Statistical Yearbook for Asia and the Pacific 2012
 
   
B. Health
 
B.5. Other health risk

Causes of death can be classified into three broad categories: communicable diseases, noncommunicable diseases (NCDs) and injuries. Unfortunately, there is a dearth of recent data on causes of death (the latest being for 2008), which makes planning and monitoring effective responses to social and health challenges difficult for decision makers.

NCDs have been attracting increased attention in the Asian and Pacific region. However, in lowincome, lower-middle-income and upper-middleincome economies, where fewer resources are available for health, the risk of NCDs is rapidly growing. Most health systems in the region are currently not in a position to address the challenges that present themselves, while the human and financial impacts of NCDs are set to increase significantly in the coming decades. In response, preventive measures and health promotion must be given higher priority.

The major NCDs (including cardiovascular diseases, cancers, chronic respiratory diseases and diabetes) correspond to common, interrelated and modifiable risk factors. These include being overweight/obese, the harmful use of tobacco and alcohol, unhealthy diets, insufficient physical activity, and elevated levels of blood pressure, blood sugar and cholesterol. Due to the lack of recent data for some indicators, the present topic considers only smoking and alcohol consumption in the Asian and Pacific region.

Smoking prevalence among females was much lower in the Asian and Pacific region (5.1 per cent) than in most of the rest of the world in 2009.

In the Asian and Pacific region, the prevalence of smoking among females is well below the global average and lower than in any other region apart from Africa. Furthermore, over the period from 2006 to 2009, smoking prevalence among women in the region fell by 20 per cent. This was a decline greater than that in Latin America and the Caribbean and in Europe (where prevalence was several times higher), while there was a rise in Africa and, especially, North America. The global prevalence decreased from 9.6 per cent in 2006 to 8.6 per cent in 2009.

Unlike among females, the smoking prevalence among males in the Asian and Pacific region was above the global average and the averages of all other regions. The decrease of 12 per cent from 2006 to 2009 was, nonetheless, the greatest decline compared with that of other regions, and contrary to the increased smoking prevalence among males in North America.

Figure B.5-1
Smoking prevalence among males, 10 highest prevalence countries in Asia and the Pacific, 2006 and 2009

Figure B.5-1 Smoking prevalence among males, 10 highest prevalence countries in Asia and the Pacific, 2006 and 2009Most countries in the region have large gender differences, with men smoking more than women. However, in 2009, Nepal and some Pacific countries recorded relatively small differences between females and males in smoking prevalence. For Australia, New Zealand and Nepal the difference was between 3 percentage points and 7 percentage points, while for the Cook Islands it was 12 percentage points. Nauru stands out as being the only country in the region where the prevalence among females is greater than among males, with half of all women smoking. The above-mentioned countries, along with Kiribati and the Russian Federation, have a smoking prevalence among females of between 19 per cent and 50 per cent. While in many countries there was little change over time, female smoking prevalence in some countries with relatively high rates, namely Turkey, the Russian Federation and the Cook Islands, fell, with reductions between 2006 and 2009 of 25 per cent, 14 per cent and 9 per cent, respectively. The rates of New Zealand and Nepal increased by 20 per cent and 3 per cent, respectively, over the same period.

Figure B.5-2
Smoking prevalence among females, 10 highest prevalence countries in Asia and the Pacific, 2006 and 2009

Figure B.5-2 Smoking prevalence among females, 10 highest prevalence countries in Asia and the Pacific, 2006 and 2009In 2009, about 60 per cent of the male populations of Indonesia, Papua New Guinea, the Russian Federation and Samoa smoked tobacco, while in Kiribati the number was 71 per cent. In other countries in the region, such as Armenia, China, Georgia, the Lao People’s Democratic Republic, Malaysia and Tuvalu, at least half of male adults smoked. In Armenia, Fiji, India, the Lao People’s Democratic Republic, the Russian Federation, Sri Lanka and Tonga, the recorded smoking prevalence among males in 2009 was more than 15 per cent lower than it was in 2006. In some countries, however, there was an increase in smoking prevalence among males between 2006 and 2009, namely New Zealand (23 per cent), Mongolia (4 per cent), Nauru (4 per cent), Thailand (5 per cent) and the Cook Islands (2 per cent).

Smoking among adolescents is a serious concern in the Asian and Pacific region, with prevalence increasing in some countries.

