From stigma to ignorance, why Asians miss out on healthcare
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 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 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 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.
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 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.
Another barrier to patient engagement is low health literacy. Studies have shown many countries across Southeast Asia have limited health literacy, owing to factors such as education and socio-economic background.
This knowledge gap prevents people from taking advantage of the health resources 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 trust in the health promotion authorities. This increases the likelihood of receiving treatment as early as possible.
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.
The understanding of how people make their healthcare decisions can go beyond the scientific and commercial to encompass the cultural and behavioural aspects. Addressing 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.