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Asia Pacific should reduce inequalities in access to care for the most marginalised groups

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Access to healthcare has improved in the Asia Pacific region over the past decade but women in low-income households in rural areas still have difficulty accessing care due to distance and financial reasons, according to a new OECD report.

Health at a Glance Asia/Pacific 2018 – Measuring Progress Towards Universal Health Coverage says that in Cambodia, Nepal, the Philippines and the Solomon Islands, more than three women in four with the lowest household income reported difficulties in accessing healthcare due to financial reasons. In Nepal, Pakistan and the Solomon Islands, about two women in three from worst-off households reported having unmet care needs due to distance.

The report reveals that life expectancy has increased by almost six years since 2000 to reach 70 years across lower-middle and low-income Asia Pacific countries, but maternal mortality is still twice the Sustainable Development Goal target in these countries.

The report also tells that the infant mortality rate has fallen dramatically across the lower-middle and low-income Asia Pacific countries since 2000, with many countries experiencing declines of greater than 50%. But at an average of 30 deaths per 1 000 live births, infant mortality rate in these countries is still eight times that of the high income Asia Pacific countries and OECD average, and two and a half times the SDG target of 12 deaths per 1 000 live births.

Many countries in the region face a double burden of disease, as they still struggle to reduce maternal and child deaths at a time when the prevalence of chronic conditions and unhealthy lifestyle is growing. More than one third of adults are overweight in Asia Pacific, and one in ten persons is obese, according to the report. Among children, 5% of under age 5 and more than 20% of adolescents are overweight. Between 2010 and 2016, obesity rates increased by 33% among adults and 58% among adolescents.

Other findings of Health at a Glance Asia/Pacific 2018 include:

Between 2000 and 2015, the average maternal mortality rate across lower-middle and low-income Asia Pacific countries was cut by more than half, but is still high at 140 deaths per 100 000 live births, twice the SDG target of 70 deaths per 100 000 live births.

In high-income Asia Pacific countries, the share of the population aged over 65 years is expected to double, to reach an average of 27.6% in 2050, whereas the share of population aged over 80 years is expected to triple to reach 10.2%. In upper-middle income and lower-middle low-income Asia Pacific countries, the share of population over 65 and over 80 will be two and a half and four times the current share, and reach 23.9% and 14.5% (over 65) and 7.9% and 3.5% (over 80) respectively.

Lower-middle and low-income Asia Pacific countries spend just under USD 200 per person per year on health, against USD 670 and USD 3 450 in upper-middle income and high-income countries respectively. This amounts to over 4.3% of gross domestic product, on average, in middle- and low-income countries, compared to over 7.3% in high-income countries in 2015. Spending in high-income countries increased by 0.8 percentage points from 2010-2015, twice the increase reported by middle- and low-income countries at 0.4 percentage points.

On average, household out-of-pocket expenditure accounted for 48.2% of total health expenditure in lower-middle and low-income Asia Pacific countries in 2015, an increase of one percentage point from 2010. Spending on pharmaceuticals accounted for almost one third of all health expenditure across these countries in 2015.

Disparities in the use of essential services based on income and education remain large. For example, the divide in access to antenatal care between women in low-income and high-income households remains quite large in Bangladesh, Lao PDR and Pakistan, and in Indonesia, Lao PDR and the Philippines inequalities in the proportion of children with immunisation coverage whose mother has high education compared to no education are large with a difference of more than 50%.

Health at a Glance Asia/Pacific 2018, a joint publication of the OECD with the World Health Organisation, presents key indicators on health status, determinants of health, healthcare resources and utilisation, health expenditure and financing, and quality of care for 27 Asia/Pacific countries and territories. This report offers a comprehensive and user-friendly framework to help policy makers make further progress towards improving coverage, access and financial protection of population across the Asia Pacific region.

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Global economy projected to show fastest growth in 50 years

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The global economy is expected to bounce back this year with growth of 5.3 per cent, the fastest in nearly five decades, according to the UN Conference on Trade and Development (UNCTAD).

In its new report released on Wednesday, the agency said that the rebound was highly uneven along regional, sectoral and income lines, however.  

During 2022, UNCTAD expects global growth to slow to 3.6 per cent, leaving world income levels trailing some 3.7 per cent below the pre-pandemic trend line. 

