HONG KONG: China's economic boom has resulted in stark inequity between its urban and rural populations in terms of health, and experts urged the government to work harder at providing health care for everyone.
Infant mortality in China's countryside stands at 123 for every 1,000 live births compared with 26 in the richest counties, the experts wrote in a paper published in The Lancet medical journal.
Of every 1,000 children, 64 in the countryside will not live beyond their fifth birthday, compared with 10 in the cities.
The report, by researchers in China, the United States and Britain as well as from the World Health Organization, is part of a special series on China's health reforms.
While life expectancy in Shanghai is 78.1 years, that figure is 66.1 in Gansu, one of the poorest provinces.
The team of experts also highlighted China's "missing women."
"In China, the problem has been exacerbated in recent decades by the practice of sex-specific abortions," the experts wrote.
The report continued that "discrimination lasts through infancy and childhood, reflected in higher death rates for girls."
"In 2000, infant mortality was 33.7 per 1,000 live births for girls compared with 23.9 per 1,000 for boys."
The authors attributed the disparities to inadequate government investment in health care, which increased "out-of-pocket" costs, hitting the poorest the hardest.
There was also insufficient government stewardship, which resulted in "doctors using their knowledge to prescribe inappropriate yet profitable procedures and drugs."
Another paper in the series highlighted the preference among medical and health care graduates for joining pharmaceutical and biotechnology companies instead of the medical profession, where they are needed.
This paper, led by Sudhir Anand of the University of Oxford, estimated that one million such graduates between 2000 and 2005 were not absorbed into the country's health care workforce.
"Although the production of doctors and nurses has greatly expanded in recent years, serious problems of distribution remain," the experts wrote, adding that "the goal of its health reform should be to promote equitable and universal access to basic health services."
Another paper highlighted how health care was taking up the bulk of household incomes, or a whopping 50 percent in 2006 (more than 18 times that in 1990) because of inadequate health insurance.
This compares with 45 percent in South Korea, 16 percent in Sweden, 15 percent in Japan and 11 percent in France.
"The average cost of a single hospital admission is now almost equivalent to China's annual income per head and is more than twice the average annual income of the lowest 20 percent of the population," wrote the team, led by Hu Shanlian from Fudan University in Shanghai.
"More than 35 percent of urban households and 43 percent of rural households have difficulty affording health care, go without, or are impoverished by the costs," they wrote.
The papers noted recent moves by the Chinese government to modernize the public health system and introduce health insurance plans, but much more needed to be done, especially to raise the level of reimbursement and help people who live in poverty.
Another Lancet report warned that chronic illnesses like cancer and heart and respiratory diseases were time bombs, and that the Chinese should reduce their intake of fatty foods and salt, stop smoking and start exercising.
Increasingly affluent Chinese consumed between 25 and 100 percent more fat each day in 2002 compared with 1982, sharply raising the risk of heart disease and cancer, the experts wrote in The Lancet.
While the country was plagued by infectious diseases before 1990, chronic illnesses are now the main health problem and accounted for 74.1 percent of all deaths in 2005, up from 47.1 percent in 1973, the researchers wrote.
While these chronic illnesses have to do with people living longer, several high-risk factors are also involved.
Apart from a fatty diet, many Chinese consume a relatively high 12-gram dosage of salt daily, which the paper said accounted for hypertension in about 177 million Chinese adults.
Based on Chinese definitions, 22.8 percent of Chinese were overweight in 2002. About 7.1 percent in the population were obese in 2002.
The paper also drew attention to the smoking habit of many Chinese.
"One in every three smokers in the world is a Chinese man," the experts wrote. They reported that cigarette consumption increased to 2,022 billion in 2006, to a level 17.4 percent higher than in 2002.
The average Chinese male smoker smoked 15 cigarettes a day in 2002, up from 13 in 1984.
The costs of China's disease burden from smoking were likely to be vast, and China will suffer reduced productivity and more premature deaths, the researchers warned.
"Hypertension and tobacco can be targeted health priorities," wrote the team, led by Yang Gonghuan of the Chinese Center for Disease Control and Prevention in Beijing. "Reduction of salt intake should become a national campaign."
6 months ago