A report on "Accelerating Equitable Achievement of the MDGs: Closing Gaps in Health and Nutrition Outcomes", sponsored by the Economic and Social Commission for the Asia Pacific (Escap), the Asian Development Bank, and the UN Development Programme, has made the three organisations realise that Asia Pacific is the region the world is looking at to drive the global economy. However, as the year 2015 approaches, they warned that the world should also look towards the region to sustain a much broader set of objectives - the Millennium Development Goals (MDGs).
"The reason is partly demographic. The Asia-Pacific region has more than 60 per cent of global population. Strong achievement in our region, whether in poverty reduction, or in education, or health, or environmental protection will inevitably bolster the global averages. In many respects, Asia and the Pacific has indeed been leading the way. Thanks to strong economic growth, the region as a whole is well on track to meet the goal of halving poverty between 1990 and 2015 - the year by which all the goals are to be achieved. For some of the other goals, however, regional progress has been less impressive - and there are often striking contrasts in achievement both between countries and within them," they said in the report's foreword.
According to the "Statistical Yearbook for Asia and the Pacific" published by Escap, Asia and the Pacific has made impressive gains in improving the living conditions of its people and promoting economic growth but faces wide development gaps, particularly in basic healthcare and gender equality.
The region had the lowest unemployment rate of 4.6 per cent in 2010 compared to 9.7 per cent for Europe, 9.5 per cent for North America, 8.1 per cent for Africa and 7.2 per cent for Latin America and the Caribbean.
The region also reduced by more than half, the number of people living in extreme poverty - defined as those living on less than US$1.25 per day based on purchase power parity - from about 1.7 billion in 1990 to 800 million in 2010. The Asia-Pacific share in global extreme poverty declined from 71 to 57 per cent over this period.
The region has also made significant progress in child survival over the past two decades, reducing under-five mortality from 83 deaths per 1,000 live births in 1990 to 42 deaths per 1,000 live births in 2011, slashing infant mortality from 61 deaths per 1,000 live births to 33 over the same period. Likewise, maternal mortality levels were more than halved from 379 deaths per 1,000 live births in 1990 to 146 per 1,000 live births in 2010.
However, there are wide disparities in social and economic development within Asia-Pacific.
In 2011, Afghanistan, followed by Pakistan, Tajikistan, Myanmar, India, Timor-Leste and Bhutan had the highest under-five mortality rates, ranging from 101 to 54 per 1,000 live births.
The region accounts for 37 per cent of total world maternal deaths, with its maternal mortality ratio ranging from 260 maternal deaths per 1,000 live births in the low-income countries to just 8 in the high-income countries.
Despite increased access to basic amenities, some 380 million people in the region lacked access to improved water sources and 1.74 billion lacked access to improved sanitation in 2010.
Although the Asia-Pacific region as a whole has increased its forest area by nearly 90,000 sq km over the past decade, Southeast Asia lost about 332,000 sq km, an area about the size of Vietnam. On the other hand, East and Northeast Asia added an estimated 454,284 sq km of forest, an area larger than Uzbekistan.
The Escap regional statistics publication reports that Asia-Pacific greenhouse gas emissions continue to increase but at a lower rate. The annual growth rate of regional CO2 emissions fell from 4.1 per cent in 2008 to 2.6 per cent in 2009. China was the world's largest greenhouse gas emitter in 2009, releasing an estimated 6.8 billion tonnes of CO2, 1.1 billion tonnes more than all of North America. However, per capita emission in North America was three times that of China.
In the MDG report, it was reported that for most indicators, one of the most consistent forms of disparity is between urban and rural areas - with the rural areas generally lagging. However, it should be emphasised that the average attainment also covers a wide range of values. Indeed compared with the average rural-urban differences, there are much greater disparities within both rural and urban areas. This is illustrated for child nutrition in India. In this and subsequent charts, rural and urban households are divided into quintiles based on wealth. Household surveys assess wealth by noting the ownership of selected assets, such as televisions and bicycles, and other factors such as the materials used for housing construction. Urban households are on average wealthier than rural ones.
No single set of policies can be universally applied, and health financing solutions should respond to individual country needs. China, Thailand, and Cambodia, for example, are seeking to address health financing in promising ways. China is now home to the largest insurance scheme in the world, a scheme that has grown impressively in terms of its financial and geographical coverage.
Since 2009, China has initiated a series of reforms aimed at providing all residents with universal and equitable healthcare, including health insurance and essential drugs in a subsidised way. The Chinese programmes aim to focus equally on urban and rural needs through their Rural Cooperative Medical Scheme and the Urban Employee Based Basic Medical Insurance Scheme.
Thailand's subsidised universal health care scheme affords access to public health services and has significantly expanded coverage across the country. Cambodia, on the other hand, is considering paying for healthcare for the poor by scaling up an innovative health equity fund which would cover district hospital care, transportation costs and other vital expenses - with minimal leakage to the non-poor. Since 2005, the poor in Vietnam have been eligible for membership in a social health insurance scheme.
In India, the Planning Commission is also considering rolling out universal health insurance with the government proposing to cover premium payments for the poor.
"As incomes rise there is generally a rise in total per capita health expenditure, public and private," the report said.
A risk is when these countries moved to market economies they overshot in cutting government health expenditure. For private expenditure the largest gaps are in Bangladesh (2.4 per cent), Indonesia (2.4 per cent), Thailand (1.8 per cent), Japan (1.6 per cent) and Pakistan (1.6 per cent).
These gaps suggest potential for increasing expenditure. Cambodia for example, is in line with the trend for total health expenditure. But this is because its positive public gap is offset by a negative private gap. Increasing public expenditure in line with other countries could, for example, provide the funds needed to meet the under-5 mortality goal, estimated at 8 per cent of GDP.
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