Health at a Glance: Asia/Pacific

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ISSN: 
2305-4964 (online)
ISSN: 
2305-4956 (print)
http://dx.doi.org/10.1787/23054964
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These comprehensive volumes of key indicators, published every two years, provide data on 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.

 
Health at a Glance: Asia/Pacific 2016

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Health at a Glance: Asia/Pacific 2016

Measuring Progress towards Universal Health Coverage You or your institution have access to this content

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Author(s):
OECD, WHO
23 Nov 2016
Pages:
120
ISBN:
9789264264755 (PDF) ; 9789264267671 (EPUB) ;9789264264724(print)
http://dx.doi.org/10.1787/health_glance_ap-2016-en

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This fourth 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.
This edition is a joint OECD, WHO/WPRO and WHO/SEARO publication.

 

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  • Foreword

    More than ever, effective and well-targeted data and indicators of health and health care are essential to help policy makers assessing the quality of care and strengthen efforts to improve the performance of health systems across the Asia-Pacific region.

  • Executive summary

    Health at a Glance: Asia-Pacific 2016 presents key indicators on health status, determinants of health, health care resources and utilisation, health expenditure and financing, and quality of care for 27 Asia-Pacific countries and economies. Countries in the Asia-Pacific region are diverse, and their health issues and health systems often differ. However, these indicators provide a concise overview of the progress of countries towards achieving universal health coverage for their population.

  • 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.

  • Acronyms and abbreviations
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  • Expand / Collapse Hide / Show all Abstracts Health status

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    • Life expectancy at birth

      Life expectancy at birth continues to increase remarkably in Asia-Pacific countries, reflecting sharp reductions in mortality rates at all ages, particularly among infants and children (UNESCAP, 2014; see indicators Infant mortality and Under age 5 mortality in ). These gains in longevity can be attributed to a number of factors, including rising living standards, better nutrition and improved drinking water and sanitation facilities (see indicator Water and sanitation in ). Improved lifestyles, increased education and greater access to quality health services also play an important role (National Institute on Ageing, National Institute of Health and the World Health Organization, 2011).

    • Infant mortality

      Infant mortality, deaths in children aged less than one year, reflects the effect of economic, social and environmental conditions on the health of mothers and infants, as well as the effectiveness of health systems.

    • Under age 5 mortality

      The under age 5 mortality rate is an indicator of child health as well as the overall development and well-being of a population. As part of their Sustainable Development Goals, the United Nations has set a target of reducing under age 5 mortality to at least as low as 25 per 1 000 live births by 2030 (United Nations, 2015).

    • Mortality from all causes

      The burden from non-communicable diseases among adults – the most economically productive age group – is rapidly increasing in the Asia-Pacific region. Increasing development in countries is bringing an epidemiological transition, whereby early deaths are replaced by late deaths, and communicable diseases by non-communicable diseases (WHO, 2014h). The level of adult mortality, all-cause mortality for the population and cause of death are important for identifying the country’s public health priorities and assessing the effectiveness of a country’s health system.

    • Mortality from cardiovascular disease

      Cardiovascular disease (CVD) is the leading cause of death in the Asia-Pacific region, although highly preventable. CVD was the cause of an estimated 9.1 million deaths in SEARO and WPRO and accounted for about one-third of all deaths in 2012 (WHO, 2014h).

    • Mortality from cancer

      Cancer is the second leading cause of death after CVD in the Asia-Pacific region. Cancer was the cause of an estimated 4.1 million deaths (or 14% of total deaths) in Asia-Pacific countries in 2012 (WHO, 2014h).

    • Mortality from injuries

      Injuries are a leading cause of death and disability for all age groups and took 2.6 million lives in 2012 in the Asia-Pacific region, accounting for 9.6% of all deaths. Injuries can result from traffic collisions, drowning, poisoning, falls or burns, and violence from assault, self-inflicted or acts or war. Injuries are the leading cause of death for those aged 5-49 in SEARO (29% of deaths from all causes) and WPRO (30.9% of deaths from all causes) (WHO, 2014h). The magnitude of the problem varies considerably across countries by cause, age, sex, and income group. But injury deaths, both intentional and unintentional, are largely preventable events.

    • Maternal mortality

      Pregnancy and childbearing, whilst offering women opportunities for personal development and fulfilment, also present inherent risks. Maternal mortality – the death of a woman during pregnancy, childbirth, or within 42 days of the termination of pregnancy – is an important indicator of a woman’s health status. The Sustainable Development Goals set a target of reducing the global maternal mortality ratio to less than 70 per 100 000 live births by 2030.

