Health at a Glance: Asia/Pacific 2012

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27 nov 2012
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This second edition of Health at a Glance Asia/Pacific presents a set of key indicators of health status, the determinants of health, health care resources and utilisation, health care expenditure and financing and health care quality across 27 Asia/Pacific countries and economies.  

Drawing on a wide range of data sources, it builds on the format used in previous editions of Health at a Glance, and gives readers a better understanding of the factors that affect the health of populations and the performance of health systems in these countries and economies.

Each of the indicators is presented in a user-friendly format, consisting of charts illustrating variations across countries and over time, brief descriptive analyses highlighting the major findings conveyed by the data, and a methodological box on the definition of the indicator and any limitations in data comparability. An annex provides additional information on the demographic context in which health systems operate.

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  • Foreword

    Health at a Glance: Asia/Pacific 2012 presents the latest comparable data and trends on key aspects of health and health systems in selected Asia/Pacific countries and economies. The indicators provide a concise and quantitative overview of health status, determinants of health, health care resources and utilization, and health expenditure and financing in the region.

  • Acronyms
  • Introduction

    Health at a Glance: Asia/Pacific presents a set of key indicators on health and health systems for 27 Asia/Pacific countries and economies. It builds on the format used in previous editions of Health at a Glance to present comparable data on health status and its determinants, health care resources and utilisation, health expenditure and financing and health care quality.

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  • Ouvrir / Fermer Cacher / Voir les résumés Health status

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    • Life expectancy at birth

      Life expectancy at birth continues to increase remarkably in Asia/Pacific countries and economies, reflecting sharp reductions in mortality rates at all ages. These gains in longevity can be attributed to a number of factors, including rising living standards and better nutrition, water and sanitation. Improved lifestyles, increased education and greater access to quality health services also play an important role (OECD, 2004).

    • Infant mortality

      Infant mortality, the rate at which babies and children aged less than one year die, reflects the effect of economic and social conditions on the health of mothers and new-borns, as well as the effectiveness of health systems.

    • Under-5 mortality

      The under-5 mortality rate is another sensitive indicator of both the level of child health and the development and well-being of a population. In 1950-55, almost one quarter of all children born worldwide did not reach their fifth birthday. By 1990, this had been lowered to less than one-in-ten. As part of the Millennium Development Goals, the United Nations has set a target of further reducing under-5 mortality by two-thirds between 1990 and 2015 (United Nations, 2012a).

    • Mortality from all causes

      Mortality rates are one of the most common measures of population health. Statistics on important life events such as birth and death remain the most widely available and comparable sources of health information across whole populations, although the coverage, completeness and reliability of these data are problematic for many countries in the Asia/Pacific region. The World Health Organization uses available data and information to derive comparable estimates of mortality and its causes.

    • Mortality from cardiovascular disease

      Cardiovascular disease has long been the leading cause of death in developed countries. In the Asia/Pacific region it has become increasingly prevalent in recent decades, and now accounts for about one third of all deaths. Cardiovascular disease covers a range of diseases related to the circulatory system, including ischaemic heart disease (known as IHD, or heart attack) and cerebrovascular disease (or stroke). Together, IHD and stroke comprise three quarters of all cardiovascular deaths in the 20 Asian countries included here.

    • Mortality from cancer

      Cancer is a leading cause of death worldwide. Cancer was the cause of an estimated 3.6 million deaths (or 13% of total deaths) in Asia/Pacific countries in 2008. Cancer deaths in the region total almost half of all worldwide cancer deaths (Boyle and Levin, 2008).

    • Mortality from injuries

      Injury is a leading cause of death and disability for all age groups, causing around 5 million deaths worldwide each year. Injuries can result from traffic collisions, drowning, poisoning, falls or burns, and violence from assault, self-inflicted acts or war. In the Asia/Pacific region, it is estimated that injuries caused 2.9 million deaths in 2008 (or 10% of total deaths), which constituted more than half of worldwide injury deaths. However, the magnitude of the problem varies considerably across countries by cause, age, sex, and income group.

