Business 360-27, Public health in Asia

* This is my article for July 2015 issue of the business magazine in Kathmandu, produced monthly by Media 9.

The state of public health in Asia

We often hear complaints and  litanies about how our lives are deteriorating and how our health condition is getting more “critical.” Are there solid basis for these statements aside from the subjective observations and emotional sentiment attached to them?

Let us check some health data and see how valid or invalid those observations are. The Asian Development Bank (ADB) has a good compilation of social and economic data spanning for two decades or more, so  we can see a trend of improvement or deterioration of the social  and  economic lives of Asians. 

Below, mortality or rate of death among the young, infants and children below five years old.

There have been drastic improvements in the health condition  of young Asians. Mortality rate for both infants and under five years old in just 22 years were slashed by half in India and Pakistan, and by one-third in Nepal, Bhutan and Bangladesh. A great achievement.

The same trend of drastic reduction in mortality rate for the young is observed in South East Asian countries. In the case of developed economies like Singapore, S. Korea and Japan, the already low  figures have further gone down.

In the past, tuberculosis (TB) was a major killer infectious disease in many countries in  the developing  world. Drugs and treatment against various bacteria that cause and spread the disease were not so developed, and the system of isolation for infected people and proper hygiene for the rest were also  not well-developed.

Consistent with the trend and  data in the above table, death rates from tuberculosis have also significantly gone down after 22 years, slashed by half in Nepal, Pakistan  and  India. Bhutan made very significant progress here. Sri Lanka has an excellent record, comparable to the developed Asian economies like Singapore and Japan.

The same trend is observed among South East Asian countries. Cambodia showed good improvement but its death rate from this disease remains very high, 3x that of Nepal, India and Vietnam.

So if less people are dying, that means the average life span of Asians as well as other people in the world is rising, right?

The numbers below confirm this. Many countries in South Asia showed significant improvement here, life span rose by an  average of 14 years after 22 years. For the people in South East Asia, the increase in life span has increased by an  average of five years. But in the case of Laos, Cambodia and Myanmar, the harsh dictatorship and even genocide they experienced meant very low life span in the 1970s, 80s up to 1990. Diseases plus political murders have cut short the lives of millions of people there until the 80s.

The three tables and sets of data above have shown  that the pessimistic and emotional view that “our lives are deteriorating, public health is in critical condition” has no basis. Our lives are improving, we are living healthier and longer. And that means we now have longer productive years. Instead of dying at age of late 50s or early 60s, many people now remain productive even in their late 60s or 70s, are able to enjoy the company of their grand children much longer.

While some sectors will give high credit to government investments in public health, they sometimes  fail to notice or mention the role of healthcare competition among private healthcare providers – hospitals, clinics, drugstores, drug manufacturers, physicians, pharmacists, nurses and other health professionals.

Governments in Asia and other parts of the world should recognize the role of healthcare competition among private players and professionals. The goal is longer life span for  the people, few people dying from infectious diseases, and not more government hospitals per se.

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See also:

Business 360--23: Electricity and Development, March 07, 2015 

Business 360-24: Reducing Construction and Electricity Permits, April 08, 2015 

Business 360-25, Economic Liberalization and GDP Expansion, June 23, 2015 

Business 360--26, Nepal earthquake and lessons from it, July 13, 2015

UHC 26: Public and Private Spending on Health, January 31, 2015 

UHC 27: Paranoia on Healthcare Corporatization and Privatization, April 06, 2015 

UHC 28: Health Pessimism Despite Improving Public Health, April 20, 2015

Drug Innovation 6: Dealing with Drug-Resistant TB

Diseases evolve. These are living micro-organisms -- bacteria, virus, etc. -- that feed on certain organs of the human body. They are part of human and natural evolution, sadly. That is why treatment and cure of old and re-emerging diseases must evolve too, endlessly. That is why drug innovation, medical science and diagnostics innovation, must continue to evolve and modernize.

Below are some stories of drug-resistant tuberculosis, as well as challenges to deal with malaria, an old disease that continues to kill hundreds of thousands of people every year until now. Estimated global death from malaria in 2010 was twice that of WHO estimates of 655,000 people. A BMGF funded study published in The Lancet showed that for the same year, estimated death from malaria was 1.24 million people, mostly children, and mostly in Africa.

1. TB drug resistance, from interaksyon.com, August 30, 2012
2. Cure for malaria, from ibtimes.co, October 25, 2012
3. Malaria deaths, from The Lancet and BBC.

http://www.interaksyon.com/article/41831/tb-drug-resistance-a-fast-growing-problem-researchers-warn

TB drug resistance a fast-growing problem, researchers warn

August 30, 2012

PARIS - Researchers on Thursday sounded the alarm over drug-resistant tuberculosis, calling it a curse that was swiftly becoming more difficult and costly to treat.

In eight countries they studied, 43.7 percent of TB patients did not respond to at least one second-line TB drug, a strategy used when the most powerful first-line drugs fail.

The probe, covering Estonia, Latvia, Peru, the Philippines, Russia, South Africa, South Korea and Thailand, is reported in The Lancet medical journal.

"Most international recommendations for TB control have been developed for MDR (multidrug-resistant) TB prevalence of up to around five percent. Yet now we face prevalence up to 10 times higher in some places," Sven Hoffner of the Swedish Institute for Communicable Disease Control wrote in a comment carried by The Lancet.

The study also found a 6.7 percent rate for an even more worrying form of resistance called XDR -- for extensively drug-resistant -- TB. It means a patient who does not respond to any two second-line drugs.

An airborne disease of the lungs, tuberculosis is usually treatable with a six-month course of antibiotics.

But if patients do not take their medicines as prescribed, the bacteria that causes TB can develop resistance to the drugs. In rare cases, people can also be infected with already resistant strains.

MDR TB in the United States can cost as much as $250,000 (200,000 euros) per patient to treat.

XDR TB requires about two years of treatment with even more expensive drugs that often cause side-effects and offer no guarantee of a cure.

According to the World Health Organization (WHO), 8.8 million people fell ill with TB in 2010 and 1.4 million died. Co-infection with the disease causes about a quarter of all deaths among people with HIV.

"So far, XDR TB has been reported in 77 countries worldwide, but exact prevalence remains unclear," study author Tracy Dalton of the US Centers for Disease Control and Prevention (CDC) said.