The report also warns that growth deceleration could be bigger than expected, if policymakers lose their nerve or answer what it regards as misguided calls for a return to deregulation and austerity. 

Differences in growth 

The report says that, while the response saw an end to public spending constraints in many developed countries, international rules and practices have locked developing countries into pre-pandemic responses, and a semi-permanent state of economic stress. 

Many countries in the South have been hit much harder than during the global financial crisis. With a heavy debt burden, they also have less room for maneuvering their way out through public spending. 

Lack of monetary autonomy and access to vaccines are also holding many developing economies back, widening the gulf with advanced economies and threatening to usher in another “lost decade”. 

“These widening gaps, both domestic and international, are a reminder that underlying conditions, if left in place, will make resilience and growth luxuries enjoyed by fewer and fewer privileged people,” said Rebeca Grynspan, the secretary-general of UNCTAD. 

“Without bolder policies that reflect reinvigorated multilateralism, the post-pandemic recovery will lack equity, and fail to meet the challenges of our time.” 

Lessons of the pandemic 

UNCTAD includes several proposals in the report that are drawn from the lessons of the pandemic. 

They include concerted debt relief and even cancellation in some cases, a reassessment of fiscal policy, greater policy coordination and strong support for developing countries in vaccine deployment. 

Even without significant setbacks, global output will only resume its 2016-19 trend by 2030. But even before COVID-19, the income growth trend was unsatisfactory, says UNCTAD. Average annual global growth in the decade after the global financial crisis was the slowest since 1945. 

Despite a decade of massive monetary injections from leading central banks, since the 2008-9 crash, inflation targets have been missed. Even with the current strong recovery in advanced economies, there is no sign of a sustained rise in prices. 

After decades of a declining wage share, real wages in advanced countries need to rise well above productivity for a long time before a better balance between wages and profits is achieved again, according to the trade and development body’s analysis. 

Food prices and global trade 

Despite current trends on inflation, UNCTAD believes the rise in food prices could pose a serious threat to vulnerable populations in the South, already financially weakened by the health crisis. 

Globally, international trade in goods and services has recovered, after a drop of 5.6 per cent in 2020. The downturn proved less severe than had been anticipated, as trade flows in the latter part of 2020 rebounded almost as strongly as they had fallen earlier. 

The report’s modelling projections point to real growth of global trade in goods and services of 9.5 per cent in 2021. Still, the consequences of the crisis will continue to weigh on the trade performance in the years ahead. 

For director of UNCTAD’s globalization and development strategies division, Richard Kozul-Wright, “the pandemic has created an opportunity to rethink the core principles of international economic governance, a chance that was missed after the global financial crisis.” 

“In less than a year, wide-ranging US policy initiatives in the United States have begun to effect concrete change in the case of infrastructure spending and expanded social protection, financed through more progressive taxation. The next logical step is to take this approach to the multilateral level.” 

The report highlights a “possibility of a renewal of multilateralism”, pointing to the United States support of a new special drawing rights (SDR) allocation, global minimum corporate taxation, and a waiver of vaccine-related intellectual property rights.  

UNCTAD warns, though, that these proposals “will need much stronger backing from other advanced economies and the inclusion of developing country voices if the world is to tackle the excesses of hyperglobalization and the deepening environmental crisis in a timely manner.” 

For the UN agency, the biggest risk for the global economy is that “a rebound in the North will divert attention from long-needed reforms without which developing countries will remain in a weak and vulnerable position.”

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Italy: Pro-growth reforms and government support key to a greener and jobs-rich recovery

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The post-COVID recovery offers an exceptional opportunity for Italy to tackle long-standing obstacles to job creation and the raising of living standards, according to a new OECD report.

The OECD’s latest Economic Survey of Italy says government support for Italian households and businesses hit hard by the COVID-19 pandemic should continue until the recovery is firmly underway, but should become increasingly targeted as the economy continues to strengthen. It says that generous fiscal support has been effective in mitigating job losses and preserving productive capacity. This will help boost the short-term recovery as vaccination rates accelerate and restrictions ease. Higher public spending, including from Next Generation EU funds, will support higher investment alongside improved confidence and demand.

