What are the emerging health threats in Asia? Can you give us statistics of these diseases country wise? What is the impact of these diseases on the economies?
 |
| Professor John Wong |
Asia’s health threats span the entire spectrum from those associated with poverty and poor maternal, child, and public health, to those associated with urbanisation and increasing affluence. The emerging health threats are those associated with the latter – with a rapid rise in chronic non-communicable diseases such as hypertension, diabetes, cardiovascular and cerebrovascular disease, and cancer. Infectious diseases remain a constant threat exacerbated by urbanization, unsafe animal husbandry, and climate change, with spread accelerated by burgeoning air travel in the region. The spectrum of diseases in developed parts of Asia, such as Singapore, is best captured by Disability Adjusted Life Years (DALYs) – a measure of overall disease burden expressed as the number of years lost due to ill-health, disability or early death.
Alternatively, one can look at the leading causes of death in the following Asian countries:
| Cause Of Death | Rank | Deaths |
| Coronary Heart Disease | 1 |
1,416,858
|
| Diarrhoeal diseases | 2 |
1,231,478
|
| Lung Disease | 3 |
1,122,417
|
| Stroke | 4 |
940,052
|
| Influenza & Pneumonia | 5 |
760,422
|
| Tuberculosis | 6 |
317,108
|
| Low Birth Weight | 7 |
279,828
|
| Suicide | 8 |
243,661
|
| Liver Disease | 9 |
236,053
|
| Road Traffic Accidents | 10 |
223,524
|
India (WHO, 2009)
Thailand (Porapakkham Y, Rao C, Pattaraarchachai J et al, 2010)
 |
|
Total Disability Adjusted Life Years in 2007 = 393,229
|
We notice a huge shift (from infectious diseases) towards chronic diseases and disability during the recent years, especially in Asia. This is largely due to the change in lifestyle – one comprising little exercise and a diet of processed food as well as many taking up smoking. This has led to the rise in high blood pressure and diabetes which are all direct causes and risk factors for chronic diseases.
The rise of chronic diseases will deprive individuals and thus, countries, of their health and their ability to reach their full productive potential because the quantity and quality of the workforce is reduced. Countries could also increasingly be faced with the challenge of financing healthcare as their population age and become more burdened with diseases.
Conferences such as the World Health Summit Regional Meeting – Asia, that will be held in Singapore in April, are now becoming critical for countries to come together to address the growing tide of chronic diseases and what can be done to stem and manage the issues facing Asia.
| Males | Females | ||
| Cause of Death | % of Deaths | Cause of Death | % of Deaths |
| HIV/AIDS |
22.6
|
HIV/AIDS |
30.7
|
| Road traffic accidents |
19.0
|
Road traffic accidents |
6.5
|
| Cirrhosis of the liver |
6.6
|
Cervix cancer |
5.8
|
| Suicide |
5.7
|
Stroke |
4.1
|
| Homicide |
4.8
|
Diabetes mellitus |
3.6
|
| Stroke |
3.9
|
Suicide |
3.3
|
| Liver cancer |
3.2
|
Cirrhosis of the liver |
3.0
|
| Ischaemic heart disease |
2.7
|
Liver cancer |
2.9
|
| Drowning |
2.3
|
Breast cancer |
2.8
|
| Lower respiratory infections |
1.9
|
Nephritis and nephrosis |
2.5
|
| Other causes |
27.3
|
Other causes |
34.9
|
| Total (N) |
83,419
|
Total (N) |
36,503
|
What are the challenges faced by governments and healthcare providers in managing these health threats?
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| Professor K Srinath Reddy |
There are several, ranging from educating the public and changing behaviour, having individuals take responsibility for their own health, and governments and healthcare providers being able to provide equitable, accessible, affordable, quality healthcare. There is a need for good governance, appropriate legal and regulatory frameworks to develop and enforce public health measures, the capacity to monitor and respond to changing patterns and determinants of disease, the ability to determine outcomes and cost of healthcare delivery, and having sufficient quantity and quality of healthcare providers.
