HEALTH ISSUES IN SOUTHEAST ASIA

CHILD MORTALITY RATES INCREASING IN PARTS OF ASIA

In August 2004, Reuters reported: “Child mortality rates are spiraling in parts of Asia because of financially crippled public health care systems, a U.N. report said. An increasing reliance on privatized health care and the stripping back of state hospitals was endangering the health of thousands of mothers and children, a senior United Nations Children's Fund official said. [Source: Reuters, August 10, 2004]

"An aggressive increase in privatization and a system where the user has to fully pay for health care means that the poor tend to drop out of the picture," Dr Steve Atwood, UNICEF'S Regional Adviser for Health and Nutrition, told Reuters. "People tend to view health as an income-generating activity that doesn't require government funding. This unfortunately divides people into those who can pay for the service and those who can't," he said. Atwood pointed to the dramatic increase in child deaths in Cambodia since the country began a privatization drive.

UNICEF estimates that one in seven children die in Cambodia before they reach the age of five and has listed the country among the top 10 that have failed to make a dent in child mortality, In countries like Cambodia, UNICEF has estimated that one in seven children die before the age of 5.

The move towards privatization often forces the user to pay for the health care, something few can afford. Atwood accused private health services of “sponging” much needed resources away from public facilities already devastated by cutbacks, “We see the same problem in the West. When the private schools, private hospitals crop up, they sponge resources away from the public sector. The best doctors, the best equipment, the best facilities, he said.”

Obesity in Asia

Obesity is becoming a problem as more people move to the cities, eat more fatty food and adopt a more sedentary lifestyles. Health problems associated with obesity---such as cardiovascular disease, stroke, diabetes, hypertension---are on the rise and blamed for many more deaths than they were in the past. About a third of people in Asia and the western Pacific were overweight in 2005 with the numbers seen growing to 53 percent of men and 44 percent of women by 2015, the World Health Organisation estimated.

In China, 23 percent of the population is overweight, In India, obese people make up a quarter of the population in some cities, a by-product of rising incomes. Particularly alarming are increases in forms of diabetes among children normally associated with adults and the high rates of cardiovascular disease associated with people who eat fatty foods, smoke and don’t get much exercise.

Asians tend to store more fat around the abdomen than people of European descent and this fat puts particularly high amounts of stress on the heart and cardiovascular system. Studies also seem to indicate that Asians encounter greater health risks from smaller amounts of fat than is the case with people of European descent.

Fat has traditionally been a sign of wealth because only the rich could afford to eat a lot. In some cases countries have to deal with increasing numbers of obese people among the upper and middle classes are dealing with food shortages among the poor and lower classes.

Increased Obesity Lifts Health Food Market in Asia

Ralph Jennings of Reuters wrote: Affluence and sedentary lifestyles have brought health problems such as obesity and diabetes to Asia, prompting locals to fill up their shopping carts health food products such as oats, yoghurt and vitamins. "I went to a bookstore and read about it," said B ill Chung, 33, a self-employed Taipei resident who lost six kilograms (13 pounds) over the past two months. "I'm spending a little less and it's all healthy, so I'm on track." [Source: Ralph Jennings, Reuters, July 8, 2009]

“Asia has lagged behind other regions in packaged health foods consumption as the overall diet is relatively healthy with vegetables a main ingredient in many local dishes. Nevertheless, the region's recent economic success has prompted fast food chains to expand outlets across Asia and foods such as ice-cream and chocolates have become popular. Where high calorie junk food goes, health food follows close behind, those in the industry say, predicting solid growth for health products in Asia in the next few years. [Ibid]

"They (health foods) are emerging products," said Lyndsey Anderson, Asia food and drink head for the London-based market forecasting firm Business Monitor. "It hasn't caught on as quickly in the developing world. People traditionally have healthier diets anyway. The need to pay for packaged health foods isn't there. The region is lagging the rest of the world in that regard," Anderson said. "In terms of transitioning, that is completely turning around," she said, adding that she expected to see steady growth in this high-priced food sector from the end of 2010 or in early 2011 as the regional economy improves. [Ibid]

