AUSTRALIA IN THE ASIAN CENTURY – A series examining Australia’s role in the rapidly transforming Asian region. Delivered in partnership with the Australian government.
Today, Professor Stephen Leeder looks at the challenge of reducing rates of smoking, obesity and other lifestyle factors that contribute to deadly chronic diseases.
Think Asia and we think millions – or billions when you combine the populations of both India and China.
Unfortunately, millions is also an appropriate unit with which to measure the number of people in Asia who suffer from chronic illnesses such as heart disease, stroke, cancer, ongoing respiratory disease (like asthma and emphysema) and diabetes.
The causes often spin out of rising affluence, shifts from traditional to processed diets, decreased physical activity – as people move from rural to city employment and living – and the pervasive, rising influence of tobacco smoke.
Snapshot of China
In China, around 80% of deaths and considerable disability are now attributable to chronic disease; this percentage is set to grow as the population ages and these conditions become more prevalent.
Around 300 million Chinese men smoke, but rates are much lower among women (it’s less socially acceptable for women to smoke). Sample surveys conducted among about 20,000 people living in nine counties suggest that around half of China’s smokers have high blood pressure and are missing out on treatment. This means they’re at heightened risk of heart disease and stroke.
For a health-care system committed to reform but struggling to come to terms with contemporary expectations of rural and urban populations, this is the stuff of nightmares.
Snapshot of India
The scene isn’t any happier in India. Around half of all deaths – around five million each year – are now due to chronic illness.
In 2004, my colleagues and I published a study which estimated that India was losing more than nine million years of productive life each year from heart-disease deaths in people aged under 65 years. On current projections, this would double by 2030.
Comparable figures for China were six million years of lost life in 2004, which could rise to 11 million years by 2030.
Snapshot of Thailand
Similarly to India, chronic illness accounts for around half of all deaths in Thailand.
But there are some positives to report. The World Health Organization (WHO) estimates that the proportion of men who are overweight is likely to remain steady, at around 35%.
Rates of excess weight among women, however, are expected to rise from 47% in 2005, to 57% in 2015, which reflects local cultural norms. These cultural factors alert us to the power of the environment in setting the range of individual behaviours, which can be as strong as conventional risk factors such as high blood pressure.
Efforts to reduce tobacco consumption in Thailand have been successful, with rates declining over the past two decades. Unsurprisingly, this has raised the ire of the tobacco industry, which sees its market shrinking.
But other parts of Asia haven’t done so well in reducing rates of smoking. In fact, as the tobacco trade journal, Tobacco Reporter, noted in 2009, Asia is one of the world’s most promising cigarette markets, with Indonesia (southeast Asia’s largest market) selling 231 billion cigarettes in 2007 alone.
So, what can Australia do to improve our neighbours’ health? There are several compelling options.
First, we can provide an encouraging example of successful health promotion initiatives, particularly in tobacco control.
Thankfully, this has already been happening. Australia was a major advocate for the WHO’s Framework Convention on Tobacco Control, which aims to eliminate trade in illicit tobacco products. Now we should push for its full implementation among all signatory countries, including those in Asia.
Likewise, Australia’s approach to the detection and management of patients with elevated blood pressure has paid dividends, with an 83% drop in rates of death due to heart disease since 1968. This, too, can serve as a model that other nations can study and possibly adopt.
The commitment of the current federal government to health prevention is unusual and exemplary. Of note is the recently established Australian National Health Preventive Agency, which other nations may wish to emulate.
Second, we should consider reviewing our trade relations with Asia so that our exports, especially for food, don’t compound the disease risk profile of Asian countries.
We can learn from the Pacific, where an aggressive trade push (not so much from Australia but other big economies) allowed multinational food companies and food producers to push their high-fat products to a new market. Small, relatively powerless countries fought hard to keep these companies out but, in the end, were defeated by edicts promoting commerce through the World Trade Organisation.
So, a thoughtful “health ethics” review of our trading relations with Asia may be possible. We could, at the very least, articulate a set of national expectations of our corporations in their dealings with Asia, in the form of a health “bottom line”. While these expectations may need the support of law, first we need a discussion about corporations’ ethical obligations.
We should think carefully about the role we can play in helping our Asian neighbours develop effective, relevant health workforces.
Our obsession with recruiting overseas students to fuel our tertiary education institutions should be abandoned and replaced with a more responsive approach to assisting other countries appropriately develop their workforces.
This could include increased funding for the Colombo Plan, where Asian students are sponsored to study in Australia and, on completion, return home. The Plan operates on a shoestring budget but has provided 16,082 scholarships to 23 member countries in its lifetime.
Much else could be written about health in the Asian Century, including the need to implement a sophisticated surveillance and control system for emerging infectious diseases. Maternal and child health, and mental health, remain challenges for poorer countries and the disadvantaged in nations such as India.
But in priority order, we must focus on controlling chronic diseases, through heavy investment in prevention programs and effective, affordable health systems to treat existing patients. Australia can – and must – help.
This is part five of Australia in the Asian Century. You can read other instalments by clicking the links below:
Part Twelve: Dealing with the threat of deadly viruses from Asia
Part Fifteen: How Australia can become Asia’s food bowl