Hygeine poster
China has nearly eliminated death by infectious diseases, with mortality rates for these types of conditions falling from 7,000 per 100,000 of the population in 1970 to under 300 per 100,000 in 2008. Traditional killers such as malaria and typhoid are now effectively under control in all but the most remote areas. [Source: Iain Mills, Asia Times, April 21, 2010]

However, while infectious diseases data is encouraging, in terms of chronic conditions - long-term, hard-to-treat diseases such as cancer, diabetes and heart disease - the outlook is far less positive. Nearly 20 percent of Chinese adults now suffer from hypertension, a condition associated with a low-nutrition, high-salt diet that significantly increases the likelihood of stroke, heart disease and other sequelae. The incidence of cancer - particularly lung, liver and stomach cancer - is rising at around 30 percent per decade, and figures released last week show that China now has 92 million diabetics (7 percent of the population; nearer to 10 percent in many urban areas). More than 3,000 people die every day from smoking-related illnesses.

From this brief overview, it is possible to see two very different pictures of China's healthcare development. On the one hand, basic treatment has improved and communicable diseases have been controlled; however, on the other, China has struggled to respond to the advent of a new type of healthcare threat - social diseases. [Ibid]

Life expectancy: 74.8 years for females; 71.1 years for males. (Compared to 85 for females and 78 for males in Japan and 47 for females and 42 for males in Guinea). Life expectancy increased from 35 in 1949 to 73 today. Between 1963 and 1980 it increased one year a year from 50 to 67.

Infant mortally rate: 22 per 1,000 births (compared to 5 per 1,000 in Japan and 159 per 1,000 in Mali). The mortality rate for children under five rate dropped from 200 in 1949 to 173 in 1960 to 44 in 1985 to 32 in 2000. The infant mortally rate for girls is 24.5 per 1,000 births, compared to 20 for boys.

Improved health is not being experienced everywhere in China. In the countryside the mortality rate is "as bad as you'll find in the developing world," according to World Bank economists, and four out of five peasants can't afford to see a doctor. Life expectancy in some parts of the country may be falling.

Because of improved nutrition the average Chinese child in 6 centimeters, or 2 inches, taller and 3 kilograms of 7 pounds heavier than 30 years according to the Chinese Health Ministry.

The number of newborns with birth defects is rising. The rate of physical abnormalities among newborns in Beijing was 170 per 10,000 births in 2009, nearly double the rate in 1997. The problems is blamed on women having children later and environmental pollution.

The chances of a woman dying from pregnancy, childbirth or abortion in China are 1 in 439. In contrast the odds are 1 in 5,669 in the United States; 1 in 7 in Mali (the worst in the world); and 17,361 in Italy (the best in the world). [Source: Population Action Council]

Good Websites and Sources: Center for Disease Control on China CDC World Health Organization on China ; Wikipedia article on Public Health in China Wikipedia ; Short UNICEF Article on Health Issues in China


Chinese Health Customs

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In a 1997 survey by the Leo Burnett advertising agency 61 percent of Chinese agreed that sleep equals health (compared to 28 percent of Americans) and 61 percent of Chinese agreed that cleanliness equals health (compared to 31 percent of Americans).

Physical examinations have traditionally been a fixture of life in China. They are required before one can apply for college, get a driver’s license of get married. See Marriage.

Chinese have traditionally gone to a pharmacist rather than a doctor when they don’t feel good and have taken large doses of medicine for a short period of time rather than small doses over a long period time. They often take large doses of several kinds of medicine because they don't believe one kind will work.

When they are sick Chinese have traditionally consumed tepid boiled water. When they have a cold or a cough they wear surgeon-style face masks to keep their germs from spreading to other people, a custom common throughout East Asia and adopted by Michael Jackson. Some Chinese light incense in their houses and offices under the belief that it helps kill germs. A new mother sometimes will not bathe for a certain number of days or step outside.

Green tea is taken to lower "heat" in the body. People with fevers are discouraged from eating red fruits because they are associated with heat and bad luck from the south. Pineapples and papayas are supposed to cure orange-peel skin. Ground up pearls are sometimes taken as a medicine.

The Chinese are pretty tough. One woman from Shanghai had 1,650 gallstones removed from an inflamed gall bladder the size of a pear and then got of bed, exercised and went home the day after the operation.

Chinese Hospital Customs

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In the hospital with a broken leg
Hospitals provide bed sheets, but the families of patients are required to bring everything else: towels, soap, dish towels, toilet paper, pajamas, cups and extra food.

