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Meng Kin LIM National University of Singapore; Director of Public Health, APRU World Institute

Global Research Example: "The Challenge of Chronic, Non-Communicable Disease in the Asia Pacific Region". Meng Kin LIM National University of Singapore; Director of Public Health, APRU World Institute. Asia-Pacific. G lobal ? KEN. Lion’s share of global population.

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Meng Kin LIM National University of Singapore; Director of Public Health, APRU World Institute

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  1. Global Research Example: "The Challenge of Chronic, Non-Communicable Disease in the Asia Pacific Region" Meng Kin LIM National University of Singapore; Director of Public Health, APRU World Institute

  2. Asia-Pacific Global?KEN

  3. Lion’s share of global population

  4. Bears brunt of double burden of disease Asia Pacific Region

  5. Per capita incomes, 1960-2003 Japan Hong Kong Singapore Taiwan, S Korea Malaysia Thailand China

  6. Demographic transition:% population > 65years Japan Hong Kong Singapore S Korea China

  7. Infectious diseases Chronic diseases Epidemiological transition

  8. Globally, 60% of all deaths are due to NCDs Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005

  9. 80% of them occur in low- and middle-income countries(WHO 2005) Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005

  10. Based on current trends: NCDs 2020 73% of total deaths 60% of global burden of disease 60% of total deaths 43% of global burden of disease NCDs 1998 • Source: 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non communicable Diseases, WHO 2008

  11. 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

  12. Australian National UniversityUniversity of MelbourneUniversity of Sydney University of British Columbia University of Chile Fudan UniversityHong Kong University of Science &TechnologyNanjing University Peking UniversityTsinghua UniversityUniversity of Hong Kong Zhejiang University Chulalongkorn University University of Indonesia Keio UniversityKyoto UniversityOsaka University Tohoku UniversityUniversity of TokyoWaseda University Korea University Seoul National University University of Malaya Tecnológico de Monterrey University of Auckland University of the Philippines Far Eastern National University National University of Singapore California 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 Washington National Autonomous University of Mexico University of Science and Technology of China National Taiwan University

  13. 2008 University of Tokyo AWI Public Health Workshops Background 2007 Peking University

  14. Public Health Project “To come together in research collaboration so as to bring our collective expertise and capabilities to bear on a significant Public Health issue facing the Asia Pacific region”

  15. Public Health Project Chronic, Non-communicable disease- the #1 cause of death globally (WHO 2005, 2008)

  16. Claremont Graduate University Hanoi School of Public Health Nanjing University National Taiwan University National University of Singapore Peking University Stanford University The Chinese University of Hong Kong United Nations University University of Sydney University of Tokyo University of Indonesia Zhejiang University Founding Charter Members • 14 Johns Hopkins University • University of Southern California

  17. Public Health Project inaugural meeting Singapore 9-11 November 2008

  18. Operating Principles Japan China USA Taiwan Hong Kong • Charter members self-fund participation at meetings • Communication through electronic means • Decisions through consultation and consensus • Projects driven by lead “champions” • Make sufficient progress, then seek external funding for multi-year endeavor Vietnam Malaysia Singapore Indonesia Australia

  19. Steering Committee Japan China USA Taiwan Hong Kong 2 Vietnam 1 Malaysia Singapore AWI Indonesia 3 Australia • Meetings • Singapore Nov 08 • Stanford Feb 09 • Johns Hopkins Jun 09

  20. What Next? Baseline study Completion Start June 2009 Nov 2009 June 2010 Nov 2008 Feb 2009 Start Grant Proposal 1st draft Funding Projects up and running 4 studies

  21. Total Population (2008) source: WHO (2006)

  22. GDP per capita (2008)

  23. Health expenditure per capita (USD 2008)

  24. % Elderly (>65 years, 2008)

  25. Obesity (latest figures) NB: No data for Taiwan; Vietnam data available but not comparable

  26. 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

  27. Alcohol (% “heavy drinker”) Thailand: 2001 Hong Kong: 2008 Indonesia: male Japan: frequent drinker Malaysia: (18+, heavy drinker), World Health Survey Malaysia Vietnam: heavy drinker China: 1998, current drinker Laos: heavy drinker USA: heavy drinker

  28. High Cholesterol (%) Thailand (2000) Hong Kong: 2003/2004 Malaysia: 20-90, 1995 Australia: self reported No data for: China,Laos Taiwan,Vietnam

  29. Hypertension (%) Hong Kong: 2003/2004 Indonesia: male Japan: male (>=SBP 140 and/or DBP 90mmHg) Malaysia: (30+, SBP 140 and DBP 90) Vietnam: no national China: >= SBP 140 and/or DBP 90mmHg or antihzpertensive medication USA: >=SBP 140 and/or DBP 90mmHg 20+) Australia: male, self-reported, 2004

  30. Literacy rate (%)

  31. Graphic health warnings on cigarette packs 2009 2009 2008 2006 2005 Not implemented: USA, Japan, China, Vietnam, Indonesia, Laos 2004 Year of implementation

  32. WHO: 36 million lives The challenge: 20 million in the Asia Pacific Region

  33. We know what the root causes are 80% of premature heart disease, stroke and type 2 diabetes is preventable, 40% of cancer is preventable (WHO)

  34. We know prevention works Heart disease rates among men aged >30yrs, 1950-2002

  35. Yet risk factors are increasing e.g. obesity Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005

  36. We know there are better ways to manage chronic disease Integrated care

  37. Personal Lifestyle Plan Disease Management Risk Modification Participating Population Yet medical practice is still focused on the wrong end of the curve Late Chronic Cost Irreversibility Disease Burden Early Chronic Low Risk High Risk Time holistic health care

  38. Public Health Project • Will 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

  39. Ultimate goal: Healthier World Healthier Asia Pacific Region

  40. Thank you!

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