Achieving Health related SDGs in China and Other Asian Countries: - - PowerPoint PPT Presentation

Achieving Health related SDGs in China and Other Asian Countries: Issues and Challenges

Shenglan Tang, PhD, MD

Duke Global Health Institute, Duke University Global Health Research Center, Duke Kunshan University

Outline

• 1. Health related Millennium Development Goals (MDGs) and

achievements of Asian countries

• 2. Transition from MDGs to Sustainable Development Goals

(SDGs)

• 3. Current situation and gaps to achieve health SDGs in China

and other Asian countries

• 4. Achieving Health SDGs – issues and challenges for China and
• ther Asian countries
• 5. Achieving Health SDGs- opportunities for China and other

Asian countries

• 6. Final remark

Health MDG Targets and achievements

Inter-Agency and Expert Group on MDG Indicators. The Millennium Development Goals Report 2015.

• Child mortality rate: cut by more than half

since 1990

• Since 1990, the global maternal mortality

ratio fell by 45%

• Between 2000 and 2013, new HIV

infections fell by 40%

MDG 4: achievements in China and other Asian countries

Neonatal mortality rate per 1,000 live births in China and other Asian countries (1990-2015) Under-five mortality rate per 1,000 live births in China and other Asian countries (1990-2015)

South Asia China East Asia and Pacific South Asia China East Asia and Pacific

NMR per 1,000 live births dropped substantially from 1990 to 2015 in Asian countries: South Asian countries: from 58.4 to 29.9 East Asia and Pacific: from 27.59 to 8.55 already met SDG goal 12/1000 China: from 29.7 to 5.5 already met SDG goal 12/1000 U5MR per 1,000 live births dropped substantially from 1990 to 2015 in Asian countries: South Asian countries: from 129.3 to 52.5 East Asia and Pacific: from 56.6 to 18.0 already met SDG goal 25/1000 China: from 53.8 to 11.2 already met SDG goal 25/1000 Data and pictures cited from: Atlas of SDGs 2017, the World Bank Group http://datatopics.worldbank.org/sdgs/

MDG 5: achievements in China and other Asian countries

South Asia China East Asia and Pacific

Maternal mortality rate per 100,000 live births in China and other Asian countries (1990-2015)

MMR per 100,000 live births dropped substantially from 1990 to 2015 in Asian countries: South Asian countries: from 558 to 182 East Asia and Pacific: from 159 to 59

already met SDG goal 70/100,000

China: from 97 to 27

already met SDG goal 70/100,000 Data and picture cited from: Atlas of SDGs 2017, the World Bank Group http://datatopics.worldbank.org/sdgs/

MDG 6: achievements in China and other Asian countries

(HIV/AIDs is not prevalent in Asian countries)

South Asia East Asia and Pacific China

Tuberculosis incidence per 100,000 people in China and other Asian countries (2000-2015) Malaria incidence per 100,000 people in China and other Asian countries (2000-2015)

South Asia East Asia and Pacific China TB incidence per 100,000 people decreased from 2000 to 2015 in Asian countries: South Asian countries: from 275 to 220 East Asia and Pacific: from 167 to 136 China: from 109 to 67 Malaria incidence per 1,000 people decreased from 2000 to 2015 in Asian countries: South Asian countries: from 43.5 to 16.9 East Asia and Pacific: from 22.7 to 5.7 China: from 0.1 to 0.0 already met SDG goal

Data and pictures cited from: Atlas of SDGs 2017, the World Bank Group http://datatopics.worldbank.org/sdgs/

17 Sustainable Development Goals 2016-2030

From MDGs to SDGs

• 17 goals and 169 targets
• Applicable to all countries: no one left behind
• Integrated approach: people, planet, prosperity, peace and

partnership

MDGs SDGs Total Health Total Health Goals 8 3 17 1 Targets 21 8 169 23

The place of health in the SDGs

• Health is centrally placed in the 2030 agenda and linked to many other SDGs.
• It emphasizes the need for a more integrated approach to sustainable development compared with the MDGs.
• There is a strong focus on equity and UHC