    • Tuberculosis

      Tuberculosis (TB) is the leading cause of death from an infectious disease in the Asia-Pacific region. In 2014, there were 9.7 million new TB cases worldwide, 1.5 million including people with HIV died of TB globally. One third of new cases and one fourth of deaths were estimated in India and Indonesia alone. Most of these TB cases and deaths occur disproportionately among men, but the burden of disease among women is also high as it remains among the top three killers for them in the world. Most cases of TB are preventable if diagnosed and the right treatment is provided.

    • HIV/AIDS

      Although the first cases of AIDS in Asia were reported mid-1980s, 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). Asia is second only to sub-Saharan Africa as the region with the greatest number of people living with HIV. The UN set a SDG target to end the epidemic of AIDS as a public threat by 2030.

    • Malaria

      Malaria is a tropical disease caused by a parasite transmitted by the bites of infected female Anopheles mosquitoes. After a period spent in the liver, malaria parasites multiply within red blood cells, causing symptoms such as fever, headache and vomiting. Malaria is preventable and curable, although no vaccine currently exists (a vaccine against falciparum is currently being trialed in Africa though). But if left untreated, malaria can become life-threatening by disrupting the blood supply to vital organs.

    • Diabetes

      Diabetes is a chronic metabolic disease, characterised by high levels of glucose in the blood. It occurs either because the pancreas does not produce sufficient amounts of the hormone insulin, which regulates blood glucose, or through reduced ability to respond to insulin (i.e. insulin resistance). People with diabetes are at a greater risk of developing cardiovascular diseases such as heart attack and stroke. They also have elevated risks for vision loss, foot and leg amputation due to damage to nerves and blood vessels, and renal failure requiring dialysis or transplantation.

    • Ageing

      Population ageing is characterised by a rise in the share of the older people resulting from longer life expectancy (see indicator Life expectancy at birth in ) and declining fertility rates (OECD, 2011; UNESCAP, 2013). In Asian countries, since 2000, life expectancy has increased by about 4.5 years and fertility has decreased from 2.6 children per woman of reproductive age, to the population replacement level of 2.1. This has been mainly due to better access to reproductive health care, primarily a wider use of contraceptives (see indicator Reproductive health in ). Population ageing reflects the success of health and development policies over the last few decades.

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  • Expand / Collapse Hide / Show all Abstracts Determinants of health

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    • Family planning

      The UN Sustainable Development Goals set a target of ensuring universal access to reproductive health care services by 2030, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

    • Preterm birth and low birth weight

      Preterm birth (i.e. before 37 completed weeks of gestation) is the leading cause of neonatal death (i.e. during the first four weeks of life or days 0-27) and the second leading cause of death in children under 5 (see indicator Under age 5 mortality in ). Many survivors of preterm births also face a lifetime of disability, including learning disabilities and visual and hearing problems. But preterm birth can be largely prevented. Three-quarters of deaths associated with preterm birth can be saved without intensive care facilities. Current cost-effective interventions include warmth (skin to skin contact within the first minute of birth), kangaroo mother care and early initiation of breastfeeding (within the first hour of birth) and basic care for infections and breathing difficulties (WHO, 2013d; see indicator Infant mortality in ). Preterm birth rates can be also reduced if women, particularly adolescents, have better access to family planning and increased empowerment, as well as improved care during pregnancies (see indicator Reproductive health in ).

    • Infant and young child feeding

      Optimal feeding practices of infants and young children can increase their chances of survival. They play an important role for healthy growth and development, decrease rates of stunting and obesity and stimulate intellectual development (Victora et al., 2016).

    • Child malnutrition (including undernutrition and overweight)

      National development is largely dependent on healthy and well-nourished people, but many children are not able at all times to access sufficient, safe, nutritious food and a balanced diet that meets their needs for optimal growth and development, an active and healthy life. Undernutrition is an important determinant of poor child health and is estimated to contribute to more than one-third of all child deaths worldwide, although it is rarely listed as a direct cause. Child malnutrition also predicts poorer cognitive and educational outcomes in later childhood and adolescence and has important education and economic consequences at the individual, household and community levels. Children who are overweight or obese are at greater risk of poor health and reduced quality of life not only in adolescence, but also in adulthood.

