meng kin lim national university of singapore; director of public health, apru world institute

Global Research Example: "The Challenge of Chronic,

Non-Communicable Disease in the Asia Pacific Region"

Asia-Pacific Global?KEN

Lion’s share of global population

Bears brunt of double burden of disease

Asia Pacific Region

Per capita incomes, 1960-2003

Japan

China

S Korea

Taiwan,

Singapore

Hong Kong

Malaysia Thailand

Demographic transition:% population > 65years

Hong Kong

Japan

Singapore

S Korea

China

Epidemiological transition

Infectious diseases

Chronic diseases

Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005

Globally, 60% of all deaths are due to NCDs

80% of them occur in low- and middle-income countries(WHO 2005)

Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005

Based on current trends:

Source: 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non communicable Diseases, WHO 2008

73% of total deaths

73% of total deaths

60% of total deaths

60% of total deaths

43% of global

burden of disease

43% of global

burden of disease

60% of global

burden of disease

60% of global

burden of disease

NCDs1998

NCDs2020

In WHO’s Western Pacific Region, 78% of all deaths are due to NCDs

Cause of death in the all ages, 2005. Source: WHO Western Pacific

Australian National UniversityUniversity of MelbourneUniversity of SydneyUniversity of British ColumbiaUniversity of ChileFudan UniversityHong Kong University of Science &TechnologyNanjing UniversityPeking UniversityTsinghua UniversityUniversity of Hong KongZhejiang University

Chulalongkorn UniversityUniversity of IndonesiaKeio UniversityKyoto UniversityOsaka UniversityTohoku UniversityUniversity of TokyoWaseda UniversityKorea UniversitySeoul National UniversityUniversity of MalayaTecnológico de MonterreyUniversity of Auckland

University of the PhilippinesFar Eastern National UniversityNational University of SingaporeCalifornia Institute of TechnologyStanford UniversityUniversity of California, Berkeley University of California, Davis University of California, IrvineUniversity of California, Los AngelesUniversity of California, San Diego University of California, Santa BarbaraUniversity of OregonUniversity of Southern CaliforniaUniversity of WashingtonNational Taiwan UniversityNational Autonomous University of Mexico

University of Science and Technology of China

2008University of Tokyo

Background2007

Peking University

AWI Public Health Workshops

Public Health Project

(WHO 2005, 2008)

Public Health Project

Founding Charter Members

14 Johns Hopkins University15 University of Southern California

Public Health Project inaugural meeting

Singapore 9-11 November 2008

JapanChinaTaiwan

SingaporeMalaysia

Indonesia

Australia

USA

VietnamHong Kong

Operating Principles

JapanChina

Taiwan

SingaporeMalaysia

Indonesia

Australia

USA

VietnamHong Kong

1

3

AWI

2

Steering Committee

June 2009

Feb 2009

Nov 2008

Nov 2009

June 2010

What Next?

Completion

Grant Proposal 1st draft

Funding Start Projects up and running

Start

Baseline study

4 studies

Total Population (2008)

source: WHO (2006)

GDP per capita (2008)

Health expenditure per capita (USD 2008)

% Elderly (>65 years, 2008)

Obesity (latest figures)

NB: No data for Taiwan;Vietnam data available but not comparable

Physical inactivity (%)

Thailand: no data

Hong Kong: 2003/2004

Indonesia: no data Japan: < 10000 steps/day

Malaysia: 18-69, World Health Survey Malaysia 2003

China: age 35-74

Australia: male

Alcohol (% “heavy drinker”)

Thailand: 2001Hong Kong: 2008Indonesia: maleJapan: frequent drinkerMalaysia: (18+, heavy drinker), World Health Survey MalaysiaVietnam: heavy drinkerChina: 1998, current drinkerLaos: heavy drinkerUSA: heavy drinker

High Cholesterol (%)

Thailand (2000)Hong Kong: 2003/2004Malaysia: 20-90, 1995Australia: self reportedNo data for: China,LaosTaiwan,Vietnam

Hypertension (%)

Hong Kong: 2003/2004Indonesia: maleJapan: male (>=SBP 140 and/or DBP 90mmHg)Malaysia: (30+, SBP 140 and DBP 90)Vietnam: no nationalChina: >= SBP 140 and/or DBP 90mmHg or antihzpertensive medicationUSA: >=SBP 140 and/or DBP 90mmHg 20+)Australia: male, self-reported, 2004

Literacy rate (%)

Graphic health warnings on cigarette packs

Not implemented:USA, Japan, China, Vietnam, Indonesia, Laos

Year of implementation

2009

2009

2008

2006

2005

2004

Phase 2 Projects Champions Team Members “N-City Study” Claremont GU

C. Anderson Johnson CGU, CUHK, HSPH, Stanford U, JHUUI, UNU, U Tokyo, Zhejiang U, NUS

“Breakthrough Collaborative Study”

University of SydneyG Rubin

CGU, CUHK, HSPH, PKU, Stanford, UI, U Tokyo, JHU, NUS

Diabetes study” Stanford UniversityKaren Eggleston,

CGU, CUHK, PKU, Stanford U, UI, UNU, JHU, NUS

“Health workforce study”

University of TokyoMasamine Jimba

CGU, CUHK, HSPH, Stanford U, U Tokyo, Zhejiang U, JHU, NUS

WHO: 36 million lives

20 million in the Asia Pacific Region

The challenge:

80% of premature heart disease, stroke and type 2 diabetes is preventable, 40% of cancer is preventable (WHO)

We know what the root causes are

We know prevention works

Heart disease rates among men aged >30yrs, 1950-2002

Yet risk factors are increasing e.g. obesity

Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005

We know there are better ways to manage chronic disease

Integrated care

Personal Lifestyle Plan

Disease Management

Risk Modification

Dis

eas

e B

urd

en

Time

Low Risk High Risk

Early Chronic

Co

st

Irre

vers

ibil

ityLate

Chronic

Participating Population

holistic health care

Yet medical practice is still focused on the wrong end

of the curve

Public Health ProjectWill focus on establishing a program of research and development to prepare tools for use by health systems worldwide to implement “best-practices” in chronic disease prevention and management through better :

•Risk factor surveillance;•Assessment of costs and organization of services;•Change management to implement best practice; •Monitoring and evaluation

Healthier World

Thank you!