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Public Health. ROC (Taiwan) Yearbook 2011 Ch14 public health


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From the last edition of the ROC (Taiwan) Yearbook that used to be published by the disbanded Government Information Office (GIO).

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Public Health. ROC (Taiwan) Yearbook 2011 Ch14 public health

  1. 1. A surgical team at the Far Eastern Memorial Hospital in New Taipei City prepares to insert a stent into a patient’s narrowed coronary artery. Most of the expenses for this procedure will be covered by Taiwan’s National Health Insurance program.14五校OK(spelling and indexed).indd 190 2011/10/18 3:19:05 AM
  2. 2. 14 Public Health At a Glance • Reforms to national health insurance • Disease prevention and control • Health work in the world community T he Republic of China’s National Health Insurance system provides high-quality, affordable health care to virtually all citizens. Since the government-administered system was launched in 1995, overall health levels have improved, and life expectancy has risen. Notwithstanding its success, the system is facing challenges of an aging population and rising costs. In January 2011, a “second-generation” insurance program was approved by the Legislature to shore up the sys- tem’s finances and administrative efficiency so that it can be sustained into the future while providing higher-quality services. At the international level, Taiwan’s participation in recent annual meet- ings of the World Health Assembly has enabled it to better safeguard the welfare of its 23 million citizens and share its considerable health resources with the global community. Taiwan’s governmental and non- governmental organizations, meanwhile, continue to send medical mis- sions to other countries to improve the levels of public health there. 19114五校OK(spelling and indexed).indd 191 2011/10/18 3:19:10 AM
  3. 3. 14 Health Indices Public Health communicable diseases as the major se- rious illnesses among adults. Air pollu- The overall health of Taiwan’s people tion and other factors, apparently, have has improved considerably over the past led to higher rates of lung cancer among several decades, with a steady rise in the both men and women, especially in standard of living and advances in the urban areas. Early detection and screen- health and medical sciences. Between ing, however, have reduced the associ- 2000 and 2010, the neonatal (0-4 weeks) ated rates of death and disability. mortality rate declined from 3.4 per In 2010, the 10 leading causes of 1,000 live births to 2.6 per 1,000, while death in Taiwan accounted for 75.4 per- the infant (0-1 year) mortality rate fell from 5.9 per 1,000 live births to 4.2 per cent of all deaths. Malignant tumors have 1,000. Over the same period, average life remained the No. 1 killer for 29 consecu- expectancy rose from 73.8 to 76.2 years tive years, causing 28.4 percent of all for males, and from 79.6 to 82.7 years for deaths in 2010. Suicides dropped off the females. This increase has led to a cor- Top 10 list for the first time since 1997, responding growth of the population aged while hypertensive illnesses made the list 65 and above from 8.6 to 10.7 percent of for the first time, coming in at No. 9 in the total. Health spending as a share of 2010. (See chart “Causes of Death.”) gross domestic product rose to 6.9 per- cent in 2009 while spending per capita was US$1,126. National Health Insurance Rising living standards and chang- Taiwan’s public health care system, ing lifestyles have given rise to a new the National Health Insurance (NHI) 全 set of health challenges. Chronic car- 民健康保險 program, has been touted diovascular diseases have replaced worldwide for providing equal access to Life Expectancy Age 83 82 81 80 79 78 77 76 75 74 73 72 71 70 69 80 82 84 86 88 90 92 94 96 98 00 02 04 06 08 10 Female Male Source: Department of Health 19214五校OK(spelling and indexed).indd 192 2011/10/18 3:19:10 AM
