Written by Pedram Lalla.
That Asia and the Pacific now represent over a third of global GDP is well known. From the layman’s perspective, one may thus expect their healthcare narrative to rival the successes of its well-documented western counterparts. Whether they actually have, however, is a source of much debate.
While exploring any of a wide array of statistical analyses of healthcare data goes well beyond the scope of this article, there are several salient points that must be noted. Playing a pure numbers game, we can ascertain that Asia’s average life expectancy at birth (the most common global health indicator) as of 2015 is 71 years for males and 74 for females. Oceania fares better with 75 for males and 80 for females, placing them alongside Europe and North America as the highest worldwide. One may wonder why Asia appears to lag so far behind the others, despite possessing four of the world’s twelve largest economies.
Quite simply, it becomes a matter of perspective. Do we look at absolute numbers or relative improvement? While at a continental level Asia and the Pacific match the economies of Europe and North America, the GDP per capita remains lower. There is a well-known correlation between socio-economic status and health outcomes, so it comes as little surprise that within Asia, and in fact the broader world, countries with a lower GDP trend to lower life expectancies (as well as poor performance on other health indicators).
Of equal relevance, though, and unique to Asia and the Pacific, is the rate at which their economy grew. While the industrial revolution took place over the course of a century or more in what is roughly now considered the modern western world, Asia’s economic transformation has occurred in the space of mere decades. This has left many of their countries in a precarious position along the epidemiologic transition, a theory posited by Abdul Omran in 1971 and widely accepted by public health specialists worldwide. This transition is said to occur when a country undergoes the process of modernisation from developing nation to developed nation status. Improvements in, and increased access to, healthcare and medicine, together with upgraded public health and sanitation, results in a shift from infectious diseases to chronic and degenerative diseases. These improvements are a direct consequence of a bolstered economy and were thus seen at a much more rapid pace in the higher income countries. The likes of Singapore, Hong Kong and South Korea have made a clear shift from communicable to non-communicable diseases, which has seen the need for a concurrent shift in health policy to tackle these new disorders. On the other hand, lower and middle-income countries such as India have been caught in the middle and now face a ‘double burden.’ HIV remains relatively prevalent in several South-east Asian countries, while Tuberculosis incidence has risen in parts of Central and West Asia.
Of course, there are exceptions, and this article serves to give only a broad overview of some of the major factors at play. Vietnam and Japan have higher, and Brunei and Malaysia have lower life expectancies than would be predicted by their GDP per capita alone. High obesity rates, previously considered synonymous with the western developed world, have crept their way into lower and middle-income countries in the region; Pacific Island countries are demonstrating particularly alarming rates of this disorder.
On the other hand, while present day absolute numbers of health indicators may often seem poor in comparison to North America and Europe, there is much for Asia and the Pacific to be proud of. At a continental level, life expectancy at birth in 22 Asian countries has been estimated to have increased by 15 years since 1970 (excluding OECD member states Australia, Japan, New Zealand and South Korea), comparing favourably to a 10-year increase among OECD economies in the same timeframe. Similarly, maternal mortality and infant mortality rates, two crucial health indicators, have halved in the space of 20-30 years. This provides much hope going forward while emphasising the need for continued strides to be made.
Until recently, however, there have been no successful unifying healthcare committees to oversee and assist in promoting evidence-based health system policies. It is insufficient to paint the region with a broad brush, as there exists significant diversity between economies and their citizens. Collection and standardisation of data, for example, is difficult to find in the lower income countries. Health inequalities are also very prevalent, with India being a prominent example where children in the poorest 20 per cent of the population are three times more likely to die before their fifth birthday than those in the richest 20 per cent.
Launched in 2011, the Asia Pacific Observatory on Health Systems and Policies (the APO) hosted by the World Health Organisation has sought to begin correcting deficiencies among partnership countries and organisations. They have improved collaboration among all stakeholders and developed and strengthened capacity for research, both at individual country and regional levels, while also assisting in policy formation and implementation. Partnerships such as these can only be positive and help effect progression, which despite the vast improvements made in the last few decades, is undoubtedly necessary.
Dr. Pedram Lalla (M.B.B.S.) is pursuing his MSc in Public Health at the London School of Hygiene and Tropical Medicine, University of London and his M.D. at the University of West Indies. Photo Credit: CC by Health Asia/Flickr