    • Overweight and obese adults

      Globally, overweight and obesity is a major public health concern, and there are more overweight or obese than underweight adults. In 2014, 39% of adults aged 18 years and older (38% of men and 40% of women) were overweight, while 11% of men and 15% of women aged 18 years and older were obese (WHO, 2014j). Obesity is a known risk factor for numerous health problems, including hypertension, high cholesterol, diabetes, cardiovascular diseases, respiratory problems (asthma), musculoskeletal diseases (arthritis) and some forms of cancer, and mortality also increases progressively once the overweight threshold is crossed (Sassi, 2010). Social determinants of health such as poverty, inadequate water and sanitation, and inequitable access to education and health services underlie malnutrition. A key driver of the increasing obesity epidemic is a changing food environment, in which nutrient poor and energy dense processed foods are aggressively marketed, readily available and often cheaper than healthier alternatives.

    • Water and sanitation

      Safe water and adequate sanitation are vital to individual health, livelihood and well-being. Exposure to diarrhoea-causing agents is frequently related to the use of contaminated water and to unhygienic practices in food preparation and disposal of excreta. Globally, diarrhoeal diseases are responsible for the deaths of 1.8 million people every year (WHO, 2004). It was estimated that 88% of that burden is attributable to unsafe water supply, sanitation and hygiene and is mostly concentrated on children in developing countries (UNICEF and WHO, 2014). Better access to water and sanitation contributes to better health but also 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. The United Nations set a target of achieving universal and equitable access to safe and affordable drinking water for all, as well as achieving access to adequate and equitable sanitation and hygiene for all and end open defecation by 2030.

    • Tobacco

      Tobacco use is the leading global cause of preventable deaths and kills nearly 6 million people each year, of whom more than 5 million are from direct tobacco use and more than 600 000 are non‑smokers exposed to second-hand smoke (WHO, 2013e). In the Asia-Pacific region, approximately 6 000 people die prematurely from tobacco-related diseases every day, equating to 2.3 million deaths per year (WHO, 2013e).

    • Alcohol

      The health burden related to harmful alcohol consumption, both in terms of morbidity and mortality, is considerable in most parts of the world (Rehm et al., 2009; WHO, 2014i). Alcohol use is associated with numerous harmful health and social consequences, including an increased risk of a range of cancers, stroke, and liver cirrhosis, among others. Foetal exposure to alcohol increases the risk of birth defects and intellectual impairment. Alcohol misuse is also associated with a range of mental health problems, including depressive and anxiety disorders, obesity and unintentional injury (Currie et al., 2012). Alcohol also contributes to death and disability through injuries, assault, violence, homicide and suicide, and is estimated to cause more than 2.5 million deaths worldwide per year (WHO, 2014i). While many countries set age limits for purchasing or drinking alcohol, lack of enforcement and no age limits in some countries allow young people to access alcohol easily, increasing their consumption and risk of harmful consequences.

    • Road safety

      Out of an estimated 1.25 million deaths and millions of injuries globally each year due to road accidents, 60% occur in Asia. This reflects not only traffic growth but also high road injury rates – injury rates in developing Asia are much higher than those in advanced countries.

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  • Expand / Collapse Hide / Show all Abstracts Health care resources, utilisation and access

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    • Doctor and nurses

      Access to high-quality health services critically depends on the size, skill-mix, competency, 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 in primary care without hospitalisation, and a doctor consultation often precedes a hospital admission.

    • Medical technologies

      Medical technologies may improve diagnosis and treatment. Access to these technologies is improving, but also contributing to increases in health spending. Computed tomography (CT) scanners and magnetic resonance imaging (MRI) units help doctors diagnose a range of conditions by producing images of internal organs and structures of the body. MRI exams do not expose patients to ionising radiation, unlike conventional radiography and CT scanning. Mammography is used to diagnose breast cancer, and radiation therapy units are used for cancer treatment. But such equipment is expensive.

    • Hospital care

      Hospitals in most countries account for the largest part of overall fixed investment. Beside quality of hospital care (see indicator In-hospital mortality following acute myocardial infarction and stroke in ), it is important to use resources efficiently and assure a co-ordinated access to hospital care.

    • Pregnancy and birth

      Antenatal care, delivery attended by skilled health professionals and access to health facilities for delivery are important for the health of both mothers and their babies as they reduce the risk of birth complications, morbidity and mortality (see indicators Reproductive health, Preterm births and low birthweight and Infant and young child feeding in ). WHO currently recommends a minimum of four antenatal visits, and antenatal care coverage has been monitored to ensure the progress towards universal access to reproductive health, set in the UN’s MDGs.

