Thursday, November 17, 2011

China Has a Health Crisis

China has been blessed by rapid economic growth for many years now. Many seem to believe that this growth can and will continue. In order to reach such elevated levels of economic activity, China has had to neglect other areas critical to its society. At some point it will have to pay the price for that neglect. We recently wrote of China’s Environmental Burden, which was based on the book The River Runs Black: The Environmental Challenge to China’s Future by Elizabeth C. Economy. China’s environmental issues are enormous and will be costly to remedy. They also constitute a major health problem. Yanzhong Huang provides an article in Foreign Affairs that addresses China’s health issues: The Sick Man of Asia: China’s Health Crisis. Huang issues a similar warning about China’s accumulating deficit in healthcare. Both issues will impact its economy and its society.

Huang provides this interesting insight: under Mao’s leadership the life expectancy increased from 35 years to 65 years, while under the current regime it increased only about five years between 1981 and 2009, a comparable period. To put this in context, Huang points out that other countries having similar life expectancies in 1981attained much better results with expectancy growth in the range 7-14 years. Countries in this category include Columbia, Malaysia, Mexico, and South Korea. Mao had set up a crude but functional process for training large numbers of people who could contribute to healthcare and wellness even in the most rural of regions. This system fell into decay when the new order took power and the focus changed towards economic growth.

What are the consequences of neglecting the health of its citizens?

"As a result, communicable diseases that had been all but eradicated during the Mao era reemerged and spread quickly in the 1980s."

"Like many less developed countries, China still battles a legion of microbial and viral threats, including HIV/AIDS, tuberculosis, viral hepatitis, and rabies. For instance, more than 130 million people in China have the hepatitis B virus -- accounting for about one-third of all HBV carriers in the world."

Perhaps more ominous is data that indicates the ills of a poor society are being compounded by the maladies of a rich society.

"A 2010 study by The New England Journal of Medicine suggests that China has the largest population of diabetics in the world and that the disease is spreading at a faster rate there than in Europe and the United States. Nearly ten percent of adults aged 20 or more in China now have diabetes -- close to the rate in the United States (11 percent) and far higher than those in Canada, Germany, and other Western countries. Noncommunicable diseases, including cardiovascular disease, chronic respiratory diseases, and cancer, account for 85 percent of total deaths in China today -- much higher than the average worldwide, which is 60 percent."

For some reason even mental health seems to be a problem.

"Data from the Ministry of Health suggest that the incidence of mental disorders climbed by more than 50 percent between 2003 and 2008. A major national survey conducted between 2001 and 2005 partly by the Beijing Suicide Research and Prevention Center at Beijing Huilongguan Hospital and based on interviews with 113 million Chinese throughout four provinces found that 17.5 percent of the population, or more than 227 million Chinese, suffered from some form of mental problem, such as mood and anxiety disorders. This is one of the highest such rates in the world. An estimated 287,000 people kill themselves in China each year; at 23 per 100,000, this, too, is one of the highest such rates worldwide and more than twice the suicide rate in the United States."

Huang also visits some of the environmental issues.

"According to a Ministry of Health report, the operations of 16 million companies and factories in China are poisonous or hazardous, and about 200 million workers are directly exposed to occupational hazards. Because of industrial pollution, especially water contamination in the countryside, China now counts 459 so-called cancer villages, villages with an unusually high number of cancer patients. Environmental pollution is also believed to have significantly increased the infertility rate for all couples of childbearing age, from three percent in 1990 to 12.5–15.0 percent today. According to a 2009 epidemiological study by the nongovernmental organizations China Women and Children Development Center and the Population Association of China, more than 40 million couples in mainland China may now be infertile."

Huang details how healthcare has been organized and then reorganized over the years. It makes interesting reading. Suffice it to say that the central government has recognized the problem and is trying to address it.

We tend to think of China as a strictly regulated country where a few decision makers formulate policy that is implemented nationwide according to their will. Both Huang on healthcare and Elizabeth Economy on the environment make the same point: the central government is unable to control what occurs in the provinces.

"....Chinese officials, especially local ones, have little interest in promoting health care. Their lack of action is reinforced by multiple interest groups. The tobacco industry is resisting stricter controls, for example, and health-care providers and government health departments have sometimes colluded to hijack the reform of public hospitals."

"Another problem is the lack of bureaucratic capacity when it comes to health policy. In addition to an ill-defined fiscal system, which has crippled the government’s ability to fund public services, policymakers in China cannot effectively monitor the behavior of policy implementers. In democracies, there are citizen groups to keep misbehavior by officials in check. But as long as China refuses to enfranchise the general public to monitor administrative measures, upper-level bureaucratic actors will continue to be foiled in their efforts by their subordinates."

Both Huang and Economy fear that this failure in governance could generate public unrest sufficient to threaten the legitimacy of the rulers. Consider this factoid from Huang:

"The high costs and inaccessibility of health care lead to frequent disputes between patients and health-care providers, and these could easily devolve into violence. More than 73 percent of China’s hospitals reported violent conflicts between patients and health-care workers in 2005, and close to 77 percent of them reported instances in which patients refused to be discharged after treatment or to pay hospital charges. In 2010, Shenyang, the capital city of Liaoning Province, in northeastern China, sought to hire police officers to handle conflicts between patients and health-care providers at the city’s 23 major hospitals."

Elizabeth Economy provides a more general assessment:

"In China, societal discontent is evident everywhere. It is expressed in forms as diverse as labor unrest, mounting peasant protest, and increased ethnic violence. As the government has diminished its role in guiding the economy, its role in managing society has decreased as well. For this reason, it retains few levers to shape public opinion and action, with the exception of suppression or media and internet censorship. It is this discontent, if mobilized throughout the country and more specifically directed at the Communist Party, that Chinese authorities fear."

If China hopes to continue to grow its economy it will need greater internal consumption to balance its export sector. This will be hampered if its people feel a lack of security and save their money in fear of expensive health problems. It must also improve its governance if it to develop thriving local economies.

"According to a series of public opinion surveys published in 2009, respondents ranked corruption, health-care reform, and food and drug safety as their top three concerns."

China watching continues to enthrall. Stay tuned—it will be fascinating.

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