The Economic Development & Public Health Challenge in China

1. The Economic Development & Public Health Challenge inChina LimingLee M.D., M.P.H Professor, School of Public Health, Peking University

2. Outline • Introduction of Health Enterprises in China • Public Health Challenge in China • Future strategy for the challenge

3. Outline • Introduction of Health Enterprises in China • Public Health Challenge in China • Future strategy for the challenge • General Information • The Characteristics of China Health Enterprises • Health Policy in China • Health Care System in China

4. General Information • The Characteristics of China Health Enterprises • Health Policy in China • Health Care System in China • Area: 9.6 million km2 • Total population: 1.27 billion (2000) • Population in rural areas: 63.8％ • Administrative: 31 provinces • GDP: 8940.4 billion RMB • Number of health agencies: 330 thousand • Number of health workers: 5.568 million • Number of school of public health: 36 Source: 《China Statistical Yearbook》2001

5. General Information • The Characteristics of China Health Enterprises • Health Policy in China • Health Care System in China

6. General Information • The Characteristics of China Health Enterprises • Health Policy in China • Health Care System in China

7. General Information • The Characteristics of China Health Enterprises • Health Policy in China • Health Care System in China • 1949-1977 Welfare enterprises for the whole population (Government paid health services) • 1978-1996 Public welfare enterprises (Government & hospital paid health services) • 1996-now Welfare public enterprises (Government, Collective & individual paid health services)

8. General Information • The Characteristics of China Health Enterprises • Health Policy in China • Health Care System in China Dec.1996 the health meeting of China Center Gov. • Stress the health work in the rural areas • Put the prevention first • Lay equal stress in the Western and Chinese traditional medicine • Rely on the science and education • Mobilize the participation of the whole society

9. The organization structure of Chinese health system CAMS China CDC FDA PUMC State Department The Ministry of Health Specialized Hospital Local CDC MCH Hospital (Clinic) Drug Inspection Station Medical college or university Government of Provincial, Municipal, Autonomous Region The Bureau of Health Specialized hospital Anti-epidemic station MCH Hospital (Clinic) Drug Inspection Station Regional Administrative Office The Board of Health General Public Hospital Anti-epidemic Station Endemic Disease Prevention Station MCH Care Center (Clinic) Secondary Health School Government of Municipal, County, District The Board (department) of Health Township government, Sub-district Office Three tiered prevention and health care system Township hospital (clinic) District health center(outpatient clinic) MCH care center Villagers’ committee, Neighborhood residents’ committee Village health station Red Cross health station

10. Outline • Introduction of Health Enterprises in China • Public Health Challenge in China • Future strategy for the challenge • Population Dynamics • Double Burdens of Diseases • Urbanization and Industrialization • Behavioral Risk Factors • Unreasonable of Resource Allocation

11. 2050 China 410 million Asia 1.24 billion World 1.97 billion The proportion of senile population (≥60 years old) 1999 China126 million Asia314 million World 593 million

12. 2015 Aging 14% 1949 Total 0.058 billion Aging 8% 2000 Total 0.126 billion Aging 10% 2050 Aging 25% Trend of Population and Aging (0.1 Billion) 18 16 14 12 10 8 6 4 2 0 1953 1964 1982 1990 1995 2000 2015 2050

13. Most of the aging population is living in the rural area

14. 4 2 1 The family support system is weak 4-2-1 syndrome

15. Outline • Introduction of Health Enterprises in China • Public Health Challenge in China • Future strategy for the challenge • Population Dynamics • Double Burdens of Diseases • Urbanization and Industrialization • Behavioral Risk Factors • Unreasonable of Resource Allocation

16. Increasingly serious threats from… • Communicable diseases • Re-emerging: TB, STD, plague, cholera… • Emerging: AIDS, SARS… • Non-communicable diseases (NCD) • Stroke, cancer, CHD, diabetes, chronic obstructive pulmonary diseases (COPD), mental diseases…

17. Main communicable diseases The Incidence Rate of Communicable Diseases in China, 1965~1998

18. 1.Communicable Diseases The Proportion of Different Communicable Diseases by Etiology in China, 1950’s-2002’s (%) Transmitted by sex or blood Gastrointestinal Respiratory Vector-borne and natural endemic

19. The first 10 communicable diseases, 2003 Main communicable diseases

20. Tendency of Death Pattern, China, 1954-1998 Injuries & poisoning Others Non-communicable diseases Communicable, maternal and child diseases

21. 2.Non-communicable diseases Mortality rate of Leading Causes of Death in China(2003)

