The problem lies in the delay in seeking action for medical concerns, according to experts from Malaysia, Indonesia, Singapore and the Philippines (MISP). Fact of the matter is adults do talk about their health, but nothing much comes out of it. The consistent postponement of seeing a doctor creates a bigger problem. By the time the doctor has seen the patient, the condition has become complicated, particularly when it concerns respiratory illnesses like pneumonia, influenza, Covid-19, and respiratory syncytial virus (RSV).
“Timing is a problem in terms of adult health care. How can science advance if people say later, nanti (Indonesian), mamaya na (Filipino), or next time lah? The science is delayed in reaching them, and respiratory illnesses disrupt lives,” said Pfizer MISP cluster lead Deborah Seifert.
“We’re here to start better, more informed conversations. ‘Is it relevant to me right now? Should I speak to my doctor now about pneumonia, influenza, Covid-19, and RSV?’” she said.
The delay Seifert mentioned in her opening remarks was a major concern highlighted in “For the reasons that matter,” a four-country YouGov study and public awareness campaign launched simultaneously in MISP last April 28, and streamed live from Kuala Lumpur.
In conjunction with this year’s World Immunization Week late in April, the health initiative targeted more than 300 million adults in MISP to study their attitudes and behaviors toward respiratory health, in the hope that they will start seeking relevant conversations with their doctors soon.
A major activity of the launch was a panel discussion, “Unveiling of Adult Health Attitudes and Behaviors Survey: First-of-its-kind four-country study findings by YouGov,” moderated by Sheahnee Iman Lee. The guest panelists were Prof. Dr. Tan Maw Pin and Dr. Rokeshwar Hari Dass of Malaysia; Dr. Dirga Sakti Rambe of Indonesia; Dr. Lim Wee Peng of Singapore; and Dr. Karl Henson and Dr. Anthony Cueto Leachon of the Philippines.
YouGov is a global online market research and data analytics firm that provides insights into consumer behavior, public opinion, and brand perception.
Wide gap
Quoting survey data, Lee said 74% of Singaporean adults aspire to be healthy yet nearly four out of 10 say they don’t look after their health as much as they should. She turned to Lim and asked the family physician why the gap persists between intention and action.
“The gap exists because respiratory illness is out of sight until it interferes with your life. If someone still goes to work, still cares for the family, and functioning normally, it’s easy to assume that everything is fine,” said Lim, who also serves as medical director of Parkway Shenton.
He continued: “Generally, adults don’t care about their health. Their primary concerns are work, family, and other more immediate health concerns. Conversations are postponed until there is an infection, prolonged confinement, and hospital admission.”
Lim also said pneumonia and other respiratory ailments can have a bigger impact that people don’t expect, especially older adults and those with underlying medical conditions.
“It’s not just about being unwell. It can affect recovery, independence, and ability to keep up with everyday responsibilities,” he said.
Lim further explained that Singapore is addressing the situation through its initiative dubbed Healthier SG, which helps strengthen regular preventive conversations in primary care. He said this is crucial because when people have an ongoing relationship with their family doctor, they have better chances of raising the issue in a calm, practical way before the respiratory illness becomes a major disruption.
In the Philippines, the data show that 70% of Filipino adults aspire to be fit and healthy yet 31% admit they don’t look after their health enough, and that pneumonia is a leading cause of hospitalization. Lee asked Henson about the hindrance to taking action.
Henson, an infectious disease specialist, answered: Cost, with most Filipino patients paying out of pocket, alongside the tendency to invest some of their resources on what they deem more important.
“Value of importance is subjective, so it’s up to … physicians to have conversations with patients to drive home the point that health is important,” he added.
Social media or doctor?
Per data in Indonesia, 63% of adults cite social media as a health info source and 30% cite doctors; as much as 51% do research on treatment on their own before speaking to a doctor. Lee asked Rambe, an internal medicine specialist, how Indonesians are forming their understanding of respiratory illness.
Rambe acknowledged the phenomenon of more than 200 million of his compatriots turning to the internet for health information. At the same time, he highlighted the risk of inaccurate information and emphasized the need to help patients make good decisions.
The situation becomes positive if patients are persuaded to seek medical attention, Rambe said, adding: “It means they care [and] we must welcome them. That’s how you turn info into conversation and conversation into action. Moving forward, they must have access, trust, and relevance.”
In Singapore, 52% of adults cite doctors as a source of health information, with their Healthier SG creating a framework for systematic preventive cure. Lim said primary care plays a big role in helping adults understand the importance of protecting their respiratory health.
He described patient-doctor conversations as more regular than episodic, which matters for respiratory health. He said touch points, like patients coming in for diabetes checkup, can become opportunities to inquire if they understand their respiratory health risks.
