A highly heterogeneous region, Asia has established itself as one of the most exciting and challenging markets across many industries, but particularly so for healthcare products and services. Beyond price affordability issues, logistical challenges, and the regulatory labyrinths, many parts of Asia are also plagued by cultural barriers, especially for women’s health management.
The lack of awareness and education the general public has about personal health management in Asia is compounded by the cultural issues with women being shy or embarrassed about their afflictions in a historically paternalistic/chauvinistic society that also views various female degenerative conditions as a normal consequence of aging with no further interest or action required. In order to overcome this challenge, community driven education programs about the illnesses and its treatment must be embarked upon to assist women so that they can become aware of the conditions and options and seek help, and to men as well so that they become more educated and accepting and when faced with these sensitive female health issues.
Other major issues in large countries like India, China, and in less developed countries such as Indonesia or the Philippines, is the accessibility to healthcare facilities that can offer the appropriate treatment in rural areas. The lack of facilities and trained doctors in rural areas often mean that patients travel long distances to the major cities of the country to get the appropriate treatment, likely a major financial burden to rural families. Large proportions of India, China, and Indonesia’s population still live in poverty or below the middle class income level and hence cannot afford the appropriate treatment even if they are aware of it. In order to make such treatments more accessible and affordable to these populations, private and public health systems with both infrastructure investments along with subsidized reimbursement for underprivileged people must be encouraged as a priority.
We investigated some of the top surgical and treatment procedures used to treat urinary incontinence, a predominantly female affliction, affecting women across various Asian countries to attempt to uncover the trends and key differences across Asia. The image below labelled Fig. 3. illustrates the various varying symptoms of pelvic prolapse and urinary incontinence. Perhaps understanding the way sufferers behave and their pathway to seek diagnosis and treatment could be a key to reach out to greater population.
The chart labelled Fig. 1 below illustrates our results specifically for surgical procedures involving women’s health management particularly for the treatment of urinary incontinence and pelvic prolapses. These surgeries are often used to treat vaginal prolapse involving risk factors such as by multiple child births, menopause, or hysterectomy.
In countries such as China, India, and South Korea, suspension and cystocele/rectocele repair procedures take up the greatest percentage of surgeries performed to treat incontinence and prolapse as compared to the other surgical options. These are two late stage procedures and are suggestive that patients are presenting later in the course of their suffering. Another potential more complex consideration, though one not likely to be prominently discussed is physician remuneration and it’s potential distorting effects of the procedure selected vis-a-vis the status of the patient’s condition.
It is also apparent that China performs more repair and suspension procedures, in absolute numbers, compared to India. However the female population in India should have a higher incidence rate of these conditions affecting women than China due to the much higher child birth rates, especially with China’s one-child-policy over the past decades. This suggests that a majority of Indian women suffering from the condition either do not seek treatment or lack access to treatment for vaginal collapse.
A further analysis illustrated by the following chart labelled Fig. 2 assesses the procedure volume vs. total women population in each country, a compounded indicator of possibly, disease incidence, diagnosis efficiency, and access to medical facilities and treatment.
Although a quick initial assessment of the procedure volumes index may lead us to believe that South Korea, could potentially have a much higher incidence of prolapses and urinary incontinence, the large procedure volumes as a percentage of total female population in South Korea more likely suggests a higher level of acceptance and awareness of the affliction and related treatments consistent with much greater developed economy. Attempted verification with key opinion leaders in the countries also noted that disease incidences for women’s health issues across countries, though not well documented, are unlikely to be substantially different due to similar ethnographic, genetic, and perhaps even lifestyle habits. This is particularly seen between China and South Korea.
Thus, though not overly conclusive, we can hypothesize that the differences we see in the charts are largely due to the cultural issues possibly patients’ embarrassment of their condition compounded by the lack of awareness as well as the level of economic development and education within a nation. These findings are even more pronounced in rural areas, where the afflictions are often diagnosed only in the late stages. The acuteness and severity of the conditions also affects the patients’ decisions to take action on seeking help or treatment, leading many ill-informed patients to accept their condition as a norm of aging until the condition is intolerable.
In order to solve these challenges, government, local communities, and especially the medical communities advocating for their patients, will have to work together, ultimately through public education. Everyone benefits as effective diagnosis and treatments in the early stages of disorders such as pelvic prolapses may more effectively prevent and manage very difficult and potentially embarrassing symptoms for the female patients involved (and their families) and is ultimately more cost effective than subsidizing high surgical procedure costs for late stage prolapses.
Tej Deol, M.D.