The Silent Health Crisis: Chronic Diseases and the Urgent Need to Reform Primary Care in East Asia

The World Bank’s A Healthy Future warns that East Asia and the Pacific is facing a growing epidemic of chronic diseases that is shortening healthy lives and threatening economic progress, despite major gains in life expectancy. It argues that stronger, prevention-focused primary health care is the most effective way to protect health, productivity, and long-term development.

A major World Bank study, "A Healthy Future: Primary Health Care and the Chronic Disease Epidemic in East Asia and the Pacific", based on research and data from institutions such as the World Health Organization (WHO), UNICEF, the Institute for Health Metrics and Evaluation (IHME), and national health systems across the region, argues that East Asia and the Pacific, long celebrated for turning better health into rapid economic growth, is now at a turning point. While people are living longer, many are spending more of those years in poor health, threatening productivity, public finances, and hard-won development gains.

Living Longer, But Not Healthier

Over the past few decades, the region has made remarkable progress. Life expectancy has risen sharply, and deaths among mothers and young children have fallen dramatically. These improvements helped fuel economic growth by building strong human capital. However, the report indicates that health-adjusted life expectancy has not kept pace with increasing life expectancy. People now spend more years living with illness or disability. This growing gap is driven mainly by noncommunicable diseases (NCDs) such as diabetes, high blood pressure, heart disease, cancer, and chronic respiratory illnesses. Once seen as problems of rich countries, these conditions are now widespread across low-, middle-, and high-income countries in East Asia and the Pacific.

Why Chronic Diseases Are Rising

The book explains that the surge in chronic disease is closely linked to big structural changes. Populations in this region are aging faster than anywhere else in the world, resulting in an increasing number of people living with multiple long-term conditions. Rapid urbanization has changed how people live and work, encouraging sedentary lifestyles and greater consumption of processed food, tobacco, and alcohol. Obesity and overweight rates have risen sharply, especially in Pacific island countries. Climate change adds further stress through extreme heat, air pollution, stronger storms, and disruptions to food systems, all of which worsen health outcomes. At the same time, deforestation and dense urban living increase the risk of new infectious diseases, as shown clearly during the COVID-19 pandemic. Together, these forces are reshaping health needs across the entire life cycle.

The Central Role of Primary Health Care

At the heart of the report is a strong message: primary health care (PHC) is the most effective response to this new health reality. PHC refers to the first level of care people turn to, local clinics, family doctors, and community health services that provide prevention, early diagnosis, treatment, and long-term management. The evidence reviewed in the book shows that strong PHC systems lead to lower death rates, fewer complications from chronic diseases, fewer hospital admissions, and lower overall health costs. Continuity of care, seeing the same provider over time, is especially important for managing lifelong conditions like diabetes and heart disease. PHC also promotes fairness by reaching rural areas and poorer communities and plays a crucial role during health emergencies, from disease surveillance to vaccination.

Why Primary Care Is Falling Short

Despite its promise, primary health care has not performed as well as it should in much of the region. Governments have often invested more in hospitals and specialized care, leaving primary care underfunded and understaffed. Many primary care facilities focus on treating illness after it appears rather than preventing disease or managing chronic conditions early. Quality is uneven, with weak diagnosis, inconsistent treatment, and limited follow-up. Health systems also tend to measure what is easy, such as buildings and equipment, rather than what truly matters, like patient outcomes. On the demand side, many people see primary care as low quality and delay seeking help or bypass it altogether, creating a cycle of low use and low investment.

A Clear Path for Reform

The report outlines a practical path forward. First, people need better information and incentives to adopt healthier lifestyles and seek preventive care, using tools such as digital reminders and screening programs. Second, primary care services must be strengthened through better-trained health workers, wider service packages, telemedicine, mobile clinics, and stronger links with hospitals. Third, quality must be improved by measuring outcomes, making performance information public, and rewarding good care through smarter payment systems. Finally, essential primary care services must be affordable, ideally free at the point of use, so that cost does not stop people from seeking care early.

In conclusion, the report warns that without reform, chronic diseases could undermine decades of progress. But it also shows that with strong political leadership and renewed investment in primary health care, East Asia and the Pacific can turn longer lives into healthier, more productive ones and secure the foundations of future growth.