Asian health trends and emerging issues for the 1990s

The combined population of the 14 USAID-assisted countries in Asia, at about 1.5 billion, is half the total population of the developing world (excluding China), and is projected to increase to about 2 billion by 2005. Mortality and fertility rates have declined appreciably in many parts of Asia in recent decades, yet overall they are still high by developing country standards, and in some major parts they are still quite high -- especially among the very large populations of South Asia. The under age 15 population will continue to grow rapidly, but the age 15-49 population will grow even more rapidly, with accompanying growth in women"s, maternal, and other adult health care needs, as well as in family planning service needs. For over 25 years USAID has committed significant financial and technical resources to reducing fertility and improving health in Asia. Since 1985 USAID has had a global child survival program with roughly one-quarter of total funding committed to this region. However, about half of all children under age 5 in the developing world are in this region, and 75% of all children under age 5 in USAID child survival emphasis countries are located in this region. Remarkable progress has been made in some countries in immunization and Oral Rehydration Therapy (ORT) coverage, and in access to fertility control, but hundreds of millions continue to lack adequate access to basic health services, particularly children, among whom mortality and morbidity from measles, malnutrition, diarrhea, tetanus, and upper or acute lower respiratory infections continue to take their toll. Maternal mortality is still extremely high, especially in South Asia, and maternal health services are woefully neglected. Total health care expenditures, both public and private, are low relative to other world regions. The region is predominately rural (73% in 1990). However, during the next 15 years the urban population is expected to grow about 4% annually -- four times the expected rural growth rate -- nearly doubling to 720 million by 2005, when it will make up about 36% of the total population. This rapid urban growth will be accompanied by increasing demands on urban health care services, ever more serious environmental health problems, and greatly increased pressures on already overburdened infrastructures for providing water, sanitation, and other essential services. The study concludes that while there have been significant accomplishments in reducing fertility and infant mortality in recent years, the goals of low infant and child mortality and fertility throughout the region are far from being achieved. At the same time, in the more economically, technologically, and demographically advanced parts of the region, emerging health conditions and health care needs will make growing claims on scarce public and private financial and technical health care resources during the next decade and beyond, for example, there is compelling evidence that during the next decade HIV/AIDS is likely to become an epidemic in some parts of this region. (Author abstract)