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Overview of health promotion in Taiwan

On 7 July the ECCT's Healthcare Enhancement committee hosted a lunch with guest speaker Dr Chiou Shu-Ti, Director-General of the Health Promotion Administration (HPA) under the Ministry of Health & Welfare (MoHW). Dr Chiou gave an overview of the HPA.

The Health Promotion Administration (HPA) was officially launched on 23 July 2013. Unlike in the United States, health promotion in Taiwan and is dealt with by a department that is separate from the one dealing with Non-Communicable Diseases (NCDs). According to Chiou, this is preferable as it allows enough attention and resources to be focused on promoting long-term health goals, which otherwise would get overshadowed by short-term emergencies and health crises.

The HPA provides comprehensive health promotion services to the public, covering all stages of life from family planning, to maternity and child care to care for adults and the aged. Its goal is to promote not just life expectancy but healthy life expectancy (or prolonging health expectancy) and reduce health inequality, so that citizens can live longer and better regardless of wealth, region, gender or ethnicity. It does this by promoting the development of a supportive environment.

The HPA's priority areas of focus are enhancing health literacy and promoting healthy lifestyles; spreading preventive healthcare services and promoting effective prevention and screening; upgrading the quality of healthcare and improving chronic disease control and prognosis; creating a friendly and supportive environment and bolstering healthy options and equality.

The MoHW has gone further than adopting the World Health Organisation's (WHO) set of nine voluntary global NCD targets for 2025 (the main target being a 25% reduction in mortality from NCDs by 2025). For example, the WHO target is to reduce tobacco usage by 30% and reduce physical inactivity by 10% while Taiwan's targets are a 50% reduction in smoking and a doubling of physical activity.

While Taiwan spends only about 6.6% of its GDP on healthcare, Taiwan's health outcomes compare relatively favourably with OECD countries. Taiwan has a very low infant mortality rate and relatively good longevity rates. Moreover, in most health-related areas, such as prevalence and treatment of diseases, there have been steady improvements over the past ten years. For example, the mortality rate from diabetes has dropped by 15% since 2002.

There are however, some discrepancies. For example, the average Taiwanese woman lives longer than OECD average but the longevity rates for Taiwanese men are lower than average. Taiwan also has higher than average levels of certain diseases such as oral and colorectal cancer, liver and kidney disease, all of which can be tackled better by addressing lifestyle choices and increasing screening. (Chiou admitted it is difficult to get people to volunteer for screening because Taiwan's national health insurance system offers such good treatment and therefore people don't have enough of a sense of urgency).

Given Taiwan's aging society and the consequent strains on the healthcare system, Chiou believes that the level of quality will be difficult to maintain without spending more. She therefore hopes that spending will be increased to around 7.5% of GDP and more should be spent on prevention, which is the most efficient and cost-effective way to achieve a healthy population.

Achieving better health outcomes requires collaboration to create a healthy environment. The HPA welcomes opinions from all stakeholders to provide references for developing policies and programmes.

The HPA's programmes have been effective in addressing issues such as smoking and betel nut chewing. Educational and support programmes, coupled with higher health surcharges on tobacco products have led to a decrease in the number of people smoking and chewing betel nuts.

Given high obesity rates (although they have stabilized recently), more attention will be paid to physical activity and nutrition in future. This will be challenging given Taiwan's environment. Good public and private transport means that people don't exercise enough while the abundant variety and availability of food options (many of which are unhealthy) mean people often make poor food choices. The HPA therefore plans to work with other stakeholders to create an environment which encourages exercise and healthy food choices.