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Global Research Example: "The Challenge of Chronic, Non-Communicable Disease in the Asia Pacific Region". Meng Kin LIM National University of Singapore; Director of Public Health, APRU World Institute. Asia-Pacific. G lobal ? KEN. Lion’s share of global population.
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Global Research Example: "The Challenge of Chronic, Non-Communicable Disease in the Asia Pacific Region" Meng Kin LIM National University of Singapore; Director of Public Health, APRU World Institute
Asia-Pacific Global?KEN
Bears brunt of double burden of disease Asia Pacific Region
Per capita incomes, 1960-2003 Japan Hong Kong Singapore Taiwan, S Korea Malaysia Thailand China
Demographic transition:% population > 65years Japan Hong Kong Singapore S Korea China
Infectious diseases Chronic diseases Epidemiological transition
Globally, 60% of all deaths are due to NCDs Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005
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: NCDs 2020 73% of total deaths 60% of global burden of disease 60% of total deaths 43% of global burden of disease NCDs 1998 • Source: 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non communicable Diseases, WHO 2008
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 Sydney University of British Columbia University of Chile Fudan UniversityHong Kong University of Science &TechnologyNanjing University Peking UniversityTsinghua UniversityUniversity of Hong Kong Zhejiang University Chulalongkorn University University of Indonesia Keio UniversityKyoto UniversityOsaka University Tohoku UniversityUniversity of TokyoWaseda University Korea University Seoul National University University of Malaya Tecnológico de Monterrey University of Auckland University of the Philippines Far Eastern National University National University of Singapore California 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 Washington National Autonomous University of Mexico University of Science and Technology of China National Taiwan University
2008 University of Tokyo AWI Public Health Workshops Background 2007 Peking University
Public Health Project “To come together in research collaboration so as to bring our collective expertise and capabilities to bear on a significant Public Health issue facing the Asia Pacific region”
Public Health Project Chronic, Non-communicable disease- the #1 cause of death globally (WHO 2005, 2008)
Claremont Graduate University Hanoi School of Public Health Nanjing University National Taiwan University National University of Singapore Peking University Stanford University The Chinese University of Hong Kong United Nations University University of Sydney University of Tokyo University of Indonesia Zhejiang University Founding Charter Members • 14 Johns Hopkins University • University of Southern California
Public Health Project inaugural meeting Singapore 9-11 November 2008
Operating Principles Japan China USA Taiwan Hong Kong • Charter members self-fund participation at meetings • Communication through electronic means • Decisions through consultation and consensus • Projects driven by lead “champions” • Make sufficient progress, then seek external funding for multi-year endeavor Vietnam Malaysia Singapore Indonesia Australia
Steering Committee Japan China USA Taiwan Hong Kong 2 Vietnam 1 Malaysia Singapore AWI Indonesia 3 Australia • Meetings • Singapore Nov 08 • Stanford Feb 09 • Johns Hopkins Jun 09
What Next? Baseline study Completion Start June 2009 Nov 2009 June 2010 Nov 2008 Feb 2009 Start Grant Proposal 1st draft Funding Projects up and running 4 studies
Total Population (2008) source: WHO (2006)
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: 2001 Hong Kong: 2008 Indonesia: male Japan: frequent drinker Malaysia: (18+, heavy drinker), World Health Survey Malaysia Vietnam: heavy drinker China: 1998, current drinker Laos: heavy drinker USA: heavy drinker
High Cholesterol (%) Thailand (2000) Hong Kong: 2003/2004 Malaysia: 20-90, 1995 Australia: self reported No data for: China,Laos Taiwan,Vietnam
Hypertension (%) Hong Kong: 2003/2004 Indonesia: male Japan: male (>=SBP 140 and/or DBP 90mmHg) Malaysia: (30+, SBP 140 and DBP 90) Vietnam: no national China: >= SBP 140 and/or DBP 90mmHg or antihzpertensive medication USA: >=SBP 140 and/or DBP 90mmHg 20+) Australia: male, self-reported, 2004
Graphic health warnings on cigarette packs 2009 2009 2008 2006 2005 Not implemented: USA, Japan, China, Vietnam, Indonesia, Laos 2004 Year of implementation
WHO: 36 million lives The challenge: 20 million in the Asia Pacific Region
We know what the root causes are 80% of premature heart disease, stroke and type 2 diabetes is preventable, 40% of cancer is preventable (WHO)
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 Participating Population Yet medical practice is still focused on the wrong end of the curve Late Chronic Cost Irreversibility Disease Burden Early Chronic Low Risk High Risk Time holistic health care
Public Health Project • Will 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
Ultimate goal: Healthier World Healthier Asia Pacific Region