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The Health of Asia Barometer - PULSE OF ASIA Challenges and opportunities for health and well-being - The Economist
PULSE OF ASIA

The Health of
Asia Barometer
Challenges and opportunities
for health and well-being

                               Written by:
The Health of Asia Barometer - PULSE OF ASIA Challenges and opportunities for health and well-being - The Economist
2     Health of Asia Barometer: Challenges and opportunities for health and well-being

    © The Economist Intelligence Unit Limited 2021
The Health of Asia Barometer - PULSE OF ASIA Challenges and opportunities for health and well-being - The Economist
Health of Asia Barometer: Challenges and opportunities for health and well-being           3

                                          © The Economist Intelligence Unit Limited 2021
The Health of Asia Barometer - PULSE OF ASIA Challenges and opportunities for health and well-being - The Economist
The Health of Asia Barometer:
44     Health
       An     of Asia Barometer:
          information challenge Challenges and opportunities for health and well-being

                                   Foreword

                                   Prudential is proud to support the Economist Intelligence Unit (EIU)
                                   in taking on its first Pulse of Asia – The Health of Asia Barometer in 13
                                   Asian markets. Our aim is to shine a light on the challenges people in
                                   the region face to improve their health and well-being.

                                   This report could not have been more timely. Covid-19 has highlighted
                                   the importance of personal and societal health and has motivated
                                   many businesses, including ours, to examine how we can enhance the
                                   access and delivery of healthcare during the pandemic. Throughout
                                   2020 we have re-aligned our priorities to deliver what matters most to
                                   our customers and our communities.

                                   What this research clearly highlights is the demand for recognised
                                   tools and services to be made available to vast segments of people
                                   across Asia: 78.5% of respondents use some form of personal health
                                   technology. Millions are looking for the ability and support to help them
                                   better navigate the healthcare system, and as a result, improve the way
                                   they manage their health and well-being. One trend is that many in the
                                   region are turning to informal sources, such as social media, for this advice.

                                   People in Asia often believe that their future will be financially healthier.
                                   This report reveals the same optimism when it comes to health and
                                   well-being. The underlying belief is that the region will recover from
                                   the devastation that covid-19 has brought to so many families. There
                                   will eventually be a return to the levels of socio-economic growth and
                                   development that previously transformed societies across Asia, that
                                   lifted many millions out of poverty.

                                   Prudential is proud to have been part of this regional dynamism for
                                   many years, providing protection and peace of mind to millions. What
                                   we are doing now is leading the way in redefining what access to health
                                   and well-being looks like for millions more.

                                   The research informs us of people’s sentiment on the affordability
                                   and accessibility of healthcare, which technology could help address.
                                   While 54% of respondents said medical care was easily accessible and
                                   affordable to them, 71% said that three years from now, they would be
                                   using more technologies to improve their health and well-being.

     © The Economist Intelligence Unit Limited 2021
The Health of Asia Barometer - PULSE OF ASIA Challenges and opportunities for health and well-being - The Economist
Health of Asia Barometer: Challenges and opportunities for health and well-being             1

Making digital healthcare a reality is an integral part of our efforts.
Through our app, Pulse by Prudential, we are helping people protect,
prevent and postpone diseases. Pulse delivers health information
and advice as well as access to medical professionals - all through the
touch of a button. We continue to build Pulse, our all-in-one AI-driven
healthcare app, bringing in partners that will help us support people’s
journey to physical, mental and financial health. We believe this will in
turn enable people to live well, for longer.

I want to thank the EIU and the subject matter experts for their deep
insights on the important debate about improving people’s health and
well-being in Asia. At Prudential, we remain committed to be an active
voice in that debate, in the service of our customers and communities.

Nic Nicandrou
Chief Executive
Prudential Corporation Asia

                                                            © The Economist Intelligence Unit Limited 2021
The Health of Asia Barometer - PULSE OF ASIA Challenges and opportunities for health and well-being - The Economist
2     Health of Asia Barometer: Challenges and opportunities for health and well-being

                                 About the research

                                  The inaugural Pulse of Asia: Health of Asia Barometer is a report written
                                  by The Economist Intelligence Unit and supported by Prudential.
                                  It explores the challenges that Asian societies face in efforts to
                                  improve citizens’ health and wellness. The analysis in it is based
                                  on a survey of 5,000 people conducted in the second half of 2020.

                                  The respondents hail from Cambodia, Hong Kong, India, Indonesia,
                                  Laos, mainland China, Malaysia, Myanmar, Philippines, Singapore,
                                  Taiwan, Thailand and Vietnam. They range in age from 21 to 55,
                                  with 49% aged between 25 and 34, and 31% between 35 and 44.
                                  The respondents have different income levels and are split roughly
                                  evenly between males and females. A wide range of occupations
                                  is represented in the sample, as well as various categories of
                                  non-employment.

