Health in China

This article is about Health in Mainland China. For Hong Kong, see Health in Hong Kong. For Macau, see Health in Macau. For Taiwan, see Health in Taiwan.

See also Healthcare in China.

Health indicators

China's health indicators include the nation’s fertility rate of 1.8 children per woman (a 2005 estimate) and the infant mortality rate per 1,000 live births was 19 (a 2005 estimate).

Post-1949 history

An emphasis on public health and preventive treatment characterized health policy from the beginning of the 1950s. At that time the party began to mobilize the population to engage in mass "patriotic health campaigns" aimed at improving the low level of environmental sanitation and hygiene and attacking certain diseases. One of the best examples of this approach was the mass assaults on the "four pests"—rats, sparrows, flies, and mosquitoes—and on schistosoma-carrying snails. Particular efforts were devoted in the health campaigns to improving water quality through such measures as deep-well construction and human-waste treatment. Only in the larger cities had human waste been centrally disposed. In the countryside, where "night soil" has always been collected and applied to the fields as fertilizer, it was a major source of disease. Since the 1950s, rudimentary treatments such as storage in pits, composting, and mixture with chemicals have been implemented. As a result of preventive efforts, such epidemic diseases as cholera, bubonic plague, typhoid fever, and scarlet fever have almost been eradicated. The mass mobilization approach proved particularly successful in the fight against syphilis, which was reportedly eliminated by the 1960s. The incidence of other infectious and parasitic diseases was reduced and controlled.

Political turmoil and famine following the failure of the Great Leap Forward led to starvation of 20 million people in China. With recovery beginning in 1961, more moderate policies inaugurated by President Liu Shaoqi ended starvation and improved nutrition. The coming of the Cultural Revolution weakened epidemic control, a rebound in epidemic disease and malnutrition in some areas.

Barefoot doctors were a good contribution to primary health systems in China during the Cultural Revolution (1964–1976). It encompasses all principles stated in primary health care. Community participation is possible because the team is composed from village health workers in the area. There’s equity because it was more available and combined western and tradition medicines. Intersectoral coordination is achieved by preventative measures rather than curative. Lastly it’s comprehensive using rural practices rather than urban ones.

The barefoot doctor system was based in the people's communes. With the disappearance of the people's communes, the barefoot doctor system lost its base and funding. The decollectivization of agriculture resulted in a decreased desire on the part of the rural populations to support the collective welfare system, of which health care was a part. In 1984 surveys showed that only 40 to 45 percent of the rural population was covered by an organized cooperative medical system, as compared with 80 to 90 percent in 1979.

This shift entailed a number of important consequences for rural health care. The lack of financial resources for the cooperatives resulted in a decrease in the number of barefoot doctors, which meant that health education and primary and home care suffered and that in some villages sanitation and water supplies were checked less frequently. Also, the failure of the cooperative health-care system limited the funds available for continuing education for barefoot doctors, thereby hindering their ability to provide adequate preventive and curative services. The costs of medical treatment increased, deterring some patients from obtaining necessary medical attention. If the patients could not pay for services received, then the financial responsibility fell on the hospitals and commune health centers, in some cases creating large debts.

Consequently, in the post-Mao era of modernization, the rural areas were forced to adapt to a changing health-care environment. Many barefoot doctors went into private practice, operating on a fee-for-service basis and charging for medication. But soon farmers demanded better medical services as their incomes increased, bypassing the barefoot doctors and going straight to the commune health centers or county hospitals. A number of barefoot doctors left the medical profession after discovering that they could earn a better living from farming, and their services were not replaced. The leaders of brigades, through which local health care was administered, also found farming to be more lucrative than their salaried positions, and many of them left their jobs. Many of the cooperative medical programs collapsed. Farmers in some brigades established voluntary health-insurance programs but had difficulty organizing and administering them.

Their income for many basic medical services limited by regulations, Chinese grassroots health care providers supported themselves by charging for giving injections and selling medicines. This has led to a serious problem of disease spread through health care as patients received too many injections and injections by unsterilized needles. Corruption and disregard for the rights of patients have become serious problems in the Chinese health care system.