Picture cited from: Health in the SDGs: where are we now in the South-East Asia Region? What Next? The WHO 2016. http://apps.who.int/iris/bitstream/10665/249536/6/9789290225218-Eng.pdf

Goal 3: Good health and well-being

Goal 3: 9 targets and 4 means

Picture cited from: Health in the SDGs: where are we now in the South-East Asia Region? What Next? The WHO 2016. http://apps.who.int/iris/bitstream/10665/249536/6/9789290225218-Eng.pdf

New Health Targets Included in SDGs

• Infectious diseases – hepatitis
• NCDs – hypertension, stroke, CVD, diabetes,

mental health, etc.

• Road injuries
• Substance abuse
• Universal health coverage
• Pollution

Reduce by one-third Reduce by half

Current situation and gaps to achieve health SDGs in China and other Asian countries

Health-related SDG index

• This is cited from GBD 2015 SDG Collaborators. Measuring the health-related Sustainable Development Goals in 188 countries: a

baseline analysis from the Global Burden of Disease Study 2015. Lancet 2016; 388: 1813–50

• The health-related index is a function of the 33 health-related SDG indicators
• The majority of Asian countries are marked in yellow, pink or red: still huge gaps to fill to achieve the health-related SDGs, especially

in NCDs, mental health, hepatitis, road injuries and pollution etc.

Many Asian countries facing big challenges on NCD targets

Probability of dying from any of CVD, cancer, diabetes, CRD between age 30 and exact age 70 (%)

Air pollution in Asian countries

Picture cited from: Global Burden of Air Pollution. Institute for Health Metrics and Evaluation http://www.healthdata.org/infographic/global-burden-air-pollution

In 2013:

• Among 2.6 million deaths

from ambient air pollution globally, 64% are in Asian countries.

• In China and India, less

than 1% of the population lives in areas meeting WHO guidelines.

• Deaths from ambient air

pollution and household air pollution in China and India:

Mental health issues in Asian countries

Suicide mortality rate, per 100,000 people in China and other Asian countries (2000-2015)

China East Asia and Pacific South Asia

Suicide mortality per 100,000 people in 2015 in some Asian countries:

• Korea, Rep.: 32.0 (ranked

first among Asian countries)

• Japan: 19.6
• Korea, Dem. People’s Rep.:

15.8

• India: 15.7
• China: 10
• Cambodia: 11.9
• Bangladesh:5.5
• Singapore: 9.9
• Vietnam: 7.4

Road injuries in Asian countries

Mortality caused by road traffic injuries per 100,000 people in 2015 in some Asian countries:

• Vietnam: 24 (ranked first among

Asian countries)

• Malaysia: 22.3
• Korea, Dem. People’s Rep.:

20.7

• China: 19.4
• Cambodia: 18.9
• Bangladesh:12.8
• Singapore: 3.7

Mortality caused by road traffic injury, per 100,000 people in China and other Asian countries (2000-2015)

South Asia East Asia and Pacific China

Alarming Numbers Show the State of Health in China

• Over 90 million HBV infected people
• 15 million HCV infected people
• Over 300 million hypertensive patients
• Over 2.4 million new stroke patients/year, and over

1 million death due to stroke

• Over 100 million diabetes patients
• Road injuries – approximately 300,000 deaths per

year

• Air pollution leads to an 1.2 million premature

annual deaths

Hypertension in China

• Prevalence rate among Chinese adults in 2010
• Men vs. women: 31.2% vs. 28%
• North vs. south: 31.0% vs. 28.5%
• Urban vs. rural: 32.0% vs. 29%
• Awareness, treatment and control rate among Chinese adults in

2010: by gender and district

35.1 26.8 7.6 28.2 51 42.3 11.3 26.7 10 20 30 40 50 60 awearness rate (%) treatment rate (%) control rate (%) control rate (%) among treated hypertensive patients men women 50.9 46.7 18.5 39.6 39.9 30.1 6.4 21.2 10 20 30 40 50 60 awearness rate (%) treatment rate (%) control rate (%) control rate (%) among treated hypertensive patients urban rural

Data cited from: Wang J, Zhang L et al. Prevalence, awareness, treatment and control of hypertension in China: results from a national survey. Am J Hypertension. 2014. Nov;27(11):1355-61. doi: 10.1093/ajh/hpu053. Epub 2014 Apr 3.

