Addressing Mental Health Disorders in Asia
We all face stress and mental anguish; these emotions are experienced by both the rich and the poor. The only difference is the rich tend to possess the means for coping and addressing mental health disorders. People who experience mental illness often remain adrift in social stigma and thus excluded from revenue-generating incomes. This vicious cycle — Poverty -> Social Causation -> Mental Illness -> Social Drift — also excludes these people from access to healthcare.

How Does Stress Lead to Mental Disorders?

But biologically speaking, how exactly does stress lead to mental disorders? Constantly worrying over where to find food or a place to sleep results in a heightened production of stress hormones called cortisol.

High levels of cortisol for extended periods can affect the brain down to the genetic level. It can increase the level of neural connections of the amygdala, or the “fear center.” This increase will then inhibit neural connections of the hippocampus, the part of the brain that is associated with learning and memory.

The majority of this mental disorder is experienced in developing nations. These are the same nations with the widest gap of healthcare inequity, and the ones most unequipped to properly address physiological needs, let alone mental health disorders.

The Stress of Poverty

Many of the issues underlying depression — such as violence, unemployment, crime, inadequate housing, lack of education and poor sanitation — all stem from the stress of poverty.

Too much cortisol can lead to the loss of synaptic connections between brain cells, and fewer brain cells created in the hippocampus. This deficit will cause the brain to actually shrink in size, specifically in the prefrontal cortex — the region of the brain that allows for control of behaviors such as judgment and social interaction.

The Destigmatization of Mental Disorders

In Asian cultures, if a person is suffering from a mental disorder, his or her community will pretend like it never happened, since the impact is not outwardly apparent. However, just because it’s not outwardly apparent, that doesn’t mean ignoring the disorder will make it go away. The reason Asian communities cover up a sufferer’s condition largely stems from shame or embarrassment. There is also widespread belief that mental disorders are a divine punishment in retribution for a person’s past sins or crimes.

The 10-member nations of ASEAN have outlined their 2025 Socio-Cultural Blueprint that aims to raise mental health as one of the health priorities under the ASEAN Post 2015 Health Development Agenda for 2016-2020. This prioritization would mean integrating mental health into each of the national health systems, and coordinating between facilities, local organizations and NGOs for spreading awareness and empowerment.

The power of possessing a positive or negative outlook is more powerful than one might think; people with positive emotions can live longer and more fulfilling lives. Before we can harness the powers of emotions for improved physical health, we must first invest in better understanding and addressing mental health disorders. Once this is accomplished, we will then have made remarkable strides and come a long way from stigma and dehumanization.

– Awad Bin-Jawed

Photo: Flickr

In India, 1.2 million children die every year from preventable diseases. Pneumonia, which is preventable through a vaccine, is the single-largest cause of death among children under the age of five. Nearly one of every four deaths of children under five years old is caused by pneumonia. As part of India’s Universal Immunization Program (UIP), the government will begin to provide the Pneumococcal Conjugate Vaccine (PCV) for free beginning in 2017. By offering PCV in India for free, up to 180,000 lives may be saved annually.

As Indian health minister JP Nadda notes, pneumonia kills more children under five than it does adults. Their weaker immune systems make it more difficult to fight off the illness’s symptoms as compared to older children and adults. Thousands of children have been hospitalized annually due to the spread of pneumonia. The inability of underprivileged families to afford the PCV in India has been a direct cause of increased illnesses among the child population.

Before now, the vaccine was accessible only via the privatized market to those able to afford it. By adding PCV to the vaccines given for free under the UIP, the underprivileged population will be on more equal footing in terms of health care access.

With free access to the PCV in India, child mortality rates are expected to decrease substantially. Millions of children will be protected against pneumonia in various states throughout India, including Uttar, Himachal Pradesh and Bihar. In addition, global healthcare alliance groups such as the World Health Organization and UNICEF remain dedicated to providing aid in support of the immunization plan.