    • Maternal mortality

      Pregnancy and childbearing offer women opportunities for personal development and fulfilment. But in different countries and to varying extents, it also has inherent risks. Maternal mortality – the death of a woman during pregnancy, childbirth, or in the weeks after delivery – is an important indicator of woman’s health and status. It shows clearly the differences between rich and poor, rural and urban, with the vast majority of deaths occurring in resource-poor settings, and most being preventable (WHO, 2011b). Fertility and maternal mortality have strong associations with economic development and GDP.

    • HIV/AIDS

      Although the first cases of AIDS in Asia were reported in 1984 and 1985, the more extensive spread of HIV began late compared with the rest of the world, occurring in Cambodia, India, Myanmar and Thailand in the early 1990s (Ruxrungtham et al., 2004). But by 2010, 4.8 million people in the region were living with HIV/AIDS, with about half of these in India. In this year alone, there were 360 000 new infections and 310 000 deaths (WHO, UNAIDS and UNICEF, 2011).

    • Tuberculosis

      One of the most widespread infectious diseases in Asia and the Pacific is tuberculosis. About 5.2 million new cases occurred in the region in 2010, and tuberculosis claimed the lives of 630 000 people, more than all other infectious diseases combined (WHO, 2011d). In addition, many cases are undetected and untreated. Over 60% of the world’s burden of tuberculosis (around 7.5 million prevalent cases) is found in the region.

    • Malaria

      Malaria is a disease transmitted by the bites of infected mosquitoes. In the human body, the Plasmodium parasites multiply in the liver, and then infect red blood cells. If left untreated, malaria can become life-threatening by disrupting the blood supply to vital organs.

    • Diabetes

      Diabetes is now one of the most common non-communicable diseases globally. It is a chronic metabolic disease, characterised by high levels of glucose in the blood. It occurs either because the pancreas stops producing the hormone insulin (type 1 diabetes), or through a combination of the pancreas having reduced ability to produce insulin alongside the body being resistant to its action (type 2 diabetes). People with diabetes are at a greater risk of developing serious complications, including cardiovascular diseases, renal failure, foot damage and sight loss.

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  • Ouvrir / Fermer Cacher / Voir les résumés Determinants of health

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    • Reproductive health

      Reproductive health involves having a responsible, satisfying and safe sexual life, along with the freedom to make decisions about reproduction. This includes accessing methods of fertility regulation and appropriate health care services, so as to provide parents with the best chance of having a healthy baby.

    • Low birthweight

      Low birthweight is the result of many factors. In countries where mothers face difficult socioeconomic conditions, poor nutrition and health during pregnancy are closely associated with low birthweight. Occurring from either restricted foetal growth or from pre-term birth, low birthweight infants have a greater risk of poor health or death, need a longer time in hospital after birth and are more likely to develop disabilities (UNICEF and WHO, 2004).

    • Breastfeeding

      Mothers breastfeeding their babies is one of the best ways to ensure child health and survival. Breast milk gives infants the nutrients they need for healthy development, including the antibodies that help protect them from common childhood illnesses such as diarrhoea and pneumonia, the two primary causes of child mortality worldwide. Breastfeeding is also linked with later good health. Adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as lower rates of overweight, obesity and type-2 diabetes.

    • Nutrition

      National development is largely dependent on healthy and well-nourished people. Food security means being able at all times to access sufficient, safe and nutritious food which meets food preferences and dietary needs for an active and healthy life. Yet this basic need is not met for many people in the Asia/Pacific region. Chronic hunger has devastating effects on health and well-being, both now and among future generations.

    • Underweight and overweight

      Poor nutrition, leading to either underweight or overweight, is closely associated with ill health. More than one-third of all deaths worldwide are due to ten main risk factors, and seven of these are related to nutrition (WHO, 2002).

    • Water and sanitation

      Safe water and adequate sanitation are vital to human health and well-being. Their want has serious repercussions for individual health, livelihood and quality of life. Diarrhoeal diseases alone kill almost 2 million people annually, mostly children under the age of 5. Better access to water and sanitation leads to great social and economic benefits, whether through higher educational participation, improved living standards, lower health care costs or a more productive labour force.

