Volume 201 - Issue 7
Will current health reforms in south and east Asia improve equity?
Author: Rohan Jayasuriya
Med J Aust 2014; 201 (7): 382. || doi: 10.5694/mja14.00880
Published online: 6 October 2014
Published online: 6 October 2014
Dietary changes that follow economic development will increase the risks of non-communicable disease among the poor
To the Editor: Hipgrave and Hort review health reform initiatives in south and east Asia and draw attention to the increasing privatisation of services and the inequity created as the poor have less access.1 More importantly, countries in south and east Asia are enjoying a period of economic development that has resulted in urbanisation and lifestyle change, specifically dietary change, in both urban and rural populations. This has resulted in a nutrition transition, which is associated with the chronic non-communicable disease (NCD) “epidemic”.2 The trends are that the poor in these countries will have higher levels of risk factors for chronic NCD.3
Health systems in most low and middle income countries have been designed for episodic care for acute conditions, and not for primary health care involving the continuity of care required for managing chronic disease. Second, most of these countries have made negligible investments for prevention of risk factors through population-based programs. Third, intersectoral policies to deal with “upstream” issues, such as marketing of unhealthy food, are not yet in their reform agenda.
Australia's success in tobacco control and reduction of HIV/AIDs are lessons that we can share. However, the same cannot be said of food policy, and many countries have failed to resist the pressures of the multinational food industry.4 Countries in south and east Asia require intersectoral policies on healthy food to achieve a long-term, sustainable solution to health inequity.5
Competing interests
No relevant disclosures.
References
- Hipgrave DB, Hort K. Will current health reforms in south and east Asia improve equity? Med J Aust 2014; 200: 514-516. _Ref398185661
- Popkin BM. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr 2006; 84: 289-298. _Ref398018264
- Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012; 70: 3-21. _Ref398018305
- Fraser B. Latin American countries crack down on junk food. Lancet 2013; 382: 385-386. _Ref398018723
- Popkin BM; Bellagio Meeting group. Bellagio Declaration 2013: countering Big Food's undermining of healthy food policies. Obes Rev 2013; 14 Suppl 2: 9-10. _Ref398018727