  4. 4. Causes of Death 180 170 160 150 140 Death rate per 100,000 population 130 120 110 100 90 80 70 60 50 40 30 20 10 0 86 88 90 92 94 96 98 00 02 04 06 08 10 Malignant tumors Diabetes Heart disease Accidents Cerebrovascular disease Tuberculosis Source: Department of Health quality health care for virtually all citi- rehabilitation and chronic mental illness zens. Prior to 1995, a total of 13 different care, among other services. Most forms of public health insurance plans covered treatment, including surgery, are covered only 59 percent of Taiwan’s population. by the system, as well as examinations, To provide efficient, universal health care laboratory tests, prescription medication, and rein in costs, the NHI program was medical materials and paraphernalia, lim- launched in 1995. All citizens and foreign ited home nursing care and certain over- residents who have lived in Taiwan for at the-counter drugs. least four months are required to enroll. Currently, over 99 percent of ROC na- Premiums and Copayments tionals are covered by the program, and more than 80 percent of the public have The NHI system is largely premium- consistently expressed satisfaction with financed, with the basic premium rate the system. currently set at 5.17 percent of salary in- come. Of that amount, the employee pays 30 percent, while the employer and the Services central government pay 60 percent and 10 The NHI system provides comprehen- percent, respectively. Premiums for low- sive and uniform benefits to all covered income households are covered by the by the program. The insured have access central government, while subsidies or to more than 18,000 contracted health interest-free loans to cover premiums are care facilities around the country provid- provided to other disadvantaged groups, ing inpatient and ambulatory care, dental including certain rural residents, indig- services, traditional Chinese medicine enous people and low-income groups. therapies, obstetric services, physical Government funding comes mainly from 19314五校OK(spelling and indexed).indd 193 2011/10/18 3:19:10 AM
  5. 5. 14 Public Health the tobacco health and welfare surcharge (see “Tobacco Hazards Control” section) heavier penalties for fraudulent claims, counseling persons who visit hospitals ex- and lottery proceeds. cessively, and allocating medical resources The insured have complete freedom more effectively. of choice of medical service providers. The new system will be implemented To access any NHI-contracted medical following amendments to related laws facility or pharmacy in Taiwan, patients and regulations. Meanwhile, health are required to make a copayment and agencies and hospitals across the country pay a small registration fee. For outpa- will work to inform the public on forth- tient services, copayments start at NT$50 coming reforms. (US$1.69) for a visit to a clinic. Copay- ments for prescription medication are capped at NT$200 (US$6.77) per visit. Medical Care System As to inpatient care, a progressive rate applies, depending on the intensity of Personnel care and length of stay. To ease the finan- As of 2010, nearly 205,000 medical cial burden of patients, copayments for professionals were working in Taiwan. hospital stays are capped at NT$47,000 There were 19.08 physicians (including (US$1,593) per condition over the entire physicians of Chinese medicine) and 5.03 calendar year. dentists per 10,000 people. To control the quality of medical practice, Taiwan limits NHI Reform the number of new doctors entering the system to 1,300 per year. After qualifying, Since the implementation of the NHI new doctors are licensed as specialists program in 1995, the premium rate has in one of 26 categories; further periodic been adjusted twice, in 2002 and 2010, training is required to renew licenses. to cover rising costs. Still, NHI finances Higher salaries and transportation continue to face strains from Taiwan’s subsidies are offered to attract doctors and graying population, costly new drugs and nurses to rural or remote areas and ensure treatments, as well as lifetime coverage that a high standard of medical service is for chronic illness, rare diseases and se- available to all citizens. The Department vere disabilities. of Health (DOH) 行政院衛生署 also runs a To improve the efficiency of the sys- sponsorship program for medical students tem while enhancing equity and quality in who agree to serve in outlying islands, ru- health care, the National Health Insurance ral and mountainous areas or other desig- Act 全民健保法 was amended in January nated areas for six years after graduation. 2011. Under the “Second-generation NHI” From 1975 through June 2011, a total of system, a 2-percent supplementary pre- 6,170 students completed post-graduate mium charge will be placed on non-payroll training under this program. income from stock dividends, interest earnings, rental income, professional prac- tice income and bonuses exceeding four Medical Facilities months’ salary. The basic premium rate In 2010, there were 508 hospitals and will be lowered, meanwhile, reducing the 20,183 clinics operating in Taiwan. These burden for around 83 percent of the popu- included 82 public hospitals and 461 lation while 17 percent will pay more in public clinics. Medical institutions had a supplementary premiums. Measures will total of 158,922 beds, or 68.61 beds per also be taken to reduce waste by imposing 10,000 people. 19414五校OK(spelling and indexed).indd 194 2011/10/18 3:19:11 AM
