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Lunch with HPA Director-General

The ECCT's Healthcare Enhancement committee hosted a lunch on the topic "Promoting Health in Taiwan - The HPA's strategic priorities" featuring guest speaker Dr Wang Ying-wei, Director-General of the Health Promotion Administration (HPA) under the Ministry of Health & Welfare (MoHW). The speaker gave an update on the general state of healthcare in Taiwan and an overview of some of the HPA's policies and strategies to enhance the overall health of Taiwan's citizens.

The HPA provides comprehensive health promotion services "from the womb to the tomb", promoting the health of individuals, families and communities. Its goal is to prolong health expectancy and reduce health inequality, so that citizens can live longer and healthier lives. The scope of the HPA's remit includes promoting healthy lifestyles, enhancing preventive healthcare services, promoting effective prevention and screening and improving chronic disease prognosis and control.

It starts with pre-natal care for expectant mothers, in order to increase the chances of them giving birth to healthy babies, and goes all the way to improving Taiwan's palliative care for the aged and terminally ill to minimise their suffering and enable them to live the last of their days with dignity.

A lot of the HPA's programmes are aimed at keeping people as healthy as possible. This begins with infants by encouraging their mothers to breastfeed and give them vaccinations. For young children and teenagers, and adults the focus is on healthy lifestyles, including promoting healthy eating and exercise. Educational efforts are targeted depending on the audience. Schools are used to target the youth, workplaces for working adults and hospitals and community centres for seniors.

The HPA's programmes draw on international experience and programmes such as the United Nation's Sustainable Development Goals (SDG). While only one of the SDG goals refers to good health and well-being, Wang made the point that many of the other goals are prerequisites for good health such the goals to end poverty and hunger, provide clean water and sanitation and reduce pollution.

Based on the SDG's 2015 Global Burden of Disease Study, which systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015, Taiwan placed 32nd in the rankings. However, Wang pointed out that some inaccurate data was used in the survey. If the correct data had been used he said that Taiwan would likely place in the top 10.

Non-Communicable Diseases (NCDs) caused 36 million deaths (two thirds of total deaths) in 2008 and 25% of these happened to people before they reached the age of 60. The four major risk factors are tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity. Based on these risk major risk factors, the World Health Organisation has set nine voluntary global NCD targets by 2025 aimed at reducing overall mortality from the four major risk factors by 25%.

Taiwan's health statistics compare favourably to the United States and the United Kingdom in terms of life expectancy and infant mortality rates. However, Taiwan has a much lower fertility and birth rates, a situation which has persisted for decades and led to a rate of aging that is higher than the OECD average.

While the HPA has set up a taskforce to tackle the issue, Wang acknowledged that the reasons for the low birth rate go well beyond health issues, noting that the reason most cited for the low birth rate is the high economic burden of raising children.

The leading causes of death in Taiwan are cancer and heart disease. While lung and liver cancer remain the largest killers, the numbers of these two cancers have been declining over the past decade while the numbers of fatalities from colon and breast cancer have been rising.

The decline in lung cancer can largely be attributed to a decline in smoking in recent years. While the prevalence of obesity is lower in Taiwan than most Western countries, it is higher than many Asian countries. This is the case for both adults and children. The main problem in Taiwan, according to Wang, was a lack of physical activity. Too many people do not do enough exercise. However, Wang said he was encouraged by an improvement in recent years thanks to better efforts in schools. According to Wang, helped by the HPA's efforts in cooperation with the Ministry of Education, the prevalence of regular physical activity of people aged over 13 had increased from 20.2% in 2007 to 33.0% in 2016.

He believes the solution is to intervene early and encourage people to adopt healthy lifestyles while they are young, which they will carry on in later life. In this way, they can maintain the highest possible level of functionality in middle age and prevent disability and maintain independence into old age.

The basic plank of the HPA is building a supportive environment in all settings. The Healthy City Programme has 13 counties/cities and 11 areas joining the Alliance for Healthy Cities. 455 communities are promoting community building and 163 hospitals are involved.

Wang cited figures showing the success of various HPA programmes in the form of increasing rates of pre-natal examinations, preventive child health services, cancer screening (for various types of cancers) and smoking cessation services.

Taiwan has also had great success in artificial reproduction services, so much so that the programme is attracting medical tourists from countries like Japan.

It also has programmes addressing nutrition such as promoting healthy meals in schools, workplaces, communities and hospitals.

Looking at cardio-vascular related mortality rate statistics between 1986 and 2015, heart disease has decreased by 45.0%, strokes by 77.1% and hypertension by 55.1%. Only the rate of diabetes has increased by 5.2%. However, when comparing figures from the past few years (2010 and 2015), mortality from heart disease and hypertension has increased by 1.5% and 8.8%, respectively while rates for strokes and diabetes have decreased by 8.8% and 4.0%, respectively.

As part of the MoHW's health promotion efforts, people aged 40-64 may get free health exams once every three years. Those over 65 can get free health checks annually.

Much focus has been placed on creating a friendly environment for Taiwan's aging society by making cities "age-friendly", arranging health promotion activities for the elderly, pre-frailty health promotion and finally community palliative care. In 2015 Taiwan was ranked sixth globally on the "Quality of Death" index.

Wang concluded that the HPA's approach is a combination of five Ps: promotion, prevention, protection, participation and partnership.