The government’s Health Promotion Administration seeks to reduce the toll from noncommunicable diseases.
Communicable diseases such as Zika, dengue fever, and Ebola may grab headlines and inspire fear, but in developed countries such as Taiwan, it is slower-moving but highly destructive noncommunicable diseases (NCDs) that are the biggest threat to both lives and the economy.
In 2011 the United Nations General Assembly met to discuss NCDs – which include cancers, diabetes, heart disease, respiratory illness, and strokes – marking only the second time the body has convened to discuss a health issue. The first time was for HIV/AIDS in 2001.
In a declaration adopted at the meeting on NCDs, the assembly did not mince words about the seriousness of the health threat. The UN declaration acknowledged “that the global burden and threat of non-communicable diseases constitutes one of the major challenges for development in the twenty-first century, which undermines social and economic development throughout the world and threatens the achievement of internationally agreed development goals.”
Although NCDs pose a serious problem, the upside is that they are often preventable through the adoption of a healthy lifestyle. In Taiwan, the agency responsible for taking on the challenge of reducing NCD occurrence is the Ministry of Health and Welfare’s Health Promotion Administration (HPA). Taiwan Business TOPICS recently visited with the HPA’s new director-general, Dr. Wang Ying-Wei, to discuss Taiwan’s efforts to address the public health challenge posed by NCDs.
Dr. Wang may be new at his current post, but he’s a familiar face at the HPA and its predecessor, the Bureau of Health Promotion (BHP), where he previously served as a consultant as well as deputy director-general. His views on how best to prevent NCDs hasn’t changed over the years.
“When I was consulting here, I wanted to change the department’s name to the Department of Exercise and Nutrition,” he said with a laugh. Despite the simple logic behind leading an active lifestyle and eating right, motivational issues prevent many people from getting off the sofa, skipping the bacon cheeseburger, or quitting cigarettes.
“The farthest distance for a human being,” Dr. Wang said, pointing at his head and then to his shoe, “is from their brain to their feet.” In other words, thinking of making a change is much easier than actually getting up and doing it.
With the average person’s motivational challenges in mind, Dr. Wang and the HPA are shifting focus from promoting “exercise” to “daily activity” with an aim at a cumulative benefit. This orientation is particularly important for people who don’t have time, money, or motivation to hit the gym, or even to go for a hike, run along the riverside, or get up early in the morning to join a group of tai chi practitioners or folk dancers.
The revised strategy relies upon people making many little changes to their lives in order to achieve a large combined effect. Dr. Wang suggests finding ways to add some extra walking wherever possible, such as taking the stairs in one’s building up to the fifth floor or getting off one stop early on the MRT and continuing on to one’s destination on foot. The low entry barrier for these types of activities, including hobbies such as gardening, make greater fitness more accessible to individuals who don’t think of themselves as being able to exercise.
In addition to physical fitness, proper nutrition, abstaining from smoking, and drinking only moderate amounts of alcohol are also important aspects of the fight for better health, although they cannot entirely eliminate the chance of developing an NCD.
In terms of prevalence, Taiwan’s biggest health problem today is cancer, so that is where the HPA is focusing most of its effort, through cancer prevention initiatives, early screening and detection, and high-quality treatment. Lung/trachea/bronchia cancer and liver cancer are the most serious types of cancer in Taiwan, accounting for 34.4% and 33.6% of cancer deaths respectively in 2014, according to HPA data. Colon cancer was not far behind, accounting for 18.4% of cancer deaths.
Oral cancer rates in Taiwan are higher than in many other parts of Asia, largely due to the local custom of chewing betel nut. Cervical cancer is also being targeted by the HPA via pap smears and vaccination against the human papillomavirus (HPV).
While promotion of a healthy lifestyle is one aspect of the HPA’s efforts against cancer, frequent screening and early detection are also crucial in ensuring that cases are treated as soon as possible, at a stage when the likelihood of successful treatment is higher. Despite the expense of this approach, it is still cost-effective, as treatment of cancers in later stages is even more costly, not to mention the opportunity to prevent unnecessary patient suffering.
