Life expectancy at birth continues to increase remarkably in Asia-Pacific, reflecting sharp reductions in mortality rates at all ages, particularly among infants and children (see indicators “Infant mortality” and “Under age 5 mortality” in Chapter 3). These gains in longevity can be attributed to a number of factors, including rising living standards, better nutrition and improved drinking water and sanitation facilities (see indicator “Water and sanitation” in Chapter 4). Improved lifestyles, better education and enhanced access to health care also play an important role (WHO; US National Institute on Aging; National Institutes of Health;, 2011[1]). The large decline in under age 5 mortality, which reflects important commitment and investment at local, national, and global levels over several decades, is another major drive of the increase of life expectancy (Dicker et al., 2018[2]).

Neonatal mortality, deaths in children within 28 days of birth, encompasses the effect of socio-economic and environmental factors on new-borns and mothers, and also the capacities and responsiveness of national health systems.

Infant mortality reflects the effect of social, economic and environmental factors on infants and mothers, as well as the effectiveness of national health systems.

The under age 5 mortality rate is an indicator of child health as well as the overall development and well-being of a population. As part of their Sustainable Development Goals, the United Nations has set a target of reducing under age 5 mortality to at least as low as 25 per 1 000 live births by 2030 (United Nations, 2015[8]).

The burden from non-communicable diseases among adults – the most economically productive age group – is rapidly increasing in Asia-Pacific. Increasing development in countries and territories is bringing an “epidemiological transition”, whereby early deaths are replaced by late deaths, and communicable diseases by non-communicable diseases (Omran AR, 2005[11]). The level of adult mortality, all-cause mortality for the population and cause of death are important for identifying the country’s public health priorities and assessing the effectiveness of a country’s health system.

Cardiovascular disease (CVD) is the leading cause of death in Asia-Pacific, although highly preventable. CVD was the cause of an estimated 9.4 million deaths in SEARO and WPRO and accounted for one‑third of all deaths in 2016 in these regions (https://www.who.int/data/gho).

Cancer is the second leading cause of death after CVD in the Asia-Pacific region. Cancer was the cause of an estimated 4.5 million deaths (or 16.3% of total deaths) in Asia-Pacific in 2016 (https://www.who.int/data/gho).

Injuries are a leading cause of death and disability for all age groups and took 2.3 million lives in 2016 in WPRO and SEARO, accounting for 8.6% of all deaths in these regions. Injuries can result from traffic collisions, drowning, poisoning, falls or burns, and violence from assault, self-inflicted or acts or war. The magnitude of the problem varies considerably across countries and territories by cause, age, sex, and income group. However, injury deaths, both intentional and unintentional, are largely preventable events.

Pregnancy and childbearing, whilst offering women opportunities for personal development and fulfilment, also present inherent risks. Maternal mortality is an important indicator of a woman’s health and status. The Sustainable Development Goals set a target of reducing the maternal mortality ratio to less than 70 deaths per 100 000 live births by 2030.

Tuberculosis (TB) is the leading cause of death from an infectious disease in Asia-Pacific. In 2018, there were 10 million incident (new and relapsed) TB cases worldwide, 1.2 million deaths among HIV-negative people globally. More than 40% of new cases and almost half of deaths were estimated in India, Indonesia and Pakistan alone. Most of these TB cases and deaths occur disproportionately among men, but the burden of disease among women is also high as it remains among the top three killers for them in the world. Most cases of TB are curable if diagnosed early and the right treatment is provided – such as first-line antibiotics for 6 months -, therefore curtailing onward transmission of infection (WHO, 2019[26]).

Although the first cases of AIDS in Asia were reported mid‑1980s, the more extensive spread of HIV began late compared with the rest of the world, occurring in Cambodia, India, Myanmar and Thailand in the early 1990s (Ruxrungtham, Brown and Phanuphak, 2004[29]; UNAIDS, 2013[30]). Asia is second only to sub-Saharan Africa as the region with the greatest number of people with HIV. The UN set a SDG target to end the epidemic of AIDS as a public threat by 2030.

Malaria is a tropical disease caused by a parasite transmitted by the bites of infected female Anopheles mosquitoes. After a period spent in the liver, malaria parasites multiply within red blood cells, causing symptoms such as fever, headache and vomiting. Malaria is preventable and curable, although no vaccine currently exists (a vaccine against falciparum is currently being trailed in Africa though). If left untreated, malaria can become life-threatening by disrupting the blood supply to vital organs.

Diabetes is a chronic metabolic disease, characterised by high levels of glucose in the blood. It occurs either because the pancreas stops producing the hormone insulin (type 1 diabetes, insulin-dependent diabetes, genetic predisposition), which regulates blood sugar, or through a reduced ability to produce insulin (type 2 diabetes, non-insulin dependent, lifestyle related), or through reduced ability to respond to insulin (i.e. insulin resistance). People with diabetes are at a greater risk of developing cardiovascular diseases such as heart attack and stroke. They also have elevated risks for vision loss, foot and leg amputation due to damage to nerves and blood vessels, and renal failure requiring dialysis or transplantation.

Population ageing is characterised by a rise in the share of the older people resulting from longer life expectancy (see indicator “Life expectancy at birth and survival rate to age 65” in Chapter 3) and declining fertility rates. In Asia-Pacific countries, since 2000, life expectancy has increased by about 6 years in low and lower-middle income countries and by 4 years in upper-middle and high income counties. During the same period, fertility has decreased from 2.6 children per woman of reproductive age, to the population replacement level of 2.1. This has been mainly due to better access to reproductive health care, primarily a wider use of contraceptives (see indicator “Family planning” in Chapter 4). Population ageing reflects the success of health and development policies over the last few decades.