China’s economy has developed significantly in the last decades, lifting millions of people out of poverty and improving their health. One of the consequences of economic progress has been the increase in life expectancy at birth from 69 in 1990 to 74.51 in 2010. Also notable have been the decreases in infant mortality rate (expressed as per 1,000 live births) which declined from 37 in 1990 to 17 in 2009, and under-five mortality rate (also expressed per 1,000 live births) which declined from 46 in 1990 to 19 in 2009.
Despite this progress, however, many health issues remain unresolved. While the wealthier portion of the Chinese population has benefited from advanced health technologies, many among the poor do not have adequate access to even the most essential services. It is estimated that about 80 percent of the health and medical care services are concentrated in cities, while timely medical care is not available to more than 100 million people in rural areas.
Although some progress has been made in underdeveloped rural areas there is still lack of safe water and sanitation, under-nutrition, vitamin and mineral deficiencies and indoor air pollution. It is estimated that 80 percent of rural households have no access to a sanitary lavatory and 20 percent of rural households lack safe drinking water. A 2008 Report on Chinese Children Nutrition and Health Conditions concluded that 7.6 million children in West China lack adequate nutrition.
New threats related to the environment, workplace and lifestyle are also becoming more widespread. Emissions from motor vehicles have increased considerably in the major Chinese cities. Today, 16 of the 20 most polluted cities in the world are in China. Coal burning, however, continues to be the number one source of air pollution in China and conditions in the workplaces are an important source of disease, injury and death.
In addition, smoking is a serious problem throughout China and it is estimated that more than half of children in China are exposed to second-hand smoke which may explain increased rates among them of respiratory tract infections and sudden infant death syndrome. Presently, tobacco causes 13 percent of deaths among men. Alcohol consumption and alcohol-related problems have also increased steadily in the last decades.
Obesity is increasingly becoming a serious problem. It is estimated that over 25 percent of urban children are overweight. In addition, diseases associated with obesity such as diabetes and cardiovascular problems are on the increase. According to a study by Tulane University researchers 92.4 million adults in China age 20 or older have diabetes, and 148.2 million have pre-diabetes, a risk factor for developing diabetes and/or cardiovascular disease. Recent studies have shown that people who have diabetes live an average of six years less than people not affected by the disease.
Like other nations with migrant and socially mobile populations, China has experienced increased incidence of HIV/AIDS, and the stigma against this syndrome remains prevalent in Chinese society. Although the Chinese government has adopted a much more proactive attitude toward the infection, efforts are still hindered by poor baseline data necessary for properly assessing the problem and earmarking needed resources.
The problem is compounded by the fact that in traditional Chinese culture sex and sexuality are not openly discussed. Many young people lack information on sexually transmitted diseases and HIV transmission. According to the U.S. Centers for Disease Control, only 10% of Chinese who have HIV/AIDS know that they are infected.
Mental illness is an underestimated problem in China. According to a recent study 17 percent of the population has some kind of mental illness. In 25 percent of the cases, the severity of their disability causes them to be unable to work. Because of its impact on society, new ways of addressing this problem have to be developed.
The Chinese government’s 850 billion yuan (US $125 billion) health care reform plan is being implemented to help solve some of these problems. According to this plan, primary health care facilities will be improved, an essential drug system will be introduced, there will be equitable access to basic public health services and there will be a pilot reform of state-run hospitals. Public non-profit hospitals will continue to be the main providers of health care services, but more priority will be given to grassroots-level hospitals and clinics.
Although the government has admitted that building a “safe, effective, convenient and affordable” health service will not be easy, these are commendable goals. The government should prioritize the promotion of healthy lifestyles and the prevention of chronic non-communicable diseases.
A critical aspect stressed by WHO and the Social Development Department of China State Council Development Research Center is the need to create a better system of information, accountability and enforcement of health laws and regulations.
With the assistance of the World Health Organization and other international agencies, the Chinese government has improved the health of its population. Although millions have benefited, millions are also lagging behind. The great challenge for China is how to strengthen its health care system to reduce disparities and improve quality health care for the population at large.
As Wagstaff and Claeson from the World Bank have remarked, “It is vulnerable populations in China who need to be empowered, protected from risks, informed and educated, and encouraged to participate in health activities…Public health regulations need to be established and enforced…Public health infrastructure needs to be in place to reduce the health impact of emergencies and disasters. All this needs to be done through a public health system that is transparent and accountable. Thus, the government has responsibilities beyond the provision and financing of health services to improve health outcomes.”
Dr. Cesar Chelala is an international public health consultant.
Leave a Reply