Netherlands is healthiest country for food, Malaysia ranks 44th

In a new list that ranks countries according to the quality of their food, The Netherlands came out on top, while Malaysia only managed 44th.

The Netherlands nudged past France and Switzerland as the country with the most nutritious, plentiful and healthy food, while the United States and Japan failed to make it into the top 20, a new ranking released by Oxfam showed.

Chad came in last on the list of 125 nations, behind Ethiopia and Angola, in the food index from the international relief and development organisation. Meanwhile, Malaysia ranked 44th on the list.

“The Netherlands have created a good market that enables people to get enough to eat. Prices are relatively low and stable and the type of food people are eating is balanced,” Deborah Hardoon, a senior researcher at Oxfam who compiled the results, said in an interview. 

“They’ve got the fundamentals right and in a way that is better than most other countries all over the world.”

Oxfam ranked the nations on the availability, quality and affordability of food and dietary health. It also looked at the percentage of underweight children, food diversity and access to clean water, as well as negative health outcomes such as obesity and diabetes.

European countries dominated the top of the ranking but Australia squeezed into the top 12, tying with Ireland, Italy, Portugal and Luxembourg at No. 8.

The United Kingdom failed to make the top 10, tying for the 13th spot, because of the volatility of its food prices compared to other goods, which Oxfam said is on a level with Peru (51), Malta (33) and Kyrgyzstan (65).

African nations, along with Laos (112), Bangladesh (102), Pakistan (97) and India (97), were predominant in the bottom 30 countries.

Although the United States has the most affordable and good quality food, high levels of obesity and diabetes pushed the nation into 21st place in the ranking, tying with Japan, which scored poorly on the relative price of food compared to other goods.

The Netherlands got top marks for its low food prices and diabetes levels, while Chad had the worst score for the cost of food in the country and the number of underweight children at 34%. The only countries where food is more expensive are Guinea and the Gambia, which were both at the lower end of the ranking.

Burundi (119), Yemen (121), Madagascar (122) and India have the worst rates of nutrition and the most underweight children, according to Oxfam.

People going hungry

Oxfam said the latest figures show 840 million people go hungry every day, despite there being enough food for the hungry. It called for changes in the way food is produced and distributed around the world.

The causes of hunger, it added, include a lack of investment in infrastructure in developing nations and in small-scale agriculture, security, prohibitive trading agreements, biofuel targets that divert crops from food to fuel and the impact of climate change.

Research suggests that climate change could raise the number of people at risk of hunger by 20% to 50% by 2050, according to the group.

“This index quite clearly indicates that despite the fact of there being enough food in the world we are still not able to feed everybody in all the countries around the world,” said Hardoon.

“If we had a more equal distribution of wealth and resources, and particularly food, this wouldn’t be a problem,” she added.

Oxfam compiled the data between October and December 2013 using the latest information from the World Health Organisation, the Food and Agriculture Foundation, the International Labour Organisation and other international organizations.

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With nearly 9 of 10 Filipinos suffering dental disease, DOH steps up oral health drive in schools

MANILA – Nearly nine of 10 Filipinos have dental caries, and worried health authorities are trying to bring that down by focusing on the younger generation.

The Department of Health’s National Capital Region office Friday unveiled plans to step up its oral health campaign in Metro Manila, with the director for DOH-NCR, Dr. Eduardo Janairo, noting the Philippines is far behind other countries in the Western Pacific Region concerning oral health.

 “The two most common oral health problems in the country are dental caries and periodontal diseases. These two dental concerns can be avoided by improving oral health conditions among pre-school children and inculcating a positive oral health behavior to children who will be entering school age,” added Janairo.

 The DOH-NCR is leading the promotion of oral hygiene through the prevention of dental caries among school-aged children, and providing dental sealants to children aged 12 and below who have healthy but erupted permanent molars.