Tobacco companies often target adolescents to make them their key consumers and thus adolescents are often at high risk of tobacco consumption. Given that many young smokers continue the habit to, and throughout, adulthood, exposure to tobacco use and to smoking during adolescence may establish risk factors for NCDs that can set in later in life. Studies show that tobacco consumption has a direct link with the incidence of cancer, heart disease and stroke, and theearly symptoms of these diseases can be found in adolescents who consume tobacco.1

In 2010, 40 per cent or more of adolescents, both male and female, in the Federated States of Micronesia, Palau, Papua New Guinea and Timor-Leste consumed tobacco. For 2008 and 2010, the proportions in the Federated States of Micronesia and Papua New Guinea remained constant, while Timor-Leste and Palau recorded alarming increases. In 2010, smoking prevalence among female adolescents in Timor-Leste (53 per cent) and in Palau (42 per cent) increased by 79 per cent and 49 per cent, respectively, from the figures for 2008. In other countries, such as the Cook Islands, the Federated States of Micronesia and Tuvalu, between 33 per cent and 40 per cent of female adolescents were smokers and there was no change in the figures from 2008 to 2010.

Figure B.5-3
Smoking prevalence among adolescent males, 10 highest prevalence countries in Asia and the Pacific, 2008 and 2010

Figure B.5-3 Smoking prevalence among adolescent males, 10 highest prevalence countries in Asia and the Pacific, 2008 and 2010

Figure B.5-4
Smoking prevalence among adolescent females, 10 highest prevalence countries in Asia and the Pacific, 2008 and 2010

Figure B.5-4 Smoking prevalence among adolescent females, 10 highest prevalence countries in Asia and the Pacific, 2008 and 2010In 2010, the proportions of male adolescent smokers in Timor-Leste (60 per cent) and in Palau (58 per cent) were the highest in the region, with Palau recording a 53 per cent increase from 2008. Within the same period, Indonesia and Turkey also recorded increases in the prevalence of smoking among both male and female adolescents. Smoking among male adolescents in Indonesia increased from 24 per cent in 2008 to 41 per cent in 2010, an alarming change that could imply a significant increase in the future disease burden. In Bhutan, Kazakhstan and Malaysia signs were more promising, these being the only countries in the region that recorded reductions in the prevalence of smoking among both male and female adolescents.

There are substantial differences in the amount of alcohol consumed per capita across Asian and Pacific subregions, with North and Central Asia and the Pacific recording the highest rates, and South and South-West Asia by far the lowest.

In 2007, adult per capita alcohol consumption in the region was 3.18 litres, 30 per cent lower than the global average and lower than in any other region. Over recent decades, the region’s annual rate has fluctuated; it reached a peak of 3.38 litres per adult in 1995, then fell steadily to a nadir of 2.67 litres per adult in 2000. Since then, the average consumption level among adults has risen again. Among the subregions, there are large differences in the levels of alcohol consumption per adult; the most recent data show high levels in North and Central Asia (10.9) and the Pacific (10.2), moderate levels in East and North-East Asia (5.1), and low levels in South-East Asia (2.0) and especially in South and South-West Asia (0.8).

From the 1980s through the 1990s and on until the 2000s, the Pacific recorded high levels of adult per capita alcohol consumption. In North and Central Asia, the level was moderate in the 1980s, rose in the 1990s and by 2003 was the highest in the region. Generally, increases have also been experienced in the remaining three subregions, yet with levels consistently lower than those of the two above-mentioned subregions.

Figure B.5-5
Per capita alcohol consumption (litres), Asian and Pacific subregions, 1990 to last year with data available

Figure B.5-5 Per capita alcohol consumption (litres), Asian and Pacific subregions, 1990 to last year with data availableIn the year with the most recent data, more than 10 litres of alcohol was consumed by each adult in the Cook Islands (18.0), the Republic of Korea (12.1), the Russian Federation (11.5), Australia (10.4) and New Caledonia (10.1). The highest levels of per capita alcohol consumption observed in South-East Asia and in South and South-West Asia were 6.1 in Thailand and 1.3 in Turkey.

Box B.5-1
Non-communicable diseases and related risks in the Pacific

The World Health Organization (WHO) estimates that 75 per cent of deaths in the Pacific are caused by NCDs.a In all Pacific island developing economies, with the exception of Papua New Guinea and Solomon Islands, there are more years of life lost to NCDs than to communicable diseases. Papua New Guinea and Solomon Islands have the dual burden of a high rate of communicable diseases and an increasing rate of NCDs. The high prevalence of NCDs in the Pacific can be explained by a number of factors, including excessive alcohol consumption, a high prevalence of smoking, poor nutrition, a lack of physical activity and obesity. As stated in this chapter, smoking prevalence in the Pacific is high for both women and men, and per capita alcohol consumption is almost double the world average. In addition, a large percentage of the population of almost all countries in the Pacific has a low daily intake of fruits and vegetables and low levels of physical activity (see table).

