Recent years have seen a considerable shift in the sources of financial assistance for global health activities. With the private sector as well as emerging economies joining the more developed nations as major players, the balance of power is changing, leading to a momentous shift in perceptions of "global health." Japan has yet to adopt a comprehensive approach that acknowledges the new global health reality. With political changes, natural disasters, and a sluggish economy dominating the policy scene in recent years, there has been little appetite among decision-makers to develop -- in a practical sense - more effective ways to strategically support global health activities in facilitating a greater impact of Japan's foreign policy. Japan must develop a comprehensive perspective of global health in order to maximize aid effectiveness and to promote transparency in order to boost the overall effectiveness of the country's initiatives and benefit the people of Japan, as well.