Although Brunei Darussalam’s ongoing commitment to providing its citizens with high-quality universal health care has produced a robust public health care network, non-communicable diseases still pose a significant threat to the population. Cancer is far and away the country’s primary cause of mortality, with 295 deaths recorded in 2013, according to the Department of Economic Planning and Development. This is up from 256 deaths in 2011 and 280 in 2012. Noncommunicable diseases also round out the top five causes of death, with heart disease leading to 183 deaths in 2013, followed by diabetes mellitus with 131, cerebrovascular diseases with 82 and hypertensive diseases (known more commonly as high blood pressure) with 71. Like cancer, deaths resulting from all of these largely preventable diseases are either increasing in frequency or remaining stable.

“We are seeing an increase in cardiac patients primarily for two reasons,” Dr Peter Tay, CEO of tertiary cardiac centre Gleneagles Jerudong Park Medical Centre (JPMC), told OBG. “Firstly, because of an increased awareness leading to earlier diagnosis of coronary artery disease and secondly, because of an actual increase in incidence due mainly to unhealthy lifestyles such as obesity, hyperlipidaemia [raised cholesterol levels], inactivity and smoking.”

Treating The Symptoms

The growing prevalence of these diseases has over the years placed an increasing strain on the public health care system, leading to the creation of public-private partnerships starting in the early 2000s. To reduce the cost of transporting ill patients abroad for specialised treatment while at the same time decreasing patients’ medical risk, the government has developed cardiac and cancer centres of excellence within the Sultanate.

Established in 2002 in partnership with Singapore’s Parkway Group Healthcare, the privately run Gleneagles JPMC now treats a growing number of cardiac patients each year, with about 90% of cases referred from public hospitals. According to Dr Tay, the number of cardiac procedures performed at the centre is increasing by around 5% per year, with the number of surgeries averaging between 120 and 150 annually at present. In 2013, 950 angiograms, 550 angioplasties and 160 surgeries were carried out.

Meanwhile, the JPMC also houses the Neuroscience Stroke and Rehabilitation Centre and the Brunei Cancer Centre. The centre is currently in the midst of a substantial expansion, which will include a new 13-story facility and will increase domestic cancer treatment capacity upon its completion in 2017.

Addressing The Root Cause

Although the new centres of excellence provide much-needed resources to treat major illnesses and, ultimately, save lives, the growing incidence of these diseases reflects wider problems brought on by poor health and lifestyle choices by the population at large. “At the cancer centre we see a lot of patients presenting stage 3 and 4 cancer, so we need to increase patient knowledge to get these things checked out early,” Dr Kenneth Y Y Kok, medical director for the Brunei Cancer Centre, told OBG. “The centre, with the support of the Ministry of Health (MoH), is investing a lot in preventive measures to promote good health by conducting education talks in schools, private companies and public spaces to create cancer awareness.”

The government, primarily through the MoH, is attempting to combat this lack of knowledge and increasingly sedentary lifestyle by rolling out a host of public education programmes, screenings and more robust data collection. Much of this is coordinated by the MoH’s Health Promotion Centre, which was set up in 2008 and has since implemented outreach efforts such as the Health Galleria Youth Outreach and Healthy Settings Programmes. In addition to road shows and public awareness events, the government announced plans in 2014 to increase screenings for those over 40 in an effort to build upon the existing Integrated Health Screening and Health Promotion Programme for Civil Servants, launched in 2007.