“Health foods already make up roughly 5 percent of product lines sold by food companies in Asia, she said. The market for functional foods, which range from flaxseed, wheatgerm and soy-based products to probiotic yoghurt, is worth about $20 billion a year in Asia, including Japan, Anderson said. In addition to standard health foods, the supplements industry, which includes vitamins and protein mixes, was worth about $14 billion in Asia in 2006, not including Japan, according to estimates by the research firm DataMonitor. "In Asia, as people are getting more and more affluent, the health food market is certainly on the rise," said Shirley Ivarsson, a dietician in Hong Kong. [Ibid]

"We've moved away from traditional agrarian values," said Ted Ning, executive director of Lifestyles of Health and Sustainability, a U.S.-based consumer movement. "Consumers are increasingly seeking quick fixes to address health needs as they grow increasingly tired due to demands of work," the company said in a statement. [Ibid]

Types of Health Food Products in Asia

Ralph Jennings of Reuters wrote: “Jostling for space on supermarket shelves in cities from Shanghai to Singapore are local health products such as root powders, herbal teas and variations of chicken soup, a favourite elixir among ethnic Chinese. Singapore-based Cerebos Pacific (CERE.SI), which makes bottled Essence of Chicken, saw 33 percent profit growth from 2004 to 2008. [Source: Ralph Jennings, Reuters, July 8, 2009]

“The drinks market has gone healthy with Coca-Cola Co introducing a new bottled spring water in Japan last month after expanding its product lines in Hong Kong with drinks flavoured with preserved almonds, jujubes and pears. PepsiCo launched SoBe beverages, a range that included fortified teas, fruit drinks and energy drinks in India. Nestle was the first to introduce probiotic yogurt in India in 2007, while Tata Tea, India's top tea company, recently introduced a series of cold drinks with tea, fruit and ginseng. [Ibid]

:It's not always easy to convince consumers that a specialised food can help them, said Charu Harish, who does publicity in Hong Kong and Malaysia for GlaxoSmithKline's (GSK.L) Horlicks milk-and-wheat drink and Ribena fruit drinks. "It's not about a soft sell," Harish said. "Health and well being are the first things people in Asia think of. We are trying to market our products with as much transparency as possible." [Ibid]

“For this reason, companies go to great lengths to emphasise the health properties of their products when targeting consumers in Asia.In its marketing campaigns in the region, the Almond Board of California, which represents 6,000 growers, has stressed that its nuts contain anti-oxidants and protein. As a result, the board saw 24 percent growth from 2006 to 2008, with its members earning $486 million in 2008 from sales in four Asian countries, including China and India, said chief marketing officer Shirley Horn. [Ibid]

“Consumers associate health food with better quality, a sensitive issue in the wake of a string of China-produced food scandals which resulted in supermarkets across the region removing items with chemicals such as melamine from shelves. Reflecting the food safety concerns of many consumers in Asia, Wanpen Thongsri, 49, a company executive in Thailand where health food popularity has grown exponentially, said that she is willing to pay a premium for health foods. "Frankly, I don't know if I can feel safe with all brands. But I'm willing to pay more for good health," she said. [Ibid]

Skin Cancer Rates Rise as More Asians Seek Out the Sun

In 2007, Reuters reported: “A growing trend in East Asia to soak up the sun - either on beaches or in tanning salons - is worrying dermatologists in the region who say there is a rise in skin cancer. The number of cases is low compared to Australia and the US but the tanning trend has raised concern of cancer risks in a region where a porcelain complexion was traditionally considered the ultimate sign of beauty and refinement.[Source: Reuters, October 30, 2007]

In Asia, sun worshippers do not just work on their tans on the beach or by the pool - tanning salons are increasingly popular as beauty salons offering a range of treatments take off in a region that is enjoying unprecedented affluence.