                                  Additional insights were obtained from in-depth interviews with
                                  executives in health institutions, companies and government
                                  administration. We would like to thank the following for their time:

                                  • Edward Booty, chief executive officer, reach52

                                  • Ryoji Noritake, chief executive officer, Health and Global Policy
                                    Institute

                                  • Rashmi Sharma, global learning & wellbeing lead, Unilever South
                                    East Asia & ANZ

                                  • Dr Wang Ying-wei, director general, Health Promotion
                                    Administration, Taiwan Ministry of Health and Welfare

                                  • Singapore Health Promotion Board

                                  The report was written by Denis McCauley and edited by Michael Frank
                                  and Charles Ross.

    © The Economist Intelligence Unit Limited 2021
The Health of Asia Barometer - PULSE OF ASIA Challenges and opportunities for health and well-being - The Economist
Health of Asia Barometer: Challenges and opportunities for health and well-being           3

                                          © The Economist Intelligence Unit Limited 2021
The Health of Asia Barometer - PULSE OF ASIA Challenges and opportunities for health and well-being - The Economist
1     Health of Asia Barometer: Challenges and opportunities for health and well-being

                                 Executive summary

                                 The world is facing its gravest health crisis in a century, giving people
                                 a stronger incentive to focus on personal health and wellness.
                                 By and large, people living in Asia do not need to be convinced of
                                 the connection between their diet, physical exercise, stress levels
                                 and other facets of personal health on the one hand, and their
                                 susceptibility to disease on the other. This is thanks to years of public
                                 health education campaigns by international organisations and
                                 governments and, more recently, the growth of a wellness industry.
                                 Awareness, however, does not necessarily lead to action by individuals
                                 to improve their personal health, as this report has found.

                                 We surveyed 5,000 people in Asia to find out what they are doing to
                                 manage their personal health and wellness, the resources they use to
                                 do it, and the challenges they face in the process. The results point to a
                                 population more than minimally aware of the benefits that accompany
                                 a healthy lifestyle, but in many parts of the region, constrained in
                                 building one. The challenge for policymakers is finding innovative
                                 ways—either alone or in conjunction with the private sector— to
                                 increase citizens’ access to reliable health and wellness information,
                                 advice and services.

                                     Defining health and wellness

                                     According to the World Health Organisation (WHO), health is
                                     a “state of complete physical, mental and social well-being and
                                     not merely the absence of disease or infirmity”.1 Wellness may
                                     be summarised as the practices people pursue and the lifestyle
                                     choices they make that contribute to a state of personal health.
                                     According to the Global Wellness Institute, the dimensions of
                                     wellness are physical (exercise, diet, sleep), mental, emotional,
                                     spiritual, social and environmental.2

                                     For the purposes of our research and analysis, we subscribe to
                                     these definitions of health and wellness.

    1 Constitution of the World Health Organisation (from the WHO website). https://www.who.int/about/who-we-are/constitution#:~:text=Health%20
      is%20a%20state%20of,absence%20of%20disease%20or%20infirmity.
    2 Global Wellness Institute website. https://globalwellnessinstitute.org/what-is-wellness/

    © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being               2

The main findings of the research are as follows:

Ample information does not necessarily lead to good health
decisions. Survey respondents have no shortage of personal
health information available to them, although the quality of the
information varies. A slight majority of respondents report sourcing
health information from social media; a far lower proportion consult
formal medicine. Overload is a problem as well, especially in the wake
of the pandemic: for 53% the volume of information available is so
overwhelming that they don’t know what to focus on.

Respondents are seeking more control over their physical as well
as mental health. Awareness of the connection between wellness
and disease has been growing, driven by the covid-19 pandemic. Over
half of those surveyed (52%) have taken two or more measures in the
past three months to improve their personal health, mainly by engaging
in more physical exercise and changing eating habits, cited by 34%
and 29%, respectively. Around one-quarter (24%) have also sought to
improve their mental health, a need underscored by the 34% who say
the covid-19 crisis has caused them greater stress, anxiety or depression.

Income levels do not dictate health and wellness optimism. The Health
of Asia Barometer developed for this report reveals a striking contrast
between the less and more developed markets in the region. Citizens of
the former are considerably more positive than those of the latter about the
state of their personal health and its near-term outlook, as well as about
their ability to manage their health and wellness. The exceptions to this
revolve around financial constraints and access to facilities.

Low affordability limits people’s scope of action to live more healthily.
Financial considerations constrain 56% of survey respondents from taking
action to improve their health and wellness. The figures are higher in less
developed markets such as Thailand and Vietnam. Half of the respondents
also cite limited access to exercise or other facilities as an impediment.

Digital health technologies are popular but need to work harder
for citizens. Survey respondents use a wide variety of personal health
tools, including smart watches, smart thermometers and blood pressure
monitors. Experts interviewed for this report say the value of such
technologies can be enhanced if they can connect to centralised data
repositories, such as patient health records, a reality today only in the
region’s developed markets.

