China’s Public Health Challenges

China’s economy has developed significantly in the last decades, lifting more than 200 million people out of poverty and improving their health. One of the consequences of the country’s effective public health policies has been an increase in life expectancy at birth from 69 years in 1990 to nearly 74.84 years in 2012. Also notable have been the decreases in the infant mortality rate, which declined from 37 per 1,000 live births in 1990 to 15.2 in 2013, and in the under-five mortality rate, which declined from 46 per 1,000 live births in 1990 to 15 in 2011.

Urban-rural disparities

Despite this progress, however, many health problems remain unresolved. While the wealthier portion of the Chinese population has benefited from advanced health care technologies, many among the poor particularly those living in rural areas do not have adequate access to even the most essential services. For example, it is estimated that 80 percent of rural households do not have access to a sanitary lavatory and 20 percent of rural households lack safe drinking water.

In China, approximately 80 percent of health and medical services are concentrated in the main cities which mean that medical care is not available to more than 100 million people in remote rural areas. Although almost half of the population lives in the countryside, government expenditures in health tend to heavily favor those living in urban areas.

Although some progress has been made in underdeveloped rural areas, there is still widespread under-nutrition, vitamin and mineral deficiencies and indoor air pollution, all of which affect the health of people of all ages but children’s health in particular. Malnutrition among rural children is still a concern. The rate of stunted growth among children in China is estimated at 22 percent, and is as high as 46 percent in poor areas.

Migrants’ needs

It is estimated that China has a highly mobile population of more than 260 million rural-to-urban migrants, a number that will probably increase in the coming decades. They tend to work in high-risk jobs, such as construction projects and in a variety of industries where health and safety protection are not properly regulated.

These migrant workers have special health needs that need to be met, particularly since they usually do not qualify for public medical insurance, which usually depends on locally-based household schemes. In addition, rural migrants working in the cities constitute a population whose health status and needs are usually not monitored by either the rural or the urban health systems.

Migrants tend to suffer from several diseases differently than the non-migrant urban population. For example, they have more communicable diseases such as sexually transmitted diseases (including HIV/AIDS) and tuberculosis because of poor working and living conditions. In addition, China is going through an epidemic of chronic, non-communicable diseases which account for most of the disease burden in the country. The most important are cardiovascular diseases, cancer, respiratory diseases and diabetes which affect people of all economic and social conditions.

Migration is also a source of stress and stress-related diseases such as depression and anxiety disorders as a result of workers’ isolation and lack of family support. Some studies show many workers surveyed had considered the idea of suicide. There is a great need for qualified health personnel to respond adequately to these issues. In 2007 it was estimated that China had only 17,000 certified psychiatrists, which represents only a fraction of the number in developed countries in proportion to the population.

Effect of the environment on health

Water and air pollution are significant causes of disease in China. Several major lakes and rivers are severely polluted. Less than a quarter of its 28 major lakes and reservoirs are suitable for use as drinking water after treatment, reported the Lancet. At the same time, air pollution –such as that caused by burning solid fuels- is one of the major environmental health risk factors. In addition, Chinese cities have among the worst air pollution levels in the world. Major health problems associated with air pollution include COPD (Chronic obstructive pulmonary disease), acute lower respiratory infections and lung cancer.

Need for qualified health personnel

To address all health problems affecting the Chinese population, doctors and health personnel must to be better prepared to respond effectively to people’s needs. According to the Organization for Economic Cooperation and Development, almost half of the nation’s doctors have no better qualifications than a high school degree. In the case of rural doctors, they have less experience and medical education than their urban counterparts. At the same time, there is a lack of doctors trained in Western medicine throughout the country.

Many doctors in positions of responsibility such as the heads of medical centers tend to be political appointees rather than professionals with managerial training and experience. Despite this need, however, the medical education system doesn’t include hospital administration programs.

To help solve people’s most basic health problems, the education of rural healthcare medical and paramedical personnel needs to be upgraded. They should also receive economic incentives so that their salaries are on an equal basis with urban workers. In addition, rural health facilities need to be improved and well provisioned with basic medicines.

Cost of health care

Many among the poor limit their use of medical services for purely financial reasons, since the cost of treating serious illness can wipe out a family’s life savings. A great proportion of medical costs are due to unnecessary tests and prescriptions. Chinese hospitals’ reliance on profits from the sale of drugs has led to over-prescribing unnecessary medications. In addition, in order to increase profitability some pharmaceutical companies offer under-the-table inducements for prescribing drugs. The resulting high costs of treatment cause many patients to avoid going to hospitals, even for treatment that might be critical for their health.

Ageing and health

The elderly population in China is increasing significantly, while at the same time the working-age population is shrinking. This has implications for the care of the elderly by their children, and on the increase demand on the country’s health care system.

By some estimates, by 2035, about 25 percent of China’s population will be aged 60 or older. At the moment, there are no long-term care services available for most of this ageing population. Medical costs can increase dramatically with age, while at the same time the share of individuals who contribute to government revenues will decline, placing further strains on the country’s health care system.

Improving people’s health

The government must to address several challenges in health care provision such as the need to improve quality of services to increase access to health care services, to make the healthcare system more equitable, to reduce costs by improving efficiency, and to improve the health insurance system making it more accessible and comprehensive.

The government should focus on the promotion of healthy lifestyles and the prevention of chronic non-communicable diseases, which constitute a heavy burden on the country’s health care system. Health education should be given priority among government-funded interventions.

The Chinese government has taken several actions to improve the health of the population. Although millions of people have benefited, millions are still lagging behind. One of China’s greatest challenges is how to improve its health care system to reduce disparities and improve the health of the majority of the population.

Dr. Cesar Chelala is a co-winner of the 1979 Overseas Press Club of America award for the article “Missing or Disappeared in Argentina: The Desperate Search for Thousands of Abducted Victims.”