December 2015

Asia Pacific’s health trends-

Obesity, NCDs

and

ADB’s Operational Plan for Health 2015-2020

Dr. Susann Roth, Senior Social Development Specialist

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Outline

1.Obesity and NCDs in Asia Pacific

2. Asia Pacific’s health systems

3. ADB’s support to DMCs- The Operational Plan for Health 2015-2020

4. ADB-ADBI collaborations for better evidence based policy making

Outline

1.Obesity and NCDs in Asia Pacific

2. Asia Pacific’s health systems

3. ADB’s support to DMCs- The Operational Plan for Health 2015-2020

4. ADB-ADBI collaborations for better evidence based policy making

1. Obesity and NCDs in Asia Pacific

How do you define overweight and obesity?

Body Mass Index (WHO)

• a BMI greater than or equal to 25 is overweight

• a BMI greater than or equal to 30 is obesity.

What are non-communicable diseases risk associated to overweight and obesity?

• Cardiovascular diseases (mainly heart disease and stroke)

• Diabetes

• Musculoskeletal disorders (especially osteoarthritis)

• Some cancers (endometrial, breast, and colon)

Asia and the Pacific is getting

“fatter” and older

5

Asia Pacific’s population’s diet is

carbohydrate and fat rich

Source: The Blueprint for Chance Program Novo Nordisk. 2013

Expected economic output loss for

Indonesia: $4.47 trillion lost due to NCDs

Source: Background paper for World Economic Forum. Economics of non-communicable

diseases in Indonesia. 2015

Diabetes incidence is increasing faster in

developing countries

Source: The Blueprint for Chance Program Novo Nordisk. 2013

Economic burden from NCDs in increasing

Example: Singapore is investing in

healthy nutrition

Return of

Investment

> 1,1%

Situation High consumption of saturated

fat and sugar

Intervention Training of cooks of foot stalls

and restaurant use health oil

and less sugar

Investment • SGD 8M in saturated fat intake reduction program through grants

• To cover the average costs of price differences between

the healthier and regular ingredient

Result 23%reduction in coronary heart disease incidence

averting 1,860 unhealthy life years in 2020

Economic benefits of SGD 102M2

Epidemiological transition in Viet Nam (hospital cases)

59.2

37.6

24.9 19.8

39

50

62.4

71.6

1.8

12.4 12.7 8.6

0

10

20

30

40

50

60

70

80

1986 1996 2006 2010

Communicable diseases Non-Communicable diseases Injuries, poisoning

National Insurance Agency Viet Nam

NCDs Increase health care costs

12

1,700,000,000,000

170,000,000,000

Cost of

inaction in developing countries globally:

US$ 1.7 trillion (2015)

Cost of

action

in developing countries

US$ 170 billion (2015)

Fighting NCDs: Sooner rather than later

Source: Interim Report of the WHO Working Group of Financing for NCDs

13

Cost of

inaction in developing countries:

US$ 1.7 trillion (2011-2015)

Cost of

action

in developing countries

US$ 170 billion (2011-2015)

Source: Interim Report of the WHO Working Group of Financing for NCDs

Population risk factors

Primary care

• CVD & diabetes

• Cancer

Tobacco use Alcohol use Obesity/

Diet/inactivity

Less than

$0.40 - $1

Prevention annual costs per person

Fighting against NCDs is not expensive

Low availability of essential NCD medicines

in low & middle income countries

65

57.1

43.1 40.3

45.1

65.6

49.5

34.7 30.1 29.4 27.8

56.1

0

10

20

30

40

50

60

70

Mea

n a

vaila

bili

ty (

%)

Private sector Public sector

From Cameron et al. Bull World Health Organ 2011;89:412–421.

Antidiabetics

Antihypertensives

Antidepressants

Acute medicines

Higher priority still given to acute medicines

65%

57%

45%

67%

50%

35%

28%

56%

Public sector Private sector Mean availability

NCD medicines

Access to Insulin in Indonesia is low Leading to expensive diabetes related complication

Source: The Blueprint for Chance Program Novo Nordisk. 2013

Population impoverished

purchasing essential NCD medicines Country % pop.

below US$ 2 / day

% population below poverty line after generic medicine purchase (1 month supply)

Salbutamol inh.

Glibenclamide

Atenolol Amoxicillin

Pakistan 8 13* 12 12 21

Uzbekistan

38 46 43 41 58

Indonesia

4 20* 6 12 9

Philippines

21 28 29 28 32

Population impoverished by medicine purchase

16 countries

Total pop. 71 m 112 m 133 m

Patient pop.

