1. The Impact of Socio - Economics
Changes on Health and Health
System
chuchai.s@nhso.go.th February 20, 2012
2.
3.
4. Total Health Expenditure (THE) 1994-2008
Rising healthcare costs
But… compare to % of GDP: rather stable ~ 4%
400,000 4.2% 4.5%
4.0%
3.8% 3.7%
350,000 3.7% 3.7% 3.7% 4.0%
3.5% 3.5% 3.5% 3.4% 3.5% 3.5% 3.5%
3.3% ~ 30% 3.5%
300,000
3.0%
THE was increasing…
Mil. Baht
250,000
%GDP
2.5%
200,000
2.0%
150,000
~ 70% 1.5%
100,000 ~ 55% 1.0%
50,000 0.5%
~ 45%
0 0.0%
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
1994 2008
public private %GDP
Increasing rate of THE was not greater increasing rate of GDP: Affordable
Source: Thai Working Group on National Health Account 2009
5. Household payment for health as % of income
8.17
% of income: The poor paid more… 1992
4.28
3.74 3.65
2.87
2.57 2.45
1.99 1.84 2.18
2.05 1.95 1.69 1.66 1.74 1.68 1.66 1.83 1.64 1.27
% of income: The poor and the rich paid ~ the same 2008
Poorer Richer
From: Prakonsai et al. 2009
29. Cross-Cultural Impact
Health Literacy
Health literacy is the degree to which individuals have the
capacity to obtain, process, and understand basic health
information and services needed to make appropriate
health decisions.
Health literacy is dependent on both individual and
systemic factors:
1. Communication skills of lay people and professionals
2. Knowledge of lay people and professionals of health
topics
3. Culture
4. Demands of the healthcare and public health systems
5. Demands of the situation/context
http://www.health.gov/communication/literacy/
30.
31. Demand side Supply side
Dependency Ratio Drugs , Medical supplies,
Elderly persons 65 & over Food for health promotions
/ Working persons 15-64 Shelter
Sex Ratio Health care professional
Women 65 & over Aging Gen B professional
Potential (Golden Aged) Gen
Marital Status
X
Widowhood Gen Y
1-parent and 1-person Care givers of Thai and
households global
New comers Expat & Retire
Self management support
From Abroad : Domestic cross
culture tools
32. Special Conditions in Asia
Impact
Social security and health care reform policies
must contend with such considerations
Fastest pace of economic transition
Highest rates of population ageing and
population growth
Strong traditional family support systems
33.
34.
35. International travel and commerce that quickly
transport people and goods vast distances.
Changes in food processing and handling, including
foods prepared from many different individual
animals and transported great distances.
40. Impact
Access to healthy lifestyle options
Implications
Access to healthy food
Availability & affordability of recreational
opportunities
Urban environments
41.
42. The top 10 emerging technologies for 2012
1. Informatics for adding value to information
2. Synthetic biology and metabolic engineering
3. Green Revolution 2.0 – technologies for increased food
and biomass
4. Nanoscale design of materials
5. Systems biology and computational modelling/simulation
of chemical and biological systems
6. Utilization of carbon dioxide as a resource
7. Wireless power
8. High energy density power systems
9. Personalized medicine, nutrition and disease prevention
10. Enhanced education technology
World Economic Forum’s Global Agenda Council on Emerging Technologies Global Agenda Council on Emerging Technologies
presents the technological trends expected to have major social, economic and environmental impacts worldwide in 2012.
43. Imaging
This is especially the case in today’s rapidly evolving and
hyperconnected globalized society.
PACT and Digital Imagings
Scanning + fast visualization
+ information fusion
Non-invasive exploration
Direct information to doctors
Shorten the treatment chain,
reduce sidetracks
Requires change in routines
44. Biotech medicine
Systems biology and computational modelling and
simulation are playing increasingly important roles in
designing therapeutics, materials and processes that
are highly efficient in achieving their design goals,
while minimally impacting on human health and the
environment.
Regenerative medicine
Rational drug design
Bionics
Genetic testing
Vaccines
Enhancing medicine
45. The New Pharmacology
Rapid advances in synthetic biology and metabolic engineering
are allowing biologists and engineers to tap into this potential in
unprecedented ways, enabling the development of new
biological processes and organisms that are designed to serve
specific purposes
Rational design
Based on genomics, simulation and
knowledge of basic processes
Generics threatened, business models in
pharma threatened
Blurs the borders between palliative,
curative, preventative and enhancing
medicine
46. Prosthetics and Neurointerfaces
Systems biology and computational
modelling and simulation are playing
increasingly important roles in designing
therapeutics, materials and processes
that are highly efficient in achieving their
design goals, while minimally impacting
on human health and the environment.
Neurointerfaces rapid
development (~300 electrodes,
permanent)
Prosthetic research
underfinanced
Large gains for small groups
47. Geno Informatics
Genetic Testing
Advances in areas such as genomics, proteomics and
metabolomics are now opening up the possibility of tailoring
medicine, nutrition and disease prevention to the individual.
Cheap, fast genetic tests many
conditions
How many wants to test? How does the
health system respond?
Benefits: More individually adapted,
good for preventative medicine and
pharmacogenomics
Problems: Interpretation, too much faith
in genetics, diagnosis develops faster
than treatment, breaks information
monopolies
48. Reproductive Medicine
The quantity of information now available to individuals and
organizations is unprecedented in human history, and the rate of
information generation continues to grow exponentially.
Reproduction as a right?
