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Noa Ronkin
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The Walter H. Shorenstein Asia-Pacific Research Center (APARC) is pleased to invite applications for a suite of fellowships in contemporary Asia studies to begin fall quarter 2023.

The Center offers postdoctoral fellowships that promote multidisciplinary research on contemporary Japan and contemporary Asia broadly defined, inaugural postdoctoral fellowships and visiting scholar positions as part of the newly launched Stanford Next Asia Policy Lab, and a fellowship for experts on Southeast Asia. Learn more about each opportunity and its eligibility and specific application requirements:

Postdoctoral Fellowship on Contemporary Japan

Hosted by the Japan Program at APARC, the fellowship supports research on contemporary Japan in a broad range of disciplines including political science, economics, sociology, law, policy studies, and international relations. Appointments are for one year beginning in fall quarter 2023. The application deadline is December 1, 2022.
 

Shorenstein Postdoctoral Fellowship on Contemporary Asia

APARC offers two postdoctoral fellowship positions to junior scholars for research and writing on contemporary Asia. The primary research areas focus on political, economic, or social change in the Asia-Pacific region (including Northeast, Southeast, and South Asia), or international relations and international political economy in the region. Appointments are for one year beginning in fall quarter 2023. The application deadline is December 1, 2022.
 

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The Center offers a suite of fellowships for Asia researchers to begin fall quarter 2023. These include postdoctoral fellowships on contemporary Japan and the Asia-Pacific region, inaugural postdoctoral fellowships and visiting scholar positions with the newly launched Stanford Next Asia Policy Lab, and fellowships for experts on Southeast Asia.

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Beth Duff-Brown
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The Supreme Court ruling eliminating the constitutional right to an abortion could also result in women’s personal reproductive health data being used against them, warns Stanford Health Policy’s Michelle Mello.

The Dobbs v. Jackson Women’s Health Organization ruling could, for example, lead to a woman’s health data in clinician emails, electronic medical records, and online period-tracking platforms being used to incriminate her or her health-care providers, Mello said.

“Ultimately, broader information privacy laws are needed to fully protect patients and clinicians and facilities providing abortion services,” writes Mello, a professor of health policy and law in this JAMA Health Forum article with colleague Kayte Spector-Bagdady, a bioethicist from the University of Michigan. “As states splinter on abortion rights after the Dobbs Supreme Court decision, the stakes for providing robust federal protection for reproductive health information have never been higher.”

Eight states banned abortions on the same day the Dobbs ruling came down, and 13 states that had “trigger bans” that, if Roe v. Wade were struck down, would automatically prohibit abortion within 30 days. Other states are considering reactivating pre-Roe abortion bans and legislators in some states intend to introduce new legislation to curb or ban the medical procedure.”

Three Potential Scenarios

The authors note these new abortion restrictions may clash with privacy protections for health information, laying out three scenarios that could impact millions of women. And, they note, “despite popular misconceptions about the breadth of the Privacy Rule of the Health Information Portability and Accountability Act (HIPAA) and other information privacy laws, current federal law provides little protection against these scenarios.”

The first scenario is that a patient’s private health information may be sought in connection with a law-enforcement proceeding or civil lawsuit for obtaining an illegal abortion. HIPAA privacy regulations and Fourth Amendment rights against unreasonable searches and seizures won’t help physicians and hospitals resist such investigative demands, the authors write. And though physician-patient communications are ordinarily considered privileged information, the scope of that privilege varies greatly from state to state. “In many cases medical record information has been successfully used to substantiate a criminal charge,” the authors write.

Ultimately, broader information privacy laws are needed to fully protect patients and clinicians and facilities providing abortion services.
Michelle Mello
Professor of Health Policy, Law

The second privacy concern is the potential use of health-care facility records to incriminate an institution or its clinicians for providing abortion services. Relevant records could include electronic health records, employee emails or paging information and mandatory reports to state agencies. Clinicians may not realize that if they are using an institutional email address or server, their institution likely has direct access to information and communications stored there, which can be used to search for violations. State Freedom of Information Act (FOIA) laws also allow citizens to request public records from employees of government hospitals and clinics.

“Additionally, state mandatory reporting laws for child abuse might be interpreted to cover abortions — particularly if life is defined as beginning at fertilization,” the authors note.

