HYPERTENSION IN THE ASIA PACIFIC COUNTRIES

1. HYPERTENSION IN THE ASIA PACIFIC COUNTRIES Trefor Morgan Department of Physiology The University of Melbourne

2. WHO ARE WE? Malaysia 2014

3. WHO ARE WE? CHINA 1,360,460,000 19% INDIA 1,235,110,000 17% INDONESIA 237,641,326 3% Malaysia 2014

4. WHO ARE WE? CHINA 1,360,460,000 19% INDIA 1,235,110,000 17% INDONESIA 237,641,326 3% 11 of our countries have > 50,000,000 Malaysia 2014

5. WHO ARE WE? CHINA 1,360,460,000 19% INDIA 1,235,110,000 17% INDONESIA 237,641,326 3% 11 of our countries have > 50,000,000 Then the Smaller ones 23 to 30 million Malaysia, Nepal, Taiwan, Australia Malaysia 2014

6. WHO ARE WE? CHINA 1,360,460,000 19% INDIA 1,235,110,000 17% INDONESIA 237,641,326 3% 11 of our countries have > 50,000,000 Then the Smaller ones 23 to 30 million Malaysia, Nepal, Taiwan, Australia Then the Minnows Singapore, Hong Kong, New Zealand, Brunei, Cambodia, Laos, Bhutan Malaysia 2014

7. Per Capita Income$US Australia $67,000 Singapore $52,052 Japan $46,000 Hong Kong $36,676 South Korea $ 23,000 Malaysia $10,500 Malaysia 2014

8. Per Capita Income$US China $6,000 Thailand $5,500 Indonesia $3,600 Philippines $2,600 Malaysia 2014

9. Per Capita Income$US COUNTRIES WITH INCOME < $1,500 Vietnam $1,500 India $1,500 Pakistan $1,300 Bangladesh $700 Nepal $700 Malaysia 2014

10. HEALTH EXPENDITURE Country per Capita % of GDP Australia 5,900 9 Japan 4,000 9.3 Singapore 2,286 4.6 South Korea 1,600 7.2 Malaysia 346 3.6

11. HEALTH EXPENDITURE All Other Countries < $300 Country per Capita % of GDP China 278 5.2 Thailand 202 4.1 Philippines 97 4.1 Indonesia 95 2.7 Vietnam 95 6.8

12. HEALTH EXPENDITURE Countries < $60 Country per Capita % of GDP India 59 3.9 Pakistan 30 2.5 Bangladesh 27 3.7 Nepal 33 5.5 Myanmar 23 2.0

13. To Provide Basic Life Saving Health Services requires an annual spend per person of • $44

14. HEALTH EXPENDITURE Country per Capita Public % Australia 5,900 69 Japan 4,000 80 Singapore 2,392 45 South Korea 1,600 75 Malaysia 346 46 China 278 56

15. HEALTH EXPENDITURE Country per Capita Public % India 59 31 Indonesia 95 34 Pakistan 30 27 Bangladesh 27 37 Nepal 33 39 Myanmar 23 13

16. Per Capita GDP and Public Expenditure Country GDP Public % Australia 67,000 69% Singapore 52,052 45% Japan 46,000 80% Malaysia 10.500 46% China 6,000 56% India 1,000 31% Bangladesh 700 37% Nepal 700 39% Myanmar 13%

17. OUT OF POCKET EXPENSES Myanmar 89% Nepal 68% Vietnam 58% Philippines 54% Singapore 55% Pakistan 41% China 38%

18. OUT OF POCKET EXPENSES Malaysia 33% Korea 32% Australia 20% Japan 15% New Zealand 11%

19. REST OF THE WORLD Country GDP Health % Public % Switzerland 79,000 10.9 65 USA 49,900 18 45 Germany 41,000 11 76 Per capita Expenditure in USA $8,600

20. Most Efficient Health Systems Based on Life Expectance % of GDP Spent Total amount of Money Spent Malaysia 2014

21. Most Efficient Health Systems AUSTRALIA 7th 8.9% of GDP Malaysia 2014

22. Most Efficient Health Systems 1st Hong Kong 2nd Singapore 5th Japan Malaysia 2014

23. Most Efficient Health Systems 1st Hong Kong Government Fund 2nd Singapore Individual +Gov 5th Japan Fixed Fund Malaysia 2014

