1. Global Research Example: "The Challenge of Chronic, Non-Communicable Disease in the Asia Pacific Region"

2. Asia-PacificGlobal?KEN

3. Lion’s share of global population

4. Bears brunt of double burden of disease Asia Pacific Region

5. Per capita incomes, 1960-2003 Japan China S Korea Taiwan, Singapore Hong Kong Malaysia Thailand

6. Demographic transition: % population > 65years Hong Kong Japan Singapore S Korea China

7. Epidemiological transition Infectious diseases Chronic diseases

8. Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005 Globally, 60% of all deaths are due to NCDs

9. 80% of them occur in low- and middle- income countries (WHO 2005 ) Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005

10. Based on current trends: Source: 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non communicable Diseases, WHO 2008 73% of total deaths 60% of total deaths 43% of global burden of disease 60% of global burden of disease NCDs 1998 NCDs 1998 NCDs 2020 NCDs 2020

11. In WHO’s Western Pacific Region, 78% of all deaths are due to NCDs Cause of death in the all ages, 2005. Source: WHO Western Pacific

12. Australian National University University of Melbourne University of Sydney University of British Columbia University of Chile Fudan University Hong Kong University of Science &Technology Nanjing University Peking University Tsinghua University University of Hong Kong Zhejiang University Chulalongkorn University University of Indonesia Keio University Kyoto University Osaka University Tohoku University University of Tokyo Waseda University Korea University Seoul National University University of Malaya Tecnológico de Monterrey University of Auckland University of the Philippines Far Eastern National University National University of Singapore California Institute of Technology Stanford University University of California, Berkeley University of California, Davis University of California, Irvine University of California, Los Angeles University of California, San Diego University of California, Santa Barbara University of Oregon University of Southern California University of Washington National Taiwan UniversityNational Autonomous University of Mexico University of Science and Technology of China

13. 2008 University of Tokyo Background 2007 Peking University AWI Public Health Workshops

14. Public Health Project

15. (WHO 2005, 2008) Public Health Project

16. Founding Charter Members 14 Johns Hopkins University 15 University of Southern California

17. Public Health Project inaugural meeting Singapore 9-11 November 2008

18. Japan China Taiwan Singapore Malaysia Indonesia Australia USA Vietnam Hong Kong Operating Principles

19. Japan China Taiwan Singapore Malaysia Indonesia Australia USA Vietnam Hong Kong 1 3 AWI 2 Steering Committee

20. June 2009 Feb 2009 Nov 2008 Nov 2009 June 2010 What Next? Completion Grant Proposal 1 st draft FundingStart Projects up and running Start Baseline study 4 studies

21. Total Population (2008) source: WHO (2006)

22. GDP per capita (2008)

23. Health expenditure per capita ( USD 2008)

24. % Elderly (>65 years, 2008)

25. Obesity (latest figures) NB: No data for Taiwan; Vietnam data available but not comparable

26. Physical inactivity (%) Thailand: no data Hong Kong: 2003/2004 Indonesia: no data Japan: < 10000 steps/day Malaysia: 18-69, World Health Survey Malaysia 2003 China: age 35-74 Australia: male

27. Alcohol (% “heavy drinker”) Thailand: 2001 Hong Kong: 2008 Indonesia: male Japan: frequent drinker Malaysia: (18+, heavy drinker), World Health Survey Malaysia Vietnam: heavy drinker China: 1998, current drinker Laos: heavy drinker USA: heavy drinker

28. High Cholesterol (%) Thailand (2000) Hong Kong: 2003/2004 Malaysia: 20-90, 1995 Australia: self reported No data for: China,Laos Taiwan,Vietnam

29. Hypertension (%) Hong Kong: 2003/2004 Indonesia: male Japan: male (>=SBP 140 and/or DBP 90mmHg) Malaysia: (30+, SBP 140 and DBP 90) Vietnam: no national China: >= SBP 140 and/or DBP 90mmHg or antihzpertensive medication USA: >=SBP 140 and/or DBP 90mmHg 20+) Australia: male, self-reported, 2004

30. Literacy rate (%)

31. Graphic health warnings on cigarette packs Not implemented: USA, Japan, China, Vietnam, Indonesia, Laos Year of implementation 2009 2008 2006 2005 2004

32. Phase 2 ProjectsChampionsTeam Members “N-City Study”Claremont GU C. Anderson Johnson CGU, CUHK, HSPH, Stanford U, JHU UI, UNU, U Tokyo, Zhejiang U, NUS “Breakthrough Collaborative Study” University of Sydney G Rubin CGU, CUHK, HSPH, PKU, Stanford, UI, U Tokyo, JHU, NUS Diabetes study”Stanford University Karen Eggleston, CGU, CUHK, PKU, Stanford U, UI, UNU, JHU, NUS “Health workforce study” University of Tokyo Masamine Jimba CGU, CUHK, HSPH, Stanford U, U Tokyo, Zhejiang U, JHU, NUS

33. WHO: 36 million lives 20 million in the Asia Pacific Region The challenge:

34. 80% of premature heart disease, stroke and type 2 diabetes is preventable, 40% of cancer is preventable (WHO) We know what the root causes are

35. We know prevention works Heart disease rates among men aged >30yrs, 1950-2002

36. Yet risk factors are increasing e.g. obesity Source: Preventing CHRONIC DISEASES a vital investment, WHO 2005

37. We know there are better ways to manage chronic disease Integrated care

38. Personal Lifestyle Plan Disease Management Risk Modification Disease Burden Time Low Risk High Risk Early Chronic Cost Irreversibility Late Chronic Participating Population holistic health care Yet medical practice is still focused on the wrong end of the curve

39. Public Health Project Will focus on establishing a program of research and development to prepare tools for use by health systems worldwide to implement “best-practices” in chronic disease prevention and management through better : Risk factor surveillance; Assessment of costs and organization of services; Change management to implement best practice; Monitoring and evaluation

40. Healthier World

41. Thank you!