The third scenario is that information generated from a woman’s online activity could be used to show she sought an abortion or helped someone to do so. Many women use websites and apps that are not HIPAA-regulated or protected by patient-physician privilege, such as period-tracking apps used by millions of women that collect information on the timing of menstruation and sexual activity.

“There are many instances of internet service providers sharing user data with law enforcement, and prosecutors obtaining and using cellphone data in criminal prosecutions,” write Mello and Spector-Bagdady, adding commercially collected data are also frequently sold to or shared with third parties.

“Thus, pregnant persons may unwittingly create incriminating documentation that has scant legal protection and is useful for enforcing abortion restrictions,” they said.

The immediate problem, Mello notes, is in the states that have already banned abortion or passed restrictive laws.

“There could be a problem with states trying to reach outside their borders to prosecute people, but that could well be unconstitutional,” Mello said.

Some states’ laws sweep abortion pills into the definition of illegal abortions, she said, and there are legal obstacles to supplying the pills across state lines.

“There is a lot of energy going into figuring out a workaround right now, but it’s too soon to call,” Mello said.

Recommended Protections

So how can clinicians and health-care facilities protect their patients and themselves?

When counseling patients of childbearing age about reproductive health issues, clinicians should caution their patients about putting too much medical data online and refer them to expert organizations that will help them minimize their digital footprint.

When documenting reproductive health encounters, the authors said, clinicians should ask themselves: “What information needs to be in the medical record to assure safe, good-quality care, buttress our claim for reimbursement, or comply with clear legal directives?” For example, does information about why a patient may have experienced a miscarriage need to be recorded?

Patients and clinicians should be aware that email and texting may be seen by others, so conversations among staff about reproductive health issues may best be conducted by phone or in person.

Finally, if abortion-related patient information is sought by state law enforcement officials, a facility’s attorney should be consulted about asserting physician-patient privilege and determining whether the disclosure is mandated by law.

Michelle Mello

Michelle Mello

Professor of Health Policy, Law
Focuses on issues at the intersection of law, ethics and health policy.
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Michelle Mello writes that the overturning of Roe v. Wade — ending federal protection over a woman's right to an abortion — could also expose her personal health data in court.

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This press release was originally published by the University of Tokyo. It discusses a new study, published by Lancet Public Health and co-authored by researchers from the University of Tokyo along with FSI Senior Fellow Karen Eggleston, director of the Asia Health Policy Program at APARC, and Jay Bhattacharya, Professor of Health Policy and director of the Center for Demography and Economics of Health and Aging at Stanford.


A new detailed microsimulation, using a database of 40 million people, has examined the future of Japan’s aging population up to 2043. It projects that more people will live longer, and that overall years spent living with dementia will decrease. However, the model highlighted the diversity of impacts on different segments of the population, as Japanese women with a less than high school education aged 75 and over may be disproportionately affected by both dementia and frailty. Better understanding where health gaps like this exist can help inform public health planning, to minimize future economic costs and support those most in need.

Taking care of the older members of society is a common concern around the world. Japan is famous for its long-lived residents, the number of which continues to rise. In 2020, almost 30% of the Japanese population was aged 65 years or older, and this age group is not projected to peak until 2034. Caring for people with age-related ailments, such as dementia and frailty, poses a challenge both to individuals and public health care systems.

Microsimulation models, which are computer models that can provide detailed analysis on an individual basis, are currently used to project future population health in some countries, such as the U.K. and the U.S. Professor Hideki Hashimoto and researchers at the University of Tokyo, along with researchers from Stanford University in the U.S., wanted to create a new microsimulation model for Japan, which would take into account more diverse conditions than had been considered before.

“We developed a new Japanese microsimulation model that accounts for 13 chronic conditions (including heart disease, stroke, diabetes, depression and dependency), as well as frailty and dementia,” explained Hashimoto. “Using an ultralarge data system, we were able to ‘follow’ a virtual cohort of more than 40 million people aged 60 and over from 2016 to 2043.”

According to Hashimoto, projections of aging in Japan usually rely on the “average” status of older people and so don’t consider the diversity of the population. “I believe that problems of aging are a matter of health gaps over the course of people’s lives,” he said. “Our projection brings attention to a widening health gap among older people. It highlighted that women with a less than high school education aged 75 or over are more likely to be affected.”