24. MOST EFFICIENT HEALTH SYSTEMS • Country Eff Score Life E %GDP $ 1 Hong Kong 92.6 83.4 3.8% 1,409 2 Singapore 81.9 81.9 4.4% 2,286 3 Japan 74.1 82.6 8.5% 3,958 4 Israel 68.7 81.8 7.8% 2,426 5 Spain 68.3 82.3 10.4% 3,027 6 Italy 66.1 82.1 10.4% 3,436 7 Australia 66.0 81.8 8.9% 5,939 8 South Korea 65.1 80.9 7.2% 1,616 9 Switzerland 63.1 82.7 11.5% 9,121 10 Sweden 62.6 81.8 9.6% 5,331

25. Most Efficient Health Systems 46 United Statest30.8 78.6 17.2% $8,608 Malaysia 2014

26. Most INEFFICIENT Health Systems 46 United Statest30.8 78.6 17.2% $8,608 Malaysia 2014

27. Most Efficient Health Systems USA 17.2% 0f GDP Least input on Life Expectancy More per person than the average GDP of many Countries Malaysia 2014

30. Hypertension in China Men 29.2% Women 24.1% 20-45y 13% 45-65 36.7% >65 56.5% Rural > Urban Malaysia 2014

31. AUSTRALIA BP and Age 18-25y 6.0% 25-34 9.1% 35-44 15.3% 45-54 26.0% 55-65 38.7% >65 48.0% Malaysia 2014

32. AUSTRALIA BP and Income Income <$55 37.7% $55-85 31.6% $85-120 29.1% >$120 27.2% Malaysia 2014

33. High Income 35% Low and Middle Income 40% Malaysia 2014

34. Cardiovascular Disease is the most common cause of death and disability in most parts of the world

35. Anderson & Chu, NEJM 2007

36. Gaziano TA, et al. JH 2009;27:1472-77

37. HEALTH CARE COSTS • In the US the cost of high BP care ($362) is greater than the entire health expenditure in even well developed Developing Countries • No Developing Country can afford this type of Expenditure and even the USA cannot sustain this pattern

38. HOWEVER WE CANNOT AND MUST NOT IGNORE THE PROBLEM

39. CHANGE OF SOCIETY Huntergather No Hypertension No Cardiovascular disease “Developed “Hypertension Stroke Heart Attacks

40. CHANGE OF SOCIETY Huntergather No Hypertension No Cardiovascular disease No nation in our region is any longer at this stage. “Developed “ Hypertension Stroke Heart Attacks

41. CHALLENGE FACING DEVELOPING NATIONS

42. A Problem Is In The Transition from Hunter Gatherer Society to a Developed Nation

43. A Problem Is In The Transition No Hypertension No Stroke,No MI Severe Hypertension H Stroke, Acute CF&RF Treatment Starts I Stroke, MI Good Treatment Chronic HF, RF, Dem

44. A Problem Is In The Transition No Money, little health care, major problem to the individual and family. Myanmar, Nepal, Vietnam, Bangladesh

45. A Problem Is In The Transition No Health Service but not needed for this Problem. No Money, little health care, major Problem to the individual and family Conflict Exists Some money. Initially goes to alleviating the acute individual problem.

46. A Problem Is In The Transition No Health Service but not needed for this Problem. No Money, little health care, major Problem to the individual and family Conflict Exists Some money. Initially goes to alleviating the acute individual problem. Unless there are Intelligent Government Policies

47. A Problem Is In The Transition No Health Service but not needed for this Problem. No Money, little health care, major Problem to the individual and family Conflict Exists Some money. Initially goes to alleviating the acute individual problem. Unless there are Intelligent Government Policies China, Philippines, Pakistan, Malaysia, fall into this group.

48. A Problem Is In The Transition No Health Service but not needed for this Problem. No Money, little health care, major Problem to the individual and family Conflict Exists Some money. Initially goes to alleviating the individual problem. Individual care becomes very Expensive and in the long run cannot be afforded by Governments unless there is a very efficient Health System.

49. HOW CAN WE PREVENT THE CARDIOVASCULAR EPIDEMIC? BLOOD PRESSURE CHOLESTEROLOBESITYDIABETES SMOKING All these Contribute but high BP is most Important Malaysia 2014

50. Screen Population and Institute Treatment This is an acceptable Strategy but has problems. What BP to treat? What level to achieve? Drug treatment of asymptomatic problem? Long term compliance? Long term side effects of drugs? Will genetics allow this strategy? MOST IMPORTANTLY IT DOES NOT PREVENT THE PROBLEM AS 50% AT RISK WOULD NOT BE TREATED. malaysia 2014