The Association of Southeast Asian Nations (ASEAN) is currently confronting a profound public health crisis characterized by alarming increases in mental disorders, cardiovascular diseases, smoking prevalence, and injury-related mortality. Recent in-depth research published in The Lancet Public Health reveals that these interrelated health challenges are escalating rapidly across the region’s ten member states, threatening both the quality of life and economic stability of millions. Analysis spanning from 1990 to 2021, conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and the National University of Singapore’s Yong Loo Lin School of Medicine, underscores the urgency for coordinated and innovative public health strategies.
The mental health landscape in ASEAN has dramatically worsened over the past three decades, with more than 80 million individuals now living with a diagnosed mental disorder—a staggering 70% increase since 1990. This surge is particularly pronounced among vulnerable demographic groups such as children, adolescents, the elderly, and women. Anxiety disorders dominate the mental health profile, exerting a heavy toll on young people aged 15 to 19, where the prevalence shows an 11% rise. Meanwhile, older adults, despite a smaller percentage increase in prevalence, have experienced a 183% rise in absolute case numbers due to demographic aging. These findings highlight the critical importance of tailored mental health interventions, sensitive to age and gender disparities, aimed at alleviating the growing burden.
Cardiovascular diseases (CVD) have emerged as the leading cause of death and disability across the ASEAN region, marking one of the fastest-growing non-communicable disease categories. The total number of people living with CVD has surged by 148% since 1990, reaching an estimated 37 million, with 1.7 million deaths annually. This trajectory notably outpaces the global average, with particularly high mortality rates observed in Laos, Indonesia, Myanmar, Cambodia, the Philippines, Vietnam, and Malaysia. Men bear a disproportionately higher burden of CVD-related morbidity and mortality compared to women. Predominant cardiovascular pathologies include ischemic heart disease, lower extremity peripheral arterial disease, and stroke, all closely linked to modifiable risk factors such as elevated systolic blood pressure, unhealthy diets, tobacco use, and air pollution.
Smoking remains a pervasive and escalating public health challenge in ASEAN, with the number of smokers increasing by 63% over the past three decades to reach approximately 137 million, constituting 12% of global smokers aged 15 and older. Despite gradual declines in smoking prevalence in some countries, tobacco consumption is alarmingly high among males, with rates reaching 48% regionally and up to 58% in Indonesia. Youth smoking presents a particularly worrisome trend; in Malaysia, 20% of boys aged 10-14 are current smokers, with prevalence in young populations more than doubling in Cambodia and rising sharply in Indonesia. The average initiation age for smokers aged 20-24 is approximately 15 years, demonstrating early onset and establishment of tobacco dependence. This sustained tobacco epidemic is fueling related morbidity and mortality, with over half a million smoking-attributable deaths annually driven mainly by ischemic heart disease, stroke, and chronic obstructive pulmonary disease.
Injuries, largely preventable, are a critical yet often overlooked contributor to mortality and morbidity in ASEAN. Road injuries stand out as the most prominent cause of injury-related deaths, notably in Thailand and Malaysia where mortality rates reach 30 and 24 deaths per 100,000 population respectively. Motorcycle accidents predominate in Thailand, while motor vehicle collisions account for many deaths in Malaysia. Beyond road injuries, falls constitute the most common injury type and the second leading cause of injury-related mortality in several countries including Brunei, Cambodia, Indonesia, Myanmar, Singapore, and Vietnam. Meanwhile, self-harm, interpersonal violence, drownings, and conflict-related injuries contribute variably across different member states. Crucially, young males aged 15 to 19 bear the highest burden of injury-related disability and death, consistent with global patterns, while females experience the highest injury burden in childhood, especially ages 5 to 9, linked largely to drowning.
The confluence of rapid economic transition, urbanization, demographic aging, and persistent inequality in access to health care infrastructure has compounded the burden of non-communicable diseases and injuries in ASEAN. These trends strain already overburdened health systems, necessitating a recalibration of regional and national health policies. Intersectoral approaches integrating public health, urban planning, education, and environmental regulation are urgently needed to curb the modifiable risk factors driving these health challenges. Without coordinated and sustained action, preventable deaths and disabilities will continue to rise, undermining ASEAN’s considerable socioeconomic progress.
Researchers emphasize the need for robust surveillance systems and granular data analytics to identify localized epidemiological patterns and to tailor interventions efficiently. Age- and sex-disaggregated data, such as those provided by the Global Burden of Disease Study, allow policymakers to pinpoint high-risk groups and settings, enabling prioritized allocation of resources. The diversity within ASEAN—encompassing ten countries with varying demographics, income levels, and health system capacities—means that a one-size-fits-all strategy will fail. Instead, adaptive frameworks that respect individual country contexts but foster regional cooperation are vital.
Equally critical is the implementation of comprehensive tobacco control measures, including taxation, advertising restrictions, public smoking bans, and targeted cessation programs. Coupled with initiatives to promote cardiovascular health through lifestyle modification and improved management of hypertension, diabetes, and hyperlipidemia, these steps could substantially reduce premature mortality. Mental health requires destigmatization alongside investment in accessible psychosocial services, community-based support, and school-based mental health promotion, especially for youth who exhibit the steepest increases in mental disorder prevalence.
Regarding injury prevention, multisectoral policies involving transportation safety standards, enforcement of helmet laws, promotion of safe driving behaviors, and infrastructure improvements can reduce road traffic fatalities. Additionally, education campaigns, early childhood supervision, and mental health support services are necessary to mitigate the burden of falls, self-harm, and interpersonal violence. The complex interplay between social determinants of health and injury rates warrants further interdisciplinary research.
In sum, the first comprehensive regional assessment of health burdens in ASEAN reveals alarming increases in mental disorders, cardiovascular diseases, tobacco use, and injuries—all of which demand urgent policy attention and resource mobilization. This multi-dimensional health crisis threatens to reverse gains in life expectancy and economic development, underscoring the pressing need for evidence-based, contextually tailored public health interventions. Collaboration across governments, academic institutions, and international partners will be indispensable in guiding ASEAN back onto a sustainable health trajectory.
Subject of Research: People
Article Title: Mental disorders, cardiovascular diseases, smoking, and road injuries among the top causes of death and disability for millions in the ASEAN region
News Publication Date: 27-May-2025
Web References:
- Institute for Health Metrics and Evaluation: https://www.healthdata.org/
- National University of Singapore: https://nus.edu.sg/
- Global Burden of Disease Study: https://www.healthdata.org/research-analysis/gbd
- GBD Compare: https://vizhub.healthdata.org/gbd-compare/
- GBD Results: https://vizhub.healthdata.org/gbd-results/
Keywords: Cardiovascular disorders, Mental health
