Hello, welcome to visit Shanghai Forum
Thank you very much. We switch dears nowand talk about all the wonderful food you are eating in Shanghai. So you see mytitle: Better Health for 4 Billion Asians: the Battle against theNoncommunicable Diseases in the Next Decade. If you read that that title, Ihave already made my impact, because that is really my message. We have abattle coming, it’s already here. I’m going to briefly set the scene for thisbattle, describe the battle and see how you are going to fight the battle. It’sgoing be tough.
So let me first set the scene. I came herefirst time 35 years ago. I think I saw in the street were bicycles and peopledoing Tai Ji, and there were no McDonalds. I’m going to try to use theseslides. Let see how it goes. Here you see, as I set the battle, how Asia’schanging. You can see the growth of national income is very different amongdifferent countries in Asia. While Japan, Singapore and Korea high, in additionCambodia low. But we know that this region is the most rapidly advancingregion. Secondly it’s a rapidly urbanizing region, Asia. This shows you the top50 cities in the world ranked by GNP between 2007 and 2025. And look howeverything is moving east. The dark green is where most of the cities’ GNP willbe in 2025. The third change is of course the rapid globalization. Look at theincrease; this is China in cars, colored television and computers. We arebecoming westernized in Asia. Now bicycles, you see, they started down and thenthey came back up, that’s just exporting of bicycles. That’s not people ridingtheir bicycles. The fourth, said in the scene, is the industrialization. Thisshows the deaths from the urban air pollution in the world. You can see the bigcloud over Asia, in China alone; there were 1.2 million deaths as a result of urbanair pollution in 2010. And the fifth change is the rapid aging; this is goodfor those of you over 65 in you audiences. You can see here, that in the redline. That the over age of 65 in Asia is greatly increasing. By 2050, 20% ofthe population will be over 65 and 8% will be over 80. That’s good news formany of you. So what is that mean? It means that, with the rapid growingeconomic situation, urbanization, globalization and industrialization andaging, we have the perfect context for the battle of non-communicable diseases.Now the second entity that setting that battle is the fact that this region ismaking great progress in reducing maternal and child mortality, which was thecause of death in this region just a year or two ago. Look at the decreasehere; these are eight different Asian countries. Look at the decrease between1990 and 2010 in maternal death. And here you can see the thin data for 8countries under 5 mortality. Most of the decrease is U5 mortalities, because wehave less children dying of infectious diseases.
But what we do have, but I should mentionthat there is a worldwide movement going on so that there are no death fromchildren, no preventable death in children under 5 by the year 2020. This isthe goal the world has set. What of course you do have here in the region isthe Emerging Infectious Diseases. You know they have names like avian flu, SARAand AIDS and multiple resistant tuberculosis and malaria. These diseases, theydon’t cause a lot of death, but they do have an economic impact. You can seehere that the SARS epidemic cost Asia 30 billion dollars. And I can tell youthat the avian flu epidemic that you just experienced here, H7N9 has alreadycaused you 8 billion dollars. But these are not causing a lot of death, theseare more economic impact. So that’s the scene we are up against and that’s thescene of the battle. What diseases are we talking about?
We are talking about the fact that thenon-communicable diseases are the leading cause of death globally. 65% of thesedeaths worldwide were attributed to them. The non-communicable disease globallyaccount for 80% of the deaths and 90% of preventable deaths in low and middleincome countries. 25% of non-communicable disease deaths occur in people lessthan 60 and by 2030 globally these disease will increase by 50% in low andmiddle income countries. But I want you to see this map which shows you what wecall the Disability Adjusted Life Years which is a combination of pre-maturemorbidity and mortality. And the more red the color, the more the countries ofthe world are suffering in non-communicable diseases and have the greatestburden. So Asia certainly has the greatest burden of this disease. And if youlook at the series of countries in Asia, this map shows you ten countries andit shows the percent of mortality from non-communicable diseases as aproportion of total death. And if you look at the left, in Myanmar Laos andCambodia, it’s 50 to 60%. If you look at, of course, Malaysia, Singapore andBrunei, it’s close to 80 and 90%. But even in the so-called poorer Asiancountries, the noncommunicable diseases are the major cause of death.
