OR was 3.96 (95% CI 2.04, 7.66). CONCLUSIONS Fat accumulation in the pancreas could be a risk factor for developing subclinical chronic pancreatitis.
Adipose Tissue ; diagnostic imaging ; pathology ; Adult ; Alcohol Drinking ; epidemiology ; Female ; Humans ; Japan ; epidemiology ; Life Style ; Logistic Models ; Male ; Middle Aged ; Pancreas ; diagnostic imaging ; pathology ; Pancreatitis, Chronic ; diagnosis ; epidemiology ; etiology ; Physical Examination ; Prospective Studies ; Risk Factors ; Smoking ; epidemiology