                                                              © The Economist Intelligence Unit Limited 2021
3     Health of Asia Barometer: Challenges and opportunities for health and well-being

    © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being                       4

                               Health awareness and action

                               Thanks to public health education campaigns,                   Such heightened awareness may explain the
                               growing consumerism that prizes good                           propensity to take proactive measures to
                               health and physique, and other influences,                     improve personal health. In the past three
                               people’s awareness of the need to live healthy                 months, over half of those in our survey (52%)
                               lifestyles has grown steadily in recent years.3                have taken two or more such steps based
                               This is the case even in rural areas of lower-                 on information or advice they received from
                               income countries where, according to                           social media, health websites, public health
                               Edward Booty, CEO of digital health services                   authorities or other sources. Such measures
                               provider reach52, there is much greater                        have most often involved taking more physical
                               understanding than before of the factors                       exercise, cited by 34% of respondents, and
                               that contribute to disease.                                    changing their diet, cited by 29%.

                               The global pandemic has helped open                            Just under one-quarter of those surveyed
                               people’s eyes more widely to the nexus                         (24%) have acted in the past three months
                               between lifestyles and disease. This is the                    to improve their emotional well-being or
                               case in Taiwan, says Dr Wang Ying-wei, who                     mental health. Those steps are important
                               is director general of the Health Promotion                    in light of 34% of respondents reporting
                               Administration at the Ministry of Health and                   elevated stress, anxiety or even depression
                               Welfare. “There is a press conference virtually                as a result of covid-19. Large numbers of
                               every day that makes clear to citizens how                     respondents also say the crisis has affected
                               their personal health practices are helping to                 their sleep and eating habits (cited by 28%
                               control the virus,” he says.                                   and 25%, respectively).

                               Figure 1: Measures taken to improve personal health and wellness
                               (Measures taken by respondents in the past three months)

                               Increased the amount of physical exercise I engage in                                                    34%
                               Changed my diet                                                                                    29%
                               Measures to improve my emotional well-being/ mental health                                   24%
                               Measures to improve my sleep                                                                22%
                               Had a health check-up                                                                 19%
                               Measures to reduce work-related or other stress                                       18%
                               Began shopping from healthy food stores/providers                               15%
                               Measures to improve the quality of my water intake                              15%
                               Measures to improve the quality of air in or near my home                   13%
                               Eliminated or reduced my alcohol consumption                              11%
                               Quit or cut back on smoking                                            8%

                               Source: The Economist Intelligence Unit

1 For a discussion of the steps that Singaporeans, for example, have been taking to prepare for longer life spans that could involve chronic disease,
  see Ready for 100? Preparing for longevity in Singapore, a report written by The Economist Intelligence Unit in 2018 and commissioned by
  Prudential. https://readyfor100.economist.com/wp-content/uploads/2019/07/20180924-ECO035-Ready-for-100-Whitepaper-Spread.pdf

                                                                                                        © The Economist Intelligence Unit Limited 2021
5     Health of Asia Barometer: Challenges and opportunities for health and well-being

    Over one-fifth of respondents (22%) have                                  Philippines, basketball and Zumba fitness
    taken no measures at all to improve their                                 classes are common, even in the countryside.”
    health during this period. (This number is                                The bigger problem affecting personal health
    considerably higher than the average in                                   there, he says, is poor diet—as well as, more
    Cambodia, Myanmar and even Singapore). “I                                 broadly, an acute shortage of doctors to obtain
    don’t feel the need to take action,” is the most                          advice from.
    oft-cited explanation for inactivity—surely a
                                                                              Affordability—whether of good quality food,
    concern as health and wellness usually need
                                                                              exercise facilities or health technologies—is
    personal attention just to remain stable.
                                                                              a significant constraint to adopting healthier
    Another common excuse is “not enough time”.
                                                                              lifestyles in Asia. Across the survey sample as
                                                                              a whole, 56% say financial constraints make
    Building awareness is only half
                                                                              it difficult to take measures to improve their
    the battle                                                                health and wellness, an inhibitor felt especially
    Awareness does not always lead to action.                                 keenly in Thailand, Vietnam and Malaysia. Half
    “In some countries, there is a huge disconnect                            (50%) also say that limited access to exercise
    between awareness and incentives to take                                  or other facilities make health improvement
    action,” says Mr Booty. As an example, he                                 difficult for them.
    points to the affordability of fast food in
    Philippine cities and towns, and the effect
    this has on obesity levels. Physical activity
    is seemingly less of a problem. “In the

    Figure 2: Affordability of personal health improvement
    (% of respondents agreeing that financial constraints will make it difficult for them to improve
    their personal health and wellness over the next year)

                                                                                                                  Agree        Strongly agree

                  24%
                            30%        28%         22%         21%              16%      15%
       19%                                                            23%                          12%
                                                                                                             18%        12%                 7%
                                                                                                                                  16%

                  48%       42%                                                 42%               42%
       37%                             41%         42%         41%                       40%
                                                                      35%                                               35%                35%
                                                                                                             31%                  29%

