Health in southeast Asia.

Neglect of human rights that compromises health outcomes, the combination of high population density and domestic livestock that encourages zoonoses, claims over viral sovereignty, and an emphasis on health tourism that creates dual standards of care: too often health in southeast Asia is in the news for the wrong reasons. Today’s Lancet reports good news from the region as well as disappointments, and provides opportunities to improve care locally by analysing how a variety of health systems in diff erent settings within the region are responding to rapid socioeconomic change and shifting threats to health. The six theme papers in the Series on health in southeast Asia show a range of responses to public health challenges, some of which might inform policy in other countries at similar stages of development. This is the fi rst Lancet Series to focus on a region. In doing so, health professionals from diff erent disciplines in the ten member countries of the Association of Southeast Asian Nations (ASEAN)—Brunei, Myanmar, Cambodia, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand, and Vietnam—collaborated to identify common themes and individual approaches to problems that challenge health systems locally and around the world. The strength of southeast Asia is its diversity: social, geographic, religious, and economic. But these same factors can also be weaknesses that limit intercountry cooperation on levels deeper than superfi cial selfinterest. Health care off ers a path to better mutual understanding by developing and sharing best practice and, as local capacity is developed (eg, the Mekong Basin Disease Surveillance Network), to forge more meaningful and substantial surveillance and clinical links between countries to improve health across the region. The Series addresses aspects of concern to all health systems: the burden of disease, prevention, and treatment; human resources for health; and fi nancing. Other topics were too controversial, for example, human rights. To advocate for health based on human rights was an agreed goal of WHO’s 6th Global Conference on Health Promotion, held in Bangkok, Thailand, in 2005. Human rights are also enshrined in the 2008 ASEAN charter, to which all ten countries in the Series subscribe. But they are too often absent in health and the social determinants of health in southeast Asia. For example: limited sanitation to marginalised rural ethnic minorities in Vietnam and discrimination against people with HIV/AIDS in Cambodia. Addressing the social determinants of health, such as sanitation, education, nutrition, and equitable access to care are fundamental to improving the health of the population. There are examples of hope. Six ASEAN countries— Cambodia, Indonesia, Laos, Philippines, Thailand, and Vietnam—are signatories to the International Covenant on Economic, Social and Cultural Rights, which forms a core for health-related rights. The Philippines and Vietnam recognise the right to health in their constitution. The Philippines also makes access to information a right in law (as does Thailand) and has legislated for access to essential medicines. Another marker of good practice is Malaysia’s charter for patients’ rights. In Myanmar, the release from prolonged house arrest of pro-democracy advocate Aung San Suu Kyi, as the Series went to press, may herald a change in attitude that could allow greater external collaboration to improve the country’s health performance. To establish a rights-based approach to health and improve health outcomes in southeast Asia requires not only political will and investment, but also leadership by health professionals. In doing so, health professionals must stand apart from the politics and narrow interests that have too often fettered, rather than fostered, progress in the region. This leadership needs to come from within the members of ASEAN, so that regional identity and focus is clear (by contrast to the WHO regions that subdivide southeast Asia). Until public health trumps private wealth, progress in health across the region will be disjointed and inequitable. Only by placing human rights at the heart of development will the right of the region’s 580 million people to the highest attainable standard of health begin to be realised.