Health and Demograhpic Challenges In China

Biggest Challenges:

 Aging Population
 Chronic Diseases (non-communicative diseases) (diabetes, obesity, smoking related diseases)
 Emerging and drug resistance infectious diseases
 Massive environmental pollution (air, water, soil. Water scarcity)
 Food safety
 Adolescent health

Demograhpics:

 One child policy for 35 years. Age & Sex distortion

 1.17:1 boys to girls ratio (33m extra lads than girls)
 Growing aging populatin (high life expectancy)
 Urbanisation (57% now, 70% in 2050)

Health:

 Interverntion & lifestyle changes too late leading to shift to chronic (NDC) diseases
 Robust health insurance system in place (92% covered). Costs will surge due to demographic
and NCD burden

Policy Context:

 Urbanisation Push (2013)

 Health Insurance refort program (2008) urban and rural health insurance consolidated in SAMSI
(2018)
 End of ‘one child policy’ in 2016
 LACK OF PORTABILITY OF ENTITLEMENTS (HUKOU SYSTEM) – SAMSI Trying to fix this
 Food safety law (2009) following scandals and China FDA (2013)
 Stronger environmental pollution regulations. Ministry of Ecological Environment (2018) w/
resaponsbilioty for climate change, pollution, convservation

China Population:

- About 1.4bn now. Annual increase of 12 million/year. (peak increases were 1980’s, 23m + a
year)
- Already at ‘below replacement fertility’ of 1.2 avg # of births per women (negative population
growth)
READ CHINAS NEW TWO CHILD POLICY (TOO LITTLE TOO LATE) JOAN KAUFMAN

Norm is one child for family. This will cause problems in future as this is embedded in society and
culture

Given that China was able to force one child policy on population, would it be able to force 2/3 child
policy in the future?

China getting old before it’s getting rich (opposite of Japan)

Less women overall = less women giving birth as prpoportion of population

Non Communicable Diseases:

- 80% of 10m annual deaths are NDC’s

- Lung cancer – 300m smokers (51% men)
- Diabetes mellitus – 10% of adults over 20 years
- Child obesity (China #2 overall)
- Beijing more aggressive in banning smoking in public areas, advertising smoking etc

Urbanisation:

- In 1980, only 20% urban (200m urban residents). Now 53% urban (BUT, only 35% with urban
hukou). In 2013 this means 670m people in cities
- Shanghai (China’s largest city) grew from 16m in 2000 to 23m in 2010
- China’s big urbanization experiment

Antibiotic Resistance:

- Overuse of antibiotics in livestock, overprescribing to humans

- ^^ hospital acquiried infections resistant to standard antibiotics

Third largest TB epidemic (15% of global burden)

Emerging infectious diseases

- Close proximity of people and animals

- Huge poultry industry
- Origin of SARS, swine flu, avian flu
Surveillance: Close collaboration with WHO & CDC. Best computerized disease reporting in the world.
Nearly all county and 50% of township hospitals with direct link to computerized CDC system

Air Pollution:

In January 2013: AQI Reached 886 PPM (35X WHO standard for safe) ‘Airpocolypse’.

5.5 Year reduction in life expectancy for those living north of Huaihai river (Seperates North from South
China)

90,000 ‘mass incidents’ (protests) about air quality in 2011

‘Under the Dome’ (2015) Movie – APEC Blue (WATCH)

Water & Soil Pollution:

- 60% of China’s groundwater polluted due to toxic run-offs from industry (heavy metals:
chromium, lead, mercury, arsenic).
- ‘Cancer villages’ near heavily polluted lakes and rivers

For major events, Chinese Govt. tells all polluting industries to shut down (coal & steel plants). Such as
during China/Africa summit or APEC

Factories 400/500km south (winds usually blow north and mountains above Beijing trap the airs) can
affect air quality in Beijing (Henan, Huangdong provinces etc)

Food Safety:

Farmers being moved to cities and arable land is being converted to industrial use.

Illegal food additaves (food dye in watermelosn, melanine in milk powder, ractopaine in pork, gutter oil)

Unprotected sex nad high abortion rate among youth