    Asia average Thailand   Vietnam   Malaysia   Philippines   Laos   India    Indonesia Cambodia Myanmar   Singapore   Hong    Mainland   Taiwan
                                                                                                                        Kong     China

    Source: The Economist Intelligence Unit

    © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being                             6

     The Health of Asia Barometer: A contrast in perceptions
     Using responses to eight survey questions, The                                  The barometer values are generated from responses
     Economist Intelligence Unit constructed a benchmark                             to eight survey questions that relate to respondents’
     that provides a view into how people in Asia feel                               self-assessed health and wellness status, the extent
     about the current state of their personal health,                               of recent health improvement, and the prospects
     their management of it and its future trajectory.4                              for its improvement in the near future. Another set
     The barometer values reveal a striking contrast                                 of questions asks respondents about the extent
     between the perceptions of those living in Asia’s                               to which they seek health and wellness information,
     less developed markets and those in its more                                    from which sources, their use of health technologies,
     developed ones: the former are more positive about                              and the constraints they face in seeking to improve
     their health, and their control over it, than the latter. 5                     their health.

     The barometer shows residents of India representing                             The survey responses are converted to barometer
     the most positive view of their own health, with a                              values that fall along a 0-100 scale, with 100 being
     value of 59 out of 100. Close behind follow those from                          the best possible score. The eight indicators are
     Vietnam, Indonesia and Philippines. At the other end of                         equally weighted, with the three categories—health
     the scale, with a value of 46.5, are Hong Kong residents,                       status, managing heath and future health outlook—
     the most pessimistic in the study; their peers from                             reflective of the number of indicators.
     Singapore and Taiwan are only slightly more positive.

     Figure 3: Health of Asia barometer, overall values

                                                                                                               57.5         57.8        58.5     59.0
                                                              53.6        54.0          54.0       55.1
                               50.8      51.0      52.6
                    47.3
         46.5

       Hong Kong   Singapore   Taiwan   Myanmar     Laos   Mainland China Cambodia     Malaysia   Thailand   Philippines   Indonesia   Vietnam   India

     Source: The Economist Intelligence Unit

4 The barometer will be updated in future years, in order to gauge how people’s view of their own health and wellness, and their ability to manage it,
  is changing over time.
5 We provide here a high-level discussion of the barometer findings. For a detailed look into category and indicator values in each country,
  see pulseofasia.economist.com

                                                                                                               © The Economist Intelligence Unit Limited 2021
7     Health of Asia Barometer: Challenges and opportunities for health and well-being

        Health status and future health outlook                                           Managing health

        The barometer values in these two categories—                                     The comparatively low values in this category across
        which broadly mirror each other in terms of the                                   all markets (none exceed 50) point to the difficulties
        relative position of markets—indicate that survey                                 that many people face in adopting healthier lifestyles.
        respondents as a whole feel positive about                                        By and large, the availability of health and wellness
        their personal health and wellness and what lies                                  information is not one of them, as we discuss
        immediately ahead for it. When it comes to overall                                later—although people’s ability to access accredited
        health, every country registers a barometer value                                 information is suspect. Access to technology does
        of more than 70. Respondents’ assessment of their                                 not seem to be a major constraint. More than 60% of
        current wellness (lifestyle and emotional well-being) is                          survey respondents in each country affirmed their
        also positive: only Hong Kong and Singapore register                              access to relevant technology in managing their health.
        values of under 60. The category value is pulled down
        in each country by an indicator of how frequently                                 Financial constraints and physical access to exercise
        respondents have taken steps in recent months to                                  facilities are larger barriers for many. In these two areas
        improve their health. Although most have taken                                    the positions of the more and less developed markets are
        more than one such step (see earlier discussion),                                 reversed from the general pattern: respondents in markets
        the barometer values generated are more modest                                    such as Vietnam and Thailand cite financial constraints
        than those for the other indicators."                                             and physical access as more of a barrier than those in,
                                                                                          for example, Taiwan, mainland China or Hong Kong.

        Figure 4: Barometer categories
         90

         80

         70

         60

         50

         40

         30

         20

         10

         0
              Hong Kong   Singapore   Taiwan   Myanmar   Laos   Mainland China Cambodia   Malaysia   Thailand   Philippines   Indonesia   Vietnam   India

                                                                       Current health status         Managing health            Future health outlook

        Source: The Economist Intelligence Unit

    © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being                              8

The disparity between this category score and the                                One possible explanation lies in better education
others suggests that respondents in all the surveyed                             and information availability in wealthier places.
markets may not in reality be doing enough to justify                            The link between personal health and chronic
the positive assessment of their own health. If that is                          disease—and therefore longevity—can sober
the case, it could point to problems ahead in terms of                           people about health risks and what it takes to
their mental health and their susceptibility to disease.                         manage them. At the other end of the scale,
Should the covid-19 crisis drag out further, their                               the considerably lower life expectancy figures
current health optimism will be put to a bigger test.                            in markets such as India, Cambodia and the
                                                                                 Philippines (although steadily rising in all for
Reality check?                                                                   several years) could indicate that their citizens’
                                                                                 optimism is more a product of cultural attitudes
Are respondents from Asia’s less developed markets                               than actual health outcomes. Health authorities
overly optimistic about their health, and those from                             in those markets may find their efforts to provide
the others unduly pessimistic? There are no objective                            more targeted health and wellness education an
means to make that judgment. Health perceptions are                              uphill battle, owing to lower levels of health literacy,
negatively correlated with average life expectancy. The                          falsely optimistic personal health assumptions and
latter figures for Hong Kong, Singapore and Taiwan                               less developed communication channels.
are among the highest in the world, but residents are
relatively downbeat about their personal health.