  6. 6. Hospitals receive accreditation from Health Concerns and the DOH for either three or four years, based on quality of medical service, per- Health Promotion sonnel, facilities, management and com- Cancer Control munity services. Clinics are not subject to accreditation reviews. Cancer has been the leading cause of death in Taiwan since 1982. According to the Cancer Registry Annual Report, 2008 Industry Trends (Taiwan) 中華民國97年癌症登記報告, 79,818 In 2009, the four-year Health Care new cases of cancer (excluding carci- Value-added Platinum Program 健康照 noma in situ) were reported in that year, 護升值白金方案 was launched to promote with crude incidence rates for men and development of various segments of the women rising to 389 and 304 per 100,000 health care industry. Focuses of atten- persons, respectively. In 2010, liver, lung, tion include long-term care, “intelligent” colorectal, oral and esophageal cancer medical services, marketing Taiwan as a were the leading causes of death from superior destination for medical tourism cancer for men; while lung, liver, colorec- and biopharmaceutical manufacturing. tal, breast and gastric cancer remained the The program calls for an investment of top causes for women. NT$59.6 billion (US$1.8 billion) to boost The DOH drew up the National Five- output value by around NT$95.3 billion year Cancer Prevention Program 國家癌症 (US$2.9 billion) and create nearly 60,000 防治五年計畫 in 2005 as a working guide- jobs by 2012. line for lowering incidence and mortality National Health Expenditure US$ % 1,500 7.0 6.4 6.9 6.2 6.3 6.5 1,300 6.2 6.2 6.1 6.0 5.9 6.0 1,129 1,126 5.6 5.5 1,100 1,031 1,056 1,002 5.5 931 900 847 5.0 813 799 760 773 4.5 700 4.0 500 3.5 300 3.0 99 00 01 02 03 04 05 06 07 08 09 Health expenditure per capita Health expenditure as percent of GDP Source: Directorate-General of Budget, Accounting and Statistics, Executive Yuan 19514五校OK(spelling and indexed).indd 195 2011/10/18 3:19:11 AM
  7. 7. 14 Public Health rates through education, free screening services, enhanced diagnosis and treat- areas such as workplaces shared by three or more persons, karaoke lounges, res- ment, and hospice and palliative care. The taurants and Internet cafes, as well as in second phase of the program (2010-2013) outdoor public areas such as those close aims to reduce mortality rates by focusing to the entrances of railway stations and on cancer screening (see table “National medical institutions. The amended act Cancer Screening Objectives”). also increased the health and welfare sur- In 2005, the DOH established the charge on cigarettes to NT$20 (US$0.61) Cancer Care Quality Assurance Measures per standard pack. Revenue from this 癌症診療品質保證措施準則, which provide surcharge goes into the NHI reserve fund, hospitals with guidelines as well as sub- which is used to subsidize NHI premi- sidies for upgrading their cancer care ums for the economically disadvantaged, services. And in 2008, it implemented as well as to support smoking cessation a system for assessing and certifying courses, tobacco hazard awareness cam- the quality of hospitals’ screening, di- paigns, and improvement of public health agnostic and treatment services. A list- and medical care. ing of accredited institutions—41 as of Wide-ranging efforts were made mid-2011— is available online. during 2010 to discourage tobacco use: The DOH also encourages cancer pa- 370,000 public places were inspected by tients to seek hospice care. At the end of health authorities for compliance with 2010, there were 39, 64 and 65 hospitals non-smoking regulations; 1,866 contract- respectively providing inpatient hospice ed medical institutes operated smoking care, hospice home care and hospice cessation clinics; 27,000 medical person- shared care. nel completed training as counselors, more than twice as many as in recent Tobacco Hazards Control years; a toll-free counseling hotline for In recent years, the public and the pri- quitting fielded 89,000 calls; 1.4 million vate sectors have adopted a strict stance booklets were distributed to encourage on controlling tobacco hazards. Amend- smokers to access quitting services, in ments to the Tobacco Hazards Prevention response to which 730,000 people sub- Act 菸害防制法, which came into effect in mitted requests for assistance. January 2009, helped lower smoking rates By the end of 2010, the second- and minimize exposure to secondhand hand smoking exposure rate in public smoke by prohibiting smoking in indoor venues had dropped to 9.1 percent from National Cancer Screening Objectives 2009 Actual 2013 Target Screening Group Screening Rate Screening Rate (%) (%) Pap smear Women 30-69 58 70 Mammography Women 45-69 11 30 Betel quid chewers and Oral inspection 28 50 smokers, 30 and above Fecal occult blood test People 50-69 10 50 Source: Department of Health 19614五校OK(spelling and indexed).indd 196 2011/10/18 3:19:11 AM
