Comparative country studies on health system responses to population ageing and noncommunicable diseases in Asia

Many countries in the Asia-Pacific region will experience rapidly ageing societies over the next few decades. Globally, the number of people aged 60 years and over is expected to double by 2050. The projected increase in the number of older people, along with the rapid rise in the prevalence of lifestyle risk factors, will contribute to the increase in noncommunicable diseases (NCDs).

A high proportion of total deaths across the Asia-Pacific region are caused by NCDs, particularly in South-East Asia and the Western Pacific. NCD rates, both morbidity and mortality, are projected to increase dramatically over the next few decades. While risk factors stretch back across the life span, the prevalence and treatment of most NCD conditions occur among older people. NCDs develop progressively over the life span with ever-increasing impacts on functional capacities. Major NCDs include cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. These generally have strong social determinants and numerous shared risk factors, many of which are amenable to prevention and improvement throughout life.

While many NCDs share common risk pathways, health system responses may require different strategies, depending on the cause of the particular condition and the most cost-effective point of intervention from different levels of care. For example, one of the selected tracer conditions (diabetes) can be detected and managed at the level of primary health care; while the other (stroke) requires timely access to a higher level of care and treatment services. Continuity and integration in the management of chronic care will be essential to improve population health outcomes.

The rationale for this study is that a comparative analysis of the ways that health services across different countries are reorienting to older people and NCDs may offer insights into policy options and directions for service developments. Sri Lanka and Thailand, countries in South and South-East Asia, were purposefully selected as case studies to represent rapidly ageing societies with somewhat different demographic, epidemiological and health system profiles. Diabetes and Stroke management have been chosen as they cover a range of health services needed to manage and hence can provide insights to the system’s capacity for providing services at all levels.