Figure 5: Average life expectancy (2018) and overall barometer scores

90

80

70

60

50

40

30

20

10

 0
     Hong Kong   Singapore   Taiwan   Myanmar   Laos   Mainland China Cambodia   Malaysia   Thailand   Philippines   Indonesia   Vietnam    India

                                                                                                           Life expectancy 2018            HAB

Sources: World Bank, World Development Indicators; The Economist Intelligence Unit

                                                                                                             © The Economist Intelligence Unit Limited 2021
9     Health of Asia Barometer: Challenges and opportunities for health and well-being

    A wealth of information

    The citizens of most Asian countries can have                information, as are health advice websites
    few complaints about a shortage of information               and the public authorities.
    on what constitutes a healthy lifestyle and
    good personal health practices. Besides                      The most useful of these, as rated by the
    periodic education campaigns run by public                   survey respondents, are national government
    health authorities and NGOs, locally oriented                and public health authorities. According to
    wellness websites and wellness businesses have               Ryoji Noritake, CEO of the Health and Global
    proliferated across Asia in recent years.6 Should            Policy Institute, a not-for-profit think tank,
    these sources prove insufficient, social media               the value that people attach to government-
    channels provide individuals with a plethora                 sourced information on personal health is
    of opportunities to obtain information and                   in line with the deference typically shown
    advice almost on-demand.                                     toward government experts and their advice
                                                                 on a range of issues. The family doctor and
    In the three months prior to taking the survey,              health advice websites trail closely behind
    50% of respondents obtained personal health                  government in information utility. Social
    and wellness information from social media—                  media, although rated highly, has slightly
    the most frequently cited source. Family                     less utility for people than the other sources,
    and friends are another common source of                     judging by the responses.

    Figure 6: The usefulness of different sources of personal health and wellness information
    (% of respondents assessing each source as extremely useful or useful)

    National government and public health authorities            32%                             38%
    GP/family doctor                                              33%                        35%
    Health advice websites                                        35%                        32%
    Local government and public health authorities               32%                        34%
    Social media                                                  33%                       30%
    Television and radio                                          32%                      29%
    Relatives and friends                                         35%                       26%
    Smartphone health apps                                       31%                       28%
    Traditional medicine providers                               30%                18%

                                                        Useful          Extremely useful
    Source: The Economist Intelligence Unit

    6 The Asian Development Bank estimates that the wellness economy has grown by an average of 10% annually in nine Asian countries since 2010 and
      accounted for about 11% of their combined GDP in 2017. Asian Development Outlook 2020 Update, Theme Chapter: Wellness in Worrying Times,
      September 2020. https://www.adb.org/what-we-do/economic-forecasts/september-2020/theme-chapter#wellness-asia

    © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being               10

Figure 7: Where too much health information can be problematic
(% of respondents agreeing that “The amount of information available about health and
wellness is so overwhelming, I don’t know what to focus on”)

Asia                                       40%                                13%
Mainland China                                  41%                                 19%
Laos                                             46%                                 11%
India                                      38%                                19%
Taiwan                                            47%                                9%
Vietnam                                   36%                             18%
Malaysia                                        42%                           11%
Cambodia                                    41%                               11%
Thailand                                   39%                             13%
Philippines                                39%                             11%
Myanmar                                         43%                         6%
Hong Kong                                  38%                          10%
Singapore                                 35%                     7%
Indonesia                           28%                    9%                        Agree     Strongly agree

Source: The Economist Intelligence Unit

Too much of a good thing?