    • Tobacco

      Tobacco smoking is a common risk factor for a large number of diseases that cause illness and death, including lung and other cancers, COPD and cardiovascular disease. The global tobacco epidemic is directly responsible for around 12% of adult deaths worldwide, or some 5 million deaths each year, many of which occur in low- and middle-income countries (WHO, 2011h and 2012d).

    • Alcohol

      Although most people enjoy drinking alcohol responsibly, the health burden related to hazardous and harmful alcohol consumption, both in terms of morbidity and mortality, is considerable in many parts of the world. High alcohol intake increases the risk for chronic diseases such as liver cirrhosis, cancers, cardiovascular diseases and injury, and impacts foetal and child development. Drunkenness and alcohol dependence also leads to harmful social consequences, such as drink-driving and violence (WHO, 2011i).

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  • Ouvrir / Fermer Cacher / Voir les résumés Health care resources and utilisation

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    • Doctors and nurses

      Access to high-quality services depends crucially on the size, skill mix, geographic distribution and productivity of the health workforce. Health workers, and in particular doctors and nurses, are the cornerstone of health systems.

    • Consultations with doctors

      Consultations with doctors are an important measure of overall access to health services, since most illnesses can be managed without hospitalisation, and a doctor consultation often precedes an hospital admission. In general, consultation rates tend to be highest in the high and middle-income economies in the Asia/Pacific region, and significantly lower in low-income economies.

    • Hospital beds and average length of stay

      The number of hospital beds provides a measure of the resources available for delivering care to inpatients in hospitals, and is related to overall access to hospital services. In most health systems, hospitals account for the largest part of overall fixed investment, so the supply of hospital beds is also a reflection of past capital investment.

    • Hospital discharges

      Hospital discharge rates are a measure of the number of people who stay overnight in a hospital each year. Together with the average length of stay, they are important indicators of the level and pattern of hospital activities. The discharge rates presented here are not age-standardised, meaning that they do not take into account differences in the age structure of the population in different countries. Hospitalisation rates tend to be higher among elderly people than for younger persons.

    • Pregnancy and birth

      The provision of medical care and counselling during pregnancy and birth is an important determinant of the health of both the mother and the child.

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    • Health expenditure per capita

      Much variation in health spending levels can be observed in Asia/Pacific countries and economies (), ranging from Australia with a total health spending per capita of USD PPP 3 441 to Myanmar with spending of only USD PPP 34. The average OECD health spending per capita in 2010 was around five times that of the Asian economies (3 265 versus 616). In Asia, USD PPP 382 (62% of the total) are from public sources, as compared to USD PPP 2 354 (72.2%) reported in OECD countries.

    • Health expenditure in relation to GDP

      Health expenditure as a percentage of gross domestic product (GDP) in 2010 was 4.5% in the Asian region. This indicator varied from 2% in Myanmar to up to 10.1% in New Zealand (). Generally, the richer a country, the more it spends on health as a percentage of GDP. The percentage of GDP allocated to health across OECD countries is – on average – twice that of the Asian countries and economies (9.5 versus 4.5).

    • Financing of health care

       shows the change in the public share of health financing between 2000 and 2010. On average, the public share of health spending has slightly increased in the Asian countries and economies from 44.4% in 2000 to 46.6% in 2010. This is about the same share as in the United States, but is much lower than the average in OECD countries, where the public sector accounted for 72.2% of financing in 2010, similar to 2000. In Thailand, Brunei Darussalam, and the Solomon Islands, public financing accounted for more than 75% of all health expenditure, while it accounted for less than one third of total health spending in Lao PDR, Nepal and India. Myanmar reported only 12.2% of public health spending in total health spending.

    • Pharmaceutical expenditure

      Per capita pharmaceutical spending varies greatly among Asia-Pacific countries and economies. In 2009, a large number reported spending below USD PPP 60 per capita, with Cambodia, Indonesia, Myanmar and Nepal spending less than 20 USD PPP per capita. On average, OECD countries spend more than three times as much as Asian countries and economies (487 versus USD PPP 136) ().