  8. 8. Myozyme is used to treat Pompe disease, a rare disorder that disables the heart and muscles. In Taiwan, patients with rare diseases are guaranteed treatment and receive subsidies for the costs of diagnosis, pharmaceuticals and special nutrients. 23.7 percent in 2008. The smoking rate Long-term Care among adult men also dropped steadily to Taiwan’s aging population, longer 35 percent in 2010 from 42.9 percent in life expectancy and changes in disease 2004, while the rate among adult women patterns have increased the need for declined to 4.1 percent from 4.6 percent. long-term care. As of 2010, 10.7 per- cent of the population was aged 65 and Rare Diseases over. By 2025, Taiwan’s senior citizens Special efforts have been made are expected to account for one-fifth of to address rare diseases that are life- the total population, making Taiwan a threatening or chronically debilitating. “super-aged” society as defined by the In addition to ensuring the availability United Nations. of comprehensive health care through In response to this trend, in 2007 the the NHI system, in cases where ex- Executive Yuan launched the National penses are not covered under the Na- 10-year Long-term Care Plan 我國長期照 tional Health Insurance Act, the DOH 顧十年計畫 with a budget of NT$81.7 bil- subsidizes costs of diagnosis, treatment, lion (US$2.49 billion). Under the plan, pharmaceuticals and special nutrients subsidies are available for four groups for patients with rare diseases under the of people who need assistance in their Rare Disease and Orphan Drug Act 罕 daily lives because of functional disorder: 見疾病防治及藥物法. The ROC is the fifth people over 65 years of age, indigenous country in the world to have passed people over 55 in mountainous areas, legislation ensuring that those with rare handicapped people over 50, and elderly diseases receive treatment. It also main- people living alone who need help with tains a supply center for nutrients and “instrumental activities of daily living.” so-called orphan drugs specially formu- Under the plan, subsidies cover home lated for treatment of rare diseases and nursing care and rehabilitation, purchase subsidizes laboratory testing in partner- or rental of equipment, improvement of ship with other nations. home living environments, as well as 19714五校OK(spelling and indexed).indd 197 2011/10/18 3:19:16 AM
  9. 9. 14 Public Health meals, transportation, respite care and other institutional services. Such subsi- Communicable Diseases dies range from 70 to 100 percent, based Prevention and control of infectious on level of disability and family income. diseases has improved greatly in Taiwan Between 2007 and 2010, approximately in recent decades. Considerable efforts 70,000 persons received assistance, most- have been made to implement the Interna- ly relating to home care and respite care. tional Health Regulations adopted by the To provide accessible, affordable and World Health Organization (WHO). The quality long-term care, the DOH is creat- Communicable Disease Control Act 傳染 病防治法 has been amended to strengthen ing a Long-Term Care Service Network 長期照護服務網計畫 for the purposes of es- Taiwan’s emergency response capability. tablishing long-term care institutions, en- Several systems, including the Real-time suring quality control, training personnel Outbreak and Disease Surveillance Sys- and developing resources in rural areas. tem 即時疫情監視及預警系統, the School- based Surveillance System 學校傳染病監視 As of mid-2011, a draft Long-term 通報資訊系統 and the National Nosocomial Care Services Act 長期照護服務法草案 was Infections Surveillance System 院內感 under legislative review. A long-term care 染監視通報系統, have been established insurance bill 長期照護保險法草案 is also to collect timely, complete and precise expected to be enacted in the near future. information on infectious diseases. In addition to this integrated network that Community Health is instrumental in controlling commu- In order to encourage healthier life- nicable diseases, Taiwan’s Centers for styles, the DOH promotes the “ten thousand Disease Control (CDC) 行政院衛生署疾病 steps a day” concept and has designated 管制局 has been working in collaboration November 11 as National Walking Day. with medical care and academic research Related activities are held