The Chinese economist Yang Fan wrote in 2001 that lip service being given to the old socialist health care system and deliberately ignoring and failing to regulate the actual private health care system is a serious failing of the Chinese health care system. "The old argument that "health is a kind of welfare to save lives and assist the injured" is so far removed from reality that things are really more like its opposite. The welfare health system supported by public funds essentially exists in name only. People have to pay for most medical services on their own. Considering health to be still a "welfare activity" has for some time been a major obstacle to the development of proper physician - patient relationship and to the law applicable to that relationship."

Despite the decline of the public health care system during the first decade of the reform era, Chinese health improved sharply as a result of greatly improved nutrition, especially in rural areas, and the recovery of the epidemic control system, which had been neglected during the Cultural Revolution.

Major indicators of health

Since 1949, China had a huge improvement in population's health. There are health related parameters:

	1950	1960	1970	1980	1990	2000	2011
Life expectancy	41.6	31.6	62.7	66.1	69.5	72.1	75.0
Total Fertility Rate	5.3	4.3	5.7	2.3	2.5	1.5	1.7
Infant Mortality Rate	195.0	190.0	79.0	47.2	42.2	30.2	12.9
Under 5 Mortality Rate/Child mortality	317.1	309.0	111	61.3	54.0	36.9	14.9
Maternal Mortality Ratio				164.5	88.0	57.5	26.5

• data from www.gapminder.org.

In general, all indices showed improvement except the drop around 1960 due to the failure of the Great Leap Forward, which led to starvation of tens of millions of people. From 1950 to 2012, life expectancy nearly doubled (41.6-75.1). Total Fertility Rate changed from 5.3 to 1.7 which mainly caused by One-child policy. Infant Mortality rate and Under-5 mortality rate went down sharply. Though there is no data from 1963 to 1967, we can see the trend. The gap between IMR and U5MR became smaller and smaller, which indicates health in children has been promoted. Maternal Mortality Ratio isn't showed in the graph since data insufficiency, but it did go down from 164.5(1980) to 26.5(2011).

Medical issues in China

Smoking

Main article: Smoking in the People's Republic of China

Smoking related illnesses kill 1.2 million in the People's Republic of China; however, the state tobacco monopoly, the China National Tobacco Corporation, supplies 7 to 10% of government revenues, as of 2011, 600 billion yuan, about 100 billion US dollars.

Sex education, contraception, and women's health

Main article: Women's healthcare in the People's Republic of China

Sex education lags in China due to cultural conservatism. From ancient China to the first half of the 20th century, formal sex education was not taught. Instead, a woman's parents were mostly responsible for her sex education after she is wed. Many Chinese feel that sex education should be limited to biological science. Combined with migration of young unmarried women to the cities, lack of knowledge of contraception has resulted in increasing numbers of abortions by young women.

The Basic Health Services Project piloted strategies to ensure equitable access to China's rural health system; health outcomes for women improved significantly, with substantial declines in maternal mortality due to increased coverage of maternal health services.

SARS

Further information: Progress of the SARS outbreak

Although not identified until later, China’s first case of a new, highly contagious disease, severe acute respiratory syndrome (SARS), occurred in Guangdong in November 2002, and within three months the Ministry of Health reported 300 SARS cases and five deaths in the province. Dr. Jiang Yanyong exposed the level of danger the SARS outbreak posed to China. By May 2003, some 8,000 cases of SARS had been reported worldwide; about 66 percent of the cases and 349 deaths occurred in China alone. By early summer 2003, the SARS epidemic had ceased. A vaccine was developed and first-round testing on human volunteers completed in 2004.

The 2002 SARS in China demonstrated at once the decline of the PRC epidemic reporting system, the deadly consequences of secrecy on health matters and, on the positive side, the ability of the Chinese central government to command a massive mobilization of resources once its attention is focused on one particular issue. Despite the suppression of news regarding the outbreak during the early stages of the epidemic, the outbreak was soon contained and cases of SARS failed to emerge. Obsessive secrecy seriously delayed the isolation of SARS by Chinese scientists. On 18 May 2004, the World Health Organization announced the PRC free of further cases of SARS.

