Wednesday, November 9, 2011

Healthcare in China: Encouraging Children to Smoke

China watching is endlessly fascinating. One class of pundits views China’s ascendency as inevitable with its size and market prowess exerting great influence over all the nations of the world. Another views China and its economy as unconditionally unstable with a future of bursting economic bubbles, environmental Armageddon, or revolution—or all of the above. A third is convinced that China will be forced by social and economic forces to slow its growth and assume a development path similar to that of other BRIC-like countries.

A recent article by Yanzhong Huang in Foreign Affairs reminds us of social debts that China is accumulating in its frenzy to maximize economic growth—debts that are beginning to fall due. Huang’s focus is healthcare in China: The Sick Man of Asia: China’s Health Crisis. Much of China’s developing health problems will be derived from environmental issues that lead to birth defects, infertility, high cancer rates, lead poisoning, atmospheric pollution..... The list is quite extensive.

"A 2011 report by some of China’s leading economists and public health experts estimates that in 2005, disease cost more than five billion working days and 2.4 trillion yuan ($296 billion) in lost economic activity -- about 13 percent of China’s GDP."

"A 2004 survey conducted by the Development Research Center of the State Council found that disease and injury were the leading cause of poverty in rural areas: almost 41 percent of the farmers below the poverty line (defined by the government as annual earnings of 860 yuan, or $106 at the time) reported having fallen below it after they became sick or injured."

Huang’s article is long and detailed in providing a history of healthcare in China from Mao to the present day. More will come from that excellent article, but here the focus will be on one aspect of the issue: smoking.

A Businessweek article by Daryl Loo provides some insight into how China is dealing with the issue—or not dealing with it: For Chinese Students, Smoking Isn’t All Bad.

While China officially goes through the motions of discouraging the habit, what is actually occurring is something quite different. Some background statistics:

"China has more than 320 million smokers, a third of the world’s total, and 53 percent of men there smoke. About 1 million Chinese die from tobacco-related illnesses every year. The tobacco industry grew at an average annual rate of 19 percent from 2006 to 2010, according to State Tobacco. Last year, earnings rose 17 percent, to ¥605 billion ($95 billion), including ¥499 billion paid in taxes."

It is not surprising that smoking is common when the regulator happens to be the world’s biggest cigarette maker.

"Anti-tobacco groups say efforts in China to reduce sales, including a ban on smoking in public places introduced in May, have been hampered by light penalties, a lack of education about the dangers of smoking, and the fact that the regulator, the State Tobacco Monopoly Administration, also runs the world’s biggest cigarette maker."

What was so striking about this article was the photo lead-in, which showed two Chinese boys (probably under ten years old) puffing away. The tie-in was the fact that the tobacco industry builds schools around the country as a means of advertising their product, in hopes of getting the children to take up smoking.

"In dozens of rural villages in China’s western provinces, one of the first things primary school kids learn is what helps make their education possible: tobacco. The schools are sponsored by local units of China’s state-owned cigarette monopoly, China National Tobacco. ‘On the gates of these schools you’ll see slogans that say "Genius comes from hard work—tobacco helps you become talented,"’ says Xu Guihua, secretary general of the Chinese Association on Tobacco Control, a privately funded lobbying group. ‘They are pinning their hopes on young people taking up smoking’."

One of the most striking impressions of China is the extent to which greed will drive people to injure their neighbors: tainted milk, tainted toys, tainted food. Children always seem to be the most vulnerable. Somehow the notion of allowing the school system to become an enticement to take up smoking seems beyond the pale—even in China. Then again, perhaps the nasty habit is of less consequence than one might fear.

Elizabeth C. Economy, in her book The River Runs Black, brings us this perspective on what it means to inhale in China today.

"China’s poor air quality, too, has serious implications for public health. A joint study by the World Bank and SEPA in 2007 estimated that 650,000 and 700,000 people in China die prematurely from air pollution annually. In the country’s most polluted cities, when children breathe, it is the equivalent of smoking two packs of cigarettes per day."

Yes, there will be a big healthcare bill in the future.

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