Ting Yu Lin
Assistant Research Fellow, Division of International Affairs, TIER
In the twentieth century, it can be easily noticed that the life expectancy is
increasing globally. While the pursuit of longevity seemed always is human’s
ultimate goal, yet it results to greater number of age-related issues, such as chronic
diseases, dementia and fragility. Therefore, APEC Health Working Group (HWG)
conducted two series of meetings focused on immunization and dementia in 2019.
The HWG use its February/March meeting to discuss best practices with
immunization experts, challenges and success encountered by member economies,
and how to best add APEC’s voice on Universal Health Coverage (UHC).
Immunization has endured as one of the most effective public health interventions
and saves approximately two to three million lives each year. It has contributed
to the eradication of smallpox, lowered the global incidence of polio by 99%,
and reduced illness, disability, and death due to many other contagious diseases.
Investment on immunization can also provide a platform for achieving global
health goals such as UHC and global health security (GHS). Immunization is
considered a key indicator of progress towards target 3.8 of achieving UHC under
Sustainable Development Goal (SDG) 3: Ensure healthy lives and promote wellbeing
for all at all ages. Investing in immunization in the APEC economies presents
an important opportunity to improve the regional health landscape.
Taiwan has been promoting various immunization policies and carrying them
out through our primary healthcare system and medical institutions. In doing
so, most vaccine-preventable diseases have been effectively controlled or even
eradicated. Taking the case of influenza vaccine as an example: many key measures
were taken in order to attain 25% of the immunization rate, such as increasing
vaccine purchasing, expanding vaccination targets, as well as subsidizing local
government for conducting campus-centered and community-centered vaccination.
However, challenges appear such as funding shortage, increased demand for
storage and the insufficient capacity to keep stable and continuous vaccination
supply. In responding to that, expanding vaccination and improving quality of
vaccination operation are two main strategies to the evolving international trend in
immunization. We consider necessity and rationality of subsidies, increasing the
distribution from the surcharge of tobacco products, and the possibility of inclusion
of vaccination into health insurance.
Following the top on “Healthy Aging”, dementia was especially deliberated
in the High Level Meeting in August which took part in Puerto Varas, Chile.
The High Level Meeting focused on ‘Healthy Economies in an Aging World’
with a roundtable session mainly on ‘Unlocking Regional Collaboration to
Accelerate Progress on Dementia.’ In details, it is to highlight opportunities for
regional collaboration to ensure the optimal well-being of aging populations in
APEC economies. Dementia is a general term for a decline in cognitive ability
serve enough to interfere with daily life. It can also refer to an umbrella term
used to describe a set of symptoms affecting brain function that are caused by
neurodegenerative and vascular diseases or injuries. Dementia is usually chronic
or progressive in nature, in which there is deterioration beyond what is expected
from normal aging in memory, thinking, behaviour, and the ability to perform everyday activities. In 2015, dementia affected 47 million people worldwide or
roughly 5% of the world’s elderly population. An aging population is the main
driver behind a projected increase in the disease worldwide and it is estimated that
dementia will affect 75 million people in 2030 and 132 million in 2050. APEC
economies are among those with the most rapidly aging populations in the world,
the cost of informal care was estimated to be US$ 92.1 billion in a 2014 analysis by
Alzheimer’s disease International. Taking coordinated action to prevent dementia
and enabling those living with dementia to live well is critical for ensuring health
and economic well-being in the APEC region.
The population of those who are suffering from Dementia in Taiwan is about
270,000 by the end of 2017. The implantation of “Dementia Prevention and
Treatment Policy Program” was launch since 2014, continued the second phase
at 2017. In the first phase of the project, the attention draw on the population
education and capacity building on primary health care workers. Details about
the disease were explicated through booklet, TV program and musical. Besides, it
aimed to develop a cross-sectoral integration for healthcare service, by leveraging
local medical resources to train care providers and cooperate with local police
and social worker, establish a care network and promote primary prevention.
Additionally, the second phase of the program aims at decreasing the prevalence
of dementia, delaying dysfunction as well as encouraging research and innovative
development. It is to minimize the inequalities caused by social determinants
of health to prevent dementia, risk factors such as smoking, obesity, alcohol
over partake, physical inactivate and depression. In addition, it is also our goal
to leverage resources from the healthcare system and long-term care plan, and
provide comprehensive services and training not only for the patients but also care
providers as well.
What's more on the care for dementia patients is the implantation of “Patient
Autonomy Act” launched in 2019. The Act aims to respect patients’ medical
autonomy and guard their hospice rights in their late-stage of dementia. The Act
is to safeguard their rights to a good death which means they can choose to pass
away peacefully without regrets and pain with an advance decision in their earlier
stage of dementia. In this light, their family or caregivers will no longer suffer
from the ethical dilemmas either. Moreover, it is noticeable that the incidence of
dementia happens on female is always higher than male. This can be estimated
by the differences on life expectancy and participation in labour market between
two genders. The prevention scheme thus should not only rely on medicines or
medical care but on the women’s social participation. As a final point, under the
frame of digital society, we also attract related research and innovate projects on
dementia from numerous departments. It would also collect dementia related data
for reviewing the need on amendments of medical and social policies. We hope to
promote social well-being as a whole through these initiatives and dedication.
Noting the importance of adapting not only health systems, but also entire
region, the HWG illustrates how economies can invest the needs of their population
through a variety of innovative approaches on different issues faced. In recent
years, the HWG has similar targeted discussion trend as WHO. It might seem
practical that APEC region has alike global trend in which we tackle similar healthrelated
issue, yet APEC does not hold WHO’s resources nor does it work similarly.
Chile, and the co-chair from Canada, made a comprehensive plan this year for
APEC economies to discuss two main health-related issues in both meeting,
immunization and dementia. However, it might in lack of consistency in which
both meetings remain vacancy in conclusion and follow-up plans. To conclude
healthy aging in 2019 in APEC region, certain actions and coordination was well
developed while further strategies are remained to do in the future.