Hepatitis B

Main article: Hepatitis B in China

HIV and AIDS

Main article: HIV/AIDS in the People's Republic of China

The AIDS catastrophe of Henan in the mid-1990s was estimated as the largest man made health catastrophe, concerning from half to one million persons. It was also in Hebei, Anhui, Shanxi, Shaanxi, Hubei and Guizhou. HIV was transmitted in blood sale. Blood plasma mixture from several persons was returned so that same person could give blood up to 11 times a day. Catastrophe was recognized only in 2000 and found out abroad in 2001. Pensioner Gao Yaojie sold her house to deliver data leaflets of HIV to people, while the officials tried to prevent her. Some local officials and politicians were involved in the blood sale. In 2003 2.6% of Chinese knew that a condom could protect from AIDS.

China blocked by police protest over ineffective drug treatments, cancelled meetings on HIV groups, closured office of the AIDS organization, and detained or put under house arrest prominent AIDS activists such as 2005 Reebok Human Rights Award winner Li Dan, eighty-year-old AIDS activist Dr. Gao Yaojie, and the husband-and-wife HIV activist team of Hu Jia (activist) and Zeng Jinyan.

China, similar to other nations with migrant and socially mobile populations, has experienced increased incidences of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). By the mid-1980s, some Chinese physicians recognized HIV and AIDS as a serious health threat but considered it to be a "foreign problem". As of mid-1987 only two Chinese citizens had died from AIDS and monitoring of foreigners had begun. Following a 1987 regional World Health Organization meeting, the Chinese government announced it would join the global fight against AIDS, which would involve quarantine inspection of people entering China from abroad, medical supervision of people vulnerable to AIDS, and establishment of AIDS laboratories in coastal cities. Within China, the rapid increase in venereal disease, prostitution and drug addiction, internal migration since the 1980s and poorly supervised plasma collection practices, especially by the Henan provincial authorities, created conditions for a serious outbreak of HIV in the early 1990s.

As of 2005 about 1 million Chinese have been infected with HIV, leading to about 150,000 AIDS deaths. Projections are for about 10 million cases by 2010 if nothing is done. Effective preventive measures have become a priority at the highest levels of the government, but progress is slow. A promising pilot program exists in Gejiu partially funded by international donors.

Tuberculosis

Main article: Tuberculosis in China

Scanning electron micrograph of Mycobacterium tuberculosis

Tuberculosis is a major public health problem in China, which has the world's second largest tuberculosis epidemic (after India). Progress in tuberculosis control was slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and multidrug-resistant tuberculosis was a major problem. These signs of inadequate tuberculosis control can be linked to a malfunctioning health system. Prevalent smoking aggravates its spread.

Leprosy

Main article: Leprosy in China

Leprosy, also known as Hansen's disease, was officially eliminated at the national level in China by 1982, meaning prevalence is lower than 1 in 100,000. There are 3,510 active cases today. Though leprosy has been brought under control in general, the situation in some areas is worsening, according to China’s Ministry of Health.

Mental health

Main article: Mental health in China

Some 100 million Chinese have mental illnesses, with varying degrees of intensity. Currently, dilemmas such as human rights versus political control, community integration versus community control, diversity versus centrally, huge demand but inadequate services seem to challenge the further development of the mental health service in the PRC. China has 17,000 certified psychologists, which is ten percent of that of other developed countries per capita.

Nutrition

See also: Food safety in the People's Republic of China

In the 2000–2002 period, China had one of the highest per capita caloric intakes in Asia, second only to South Korea and higher than countries such as Japan, Malaysia, and Indonesia. In 2003, daily per capita caloric intake was 2,940 (vegetable products 78%, animal products 22%); 125% of FAO recommended minimum requirement.

Malnutrition among rural children

See also: Zhejiang Xinhua Compassion Education Foundation

China has been developing rapidly for the past 30 years. Though it has uplifted a huge number of people out of poverty, many social issues still remain unsolved. One of them is malnutrition among rural children in China. The problem has diminished but still remains a pertinent national issue. In a survey done in 1998, the stunting rate among children in China was 22 percent and was as high as 46 percent in poor provinces. This shows the huge disparity between urban and rural areas. In 2002, Svedberg found that stunting rate in rural areas of China was 15 percent, reflecting that a substantial number of children still suffer from malnutrition. Another study by Chen shows that malnutrition has dropped from 1990 to 1995 but regional differences are still huge, particularly in rural areas.

In a recent report by The Rural Education Action Project on children in rural China, many were found to be suffering from basic health problems. 34 percent have iron deficiency anaemia and 40 percent are infected with intestinal worms. Many of these children do not have proper or sufficient nutrition. Often, this causes them not being able to fully reap the benefits of education, which can be a ticket out of poverty.

