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    The epidemiological situation in the ESCAP Region: facts, fallacies and implications.

    Hansluwka H

    In: Mortality and health issues in Asia and the Pacific: report of a seminar held at Beijing in collaboration with the Institute of Population Research, People's University of China from 22 to 27 October 1986. New York, New York, United Nations, 1987. 107-32. (Asian Population Studies Series No. 78.; ST/ESCAP/485.)

    Around 1980, half of the population of the Economic and Social Commission for Asia and the Pacific (ESCAP) region was already living in countries where the average life expectancy at birth is 65 years. Impressive as this progress is, its interpretation as a proof for improvement of the health status of the populations has not remained unchallenged. Repeatedly, it has been argued that as a consequence of the import of sophisticated modern medical technology, as well as large-scale foreign aid inspired and financed public health programs, the reduction of mortality has outpaced improvements in health. Similar reservations against the use of mortality data as evidence for trends and differentials in health status have been put forward in the more developed countries of the ESCAP region, particularly vocally in Japan. The debate is not academic but concerns crucial policy issues. In many countries of the ESCAP region, the health care delivery system is neither sufficiently organized nor staffed, in numbers and qualifications, to cope with the problems raised by a rapidly increasing population, particularly in certain high risk groups such as pregnant women, infants, and children. This challenge is compounded by the fact that very often traditional health problems exist side by side with newly emerging hazards. The dominant conclusion of an analysis of all the available information is that in contrast to the significant advances in the control of mortality, the morbidity situation has either stagnated or, at any rate, failed to match the gains in longevity. Impressive advances in some areas and countries exist side by side with grave setbacks in others. On the whole, the diversity of national health conditions has increased, with some countries approaching a "modern" epidemiological scenario, others lagging behind, and another group tackling old and new disease problems concurrently. Likewise, within countries, similar differences exist or gradually emerge between urban and rural populations. Malnutrition, in synergistic action with diarrhoeal diseases and acute respiratory infections, as well as malaria, are the main challenge in the ESCAP region, particularly for the countries of Middle South Asia. Successful agricultural policies have laid the foundation for overcoming the age-old threat of mal- and undernutrition. As regards malaria, the current situation hardly justifies optimism. In the developed countries of the region, the common causes of illness are cardiovascular diseases, cancer, and accidents.
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