The number of cases in Asia has jumped markedly in recent years. There were 1,712 new cases of skin cancer diagnosed in South Korea in 2005, up from in 1995, the Korea Central Cancer Registry says. Incidences in Hong Kong went up to around 650 in 2004 from 370 in 1995.

Skin cancer is one of the commonest forms of cancer and is linked to other risk factors like fair skin, light coloured hair and eyes, a compromised immune system, genes and old age. There are three major types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. The first two are slow growing and highly treatable if discovered early. Melanoma is the most lethal as it affects deeper layers of the skin and can quickly spread to other parts of the body.

Ro Young-suck, head of the Korean Dermatologist Association, says Asians used to think they were pretty safe from skin cancer. "However, due to increased outdoor activity, more [sun] exposure and sun tanning, there is an increasing incidence of skin cancer amongst younger people," he said.

"There has been a huge increase in skin cancer rates in Korean men in particular. "We predict it's because while most Korean women usually wear sunscreen while putting on their makeup, men aren't used to this, aren't aware how dangerous it is, and so they don't bother to."

Dr George Li said, a plastic surgeon at Hong Kong's public Queen Mary Hospital, says people who are constantly exposed to ultraviolet radiation (UV) in sunlight will not get cancer immediately. "It takes a long time to cause skin damage, as people get older there is a high chance to develop skin cancer," he said.

Medical Tourism in Asia

Andrew Bender wrote in the Los Angeles Times: “Americans fretting about rising medical costs at home are among those creating a boom in Asian medical tourism. Thailand, South Korea, Singapore and India are leading the way in checkups, fertility treatments, joint replacements and cosmetic surgery by professionals, many trained stateside, at a fraction of the cost in the U.S. [Source: Andrew Bender, Los Angeles Times, March 06, 2011]

“Costs for Americans can be as much as 70 percent less than in the U.S., says Paul Keckley, executive director of the Deloitte Center for Health Solutions in Washington, D.C. He estimates that 140,000 travelers went to Thailand alone in 2009 for medical procedures. American medical tourists go for "short-stay surgical procedures where people don't perceive much risk," such as breast augmentation, gum surgery and nose jobs, he says. "You're probably not going over for a lung transplant." [Ibid]

“In techie Korea, there's a smart phone app for that (MediApp Korea) in four languages, including English, and a Medical Tourism Information Center at Seoul's Incheon International Airport directs visitors to clinics for plastic surgery, dentistry, fertility, Oriental medicine and more. Treatments in India span Western medicine and ayurvedic massage and yoga, and Bangkok's Bumrungrad Hospital has an international reputation for arthroscopy, tattoo removal and other specialties. Bangkok is even known as a center for gender reassignment surgery. Keckley cautions those considering such a trip that it's a buyer-beware market. The risk is not so much in the procedure, he says, but in the potential for complications after travelers return home. Some Asian practitioners are enhancing pre- and post-care by using such tools as electronic record keeping. [Ibid]

Jeremy Laurence of Reuters wrote: “Traveling abroad for medical treatment is now a multi-billion dollar business. From a nip-and-tuck to a heart bypass, hospitals from India to Singapore and South Korea treat more than 1 million foreign patients a year -- lured by cut-price surgery, no waiting lists, cutting-edge technology, and highly trained doctors. [Source: Jeremy Laurence, Reuters, October 4, 2011]

Thailand and India, Asia's leading destinations, specialize in orthopedic and cardiac surgery. India's government says its medical services are cheaper than those in southeast Asia, and identifies its English-speaking doctors as providing a "major comfort factor." It has even introduced a special visa category to cater for the growing number of medical tourists. Thailand sells itself as dual purpose destination where medical treatment can be combined with a cheap recuperative holiday. Bangkok was this year identified by TripIndex as the best value global city for U.S. travelers.