Identifying where health gaps like this exist could be used to better inform public policy, not only about health care but other influential aspects of life. “Japan’s case may suggest that improvement in educational attainment, as well as population health, could be a key to making a healthier and more manageable aging society,” said Hashimoto.

Positively, this study shows hope for a future where many people live longer and more healthy lives. “People might believe that an increase in cases of dementia is inescapable, given population aging. However, in this study we found that in Japan, despite an aging population, the number of people with dementia is expected to decrease over the next two decades,” said Hashimoto. “Population aging does not necessarily mean an increase of social burden for care, but it does bring a diversity of problems that requires careful study and science-based policy attention, to close the health gap.”

Karen Eggleston 4X4

Karen Eggleston

Senior Fellow at FSI and Director of the Asia Health Policy Program, Shorenstein APARC
Full biography

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A new microsimulation projects that over the next 20 years, Japanese people will live longer without dementia, but older women with a less than high school education will benefit less than men.

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Background

Dementia and frailty often accompany one another in older age, requiring complex care and resources. Available projections provide little information on their joint impact on future health-care need from different segments of society and the associated costs. Using a newly developed microsimulation model, we forecast this situation in Japan as its population ages and decreases in size.

 

Methods

In this microsimulation modelling study, we built a model that simulates an individual's status transition across 11 chronic diseases (including diabetes, coronary heart disease, and stroke) as well as depression, functional status, and self-reported health, by age, sex, and educational strata (less than high school, high school, and college and higher), on the basis of nationally representative health surveys and existing cohort studies. Using the simulation results, we projected the prevalence of dementia and frailty, life expectancy with these conditions, and the economic cost for formal and informal care over the period 2016–43 in the population of Japan aged 60 years and older.

 

Findings

Between 2016 and 2043, life expectancy at age 65 years will increase from 23·7 years to 24·9 years in women and from 18·7 years to 19·9 years in men. Years spent with dementia will decrease from 4·7 to 3·9 years in women and 2·2 to 1·4 years in men. By contrast, years spent with frailty will increase from 3·7 to 4·0 years for women and 1·9 to 2·1 for men, and across all educational groups. By 2043, approximately 29% of women aged 75 years and older with a less than high school education are estimated to have both dementia and frailty, and so will require complex care. The expected need for health care and formal long-term care is anticipated to reach costs of US$125 billion for dementia and $97 billion for frailty per annum in 2043 for the country.

 

Interpretation

Japan's Government and policy makers should consider the potential social challenges in caring for a sizable population of older people with frailty and dementia, and a widening disparity in the burden of those conditions by sex and by educational status. The future burden of dementia and frailty should be countered not only by curative and preventive technology innovation, but also by social policies to mitigate the health gap.

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A Microsimulation Modelling Study

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The Lancet Public Health
Authors
Megumi Kasajima
Karen Eggleston
Shoki Kusaka
Hiroki Matsui
Tomoki Tanaka
Bo-Kyung Son
Katsuya Iijima
Kazuo Goda
Masaru Kitsuregawa
Jay Bhattacharya
Hideki Hashimoto
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Noa Ronkin
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No health system can function without health workers — nurses, paramedical professionals, medical laboratory technicians, care assistants, and more — who make it possible to deliver health care. This has led the World Health Organization (WHO) to declare “No health without a workforce” as a universal truth. Yet relatively few studies have analyzed the relationship between health workforce and health outcomes, and some such cross-country and within-country studies show inconsistent results.

A new study published in the journal Social Indicators Research addresses this gap by investigating the strength and significance of the associations of the health workforce with multiple health outcomes and COVID-19 excess deaths across countries. The coauthors of the study — Karen Eggleston, APARC Asia Health Policy Program Director and FSI Senior Fellow, and Jinlin Liu, a professor at China’s Northwestern Polytechnical University’s School of Public Policy and Administration and a 2019-20 visiting scholar at APARC — find that higher density of the health workforce was significantly associated with better levels of multiple health outcomes and with a lower level of COVID-19 excess deaths per 100,000 people.

The study also confirms the pivotal role of socioeconomic factors in affecting health outcomes and underscores the wide disparities in health outcomes across countries in different income categories. In light of the strains on the health workforce during the coronavirus pandemic, this research also emphasizes the importance of investing in the health workforce to strengthen health system resilience and achieve long-term improvement in health outcomes.