22. Outline • Introduction of Health Enterprises in China • Public Health Challenge in China • Future strategy for the challenge • Population dynamics • Double burdens of diseases • Urbanization and industrialization • Behavioral risk factors • Unreasonable of resource allocation

23. China 55 Anniversary The overall capacity Annual average growth rate of… GDP9.3% GDP per capita8.2% Year 2003… GDPRMB11669 billion GDP per capita$1000 Foreign exchange reserve$403 billion

24. China 55 Anniversary Industry rapidly developing % of GDP: 44.4% (Year 2002) Value added of industry: RMB 5361.2 billion (12.6%) (Year 2003)

25. Natural Environment Destroy • Pollution from waste water, waste gas, waste residue • Devastation of forest vegetative cover and the loss of soil and water • Eutrophication of the water bodies

26. China 55 Anniversary Energy production (Year 2002) Total energy production: 139000 (10,000 tons of SCE) Coal 70.7% Crude oil 17.2% Natural gas 3.2% Hydro-power 8.9%

27. Occupational Health Issues • Occupational diseases • Occupational accidents

28. China 55 Anniversary Transportation Newly built railways 1210 km Newly built double-Tracking Length 1443 km Length of Railways in Operation 72 thousand km Length of highways 1.77 million km Expressway 25 thousand km Private cars in urban 7.7million units

29. Traffic Accidents

30. China 55 Anniversary Number of major durable consumer goods owned per 100 urban households at the Year 2002-end Refrigerator (set) 87.38 Color Television Set (set) 126.38 Video-recorder (set) 18.43 Air conditioner (unit) 51.10 Oven (unit) 30.91 Mobile telephone (unit) 62.89 Personal computer (set) 20.63

31. Living Environment Pollution • Building decoration materials pollution • Electromagnetic pollution • Light pollution

32. China 55 Anniversary Peasant Out-Migration increasing Number of laborer in rural: 485 million Number of peasant out-migration: 99 million

33. Health issues of floating population • Unsanitary living environment • Poor immunization protection • Unhealthy behavior • Be difficult to manage

34. Outline • Introduction of Health Enterprises in China • Public Health Challenge in China • Future strategy for the challenge • Population Dynamics • Double Burdens of Diseases • Urbanization and Industrialization • Behavioral Risk Factors • Unreasonable of resource allocation

35. Smoking Tobacco Epidemic in China • Approximately 320 million smokers in China. (1996) • The prevalence of smoking among 15 years old and above was 35.10%. • 60% smokers have never contemplated quitting. • The majority of the population is involuntarily exposed to tobacco smoke (53.5%).

36. Smoking Tobacco Epidemic in China • 61% of adults believed that tobacco use was of a little or no harm to their health. • The average age at which smoking starts is 20 years old. • Smoking already causing about 750,000 deaths a year and predicting that this will rise to three million a year.

37. Smoking The smoking behavior comparison of Chinese aged 15+ between 1984 and 1996

38. Smoking Economics of tobacco in China • China is the world’s leading producer of tobacco. • Cigarette tax revenue in China was 31.0 billion RMB in 1992, 65.0 billion RMB in 1997, average representing 10.0% of total government revenue.

39. Smoking Production and Marketing of tobacco in China Source:The Report of Tobacco in China

40. Smoking Trend of Tobacco Sales & Mortality in Chinese Pop, 1996

41. Drinking Source: 《China Statistical Yearbook》2003

42. Drinking • The frequency of drinking

43. Drinking • The Drinking Type Male High degree white spirit Beer Low degree white spirit Female Wine Beer

44. Drinking The proportion of heavy drinkers to the whole drinking population

45. Physical Exercise The average sedentary time per day during free time

46. Physical Exercise The proportion of persons taking exercises

47. Overweight & Obesity The long-term trend of the prevalence of overweight and obesity in China 36.7% 83.9%

48. Overweight & Obesity The prevalence of Chinese overweight and obesity by age in 2002 Diagnostic criteria: <7 years old: (WHO Z score reference) 2<WHZ≤3 overweight, WHZ>3 obesity 7-17 years old : BMI≥p85 overweight, BMI≥p95 obesity ≥18 years old : 24≦BMI<28 overweight, BMI≥28 obesity

49. Hypertension The comparisons among 4 times of National Hypertension Survey • 与1991年相比，患病率的相对增长量为30.9%，患病人数的绝对增长量为9千万人。 : Nominal prevalence with different diagnostic criteria. : Age-adjusted standardized prevalence. The diagnostic criteria was unified with SBP≥141mmHg and/or DBP≥91mmHg regardless of whether taking medication within 2 weeks (the criterion in 1979).

50. Hypertension The rates of awareness, treatment and control of hypertension between 1991 and 2002