Government data show 87.4 percent of Filipinos have dental caries, also known as tooth decay and cavity. The more advanced periodontal disease is a condition where the tissue – gums, deeper supporting tissue, and bone – around a tooth or teeth become infected and swollen. The  2011 National Monitoring and Evaluation Dental Survey (NMEDS) says 48.3 percent of Filipinos have periodontal disease.

Janairo said prevention “is a very important strategy in the promotion of oral health especially among school aged children,” because, when children are initiated into healthy behaviour early enough, “the practice is more likely to become sustainable and will hopefully continue as a life-long habit that will be passed on to their children.”

Meanwhile, DOH-NCR is collecting data and information on dental health concerns in Metro Manila in a bid to identify health facilities in the region where people with oral health concerns can be helped.

There are plans as well to ask help from the Philippine Health Insurance Corporation to give special attention to oral health and include it in their case rate identification, separate from all other diseases, according to Janairo.

The DOH-NCR oral health campaign was piloted at Santiago Syjuco Elementary School, where 181 school children received given dental sealant--applying a plastic material to a tooth in order to prevent dental caries or other forms of tooth decay.

Those who received the treatment will be monitored and documented every six months until they reach 12 years old.

Janairo said early loss of milk teeth can lead to incorrect or imperfect alignment of the permanent teeth. Untreated dental disease may bring inconvenient pain, which may affect a child´s performance in school, social interactions and health.

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20pc of children are depressed

MENTAL HEALTH SURVEY: It may be due to pressure on classroom performance, problems at home, says expert

KUALA LUMPUR: THE number of children with  poor mental health is  rising,   with 20 per cent found to be suffering from stress, anxiety and depression in the latest National Health  Morbidity Survey  (NHMS).

The survey, conducted in 2011, said there were more children aged between 5 and 15 suffering from mental health issues or were prone to mental disorders, compared with the number from the NHMS conducted in 2006.

Deputy director-general of Health (Public Health) Datuk Dr Lokman Hakim Sulaiman told the New Straits Times the NHMS revealed that the figure stood at 13 per cent in 1996.

"It was at 19.4 per cent in 2006 and reached 20 per cent in 2011.

"Stress, anxiety and depression are the common mental health conditions from which students suffer.

"Some also suffer from schizo-phrenia, a severe form of mental illness."

The NHMS used to be conducted every 10 years, but has been held every five years since 2006.

Dr Lokman said the Healthy Mind Programme survey conducted last year revealed seven per cent of 19,919 Form Four students from 157 schools showed signs of severe and extremely severe stress, anxiety and depression.

The mental health screening was carried out based on the Depression, Anxiety and Stress Scale, where students answered a set of questionnaires.

The growing number has compelled the authorities to extend the screening programme in schools to cover Forms Two to Five students. Previously, it only covered Form Four students.

Dr Lokman said poor mental health could be the result of pressure on students from the high expectations of parents and teachers in academic excellence and individual personality, as well as social, family and interpersonal problems.

"Mental health problems cause major changes in a person's thinking, emotional state and behaviour, and disrupt the person's ability to work and carry on with personal relationships.

"Children and adolescents are assets to the nation's development.

"To achieve maximum potential, students have to develop self-identity, good self-esteem and be ready to accept life challenges in preparation for adulthood."

Poor mental health, he said, could be identified through emotional and behavioural symptoms.

"Students with poor mental health have low self-esteem, suffer from sadness or restlessness, show poor performance in school and have relationship problems.

"There are also mental and behavioural problems, like truancy, bullying, vandalism, substance abuse, tendency to self-harm and suicidal behaviour, that are tell-tale signs."

Dr Lokman said there were resources to support students who had poor mental health, including counselling and psychological and social service programmes by schools.

"For example, the Education Ministry has a school counsellor to student ratio of 1:500.

"It also has a referral system to health facilities."

He said schools should incorporate the Healthy Mind Policy in the existing school policy and conduct the Mental Health Awareness Week programme, which would see the participation of parent-teacher associations.