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Determining Country-Level Health Outcomes 

Eggleston and Liu investigated how the density of skilled health workers — medical doctors and nursing and midwifery personnel for each country — affected six measures of health outcomes. These measures included maternal mortality ratio, under-five mortality rate, and neonatal mortality rate — all of which are health-related Sustainable Development Goals (SDG) indicators — plus healthy life expectancy at birth, the mortality rate of teens and adults aged 15−60, and infant mortality rate. The researchers also examined COVID-19 excess deaths per 100,000 people as a health outcome measure proxying for the health impact of the coronavirus pandemic.

Additionally, Eggleston and Liu collected and analyzed data on four measures to account for country-level socioeconomic factors pertinent to determining health outcomes. These explanatory variables included health spending per capita, gross national income per capita, poverty headcount ratio, and the mean years of female schooling as a proxy for female educational attainment. They used the latest WHO dataset on the global health workforce, covering 191 WHO member countries.

Our results underscore the importance of accounting for poverty and the broader social determinants of health when studying the association of health outcomes with the health workforce, and the distinction between cross-individual and cross-country disparities.
Karen Eggleston & Jinlin Liu

The researchers found that countries with a higher density of skilled health workers could expect to have better health outcomes across all six measures of health outcomes. Unsurprisingly, high-income countries generally enjoy a high density of skilled health workers and world-leading health outcomes, whereas low-income countries suffer from a shortage of health workers and poor health outcomes. A higher density of skilled health workers was also significantly correlated with a lower level of COVID-19 excess deaths per 100,000 people, highlighting the importance of the health workforce under the pandemic.

A Cause and Effect of Socioeconomic and Health-System Developments

The cross-country results confirm the importance of the health workforce in affecting multiple health outcomes. “Therefore, investment in health workforce should be an integral part of the strategies to improve health outcomes and achieve health-related SDGs for every country, especially for low- and lower-middle-income countries,” write Eggleston and Liu. The vast majority of these countries (about 80%) are tremendously off track to meet the health-related SDGs by 2030.

From a global perspective, the data underscores the wide disparities in health outcomes between different countries, especially between those most and least advantaged (e.g., healthy life expectancy at birth of 44.9 years in the Central African Republic compared with 76.2 years in Singapore).

A strong health workforce contributes to better health outcomes and is itself a manifestation of a country’s previous investments that reduced poverty, improved health outcomes, and laid the foundation for a robust health system.
Karen Eggleston & Jinlin Liu

It is difficult, however, to improve disparities in health outcomes between countries in different income categories by improving the density of the health workforce alone. The reason is that socioeconomic factors, as the data confirms, are critical determinants of health outcomes. For example, higher health expenditure per capita and the poverty headcount ratio have significant associations with all six health outcomes, while female education is interrelated with broader social determinants of health.

Thus, the relationship between the health workforce and health outcomes is the cause and effect of broader socioeconomic and health-system developments. “A strong health workforce contributes to better health outcomes and is itself a manifestation of a country’s previous investments that reduced poverty, improved health outcomes, and laid the foundation for a robust health system,” Eggleston and Liu explain.

Investment in the health workforce is an urgent task, the researchers conclude. It should be an integral part of strategies to achieve health-related SDGs, and these strategies, in turn, should include means to achieving complementary non-health SDGs related to poverty alleviation and expansion of female education.

Karen Eggleston 4X4

Karen Eggleston

Senior Fellow at the Freeman Spogli Institute for International Studies and Director of the Asia Health Policy Program, Shorenstein APARC
View full biography

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Analyzing data from 191 World Health Organization member countries, a new study from APARC’s Karen Eggleston indicates that strengthening the health workforce is an urgent task in the post-COVID era critical to achieving health-related Sustainable Development Goals and long-term improvement in health outcomes, especially for low- and lower-middle-income countries.

Paragraphs

Image
Cover of the journal Social Indicators Research
This study investigates the strength and significance of the associations of health workforce with multiple health outcomes and COVID-19 excess deaths across countries, using the latest WHO dataset.