This combination of risk factors, along with ageing populations, has led to an increased risk of heart disease, diabetes, stroke and cancer. The high NCD risk and a lack of early clinical intervention for many NCDs result in the additional risk of permanent disability for many Pacific islanders. Defining and measuring disability is challenging; however, disability prevalence rates are available for many countries in the Asian and Pacific region. The Pacific has the highest estimated prevalence of disability of any of the subregions, and although NCDs are not the only cause of disability, the increasing threat of NCDs poses an additional risk of disability if preventive measures and clinical intervention are not improved.

Momentum has been building for positive change and in September 2011, the Pacific Islands Forum Leaders recognized the emerging challenges caused by NCDs and committed to improving accountability, prevention and early intervention.

Table. Prevalence of behavioural risk factors for non-communicable diseases, Pacific island developing economies with data available, most recent year

Percentage of the population (most recent data available)

 

Low fruit and vegetable intake

Low physical activity

Obesity

High non-communicable disease risk

Cook Islands
84.7
73.9
61.4
71.8
Fiji
..
..
29.6
..
Kiribati
99.3
50.1
50.6
74.6
Marshall Islands
91.1
50.0
..
..
Nauru
97.0
52.3
..
79.3
Papua New Guinea
98.9
9.9
6.8
21.9
Samoa
43.3
50.3
54.8
33.8
Solomon Islands
93.6
41.9
32.8
46.0
Tonga
69.4
42.4
69.1
..
Source: Secretariat of the Pacific Community, various NCD Risk Factors STEPS reports for the years 2005-2010 for the Pacific countries and territories listed in the table (2005-2010). Available from http://www.spc.int/hpl/ index.php?option=com_content&task=view&id=54&Itemid=42.
____________________
a Secretariat of the Pacific Community, “Pacific NCD Forum Meeting report” (New Caledonia, 2010).
 

Box B.5-2
Improving national civil registration systems for safeguarding rights, promoting good governance and producing better data, including on causes of deat

The United Nations Children’s Fund estimates that, globally, 49 per cent of children under 5 years of age have not had their birth registered and do not have a birth certificate.a Of similar concern, it is estimated that two thirds of deaths, approximately 38 million, occur every year without being registered.b Births and deaths are just two types of important life events that are not being registered; others include marriages, divorces and adoptions.

The implications of these life events going unregistered are profound. Related rights and entitlements, many of them fundamental, are being lost. These include the right to have a name and a legal identity, to claim inheritance, to participate in political processes, and to access such essential services as health, education and social protection. If these life events are not legally recorded, it is as if they had never happened.

At the same time, the registration of these life events is an important opportunity to collect data that can be used to generate vital statistics on the health and demographics of the population, including on mortality. For example, precise cause-of-death statistics can be produced through correct death registration and certification processes. Unlike other sources of vital statistics, such as surveys and censuses, the data generated from universal and effective civil registration systems are complete and continuous and can be disaggregated to the administrative subdivisions of a country.

Data from civil registration systems also serve the imperative purpose of providing reliable and recent information on socioeconomic progress and thus have a role in improving development outcomes. Importantly, the vital statistics generated through civil registration systems form the basis of measuring most of the Millennium Development Goal indicators.

To measure progress towards meeting Millennium Development Goal 5 on maternal health, the main sources of information in developing countries are demographic and health surveys, and multiple indicator cluster surveys. While these surveys provide highly useful information and without them possibly no other source of data would be available, they are not the best longterm solution to measuring maternal mortality and causes of death. In these cases, the preferred source of data is from civil registration systems.

Unfortunately, the majority of ESCAP member States do not have well-functioning civil registration systems to safeguard the rights of individuals and to produce better vital statistics. In response, ESCAP is partnering with over a dozen other organizations, including Plan International, the Secretariat of the Pacific Community, the United Nations Children’s Fund, the United Nations Population Fund, the Office of the United Nations High Commissioner for Refugees and the World Health Organization, to work with countries to remedy the situation.

In November 2014, ESCAP and development partners will convene a ministerial meeting with the aim of raising awareness of the importance of universal and effective civil registration and vital statistics systems in the Asian and Pacific region and to secure commitment by governments and development partners to a set of actions and milestones for the region.

____________________
a United Nations Children’s Fund, “Without birth registration, children are shut out of society altogether”, 14 February 2013. Available from www.unicef.org/protection/57929_67803.html.
b P.W. Setel and others, “A scandal of invisibility: making everyone count by counting everyone”, The Lancet, vol. 370, No. 9598 (November 2007), pp. 1569-1577.

