China’s Surge Up The Chronic Ladder

By Jack Fisher

After having the pleasure of visiting China in the summer of 2011, I was unaware of the severity of the health issues which China faces.

I distinctly remember being impressed by the level of physical activity within the areas of Jinan, Qindao and Qufu. There were people of all ages participating in physical activity ranging from Tai Chi to taking a dip in the sea. However, at the same time I was amazed at the vast amount of older male adults smoking. Therefore, on reflection, it should have not come as a great surprise that China is at the forefront of the Non Communicable Disease (NCD) epidemic.

China 1 As China has rapidly developed over the last 30 years, becoming the current world leading economy, there has been a drastic epidemiological transition.  China has successfully combated communicable diseases, through improving vaccination coverage, hygiene and sanitation, water quality and medical care. There were also changes to population dynamics with mortality and fertility decreasing and the older population increasing in size. This was overlooked as there were positive changes to income, housing, education and transport, as China aimed to become more westernised. However this development came at a price.

China 4Like many Western countries, China now faces a growing NCD epidemic. NCDs are diseases which are associated with lifestyle behaviors, and are often referred to as the big four: Cardiovascular Disease, Diabetes, Cancer and Chronic Respiratory Disease. They often affect the poorest the greatest, have no cure, and health systems around the world from United Kingdom to Uzbekistan are counting the cost. But not as much as China.

China is renown for winning Olympic medals, however they currently hold an undesired type of accolade. China currently holds the title for largest group of adults with hypertension, with a staggering 177 million people, which equates to 18.9% of the population. China also holds the title of largest tobacco grower and consumer in the world, where of the 2 trillion cigarettes produced in China, only 0.8% are exported, while the remaining 99.2% are consumed. The remaining 50% of non smokers are exposed to passive smoking in working, public and private places.

As a significant amount of smokers are older adults, there has been significant rise over the last 20 years, in mortalities associated with cardiovascular disease, diabetes and cancers of the lung, liver and breast. However tobacco is not the only culprit. Both the rural and urban food systems have undergone rapid changes with increases in dietary fat, salt and overall calorie intake.

China 2On the other end of the age spectrum, a 97% increase in obesity in Children between 1992 and 2002 has caused great alarm. As expected these children are replicating the new westernised diet seen in China, which is causing great concern to see such high risk behaviour at a young age.

Another one of these concerning health behaviors is a lack of physical activity. As transport infrastructure has improved, there has been a significant rise in the consumption of private motorised transport, which has resulted in a decrease in walking and cycling. One of the subsequent side effects of increase carbon emissions from transport vehicles, and large manufacturing production plants, has resulted in environmental health concerns related to air pollution. Only last weekend, there was a reported 50% increase in lung cancer in Beijing over the last ten years, which is thought to be partly attributed to the thick smog which plagues the capital’s skyline.

China 3Overall these factors have accumulated to NCDs resulting in 82.9% of total deaths in China each year. These rates are estimated to increase by 50% by 2030. The direct and indirect economic costs of managing and treating chronic diseases is already large, and if left to expand, could be crippling to the Chinese health system and economic viability. After all, health care spending has tripled since the start of the millennium and is expected to increase by another 50% in 5 years.

So here is the billion dollar question: ‘‘How do we reverse the trend of NCDs in China ?’’.

If China wanted to follow the Western model, then maybe they should introduce taxation on cigarettes, a smoking ban in public places, restrict smoking advertisements and health promotion labeling of cigarettes. Why not reduce dietary intake of salt, introduce dietary guidelines and food labeling ? Why not introduce health education programs into schools to enhance nutrition standards and physical activity interventions ?

china 5The answers is that it is not that easy. There are many cultural, political and social differences which results in this challenge being unique. Some would state that this current approach in the West is not proving particularly effect.

One fact which can’t be disputed is that investment into health care is essential for China’s battle with NCDs and economic future. With an investment of $297.22 billion, which is a mere $220 per person, China could reduce NCD rates by 45-60%. Economically speaking, to put this investment into context, predictions state that even a 1% decrease in cardiovascular disease between 2010 and 2040, would generate an economic return of $10.7 trillion.

Either way China needs to act, and act fast. NCDs as a health topic is very much underrepresented, not only within academia, but also within the public, policy and political sphere. To add to this, I would argue while the world is looking at developed countries such as United States of America, Australia and my native United Kingdom, along with the growing NCD burden in low and middle income countries, China provides the greatest global challenge in terms of sheer quantity at risk. Therefore as an individual who feels very passionate about NCDs as a topic, and has an interest in China as a whole, it drives me to delve more into this fascinating and complex health quandary.

For more from Jack, follow him on Twitter and his Personal Blog: Our Global Health

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