The health of the Chinese population has improved enormously in the last fifty years. However, increasing life expectancy has been accompanied by the re-emergence of old infectious diseases and emergence of new ones such as HIV/AIDS. Economic growth and modernisation have also led to a rise in non-communicable diseases. An effective response to these changing circumstances will require a coherent, government-led approach that prioritises particularly high risk population groups.

The better health experienced by China's population fits with what researchers call ‘the classical epidemiological transition model’.  This is a model in which the high rate of infectious disease and early mortality associated with a predominantly peasant society have changed into disease patterns that correspond to an aging, increasingly urban, population. Does the current picture of China’s health fit within the classical epidemiological transition model? What are the main challenges facing the country’s health policy-makers?

China’s pre-revolutionary health situation was dominated by high rates of infectious disease, high levels of infant mortality and a very poor health care infrastructure. Since then, basic health statistics like infant mortality rates show a progressive improvement in the country’s health that is comparable to other rapidly developing countries.

Researchers at Liverpool's John Moores University, UK carried out a review of China’s changing health situation to establish whether the concept of epidemiological transition applies. Although, on the surface, it appears that increasing life expectancy and degenerative diseases fit with this explanation, there are other elements that may not correspond. The research found that:

• Respiratory diseases – asthma and lung cancer - continue to be a major cause of death. Much of this is due to the heavy environmental pollution resulting from economic growth that has been fuelled mainly by coal containing high levels of sulphur, arsenic and other toxins, and smoking.
• There has been a resurgence of infectious diseases, such as tuberculosis, leprosy and schistosomiasis. The latter resulting from high levels of water pollution.
• Modernisation has altered many people's lifestyles. These have resulted in a high prevalence of smoking amongst adult males that could lead to more than three million deaths per year from tobacco related disease by 2025. Also, high fat diets and greater alcohol consumption have resulted in obesity and cardiovascular disease.
• The increased levels of prostitution and intravenous drug use have led to a growing incidence of HIV/AIDS. Official figures now suggest that China has up to one million AIDS sufferers, but observers claim the real figure could be twice as high. Government policy continues to be surrounded by secrecy and public ignorance about the disease.

All the above problems are compounded by the increasing socio-economic inequalities brought about by China’s rapid economic development. These express themselves also in the form of inequalities of access to health care. As a result, infant mortality is ten times higher in rural areas than in urban ones.

The researchers suggest that, similar to other rapidly developing countries, China’s health situation cannot be explained by the classical epidemiological transition model alone. Indeed, China faces both health issues common in an aging, increasingly urban population, and a re-emergence of infectious disease, in the context of growing inequalities in health and heath care.

The study calls for appropriate state-led health measures to deal with the situation. Groups most at risk of ill-health, such as the elderly, women and the poor, many of whom reside in rural areas, should be targeted. Adopting a more open approach to health by abandoning the state secrecy surrounding certain health issues such as AIDS or SARS and engaging fully with the World Health Organisation and other external agencies, must also be made a priority.

Source(s):
'Changing health in China: re-evaluating the epidemiological transition model', Health Policy 67: 329-343, I.G. Cook and T.J.B. Dummer, 2004
HINARI subscribers can access the full-text article here Full document.

id21 Research Highlight: 15 June 2004

Further Information:
Ian G. Cook
School of Social Science
Liverpool John Moores University
Henry Cotton Campus
21-25 Webster Street
Liverpool L3 2ET
UK

Tel: +44 (0)151 231 4071
Contact the contributor: i.g.cook@livjm.ac.uk

John Moores University, UK

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