Multiple log-linear regression analyses, counterfactual scenarios analyses, and Pearson correlation analyses were performed. The average density of health workforce and the average levels of health outcomes were strongly associated with country income level. A higher density of the health workforce, especially the aggregate density of skilled health workers and density of nursing and midwifery personnel, was significantly associated with better levels of several health outcomes, including maternal mortality ratio, under-five mortality rate, infant mortality rate, and neonatal mortality rate, and was significantly correlated with a lower level of COVID-19 excess deaths per 100K people, though not robust to weighting by population.

The low density of the health workforce, especially in relatively low-income countries, can be a major barrier to improving these health outcomes and achieving health-related Sustainable Development Goals (SDGs); however, improving the density of the health workforce alone is far from enough to achieve these goals. Our study suggests that investment in health workforce should be an integral part of strategies to achieve health-related SDGs, and that achieving non-health SDGs related to poverty alleviation and expansion of female education are complementary to achieving both sets of goals, especially for those low- and middle-income countries. In light of the strains on the health workforce during the current COVID-19 pandemic, more attention should be paid to health workforce to strengthen health system resilience and long-term improvement in health outcomes.

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Social Indicators Research
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Karen Eggleston
Jinlin Liu
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Radhika Jain and Pascaline Dupas with a screenshot of the cover of their Social Science & Medicine journal article

Highlights

  • India's nationwide COVID-19 lockdown severely disrupted critical chronic care.

  • Non-COVID-19 morbidity and mortality increased sharply in the subsequent months.

  • Socioeconomically disadvantaged patients were worst affected.

  • Indirect health effects increase the toll of pandemics and worsen health inequality.

  • Pandemic control policies must ensure critical health services continue.

Abstract

India's COVID-19 lockdown, one of the most severe in the world, is widely believed to have disrupted critical non-COVID health services. However, linking these disruptions to effects on health outcomes has been difficult due to the lack of reliable, up-to-date health outcomes data. The authors identified all dialysis patients under a statewide health insurance program in Rajasthan, India (N = 2110), and conducted surveys to examine the effects of the lockdown on non-COVID care access and health outcomes. Post-lockdown mortality was their primary outcome and morbidity and hospitalization were secondary outcomes.

63% of patients experienced a disruption to their care. Transport barriers, hospital service disruptions, and difficulty obtaining medicines were the most common causes. We compared monthly mortality in the four months after the lockdown with pre-lockdown mortality trends, as well as with mortality trends for a similar cohort in the previous year. Mortality in May 2020, after a month of exposure to the lockdown, was 1.70 percentage points (95% CI 0.01–0.03) or 64% higher than in March 2020 and total excess mortality between April and July was estimated to be 22%. A 1SD increase in an index of care disruptions was associated with a 0.17SD (95% CI 0.13–0.22) increase in a morbidity index, a 3.1 percentage point (95% CI 0.012–0.051) increase in hospitalization, and a 2.1 percentage point (95% CI 0.00–0.04) increase in probability of death between May and July. Females, socioeconomically disadvantaged groups, and patients living far from the health system faced worse outcomes. The results highlight the unintended consequences of the lockdown on critical, life-saving non-COVID health services that must be taken into account in the implementation of future policy efforts to control the spread of pandemics.

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Evidence from Dialysis Patients

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Social Science & Medicine
Authors
Pascaline Dupas

This event will offer simultaneous translation between Japanese and English. 
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Febuary 14, 4-5:30 p.m. California time/ February 15, 9-10:30 a.m. Japan time

This event is part of the 2022 Japan Program Winter webinar series, The Future of Social Tech: U.S.-Japan Partnership in Advancing Technology and Innovation with Social Impact

 

COVID-19 has changed the way we work. While remote work has become the norm, the pandemic has also highlighted the inequity in childcare, elderly care, and household work. Japanese workplaces feel a particularly acute need for adjustment, as lack of digitalization and persistent gender inequality continue to limit productivity gains and diversity in the workforce. Social entrepreneurs in Japan have started offering new technologies that address these problems and transform Japanese work environments, using matching algorithms, innovative apps, and other new technologies. How can these social technologies reshape the workplace? What principles do we need in using these technologies in practice, in order to unlock the keys to untapped human resource potentials and realize a more equitable and inclusive work environment in Japan, the United States, and elsewhere?  Fuhito Kojima, a renowned economist specializing in matching theory, will talk about market design from the perspective of regulation design and economics, and Eiko Nakazawa, an influential entrepreneur, will speak about her experiences founding education and childcare startups in the United States and Japan, moderated by Yasumasa Yamamoto, a leading expert on technology and business in Japan and the United States. 