"Schools should provide social support to children through peer education groups and occasionally conduct courses on parenting skills."

On why the screening programme was not extended to cover all primary school pupils and secondary school students, Dr Lokman said the screening tools available were only suitable for those between 13 and 17.

"For primary schools, mental health promotion activities are carried out through other programmes, such as 'Pembimbing Rakan Sebaya'."

Dr Lokman said the Health Ministry would train more school counsellors and healthcare providers to detect early symptoms of mental health problems and suicidal behaviour.

He stressed that family and good parenting played a vital role in helping children and adolescents deal with mental health issues.

"This is because conflicts between parents and in the family environment, domestic violence and physical, emotional or sexual abuse can cause mental and emotional disturbances."

On Dec 13, Health Minister Datuk Seri Dr S. Subramaniam said school counsellors would be given extra training to increase their expertise in counselling students to tackle mental health problems.

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Opportunities in the medical devices sector in India

Growing medical tourism, a burgeoning hospital sector and increased patient affluence make India an attractive prospect for medical device companies looking for partnerships

The Indian healthcare sector provides a lucrative growth avenue for companies already operating in the region and for new entrants, particularly diagnostic device manufacturers, pharmaceutical companies and health insurance providers.

The total Indian healthcare sector today is worth $65bn and is projected to reach $100bn by 2015 (see Figure 1 below).

 

Within this, the diagnostic and medical equipment segment makes up 5 per cent of the total market, having experienced growth rates of 15-20 per cent over the past few years, and anticipating further growth to $5bn by 2015. This represents a massive opportunity for medical diagnostic manufacturers, and as there are several areas that still need significant development, growth is estimated to continue at this rate for another decade.

Factors such as the rising prevalence of diseases, medical tourism, improving affluence of patients and increasing penetration of health insurance have contributed substantially in stimulating the demand for diagnostic services in India. 

Growing medical tourism
An additional area of revenue for the Indian healthcare system is medical tourism, which has grown significantly from $400m in 2006 to over $1.5bn in 2012 (CAGR of 20.8 per cent).

International organisations are beginning to recognise the potential value of the Indian diagnostics market thanks to the continuing expansion of medical tourism. The country has a level of technological sophistication and infrastructure that will enable it to maintain a strong position in this sector even as other countries such as South Africa, Argentina and Malaysia look to enter the market. 

Moreover, the Indian government has undertaken initiatives in the public health sector which focus on improving medical infrastructure and rural health facilities, as well as encouraging foreign direct investment for medical services.

[There is] a massive opportunity for medical diagnostic manufacturers, and several areas that need significant development

One CEO from an international private hospital company said recently: “India currently treats more patients from the western world than any other healthcare destination in Asia. The last decade has seen the private sector power the growth and maturity of the healthcare delivery sector in India. 

“Many hospitals in India have achieved JCI (Joint Commission International) accreditation which demonstrates that they meet global standards of healthcare delivery. High-quality, affordable healthcare will continue to make India a favoured medical value destination for patients from the developed and developing world,” he continued. 

Several procedures costing thousands of dollars in the US can be undertaken for a fraction of the cost in India, and this is boosting medical tourism in the region. For example, a bone marrow transplant costing $300,000 in the US can be performed for $40,000 in India with comparable facilities and by world class physicians. Similarly, liver transplants costing $250,000 in the US can be performed for $ 30,000 in India. 

Growing hospital sector
The hospital industry in India is also growing, and is widely believed to be the 'next big thing' in the Indian market by most global healthcare investors. Some of the growth factors for this expansion include: a rise in medical tourism, improving medical insurance systems, an ageing population, increasing lifestyle-related health issues, increasing discretionary income, government initiatives and a focus on models such as the public–private partnership (PPP).

