In developed countries, years of life lost (YLL)
to communicable diseases are relatively low; in
stark contrast with developing countries,
where communicable diseases have a higher
share of YLL than non-communicable
diseases. This overview highlights the growing
and disproportionate impact of communicable
versus non-communicable diseases in the Asia-
Pacific.
Cause of death
Causes of death are broadly classified in three
categories, communicable diseases, noncommunicable
diseases (such as cancer and heart
disease) and injuries.
One way of assessing the impact of different
causes of death is by assessing the years of life lost
(YLL) for each broad cause of death. YLL,
a measure of premature mortality, is an estimate
of the average number of additional years
a person would have lived if he or she had not
died prematurely. YLL per person represents the
difference between the global standard life
expectancy, which is the same for all countries for
a given year, and the age at death (if the age of
death exceeds the life expectancy YLL is zero).
YLL is an alternative to death rates that give more
weight to deaths by younger people.
The shares of YLL for non-communicable and
communicable diseases vary substantially among
countries in the Asia-Pacific region. Developed
countries have advanced healthcare systems and
living conditions that help counter disease and
prolong life, thus most developed Asian and
Pacific countries have a high percentage of older
people in their population. For developed
countries, the risk of communicable disease is less
than that of developing countries; however, as
non-communicable diseases are more prevalent
and severe among older persons (e.g., diabetes
mellitus, cardiovascular disease, respiratory
disease, genitourinary disease) these countries
are more likely to have a higher percentage of
YLL owing to non-communicable than to
communicable diseases (and to have a lower YLL
per capita).
Figure I.26 – Years of life lost by cause, high
income Asia and the Pacific countries, 2008
On the other hand, developing and leastdeveloped
Asian and Pacific countries are
vulnerable to both non-communicable and
communicable diseases. Since most of these
countries have a relatively high proportion of
deaths of young people (including children)
which are often caused by communicable
diseases, the figures for YLL due to
communicable diseases are higher. Noticeably of
the five Asia-Pacific countries with an YLL of
60% or more for communicable diseases (Timor-
Leste, Afghanistan, Pakistan, Papua New Guinea
and Tajikistan), three are LDCs.
Interestingly, non-communicable diseases kill at
younger ages in low- and middle-income
countries, where 29% of such deaths occur
among people less than 60 years old; whereas in
high-income countries, the proportion is 13.1
This further demonstrates the value of advanced
healthcare systems.
Figure I.27 – Most affected countries with 60%
or more years of life lost to communicable
diseases in Asia and the Pacific, 2008
Smoking
Smoking, the primary form of tobacco use, is one
of the major risk factors related to noncommunicable
diseases (lung cancer, obstructive
pulmonary disease and heart attacks). Tobacco is
one of the five main risk factors for noncommunicable
diseases identified by the WHO
(high blood pressure, raised cholesterol, tobacco
use, alcohol consumption, and obesity). In 2008,
more than 5 million people in the Asia-Pacific
region died from tobacco use and exposure to
tobacco smoke, for an average of 1 death every
6 seconds.2
In 2006, North and Central Asia had the highest
smoking prevalence rate for both females (22%)
and males (61%). Huge differences in
percentages of female and male smokers are
observable in all subregions except in the Pacific.
The difference between smoking prevalence of
males and females was large in the Democratic
People’s Republic of Korea (58 percentage point
difference), Armenia (58), Indonesia (57) and
China (56), while it was minimal in New
Zealand (2), Australia (3), Nauru (6), and Nepal
and Cook Islands (8 each). Nauru was the only
country in the region where the smoking
prevalence of females (54%) was higher than
males (48%).
Of serious concern for public health, many
countries in Asia and especially the Pacific have
very high percentages of adolescents (13 to 15
years old) who use tobacco, both male and
female. All of he Pacific island developing
economies, except Fiji, showed ranges of
adolescent tobacco use at or above 20% (for both
males and females) – in contrast with the lower
rates, especially among adolescent females seen
in most Asian countries. Continuation of tobacco
use from such an early age puts people at a much
greater risk of contracting non-communicable
diseases at an earlier age. If not addressed
effectively, the problem will increase pressure on
healthcare systems in the future and cause health
expenditures to rise in those countries.
Alcohol
Alcohol is a causal factor in 60 types of diseases
and a component cause in 200 others and it is
also a precursor to injury and violence.3
Asia and the Pacific has a lower level of alcohol
consumption than most other regions of the
world – 5 litres of pure alcohol per adult
(15 years and older) per year in 2005, compared
with a worldwide average of 6 litres per adult per
year. Such a low figure derives mostly from the
large proportion of non-consumers in the
population of many countries, as the Asia-Pacific
region consumes 16 litres of alcohol per
consumer as compared to the world average
of 17.
Among subregions there is considerable variation
in alcohol consumption, the regions with the
highest consumption per capita are North and
Central Asia (at 13 litres per adult per year) and
the Pacific island countries (9 litres per adult per
year). Based on alcohol consumption per
consumer, the regions with the highest
consumption figures are North and Central Asia
(at 25 litres per consumer per year) and South
and South-West Asia (21 litres). The Russian
Federation has the highest adult consumption of
the region, at 16 litres per adult per year, followed by the Republic of Korea (15 litres), Armenia
(11 litres), Azerbaijan (11 litres) and Kazakhstan
(11 litres). Some countries show a high level of
alcohol consumption among consumers only,
while per capita consumption among all adults
is low. That duality indicates that many alcohol
consumers in those countries are drinking at very
high levels.
For every Asian and Pacific country with available
data, women who consume alcohol drink less
than men (differences range from 1 in Singapore
to 24 in Tonga).
Figure I.28 – Alcohol consumption per adult
and per alcohol consumer, Asia-Pacific
subregions, 2005
Figure I.29 – Alcohol consumption per adult
and per alcohol consumer in some Asia and the
Pacific countries, 2005
Suicide
The incidence of suicide is very country-specific,
with no distinct pattern among Asian and Pacific
countries. China, Japan, Kazakhstan, Mongolia,
the Republic of Korea, the Russian Federation,
Samoa and Sri Lanka have the highest reported
suicides. Huge differences between female and
male suicide rates can be seen in many countries.
In all Asia-Pacific countries, with the exception
of China, male suicide rates are higher. The
greatest gender differences can be seen in the
Russian Federation (with 54 for men versus 10
for women, per 100,000 people) and Kazakhstan
(with 46 versus 9). These two countries are also
the two countries in the region with the highest
reported suicide rates among men.
Prevention to counter the threat of non-communicable diseases
Non-communicable diseases are a serious health threat and were the leading cause of death globally in 2008, according
to the WHO Global Status Report on Non-communicable Diseases 2010. Chief among the non-communicable
diseases causes of deaths were cardiovascular diseases, diabetes, cancers and chronic respiratory diseases, constituting
almost two thirds (63%) of all deaths due to non-communicable diseases.
Deaths from non-communicable diseases by sex, Asia and the Pacific subregions, 2008
Many non-communicable diseases are preventable through reduction of the main behavioural risk factors: tobacco
use, physical inactivity, harmful use of alcohol and an unhealthy diet. Interventions to prevent non-communicable
diseases are both achievable and cost-effective. For governments – as a public health measure – and for the affected
individuals or families, prevention is cheaper than treatment. |
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Other health risks