all across institutes to better understand epidemic Taiwan. Information on walking and bik- conditions and formulate prevention and ing trails (see Chapter 18, “Tourism”) is control measures. available online. Surveys indicate that walking is the favorite exercise of over 40 Tuberculosis percent of physically active adults. Decades ago, tuberculosis (TB) had Under the Community Health Build- one of the highest incidences of commu- ing Program 社區健康營造計畫 launched nicable diseases in Taiwan, amounting to by the Bureau of Health Promotion 行政 many hundreds or thousands of persons 院衛生署國民健康局, communities around per 100,000 population. By the end of Taiwan receive subsidies for creating 2010, the incidence of TB had dropped healthy, supportive environments, while to 57 persons per 100,000 population— residents are encouraged to participate in about 13,200 out of a population of over that process. The program allows health 23 million. professionals to work alongside resi- In step with the WHO’s Global Plan dents and bring their resources together to Stop TB, Taiwan’s CDC in 2006 to address community health issues such launched a mobilization program to halve as healthier diets, physical fitness and TB incidence by 2015. The program fo- activities, smoke-free and betel-nut-free cuses on early detection of TB infection environments, healthy aging, community cases and efficient provision of compre- safety and cancer screenings. hensive medical care. Its key approach to 19814五校OK(spelling and indexed).indd 198 2011/10/18 3:19:17 AM
  10. 10. eradication of TB is the DOTS (Directly had reached 20,801, of whom 20,057 were Observed Treatment, Short-course) strat- ROC nationals. egy, whereby social workers regularly In reported cases of infection among visit TB patients and make sure they take ROC nationals, approximately 66 percent prescribed medication on schedule. contracted the virus through sexual con- Indicative of progress in the anti-TB tact and 32 percent through injecting drug mobilization program, the aforementioned use (IDU). Of the 1,679 new infections in incidence of TB cases in 2010 repre- 2010, nearly 71 percent occurred among sented a decline of 22 percent from 2006 men who have sex with men (MSM) when the program was launched. During and 16 percent occurred through sexual that period, moreover, the TB mortality contact between men and women. To pro- rate declined by 30 percent, causing the mote safe sex, the DOH has implemented disease to fall from 13th to 17th place in aggressive programs that include the 2010 as the leading cause of death. dissemination of innovative educational materials, establishment of a dedicated Hepatitis information website, and provision of free Hepatitis B and hepatitis C virus counseling and medical services at com- infections are a major cause of liver ail- munity health centers. Meanwhile, new ments such as cirrhosis and hepatoma, infections through IDU dropped from a together constituting the No. 8 leading high of 72 percent in 2005 to 6 percent cause of death. In Taiwan, 15 to 20 per- in 2010, thanks to a harm reduction plan cent of adults are carriers of the hepatitis implemented in 2008 covering needle- B virus, and nearly 4 percent of those syringe programs, drug substitution treat- over 15 are infected with hepatitis C. ment, as well as information, education Prenatal testing for hepatitis B and and communication strategies. immunization of newborn babies have The HIV Infection Control and Patient greatly reduced the percentage of hepa- Rights Protection Act 人類免疫缺乏病毒傳 titis B carriers among 6-year-olds, from 染防治及感染者權益保障條例 was enacted a high of 10.5 percent in 1989 to 0.8 in 1990 to protect the rights and privacy percent in 2010. Catch-up immunization of persons infected with HIV and require is provided for children at the time of medical institutions to provide care with- initial enrollment in preschool and el- out discrimination. ementary school. Free immunization against hepatitis A A(H1N1) Influenza has virtually eradicated the disease from Taiwan’s success in controlling the indigenous communities in remote moun- 2009 novel influenza A(H1N1) pandemic tain areas, compared with an incidence can be largely attributed to effective imple- rate of 90.7 per 100,000 people in 1995. mentation of the National Influenza Pan- demic Preparedness Plan 因應流感大流行準 HIV/AIDS 備計畫, a comprehensive response program Since the first case of AIDS (acquired that includes border control, a well-knit immune deficiency syndrome) in Taiwan disease surveillance network, temporary appeared in 1984, the number of reported school suspension policies, public health HIV (human immunodeficiency virus) education campaigns and immunization. infections has increased gradually. As of After obtaining H1N1 virus stock, the end of 2010, the cumulative number a government-invested firm in Taiwan, 19914五校OK(spelling and indexed).indd 199 2011/10/18 3:19:17 AM