Right message, right setting
The HPA website features extensive health promotion content, as do video discs that the HPA distributes, but Dr. Wang regards these traditional communication channels as too passive.
The World Health Organization recommends a setting-based approach to health promotion, in which strategic locations such as schools, workplaces, activity centers, and hospitals serve as ready-made platforms through which to target different audiences. The HPA has been promoting its healthier agenda through this setting-based approach for close to a decade, Dr. Wang says.
Over the years, the HPA has integrated multiple international health promotion initiatives into its national strategy. Among these are Health Promoting Schools, Health Promoting Workplaces, Health Promoting Hospitals, Healthy Cities, and Healthy Communities. These programs require participating organizations or communities to meet certain criteria verifying that they are promoting the well-being of their members.
One of the first programs adopted was Health Promoting Schools. About 10 years ago the BHP started actively promoting health to students through cooperation with national education officials. The Ministry of Education required primary and secondary schools to implement the Health Promoting School concept at the school level, with the goal of promoting a culture of health among students that they bring home and share with their familieseas emphasized under the program have been nutrition, exercise, tobacco avoidance, and basic road safety rules.
Under the Health Promoting Workplace scheme, the approaches to white-collar offices and blue-collar factories differ in some ways, but a focus on nutrition is common to both, Dr. Wang says. HPA officials provide consulting and recommendations regarding food preparation methods and improving nutrition in meals at factory cafeterias. For those working in offices, the HPA encourages nearby restaurants to offer healthy bento-style lunch boxes, with the calories labeled.
Taiwan has more than 180 accredited Health Promoting Hospitals, the highest number of any country worldwide, Dr. Wang notes. Accredited hospitals must satisfy a number of criteria, including administrative policies, the healthfulness of the environment, and the standard of employee health.
“In the past, we only focused on the patient,” Dr. Wang says. “Now, with Health Promoting Hospitals, there’s also an emphasis on having healthy employees.” Hospital staff members, the thinking goes, are likely to be more effective in promoting healthy living if they are themselves leading healthy lives.
Hospitals are in a unique position to help change how people think about their lifestyles. “When patients are in the hospital, it’s because they have a problem – this is a time when there is a great motivation to make one’s life healthier,” he says. “So we encourage hospitals to provide patients not just with medicine and surgery, but also with education.”
Making the hospital experience friendlier for elderly patients is another of the HPA’s new objectives. Since more than 60% of hospital visits in Taiwan are made by the elderly, improving the safety and efficiency of visits by older people is an important goal, Dr. Wang says. As Taiwan’s post-war generation retires and the average age of the population continues to rise rapidly, it will add pressure on the national healthcare system well into the future.
Some adjustments, such as installing higher armrests on chairs in hospital waiting areas, are matters of hardware, but others involve software. “We need to provide our elderly with the safest and most comfortable hospital environment possible,” Dr. Wang says. “But we also need to change our culture.”
Younger hospital staff may have difficulty understanding things from an elderly patient’s perspective and must be trained to show proper patience and respect when assisting them. “We must learn to change people’s attitudes to one of respect for the elderly, because one day we’ll all be in that same situation,” he says.
Care for the elderly is one of the two major priority areas that the HPA intends to address in the months and years ahead. The other is e-health, where medicine and IT intersect.
“In the future we’ll take a more active approach to providing patients with information,” Dr. Wang says. Patients will have an individual health portfolio featuring records from previous doctor visits plus health data that is collected for analysis by wearable devices. Based on the analysis, the network will send a message with relevant information to the patient’s mobile device.
Taiwan’s healthcare system will also undergo a shift to the shared decision-making (SDM) model currently popular in the United States and Britain, he says. Under the SDM model, rather than hospital staff being the main decision-making agent, patients are presented with clear information and likely outcomes so as to enable them to reach their own conclusions about what course of treatment will be best for them.
“SDM is all about empowerment,” Dr. Wang says. “For the patient, that means power and participation.”
The ultimate goal for the HPA, he says, is getting individuals to consider their health as one of their most important responsibilities. When that happens, making healthy choices becomes less of a chore and more a part of their lives in which they are actively interested and invested.