2 m 5 m 29 m

*Brand purchase; no generic available

From Niens et al. PLOS 2010; 7(8):e1000333

B E F O R E

% of people living on less than $2 a day

A F T E R

8 % Pakistan

4 % Indonesia

Philippines

Uzbekistan

21 %

38 %

12 - 21 %

6 - 20 %

28 - 32 %

41 - 58 %

4% 13% 4%

2% 5% 8%

8% 11% 7%

5% 20% 3%

Preventing overweight and obesity is a

public health best buy

Outline

1.Obesity and NCDs in Asia Pacific

2. Asia Pacific’s health systems

3. ADB’s support to DMCs- The Operational Plan for Health 2015-2020

4. ADB-ADBI collaborations for better evidence based policy making

2. Asia Pacific Health Systems

In-equitable access to

quality health care

Countries commitment to Universal Health

Coverage (SDG 3)

but reform process is slow

Aging

Urbanization

NCDs

Demand Supply

Government commitment

Health spending grows faster than income

Source: HEALTH AT A GLANCE: ASIA/PACIFIC 2012 © OECD 2012 (official WHO data)

.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Health expenditure,public (% of totalhealth expenditure)

External resources forhealth (% of totalexpenditure on health)

Out-of-pocket healthexpenditure (% of totalexpenditure on health)

21

Out-of pocket payments remains high

LICs and MICs are aiming for UHC

To do:

• Introduce essential packages for the poor and vulnerable

• Improve quality of essential care

• Improve quality and quantity of health workforce

Low Income

Countries

Financial

Protection and

quality low

To do:

• Purchase of

services from

private sector

• Provide services

for poor and

vulnerable

• Improve quality,

efficiency Coverage and

quality low

Middle Income

Countries

23

To ensure healthy lives and promote wellbeing for all at all ages

Reduce maternal mortality

Reduce child and neonatal mortality End epidemics of HIV, TB, malaria and NTD, and combat hepatitis, water-borne diseases and other

communicable diseases

Reduce mortality due to NCD and improve mental health

Strengthen prevention and treatment of substance abuse (narcotics, alcohol)

Reduce mortality due to road traffic injuries Universal access to sexual and reproductive health-care services

Achieve universal health coverage Reduce deaths and illness due to pollution and contamination

Strengthen implementation FCTC (tobacco)

Access to affordable essential medicines and technologies

Increased health financing and health workforce in developing countries

Enhance capacity for early warning, risk reduction and management of national and global health risks

Targets

3.1

3.2 3.3

3.4

3.5

3.6

3.7

3.8

3.9 3.a

3.b

3.c

Countries are implementing

Social Health Insurance

CHARACTERIZED BY

• Quasi-Independent and

Protected (Pooled) Fund with

Autonomy

• Split between Financing and

Provision

• Funded by payroll taxes and

government revenues

• Entitlements because of your

citizenship and not because of

your job (universality of

population coverage)

DRIVING

• Strategic Health Purchasing for

Results, Outcomes and Outputs

• Leveraging Payments to

ensure:

– Enhanced Efficiency

– Equity and Fairness

– Quality of Care

– Comprehensive Health Services

(primary care, medicines,

referral, hospital)

• Harnessing the private sector

• Empowerment of the insured

– “you do not owe the

provider a favor”

25

• Latest amendment in Health Insurance

law in 2014 now calls for Universal Health

Insurance (UHI)

• Poor (and other populations – war

veterans, soldiers, widows) are subsidized

by the government

• Under-six children ALL covered

• Massive investments in supply side using

“Health Bonds”

• (Explicit) premium subsidies for ALL

informal sector

• Developing NCD insurance packages

Viet Nam

26

• In 2004, decided to have a single health insurance fund

– Survived legal challenges and finally implemented of national health insurance program (JKN) in 2014

– All five health insurance funds pooled into a single fund

• Targets universal health insurance coverage by 2019

– Currently, 63% (151.5 million people) are covered

– Poor (individually determined by provinces) are subsidized by the government

• Government and private providers are

contracted

– ALL required NOT to charge co-payments or to balance bill

Indonesia

27

• National Health Insurance enacted in 1995

• PhilHealth (a government corporation) was established to run the NHI with policies set by its governing board