  11. 11. 14 司, Public Health Adimmune Corp. 國光生物科技股份有限公 produced its own vaccine in October was up from a total of 1,052 cases (204 foreign-origin) in 2009 and 714 cases (226 2009. The subsequently launched H1N1 foreign-origin) in 2008, yet much lower immunization program, using vaccines than the 2,179 (179 foreign-origin) cases made by Adimmune and Switzerland’s in 2007. Novartis International, was the largest- scale such program in Taiwan’s history. Enterovirus By April 2010, over 25 percent of the population had been vaccinated, the Since the outbreaks of enterovirus fifth-highest rate worldwide. Moreover, that claimed the lives of hundreds of Taiwan’s mortality rate in connection young children in the late 1990s and early with the H1N1 flu outbreak was only 2000s, close monitoring and supervision 1.8 per million, one-third that reported by health authorities and teachers and the among members of the Organization for cooperation of parents have helped reduce Economic Cooperation and Development. the incidence and severity of the disease. Though the WHO in August 2010 The CDC provides weekly online declared the H1N1 virus to have entered updates on enterovirus epidemiological the post-pandemic period, the DOH and conditions to help local authorities take cooperating organizations are proceeding preventive measures. Programs are in place with the second phase of the National In- to teach high-risk groups (particularly chil- fluenza Pandemic Preparedness Plan, set dren under 5) the importance of personal to run through 2015. Focuses of the new hygiene. Guidelines and consultation are plan include monitoring epidemiological provided for the treatment of cases with conditions, stockpiling materials for epi- severe complications. Timely, comprehen- demic prevention, enhancing health care sive medical care services are available quality and capabilities, and establishing a at designated referral hospitals. In 2010, community-based disease prevention network. confirmed severe cases of enterovirus in- fection dropped to 16, with no fatalities. Dengue Fever The CDC has devised a three-stage Traditional strategy to prevent and control dengue fe- Chinese Medicine ver epidemics. Primary measures include reduction of mosquito vector-breeding In Taiwan, traditional Chinese medi- sources and populations, especially in cine is a popular alternative for health care southern Taiwan, where flood waters therapy. Two-thirds of the general public dumped by typhoons often leave pools use Chinese herbal preparations regularly of water lingering for weeks and provide for health maintenance and medicinal pur- an ideal condition for the proliferation of poses, and over 15 percent of patients visit dengue fever mosquito vectors. Secondary traditional Chinese medical clinics. As of measures involve disease surveillance and 2010, Taiwan had 5,277 licensed practitio- rapid-response emergency mechanisms. ners and 3,313 Chinese medicine clinics, Tertiary prevention focuses on treatment pharmacies and hospitals. protocols to avert life-threatening hemor- The Committee on Chinese Medicine rhagic conditions among infected persons. and Pharmacy (CCMP) 行政院衛生署中 In 2010, a total 1,896 cases of den- 醫藥委員會 under the DOH oversees the gue fever were confirmed, of which 304 practice of Chinese medicine in Taiwan originated outside Taiwan’s borders. This and supports research on pharmaceutical 20014五校OK(spelling and indexed).indd 200 2011/10/18 3:19:17 AM
  12. 12. development, acupuncture and other tra- the country, the FDA is responsible for ditional practices. Strict regulations on assuring the safety and effectiveness of the manufacture and sale of traditional human drugs, vaccines and other biologi- Chinese medicines as well as mandatory cal products, medical devices, dietary certification procedures are in place. supplements, foodstuffs and cosmetics. The CCMP’s policy focus in 2010 was on tightening quality controls on me- Food Safety dicinal products. Measures included sup- Food safety has become universally plementary training of practitioners and acknowledged as a core issue in view of enhancing their professional knowledge, mounting concerns over chemical addi- evaluating Chinese medicine departments tives, artificial coloring and contamina- at hospitals, and strengthening manage- tion by pesticides and other chemicals. ment of raw materials and manufactur- Food