This abundance of health information is a               blood pressure. “People will get different,
two-edged sword. The sheer volume and                   often conflicting information about this from
variety available can make it difficult for             social media, from the internet, and from
people to make the right decisions on diet,             family and friends.”
exercise and other aspects of personal health
improvement. Over half of the respondents               The pandemic has added considerably
(53%) say the amount of information available           to health information overload—and
about health and wellness is so overwhelming,           misinformation—notes Dr Wang. “More
they don’t know what to focus on.                       isn’t always better when it comes to health
                                                        information,” he says. “We [government
“Information overload is a defining feature             authorities] must ensure that people are
of our times,” says Mr Noritake, affecting              getting the correct information.” With
health and many other aspects of daily                  digital technology increasingly integral to
life. A by-product of this, he says, is often           how people receive health information,
conflicting advice and information on core              governments may need to partner with
health prevention issues. Mr Booty agrees,              private-sector firms to share capabilities
noting that there are even debates within               and provide the information people need.
communities as to what constitutes high

                                                                © The Economist Intelligence Unit Limited 2021
11     Health of Asia Barometer: Challenges and opportunities for health and well-being

     © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being           12

                                          © The Economist Intelligence Unit Limited 2021
13     Health of Asia Barometer: Challenges and opportunities for health and well-being

     The digital factor

     Smartphone penetration across the                                by more than 20% of respondents). Among
     Asia-Pacific region stood at 67% in 2019,                        the technologies that respondents do not
     according to the GSM Association, a                              yet use, the adoption of wearable monitors
     mobile industry group.7 That connectivity                        (measuring indicators such as heart rate, sleep
     extends to wearables that act as fitness                         and oxygen levels) looks likely to grow fastest
     aids and monitors such as smart watches                          over the next year. Just 29% of those surveyed
     or wristbands. According to one source,                          say they are uncomfortable using personal
     penetration of such devices is higher in Asia                    health technologies.
     Pacific (at 22% of internet users) than in any
     other region of the world. 8                                     Digital health, of course, consists of more
                                                                      than gadgets. Online services connecting
     That affinity for health technologies is                         people to doctors and other providers of
     reflected in our survey. It shows a wide variety                 health advice—including advice on disease
     of digital devices that individuals in the region                prevention—are sprouting throughout the
     use to improve their personal health. Top of the                 region. For example, the health apps and
     list in popularity are blood pressure monitors,                  services of China tech giants Tencent, Alibaba
     followed closely by smart watches, smart body                    and JD.com have reportedly experienced
     temperature thermometers, wearable fitness                       strong user growth as well as new investment
     trackers and intelligent weight scales (all used                 since the onset of covid-19.9

     Figure 8: Taking control with digital health devices
     (% of respondents using different personal health technologies)

     Blood pressure monitor                                                                                             27%
     Smart watch                                                                                                      26%
     Smart thermometer                                                                                             25%
     Wearable fitness tracker                                                                                     24%
     Intelligent weight scales                                                                                  22%
     Wearable health monitor (for heart rate, oxygen level, sleep, etc)                                     20%
     A digital platform (e.g. app) to speak directly with a health professional                           18%
     A digital platform (e.g. app) that uses AI to diagnose or manage your health                      17%
     Air quality monitor                                                                            15%
     Glucose meter                                                                               13%
     I do not use personal health technologies                                                                  22%

     Source: The Economist Intelligence Unit

     7 GSM Association, The Mobile Economy Asia Pacific 2020, July 2020. https://www.gsma.com/mobileeconomy/asiapacific/
     8 “Wearables: Now a Health Essential?”, GlobalWebIndex, December 17, 2019. https://blog.globalwebindex.com/chart-of-the-week/are-wearables-
       the-new-health-essential/
     9 See, for example, “China’s digital health care start-ups get a boost from the coronavirus, Beijing and investors”, CNBC, September 10, 2020. https://
       www.cnbc.com/2020/09/11/chinas-digital-health-care-start-ups-get-a-boost-from-the-coronavirus-beijing-and-investors.html

     © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being                    14

                              One of the better-known digital health                      lower-income communities,” he says. “Many
                              platforms in South-East Asia is DoctorOnCall,               innovations aimed at middle-income countries
                              launched by a Malaysian start-up, Health                    or cities just won’t work there.”
                              Digital Technologies, in 2017. Pandemic-
                              related growth in local demand for health                   Governments in Asia need little convincing
                              advice has led the firm to launch multiple                  of the merits of citizens’ adoption of digital
                              new ventures with partners in 2020.10 Similar               health technologies, although some—such
                              examples of digital health services can be                  as Singapore’s—are more proactive than
                              found in Singapore, Indonesia, Hong Kong                    others in promoting it. An example of that
                              and other Asian markets.                                    government’s approach is its recent tie-
                                                                                          up with a technology company to make a
                              Digital health devices and services such as                 personal health app available to Singaporeans
                              those described above can help fill the gap                 using a smart watch. The app helps users
                              in many Asian markets left by understaffed                  to meet weekly activity goals, make healthy
                              health systems, particularly where doctors are              food choices and keep up with immunisation
                              not available to provide advice. Indeed, people’s           and health screening. The government’s
                              affinity for health technologies in the region’s            Health Promotion Board (HPB) entices people
                              less developed markets offers the potential of              to download and use the app by offering
                              making up ground on their more developed                    monetary rewards for meeting personal
                              neighbours in terms of access to health services.           wellness goals.11

