Over the past half-century, Asia has become the world’s standard-bearer for both economic expansion and poverty reduction. Asia has made tremendous growth that accompanies poverty reduction.

Asia’s Economic Profile

In 2020, the Gross Domestic Product (GDP) of Asia was greater than the GDP of the rest of the world combined. Experts estimate that by 2030, the Asia-Pacific region will account for 60% of the world’s economic growth.

Tremendous economic growth is not a new phenomenon in Asia. In fact, since 1960, Asia’s economy has grown at a higher rate than any other continent. East Asia’s economy, specifically, has exceeded the rest of the world over the same time frame. Japan kickstarted Asia’s period of growth after World War II. Soon after, the “four dragons” —  Taiwan, Singapore, Korea and Hong Kong, emerged. The dragons each experienced tremendous and sustained economic growth in the latter half of the 20th century. In 1978, China opened its economy to the world, marking a huge leap forward for Asia’s economy.

With economic growth comes an increase in prosperity as the Asia-Pacific region is home to 90% of the world’s new members of the middle-class. While Asia’s economic prospects are tremendously promising, economic growth does not always translate into advancements in quality of life. Poverty reduction is an essential component of improving living standards and poverty reduction in Asia has been an important focus for Asian governments.

Poverty Reduction in Asia

Since the beginning of Asia’s period of tremendous economic growth, the region has seen similarly tremendous progress in poverty reduction. Asia continues to lead the world in poverty reduction.

No single country is more responsible for this achievement than China. In the last 30 years, more than 700 million people in China have made it out of extreme poverty. On a shorter time scale, China’s efforts to reduce poverty have yielded similarly promising results. From 2015 to 2019, China reduced poverty from 5.7% to 0.6% of the total population. In February 2021, China officially celebrated the end of absolute poverty, defined as the level at which a person cannot afford to meet their basic needs like food, water, healthcare, education and more.

Room for Improvement

Economic growth is not solely responsible for the successes of poverty reduction in Asia. In fact, as economic growth has progressed, Asia has actually experienced diminishing marginal returns in poverty reduction. In other words, as Asian economies have continued to grow, the growth has had a reduced effect on poverty reduction rates. Economic expansion and poverty reduction do not always happen equally. Policy is still needed to ensure poverty does not become a hidden issue. Despite all the expansion of the past 50 years, poverty in Asia is still a significant problem.

Asia’s progress in reducing poverty has been substantial but continued efforts are needed to truly eradicate poverty with further progress. There are still more than 320 million people in Asia who live in extreme poverty, defined as less than $1.90 a day. Furthermore, the COVID-19 pandemic has negatively affected poverty reduction in Asia. A World Bank report in September 2020 estimated that for the first time in 20 years, poverty could rise in East Asia. It estimated that as many as 38 million East Asian people could fall below the $5.50 poverty line. As such, continued focus on poverty reduction efforts is crucial, now more than ever.

– Leo Ratté
Photo: Flickr

Armenia is a mountainous nation of nearly 3 million people. It neighbors Iran, Georgia and Turkey. Over the past three decades, healthcare in Armenia has undergone a slow reform. The country is transitioning from an inefficient model of centralized healthcare to a modern system focusing on family medicine. Many Armenians feel dissatisfied regarding their healthcare system. However, organizations like the Health for Armenia Initiative and the World Bank are working with the Armenian government to improve options for Armenians.

Armenia’s Healthcare History

Healthcare in Armenia during the Soviet era was a centralized medical system. Experts state that the Soviet system was technologically underdeveloped and inefficient. The healthcare model focused on centralized care in hospitals and medical professionals were highly specialized.

Armenia declared independence in 1991, and healthcare in Armenia underwent radical changes. Local governments took over primary health care sectors while regional governments gained ownership over hospitals. Armenia’s State Health Agency is now in charge of the healthcare system. The government allocates resources to these publicly owned facilities. Since its independence, Armenia has implemented many healthcare reforms. A major piece of legislation called the “On Medical Aid and Medical Services for The Population” created a system that allows patients to help pay for healthcare services. This development plays a role in why Armenians find themselves funding most healthcare expenditures with out-of-pocket expenses.

Armenians in certain years paid up to 89% of healthcare charges in out-of-pocket expenses. This is incredibly taxing, given that Armenians earn an average per capita household income of around $1,500 USD. Their inefficient and expensive healthcare system places a heavy financial burden on impoverished peoples. Patients are slowly transitioning to primary healthcare providers with financial regulations replacing older regulations. However, a lot of work is still ongoing to improve the healthcare situation in Armenia.

How Armenians Feel About Their Healthcare

A 2018 report outlined a recent picture of healthcare in Armenia. Around 400,000 people in Armenia are poor or near-poor. Meanwhile, at least 233,000 of these people are part of a vulnerable group including the disabled, children and the elderly. In 2014, 31.8% of the poorest of Armenians reported that they were sick for more than three days, but they did not seek treatment because of financial reasons. Only 4.2% of the richest Armenians made the same decision.

A public opinion report that BMC published in 2020 outlined the current feelings the Armenian people have towards their healthcare system. The researchers polled over 500 Armenian citizens about the country’s healthcare system. Nearly half of respondents did not believe that citizens had equal access to healthcare in Armenia. Almost 70% of respondents felt that the government should have a larger responsibility towards an individual’s health which included funding healthcare services.

The Healthcare for Armenia Initiative’s Mission

Armenian natives and internationals formed the Healthcare for Armenia Initiative (HAI) in 2016. The initiative’s team focuses on bottom-up reforms to increase rural Armenians access to the constitutional right to healthcare. HAI’s projects focus on developing and maintaining healthcare professionals that can provide services in high-need areas.