safety management mechanisms ing processes. The CCMP also worked in Taiwan address basic food production to promote Taiwan’s Chinese medicine processes, food processing in factories products and services abroad as well as to and slaughterhouses, temperature controls integrate knowledge and practice of Chi- nese and Western medicine. In response to international demand for training in traditional Chinese medi- cine, the CCMP provides funding to qualified universities and hospitals that offer English-language courses in the field. Graduates from Taiwan’s colleges of Chinese medicine are well-grounded in Western-tradition medical theory and techniques of diagnosis and treatment, and must undergo a period of intern- ship and pass a battery of government- administered examinations before being licensed to practice. Regulation and Oversight The Food and Drug Administration ( F DA ) 行政院衛生署食品藥物管理局 w a s established in 2010 to better ensure food and drug safety and provide a single serv- ice window for the public. The agency combines the functions of four offices previously under the DOH—the Bureau of Food Sanitation 食品衛生處, the Bureau of Pharmaceutical Affairs 藥政處, the Widely used for treating ailments and Bureau of Food and Drug Analysis 藥物 promoting health and energy, traditional 食品檢驗局 and the National Bureau of Chinese herbal preparations can be Controlled Drugs 管制藥品管理局. With customized for an individual’s constitution. inspectors stationed at all entry points to 20114五校OK(spelling and indexed).indd 201 2011/10/18 3:19:22 AM
  13. 13. 14 Public Health during transportation, food storage and handling in retail operations and food Plasticizer Contamination In May 2011, a food contamination preparation at eateries. Other mechanisms crisis hit the country when traces of the include inspection of imported products, toxic plasticizer DEHP (diethylhexyl promotion of food safety education in phthalate) and similar chemicals were de- schools and monitoring of advertisements. tected in a wide array of processed food The FDA has established a task force products, beverages and health supple- to assess risks in food products and the ments in Taiwan. Health experts concur environment arising from chemical con- that DEHP and other plasticizers mimic taminants, food additives, pesticides, hormones and cause abnormalities in the heavy metals, genetically modified organ- functioning of the endocrine system, pos- isms and biological toxins. Such assess- sibly resulting in stunted development of ments provide a scientific foundation for male reproductive organs, for example. risk management and formulation of food Following announcement of the safety policies. discovery on May 23, health and law Globally, Taiwan participates in a enforcement authorities immediately number of food-related bodies such as the launched a nationwide hunt for products World Trade Organization’s Committee and materials adulterated with plasticiz- on Sanitary and Phytosanitary Measures, ers, and traced the source to two food ad- which works to promote implementation ditive manufacturers who, in order to cut of the multilateral Sanitary and Phytosan- costs, produced food emulsifiers by using itary Measures Agreement concerning ac- plasticizers in place of more expensive tions governments should take to ensure palm oil. the safety of foods. Through such coop- On May 24, Taiwan notified the erative forums, Taiwan will strive to help WHO of the plasticizer contamination establish and enforce universal standards case and informed the health authorities of food safety. of countries believed to have imported Medicines and drugs are thoroughly tested and certified for quality, safety and efficacy before being marketed. 20214五校OK(spelling and indexed).indd 202 2011/10/18 3:19:28 AM
  14. 14. tainted products. On May 27, the FDA and prohibited drugs. Victims of severe ordered thousands of retail operators to drug side effects may seek compensation remove all products suspected of contain- from a relief fund set up by the DOH and ing “clouding agent” emulsifiers from supported by fees levied on pharmaceuti- their shelves for testing. Starting May 31, cal companies in accordance with a sliding stores across the island were forbidden to scale based on their revenues. sell five types of products—sports drinks, International Cooperation juices, teas, syrups and jams, and tablets and powders—unless those products were certified as being free of plasticiz- Participation in the ers. Meanwhile, exports of these types of products require safety certification. Global Health Community On June 10, the Legislative Yuan The past few years have seen encour- (Legislature) passed