Diabetes in China

• Diabetes prevalence among Chinese adults in 2010
• Awareness, treatment and control rate among Chinese adults in 2010

38.7 32.7 40.8 24.6 21.5 38.6 5 10 15 20 25 30 35 40 45 awearness rate (%) treatment rate (%) control rate (%) urban rural 29.7 25.5 40.7 30.5 26.2 38.6 5 10 15 20 25 30 35 40 45 awearness rate (%) treatment rate (%) control rate (%) men women

Data cited from: Xu Y, Wang L et al. Prevalence and Control of Diabetes in Chinese Adults, JAMA. 2013 Sep 4;310(9):948-59. doi: 10.1001/jama.2013.168118.

Pollution in China: Economy VS. Environment

• China now produces the largest number of major pollutants in the world, which cause serious air

pollution and substantially reduced visibility. In addition to 1.2 million annual premature deaths in China, airborne pollutants from China are estimated to have caused around 30 000 additional deaths

• utside the country.
• Recent reports that more than half of China's groundwater is polluted.

Data and picture cited from: Zhu C, Wang J et al. China tackles the health effects of air pollution. The Lancet; London382.9909 (Dec 14, 2013): 1959-60. Kan H. Globalisation and environmental health in China. The Lancet; Comment| volume 384, issue 9945, p721–723, 30 august 2014

UHC

• The SDG declaration puts UHC at the center of the overall

health goal. The WHO World Bank UHC monitoring framework focuses on these two core components and presents two proposed indicators:

• A coverage index of essential health services: 16 indicators grouped

into 4 main categories - RMNCH, infectious diseases, NCDs (data limited, used proxy indicators), service capacity and access. Data are accessible for some Asian countries (shown in the next slide)

• A measure of financial protection against the costs of services. The

WHO-World Bank UHC framework uses 2 indicators of financial protection: ‘catastrophic’ health spending and impoverishment due to health-care costs. Data are limited for most of the Asian countries and the cutoff to calculate catastrophic health expenditure is under discussion.

UHC: essential health services coverage

43 47 48 49 55 58 63 64 66 67 68 70 79 82 10 20 30 40 50 60 70 80 90 100

UHC Service Coverage Index in Some Asian Countries

Data cited from: Health in the SDGs: where are we now in the South-East Asia Region? What Next? The WHO 2016. http://apps.who.int/iris/bitstream/10665/249536/6/9789290225218-Eng.pdf and WPRO Monitoring Health in SDGs and UHC in the Western Pacific Region 2016: Baselin Report (unpublished)

Health Expenditure as % of GDP (Asia), 2013

Source: WHO Global Health Expenditure Database (accessed 23 March, 2016)

1 2 3 4 5 6 7 8

Percentage of GDP

Government health spending Private health spending

Source: from Dr. Soonman Kwon’s presentation at the 2nd CCUGH conference in Kunshan, China

Health financing is dominated by out-of-pocket payments in poorer countries

Source: WHO Global Health Expenditure database; World Bank National Accounts database; OECD National Accounts database; WDI (SH.XPD.OOPC.TO.ZS, NY.GNP.PCAP.CD). Picture cited from: Atlas of Sustainable Development Goals 2017 from World Development Indicators: https://openknowledge.worldbank.org/handle/10986/26306

• Out-of-pocket payment as a

share of total health expenditure was over 50% in Asian countries including Cambodia, Bangladesh, India, Myanmar and Pakistan in 2014.

• Weakness in prepayment

mechanisms such as taxation and health insurance often impede access to health care, especially for the poorest.

