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First world problems: China’s lifestyle contributes to ill health

Enter the dragon: China joins higher-income countries with similar health concerns. PA/Fiona Hanson

China is now facing similar health issues to higher income countries including the UK and US, according to new global health figures.

Poor diet and cancer are a growing concern in China compared to issues such as TB and measles just 20 years ago.

Since 1990, rapid improvements in health have led to fewer infectious diseases. Children under five are also much more likely to survive. In a snapshot taken in 1990, there were 1m child deaths, compared to 2010, where the number was down to 213,000. People are also living longer – from a life expectancy of 69.3 years in 1990 to 75.7 today.

But health problems from smoking and high blood pressure are increasingly a problem. Just over half of Chinese men smoke - one of the highest rates in the world. Chinese women are at the opposite end of the scale, with one of the lowest smoking rates, but the number of people exposed to passive smoking in China could be as high as 72%, according to figures to be published in The Lancet journal tomorrow.

Stroke, cancer and poor diet

Stroke is now China’s biggest killer, causing 1.7m deaths in 2010. Diseases such as diabetes and cancer are also up. Chinese women are a lot less likely to die from breast cancer - only South Korea and Saudi Arabia have a higher rate of survival - but five cancers, including lung, liver and stomach, are among the top 15 killers.

The changing health trend comes from figures compiled for the Global Burden of Diseases, Injuries and Risk Factors, a collaborative study led by researchers at the Institute for Health Metrics and Evaluation (IHME) at Washington University.

The study compares China to other countries in the G20, a group of 20 of the world’s major economies. Previous health figures released by the IHME showed the UK was lagging behind most other European countries when it came to deaths from preventable causes, such as smoking, unhealthy eating, alcohol and drugs.

While people in the UK are healthier and living longer, Britons suffer more from disabling conditions such as back and neck pain and depression.

The likelihood of dying early in China is now only slightly higher than the US. Comparisons between China and the G20 countries can be made using data visualisation tools, including the top 25 causes of people dying early.

“China has made significant improvements in health over the past 20 years,” IMHE’s Dr Haidong Wang said.

“Stroke is the leading cause of death and has increased by 35% since 1990. Blood pressure is second after dietary risks.” Along with smoking, Wang said consuming high amounts of salt with not enough fruit and whole grains - even in rural areas - is a problem.

Women have fared better - mortality rates of women up to the age of 34 have dropped by a half.

“Communicable disease is down, too,” Wang said. “So there is a lot of good news. But non-communicable diseases are increasing, especially cancer.”

Changes to healthcare

While some change has been incremental - the study says the rise in non-infectious diseases and chronic disability has also been driven by urbanisation, rising incomes and ageing - the Chinese government is making healthcare changes that could also have an impact.

“In 2009, the government announced major health reforms,” Wang said. “The public was unhappy about healthcare being unaffordable and the fact that people had unequal access to healthcare based on status and where they lived. In the next decade, the government plans to train a significant number of family physicians.”

Twenty years ago, China had a health profile very similar to much of the developing world, including countries such as Vietnam or Iraq.

“The main thing other countries can learn from China is that rapid change to improve health is possible within a relatively short period of time, especially in reducing communicable disease,” says Wang. “The transformation of health in China has happened in just 20 years.”

More than 680m people in China now live in cities – now more than half of the country’s population - driven by the search for jobs and economic opportunity. But air pollution and other issues can lead to health problems.

“Urbanisation leads to lifestyle change such as reduced physical activities, added living and working pressure and unhealthy dietary change, all of which contribute to higher risks of having NCDs,” says Dr Winnie Wang from the School of Geographical Sciences at Bristol University.

“More than 200m temporary migrants in cities have more limited access to health services. Increased pollution level in cities due to vehicles and industrial development have also put the urban population at a higher health risk than those in a rural population.”

“China not only has the largest ageing population but also one of the fastest growing in the world. Ageing is considered as a driving force for NCDs as elderly people can be more vulnerable.”

Dr Gonghuan Yang, professor at Peking Union Medical College and a joint lead author of the IMHE study, said “aggressive tobacco control measures” would need to be a part of any important public health strategy. Tackling the issue, Yang has said, would take significant political will and public engagement to counter strong opposition to tobacco control in China.

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