Relatives are expected to feed and take care of patients while they are in the hospitals. Family members often stay in the hospital room of a sick person around the clock, and often take turns sitting besides the bed. Out of 100 people that enter a hospital building often only about 20 percent actually have an ailment of some sort. The other 80 percent are family members who have come along to provide care and offer encouragement.

Doctors and staff routinely spit in the hallway floors. In rural clinics it is not uncommon for dogs and patients with questions to wander into a room where a doctor is examining a patient.

People are afraid to go to hospitals because they believe that is where people go to die.

Health Problems in China

China has health problems that are found in the developing world---malnutrition and communicable diseases---and the developing world---obesity and chronic diseases such as diabetes associated with high fat diets. Matthew Crabbe of the research firm Access Asia told Reuters, “China is more like a set of regions, not one country...On one hand, a massive rural population still has a low income and low caloric intake compared with urban populations where there is a high caloric intake and rising weight.

The food and health standards are generally below those of European or North American countries. Dysentery, hepatitis, stomach parasites and malaria occur in China. Diseases like tuberculosis and measles that were once thought to have been tamed have returned.

In China as in Japan rates of heart diseases are relatively low but are increasing. Chinese between the ages of 35 and 64 are twice as likely as Americans to die of heart disease. One in five Chinese have high blood pressure. Many blame the trend on more fat- and sugar-laden Westernized diet and fast food which causes obesity and made it more likely for people to have high blood pressure and heart disease.

The Harvard School of Public Health has estimated that 65 million people will die from chronic obstructive pulmonary disease and 18 million will die from lung cancer between 2003 and 2033 from smoking and burning fuel indoors with chronic obstructive pulmonary disease accounting for around 19 percent of all deaths and hung cancer, 5 percent.

Most Chinese don’t get enough minerals, a condition that experts blame on a preference for refined foods. Iron deficiency is a problem. One in five Chinese suffer from anemia. Many also have calcium deficiencies. The average Chinese takes in 391 milligrams of calcium a day, 40 percent below the recommended level. About 40 percent of Chinese children below seven have a zinc deficiency.

Cataracts are a serious problem in China. An alarming number of peasants and their children develop them. No one is sure why. Some have speculated it is congenital and related to fact many people in remote areas marry their cousins or perhaps because of way children are carried and exposed to the sun.

Overweight Chinese

left Throughout China, but especially in cities such as Beijing, Shanghai and Tianjin, obesity is growing problem. The Chinese state media reports have said more than 300 million of the country's 1.3 billion people are overweight, 120 million of them obese. While not as severe a problem as in the United States, where estimates place more than 60 percent of adults as overweight or obese, experts say China increasingly faces a population coping with heart disease, diabetes and other weight-related illnesses.

According to some estimates, a third of China's population - some 429 million - are overweight or obese, prime candidates for heart disease and diabetes. It is growing fatter faster than any developing nation except Mexico, with grave implications for the work force and economic growth in the world's second biggest economy. [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

Obesity is a relatively recent problem in China. A 2009 report by the Chinese Association for Student Nutrition and Health said the number of overweight young people aged between seven and 17 had tripled between 1982 and 2002, a trend that had accelerated in recent years. About 35 percent of adults in Beijing are overweight, compared to 22.5 percent nationwide, and 17 percent are obese, and the rate has been increasing at a rate of 10 percent a year. Obesity is defined as being 20 percent above the accepted body weight. Currently 10 percent of children are obese and their numbers increasing by 8 percent every year.

Health experts say that the speed with which China is putting on weight is alarming. Ding Zongyi, a professor at the Chinese Medical Doctor Association, who has been studying obesity in China for the past 30 years, said the obesity rate has jumped 158 per cent since 1996 to 2006 and is set to rise further. Even the most conservative assumptions have the rate of change in overweight and obesity in China doubling over the next two decades, Barry Popkin, professor of nutrition at the University of North Carolina, wrote in the July/August 2008 issue of the journal Health Affairs.About 12 per cent of children aged 7-18 years old in China are overweight or obese, Popkin said. [Op Cit, Wee and Mao, Reuters]

See Overweight Children, Children, People

Reasons for High Rates Obesity in China

Many blame the problem on Western foods and a more sedentary lifestyle that has occurred as people have switched from farming and bicycles to cars and office jobs. Higher incomes have meant more people are eating rich, high-caloric diets In 1990 the average Chinese ate 51 grams of fat per day---the equivalent amount of fat found in one KFC chicken pt pie and biscuit. Now they eat considerably more than that.