The Indian government has undertaken initiatives in the public health sector that focus on improving medical infrastructure

Leading private hospitals that are currently controlling the country's healthcare sector include Apollo Hospitals Enterprise, Fortis Healthcare, Wockhardt Hospitals, Max Hospitals, Aravind Eye Hospitals and Manipal Hospitals, among others. 

Fortis Healthcare, Apollo and Wockhardt Hospitals are responsible for running approximately 30 hospitals across the subcontinent and are actively seeking international partners to promote medical tourism. Moreover, the increasingly educated and affluent patient population in India is demanding improved health services, to which the corporate hospital groups are responding by providing upgraded healthcare infrastructure (see Figure 2).

(click image for larger graphic)

Growing urbanisation
One of the major driving forces behind the increasing demand for modern healthcare is the migration of citizens from rural areas to urban developments. Consequently, increased investment is being made in hospitals and clinical laboratories. The rapid increase in health awareness among middle and high-income families in India is also leading to a higher demand for preventive healthcare. More than 80 per cent of medical facilities in India are concentrated in urban areas, while 73 per cent of the Indian population is still rural dwelling. Some 90 per cent of patients require primary and/or secondary care, with only 10 per cent needing specialised tertiary care.  

As the population increases in size and age in urban areas, the demand for high-value medical diagnostics is growing rapidly. High-value medical diagnostic devices can be split into two categories: 

• In vivo diagnostics – MRI,  PET, CT-scans
• In vitro diagnostics – diagnostic test devices for IHC, FISH, PCR, q-PCR, MS, sequencing or others.

A recent survey showed that of the total cost of a hospital project, nearly 30 per cent is directed towards high-value medical and/or diagnostic equipment. With the advent of newer technologies, medical equipment is increasingly relied upon to assist healthcare professionals with diagnosis and treatment. Hence, the purchase, maintenance contracts and replacement of medical equipment are an essential and integral part of hospital management.

The rapid increase in health awareness in India … is also leading to a higher demand of preventative healthcare

Prior to the purchase of equipment, a number of factors will be considered by the hospital, such as the requirement for the equipment, how it will be utilised, its purchase price and the ongoing cost of maintenance. The decision is taken in consultation with various people including medical professionals, senior management, biomedical engineers and other stakeholders.

Power of influencers
Those influencing the decision to purchase equipment vary from one institution to another. As in any other public sector organisations around the world, non-private hospitals in India have multiple stakeholders. Physicians and other healthcare practitioners, senior management, procurement and external stakeholders such as suppliers and manufacturers, all play a role in purchasing decisions. The process is slightly less complicated in private hospitals and appears to have fewer key decision makers and influencers.

In today's highly competitive market, sales personnel have to manage physicians, who in India are very cost conscious, and simultaneously manage the expectations of procurement, the C-suite, nurses and technicians. Many of these stakeholders will have preconceived ideas about different device manufacturers based on their experience, as well as secondary information from their family and friends working in the same field. 

With more stakeholders involved in the decision process, each with their own priorities and differing views about any given device, the complexity of the sales process can rise exponentially. This increased complexity translates into a greater time commitment for each account and for that time to be prioritised appropriately.

Additionally, there is a strong bureaucratic system in India, which supports a number of committees including a new product committee and a value analysis committee (VAC) among others. 

Such committees serve to lengthen the purchasing decision which in turn, lengthens the buying process. This also means that many of the decisions are made in the absence of the sales representative, allowing him or her little opportunity to influence the decision. Therefore, working with internal champions and stakeholders becomes a critical step in representing new products effectively.

Furthermore, in addition to the multiple decision-makers inside the hospital, there are a number of powerful groups outside in the market. Group Purchasing Organisations (GPOs) contract with suppliers to pool the purchasing power of a consortium of member hospitals, and independent consultants are sometimes employed to identify cost savings.

Partnerships and alliances
In a nutshell, the Indian hospital industry is undergoing significant changes driven by rapid economic growth, attracting increasing amounts of investments from the pharmaceutical and medical device manufacturers overseas. 

