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China’s ‘Hidden Epidemics’: The Preventable Diseases That Could Reshape a Nation | China


VSChina faces a health emergency from ‘hidden epidemics’ of diseases such as cancer, heart disease and diabetes that could have far-reaching social, economic and demographic consequences for the world’s most populous nation, warned the experts.

Although China has imposed the strictest containment measures in the world to protect its population from Covid-19, the deadly impact of non-communicable diseases is far less well understood and threatens to kill tens of millions of Chinese in decades. to come without stricter public health policies.

China has been transformed over the past few decades by an economic miracle that has seen rapid industrialization and the relocation of hundreds of millions of people from the countryside to the cities.

This enormous change lifted multitudes out of poverty and gave them a better standard of living than they enjoyed in rural areas. But with higher wages and urban life came “Western” diseases such as cancer linked to very high smoking rates, and diabetes and heart disease due to a richer diet, lack of exercise and to high blood pressure.

Wang Feng, a sociology professor at the University of California, Irvine, says the pace of change seen in China in the 1980s and 1990s is unlike anything seen elsewhere in history, and that social and health problems accumulated over decades come home. perch.

A view of the rooftops of Beijing.
A view of the rooftops of Beijing. Photography: VCG/Getty Images

“These are hidden epidemics and these are long-lasting epidemics,” he says. “You have an explosion in new diet and nutritional intake in a short period of time. Combined with unforeseen and unprecedented aging, this will be one of the biggest challenges China will face – not just for individual families, but this will pose a political challenge to the leadership.

“This problem could really explode out of control,” he says. “It’s not something that’s going to go away.”

Smoking “disaster areas”

More than a third of the world’s 1.1 billion smokers live in China, where about half of the male population is addicted to tobacco. According to current projections, smoking-related diseases – which include lung cancer, respiratory and heart disease – will kill one in three young Chinese men by 2050.

It’s a grim statistic in a country that is already facing a demographic crisis due to a plummeting birth rate and a rapidly aging population. The UN predicts that the population could drop from its current level of around 1.4 billion to around 1 billion by 2100. Chinese officials said in July that the population was already beginning to decline as birth rates fell at their lowest in decades. But some predictions are much more drastic, with separate research in the US and China suggesting the population will nearly halve by the end of the century to around 730 million. The populations of the United Kingdom and the United States, on the other hand, are expected to remain constant or increase slightly over the same period.

Bernard Stewart, an internationally renowned expert on the causes of cancer and professor at the University of New South Wales in Sydney, says the evidence is unequivocal and China must take action to prevent what he calls a “disaster” in progress.

Workers pack e-cigarettes on the production line at First Union, one of China's leading manufacturers of vaping products.
Workers pack e-cigarettes on the production line at First Union, one of China’s leading manufacturers of vaping products. Photography: Kevin Frayer/Getty Images

“There’s no sense in which you can qualify the disaster facing China when it comes to smoking deaths,” he says. “There is a big difference in rates between provinces, but highly industrialized cities are disaster areas.”

The leading cause of death in China is stroke, followed by heart disease, chronic lung disease and then lung cancer, according to the Global Burden of Disease study by the US Institute for Health Metrics and Evaluation. . Smoking is a contributing factor in many of these cases.

Cardiovascular disease is a major cause of death in China, especially in the heavily industrialized and urbanized north. According to a Lancet study, people in this region are more likely to suffer from high blood pressure, obesity and poor diets low in fruits and vegetables but high in red meat.

China has more people with diabetes than any other country – more than 110 million – in what the World Health Organization (WHO) has described as an “explosive” problem. This number will climb to 150 million by the middle of the century.

Diabetes and diabetes complications already contribute to nearly one million deaths in China each year, according to the WHO. More than 40% of these deaths are classified as premature – occurring before the age of 70 – which is another cause for concern.

Top 10 countries for avoiding premature deaths – plus UK, US and China
China ranks 78th in an index of countries that best avoid premature deaths. Photograph: Imperial College

China is the second largest economy in the world and has become home to hundreds of billionaires over the past decades.

But its health outcomes are still those of a much poorer nation. Chinese people have a 14.1% chance of dying prematurely from a non-communicable disease, ranking the country 76th in the world for health. South Korea leads with 4.7%, while the UK is 27th with 9% and the US is 44th with 11.8%. The results are worse for Chinese men, with a 19.8% chance of dying prematurely.

Attempts by the ruling Communist Party to tackle the health crisis include the Healthy China 2030 campaign launched in 2019 to reduce premature deaths, control risk factors and build health care capacity. There are now more smoking bans in public places such as high-speed trains, shops and restaurants. Even last year’s crackdown on children’s screen time can be seen as part of efforts to reduce burgeoning obesity and improve health outcomes.

However, obstacles remain such as the government’s reliance on cigarette tax, which provides about 10% of the tax base through state-controlled tobacco monopolies.

“Western” problems

A man with a mask around his chin smokes a cigarette with a dusty sky in the background
A man walks down a street while smoking a cigarette during a sandstorm in Beijing’s financial district. Photography: Nicolas Asfouri/AFP/Getty Images

The health crisis can in many ways be attributed to China’s stratospheric economic growth since the late 1970s, when people began to be able to consume a more Western diet and acquire Western-style habits.

In 1978, most Chinese were on a subsistence diet. In 1988, they were consuming 60% more pork and 150% more vegetable oil, Wang said, which improved their nutrition enormously. However, at the same time, alcohol consumption increased 3.5 times and the number of cigarette packs smoked doubled.

Wang says, “It was almost 30 years ago. But it now comes back as a problem for people later in life. People were consuming alcohol, sugar and tobacco faster than food… There was no awareness of the new malnutrition, overweight people and how quickly it happened.

The high cost of care for a sick and aging population is also a serious obstacle to Beijing’s hopes of reviving a flagging economy. One reason is that a greater share of spending falls on individual households than might be expected in the communist-controlled nation – about a third of health spending per capita. The need to save for health care weighs heavily on the budget of families, who often have only one child to save and take care of the others. This in turn exacerbates the demographic problem, as the current generation of children between the ages of 18 and 40 in China have less money and are less inclined to start their own families.

These growing problems are recognized by the Communist Party leadership and are part of the reason the government is sticking so rigidly to its zero-Covid strategy as the rest of the world has returned to normal life. Beijing knows that the population – especially the elderly living in rural areas – does not have access to good health care, and with underlying health conditions such as heart disease and respiratory disorders already so common. , would be at high risk of spreading Covid. Zero-Covid is estimated to have saved a million Chinese lives.

“A health problem means an economic problem”

Hospital hallway with people sitting and standing waiting for medical treatment
People seek treatment at the Traditional Chinese Medicine Hospital in Beijing. Photography: Future Publishing/Getty Images

About 95% of Chinese people have some form of health insurance, but that doesn’t mean health care is affordable. Attempts to reform the public health system have seen the number of private hospitals explode and the total now exceeds public facilities. Care provision varies greatly from province to province and especially from urban to rural areas, but it is still considered highly inefficient and the out-of-pocket expenses of insured people are still very high.

“Chronic diseases are a major contributor to health burden, inequalities in health outcomes and economic burden in China,” a group of academics wrote in The Lancet in 2021.

One of the authors, Professor Barbara McPake, a health economist at the University of Melbourne, says households are facing dire consequences from the growing problem of hidden epidemics in China.

“There are significant out-of-pocket expenses for people with non-communicable diseases in the health system,” she says. “A health problem means you have an economic problem. 95% of people have health insurance but the cost of drugs and care is high. Insurance doesn’t go far, so in some cases it’s insurance not worth having.

theguardian Gt

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