 

Panelists

Image
Photo of Fuhito Kojima
Fuhito Kojima is a Professor of Economics at the University of Tokyo and Director of the University of Tokyo Market Design Center. He received a B.A. at University of Tokyo (2003) and PhD at Harvard (2008), both in economics and taught at Yale (2008-2009, as postdoc) and then Stanford (2009-2020, as professor) while spending one year at Columbia in his sabbatical year. His research involves game theory, with a particular focus on “market design,” a field where game-theoretic analysis is applied to study the design of various mechanisms and institutions. His recent works include matching mechanism designs with complex constraints, and he is working on improving medical residency match and daycare seat allocation in Japan based on his academic work. Outside of academia, he serves as an advisor for Keizai Doyu Kai as well as several private companies.

 

Image
Photo of Eiko Nakazawa
Eiko Nakazawa is the Founder and CEO of Dearest, Inc., a VC-Backed startup in the United States that makes high-quality learning, childcare, and parenting support accessible by helping employers subsidize those costs for their working families. She also advises and invests in early-stage startups, and has recently co-founded Ikura, Inc., an education x fintech company in Japan. Prior to founding Dearest, Nakazawa spent 11 years with Sony Corporation, where she led global marketing, turnaround, and new business launch initiatives. Nakazawa earned an M.S. in Management from Stanford Graduate School of Business.

 

 

Moderator

Image
Photo of Yasumasa Yamamoto
Yasumasa Yamamoto is a Visiting Professor at Kyoto University graduate school of management and has been a specialist in emerging technology such as fintech, blockchain, and deep learning. He was previously industry analyst at Google, senior specialist in quantitative analysis of secularized products, as well as derivatives at Bank of Tokyo Mitsubishi in New York. Yamamoto holds a M.S. from Harvard University and a masters degree from University of Tokyo.





 

Via Zoom Webinar
Register:  https://bit.ly/3odkWFT 

 

 

Fuhito Kojima <br>Professor of Economics at the University of Tokyo<br><br>
Eiko Nakazawa <br>Founder and CEO, Dearest Inc.<br><br>
Yasumasa Yamamoto <br>Visiting Professor at Kyoto University
Panel Discussions
Authors
Noa Ronkin
News Type
News
Date
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As the COVID-19 pandemic remains a crucial global public health threat, pandemic control measures such as lockdowns and mobility restrictions continue to disrupt the provision of health services, leading to reduced healthcare use. Indeed, evidence shows the pandemic has emerged as a particular challenge for people with chronic conditions such as diabetes and hypertension. Yet there is limited data comparing the pandemic’s impact on access to care and the severity of chronic disease symptoms at the population level across Asia.

Now a new collaborative study, published by the Asia Pacific Journal of Public Health, addresses this limitation. The study co-authors, including APARC’s Asia Health Policy Program Director and FSI Senior Fellow Karen Eggleston, offer the first report comparing the impacts of the COVID-19 pandemic and its associated mobility restrictions on people with chronic conditions at different stages of socio-demographic and economic transitions in five Asian regions — India, China, Hong Kong, Korea, and Vietnam.

The findings show that the pandemic has disproportionately disrupted healthcare access and worsened diabetes symptoms among marginalized and rural populations in Asia. Moreover, the pandemic’s broad social and economic impact has adversely affected population health well beyond those directly suffering from COVID-19, with the resulting delayed and foregone care leading to uncertain longer-term effects.


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Unintended Adverse Consequences

Routine screening, risk factor control, and continuity of care for non-communicable diseases are a global challenge. The COVID-19 pandemic has exacerbated the challenge even further. Existing reports show the pandemic has particularly adverse impacts on essential prevention and treatment services for people with chronic conditions. These reductions in health services arose from pandemic-associated factors such as mobility restrictions, lack of public transport, and lack of health workforce.

