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Asia getting rapidly healthier, but older too

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Life expectancy across the Asia-Pacific region is increasing at one of the fastest rates in the world, but millions are being denied access to affordable, quality care because of weak government investment in health.

Across Asia, average life expectancy reached 73.4 years in 2012 – a jump of seven years since 1990, outstripping an average gain of 5.3 years among developed countries over the same period, according to the Organisation for Economic Co-operation and Development (OECD).

The improvement was underpinned by a dramatic fall in infant mortality (which has halved in many countries since 1990) and big gains in maternal health – the average maternal mortality rate across Asian countries has plunged by 48 per cent.

As a result, a massive demographic shift is underway across the region. The population is rapidly ageing, so that by 2050 more than one in every four people will be 65 years or older.

But region-wide improvements disguise major disparities in health among individual countries, the joint OECD-World Health Organisation report, Health at a Glance Asia/Pacific 2014, shows.

While a baby born in Hong Kong or Japan in 2012 could, on average, expect to live for more than 86 years, (and more than 84 years in Australia), average life expectancy in Papua New Guinea was just 64.5 years, and 67 years in Myanmar.

The differences are reflected in wide discrepancies regarding infant mortality between countries in the region. While there was just one infant death per 1000 live births in Hong Kong in 2012 (and three per 1000 in Australia), in Pakistan the rate is a massive 69 deaths per 1000 live births, 54 in Laos and 48 in PNG.

The OECD said that, while the overall improvement in life expectancy and reduced infant and maternal mortality in the Asia-Pacific region was impressive, much more can and should be done in many countries to lift health standards.

“Countries in the Asia-Pacific region need to step up their efforts to give more people access to affordable, quality health care,” the OECD said. “Too many people, especially women, cannot get the medical treatment they need due to high costs, difficulties in getting permission to see a doctor, or a lack of health care providers in rural areas.”

Part of this comes down to inadequate investment in health, particularly by governments.

The report found that Asian countries spend an average $US730 per person on health (equivalent to 4.6 per cent of gross domestic product), compared with an OECD average of $US3510 (9.3 per cent of GDP).

The shortfall in public spending is even more marked – in Asia, less than half (48.1 per cent) of total health spending comes from the public purse, compared with the OECD average of 72.7 per cent.

The relative lack of investment is obvious in the paucity of health resources available, particularly in poorer rural areas.

Across the Asia-Pacific, there is an average of 1.2 doctors and 2.8 nurses for every 1000 people, well below the OECD average of 3.2 doctors and 8.7 nurses.

There are also fewer hospitals on hand. In Asia, there are 3.3 hospital beds for every 1000 people, while among developed countries the average is 4.8.

 While spending on health in Asia is relatively low by developed country standards, individuals and governments have been outlaying more on health as economies have developed and millions have emerged from poverty.

Across Asia, per capita spending on health grew at an annual average of 5.6 per cent in real terms between 2000 and 2012, exceeding the average annual rate of economic expansion of 4.3 per cent.

The growth in spending has been particularly marked in China and Mongolia, where it has been virtually double that of the regional average.

These investments have had marked results in health outcomes.

In most Asia-Pacific countries, more than 90 per cent of one-year-olds now receive vaccination for measles, diphtheria, tetanus and pertussis – on par with global best practice.

These and other investments have helped contribute to sharp declines in infant and maternal mortality and improvements in life expectancy – both China and Mongolia registered a 71 and 70 per cent improvement, respectively, in infant mortality rates between 1990 and 2012, compared with an average gain of 55 per cent across Asian countries.

Adrian Rollins