What strategies do you suggest to improve health in Asian countries? What should be the role of both government and private sector, in improving a country’s healthcare system?
Some of the best strategies revolve around preventive medicine and public health. Good sanitation with clean drinking water and proper disposal of sewage and industrial waste, vaccinations, tobacco control, good maternal and child health, universal education and literacy, proper animal husbandry, and meaningful, safe employment will go a long way to improving health in Asia.
Similarly, investment in developing solutions to the problems faced by individual societies will result in greater innovation and ensuring relevance to any work that is done.
Both governments and the private sector need to be fully engaged for this to be effective – no government or organisation can do this on their own. For instance, governments and the private sector can look at working in concert to help people change their mindsets about living healthy lifestyles.
You are involved in hosting the World Health Summit Regional Meeting – Asia (WHSRMA) in April. What are the highlights of this summit? Any special announcement to be made during the summit or is there any imitative to be launch at the WHSRMA?
Some of the highlights include the opening address from Singapore’s Prime Minister, Lee Hsien Loong, keynote lectures, an industry leaders roundtable, a ministerial panel discussion, and a stellar faculty of key opinion leaders from around the world whom the audience can interact with during the various sessions.
We plan to issue a statement from the M8 Alliance of academic health centres and medical universities summarising key healthcare issues affecting the region and providing integrated action points for delegates to take home.
Tell us about summit’s theme ‘Health for Sustainable Development in Asia’?
The summit will focus on four sub-themes:
- The impact of health on Asian economies
- Innovations in health in Asia which may change healthcare delivery, prevention and treatment
- Financing healthcare in Asia – What is and is not working in Asia
- Emerging health threats in Asia – Infectious diseases, impact of climate change, and increasing incidence of chronic non-communicable disease
Speaking on the Indian context, Prof Reddy explains…
Where does the Indian healthcare sector stand on the global map?
India’s healthcare system represents a mix of the outstanding and the dismal. While there are some world class hospitals in both public and private sectors, which the urban population (especially the rich) can access in large cities, much of the rural population has poor access to high quality health services. There is also considerable disparity among the states, with southern states like Kerala and Tamil Nadu performing far better than central and northern states like Madhya Pradesh and Uttar Pradesh. Apart from inequities in access and wide variations in quality, there are also financial barriers, with high levels of out of pocket spending and impoverishment resulting from the unaffordable costs of healthcare. The contrast of hospitals vying for medical tourism in the cities and with high levels of maternal mortality in the villages sums up the paradox of India’s health system.
How can India promote better health policies?
India should increase the level of public financing of health (from one per cent GDP at present to at least 2.5 per cent) in the near term and spend 70 per cent of the health budget on rural and urban primary healthcare. It needs to progressively advance Universal Health Coverage (UHC), beginning with an essential package of primary and secondary services funded through tax based financing and provided through cashless services. It should rapidly expand the health work force, prioritising the development and deployment of technology enabled non-physician providers of primary healthcare. It should also establish effective regulatory systems that establish and monitor the quality, cost and equity dimensions of healthcare. Community participants too should be proactively promoted. Even as health services are being strengthened and expanded, other sectors such as water, sanitation, nutrition, education, environment and urban development must be engaged to improve the social determinants of health.
Suggest some sustainable healthcare financing strategies adopted in Singapore which can be duplicated in India?
Singapore has achieved a remarkably high level of healthcare through investments in health promotion and high quality healthcare services. Its universal health coverage draws on public and private financing, while keeping the out of pocket expenditure low. Innovative schemes such as the Medisave account provide for flexible, need based spending without the risk of catastrophic expenditure. Although medical saving accounts (MSA) addresses the issue of prepayment, absence of risk-pooling is still a major cause for worry, but in a country with high formal sector, this may not be significant challenge. While India’s economic level and size will require it to devise its own framework of health financing for universal health coverage, Singapore’s example of prioritising public financing for health promotion and primary healthcare are exemplary.
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