Paul French, co-author 'Fat China: How Expanding Waistlines are Changing a Nation,' told Reuters."In America and Europe, they had to go through the whole process of inventing supermarkets and processed food.It took stages in the West. The Chinese didn't have to invent the Mars bar. It was given McDonald's, KFC, Tesco and Wal-Mart." Popkin said that more fried food, consumption of food from animal sources, sugared drinks and too few vegetables have contributed to China's expanding girth.Although the prevalence of fast food is a major culprit, extra-high amounts of salt, sugar and oil in Chinese cooking is another factor contributing to the sharp rise in obesity.

Some blame the rising consumption of dairy products in a country where milk, cheese and butter have traditionally not been consumed, Harvard anthropologist James Watson told Reuters, “I’m personally convinced that this has much more to do with the obesity and health problems that are emerging than the usual scapegoat fast food...There’s a big change in terms of taste when people want ice cream throughout their lives.”

Experts also blame poor city planning---the dearth of green space and parks in Chinese cities---and general attitudes toward exercise and leisure. Bicycling, a key way for many Chinese to remain lean, is out of fashion. [Source: Lily Kuo, Los Angeles Times, October 31, 2010]

But the ongoing growth of China's economy---and a quest for the good life---is bound to continue influencing how the population responds to calls for healthy eating and fitness, said Paul French, co-author of the recent book, "Fat China: How Expanding Waistlines are Changing a Nation." "The idea of going and mucking around in your garden, that's like being a peasant," French said. "Why would you ride a bicycle when you can drive a car.” [Ibid]

Chinese Obesity in the Cities

Obesity is most acute in China's biggest urban cities such as Beijing and Shanghai, where people enjoy higher incomes, eat richer foods and lead more sedentary lifestyles. "Urban China got richer. It's just gone out and bought itself more food and bought itself cars and couches to sit on while watching TV,"Paul French, co-author 'Fat China: How Expanding Waistlines are Changing a Nation,' told Reuters. [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

Mu Ge, the sales manager at Bodyworks, said the most glaringdifference between China and other countries "is that the rich people in China are all extremely fat ... (whereas) in other countries, the wealthy are all very thin and beautiful." "In the U.K., only the poor people will eat junk food, and will therefore be fat," Mu said. "In China, it's the opposite. The more money you have, the fatter you are. It's almost as if it's proof that living standards have improved."

Obesity-Related Health and Economic Problems in Chinese Cities

And while China's obesity rate is still half that in the United States, the U.K. and Australia, it has led to a worrying rise in chronic non-communicable diseases such as cancer, strokes, heart disease and diabetes.In a growing number of developed nations, obesity is fast replacing tobacco as the most important preventable cause of chronic non-communicable diseases, health experts warned. [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

In China, the economic costs of obesity are enormous, Popkin said. An increasingly obese population poses economic problems in terms of treatment costs, paid sick leave, loss of productivity, disability and premature death.The indirect effect of obesity and obesity-related dietary and physical activity patterns was 3.58 per cent of GDP in 2000 and was projected to reach 8.73 per cent in 2025, Popkin wrote."These estimates do not account for much of the recent rapid increase in the use of and spending for pharmaceutical products, which would make the total costs even higher," he wrote. [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

Ding said there had been no action taken by the government to address the problem. "The government pays little attention to obesity partially because many parents and even doctors still lack the awareness to recognize and seriously cope with obesity as a problem," he said.

Discrimination Against Fat People in China

Though most Chinese think a chubby child is a healthy child, society can be less tolerant of overweight adults, who complain of not being able to find jobs. "I want to give people a good impression when I go for interviews," said Zheng Xiaojie, a 22-year-old university student from far-western Xinjiang, who has lost over 5 kilograms in seven weeks. "People feel more comfortable about thinner people." [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

In the old days, being fat was a desirable trait. It signified wealth while being thin was equated with poverty. Back then many people only were able to eat meat a few times a month; many didn’t get enough to eat period. These days being obese is viewed in an unfavorable light. Overweight people are increasingly becoming common sights in China. Overweight children are bullied in school. Some have parents who are embarrassed to be seen in public with them, Fat adults are the butt of jokes and thinly-disguised whispers on the streets. As is true with short people in China, they are routinely denied places in schools and passed over for jobs and promotions that go to thin people.

Dealing With and Cashing In On China’s Obesity Problem

Diet fads and weight loss centers are on the rise. In recent years Chinese have become obsessed with slimming down and losing weight. Ads for appetite suppressants and slimming potions are everywhere. An A.C. Nielsen survey in 2004 found that two thirds of urban Chinese interviewed were concerned about losing weight, 80 percent exercised regularly and three quarters said that health was one of their main concerns. One weight loss center that opened in 1993 now over 1,000 locations across the country. Weight reduction methods include acupuncture and eating copious amounts of cucumbers. Today there in an increasing demand for liposuction and bands placed around the stomach that restrict food intake and give a person a feeling of fullness.

