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.
Peru should help more young vulnerable people into work
Peru’s remarkable economic growth since the 2000s and policies targeting the most vulnerable young people have helped boost the youth employment rate. Peru should now focus on improving job opportunities for low-skilled youth, young women and indigenous and Afro-Peruvian youth, according to a new OECD report.
Investing in Youth: Peru says that the youth employment rate today is higher than both the average of OECD countries and many Latin American countries. But many challenges remain.
Income inequality is high and poverty has risen recently. A large share of the youth workforce with a lack of the right skills and a sizeable informal sector hinder the transition to a more productive, better-paid and better quality jobs for Peruvian youth.
Young people with tertiary education face an even higher risk of unemployment than their less-educated peers. In 2017 their unemployment rate was 14.6%, compared to 8.7% for people with a secondary education degree and 7.3% for unskilled youth.
The situation of limited employment opportunities for many youth also translates into low levels of well-being. Close to 34% of Peruvian youth affirm that they find it difficult, or very difficult, to get by with their present household income. This compares to an OECD average of about 20% and places Peruvian youth towards the worse-off end of Latin American and Caribbean countries.
Today’s high proportion and number of youth in the Peruvian working age population is set to decline in the near future. Without action, the opportunities to benefit from the growth dividend associated with the demographic bonus will fade away, according to the report.
To help more young people into work, the OECD recommends that Peru:
Strengthen social dialogue with unions, civil society and employers in order to improve labour market policies that reduce the dualism of the labour market between permanent and temporary contracts and encourage employers to hire young workers.
Ensure that business incentives, such as tax breaks for small firms, do not discourage them from expanding and hiring young workers.
Expand and increase the efficiency of the public employment services (PES) by strengthening recruitment and training programmes for caseworkers.
Continue efforts to increase the enrolment and learning performance of students from disadvantaged backgrounds.
Engage in ambitious policies to tackle the vulnerability of young Peruvian women.
Combat discrimination against indigenous and Afro-Peruvian youth; and
Boost job opportunities for rural indigenous youth by implementing a nationally co-ordinated strategy to help rural populations engage in new and more profitable entrepreneurial activities.
New safety and health issues emerge as work changes
Changes in working practices,
demographics, technology and the environment are creating new occupational
safety and health (OSH) concerns, according to a new report from the
International Labour Organization (ILO).
Growing challenges include psychosocial risks, work-related stress and non-communicable diseases, notably circulatory and respiratory diseases, and cancers.
The report, Safety and Health at the heart of the Future of Work: Building on 100 years of experience * , is being published ahead of the World Day for Safety and Health at Work , which is marked on April 28th. It reviews the ILO’s 100 years of work on OSH issues, and highlights emerging health and safety issues in the world of work.
Currently, more than 374 million people are injured or made ill every year through work-related accidents. It is estimated that work days lost to OSH-related causes represent almost 4 per cent of global GDP, in some countries as much as 6 per cent, the Report says.
“As well as more effective prevention for established risks, we are seeing profound changes in our places and ways of working. We need safety and health structures that reflect this, alongside a general culture of prevention that creates shared responsibility,” said Manal Azzi, ILO Technical Specialist on Occupational Safety and Health.
Looking to the future, the report highlights four major transformative forces driving changes. It points out that all also offer opportunities for improvements.
First, technology, such as digitization, robotics, and nanotechology, can also affect psychosocial health and introduce new materials with unmeasured health hazards. Correctly applied it can also help reduce hazardous exposures, facilitate training and labour inspections.
Demographic shifts are important because young workers have significantly high occupational injury rates, while older workers need adaptive practices and equipment to work safely. Women – who are entering the workforce in increasing numbers – are more likely to have non-standard work arrangements and have a higher risk of musculoskeletal disorders.
Thirdly, development and climate change give rise to risks such as air pollution, heat stress, emerging diseases, shifting weather and temperature patterns that can bring job losses. Equally, new jobs will be created through sustainable development and the green economy.
Finally, changes in the organization of work can bring flexibility that allows more people to enter the labour force, but may also lead to psychosocial issues (for example, insecurity, compromised privacy and rest time, or inadequate OSH and social protections) and excessive work hours. Approximately 36 per cent of the world’s workforce currently works excessive hours (more than 48 hours per week).