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  • Ouvrir / Fermer Cacher / Voir les résumés Quality of care

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    • Health care quality: Policy context and measurement

      The measurement and improvement of quality of care has become a crucial element of health system governance worldwide. Industrialised and transition countries alike are developing ways to measure quality of care and improve policies, with reliable measurement seen as a necessary first step in establishing the value of health care, and thus the performance of health care systems (OECD, 2010a). Hence, Health System Performance Assessment, as promoted by WHO, relies heavily on the assessment of quality of health care services. A chapter on quality of care has been published in OECD’s Health at a Glance since 2007. The chapter on quality of care in this 2012 edition of Health at a Glace: Asia/Pacific is the first of its kind, and builds on the indicators used in OECD’s Health Care Quality Indicator programme.

    • In-hospital mortality following acute myocardial infarction and stroke

      Acute myocardial infarction (AMI) and stroke each account for around 3 million deaths a year in the Asia/Pacific region, being two of the major causes of death and disability (WHO, 2008a). Additionally, both are associated with significant health, social and non-financial costs, because of the persistent disabilities suffered by many survivors. Treatment for AMI and stroke has advanced greatly over the past decade. Until the 1990s, treatment focused on prevention of complications and rehabilitation. But following the great improvements in AMI survival rates that were achieved with thrombolysis (Gil et al., 1999), clinical trials also demonstrated the clear benefits of thrombolytic treatment for ischemic stroke (e.g. Mori et al., 1992). Dedicated cardiac care and stroke units offering timely and proactive therapy achieve better survival than conservative care (Seenan et al., 2007), although studies have shown that a considerable number of patients fail to receive high-quality, evidence-based care (Eagle et al., 2005).

    • Mortality from breast, cervical and colorectal cancer

      Breast cancer accounts for around 187 000 deaths per year in the Asia/Pacific region (WHO, 2008b). There are a number of factors that increase risk, such as age, family history, estrogen replacement therapy, alcohol use and others. The promotion of screening mammography and self-examination have led to the detection of the disease at earlier stages. Most OECD countries have adopted breast cancer screening programmes as the most effective way for detecting the disease, although periodicity and population target groups vary.

    • Childhood immunisation programmes

      Childhood vaccination continues to be one of the most cost-effective health policy interventions. Nearly all countries or, in some cases, sub-national jurisdictions have established vaccination programmes based on their interpretation of the risks and benefits of each vaccine. Coverage of these programmes can be considered as a quality of care indicator. Pertussis, measles and hepatitis B are taken here as examples as they represent, in timing and frequency of vaccination, the full spectrum of organisational challenges related to childhood vaccination.

    • Measuring mental health care quality

      The burden of mental illness is substantial, both in the Asia/Pacific region and beyond. According to WHO’s most recent estimates (WHO, 2008b), depression is the second leading cause of disease in the Western Pacific region, accounting for 15.2 million lost disability adjusted life years (DALYs) per year, and second only to stroke. In the Southeast Asia region, depression is the fourth leading cause of diseases, accounting for 21.1 million DALYs per year. A broader sweep which includes unipolar and bipolar affective disorders, schizophrenia, alcohol and drug use disorders, post-traumatic stress disorder, obsessive-compulsive disorder and panic disorder totals 36.6 million DALYs per year in the Western Pacific region and 39.5 million in the Southeast Asia region.

    • Quality of care initiatives in the Asia/Pacific region

      Since 2009, Bangladesh has been implementing a broad array of digital services to improve the accessibility and quality of its health care. The Ministry of Health and Family Welfare now runs a digital District Health Information System connecting all health facilities, down to sub-district level (about 800 in total). Facilities can upload data directly to the repository, allowing tables and charts of service data or population health status to be quickly created at facility, regional or national level. Comparison of data between time periods and geographic locations is possible, supporting evidence-based policy making. Expansion continues down to grassroots level, with a target to reach all rural 18 000 community clinics by end of 2013.

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