    • Infant and child health

      Basic care for infants and children includes promoting and supporting early and exclusive breastfeeding (see indicator Infant and young child feeding in ), identifying conditions requiring additional care and counselling on when to take an infant and young child to a health facility. There are several cost-effective preventive and curative services for leading causes of childhood morbidity and mortality worldwide. These include vitamin A supplementation, measles vaccination, oral rehydration therapy (ORT) for diarrhoea, and antibiotic treatment for acute respiratory infection (ARI). Access to these services leads to better infant and child health.

    • Mental health care

      Despite the enormous epidemiological, social and economic burden of mental ill-health, mental health care is still not a priority in most health systems and access to mental health care is often not adequate. At any point in time, about 10% of the adult population report having some type of mental or behavioural disorder (WHO, 2001) and in some countries, over 90% of people who have attempted or committed suicide had been diagnosed with psychiatric disorders such as severe depression, bipolar disorder and schizophrenia (Nock et al., 2008). In many parts of the Asia-Pacific region, appropriate care may not be available and access to mental health care may not be assured for people with mental ill-health. Access to mental health care can be assessed by the supply of professionals and the availability of psychiatric beds in different settings such as general hospitals, mental health hospitals and community facilities.

    • Access to health care

      Evidence suggests that certain socially disadvantaged groups tend to use health services less, although these groups may need health services more. This phenomenon, sometimes referred to as inverse care law, can partly be explained by the fact that disadvantaged groups typically face multiple barriers in accessing services. This includes financial barriers, such as direct and indirect costs of accessing services, geographical and socio-cultural barriers.

    • Disparities in the use of essential services

      Persistent and growing disparities in the use of health services are increasingly evident, both between and within countries. For example, inequalities in health outcomes are observed for children (see indicators Infant mortality and Under age 5 mortality in ). Inequalities in health outcomes can partly be explained by inequalities in access to essential health services, which result in a poorer health status of underserved populations. For example, access to family planning and skilled birth attendance varies by social stratifiers (see indicators Reproductive health in and Pregnancy and birth in ).

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  • Expand / Collapse Hide / Show all Abstracts Health expenditure and financing

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    • Health expenditure per capita and in relation to GDP

      Much variation in per capita health care spending levels can be observed in Asia-Pacific countries and economies in 2014 (), ranging from Bangladesh total health spending per capita of only 88 international dollars (USD PPP) to Australia’s 4 357 international dollars (USD PPP). The average OECD current health spending per capita in 2014 was around four times that of the Asian economies (3 618 versus 935). 61.6% of total health spending per capita is funded by government sources in Asia.

    • Financing of health care from general government and external sources

      Financing of health care from government sources is analysed by reporting the ratio of government spending on health to GDP, to total health spending and to total government spending. This allows a sound international comparison of the role of government in financing the health care sector and of the importance of the health sector in the government budget.

    • Financing of health care from private sources

      shows that private health expenditure as a percentage of GDP was stable across Asian countries and economies between 2010 and 2014 at 2.2%. Cambodia reported a share of private health spending twice the Asian average, while this share was less than 1% in Lao PDR, Papua New Guinea, Thailand, Solomon Islands and Brunei Darussalam. In general, private household out-of-pocket payments, comprising direct payments, and cost-sharing payments, form the greater part of private funding sources.

    • Pharmaceutical expenditure

      Despite the commitment to a national medicines policy in many countries in the Asia-Pacific region, progress on the implementation of these policies has been slow (Asia-Pacific Conference on national medicine policies, 2012). For millions of people in those countries, problems of access to essential medicines remain. Medicines are often not available or affordable and they may be low quality products which may also be inappropriately used in practice. Consumer out-of-pocket expenses on medicines account for a substantial proportion of total health care expenditures, and for many people on lower incomes, these out-of-pocket expenses push them below the poverty line with major consequences.

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  • Expand / Collapse Hide / Show all Abstracts Quality of care

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    • Childhood vaccination 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 and reduction of burden of vaccine preventable diseases can be considered as a quality of care indicator. Polio, 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.

    • 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, 2014h). 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, 2014h). There are a number of factors that increase risk, such as age, family history, oestrogen replacement therapy, alcohol use and others. The promotion of screening mammography and self-examination has 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.

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