We are willing to spend
enormous sums on our children
and their health
Genetic testing, preventative
medicine
Perinatal medicine
49. The New Vaccines
Rapid advances in synthetic biology and metabolic engineering
are allowing biologists and engineers to tap into this potential in
unprecedented ways, enabling the development of new
biological processes
Vaccines for treatment instead of just prevention
Immune system control
Vaccines against
Allergies
Diabetes
Autoimmune illnesses
Metabolic illnesses
GYN Cancer
Narcotics
50. Neurotechnology
emerging technologies like synthetic biology and nanotechnology,
they are laying the foundation for a revolution in healthcare and
well-being that will be less resource intensive and more targeted
to individual needs.
The brain/mind increasingly visible
New pharmacology +
understanding of brain leads to
treatment of many mental
disorders
Hybrid therapies
52. The Implications of Social and Digital Media
New approaches are needed to meet the challenge of
educating a growing young population and providing the skills
that are essential to the knowledge economy.
Smart phone
Skype™
Facebook
Youtube
Etc.
56. Improve dietary habits
Increase physical activity levels
Reduce heavy drinking
Decrease disordered eating
behaviors
Improve adherence to treatment
protocols
Impact on health care utilization and
costs?
Office of Disease Prevention and Health Promotion, DHHS. Expanding
the Reach and Impact of Consumer e -Health Tools. 2006.
57. Digital
Digital Video Gaming
Audio
Imaging
Watch movies and TV
Managing money Listen to music
PC Broadband
iTV Play games
Send & receive photos and video
Browse the Internet Online shopping Download songs
E-mail
Chatting
with Friends Fantasy sports
Digital
Imaging
Shoot photos
Download songs
Audio
and video
Watch videos
Play games
on-the-go Fantasy Sports
Gaming Digital
Fantasy Sports Browse the Video
Internet
E-mail
Working
Listen to Music
E-mail
Talk to friends
Mobile Managing
Managing money money
Electronics Collaborating
Shopping PC Broadband
Trading Stocks
Trading Stocks
Digital
Stream
Wireless
Audio
Mobile
Wireless Electronics
81. Sources: National Health Examination Survey (NHES) I, age group > 20 years. Ministry of Public Health.
National Health Examination Survey (NHES) II, age group 13-59 years. Ministry of Public Health.
National Health Examination Survey (NHES) III, age group ≥ 15 years. Ministry of Public Health.
• Growth of fast food culture : One of key determinants
to an increase in overweight and dietary change from under-
nutrition to over-nutrition
(French S et al., 2001; Paeratakul S et al., 2003; Katherine L et al., 2001; Adair LS et al., 2005)
82. China S. Korea Japan Thailand USA
Calorie/day/person
Vegetable 2333 2587 2187 2172 2727
Animal 618 478 572 295 1047
total 2951 3058 2761 2467 3774
Consumption/person/year (kg)
Cereals 166.6 151.7 113.8 122.3 112.5
Starchy roots 80.7 17.2 34.1 18.0 63.7
Vegetable oils 9.5 12.3 14.1 6.3 27.8
Fruits 47.3 66.8 56.3 87.8 110.3
Vegetables 254.1 209.2 106.5 42.1 127.7
Sugar 7.2 19.2 19.3 31.9 32.9
Meat 52.5 49.2 43.9 26.4 124.1
Milk 13.3 29.4 67.1 18.8 261.3
fish 25.6 58.7 66.3 30.9 21.3
Source: FAO, quoted in Ivan Roberts & Neil Andrews, Developments in Chinese Agriculture, ABARE, eReport, July 2005, p.5, Table 2.
83. ± Impact : Retail Health Care Clinics
and Nurse Practitioners
ACNP has watched with interest the development and
growth of retail health care clinics; this new and emerging
role provides both critical visibility for NPs and offers
health care services to the public in a cost-effective,
convenient and efficient manner.
Most of these retail clinics (also called the "Convenient
Care Industry") are being staffed by nurse practitioners
and provide patients with fast, affordable treatment for
routine medical conditions as well as preventive care. NPs
are using their skills to diagnose, treat and prescribe
medications, in addition to providing health screenings,
medical tests, vaccinations/immunizations and physicals in
some locations.
http://www.acnpweb.org/
103. Social and economic (and sometimes
environmental) conditions that affect
people’s health
104. Poorer people live shorter lives and are
more often ill than the rich. This disparity
has drawn attention to the remarkable
sensitivity of health to the social
environment.[Social Determinants of Health, The
Solid Facts, WHO 2003]
110. Policy Implications –
Towards Cost-effective Care
Avoid hospitalization and
institutions
Provide substitutes and
alternatives eg. day care, home
nursing, hospice, etc
Develop community-based
services
Strengthen family support and
home care
Improve housing and living
arrangements
111. The approach in
communitarian community care:
•Partnership of the Public, Private & People
(3P) Sectors
•Joint responsibilities of the individual and
family, community
THE FUTURE
112. Building on Chronic
Care Model
Includes:
organizational support
clinical information
services and disease
registries
team-based care
case management
regular follow-up Numerous studies have demonstrated
For patient: decision Improvements in care and intermediate
support, self- patient outcomes; evidence is
management support, beginning to emerge on cost
community resources effectiveness*
*Source: Katie Coleman et al, “Evidence
On the Chronic Care Model in the New Millennium,”
Health Affairs, Jan-Feb. 2009, pp. 75-83.
113.
114. Creating Sustainability Through
Patient and family centered and health outcome based
Population health status is the benchmark
Contribute to measurable improvements in health
Appropriate range/mix of health professionals
Inter professional teams with integrated scope/ practice
Change management leadership
Emphasis on primary health care, health promotion, self
management and the social determinants of health
Changing role to accountable healthcare organization
(PHSOR Report, 2007)
115. Building Blocks of the health system and
link to health outcomes
Source: World Health Organization. Everybody’s Business:
Strengthening health systems to improve health outcomes—
WHO’s Framework for Action. Geneva: WHO, 2007, page 3.