Global Research Example: "The Challenge of Chronic,
Non-Communicable Disease in the Asia Pacific Region"
Asia-Pacific Global?KEN
Lion’s share of global population
Bears brunt of double burden of disease
Asia Pacific Region
Per capita incomes, 1960-2003
Japan
China
S Korea
Taiwan,
Singapore
Hong Kong
Malaysia Thailand
Demographic transition:% population > 65years
Hong Kong
Japan
Singapore
S Korea
China
Epidemiological transition
Infectious diseases
Chronic diseases
Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005
Globally, 60% of all deaths are due to NCDs
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:
Source: 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non communicable Diseases, WHO 2008
73% of total deaths
73% of total deaths
60% of total deaths
60% of total deaths
43% of global
burden of disease
43% of global
burden of disease
60% of global
burden of disease
60% of global
burden of disease
NCDs1998
NCDs2020
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 SydneyUniversity of British ColumbiaUniversity of ChileFudan UniversityHong Kong University of Science &TechnologyNanjing UniversityPeking UniversityTsinghua UniversityUniversity of Hong KongZhejiang University
Chulalongkorn UniversityUniversity of IndonesiaKeio UniversityKyoto UniversityOsaka UniversityTohoku UniversityUniversity of TokyoWaseda UniversityKorea UniversitySeoul National UniversityUniversity of MalayaTecnológico de MonterreyUniversity of Auckland
University of the PhilippinesFar Eastern National UniversityNational University of SingaporeCalifornia 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 WashingtonNational Taiwan UniversityNational Autonomous University of Mexico
University of Science and Technology of China
2008University of Tokyo
Background2007
Peking University
AWI Public Health Workshops
Public Health Project
(WHO 2005, 2008)
Public Health Project
Founding Charter Members
14 Johns Hopkins University15 University of Southern California
Public Health Project inaugural meeting
Singapore 9-11 November 2008
JapanChinaTaiwan
SingaporeMalaysia
Indonesia
Australia
USA
VietnamHong Kong
Operating Principles
JapanChina
Taiwan
SingaporeMalaysia
Indonesia
Australia
USA
VietnamHong Kong
1
3
AWI
2
Steering Committee
June 2009
Feb 2009
Nov 2008
Nov 2009
June 2010
What Next?
Completion
Grant Proposal 1st draft
Funding Start Projects up and running
Start
Baseline study
4 studies
Total Population (2008)
source: WHO (2006)
GDP per capita (2008)
Health expenditure per capita (USD 2008)
% Elderly (>65 years, 2008)
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: 2001Hong Kong: 2008Indonesia: maleJapan: frequent drinkerMalaysia: (18+, heavy drinker), World Health Survey MalaysiaVietnam: heavy drinkerChina: 1998, current drinkerLaos: heavy drinkerUSA: heavy drinker
High Cholesterol (%)
Thailand (2000)Hong Kong: 2003/2004Malaysia: 20-90, 1995Australia: self reportedNo data for: China,LaosTaiwan,Vietnam
Hypertension (%)
Hong Kong: 2003/2004Indonesia: maleJapan: male (>=SBP 140 and/or DBP 90mmHg)Malaysia: (30+, SBP 140 and DBP 90)Vietnam: no nationalChina: >= SBP 140 and/or DBP 90mmHg or antihzpertensive medicationUSA: >=SBP 140 and/or DBP 90mmHg 20+)Australia: male, self-reported, 2004
Literacy rate (%)
Graphic health warnings on cigarette packs
Not implemented:USA, Japan, China, Vietnam, Indonesia, Laos
Year of implementation
2009
2009
2008
2006
2005
2004
Phase 2 Projects Champions Team Members “N-City Study” Claremont GU
C. Anderson Johnson CGU, CUHK, HSPH, Stanford U, JHUUI, UNU, U Tokyo, Zhejiang U, NUS
“Breakthrough Collaborative Study”
University of SydneyG Rubin
CGU, CUHK, HSPH, PKU, Stanford, UI, U Tokyo, JHU, NUS
Diabetes study” Stanford UniversityKaren Eggleston,
CGU, CUHK, PKU, Stanford U, UI, UNU, JHU, NUS
“Health workforce study”
University of TokyoMasamine Jimba
CGU, CUHK, HSPH, Stanford U, U Tokyo, Zhejiang U, JHU, NUS
WHO: 36 million lives
20 million in the Asia Pacific Region
The challenge:
80% of premature heart disease, stroke and type 2 diabetes is preventable, 40% of cancer is preventable (WHO)
We know what the root causes are
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
Dis
eas
e B
urd
en
Time
Low Risk High Risk
Early Chronic
Co
st
Irre
vers
ibil
ityLate
Chronic
Participating Population
holistic health care
Yet medical practice is still focused on the wrong end
of the curve
Public Health ProjectWill 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
Healthier World
Thank you!