Further reading

Bloom, D. and others. The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum, 2011. Available from www3.weforum.org/ docs/WEF_Harvard_HE_ GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf.

Nikolic, I., A. Stanciole and M. Zaydman. Chronic emergency: why NCDs matter. World Bank Health, Nutrition and Population Discussion Paper. Washington, DC: World Bank, 2011. Available from http://siteresources.worldbank.org/HEALTHNUTRITIONAND POPULATION/Resources/281627-1095698140167/ChronicEmergencyWhyNCDs Matter.pdf.

World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva, 2009. Available from www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.html.

________. Global Status Report on Noncommunicable Diseases 2010. Geneva, 2011. Available from www.who.int/chp/ncd_global_status_report/en/.

________. Tobacco Free Initiative. Geneva. Available from www.who.int/tobacco/en/.

Technical notes

Years of life lost: communicable diseases, NCDs and injuries (percentage of years of life lost)
Years of life lost is an estimate of the average number years a person would have lived had he or she not died prematurely; that is, a measure of premature mortality. Years of life lost per person represents the difference between the standard life expectancy of a person and his or her age at death; if the age exceeds the life expectancy, years of life lost equals zero. The standard life expectancy value is consistent across countries and generated using a standard life table. A life table is the statistical representation of the probability that a person will survive for an additional year, and based on that probability, the probability of surviving for another year, and so on.

Suicide rate: females and males (per 100,000 population)
The total number of suicides in a given year divided by the respective midyear population, expressed per 100,000 population. Suicide is defined as the act of deliberately killing oneself. Disaggregated by gender.

Smoking prevalence rate: females and males (percentage of females or males)
Tobacco smoking includes cigarettes, cigars, pipes or any other smoked tobacco products. Current smoking includes both daily and nondaily or occasional smoking. Disaggregated by gender. Aggregate calculations: Weighted averages using the population aged 15 years or older (WPP2012) as weight. Missing data are not imputed.

Adolescent tobacco use: females and males (percentage of population aged 13-15 years)
Adolescents aged 13-15 years who report use of tobacco, including smoking, oral tobacco and snuff, on more than one occasion in the 30 days preceding the survey. Disaggregated by gender. Aggregate calculations: Weighted averages using the population aged 13-15 years (WPP2012) as weight. Missing data are not imputed.

Recorded adult per capita alcohol consumption, total (litres per annum)
The recorded amount of alcohol consumed per adult (aged 15 years or older) over a calendar year in a country, in litres of pure alcohol. The indicator takes into account only the consumption that is recorded from production, import, export and sales data often via taxation. Numerator: The amount of recorded alcohol consumed per adult (aged 15 years or older) during a calendar year, in litres of pure alcohol. Denominator: Midyear resident population (aged 15 years or older) for the same calendar year (WPP2012). Aggregate calculations: Weighted averages using the population aged 15 years or older (WPP2012) as weight. Missing data are not imputed.

Source

Source of years of life lost data: WHO Global Health Observatory. WHO uses a standardized questionnaire for data collection. Cause-of-death distributions are estimated from death registration data, together with data from population-based epidemiological studies, disease registers and notifications systems for selected specific causes of death. Causes of death for populations without usable death-registration data are estimated using cause-of-death models together with data from population-based epidemiological studies, disease registers and notification systems for 21 specific causes of death. Data obtained: 20 June 2011.

Source of suicide data: WHO, Department of Mental Health and Substance Abuse. Online report accessed on 1 March 2011. Member States report to WHO the causes of death including suicide. Country data are supplemented by data provided by the WHO Regional Office for the Western Pacific. Data obtained: 29 August 2012.

Source of tobacco data: WHO Global Health Observatory. Smoking and tobacco-use prevalence data were sourced from survey data provided by countries. Data obtained: 29 and 30 August 2012.

Source of alcohol consumption data: WHO Global Health Observatory, Global Information System on Alcohol and Health. Data were collected through the Global Survey on Alcohol and Health, which was conducted in 2008 in collaboration with all six WHO regional offices. The survey data collection tool was forwarded to every WHO member State in each region for completion by focal points and national counterparts who were officially nominated by their respective ministry of health. Data were adjusted by WHO for consistency. Data obtained: 3 October 2012.

____________________
1 United States Department of Health and Human Services, Centers for Disease Control and Prevention, “Preventing tobacco use among young people: a report of the Surgeon General (executive summary)”, Morbidity and Mortality Weekly Report, vol. 43, No. RR-4 (March 1994). Available from www.cdc.gov/mmwr/PDF/rr/rr4304.pdf.
 
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