In November, the leaders of 21 Asia-Pacific economies will meet in Honolulu for the annual Asia Pacific Economic Cooperation summit. Leading up to the meeting, the Star-Advertiser presents a monthly column of analysis on major issues in the region from experts at the East-West Center.

Like most of the world, Asia-Pacific nations face competing challenges as they plan health policies for the years ahead.

Outbreaks of new and re-emerging infectious diseases like SARS and avian flu have captured the headlines over the past decade, and most of these have emerged in Asia. Many are illnesses of both animals and humans, or zoonotic diseases.

These are indeed serious global threats that have arisen through a combination of population growth, deteriorating public health infrastructure, disturbed ecosystems, urbanization, globalization, increased air travel, more poultry and livestock, and more mixing of livestock and people.

The global public health community is implementing a number of novel programs to detect these disease threats, but they remain very real. In 2005, the World Health Organization adopted a long-awaited new set of international regulations, which should be fully functioning by 2012.

Regional cooperation is imperative and, with a few notable exceptions, it has been exemplary among APEC nations. The first priority of APEC’s Health Working Group is to enhance public health threat preparedness and response.

But the main causes of illness and death in most APEC nations, including the U.S., are non-communicable diseases like heart and respiratory disease, cancer and stroke.

These are due largely to aging populations and changing lifestyles, such as smoking (especially among men), changing diets and reduced activity levels.

Cancer was recently identified as the No. 1 cause of death in China. Smoking, air pollution and exposure to toxic chemicals have been cited as causes, but it is also because Chinese are living longer.

Obesity, including childhood obesity, is increasing not only in the United States but elsewhere in the region, contributing to chronic conditions such as diabetes, hypertension and heart disease.The APEC economies are far from homogeneous, and this includes their health risks.

While chronic diseases are becoming more prominent across the board, some countries are still plagued by decreasing but still relatively higher infant mortality rates, and persistent infectious and vector-borne diseases such as tuberculosis and malaria.

These countries are sometimes referred to as nations suffering from the "double burden of disease" — both infectious and chronic — or the "triple burden of disease," if deaths due to accidents are taken into account.

HIV/AIDS remains a serious threat in Asia and the Pacific, although it has not had the devastating impact there that it has in Sub-Saharan Africa. The nature of HIV/AIDS epidemics varies between countries and regions, due in part to cultural and socioeconomic differences. The HIV epidemics in Asia are more targeted on specific high risk groups: intravenous drug users, sex workers, and men who have sex with men.

TO HELP policymakers and health officials better understand these differences, the East-West Center in partnership with UN AIDS and other organizations has led modeling efforts that are employed not only in the region, but globally, to develop place-specific policy responses and interventions.

Asian economies like Japan, Singapore, South Korea and Taiwan have some of the lowest birthrates in the world. This has profound implications not only for their economies but also for each nation’s health profile, increasing the burden and cost of non-communicable disease. Leaders will have difficult choices to make in order to meet the health needs of their aging populations.

With a view to the future, longer-term goals for collaboration within the APEC region could include promoting a commitment to accessible primary health care coverage, a focus on prevention, fiscally responsible health insurance programs, enhancing the health workforce, and fully implementing the WHO’s International Health Regulations.

In March, the APEC Health Working Group met in Washington to address new priority areas. In addition to pandemic preparedness addressing infectious disease (including HIV/AIDS), the group identified high priorities on prevention of lifestyle- related diseases, using information technology to improve health outcomes, and strengthening the health system of each economy, including financing and human resources.

Such improvements in Asia-Pacific health systems are something worth encouraging, since a regional public health emergency could affect all of us, and healthy Asia-Pacific populations will benefit the region and the globe.