For medical device manufacturing companies in the global arena, there is considerable potential to increase profit in this region. The significance of growth drivers must be considered while defining sales strategy or conducting financial analyses in the country. For device manufacturers to exploit these opportunities fully, partnering or creating alliances with pharmaceutical companies and corporate hospital groups can be mutually beneficial, providing advantages of size and strength, as well as filling gaps in both companies' offerings.
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China removes price cap for low-cost medicines in a move to benefit private pharma companies.

The retail price cap of low-cost medicines in China will be scrapped to revive dampened production caused by weak profits and ensure supply of essential drugs, the country's top economic planner and regulator announced Thursday.
Restriction on maximum prices of 280 Western medicines and 250 Chinese patent drugs, previously priced low by the government to relieve patients' medical burden, will be lifted, allowing producers to set prices according to their production costs, according to the National Development and Reform Commission (NDRC).
Chang Feng, director of the medicine price research department under China Medical University, said that the move, allowing the market to play a bigger role in deciding prices, will help motivate low-price medicine production and guarantee necessary supply.
The supply of low-price drugs has decreased as rising costs and shrinking demand made producers shift their attention to more profitable medicines, causing production of some first-aid medication including digoxin to be suspended.
The NDRC has asked local authorities to release a list of low-cost medicines to the public by July 1 and strengthen monitoring over unreasonable price lifting.
Policy to give low-cost drugs a boost

China's National Development and Reform Commission said it will scrap caps on the retail prices of 530 types of low-cost medicines.

The new measure will allow the market to set prices for each medicine. This is certainly good news for the pharmaceutical companies manufacturing these drugs. But thanks to fierce competition in the low-cost medicine market, I don't think actual prices will increase dramatically.

With the rising cost of raw materials and labor, earlier price limits have made profit margins for these medicines extremely low. Lacking incentives, many companies stopped manufacturing these medicines, resulting in sharp supply drop-offs. Some pharmaceutical makers even renamed and repackaged these drugs as new products in order to charge higher prices. A study of 42 hospitals found a shortage of over 342 types of low-cost medicines in these institutions. Over 130 of the medicines were priced below 10 yuan ($1.61).

Apart from this new measure, the government needs to expand and improve coverage of health insurance to allow more people to afford better medication.

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Diabetes to hit 1 in 5 Malaysian adults by 2020.

PETALING JAYA, Feb 3 — If the disturbing increase in the number of non-communicable diseases (NCDs, including diabetes, hypertension and heart disease) is left uncontrolled, Malaysia is likely to be burdened with an unhealthy population, according to a health ministry expert.

The ministry’s public health specialist Dr Feisul Idzwan Mustapha said this burden will affect productivity and would have a negative impact on the country’s socio-economic development, which can possibly delay the progress in achieving developed country status by year 2020.

“Based on the results of the National health and Morbidity Surveys the prevalence of diabetes could be 21.6 per cent for adults by 2020,” he said.

Dr Feisul, who is from the Ministry’s NCD section, said the impact can be seen now, as an increasing number of patients with diabetes are seeking treatment at government clinics.

Meanwhile, there is an increase hospital admissions due to complications from diabetes, heart attacks and strokes.

Dr Feisul said individuals and communities need to take responsibility for their health.

“Excess food intake and a decrease in physical activity has caused the increasing trend of obesity among Malaysians,” he said.

Dr Feisul said the local governments and the Ministry of Youth and Sports would have to look into promoting the use of available and accessible facilities for exercise to increase the level of physical activity among Malaysians.

“The police department will also take part in personal safety for protection from personal harm, while people are out exercising,” he said.

Though Dr Feisul said behavioural change does not come easily, “pro-health” policies are needed to create a supportive living environment to achieve positive changes.

“Many policies and regulations on promoting a healthy environment lie outside the responsibility of the ministry.

“Therefore, we want the support of other ministries and stakeholders outside of the health sector in changing communities’ behaviour,” he said.

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