In the light of these challenges the study
proposes six areas on which policy makers and other stakeholders should focus.
These include more work on anticipating new and emerging OSH risks, adopting a
more multidisciplinary approach and building stronger links to public health
work. Better public understanding of OSH issues is also needed. Finally,
international labour standards and national legislation need to be
strengthened, something which will require stronger collaboration between
Governments, workers and employers.
By far the greatest proportion of current work-related deaths – 86 per cent – come from disease. In the region of 6,500 people a day die from occupational diseases, compared to 1,000 from fatal occupational accidents.
The greatest causes of mortality are circulatory diseases (31 per cent), work-related cancers (26 per cent) and respiratory diseases (17 per cent).
“As well as the economic cost we must recognize the immeasurable human suffering such illnesses and accidents cause. These are all-the-more tragic because they are largely preventable,” said Azzi. “Serious consideration should also be given to the recommendation of the ILO’s Global Commission on the Future of Work , that occupational safety and health be recognized as a fundamental principle and right at work.”
China needs further reforms to make growth sustainable, greener and more inclusive
The Chinese economy continues to slow as it rebalances, with headwinds including trade frictions and the weakening global economy undermining exports and creating new uncertainties. Policy should focus on long-term strategies to move the economy towards greater domestic consumption and services, enhancing economic efficiency and ensuring that future growth is sustainable, greener and more inclusive, according to a new report from the OECD.
The latest OECD Economic Survey of China looks at the factors behind the economic slowdown as well as policies that can boost the quality of future growth and ensure that it is more equitably distributed. Despite the slowdown, the Survey projects growth above 6% this year and next, and sees continuing convergence with more advanced economies.
The Survey, presented in Beijing by OECD Deputy Secretary-General Ludger Schuknecht, underlines the rising financial risks from high corporate debt and recommends that China prioritises the creation of a single product and labour market to boost productivity and inclusiveness.
“China continues to be the major driver of world economic growth and convergence with advanced economies continues, despite the slowdown,” Mr Schuknecht said. “Yet China is at a crossroads, facing serious domestic and external challenges to maintaining its strong position over the long-term. Policy should seek to ensure a better functioning economy that delivers stable and inclusive growth for all.”
The Survey underlines the need for more balanced trade and investment. Policy should aim to further lower import tariffs and dismantle non-tariff barriers and barriers on the entry and conduct of foreign firms, in particular requirements to form joint ventures or transfer technology.
While much has been done to address financial risks, China’s ongoing fiscal stimulus should avoid directing credit to state-owned enterprises and local governments, the Survey said. Debt ceilings should take into account sub-national government revenues.
Prudent fiscal policy should channel funds to areas where returns are highest, such as education, health and social security systems, while avoiding misallocation of capital by allowing banks to better price risks. Risk perception could be sharpened by orderly defaults. The quality, coverage and timeliness of fiscal reporting can be improved, the Survey said.
The Survey sees wide scope to improve efficiency across the economy, notably by reducing the internal barriers that hinder product market competition and labour mobility. Strengthening the rule of law, restricting the power of administrative departments and providing clear and detailed implementation rules limiting their discretionary powers would reduce protectionism at the local level. Anti-monopoly rules and enforcement can be strengthened and public procurement processes could be made more transparent, technology-neutral and open to all players.
Other measures to boost economic efficiency highlighted by the Survey include stronger protection of intellectual property rights; gradual removal of implicit guarantees to state-owned enterprises, allowing them to default; and reduction of state ownership in commercially-oriented, non-strategic sectors.
To ensure equal opportunities, the Survey recommends China to distribute more evenly high-quality education and health care in order to reduce incentives to move to mega-cities. Gradually easing restrictions on access to public services for city residents without the hukou (residency permit) and eventually delinking service provision from the hukou would also help improve equity. Centralised financing of key spending items, such as wage bills in education and health, reforms to the floor and ceiling for social security contributions and wider tax reform should be pursued.
To make growth greener, the Survey suggests China enforce environmental regulations more strictly, raise fines for polluters and boost environmental taxation, particularly on fossil fuels. Putting an end to the construction of coal-fired power plants and increasing investment in pollution treatment facilities, urban water treatment and rural sanitation is also necessary.
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