One possible reason for poor nutrition in rural areas is that agricultural produce can fetch a decent price, and thus is often sold rather than kept for personal consumption. Rural families would not consume eggs that their hen lay but will sell it in the market for about 20 yuan per kilogram. The money will then be spent on books or food like instant noodles which lack nutrition value compared to an egg. A girl named Wang Jing in China has a bowl of pork only once every five to six weeks, compared to urban children who have a vast array of food chains to choose from.

A survey conducted by China’s Ministry of Health showed the kind of food consumed by rural households. 30 percent consume meat less than once a month. 23 percent consume rice or egg less than once a month.

In a 2008 Report on Chinese Children Nutrition and Health Conditions, West China still has 7.6 million poor children who were shorter and weigh lesser than urban children. These rural children were also shorter by 4 centimetres and 0.6 kilograms lighter than World Health Organisation standards. It can be concluded that children in West China still lack quality nutrition.

Epidemiological studies

The most comprehensive epidemiological study of nutrition ever conducted was the China-Oxford-Cornell Study on Dietary, Lifestyle and Disease Mortality Characteristics in 65 Rural Chinese Counties, known as the "China Project", which began in 1983. Its findings are discussed in The China Study by T. Colin Campbell.

Iodine deficiency

Main article: Iodine deficiency in China

China has problems in certain western provinces in iodine deficiency.

Hygiene and sanitation

Further information: Water supply and sanitation in the People's Republic of China

By 2002, 92 percent of the urban population and 8 percent of the rural population had access to an improved water supply, and 69 percent of the urban population and 32 percent of the rural population had access to improved sanitation facilities.

The Patriotic Health Campaign, first started in the 1950s, are campaigns aimed to improve sanitation and hygiene in China.

WHO in China

The World Health Organization (WHO) Constitution came into force on 7 April 1948, and China has been a Member since the beginning.

The WHO China office has increased its scope of activities significantly in recent years, especially following the major SARS outbreak of 2003. The role of WHO China is to provide support for the government's health programs, working closely with the Ministry of Health and other partners within the government, as well as with UN agencies and other organizations.

China's government with WHO assistance and support has strengthened public health in the nation. The current Five Year Plan incorporates public health in a significant way. The government has acknowledged that even as millions upon millions of citizens are prospering amid the country's economic boom, millions of others are lagging behind, with healthcare many cannot afford. The challenge for China is to strengthen its health care system across the spectrum, to reduce the disparities and create a more equitable situation regarding access to health care services for the population at large.

At the same time, in an ever-interconnected world, China has embraced its responsibility to global public health, including the strengthening of surveillance systems aimed at swiftly identifying and tackling the threat of infectious diseases such as SARS and avian influenza. Another major challenge is the epidemic of HIV/AIDS, a key priority for China.

The staff of the WHO Office in China are working with their national counterparts in the following areas:

• Healthcare systems development
• Immunization
• Tuberculosis control
• HIV/AIDS control
• Maternal health and child health
• Injury prevention
• Avian influenza control
• Food safety
• Tobacco control
• Non-communicable diseases control
• Environment and health
• Communicable diseases surveillance and response

In addition, WHO technical experts in specialty areas can be made available on a short-term basis, when requested by the Chinese government. China is an active, contributing member of WHO, and has made valuable contributions to global and regional health policy. Technical experts from China have contributed to WHO through their membership on various WHO technical expert advisory committees and groups.

External links

• China Health Care Association
• Chinese Preventive Medicine Association
• China Profile by World Health Organization (WHO Office in China)
• Chinese Ministry of Health
• China Medical Board

Resources

• "Critical health literacy: a case study from China in schistosomiasis control"
• Children's Healthcare in China
• Health Information for Travelers to China U.S. Centers for Disease Control and Prevention (CDC).
• China's Healthcare System: Improving Quality of Insurance, Service, and Personnel Reforming China’s Healthcare System Roundtable series held by the Brookings-Tsinghua Center at Tsinghua University
• The Current State of Public Health in China Annual Review of Public Health Vol. 25: 327-339 (Volume publication date April 2004)
• A Critical Review of Public Health in China August 2004 paper