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Public Health Challenges in ASEAN: Lifestyle diseases, communicable diseases, and environmental contamination

Saturday 21 March 2015, 1400 – 1600, Lecture Theatre 5

Gerry Bodeker
University of Oxford

Gerry Bodeker
University of Oxford

Paper 1: Non-Communicable diseases – changing dietary patterns as a lead risk factor and local dietary traditions as a potential solution

Gerry Bodeker
University of Oxford

The World Health Organization (WHO), in a March, 2013 statement reported:  “Of the 57 million global deaths in 2008, 36 million, or 63%, were due to non-communicable diseases (NCDs), principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases.”

Popular belief presumes that NCDs afflict mostly high-income populations. However, the evidence tells a different story:

  • Nearly 80% of NCD deaths occur in low-and middle-income countries and NCDs are the most frequent causes of death in most countries, with the exception of those in Africa.
  • NCDs in Africa are projected to exceed communicable, maternal, perinatal, and nutritional diseases as the most common causes of death by 2030.

Global concern about the rise in lifestyle, or non-communicable, diseases (NCDs) has highlighted the role that diet plays in obesity, heart disease, diabetes and cancer, among others. WHO’s 2013 World Health Report notes including the e111 processes: “Diet and nutrition are important factors in the promotion and maintenance of good health throughout the entire life course. Their role as determinants of chronic NCDs is well established and they therefore occupy a prominent position in prevention activities.”

This presentation will focus on traditional Asian dietary approaches, as well as on evidence for the role of medicinal plants, in preventing and managing NCDs.


Paper 2: Impact of environmental contaminants on public health – the case of mercury in Indonesia

Yuyun Ismawati
Bali Fokus

Cisitu is the territory of a sub-ethnic group of Kasepuhan Adat, located inside the Halimun-Salak National Park, Lebak Regency, Banten Province. The village has high average annual rainfall about 3636 mm surrounded by forest and rivers. The gold ore from the mining sites would be processed in the village using ballmills and mercury. More than 2000 unit of ballmills spread out between the settlements of Cisitu and used mercury at least 30 tonnes per year mostly from illegal source.

Mercury released into the air, soil, sediment, water, fish ponds, fish and rice posing a serious health risk for all workers and the villagers. The average of total mercury concentration in the air was almost 10 times of the safe level (76.90 to 55814.47 nanogram/m3).

Our samples examination on the local rice that they grow in their wet and dry rice fields and fish from their ponds also showed a high concentration of mercury. The total mercury in rice was detected at a very high level, higher than any of the existing data ever recorded. The total mercury ingested from the fish and rice consumption in the average is more than 40 times higher than the JECFA PTWI.

On October 2014, we examined 132 villagers, and found that 37 out of 132 people were suspected to have severe mercury intoxication similar to Minamata Disease. Local Action Plan to eliminate mercury and formalisation of the activities is underway and health measures are being developed together with all stakeholders.


Paper 3: Communicable disease – the case of Dengue in ASEAN: an ASEAN solution

Soobitha Subenthiran
Institute of Medical Research, Malaysia

Dengue has become a global threat with more than 400 million cases reported annually around the world. Almost 40% of the global population live at risk of infection. As there are no specific antiviral drugs available scientist are exploring the options of using alternative therapies in the management of dengue. Papaya leaves have long been used as a traditional food and for the treatment of numerous diseases including dengue among the Asian population. An open labelled randomized controlled trial was carried out on dengue patients with and without warning signs. Patients were given 30 mls of pure Carica papaya leaf juice (CPLJ) of the Sekaki variety, once daily for 3 consecutive days and compared with a controlled group of patients who received the standard management. Their full blood count was monitored 8 hourly for 48 hours and gene expression studies conducted on the samples taken on the 3rd day of treatment. The mean increase in platelet counts were compared in both the groups using repeated measure ANOVA. There was a significant increase in mean platelet count in the interventional group (p < 0.001) but not in the control group at 40 hours since the administration of the first dose of the juice. The ALOX 12 (FC = 15.00) and PTAFR (FC = 13.42) genes were highly expressed determined using the comparative critical threshold analysis, while an accelerated defervescence of fever (p = 0.02) was determined using chi square statistics among those who received CPLJ when compared with the controls.   Paper 4: Over- and under-controlled diabetes in a Malaysian health and demographic surveillance site: Likely implications for middle income country health systems.

Pascale Allotey & Daniel Reidpath
Monash University Malaysia

It is now regarded as a notorious fact that middle income countries are facing a substantial and un-manageable growth in non-communicable diseases, with type 2 diabetes being one of the most important chronic disease.  Much of the focus in the middle income country context has been on undiagnosed diabetes.  Relatively little is known, however, about the management of diabetes in people with known type 2 diabetes.  Using data from the South East Asia Community Observatory (SEACO), a health and demographic surveillance site (HDSS) in peninsular Malaysia, we examine the issue of over and under controlled diabetes.  During a household health screening round we identified around 1,800 people with diabetes, of whom around half had under-controlled diabetes and about 15% had over-controlled diabetes.  We discuss the implication of over-and under-controlled diabetes, and use a series of simulations to discuss the likely implications for the wider health system.