• In 1997, two health funds were

consolidated into one fund. The third fund (the overseas Filipino health insurance fund) was incorporated in 2005

• Poor are subsidized by the government (increased subsidies by 2012/13 with sin taxes earmarked to increase/sustain the subsidies)

• Government and private providers are contracted

Philippines

28

UHC Coverage is still very low in the region

Outline

1.Obesity and NCDs in Asia Pacific

2. Asia Pacific’s health systems

3. ADB’s support to DMCs- The Operational Plan for Health 2015-2020

4. ADB-ADBI collaborations for better evidence based policy making

3. ADB’s Operational Plan for Health

Focusing and model building

Strengthen health systems for Universal Health Coverage

1.Health infrastructure 2.Health governance

3.Health financing

Focus on 8–12 ADB DMCs

Build best practices, share knowledge,

evaluate impact

Integrated Hospital Care

• Pooling of State and health insurance funds • Improving quality of care for disadvantaged

groups, introducing evidence based care and standards

Project link

Innovative feature

Impact

Partnerships

The next big thing

• MON - Fourth Health Sector Development Project

• Fourth Health Sector Development Project (Additional Financing)

• Fifth Health Sector Development Project

• Infrastructure investment to develop model hospitals backed by strong ICT systems

• Hospital and primary care network with referral system

• Financial autonomy of hospitals

Improved quality of health services

WHO

• Interconnected network of sentinel laboratories for early warning

• Health insurance portability between GMS countries

Project/program link

Innovative feature

Impact

Partnerships

The next big thing

• GMS Communicable Diseases Control Projects 1 + 2 (existing) in CAM, LAO and VIE

• GMS Health Security Loan (in preparation for 2016) (MYA included)

• Regional cooperation on public goods • Infrastructure projects integrate preventive

health activities (HIV) • Neighboring provinces establish cross-border

diseases surveillance, response to epidemics, patients referrals.

Control of communicable diseases with epidemic potential, malaria elimination.

WHO, Global Funds, IOM, International NGOs

• Intersectoral convergence of urban health • Patient centric Health Information System

Management • Service delivery through performance based

PPP models

Project/program link

Innovative feature

Impact

Partnerships

The next big thing

• IND-Support for National Urban Health Mission

• (learning from BAN-Urban Primary Health Care Services Delivery Project)

• Innovation creation for service delivery models and knowledge generation in urban health integrated as Disbursement Linked Indicators

• First Result Based Loan in health

Better health for urban poor

• ICT in health, big data analysis • Benchmarking of prices for services • Harnessing the private sector • Service delivery through performance based

PPP models

Project/program link

Innovative feature

Impact

Partnerships

The next big thing

• PAK- Benazir Income Support Program • MON- Fourth Health Sector Development

Project (Additional Financing)

• Innovation creation for service delivery models and knowledge generation in urban health integrated as Disbursement Linked Indicators

• First Result Based Loan in health

Improved health outcomes, Sustainable financing

University of Seoul

ADB is collaborating with

Centers of Excellence

Outline

1.Obesity and NCDs in Asia Pacific

2. Asia Pacific’s health systems

3. ADB’s support to DMCs- The Operational Plan for Health 2015-2020

4. ADB-ADBI collaborations for better evidence based policy making

38

4. ADB-ADBI collaboration

Urban Health Analyzing the impact of housing on health

NCDs

Economic impact of

NCD risk factors such as

Obesity

NCD prevention

Developing the economic

argument for investing in disease

prevention

?

Dr. Susann Roth – sroth@adb.org

LinkedIn: https://ph.linkedin.com/pub/susann-dr-roth/15/29a/940

Twitter: https://twitter.com/adb_susannr

Blog: http://blogs.adb.org/author/health-team

Health Sector Website: http://www.adb.org/sectors/health/main

For more information

Knowledge Product pipeline Opportunities for knowledge collaboration

ADB’s working paper series 2015-2016 • Pharmaceutical policy/regulatory convergence for better access

to malaria and other communicable diseases treatments

• Unique identifiers for malaria elimination, links to civil registration

and vital statistics and UHC, with reference to in-country landscape analyses

• From malaria surveillance to sustainable e-health architecture

• Interoperability lab for better HMIS

• Malaria surveillance in the GMS • Urban Health in Asia and the Pacific

• Social Health Insurance- From Design to Implementation

• The Business Case of investing in NCD Prevention

• Health Public Private Partnership in Asia and the Pacific • The UHC Dashboard- Why measuring UHC matters