Drugs, treatment and access to good doctors are expensive and beyond the reach of average Chinese. The government is spending $125 billion to revamp the health system to cover all Chinese citizens by 2020, but the plan is not expected to cover common diseases associated with weight. [Source: Lily Kuo, Los Angeles Times, October 31, 2010]

Chen Chunming, who leads research teams at the Chinese Center for Disease Control and Prevention, an agency of the Ministry of Health, told the Los Angeles Times government officials have initiated efforts to address the health risks. "The government understands that if the situation is not controlled it can get serious," Chen said. "We've already started to pay attention to the issue of obesity and overweight so we're not pessimistic about the future." [Ibid]

In Beijing, the city critics have called China's fattest, the municipal government last year announced a campaign called "Healthy Beijinger: A 10-year Plan to Improve People's Health."The campaign is aimed at overall health but one of its specific goals is reducing the amount of fat Chinese adults eat each day. Officials hope to reduce the number of overweight children in high school and primary schools from 17 percent to 15 percent by 2018. [Ibid]

The initiative has included sending informational nutrition pamphlets as well as 600,000 tape measures to schools with instructions from the Beijing Municipal Commission of Education that students should measure their parents' as well as their own waistlines and endeavor to lose weight over the Chinese New Year holiday. [Ibid]

For employees of state-owned companies, communist-style group exercise, or "radio calisthenics," were brought back in August and will become mandatory sometime in 2011. The Beijing Federation of Trade Unions has hired 5,000 instructors to teach employees how to maximize the eight-minute exercise routine. Study published in

Chinese Fat Camps

On the grounds of the Bodyworks weight loss campus in Beijing, 30 tubby men and women sweat profusely, gasping for air as they pound the treadmills in an exercise room....At the Bodyworks campus, they range in age from 7 to 55 and come from across China. Each pays 30,000 yuan ($5,673) for the six-week program. [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

For that, they get balanced meals and exercise for six hours each day. The regimen includes weight training, running, yoga and football. "For the first two to three weeks, it was especially hard. I cried on the phone to my parents and told my father, 'I can't make it,'" said Zhang Fang, a 28-year-old employee with China Unicom from northern Shanxi province. "My mother said: 'If you don't continue, you're finished. You need your health.'"

When Zhang joined the camp, she weighed 150 kilograms (300 pounds), had high blood pressure and had trouble breathing when she walked. She's lost 50 kilograms in one year."Now I'm a fat person, but at least I'm not a super-sized fat person," Zhang said.

Dressed in an oversized t-shirt that did little to conceal his rotund belly, Liu Chi has lost more than 10 kilograms since he first entered Bodyworks six weeks ago and now weighs in at about 90 kilograms.To Liu, his progress represents a new lease on life -- one he hopes will include a girlfriend and fewer taunts."I had an inferiority complex," said the cherub-faced 20-year-old student from Hebei province. "People will look at me on the streets and ask me: 'How heavy are you?'"

Beijing’s Fattest Man

A popular reality intervention television show called "Tian Weighs 462 Pounds, Beijing's Fattest Man," featured a man named Tian Ning who lost 242 pounds in six months. He lived at the Kelikexin International Weight Loss Club, where his meals were monitored and a machine jiggled his abdomen area for an hour for exercise each day. For extra exercise, Tian went for walks by himself. "When I get down to [220 pounds], I'll be ready to go home," tain said nea the end of his struggle. "I can live a normal life." [Source: Lily Kuo, Los Angeles Times, October 31, 2010]

Tian said he hopers his weight loss will change his life. His plans include a job in computer programming and a happy marriage. Among his biggest challenges are controlling himself in a city where inexpensive, unhealthy food abounds and exercise is not part of the daily lifestyle. [Ibid]

Malnutrition in China

While obesity is becoming a problem in the cities malnutrition is still a problem in the countryside. A survey in 2005 found that 9 percent of children under 9 in the rural areas were underweight, with the figure increasing to 14.4 percent in poverty stricken areas.

In the mid 2000s, 24 million Chinese suffered from malnutrition. As many as a third of the children in Guizhou and a forth of the children Guangxi are underdeveloped physically.

Image Sources: 1)Landsberger Posters ; 2) Beifan. com; 3) Cgstock ; 4) Bucklin archives ; Asia Obscura

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

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© 2008 Jeffrey Hays

Last updated November 2011

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