Although China has imposed the world’s strictest lockdowns to protect its people from Covid-19, the deadly impact of non-communicable diseases is much less understood and threatens to kill tens of millions of Chinese in the coming decades without stricter public health policies. China has been transformed in recent decades from an economic miracle that saw rapid industrialization and the transfer of hundreds of millions of people from the countryside to towns and cities. This massive change has lifted multitudes out of poverty and given them a better standard of living than they enjoyed in rural areas. But along with higher wages and urban life have come “Western” diseases such as cancer linked to very high rates of smoking and diabetes and heart disease thanks to richer diets, lack of exercise and high blood pressure. Wang Feng, a professor of sociology at the University of California, Irvine, says the pace of change seen in China during the 1980s and 1990s is unlike anything else in history, and that social and health problems that have been stored for decades are coming home. perch. View of the Beijing skyline. Photo: VCG/Getty Images “These are hidden epidemics and they are ongoing epidemics,” he says. “You have a blast on a new diet and nutritional intake in a short period of time. Coupled with unpredictable, unprecedented aging, it will be one of the biggest challenges facing China – not just for individual families, but a political challenge for the leadership. “This issue could really explode out of control,” he says. “This is not something that is going to go away.”
Smoking ‘disaster zones’
More than a third of the world’s 1.1 billion smokers live in China, where about half the male population is addicted to tobacco. Smoking-related diseases – which include lung cancer, respiratory and heart diseases – will kill one in three young Chinese by 2050 according to current projections. This is a grim statistic in a country already facing a demographic crisis due to a falling birth rate and a rapidly aging population. The UN predicts the population could drop from its current level of about 1.4 billion to about 1 billion by 2100. Chinese officials said in July that the population is already starting to shrink as birth rates hit record lows here and decades. However, some predictions are much more drastic, with separate research in the US and China suggesting that the population will almost halve by the end of the century to around 730 million. Populations in the United Kingdom and the United States, in contrast, are projected to remain stable or increase slightly over the same time frame. Bernard Stewart, an internationally renowned expert on cancer causation and professor at the University of New South Wales in Sydney, says the evidence is overwhelming and China must take action to prevent what he calls an unfolding “catastrophe”. Workers pack e-cigarettes on the production line of First Union, one of the leading manufacturers of vaping products in China. Photo: Kevin Frayer/Getty Images “There’s no way you can describe the disaster China is facing in terms of smoking deaths,” he says. “There is a huge difference in rates between provinces, but highly industrialized cities are disaster areas.” The biggest cause of death in China is stroke, followed by heart disease, chronic lung disease and then lung cancer, according to the Global Burden of Disease Study by the US Institute for Health Metrics and Evaluation. Smoking is a contributing factor in many of these cases. Cardiovascular disease is a major killer in China, especially in the heavily industrialized and urbanized north. People in this area are more likely to suffer from hypertension, obesity and a poor diet low in fruit and vegetables but high in red meat, according to a Lancet study. China has more people with diabetes than any other country – more than 110 million – in what the World Health Organization (WHO) has described as an “exploding” problem. That number will rise to 150 million by mid-century. Diabetes and diabetes complications already contribute to nearly one million deaths in China each year, according to the WHO. More than 40% of these deaths are classified as premature – occurring before the age of 70 – which is another cause for alarm. China ranks 78th in an index of countries best at avoiding premature deaths. Photo: Imperial College China is the world’s second largest economy and has become home to hundreds of billionaires in recent decades. But its health outcomes are still those of a much poorer nation. People in China have a 14.1% chance of dying prematurely from a non-communicable disease, which ranks the country 76th in the world health rankings. South Korea is first with 4.7%, while the UK is 27th with 9% and the US is 44th with 11.8%. The results are worse for Chinese men, with a 19.8% chance of dying prematurely. The ruling Communist Party’s efforts to address the health crisis include the Healthy China 2030 campaign launched in 2019 to reduce premature deaths, control risk factors and strengthen health care capacity. There are now more smoking bans in public places such as high-speed trains, shops and restaurants. Even last year’s crackdown on children’s screen time can be seen as part of the effort to reduce incipient obesity and improve health outcomes. However, obstacles remain such as the government’s reliance on the cigarette tax, which provides about 10% of the tax base through state-controlled tobacco monopolies.
“Western-style” problems.
A man walks down a street smoking a cigarette during a sandstorm in Beijing’s financial district. Photo: Nicolas Asfouri/AFP/Getty Images The health crisis can in many ways be traced back to China’s stratospheric economic growth since the late 1970s, when people began to be able to consume a more Western-style diet and adopt Western-style habits. In 1978, most Chinese were on a subsistence diet. By 1988, they were consuming 60 percent more pork and 150 percent more vegetable oil, Wang says, which greatly helped improve nutrition. However, at the same time, alcohol consumption increased 3.5 times and the number of packs of cigarettes smoked doubled. Wang says: “That was almost 30 years ago. But it’s coming back as a problem for people in later life now. People were consuming booze, sugar and tobacco faster than food… There was no awareness of the new malnutrition, overweight people and how quickly this was happening.” The high cost of caring for an ailing and aging population is also a serious obstacle to Beijing’s hopes of reviving a flagging economy. One reason is that a greater share of spending falls on individual households than expected in the communist-controlled nation – about a third of per capita health spending. The need to save for health care is a huge drain on family budgets – often with only one child doing the saving and caring. This in turn exacerbates the demographic problem because China’s current generation of 18- to 40-year-olds who are raising children have less money and inclination to start their own families. These growing problems are recognized by the Communist Party leadership and are among the reasons the government has stuck so tightly to its zero-Covid strategy while the rest of the world has returned to normal life. Beijing knows that the population – especially the elderly living in rural areas – do not have access to good healthcare and with underlying health problems such as heart disease and respiratory problems already so common, will be at high risk from the spread of Covid . Zero Covid is estimated to have saved a million Chinese lives.
“A health problem means a financial problem”
People seek treatment at the Beijing Hospital of Traditional Chinese Medicine. Photo: Future Publishing/Getty Images About 95% of people in China have some form of health insurance, but that doesn’t mean healthcare is affordable. Efforts to reform the public health system have seen the number of private hospitals explode, and the total number now outnumbers public facilities. The provision of care varies greatly from province to province and especially from urban to rural areas, but it is still considered very inefficient and costs for people with insurance are still very high. “Chronic diseases are a significant contributor to health burden, disparities in health outcomes, and economic burden in China,” a team of academics wrote in the Lancet in 2021. One of the authors, Professor Barbara McPake, a health economist at the University of Melbourne, says households face dire consequences from China’s growing problem of hidden epidemics. “The health system sees large costs for people with non-communicable diseases,” he says. “A health problem means you have a financial problem. 95% of people have health insurance, but there are high costs for drugs and care. Insurance doesn’t go far, so in some cases it’s insurance not worth having.”