The introduction of the vaccine will not only save children’s lives, but it will also drastically reduce health care costs for their families. Free and readily available access to the PCV in India will inevitably result in a healthier population and stronger economy.

Lael Pierce

Photo: Flickr

For years South Africa had the reputation as a country of disparity. During most of the 20th century it remained divided along racial lines, until its 1994 election and the abolition of apartheid. With noticeable growth in its Black African middle class, the country has undoubtedly made progress in reducing its previous inequalities.

However, disparity still defines much of South African life. It has a highly disproportionate number of people living with HIV/AIDS. While South Africa contains only 0.7 percent of the global population, it is responsible for 17 percent of the world’s infections. In fact, it bears the highest HIV/AIDS rate of any country in the world, with close to 20 percent of its population infected.

Disparity also marks healthcare in South Africa, in which there is a massive gulf between private and public care. This stratified imbalance often reflects racial divisions and hinders an effective response to the national AIDS epidemic. For most South Africans, the quality of healthcare is woefully inadequate.

The data tells it all. Though 84 percent of South Africans, or 50 million people, rely on public healthcare, only 30 percent of the nation’s doctors work at public hospitals. By contrast, private coverage applies to only 8 million South Africans, yet this small minority receives 70 percent of the physicians. A majority of those reliant on public healthcare are black, while whites comprise most of those on private plans.

Per capita, expenditures on healthcare reveal the extent of this inequality. According to The New England Journal of Medicine, “Annual per capita expenditure on health ranges from $1,400 in the private sector to approximately $140 in the public sector, and disparities in the provision of health care continue to widen.”

The lack of funding has left public hospitals in decay all across the country. What funds these hospitals do receive are often mismanaged and squandered due to corruption and incompetency. It is not uncommon for these public facilities to endure medicine shortages, broken equipment and deteriorating buildings.

The inadequacy of public healthcare became widely apparent during the presidency of Thabo Mbeki, when the government systematically denied the threat of AIDS. Over 330,000 people died needlessly after the government failed to initiate an antiretroviral treatment program.

However, if one were to visit one of South Africa’s 200 private hospitals, conditions would appear satisfactory or even superior. The private health sector spends 13 times as much as the public sector on medicine and features the country’s best doctors.

It is this elite standard of care that is actually suffocating the countries healthcare system, as private spending on state of the art medicine increases drug manufacturers and hospitals are only raising prices. Some estimate the annual medical inflation rate is at 25 percent.

Yet even the top notch private sector cannot hold onto its best doctors; reports have estimated that 30 percent of South African doctors have left to countries like Australia, the United States, the United Kingdom and Canada. What’s more, another 58 percent admitted that they would consider immigrating to Western countries for work.

This trajectory is common amongst doctors from sub-Saharan countries. In total, their exits represent 2 billion in lost investments. According to the New England Journal of Medicine, “South Africa incurs the highest costs for medical education and the greatest lost returns on investment for all doctors currently working in such destination countries.”

To remedy its national health crisis, South Africa has proposed a National Health Insurance program. It aims first and foremost to provide universal coverage and level healthcare disparity. It would also attempt to contain prices by negotiating with medicine and healthcare providers.

However, due to the overwhelming demand for healthcare as a result of the AIDS epidemic, a universal health care plan would be burdensome on the nation’s budget. Some have estimated that the cost for such a program would essentially equal the amount of money collected from personal income tax nationwide.

In the meantime, South Africa can aim on producing more physicians to deal with the AIDS crisis. The current demand for AIDS treatment exceeds the county’s entire healthcare workforce by three times. To better train this workforce, South Africa needs to invest more in its teaching facilities so that doctors can learn to treat patients more effectively.

As one of the world’s up and coming economies, South Africa should seek to fix its healthcare crisis. It is hard to have gravitas on the international stage when extensive issues in equity and quality of care get piled on top of an already staggering AIDS epidemic.

Andrew Logan

Sources: Al Jazeera, New England Journal of Medicine, The Telegraph, The World Health Organization
Photo: Flickr