Routledge Handbook of Global Public Health in Asia
Siân M. Griffiths, Jin Ling Tang, Eng Kiong Yeoh, Editors
Routledge, Taylor & Francis Group, 2014
By Kai Chen
The Routledge Handbook of Global Public Health in Asia examines public health policies in Asia and analyzes the challenges facing health systems in different Asian contexts. The editors argue that neither pure public nor pure private arrangements are adequately developing or implementing public health policies and services in Asia, and suggest there is an urgent need for transnational public-private partnerships to fill the gaps.
This volume has seven parts, covering the history of public health across the region, epidemiology, social determinants of health, infectious diseases, NCDs, and health systems.
Three themes emerge through this collection of essays. First, the budgetary gaps in public health are larger than they used to be, making it difficult for Asian countries to allocate equitable public health services to key affected populations. In many cases, neither the public nor private sectors can guarantee efficient or equitable distribution of health services, and nor can they manage adequate health information systems.
Second, in regions with a high prevalence of infectious diseases such as TB, hepatitis, and HIV, health care is often inequitable and inaccessible. This leaves many people having to make out-of-pocket payments for health service. As a result, Asia has the world’s “highest number of countries that rely on out-of-pocket payment for health services” (p.3). In India, the out-of-pocket expenditure on health is over 70 percent and in China, it represents 36 percent of health financing.
Third, private providers play a large role in public health across Asia. In Hong Kong, the private sector provides 75 percent of primary care and traditional Chinese medicine services are mainly provided in a private outpatient setting. Such arrangements make it difficult to distinguish between public and private providers.
In response to these challenges, the editors and contributors suggest establishing transnational public-private partnerships consisting of local and international NGOs, government agencies, and bilateral and multilateral institutions. These partners would prioritize health service delivery to the most vulnerable and underserved populations, co-funded with private companies and foundations in health research and development. In addition, it is proposed that these partnerships would train medical workers and practitioners and monitor health service standards. A case study of the Shanghai Center for Disease Control and the Center for Health Protection in Hong Kong is presented as an example of a public-private partnership.
The text includes advice on strategies to mitigate the effects of the unregulated profit motive in the private sector. It argues that in such cases governments must employ effective communication and education strategies to ensure the public is aware of whether services are being provided by public or private institutions. Authors also stress the importance of public participation in policy development.
The text holds an optimistic view of medical tourism in Thailand. This growing industry accommodates foreigners from high-income countries traveling to Thailand specifically to receive cheap but high-quality medical care. Successive Thai governments have encouraged this revenue-generating resource. However, some of the complex associated issues are not thoroughly explored, including organ trafficking in Thailand and the ethical dilemmas of providing health services for foreigners when there are still striking gaps in the coverage of health services for impoverished local people.
The Routledge Handbook of Global Public Health in Asia is a useful resource for students, practitioners, and scholars wanting to understand the challenges facing Asian countries’ health systems. This textbook will appeal to those interested in public health and human rights, to researchers and those engaging in public-private partnerships.
Kai Chen is an Assistant Professor in the School of International Relations at Xiamen University, China.