Health in the Asia Pacific in 2050: Challenges and Recommendation

Nowadays, Asia Pacific countries are in different stage of economic development as well as its health status. Some countries are still fighting with high maternal mortality rate while other countries have succeeded in declining it. Condition of health system also varies in Asia Pacific countries. For some countries, especially low middle income country, outreach of adequate basic health are still become the challenges while for other countries resources allocation and public private intervention are the main issue.1 However among these countries, there are similar specific health issue which become emerging case in Asia Pacific. By 2050, Asia Pacific will be home to most of the worlds elderly people. About 998 million people aged 60 and above will be living in Asia Pacific by 2050. US census bureau predict that Singapore will be the most dramatic in proportion of the population over age 50 which is set to increase from 23% to 50% over the next 25 years.2 By 2050, outdoor air pollution (particulate matter and ground level ozone) is projected to become the top cause of environment related deaths worldwide based on OECD Environmental Outlook Baseline.3 WHO Air Quality Guideline reported that air pollution concentrations in Asia are already above acceptable health standards. These two issues in Asia Pacific, aging population and outdoor air pollution contributed to another challenge that is being faced and will continue to be a bigger challenge in the future of this region, non-communicable disease (NCD). Of the 57 million global deaths in 2008, 36 million, or 63%, were due to NCDs.4 NCDs in Asia Pacific has known to be major killer since 2002. About 60.1% of deaths due to diseases in Asia Pacific caused by NCDs while communicable diseases are accounted for only 29.9%. As widely understood that Non-Communicable Diseases will be continue to rise due to increasing life expectancy, future Asia Pacific which will host most of aging population in

the world will probably fighting with highest NCDs burden among other regions. Not to mention, outdoor air pollution which is higher than the acceptable amount in some Asia Pacific countries will also contributed to increasing death of NCDs. Diseases like Chronic Obstructive Pulmonary Disease (COPD) and cancer are example of NCDs which highly correlated with it. Therefore integrated action from government along with private sector and society will need to be done to cut these toxic combinations. First thing that should be done is reforming health system. Government has primary responsibility in ensuring good public health by its role as the lawmaker and the caretaker of people.1 However it doesnt mean that the government should act alone in this matter. Health care can be delivered hand to hand by government and private sector to make sure more people can be reached. Good example is what happens in Malaysia with their pragmatic approach towards the development of public health service. Other problem in health delivery is its inequity between rural and uraban are. For most countries, rural population is dominating the urban population whereas the availability of health care in rural area is less than urban area. India has developed a good rural health system due to this matter. Outreaching rural residents by employing a social worker from its own community named ASHA (accredited social health activist) and building a community health center has succeeded specifically to increase number of attended delivery to 95%.5 Indias rural health system concept can be applied in other country to reach rural community especially in NCDs matter. Many of this aging population in rural area are asymptomatically suffered from hypertension or diabetes without seeking any help. Therefore by having a health activist in their area to bridge them with health care providers will be beneficial. Second thing that should be highlighted in providing better care for future Asia Pacific is increasing physician to population ratios as well as their quality. Countries like

Indonesia, Cambodia, Bhutan, Bangladesh have very low physician to population ratio raging from 16 to 29 physicians per 100,000 while other Asia Pacific country have sufficient ratios.1 Medical doctor training also need to be shifted from urban oriented into more rural oriented. Most of medical student are studying in tertiary hospital with modern tools to help diagnosis. However general practitioners are expected to serve in primary health care with limited tools and devices. The result of it would be unconfident of the graduated medical student in diagnosing illness and prescribing drug. Study by WHO SEARO showed that two thirds of the fresh graduate felt that their skill in medicine needed improvement for them to operate independently.5 Thus, medical curricula should be formed as it is needed, rural oriented and community based. Thirdly, government should corporating health sector policy with other sector policy such as transportation and industry. As it mentioned above, outdoor air pollution is predicted to continuously rose in Asia Pacific and will contributed in adding more suffering in NCDs. Therefore, action in reforming transportation and regulate a better industry arrangement are needed. New York City has started its way in fighting NCDs by regulating a better transportation system. The Department of Transportation of New York City has refined public transportation and increased parking fee to encourage more people to use public transportation than taking their private car. The size of the sidewalk also has been widen to make people comfortable in walking.6 By promoting public transportation, the city will be able to curb the outdoor air pollution and by widening sidewalk, many people will choose to walk which is beneficial for their health as it will increase their physical activity. As widely known, lack of physical activity is one of the major risk factor of NCDs. From now on, every country of Asia Pacific should be getting ready for future health burden and preparing their fight for it. Unless serious action is taken, the burden of aging

population, air pollution and NCDs will reach levels that are beyond the capacity of all stakeholders to manage. Reforming health system and medical education as well as incorporating health policy with other sector policy are suggested to be started from today.

Reference: 1. Bandara A. Emerging health issues in asia and the pacific: implication for public health policy. Asia Pacific Development Journal. December 2005; 12(2). 2. Watson W. Ageing workforce 2006 report: Asia Pacific [internet]. Available from: watsonwyatt.com 3. Organisation for Economic Co-Operation and Development. Environment outlook to 2050: the consequences of inaction. 2012. 4. World Health Organization. Executive Summary: Global report. 2010. 5. Kishore J. National Health Programs of India: National Policies & Legislation Related to Health. 8th Edition. 2009. New Delhi: Century Publications. 6. Rozes M. Launch of wellness week in the americas. In: PAHOs Director Newsletter. 2011; 12.