With ageing populations and the health effects of rapid urbanisation, the Asian century faces huge challenges in health reform, writes Tan Chorh Chuan.
Healthcare reform is one of Asia’s greatest challenges but also one of its greatest opportunities. Asia is a vast heterogeneous region, and includes countries with varying systems of politics and governance, and at different phases of economic development. Health priorities and needs, and capacity to deliver good healthcare, differ markedly. Even within huge Asian countries such as China and India, regional health indices may vary greatly.
There are several salient trends shaping the health landscape of Asia in the coming decades. The first is urbanisation, which is happening at an unprecedented pace and scale. Rapid economic growth has resulted in rapid social changes – in lifestyles, diet, education and family structures – and created widening income gaps and inequalities that hinder access of some segments of the population to medical services.
Across Asia, too, total fertility rates are falling quickly – already well below replacement in several countries including Japan, Korea, Singapore, China and Thailand. Only India, Cambodia, Laos and Philippines have total fertility rates greater than three.
At the same time, several Asian countries, notably Japan, Korea, Hong Kong, Singapore and China are ageing at an unprecedented pace. As early as 2025 the proportion of the population in Japan, China and Singapore who are 65 years or older will be 29.5 percent, 13.7 percent and 22.8 percent respectively. This rapid demographic transition has many serious and wide-ranging ramifications including much higher projected demands on medical services.
There are also large nutritional and dietary shifts, with Asian countries experiencing a very rapid transition from the high-carbohydrate, low-fat diets of the past, to diets that are now high in fats, cholesterol, and sugar and other refined carbohydrates.
Together with the adoption of sedentary lifestyles associated with urbanisation, such diets are fuelling an epidemic of obesity.
All these, and other, interacting factors have resulted in accelerated demographic, nutritional, epidemiological as well as healthcare system transitions throughout Asia.
All parts of Asia are experiencing a high and rising burden of chronic Non- Communicable Diseases (NCDs), but for the developing countries in Asia, this is occurring against a backdrop of a persistently high burden of Communicable Diseases (CDs).
There will also be supply-side driven increases in healthcare requirements. High-technology treatments and expensive drugs are important factors in high-income countries and will become increasingly relevant in low and mid-income economies as well.
Strong economic growth will enable Asian countries to devote more resources to their health sectors. But a crucial question is how best these new resources can be deployed to achieve good health outcomes in a sustainable manner, while being responsive to major changes in disease burden for the future.
Despite these complex trends and challenges, I believe there are three approaches that offer appealing opportunities for Asia to adopt a “leap-frogging” approach.
First, we need to give very high priority to health promotion and disease prevention. Most healthcare systems are still largely centred around clinical medicine – that is, treatment of diseases in individual patients. However, the massive increases in NCDs together with conditions associated with ageing will result in a huge burden of disease and advanced medical complications, which will overwhelm even the most well-resourced health systems.
It is therefore crucial that we adopt a public health approach that strives to improve health and prevent disease at the population-level, as this will yield the greatest payoffs in the longer-term.
Since the development of NCDs, and many CDs, is associated with unhealthy lifestyles and behaviours, arguably the most crucial issue is to better understand how to change behaviours towards more healthy ones, as
well as towards improved treatment compliance.
Financing and reimbursement policies for providers can provide powerful incentives for hospitals and healthcare institutions to strongly support and drive disease prevention.
We also need to pilot new delivery models. These models should focus on human capital innovation and technology, to reduce the intensity of specialist requirements.
“Mobile-health”, that is the use of mobile phones, the internet and other forms of technology to enhance or improve health delivery and services, would appear to hold much promise as a means of accomplishing this, with initiatives already for diabetes, chronic obstructive pulmonary disease and chronic heart failure, and for mobile patient monitoring for NCDs.
The challenges of a full-scale implementation of “mHealth” are substantial; nevertheless, the potential for such innovations in Asia is vast, particularly in rapidly emerging countries where there are still substantial unmet healthcare needs, increased resources to be invested in advancing health, and fewer entrenched infrastructure and labour practices which would impede implementation.
There are now particularly exciting opportunities to develop treatments and approaches appropriate to Asian populations because Asian countries have dramatically increased their biomedical science R&D budgets, and Asia’s research output in terms of journal publications has, as a consequence, risen very sharply.
If regional countries could work synergistically together towards these goals, we have the collective opportunity to shape the health and wealth of Asia well, for the 21st century.
*Professor Tan Chorh Chuan is president of the National University of Singapore and deputy chairman of Singapore’s Agency for Science, Technology & Research. This edited article first appeared as part of
the Asialink Essay series and is adapted from Professor Tan’s John Yu oration for the George Institute inSydney.
**View the full Asialink Essays series free online at www.asialink.unimelb.edu.au/essays