revisions to the Act aging progress in Taiwan’s participation Governing Food Sanitation 食品衛生管理 in the global health community. A break- 法 that impose harsher penalties on manu- through came in January 2009, when the facturers of food products that contain WHO invited Taiwan to participate in the toxic additives. The changes came into enforcement mechanism of the Interna- effect on June 22. tional Health Regulations. Inclusion in From the beginning, the DOH provid- this framework has given Taiwan direct ed daily updates on its website, including contact with the world health body and the latest listings of known contaminated access to first-hand information on pub- products. Emergency hotlines have been lic health issues from food safety to the set up and medical consultation services spread and control of pandemics. are available free of charge at hospitals In May 2009, for the first time since around the nation. Further, steps are be- the ROC was forced to withdraw from the ing taken to establish a food additive United Nations in 1971 and subsequently traceability system in support of the right from specialized U.N. agencies, its health of people in Taiwan and abroad to have authorities were invited by the WHO Sec- access to food that is undoubtedly safe. retariat to attend the annual World Health Assembly (WHA) meeting as an observ- er. ROC delegations again took part in the Pharmaceutical Regulation 2010 and 2011 WHA meetings. Taiwan’s health authorities have begun The 2010 Taiwan Health Forum was to promote current good manufacturing held in Taipei City 臺北市 in October of practices (cGMP) in the pharmaceutical that year. Attended by health officials from industry, and manufacturers that win such around the world, international health certification are subject to routine and experts and leaders of nongovernmental impromptu inspections. As of 2010, 164 organizations, the forum provided a plat- manufacturers were cGMP-certified. form for professional exchanges on a di- The DOH maintains a regularly up- versity of health issues. Under the theme dated listing of authorized vendors for the “Leadership and Networking: Asia-Pacific reference of medical care institutions. In Perspective,” the 2010 event included dis- addition, an online medication information cussions on best policies for facing climate database containing photos and descrip- and natural environmental changes, as well tions of over 6,600 medications is avail- as improving the efficiency and equity of able to help the public identify counterfeit health care systems. 20314五校OK(spelling and indexed).indd 203 2011/10/18 3:19:28 AM
  15. 15. 14 Public Health In March 2011 at the Health Working In ROC government-supported health- related projects, it is Taiwan Interna- Group (HWG) meeting of Asia-Pacific Economic Cooperation (APEC) held in tional Health Action (TaiwanIHA) 臺灣 Washington D.C., Taiwan was selected 國際醫衛行動團隊 that takes the lead. The to serve as HWG vice chair from 2011 group’s mission is to coordinate public- to 2012. Taiwan received APEC funding and private-sector resources so that they for its 2010 project proposal “Enhancing can be utilized as effectively as possible. Hospital Safety and Responding to Public Since its establishment in 2006, it has Health Emergencies by Applying RFID.” provided medical assistance in Indonesia, The first meeting in connection with this the Solomon Islands, Peru, Ecuador, project was held in Taipei in July 2011, Myanmar, Haiti and other countries. where professionals shared their experi- TaiwanIHA also recruits young Taiwan- ences on wide-ranging applications of ese volunteers for participation in interna- radio frequency identification systems in tional humanitarian efforts. hospitals and other health care facilities. Under the DOH’s Global Medical In- struments Support and Service Program 醫療器材援助平台計畫, well-maintained, Health and Medical Aid fully functional medical equipment is As a member of the global community, transferred from medical centers and Taiwan upholds the spirit of the WHO hospitals in Taiwan to countries in need. Constitution in seeking the attainment of As of 2010, such equipment had been the highest possible level of health for its delivered to Guatemala, Paraguay, the people and in helping other nations to do Dominican Republic, Cambodia, Vietnam the same. and Haiti, among other countries. • Department of Health: Related • Bureau of National Health Insurance: Websites • Bureau of Health Promotion: • Centers for Disease Control: • Committee on Chinese Medicine and Pharmacy: • Food and Drug Administration: 20414五校OK(spelling and indexed).indd 204 2011/10/18 3:19:29 AM