Health system responses to population ageing and
noncommunicable diseases in Asia
V. Yiengprugsawan, J. Healy and H. Kendig (eds). World Health
Organization, Regional Ofﬁce for South-East Asia, New Delhi, India,
2016. ISBN 9978 92 9022 517 1. Available from http://www.who.
If you are interested in population ageing in Sri Lanka and
Thailand, this free eBook produced by the World Health
Organization is worth downloading. Opening with an
overview of ageing in the Asia–Paciﬁc region, the book
provides two case studies, which explore in depth the
impacts of population ageing, ﬁrst in Sri Lanka and then in
The book is easy to read and would be of interest to
undergraduate and postgraduate students studying health
and human service systems and how they respond to age-
ing. Chapter one provides a succinct overview of the report
and how it is laid out, and states that the report’s founda-
tions lie in the landmark World report on ageing and
health (2015), which highlighted the importance of the
development of prevention and care strategies across the
life course. Alongside this, the authors note that ‘a high
proportion of total deaths across the Asia Paciﬁc region are
caused by non-communicable diseases (NCDs)... which are
predicted to increase dramatically over the next few dec-
ades’ (p. 4).
This report focuses on the South-East Asia region and com-
pares this to the Western Paciﬁc Region, which includes
several high-income countries (Australia, New Zealand,
South Korea and Singapore). In South-East Asia, life expec-
tancy for women is signiﬁcantly lower (70 years vs
78 years), as is the percentage of GDP spent on health (4%
vs 7%). At the systems level, the report notes that, to
address these differences, the health system must focus on
primary care and early intervention; and creation of
health-friendly services and integrated health services,
ensuring equity of access, and with a focus on quality
improvement. The report then focuses on two conditions
that can beneﬁt from prevention and care strategies: dia-
betes and stroke.
Chapters three and four provide standalone accounts of the
health systems in Sri Lanka (population 20.2 million) and
Thailand (population 65.9 million), with a key focus on
strategies to improve responses to diabetes and stroke.
Maternal and child health services have been the focus of
service provision by the government in Sri Lanka over the
past two decades, and this ‘has served the country well’ (p.
69), but with increasing security and positive economic
growth, the health system is now focusing on the ageing
population and encouraging a change in community atti-
tudes to promote healthy and active ageing. This shift has
required a change in health-care workers’ knowledge, skills
and attitudes, which is a current challenge to be addressed.
Thailand has an ageing population, with 30% of its popu-
lation projected to be aged over 60 years by 2040. Like
older people the world over, those in Thailand want to
remain ‘living independently with good health and dignity’
(p. 104). Thai postacute care and long-term care systems,
however, are limited. While steps have been made to build
a community-based system, this is still a work in progress,
and the delivery of ‘effective and efﬁcient services for the
ageing population remains a current and future challenge’
In the ﬁnal chapter, the authors reﬂect on the two case
studies, their focus on diabetes and stroke, and the urgent
need to address NCDs, because of their impact on ‘morbid-
ity, disability and dependency among older people’ (p.
122). Solutions are recommended, including training for
health professionals in the care of older people, improving
the responsiveness of services to the older person, designing
age-friendly environments, integrating primary, secondary
and tertiary health services, and effectively linking health
and human services.
This report is well written – engaging and well researched –
and alerts the reader to issues that are unique to South-East
Asia. It also highlights many of the common issues that we
face across the Asia–Paciﬁc region. The report’s recommen-
dations have relevance across the world and can play a part
in how ‘we can transform the way policy-makers and
service-providers perceive population ageing – and plan to
make the most of it’ (p. viii).
School of Health Sciences, University of Melbourne,
Melbourne, Victoria, Australia
Australasian Journal on Ageing, Vol 37 No 1 March 2018, 77
2018 AJA Inc.