                                                                                          Another HPB mobile app is “Healthy 365”.
                              Augmenting the power of digital
                                                                                          In addition to helping users to monitor their
                              As useful as personal health devices are,                   diet and physical activity, it encourages
                              Mr Noritake says, their value to citizens can               healthy eating through partnerships with
                              be greatly enhanced if they are connected to                food and beverage providers and retailers.
                              centralised repositories of health information.             By scanning the QR codes of healthy food
                              Currently, this is only possible in the region’s            and drink purchases into the app, users can
                              more developed markets such as Singapore,                   earn and redeem points with HPB’s partners.12
                              mainland China, South Korea and Taiwan
                                                                                          Governments in Asia have traditionally
                              (and, to a lesser extent, Japan), he says.
                                                                                          been conservative about involving the
                              In Asia’s less-developed markets, says                      private sector in healthcare. The Singapore
                              Mr Booty, poor data connectivity and                        government’s initiatives suggest that this
                              the absence of centralised health data                      could be changing, at least in the area of
                              restricts the usefulness of wearables, blood                personal health and wellness. According
                              pressure monitors and other personal                        to Dr Wang, Singapore’s personal health
                              health technologies. “There needs to be                     initiatives are a model for other governments
                              an ecosystem for patient-centred digital                    in the region, including his own. Among the
                              innovation to flourish that are designed for                lessons taken is how to forge partnerships

10 “An overview of Malaysia’s digital health landscape”, Healthcare IT News, July 1, 2020. https://www.healthcareitnews.com/news/asia-pacific/
   overview-malaysia-s-digital-health-landscape
11 Information provided to The EIU by the Health Promotion Board; see also “Apple and Singapore to reward health-monitoring smartwatch users”,
   Financial Times, September 23, 2020 https://www.ft.com/content/0185de62-b790-4819-903d-d182bada2295
12 Information provided to The EIU by the Health Promotion Board

                                                                                                    © The Economist Intelligence Unit Limited 2021
15     Health of Asia Barometer: Challenges and opportunities for health and well-being

     with business to promote healthy lifestyles.                   Asian companies, too—in technology and
     The Health Promotion Administration that he                    other sectors—clearly have a role to play in
     manages has, for example, begun discussions                    initiatives that encourage citizens to look
     with healthtech companies to encourage                         after their personal health. An example of
     greater adoption of wearable health devices.                   what’s possible is offered by Singapore-
     “This is a starting point,” says Dr Wang, “and                 based healthtech company mClinica, which
     we plan to involve Taiwan businesses in our                    is partnering with the Philippines’ Food and
     public health efforts in the future.”                          Drug Administration to build an integrated
                                                                    national health information system.13

         Businesses on the frontlines of wellness
         “We see wellness as a business driver,” says               that highlights the role that physical
         Rashmi Sharma, who is the global learning                  and mental health play in driving higher
         & wellbeing lead at Unilever South East                    business performance. Such a taskforce
         Asia & ANZ. In Asia, few governments or                    could include advisers or coaches who help
         health authorities make that connection,                   companies to expand and better target the
         she says, but many businesses have begun                   health and wellness support they provide
         to. “Companies are providing a lot more                    to employees. Helplines could also be set
         training now for employees about how to                    up that employees can call for personal
         look after personal health and wellness—                   health advice. Such initiatives must give
         not just their own but also that of their                  as much priority to addressing employees’
         families,” says Ms Sharma. This is a trend                 mental health as their physical health, says
         that predates the pandemic.                                Ms Sharma, as both are equally integral to
                                                                    performance.
         Governments should push businesses to
         do more to help employees look after                       Government prodding of businesses
         their well-being, Ms Sharma believes.                      through such measures can be effective,
         One option, in her view, is to mandate                     but mandates will work better, believes
         that organisations focus on health in                      Ms Sharma. “That will do more to bring
         their employee engagement activities.                      conversations about health and wellness
         Another is to form an expert taskforce                     into the mainstream in our societies.”

     13 “Singapore’s mClinica partners with Philippines FDA to create country’s first national health database”, mClinica press release, October 29, 2018.
        https://www.mclinica.com/singapores-mclinica-partners-with-philippines-fda/

     © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being           16

                                          © The Economist Intelligence Unit Limited 2021
17     Health of Asia Barometer: Challenges and opportunities for health and well-being

     © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being            18

Conclusion: Implications for health policy

Governments and other health sector actors in     Involve the private sector. Governments
Asia have by no means been inactive in nudging    should highlight the importance of employee
their citizens to adopt healthier lifestyles.     health and wellness to business performance,
This research points, however, to some areas      and by extension to economic growth.
where public actions to achieve this end can      They should encourage, or even mandate,
be expanded, re-targeted or refined:              companies to provide training and support
                                                  to employees in managing their personal
Act now to improve the health information
                                                  health. And they should collaborate with
audiences are getting. People are highly
                                                  businesses to advance health promotion
receptive—especially now—to information
                                                  initiatives (see below).
related to their health and wellness. The
pandemic serves as a daily reminder of the        Collaboration between governments
importance of healthy living, not least to        and businesses needed to drive digital
put off the onset of chronic disease. But         healthcare. With digital technology
the crisis also underscores the importance        increasingly integral to how people manage
of raising the quality of information on          their health, governments should involve
offer. Governments can set an example             technology firms in partnerships to devise
by improving the information they provide.        innovative ways of promoting healthier
                                                  lifestyles. The partnerships that the Singapore
Digital health ecosystems, supported by
                                                  government is pioneering should provide
open and fair data governance, have great
                                                  useful lessons to other governments as those
potential to support health management.
                                                  initiatives play out.
In health as in so many other realms, the power
of data is magnified when it is augmented         Treat mental health on par with physical
by other related information. Creating a          health. The toll that covid-19 is taking on
digital health ecosystem connecting data          people’s mental health and emotional well-
from personal health devices and services to      being is well-documented the world over,
patient health records, where they exist, or      Asia included. The effects are likely to be
to other centralised repositories, can benefit    felt long after the virus is defeated. It’s not
both individuals and health authorities. The      easy everywhere in the region to talk about
foundation is data governance that balances       mental health openly: governments need to
the needs of commerce and the legitimate          encourage such discussion.
privacy concerns of consumers.

                                                          © The Economist Intelligence Unit Limited 2021
The Health of Asia Barometer:
19
19     Health
       An     of Asia Barometer:
          information challenge Challenges and opportunities for health and well-being

                                   Prudential Insight

                                   Tackling the health protection gap

                                   Prudential is developing next-generation health and wealth solutions
                                   and delivering them through its OnePulse ecosystem, putting control
                                   of health and wealth in people’s hands.

                                   OnePulse is designed to address some of Asia’s biggest health and
                                   wealth challenges, at scale. It is part of Prudential’s broader strategy
                                   to make healthcare more affordable and accessible for everyone
                                   across Asia and Africa, by leveraging digital technologies and best-in-
                                   class partnerships.

                                   The OnePulse includes Pulse by Prudential (Pulse), an all-in-one
                                   health app and first-of-its-kind in Asia, that offers holistic health
                                   management, taking healthcare to a new level of engagement.
                                   The strength of the ecosystem lies in its ability to harness the power
                                   of technology and data across interconnected systems. Through
                                   Artificial Intelligence (AI)-powered tools and real-time information,
                                   Pulse empowers users to take control of their health and well-being
                                   anytime, anywhere.

                                   With Pulse, Prudential is helping address the sizable and growing
                                   health protection gap, which is underpinned by escalating medical
                                   costs and a rise in chronic and non-communicable diseases. In 2017,
                                   this gap was US$1.8 trillion in Asia alone.14

                                   While insurers have traditionally solely focused on protecting
                                   customers, Pulse has enabled Prudential to provide more holistic
                                   support across the critical stages in a person’s health journey.
                                   Prudential believes that insurers can play a more preventive role
                                   alongside protection to address the growing health burden. With
                                   Pulse, Prudential will help users prevent, postpone and protect
                                   against the onset of diseases.

     14 https://www.swissre.com/institute/research/topics-and-risk-dialogues/economy-and-insurance-outlook/asia-health-protection-gap-report.html

     © The Economist Intelligence Unit Limited 2021
The Health of Asia Barometer:
               Health of Asia Barometer: Challenges and opportunities An
                                                                      for information
                                                                          health and well-being
                                                                                      challenge             20
                                                                                                            20

Within 15 months from launch, Pulse has been downloaded over 12
million times across 11 Asian markets.

Pulse provides users with access to a range of innovative solutions
from global and local partners. At the heart of the ecosystem is a
symptom checker - an AI-powered chatbot that provides users with
a better understanding of worrying symptoms and directs them to
healthcare professionals for further advice, and a health assessment,
which, based on a digital questionnaire, creates a health report with
insights into potential long-term disease risks represented through the
“Digital Twin”, a graphic representation of the human body.

Through Pulse, users can also do video consultations with board-
certified doctors who will provide a diagnosis and recommend the
appropriate treatment, whenever applicable. Users may also have their
prescribed medicine delivered or collect it at designated pharmacies.

Other key features include personalised wellness services, health
awareness content, a hospital navigator, as well as market-specific
solutions such as a dengue outbreak predictor and an air pollution index.

Pulse is an evolving platform where new partners, functionalities and
features will be added in phases. The ecosystem will over time feature
more value-added offerings to further support users’ health and
wellness journey.

                                                           © The Economist Intelligence Unit Limited 2021
21     Health of Asia Barometer: Challenges and opportunities for health and well-being

                                  While every effort has been taken to verify the accuracy of this
                                  information, The Economist Intelligence Unit Ltd. cannot accept any
                                  responsibility or liability for reliance by any person on this report or
                                  any of the information, opinions or conclusions set out in this report.
                                  The findings and views expressed in the report do not necessarily
                                  reflect the views of the sponsor.

     © The Economist Intelligence Unit Limited 2021
Health of Asia Barometer: Challenges and opportunities for health and well-being           23

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