Equity gaps (“no one is left behind”)

Inequality in coverage of health services by income group and place of residence in south-east Asian countries

Picture cited from: Health in the SDGs: where are we now in the South-East Asia Region? What Next? The WHO 2016. http://apps.who.int/iris/bitstream/10665/249536/6/9789290225218-Eng.pdf

• Disparities existed in health services coverage among the rich and the poor, and people living in urban and

rural areas.

• The main factors leading in equity are different by countries.
• More disaggregated data are needed to assess equity among people of different gender, sex, age,

subnational region etc.

Challenges to achieve health SDGs in China and other Asian countries:

• Political challenges
• Socio-economic factors
• Health sector
• China case

Political challenges

• The governments of many developing countries do not put

health development at its priority agenda

• Since the financial crisis in 2008, ODA has not been

increasing significantly, and major OECD countries, including USA, may reduce ODA funding to support the socio-economic and health development in developing countries

• International trading agreements, e.g. TPP, have not been

making good progress to support socio-economic and health development of the poor and the vulnerable

• UN conference on financing of SDG has not produced

concrete measures to advance the implementation of SDG

Socio-economic issues

• Slowing-down economic growth
• Ageing society
• Urbanization
• Pollution
• Enlarged income gaps…

Challenges in health sector

• Multiple health issues: continue working on some infectious

diseases (eg. TB and hepatitis) and have new focuses on NCDs, mental health, road injuries, pollution etc.

• Weak national governance for health and inter-sector collaboration

to implement the integrated approach: insufficient transparency, accountability and inter-sector coordination

• Insufficient health financing and flawed financing model
• Insufficient health workforce
• Weak data collection system for monitoring and evaluation,

especially for hepatitis, NCDs, injuries and violence, access to essential medicines, financial protection etc.

In general The case for each Asian country may be different

China case: major challenges to implementing the health SDGs

1. Health SDGs require China to take more action on NCDs, mental health, road traffic deaths, infectious diseases (e.g hepatitis, MDR-TB), child nutrition and environmental health 2. Significant social and health development disparities exist between developed and less developed areas 3. Government spending on health remains low compared to other nations in the region (e.g. China’s health spending accounted for 5.6% of GDP, and about half of the funding from government investment) 4. Maldistribution of health workforce in China: not enough new medical and public health graduates are willing to work in rural areas or primary care settings 5. Monitoring and evaluation: inconsistency of data from multiple data sources; lack of data for some indicators and disaggregated data; lack of analysis especially focusing on service quality, efficiency, equity etc. 6. Other socio-economic issues: slowing-down economy vs. growing international responsibilities, ageing, rural-to-urban migration, pollution.

Opportunities to achieve health SDGs in China and other Asian countries

Opportunities

• Recent decades have seen gradual and continuing improvement in

health in Asian countries.

• Many Asian countries have shown their political commitment for the

health SDGs: eg. Several Asian countries have started national consultations on SDG implementations, monitoring and oversight. Chinese government has published the Healthy China 2030 Planning Outline.

• To achieve UHC, countries are already expanding frontline health

services to address the unfinished MDG agenda and the rise in NCDs.

• There is momentum in Asian countries to strengthen the information

system for SDGs monitoring and evaluation: eg. New technological developments and information platforms such as District Health Information Software 2 (DHIS2) are already widespread in SEAR.

China case: opportunities to implementing the health SDGs

• China has laid a solid foundation for health

development in recent decades

• China has strong government commitment to health

development (e.g. Healthy China 2030 Planning Outline)

• China has effective institutional governance in the

health sector

• Increasing new technologies are available to fight

against major health problems

Summary and final remark

• Asian countries have made remarkable progress in the MDG era
• There are huge gaps and daunting challenges for Asian countries to

achieve the health SDGs, especially in NCDs, mental health, pollution, road injuries, UHC et al.

• Strong political commitment from central government is important.
• Countries should set their own priorities based on their situation – a

‘country led’ integrated approach to achieve the health SDGs.

• Mechanisms to establish better coordination among different

government departments, and closer partnerships with private sectors, the community and general public are needed.

• Investments are needed in strengthening health information system

and statistical and qualitative research for more effective and accurate monitoring and evaluation of the health SDG indicators.