The trust rating is higher in the Philippines, with 55% of adults turning to health care professionals as a primary health info source. Given this, Henson said doctors shouldn’t antagonize patients who show up with what he termed “Dr. Google medical sheets.”
“These should be used to engage them because the patients care about their health,” Henson said. “We should direct conversations toward looking at all options and interventions that address their respiratory health. Patients need to see what will happen if they miss certain steps [of their treatment].”
Significantly, against social media’s prevalence, roughly half of adults do research on health options before seeing a doctor, yet physician guidance remains the most trusted source across MISP, pointed out Dass, Care Clinics Healthcare Services’ head of corporate health impact marketing and communications.
Lack of knowledge
The discussion moved toward the link between delayed action and lack of knowledge in the side effects of respiratory illness. The data show that side effects (45-56%), cost (23-45%), and reputation of the clinicians (33-39%) are the top factors in health decisions across MISP.
Lee asked Leachon, an internist-cardiologist, how one can prioritize health if one is not aware of the link between respiratory health and the side effects.
Leachon said patients are the ultimate stakeholder but that they fail in health care for three reasons. Quoting from the American surgeon and public health researcher Atul Gawande’s “The Checklist Manifesto,” he said the first reason is ignorance: “Education is key. If the trust is on the physician, we need to teach data-driven evidence and facts.”
The second reason, he said, is ineptitude: “The knowledge is there but it wasn’t applied correctly. Guidance should be executed.” And the third reason is the lack of a blueprint for change: “What’s the game plan?”
Leachon explained that globally, cardiovascular and noncommunicable diseases are the top killers. In the Philippines alone, based on Philippine Statistics Authority data, coronary artery disease is the No. 1 killer, followed by cancer, stroke, and pneumonia.
His solution? Focus on the overall health, specifically what he termed the cardiopulmonary interdependence. He argued that one can’t make respiratory health a standalone case considering that a lung problem can trigger a heart attack.
“Attack systemically but focus on the lungs and cardiovascular diseases, which matter most, and protect patients from developing pneumonia,” said Leachon, who served as president of the Philippine College of Physicians in 2014-2015.
To cut through the delay in communicating about respiratory health, Leachon urged doctors to educate their colleagues, patients, and policymakers. He said this would benefit the Philippines which is saddled with “brain drain” and limited access to education.
“Education is the greatest equalizer,” Leachon declared.
Aging adults
The relevant yet lesser known issue of an aging adult population and what respiratory health means to them was discussed. Lee said that Malaysia’s population is aging rapidly and that RSV is an increasingly recognized but underappreciated cause of serious illnesses and hospitalization in adults aged 60 upward.
Tan, a geriatrician, said what’s truly worrying about contracting respiratory syncytial virus, or RSV, is that patients develop secondary bacterial infection on top of the viral infection, which can land them in hospital.
“RSV infection itself causes inflammation in the whole body, increasing the chances of getting heart attacks, strokes, and clots in the lungs,” said Tan, who teaches geriatric medicine at Universiti Malaya.
She said long-term consequences include developing dementia, kidney problems, sarcopenia (or loss of muscle mass and function), and loss of independence in doing things for themselves. “RSV is no joke in older adults,” she added.
To get older adults to understand the importance of seeing their doctor about RSV, Tan said she first finds out if her patients are grandparents. If they are, the dialogue becomes easier, she said: She simply tells them that they can get RSV from their grandchildren or pass it on to them.
Equally concerning for Tan is the “sandwich generation” — or the generation simultaneously caring for both their young children and aging parents — prevalent in Asia. Lee said it’s “a huge mental load” on her, and expressed her wish that parents would take interest in their own health.
Tan, who was trained in the United Kingdom, said: “A lot of times we’re selling the message of ‘do this’ and ‘do that’s to the sandwich generation. What we should be doing is getting the message out earlier before the older generation needs assistance. They should go out on their own, be with their friends, and prevent getting RSV.”
Likewise, she maintained, children should ensure that their parents are empowered to be healthy and independent.
Reasons that matter
Seifert underscored the wide gap between intention and action regarding respiratory health. “What are you protecting? Whatever your answer is, that’s your reason and your reason matters,” she said, adding that her team and collective commitment to her patients and communities are her reasons for staying well.
The panelists shared their reasons that matter. For Lim, it’s the early health conversations that make primary care work well because “we help people stay present for the people that matter to them.” For Henson, it’s the thought that patients are part of families.
Tan said what matters most is the independence of adults — to make decisions and to do things for themselves, to not be a burden to anyone, and to contribute to their grandchildren’s lives.
For Leachon, the reasons for leading a purposeful life are faith, family and relationships, fitness, friends, and Filipinos, for whom he advocates. CS
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