The National Recovery and Resilience Plan offers a unique opportunity to create a greener, more digitised and productive economy, the report adds. The government, it says, has an ambitious agenda rightly prioritising reforms to competition, to boost the efficiency of civil justice processes and to reform the public sector in order to tackle uncertainty, delays and costs that currently hamper investment. Green infrastructure and broadband investments can improve the competitiveness of Italian firms.

The report suggests that the chances of implementing this reform plan successfully are greater than on previous occasions. Clear implementation milestones and targets linked to the disbursement of Next Generation EU funds have been publicised, while recently passed laws to simplify green investments and support decision-making  will help facilitate successful implementation of the plan.

The OECD projects Italy’s economic growth to be 5.9% this year and 4.1% in 2022, following an 8.9% fall in GDP in 2020. A stronger-than-expected second quarter explains the upward revision from the 4.5% expansion forecast for 2021 in the OECD’s May Economic Outlook. 

Presenting the report alongside Italy’s Economy and Finance Minister Daniele Franco today, OECD Secretary-General Mathias Cormann said: “Italy’s National Recovery and Resilience Plan is activating stronger, greener, fairer and more digitised growth that will benefit all Italians with improved opportunities to get ahead. A more effective public sector is crucial for ensuring its success. The plan must be fully implemented and complemented with reforms to support further growth, including with more investment in green infrastructure and R&D and reforms to keep driving the effective digital transformation of the Italian economy.”

The report recommends that once the pandemic subsides, public spending and tax policy must be reformed to complement the National Recovery and Resilience Plan. Currently, pension-related expenses crowd out investment in infrastructure, education and training, penalising the young, many of whom are out of work and at risk of poverty.

Labour force participation remains particularly low for women, especially those with children. Access to quality childcare and adult skills training needs to be improved across all regions, the report says.

Compared with the OECD average, taxes on labour remain too high. The report recommends implementing comprehensive tax reform to reduce the complexity of the system and to lower labour taxes. This should be financed through improved compliance – driven by greater use of technology and card payments.

Raising the effectiveness of Italy’s public sector is more urgent than ever. The report says that fully implementing the National Recovery and Resilience Plan will help fill skills gaps in the public sector, further its digitisation and reduce regulatory barriers that inhibit civil servants’ ability to deliver.

The report welcomes the set up for the Plan’s implementation and says the administration would generally become stronger and more agile by reducing the number of existing rules, regulating the services sector and green economy with a stronger focus on outcomes, in line with the government’s priorities and that support sustained growth. The report also recommends encouraging better coordination across Italy’s multiple layers of government.

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Lao PDR: Economic Fallout from COVID-19 Deepened

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Economic fallout from the COVID-19 pandemic, and from the efforts to contain it, deepened in Lao PDR over the second quarter of 2021 as work fell off abruptly and households and businesses reported declines in income and revenue, according to the latest round of the World Bank’s Rapid Monitoring Phone Survey.

The survey, conducted in April-May this year with 2,000 randomly selected households, shows that 51% of survey respondents reported being without work or having had to stop working in April–May 2021, up from 17% in February–March 2021. In the services sector, more than half of workers in wholesale and retail trade and other services had to stop working or switch jobs during the lockdown, according to the survey.

By May 2021, 5.5% of businesses had permanently closed, while 33% were temporarily shuttered. Among businesses that remained in operation, 65% experienced a fall in revenue from pre-lockdown levels. Also in May, around 43% of households experienced a decline in household income relative to before lockdown, leading respondents to express growing concern about food insecurity for people in their communities.

This was the third round of the COVID-19 Rapid Monitoring Phone Surveys of Households in Lao PDR. The surveys are aimed at monitoring the social and economic impacts of the pandemic. The results help provide insights into the effects of the pandemic on household well-being, and feed into policy advice and analytical studies such as the latest edition of the Lao Economic Monitor. Similar surveys are being carried out in 64 countries across the world.

The first round of the Lao phone surveys was conducted in June to July 2020, when the country had just exited the initial nationwide lockdown, and the second round ran from February to March 2021, one year into the pandemic. More details are available on the World Bank’s Lao PDR website. The monitoring is part of a wider health response to the pandemic. The Bank is coordinating a $33 million COVID-19 response project in Laos, supported by various development partners under the guidance of the Ministry of Health.

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