The Singapore healthcare industry positions itself as a "premium" center. Among its patrons have been many of Malaysia's sultans, as well as other high profile political figures and celebrities from Asia and the Middle East. By next year, Singapore aims to treat a million foreign patients a year, generating about $3 billion for the economy, the Singapore Straits Times has reported. Its area of expertise includes cancer treatments, cardiology and other specialized care. Neighboring Malaysia, attracted nearly 400,000 medical tourists last year, and aims to increase that number to 1.9 million by 2020, mainly by way of undercutting Singapore. A health official said costs in Malaysia are 30 percent cheaper than the city-state to the south. The Philippines also sees itself as a cut-price destination, and is projecting the number of medical tourists to hit one million by 2015, generating at least $1 billion in revenue.

Problems with Medical Tourism in Asia

Jeremy Laurence of Reuters wrote: “Some experts, however, lament the rise of the medical tourism industry, saying it exacerbates a brain drain of talent from the state to the private system, from rural to urban areas. A paper published in the International Journal for Equity in Health last year said specialists were being swayed by the higher wages and better technology of the private sector. If the industry achieved even a fraction of its projected growth "this could ultimately lead to locals being priced out of their own health care system, as demand from foreign patients can drive up the costs of providing care for everyone," it said. [Source: Jeremy Laurence, Reuters, October 4, 2011]

Experts cite other concerns such as medical errors, lax follow-up care, and insurance, regulatory and ethical issues. The World Health Organization said in a report late last year that rapid development of medical tourism had presented "considerable implications for public health." It said that with the influx of foreign patients, the demand for and price of healthcare might rise. "In addition, an increasing number of health services might cater for the needs of foreign patients and neglect local needs," it said.

Asians Behind the Growth of Medical Tourism in Asia

Jeremy Laurence of Reuters wrote: “Industry experts predict medical tourism in Asia will grow at a rate of 15 to 20 percent a year, mainly due to the emergence of nouveaux riches in the region. "Asian medical tourism ... seems to be increasing as affluence and mobility increase in Asia," said David Vequist, head of the Center for Medical Tourism Research at the University of the Incarnate Word in Texas. "Consumer choice is a powerful force now in healthcare and is impacted by aging and increasingly heavier, sicker, and more needy populations in Asia." Many new patients are nouveau riche Chinese."No matter how expensive it is, I will go for it," says Liu Xiao-yang, 34, of Shanghai, after having double-eyelid surgery, a facelift and corrective jaw surgery in Seoul.[Source: Jeremy Laurence, Reuters, October 4, 2011]

South Korea may be one of the fastest growing medical tourism destinations, but for now it lags far behind trailblazers Thailand, Singapore, India, Malaysia and even the Philippines. They all have their own distinctive marketing strategies in an attempt to woo clients, as well as areas of specialization.

Malaysia sees China, as well as India, as being the catalysts for growth. The Philippines It targets patients from the United States, Canada, Taiwan and Japan. "We can compete with the rest of Asia because we have an edge in providing high quality medical and dental services but at a much lower cost," said Marie Recarro, an official at the Department of Tourism in Manila.

Organ Market in Asia

Saudi Arabia, Taiwan, Malaysia and South Korea were major sources of patients which traveled for organs between 2004 and 2007. China, Pakistan, Colombia, the Philippines were major sources of organs sold in the same period. William Saletan wrote in Slate, “According to the World Health Organization, the annual tally of international kidney transactions alone is about 6,000. The evidence includes reports from brokers and physicians, accounts from Indian villages, surveys of hospitals in Japan, government records in Singapore, and scars in Egyptian slums. In Pakistan, 40 percent of people in some villages are turning up with only one kidney. Charts presented at the meetings show the number of "donations" from unrelated Pakistanis skyrocketing. Two-thirds of the people getting these organs are foreigners. Data from the Philippines show the same thing. [Source: William Saletan, The Slate, April 14, 2007]

The first successful organ transplant took place half a century ago. Since then, diabetes, hypertension, and other kidney-destroying diseases have spread. Antibiotics have improved, as have drugs that suppress the immune response to foreign organs. More people need transplants, and more can be saved by them. But donations haven't kept up with demand. An estimated 170,000 patients in the U.S. and Europe are on waiting lists. More than 70,000 Americans are waiting for kidneys, and the list has grown at a rate of almost 5,000 per year. People are dying.

