In recent years, chronic diseases have gradually overtaken infectious diseases as the most common causes of death. Fast-food culture is lowering the age at which people are affected by metabolic disorders and obesity has become one of the most important causes of death.
In promoting public health, the National Health Insurance (NHI) program excessively over-emphasizes clinical treatment, while paying scant attention to prevention. The result is Taiwanese have grown accustomed to visiting hospitals for every problem, big or small, even visiting multiple hospitals for the same illness. Taiwanese also have a bad habit of taking lots of supplements and tonics, which can damage the kidneys, thus making an extraordinarily high number of people dependent on renal dialysis. People have forgotten that exercise is the most effective and cheapest kind of medicine.
The nation’s biggest health problem is that a far lower proportion of young and middle-aged people are in the habit of taking regular exercise compared with their counterparts in advanced European and American countries. Furthermore, physical education classes in high schools are often canceled and replaced by classes in exam subjects. Many college students who would like to take physical exercise classes find that there are few available.
Meanwhile, workers suffer harsh conditions under a market-driven economy. Many employees are so overworked that they have no time or energy left for exercise. This widespread lack of physical exercise is becoming a long-term crisis for the economy.
Government officials should change Taiwan so that it becomes known as a place where everyone takes part in sports and fitness activities.
First, the Executive Yuan should promote popular participation in sports and fitness. By encouraging businesses to gradually reduce working hours and set up sports and fitness clubs, employees could get regular exercise. County and city governments should organize sport-related competitions and social activities at weekends. Time should be set aside for civil servants to do fitness activities, just as hours are allocated for mandatory education and training.
The availability of physical education and students’ levels of physical fitness should be included in the assessment criteria for schools. The business world must get used to the idea that workers are an important asset, and firms should provide motivation and facilities for employees to take exercise.
Second, the Department of Health (DOH), should adjust NHI payouts to provide incentives based on improvement in patients’ health. Health indices integrated with medical information systems can be used to determine payments based on health outcomes rather than the number of patients seen. This would help cut the NHI’s expenditure as the second-generation NHI program comes into operation.
Third, when the proposed Ministry of Health and Welfare is eventually established, the existing Bureau of Health Promotion and the Taiwan Centers for Disease Control should be combined. Like the US Centers for Disease Control and Prevention, the amalgamated bureau could integrate management of infectious and chronic diseases for more effective prevention. After all, metabolic disorders are an important cause of death for people suffering from infectious diseases, such as influenza and dengue hemorrhagic fever. This kind of integration would be of considerable benefit in improving the health of Taiwanese.
Health is our single most precious asset. Hopefully, Taiwan can serve as a successful model for advocating exercise for all citizens and promoting health for all in Asia.
King Chwan-chuen is a professor in the college of public health at National Taiwan University.
Translated by Julian Clegg