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Will current health reforms in south and east Asia improve equity?


To the Editor: Hipgrave and Hort review health reform initiatives in south and east Asia and draw attention to the increasing privatisation of services and the inequity created as the poor have less access.1 More importantly, countries in south and east Asia are enjoying a period of economic development that has resulted in urbanisation and lifestyle change, specifically dietary change, in both urban and rural populations. This has resulted in a nutrition transition, which is associated with the chronic non-communicable disease (NCD) “epidemic”.2 The trends are that the poor in these countries will have higher levels of risk factors for chronic NCD.3

Health systems in most low and middle income countries have been designed for episodic care for acute conditions, and not for primary health care involving the continuity of care required for managing chronic disease. Second, most of these countries have made negligible investments for prevention of risk factors through population-based programs. Third, intersectoral policies to deal with “upstream” issues, such as marketing of unhealthy food, are not yet in their reform agenda.

Australia’s success in tobacco control and reduction of HIV/AIDs are lessons that we can share. However, the same cannot be said of food policy, and many countries…