Now there are three major ones, I’m goingto briefly speak about: cardiovascular disease which is heart attack andstroke; diabetic and cancer, another one would be mental disorders.Cardiovascular diseases are the leading cause of death globally. 80% of deathscaused by cardiovascular disease occur in low and middle income countries. Theycause twice the number of deaths from a combination of infectious diseases,maternal & perinatal conditions, & nutritional deficiencies. By 2030,almost 23.6 million people will die from CVDs, mainly from ischemic heartdisease and stroke. This shows you the burden of these diseases in Asia, and Ijust want to point out here, this is by age group, across, this is DisabilityAdjusted Life Years. The dark yellow is cardiovascular disease. The light coloris stroke. And what’s very special about Asia is it has very high rates ofstroke, compared to other parts of the world, for reasons we don’t quiteunderstand. This shows you the same disability adjusted life graph fordiabetes. And what you can see here about diabetes is how young people aregetting diabetes in Asia. It’s not only a huge problem, but it’s a problem inyoung adults. This shows you the story on cancer, and if you look here in Asia.In man, you can see this is the incidents in pink. That’s mostly lung cancer.In women, in blue, the main cancer is breast cancer. So those are main cancersthat we are seeing in Asia.
Now what’s striking about this graph? It’show fast the problem of non-communicable disease has come. Here is Chinabetween 1990 and 2020, we are talking about the non-communicable disease inlight blue. It’s coming quickly and it continues to increase. This photo showsthe main drivers. They are smoking and the diets that we eat. Regardingsmoking, I want to be clear that globally there is no greater threat to theworld’s health than tobacco. You can see here that there will be 180 milliondeaths worldwide from tobacco by 2030. 140 million of them are in low andmiddle income countries. The deadly usage of cigarette in Asia is shown in thistable. If you look at the middle column of men, 67% of men in Indonesia, 43% ofmen in China, 48% in Korea and 38% in Japan, I can keep going; these rates arevery high. They are not quite as high in women. And the second problem, as Ihave mentioned, is our diets. This shows you the data of 10 years ago in mid90s. You can see we are eating more pork, more milk and poultry, men and women,in rural and urban China. And we are taking fewer greens as well. So that’ssmoking and diets.
But the third factor that’s very importantis that the major risk factor for heart disease and stroke is high blood pressure.What’s the main reason for this high potential? It’s salt intake. We shouldtake 5 grams of salt today. The surplus of salt intake is severe in Asia. Thesalt intake is the main reason for heart disease and high blood pressure thatwe have in Asia. So what can we do about this? Well we have to move intoprevention. And you can see here, we have four areas: Tobacco, Unhealthy diet,Physical Inactivity and Harmful use of alcohol. I worked a lot in Singapore.And Singapore had had terrible problems with smoking. It implemented the policythat banned all tobacco advertising which strictly sells cigarette with boldwarning on cigarette pact and banned smoking for people less than 18 years.That has a dramatic effect on smoking. In the United States, you may know this,coronary heart disease has gone down 36% and stroke death rate has gone down31% in the last decade， mostly as a result of the fact that many more people are aware ofthe importance of diet and exercise. Smoking rates have come down and thereforewe have much less uncontrolled hypertension at cholesterol problems and we alsohad better treatments.
The other thing we need to do is we need tointegrate our care for non-communicable diseases into existing patient regimesfor other diseases. We also need a wide research agenda. Smoking and eatingbehavior is not easy to change, we have to do some important research, and weare delighted that Fudan Global Health Institute, which is a partner of Duke,was launched last year. We also have ourselves, at Duke, we are opening up aglobal health research center. In here by Kunshan, we will open up next year, acorporate of joint adventure. We’ll study a lot with scholars from Fudan andelsewhere in China the problems of chronic disease and environmental health.Lastly let me say that for this battle to be won, we need a global movement.Asia cannot do it on its own. Many of you may know that for the past 15 years,we have had something called millennium development goals. These are eightmillennium goals, and we were delighted that three of them, four, five and sixinvolved health: Reduce child mortality; Improve maternal heath; Combat HIV/AIDS, malaria and other diseases. And now the world is debating what should bethe next set of 15 years of goals. The current thinking is that there will bedevelopment and health goals.
So my summery slide. Asia has decliningmaternal and child mortality, emerging infections though remain and will threatmore to the economy than to the population so far. But most importantly, Asiafaces a rapid expanding pandemic of non-communicable disease which presentsmajor challenges for prevention and control. Asian governments should mountmulti-sectoral responses, develop innovative, scalable interventions, and setappropriate policies. Private sectors should be a major partner in this effort.
