Symposium addresses public health in Asia

The third annual Public Health in Asia Symposium on Saturday featured two keynote speakers, Norman Epstein and Paul Kadetz, who discussed the culture of mental health care and antimicrobial resistance in China. The Symposium also included research on South Korea’s universal health care system which was presented by graduate students from the School of Public Health and an undergraduate freshman.

Epstein, a professor at the University of Maryland School of Public Health, explained a study he performed on the state of mental health in China. As a family practitioner in China, Epstein explored how to best provide cognitive-behavior therapy to families there and took into account cultural differences between China and the West.

Epstein stressed that stigma surrounding mental illness is even greater in China than in the West. It not only affects individuals, but their families as well.

“The more a therapist displays empathy and warmth, the families do better. If you work on having effective family therapy in China, we have to take account the role of collectivism. We have to respect the role of respect and hierarchy in families,” he said.

Epstein argued that promoting dialogue between children and their parents requires a different approach in China than in most Western countries. He also stressed how important it is to involve grandparents in therapy sessions, something which is not usually accepted in the U.S.

“What’s really important is how you honor interactive communication rather than direct confrontation,” he said. “I remember having a meeting with some of my colleagues in China. What often happens in China is that if a family is uncomfortable telling a therapist they don’t like it, they don’t tell me. We have to have some way to put pressure on it and a way for people to quietly disagree.”

He also noted that negative body image is a significantly larger problem in Korea than in China or Japan. People often undergo plastic surgery, and Korea has the highest plastic surgery rate in the world.

According to the speakers, a second public health issue that will impact Asian countries in the future is antimicrobial resistance. Antibiotic-treated livestock is a large source of drug-resistant microbes, which then cycle through the environment to eventually reach humans.

Other contributing factors are the ease of obtaining over-the-counter antibiotics and a medical culture that dispenses antibiotics when they are not needed.

Kadetz, an associate professor of public health at Marshall University, stressed the potentially catastrophic impact of antimicrobial resistance. His presentation focused on tracing this resistance in rural China.

“This larger system of ecosystem problems that we don’t pay much attention to is really a major issue. In the resistance of Staphylococcus aureus or MRSA, during my time at Vanderbilt, we would see healthy people one day, and the next day they were dead,” he said. “This is an issue not just there, but this is an issue everywhere.”

According to Kadetz, resistant strains are twice as deadly as non-resistant strains. He said that by 2050, it is predicted that 10 million deaths will be caused by antimicrobial resistance. This will exceed the mortality rate of cancer worldwide. At the same time, it is becoming harder to discover new antibiotics.

Kadetz shared some of his observations while he was researching how Chinese pharmacies dispensed drugs.

“What we observed happening in pharmacies was a large number of people coming in and taking an antibiotics themselves or asking a pharmacy worker,” he said. “But we did not see trained pharmacy workers, and what they were telling people for duration and amount was not the same as on the package.”

Both modern and traditional medicines have been commercialized for customer demand, unregulated and free of expert advice. Kadetz explained that even doctors will give in to their patients’ demands.

“It’s a Western, commodified health care modeled in China,” he said. “People are not content unless they are treated, and there has been an uproar where physicians are being attacked. This is a result of patients not happy with their treatments. Very often, they give IVs of antibiotics regardless of whether an antibiotic is necessary.”

The Symposium ended with three presentations on the Korean healthcare system. South Korea implemented universal healthcare coverage in 1989, but this paradoxically resulted in equity problems because it grouped coverage based on geographic and economic factors.

Over the next 20 years, South Korea reformed its system to create a National Health Insurance Program, which covers about 50 percent of hospital costs and lesser amounts for other visits. An aging population and regional inequalities still strain the system.

Chair of the Public Health Symposium Committee Isabel Evans elaborated on how they chose this year’s topic.

“Our symposium chooses our topic by discussing what we believe are the most relevant and pressing themes in the field of public health in Asia. Then, we search relevant literature to find professors at nearby universities who we believe are conducting research that matches our theme,” she wrote in an email to The News-Letter.

Robin Yang, a parent of one of the organizing committee members, explained what she took away from the Symposium.

“It touched on many of topics that we don’t talk about among Asians, like seeking therapy is not very common among Asians. They talked about how seeing an expert versus attending a class will make a lot of difference,” she said. “I learned a lot of the differences between health services in the U.S., China and Korea.”