HAI defines its work around six pillars, and among these pillars are education, research and leadership. It focuses on these three by holding workshops. It held a two-day workshop in partnership with the National Institute of Health of Armenia where it “[discussed] how to improve health education and healthcare in Armenia.” Organizations like HAI have helped to inform recent changes in government policy that will hopefully address the healthcare needs of the Armenian people.

Recent Changes for Healthcare in Armenia

The Armenian government in partnership with the World Bank published a guideline for the Health System Modernization Project. The main goal of the partnership is to improve access, quality, efficiency and governance for Armenian healthcare. The project focuses on adopting an efficient family medicine model. The transition to a family medicine model requires training new doctors that are not overspecialized.

A major priority of the project was to train the number of healthcare professionals necessary to run a family medicine-style healthcare system. At a final cost of nearly $6 million USD, this project component costs less than the projected $7 million. This key part of the project trained 980 family medicine doctors and nurses. The World Bank reports that these numbers should support 60% of the country’s needs.

Armenia and the World Bank cooperated on three other major components as part of this modernization project. They optimized and renovated the hospital network. The project reorganized the Armenian Ministry of Health so the agency could better function as a regulator of healthcare. These reforms gave the Ministry of Health many monitoring tools to efficiently implement and regulate the healthcare reforms the country is undergoing. Armenia’s government also established the Health Project Implementing Unit (HPIU). HPIU is a part of the Armenian Health Ministry that monitors, reports on and provides strategic planning for the overall healthcare modernization project. All of these developments cost around $30 million USD to achieve.

Where Healthcare in Armenia Stands

Healthcare in Armenia is an inequitable system in the process of reforms and transition. Armenia with the help of national and international institutions is moving to a family medicine system that meets the financial and medical needs of its people.

– Jacob Richard Bergeron
Photo: Flickr

Indigenous inequalities are very evident in health. Unfortunately, Indigenous Australians suffer from much worse health problems than the non-Indigenous Australian population. Here are a few key figures to demonstrate the stark inequalities. In 2017, Indigenous children experienced 1.7 times higher levels of malnutrition than non-Indigenous children. Additionally, three in 10 indigenous people who needed to go to a health provider did not go. Indigenous people’s barriers to healthcare frequently include high costs, unavailability of services, the distance from healthcare services and long waiting times.

Another inequality is that 45% of Indigenous people, aged 15 years or over, said they experienced disability, compared to just 18.5% in the non-Indigenous population. Between 2014-2016, Indigenous children aged 0-4 were more than twice as likely to die as non-Indigenous children. In the Northern Territory, Indigenous infant mortality was four times higher than the national rate. Lastly, Indigenous people had to wait 50 days on average for elective surgery compared to 40 days for non-Indigenous people. All this evidence highlights the stark Indigenous inequalities in health, demonstrating the gap that exists in access to key services and educational tools.

Original Closing the Gap Framework

In 2008, the Australian government made a promise to address Indigenous inequalities in a strategy called Closing the Gap. “The Gap” refers to the vast health and life-expectancy inequalities that exist between Indigenous and non-Indigenous Australians. The framework involved seven targets aimed at reducing socio-economic Indigenous inequalities, including many health targets. However, when the government began evaluating the success of the framework, it became clear that there is still a long way to go.

Five of the seven targets remain unmet, with very little evidence of progress in those target areas. The two targets that the Australian government has met were early education and Year 12 completion rates, but the other targets including child mortality, school attendance, literacy and numeracy and employment and life expectancy, have shown little or no improvements. A lot of the discussions around the failure of the framework have surrounded the issue of the lack of Indigenous voices. The Australian government established the framework with no engagement of the local Indigenous people it was seeking to help. It ignored their individual experiences and their local solutions, and instead came up with a one size fits all solution that failed to understand the Indigenous community.

2020 Programme Refresh

Because of the failure of the original Closing the Gap framework to address Indigenous inequalities in health, in July 2020, the government met and agreed upon a new approach. The government believed a refresh and shift in the Closing the Gap framework was necessary. This refresh involved a partnership between all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak organizations. This represents a huge advancement and the first time that an agreement with an aim to improve the lives of Aboriginal and Torres Strait Islander people has actually involved Indigenous people in its localized solutions.

This newly designed framework will embed the cultural determinants and social determinants of health to provide a single, overarching policy framework for Indigenous health. The vision is that Aboriginal and Torres Strait Islander peoples will be able to enjoy long, healthy lives that are centered in culture, with access to services that are prevention-focused, responsive, culturally safe and free of racism and inequity. The framework ensures that Indigenous people are at the center of creating solutions that work for them in their cultures. Alongside this nationwide government framework, other progress is occurring including the implementation of more healthcare services with healthcare officials that actually represent the population. In fact, healthcare services are involving more Indigenous workers and the government is implementing Indigenous-specific healthcare facilities to better cater to Indigenous people’s specific needs.

New Progress

Evidence is beginning to mount showing the positive effects of reducing Indigenous inequalities in health. For example, from 2013 to 2019, the number of Indigenous medical practitioners employed across Australia increased from 234 to 488. Additionally, Indigenous-specific primary healthcare organizations provided 3.7 million episodes of care in 2018-19. Though progress has been slow so far, there are some promising statistics and a renewed government focus that will hopefully start to reduce Indigenous inequalities in health.

– Lizzie Alexander
Photo: Flickr