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A man receives his vaccine against the respiratory syncytial virus (RSV), a common infection that can effect the elderly more seriously, in Hong Kong on December 4. Photo: Jonathan Wong
Opinion
Lance Little
Lance Little

From stigma to ignorance, why Asians don’t get the healthcare they need

  • Understanding why Asians forgo or ignore their health needs must go beyond the scientific and commercial to encompass the cultural and behavioural aspects
  • Effective patient engagement can help healthcare providers and policymakers promote preventive care, cut costs and improve outcomes
Lance Little
Lance Little
Why you can trust SCMP
Healthcare in the Asia-Pacific is facing its biggest challenge – relentless demand. According to a recent World Health Organization report, the problem of unmet need manifests in two ways: there are people who need health services but forgo care due to access barriers; there is also unrealised demand, when people are unaware of their health needs.

Unrealised demand reveals a significant “patient engagement deficit”. Patient engagement refers to the willingness of individuals to collaborate with the healthcare ecosystem to address their needs. Without effective patient engagement, even the most advanced healthcare infrastructure falters and lives slip through the cracks.

Asia is home to more than half of the world’s population. The continent is particularly affected by infectious diseases and non-communicable diseases are rising. There is a need for effective patient engagement, as early intervention can help prevent diseases and greatly affect a person’s quality of life, productivity and life expectancy.

The patient engagement deficit is influenced by social and economic factors such as beliefs, stigmas and a lack of health literacy. The stigma of being diagnosed with certain diseases can keep people from seeking proactive or preventive care. For instance, the region accounts for 58 per cent of cervical cancer deaths worldwide. Cervical cancer is preventable so regular screening and early detection are the first lines of defence. However, many women are not getting tested.

The 2024 Roche Diagnostics Asia Pacific National Women’s Health Survey found that only 22 per cent across Australia, Hong Kong, mainland China, India, Japan, South Korea, Thailand and Vietnam feel very knowledgeable about cervical cancer. One in five said they delayed or avoided medical treatment.

Such hesitancy is partly due to women prioritising other responsibilities like childcare, and partly rooted in the belief that undergoing such screening is shameful or embarrassing. That means social stigmas might be keeping millions of women from taking life-saving medical tests.

Some women still think that getting a potentially life-saving cervical screening is somehow shameful or embarrassing. Photo: Shutterstock

Cultures in Southeast Asia tend to be more paternalistic and doctor-patient communication is typically one-way, where clinicians provide information on the patient’s health and recommend steps for treatment or monitoring without much consultation or discussion. Over time, this lack of agency results in patients having low curiosity about or a lack of drive to take charge of their health decisions. Patients see their role as passive recipients of care.

Another barrier to effective patient engagement is low health literacy. Studies have shown that many countries across Southeast Asia have limited health literacy, owing to factors such as education, income and socio-economic background.

This knowledge gap is a tangible barrier; it prevents people from taking advantage of the health resources and infrastructure that might exist in their community.

On the other hand, greater patient engagement tends to yield a greater interest in routine screenings for early detection, greater patient compliance with the advice of healthcare professionals and greater trust in the health promotion authorities. This ultimately increases the likelihood of receiving treatment as early as possible, which is important when our region’s health and related care costs are staggering. Cardiovascular disease alone – the leading cause of death in Asia – caused 10 million deaths in 2019 and costs more than US$177 billion annually.
The Family Planning Association of Hong Kong promoting a new cervical screening service at a press conference on April 23, 2023. Photo: Elson Li
Effective patient engagement and early intervention can – and do – make a difference. One study found that a 10-year cervical cancer prevention programme costing just US$3.2 billion, including preventive measures such as vaccines and screening, could avert 5.2 million cases and 3.7 million deaths over our lifetime.

Looking ahead, Asia’s middle class is expected to rise from 2 billion to 3.5 billion in the next five to 10 years. Clinicians should develop more patient-centric modes of communication and processes to allow patients to play a more active role in their health journey. Over time, this creates an environment with more trust and appreciation for proactive and preventive care.

Why free breast cancer screening should be one of John Lee’s priorities

The understanding of how people make their healthcare decisions can go beyond the scientific and commercial to encompass the cultural and behavioural aspects. Addressing unmet healthcare needs across the Asia-Pacific is complicated. With a multitude of factors in play, getting to the root of the issue is anything but straightforward.

The biggest lesson is to understand the diversity of local cultures that shape and drive how people in Asia-Pacific make healthcare-related decisions, and then to develop solutions within these contexts. We can then pave the way for targeted collaborative efforts among healthcare providers, policymakers and communities to bridge the gaps. It takes a global village of passionate players to engage and empower people’s approach to healthcare.

Lance Little is head of region at Roche Diagnostics Asia Pacific

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