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A Happier, Healthier Society:
Public Health in the Republic of China (Taiwan)
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| A nutritious lunch is provided by the government to preschool earthquake victims in the aftermath of the September 21, 1999, temblor. (Photo by Huang Chung-hsin) |
The Constitution of the World Health Organization (WHO) states: "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." The Republic of China (ROC) on Taiwan affirms the dignity and worth of every person and the equal rights, equal duties, and shared responsibilities for the health of everyone. Taiwan is dedicated to the development of public health, a clean environment, and good health for all.
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| The ROC Department of Health sponsors various leisure-time activities to promote a healthy life. (Courtesy of the Department of Health) |
Public Health Indices
As health care and living standards have improved, the average life span in Taiwan has increased to 72.67 years for men and 78.44 for women. The crude death rate was 5.68/1000 in 2000, reduced by 6/1000 from 50 years ago. In the past, the ten leading causes of death were such acute diseases as gastritis, enteritis, and pneumonia. Today they are cancer, chronic diseases, and accidents. At the end of 2000, there were 18,082 hospitals and clinics in the Taiwan area, with a total of 126,476 beds and 159,212 medical personnel. Medical and health care expenses reached NT$525.3 billion, about 5.44 percent of the Gross Domestic Product.
Public Health Indices
As health care and living standards have improved, the average life span in Taiwan has increased to 72.67 years for men and 78.44 for women. The crude death rate was 5.68/1000 in 2000, reduced by 6/1000 from 50 years ago. In the past, the ten leading causes of death were such acute diseases as gastritis, enteritis, and pneumonia. Today they are cancer, chronic diseases, and accidents. At the end of 2000, there were 18,082 hospitals and clinics in the Taiwan area, with a total of 126,476 beds and 159,212 medical personnel. Medical and health care expenses reached NT$525.3 billion, about 5.44 percent of the Gross Domestic Product.
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Teaching hospitals in the ROC offer students hands-on training and invaluable clinical experiences. (Photo by Yeh Ming-yuan) |
Accomplishments in Disease Prevention
At the time Taiwan was returned to the ROC in 1945, a variety of epidemic diseases were prevalent, and the mortality rate was extremely high. The government adopted various preventive measures, which were a great success. Plague has not occurred since 1948, smallpox was eradicated in 1955, and rabies was eliminated in 1959. Consistent with the government's long-term efforts, malaria, the most prevalent disease in the early years after Taiwan was returned to the ROC, was finally rooted out in 1965. The WHO has officially certified Taiwan as malaria free. In 2000, the WHO announced that Taiwan was free of poliomyelitis.
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| Innovative medical equipment has made treatment in the ROC more efficient. (Photo by Yeh Ming-yuan) |
A high percentage of Taiwan's population is infected with hepatitis B or is a carrier. Beginning in 1984, newborn babies of those at high risk of hepatitis B were immunized. The immunization program was expanded to include children under the age of six in 1990 and under the age of 12 in 1993. After many years of hard work, the percentage of hepatitis B child carriers under the age of six was reduced from 10.5 in 1984 to 1.7 in 1998. It is expected to decrease to 0.1 percent in 2010. A research paper released by the National Taiwan University Hospital has stated that the number of children with hepatic cell cancer has decreased from 0.52 to 0.13 per 100,000 as a result of the hepatitis B immunization program. This success in hepatitis prevention has made Taiwan a primary example for other nations to follow.
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| To balance medical resources, free medical treatment is offered to people in the remote areas. (File photo of the GIO) |
Multifaceted Medical Care Network
To balance medical resources among different regions and improve medical personnel and efficiency, the ROC government launched the Establishment of a Medical Care Network project in 1985. Using the island's regions as basic units, the project manages medical manpower and facilities. A regional medical care network was established on a horizontal level, and a classification system of medical care was set up on a vertical level. By the end of 2000, there was one doctor for every 806 persons; and 43 emergency beds, 700 hospitals, and 17,000 clinics per 10,000 people, making medical care extremely convenient.
To meet today's medical needs, Taiwan will continue to develop its emergency care system, provide better medical care for the elderly, and improve medical facilities in remote areas. Future emphasis will include strengthening basic health care services, maximizing the efficiency of medical resource investment, effectively planning medical manpower, and supervising the quality of medical care.
The National Health Insurance Program
In March 1995, the ROC government launched the National Health Insurance (NHI) program to provide universal medical care in the Taiwan area. The program consolidated medical insurance coverage already provided by the original 13 public health insurance plans under different insurance systems. The NHI program also extended coverage to dependent children and the elderly, who require more medical care, and further benefited those suffering from serious illnesses with a partial payment exemption. By the end of 2000, over 96 percent of the total population were covered by the NHI program, 90 percent of the medical institutions in the Taiwan area had joined the program, and the satisfaction level of participants had reached 75 percent.
A New Era of Health Care
Taiwan has studied the health promotion efforts of the WHO in order to raise the health levels of its citizens. In addition to continuing traditional methods of educating the public about sanitation, the health sector will utilize the strength of local community health projects and will designate selected work places and schools as exemplary models. Reforms should start at the institutional level with better inter-ministerial cooperation. Strengthening the functions of communities and making a variety of resources available will help encourage widespread citizen participation in health promotion.
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| The 2001 anti-smoking campaign "Strike Back Against Tobacco" features superstar Jackie Chan. (Courtesy of the John Tung Foundation) |
Anti-smoking Campaign
To prevent tobacco-related health hazards, the Legislature passed the Tobacco Hazards Prevention Act in March 1997, effective September 1997. The law regulates the promotion and advertising of tobacco products, the mode of marketing and buyers, the age and place of smoking, health warnings (including amounts of nicotine and tar), stop-smoking counseling, and related education.
In 2001, the government brought together the John Tung Foundation, the American Cancer Society, and the Asia Pacific Association for the Control of Tobacco (APACT) in the transnational "Jackie Chan Rejects Smoking" campaign. The government also provided a series of promotional materials to 19 APACT members including Japan, South Korea, Thailand, and the United States. These were part of Taiwan's efforts in global anti-smoking activities.
Health is an issue that transcends all borders, and health care and the prevention of infectious diseases can be accomplished more effectively through international participation and cooperation.
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| Research and development is a major focus of the ROC food industry. (Photo by Huang Chung-hsin) |
Although Taiwan is not a member of the WHO, it upholds the spirit of the WHO Constitution and is dedicated to raising the health standards of its citizens. However, the absence of communication channels with the WHO has deprived Taiwan of assistance from the organization. This has severely complicated Taiwan's international efforts to ensure the health of its people.
Taiwan is intent on becoming a member of the WHO and exchanging experience and information with the rest of the world so that the people on Taiwan can enjoy better medical and health care services. Taiwan can then be free of the fear of being overlooked in the global campaign to prevent and control diseases. In this new century of transformation and challenges, Taiwan wants the opportunity to contribute to international health for the healthier and happier lives of everyone around the world.
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