Eggleston and a group of colleagues set out to provide evidence on how the pandemic has impacted chronic disease care in diverse settings across Asia during COVID-19-related lockdowns. Using standardized questionnaires, the researchers surveyed 5672 participants aged 55.9 to 69.3 years with chronic conditions in India, China, Hong Kong, Korea, and Vietnam. The researchers collected data on participants’ demographic and socio-economic status, comorbidities, access to healthcare, employment status, difficulty in accessing medicines due to financial and nonfinancial (COVID-19 related) reasons, treatment satisfaction, and severity of their chronic condition symptoms.

If no immediate actions are taken to mitigate pandemic impacts, the Asia-Pacific region will struggle to achieve the 2030 Sustainable Development Goal target 3.4 to reduce premature mortality from non-communicable diseases […] and to promote mental health and wellbeing.
Karen Eggleston et al.

The results show that the pandemic’s broad social and economic impact has adversely affected population health well beyond those directly suffering from COVID-19. Study participants with chronic conditions faced significant challenges in managing their symptoms during the pandemic. They experienced a loss of income and difficulties in accessing healthcare or medications, with the resulting delayed and foregone care leading to uncertain longer-term effects. For a nontrivial portion of participants, these factors are associated with the worsening of diabetes symptoms. The threat is twofold among people living in rural populations with limited access, availability, and affordability of healthcare services.

A Global Health Priority

The unintended adverse consequences of the COVID-19 pandemic on chronic disease care may also further aggravate inequality in health outcomes. “If the trend continues and no immediate actions are taken to mitigate pandemic impacts,” Eggleston and her colleagues caution, then “the Asia-Pacific region will struggle to achieve the 2030 Sustainable Development Goal (SDG) target 3.4 to reduce premature mortality from non-communicable diseases by a third relative to 2015 levels and to promote mental health and wellbeing.”

Addressing the pandemic’s unintended negative social and economic impacts on chronic disease care is a global health priority, determine the researchers. They propose several measures to help provide timely care for people with chronic conditions in resource-constrained settings. These include implementing innovations in healthcare delivery models to improve the adoption of healthy lifestyle changes and self-management of chronic disease and mild COVID-19 symptoms, increasing investment in interventions to provide social and economic support to disadvantaged populations, and strengthening primary healthcare infrastructure and support of healthcare providers.

The study was supported in part by funding from Shorenstein APARC’s faculty research award, Stanford King Center for Global Development, and a seed grant from the Stanford Center for Asian Health Research and Education.

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In the first report of its kind comparing the impacts of the pandemic on people with chronic conditions in five Asian regions, researchers including APARC’s Karen Eggleston document how the pandemic’s broad social and economic consequences negatively affected population health well beyond those directly suffering from COVID-19.

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Cover of Issue 34(1) of Asia Pacific Journal of Public Health, January 2022
This study aims to provide evidence on how the COVID-19 pandemic has impacted chronic disease care in diverse settings across Asia. Cross-sectional surveys were conducted to assess the health, social, and economic consequences of the pandemic in India, China, Hong Kong, Korea, and Vietnam using standardized questionnaires.

Overall, 5672 participants with chronic conditions were recruited from 5 countries. The mean age of the participants ranged from 55.9 to 69.3 years. A worsened economic status during the COVID-19 pandemic was reported by 19% to 59% of the study participants. Increased difficulty in accessing care was reported by 8% to 24% of participants, except Vietnam: 1.6%. The worsening of diabetes symptoms was reported by 5.6% to 14.6% of participants, except Vietnam: 3%. In multivariable regression analyses, increasing age, female participants, and worsened economic status were suggestive of increased difficulty in access to care, but these associations mostly did not reach statistical significance. In India and China, rural residence, worsened economic status and self-reported hypertension were statistically significantly associated with increased difficulty in access to care or worsening of diabetes symptoms.

These findings suggest that the pandemic disproportionately affected marginalized and rural populations in Asia, negatively affecting population health beyond those directly suffering from COVID-19.

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Journal Articles
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Asia Pacific Journal of Public Health
Authors
Karen Eggleston
Kavita Singh
Yiqian Xin
Yuyin Xiao
Jianchao Quan
Daejung Kim
Thi-Phuong-Lan Nguyen
Dimple Kondal
Xinyi Yan
Guohong Li
Carmen S. Ng
Hyolim Kang
Hoang Minh Nam
Sailesh Mohan
Lijing L. Yan
Chenshu Shi
Jiayin Chen
Hoa Thi Hong Hanh
Viswanathan Mohan
Sandra Kong
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