Increasing longevity, urbanization and poor lifestyles are contributing to a massive increase in non-communicable diseases (NCDs) in South-East Asia. According to the World Health Organization, 55% of all deaths in the region are due to NCDs – that is nearly 8 million people every year. More worryingly, one-third of those dying as a result of NCDs are younger than 60. Such premature mortality causes immense social and economic loss.
The growth in NCDs has also led to a “dual burden of disease” for these countries – having to transform health systems built to fight infectious diseases and provide acute care to ones which can manage the silent epidemic of chronic diseases like diabetes, heart disease, respiratory illnesses and cancer. What are the policy and operational implications of addressing this dual burden?
Four important aspects stand out. The first is health systems integration. Many infectious disease programmes were developed in so-called “vertical” formats, with different silos for diseases like HIV/AIDS, TB and malaria. These now need to be integrated in order to provide care across diseases, beyond specific conditions with a patient rather than just a disease focus. An example is HIV, where the need for long-term antiretroviral treatment has led to the upgrade of supply chains to minimize stock-outs in lower-income countries. Similarly, treatments for chronic disease require well-managed supply chains.
Research is another critical area. For instance, too little is known about how HIV interacts with cardiovascular disease, or what happens to patients with TB if they develop diabetes.
Education is the third element, and this means education not just for healthcare workers (though they need to be equipped to diagnose and treat NCDs), but also for communities and young people. Adolescence and young adulthood are when NCD risk factors are typically initiated. These risk behaviours are increasing among young Asians, setting them up for poorer health in adulthood compared to today’s adults.
Surveys conducted by the WHO show some very troubling statistics
- Over a third of Indonesian boys aged 13-15 have smoked or used tobacco products in the last month
- In the Philippines, Thailand and Vietnam, over a fifth of boys have drunk alcohol
- A quarter of boys in Malaysia and Thailand are obese or overweight. Across much of Sout-East Asia, secondary schoolchildren show alarming levels of physical inactivity
The trends for the four key risk factors – tobacco, alcohol, inactivity and poor diet – are up. These are statistics to give policy-makers concern. Bad habits established now will support an epidemic of NCDs when these young people hit middle age. By 2050, the over-45 population is projected to double in South-East Asia compared to its size today.
The fourth element is good policy. School curricula need to include education on healthy lifestyles. Secondary school children are naturally active, but they need access to parks, green spaces and playgrounds. Young people should be prevented from having access to alcohol and tobacco products, and ideally such products should be taxed to become unaffordable for schoolchildren. Promotion of high-fat and high-sugar products to young people should be restricted.
What can the pharmaceutical industry do here? We are obviously not in schools or playgrounds. But we can play a role in educating healthcare professionals about NCD diagnosis and treatment, and about the fact that some risk factors are, in effect, inherited – obese parents are likely to have obese children, for example. Talking to 40-old patients with diabetes or respiratory illness is an opportunity for a doctor or nurse to educate them, and ideally get them to talk to their own children about the importance of healthy lifestyles. We can also help with health system transformation – my own company, Novartis, is doing a lot to improve supply chains in lower-income countries, and partners with organizations on the ground to provide education around NCD diagnosis and treatment.
The future of South-East Asia’s youth is in the balance. Wise decisions now will make a significant difference to the future burden of NCDs on South-East Asia’s health systems and economies.