Pakistan may be facing annual revenue losses of Rs. 30 billion (approximately $193.37 million) due to low taxes on the tobacco industry while the health of its youth is at stake, as claimed by the Asian Development Bank (ADB).
It stated in its report ‘Enhancing Regional Health Cooperation under CAREC 2030, A scoping study’ that Pakistan has a complex three-tier tax system that indirectly supports cigarette production and consumption, and the WHO has called upon the country to increase the tobacco taxation (currently at 60.3 percent) to 70 percent.
The report further stated that access to available, affordable, and quality medicines in the CAREC region remains challenging. In some countries such as Pakistan where the public procurement of medicines has been efficient in achieving low prices, the supply is insufficient to cover the needs of patients from government health facilities; and medicines in countries like Mongolia and Pakistan are much less affordable when purchased in the private sector.
HIV/AIDS is a major public health concern in the CAREC region, especially in Afghanistan, Pakistan, and the PRC. A broad range of risk factors and health determinants may have to be considered, including changing social norms, public education, migration, and unemployment.
The report noted that the 2018 United Nations human development index of these countries ranged from 0.496 for Afghanistan to 0.817 for Kazakhstan, while the inequality-adjusted human development index ranged from 0.386 for Pakistan to 0.759 for Kazakhstan. Meanwhile, gender equity continues to be a major challenge in the region, and the gender development index is low at 0.663 for Afghanistan and 0.747 for Pakistan.
Afghanistan and Pakistan are in the early stage of transition with a declining but high burden from infectious diseases and an increasing burden from the NCDs and accidents and injuries, which has resulted in a triple burden of disease for all the CAREC countries. While the burden of infectious diseases has declined substantially in most of the CAREC countries, all the countries need to continue investing in prevention, control, and treatment efforts to sustain the control of infectious diseases. Pakistan and the PRC also have significant mortality that is attributed to indoor and ambient air pollution.
The report further detailed that rabies, anthrax, brucellosis, leishmaniasis, and Crimean-Congo hemorrhagic fever are long-established zoonotic diseases of public health concern in Pakistan
The CAREC countries are also exposed to outbreaks of other communicable diseases that may spread regionally. Among the more acute infections that persist in Pakistan and the PRC are malaria, dengue, and Japanese encephalitis.
Hepatitis, and viral hepatitis B and C in particular, are highly prevalent in all the CAREC countries. The PRC (14 percent) and Pakistan (10 percent) account for almost a quarter of the hepatitis C (HCV) burden among the 28 countries accounting for 80 percent of the global HCV burden.
Pakistan and the PRC are on the WHO’s list of the top 30 countries with the highest estimated numbers of tuberculosis (TB) cases (PRC) and MDR-TB cases (Pakistan), while Azerbaijan, Kazakhstan, the Kyrgyz Republic, Tajikistan, and Uzbekistan have the highest MDR-TB burdens in the WHO European Region.
A prominent example in the CAREC region is the facility building and service improvement project along the China–Pakistan Economic Corridor (CPEC) — the China-Pakistan Fraternity Emergency Care Centre that was inaugurated in Pakistan’s port city of Gwadar in July 2017. It is the first facility (out of seven planned ones) under the China–Pakistan Life Rescue Corridor running along the CPEC from Gwadar to Kashgar, a PRC border city in the Xinjiang Uygur Autonomous Region more than 2,000 kilometers away.
Each center is planned to be established according to the model of a community hospital in the PRC, with medical personnel, medical and communication equipment, and an ambulance. It was built to provide medical services to the PRC workers along the CPEC. Prior to 2018, the ratio of patients from the PRC to the patients from Pakistan was 8:2. It has since reversed to 2:8.
As of 2020, the center was serving a population of 70,000 to 80,000, with the number of patients varying depending on the security situation. It had treated about 290 cases within the first two weeks of March 2019.
The trends in the total health expenditure as a percentage of the GDP show that most countries have either increased or maintained similar levels over the last decade. Pakistan has maintained a similar level at almost three percent, while Afghanistan has had small increases since 2009. On the other hand, Azerbaijan, the Kyrgyz Republic, and Tajikistan have shown the strongest growths.