Instead of waiting, many patients have set out to recruit their own donors. They started with billboards, then moved to Web sites such as MatchingDonors.com, JoeNeedsaLiver.com, and HelpMyGrandpa.com. Around the world, people have learned that their organs are assets. Peruvians, Ukrainians, Chinese hospitals, and American inmates advertise their innards. Last year, a South Korean playwright used his kidney as collateral for a loan.

Politicians have tried to rein in this market. The United States banned organ sales two decades ago. India did the same in 1994, and China followed last year. But when lives are at stake, rules get bent. To procure more organs, doctors have discarded brain-death standards, donor age limits, and recipient health requirements. In the last two years, Israeli organ brokers shifted their business from Colombia to China for faster service. If China closes its doors, they can shift again. In Pakistan, kidneys already sell for a fraction of what Chinese hospitals charged. Brokers can compare organ prices from country to country, just like wheat or corn.

Already, bans on organ commerce are crumbling. Indians who lost their livelihoods in the tsunami of 2004 sold their kidneys, ignoring the law. Bulgaria imposes stiff sentences on organ traders, but that didn't deter a local hospital from serving Israeli transplant tourists last year. Nor did China's ban stop a Chinese hospital from offering a liver to a BBC correspondent. Three weeks ago, a Korean newspaper reported that China's organ crackdown had simply raised the price of a Chinese kidney in South Korea.

The key to reversing the organ market is to turn that equation on its head. Stop fighting capitalism, and start using it. What's driving the market is scarcity. Americans, Britons, Israelis, Japanese, and South Koreans are going abroad for organs mostly because too few of their countrymen have agreed to donate organs when they die. Some have religious objections. Others are squeamish. Many figure that if they don't supply the organs, somebody else will.

Wanting to Look Like a Korean

Jeremy Laurence of Reuters wrote: “The rise of an affluent class in China, and an infatuation with so-called Hallyu, or Korean Wave, culture from pop music to drama have spurred a sharp growth in South Korean medical tourism, mainly in the field of cosmetic surgery. "Every time I watch South Korean drama and TV shows, I feel that they are pretty and I want to look like them," says Liu. Kim Byung-gun, a plastic surgeon at the BK DongYang Plastic Surgery Clinic in Seoul, says his patients have ranged in age from 6, for double-eyelid procedure, to a 70-year-old seeking a skin lift. On average, they spend $5,000-$10,000 per procedure .[Source: Jeremy Laurence, Reuters, October 4, 2011]

"Medical tourism is going to be one of the growth engines of the South Korean economy," Kim says, identifying the Korean Wave as a key contributor to the rapid growth of the sector in Asia's fourth largest economy. South Korean authorities have every reason to be optimistic about the growth of the industry, particularly in the field of elective cosmetic surgery. CLSA Asia-Pacific Markets in a study released last month estimated that China would account for 60 percent of the rise in high net-worth individuals' wealth in Asia over the next five years.

Chinese patients arrive in South Korea with photographs of Korean celebrities they want to look like, says Lee Soo-jung of the Lamar Plastic Surgery Clinic in Seoul. Han Dong-woo of the Korea Health Industry Development Institute says the number of tourists coming to South Korea ballooned last year to nearly 82,000, generating about $700 million in revenues. Three years earlier, fewer than 8,000 medical tourists travelled to South Korea. Han projects some 200,000 will come next year. By 2020, the South Korean government envisages a million medical tourists a year. "I see an infinite growth potential in the plastic surgery market for foreigners," says Han, who estimates operation costs in South Korea are about half that of the United States.

Image Sources: Wikimedia Commons

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.

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© 2008 Jeffrey Hays

Last updated November 2012

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