Reviewing China S Pollution and Health Care Issues

China's Health Indicators

China has gone through impressive economic development over the past few years, and has experienced a big reduction in poverty along with other positive achievements. Due to improvement in living conditions, nutrition, and healthcare, there have been " ... declines in infant mortality and deaths from infectious diseases," according to The New England Journal of Medicine (He, 2005). But there have also been negatives associated with urbanization and industrialization -- in particular China's stubborn air pollution and its negative impacts on health -- that have increased the risk of " ... chronic disease, including vascular disease and cancer" (He, 1125). This paper reviews the health indicators for China along with other pertinent data and information relating to the well-being of the Chinese people.

China's Demographics and Data on Health Issues

The population of China (based on 2013 data from the World Health Organization -- WHO) is approximately 1.363 billion. The percentage of Chinese people living in urban areas is 53.2%, and the percentage of people under five years of age is 6.0% while the percentage of people over 65 is 8.9% (WHO). The life expectancy at birth in China is 75 years and the mortality rate for children under the age of 5 (per 1,000 live births) is 12.

Other data includes: a) the total expenditure on health as a percentage of China's gross domestic product (5.6%); b) the density of physicians per 1,000 population is 1.491; c) the density of nursing and midwifery persons per 1,000 people is 1.656; c) the adolescent fertility rate per 1,000 girls between the ages of 15 to 19 is 6.2; d) the maternal mortality ratio per 100,000 live births is 34; e) the infant mortality rate (between ages of birth and age 1) per 1,000 live births is 9.2; f) the neonatal mortality rate per 1,000 live births is 5.5; g) the stillbirth rate per 1,000 total births is 10; and h) there are about 42 hospital beds per every 10,000 population (WHO).

Leading Causes of Death in China

Dr. Jiang He and colleagues report that the five leading causes of death in China were: "malignant neoplasms" (374.1 per 100,000 person-years); heart-related diseases (319.1 per 100,000 person-years); cerebrovascular disease (310.5); accidents (54.0); and "infectious diseases" (50.5) (He, 1124).

The leading causes of death among adults in China is vascular disease and cancer; key strategies needed in order to reduce the number of premature deaths among adults, He reports, is: a) control of hypertension; b) cessation of smoking; c) increased physical activity; and d) improved nutrition (1124).

China's Air Pollution Problems

An article in the peer-reviewed journal Lancet points out that Beijing (site of the 2008 Olympics) -- and neighboring north-east Chinese provinces -- have " ... the world's worst levels of nitrogen dioxide, which can cause fatal damage to the lungs" (Watts, 2005). In fact the air pollution levels in China result in an estimated 400,000 premature deaths per year (Watts, 1761). It should come as no surprise that China's citizens suffer from the negative effects of air pollution when it is known that China is the world's " ... second-largest producer of greenhouse gases," and that acid rain falls on about "a third of its territory" (Watts, 1761).

Watts writes (based on World Bank claims) that China is home to 16 of the 20 most air-polluted cities in the world; moreover, an estimated 100 million people live in cities in China where the pollution in the air reaches "very dangerous" levels (Watts, 1761). The smog produced by coal-fired electrical generating plants and by autos is blamed for "the sharp rises in cases of bronchitis, pulmonary fibrosis, tuberculosis, and lung cancer," Watts continues, referencing the World Bank data (1761).

World Bank Overview of China's Health Sector

One of the major problems in terms of healthcare financing has occurred over the past ten years in China because the national government has " ... handed over funding responsibility for health care to the sub-national levels," which, in many cases, simply cannot afford to provide adequate care (Wee-Ling Ooi, 2005). Only about 3% of China's health expenditures now come from the central government; and only a "small proportion" of rural doctors in China "have actually been to college," Wee-Ling Ooi writes in a special World Bank report.

Moreover, what money does come from the central government coffers tends to go towards " ... infrastructure costs and staff salaries," which leaves little to cover basic services for preventative care and direct health care as well (Ooi, 3). Also, public funding tends to go towards urban areas (an estimated 80%) while just 20% is left for rural China, where an estimated 70% of the population lives, Ooi continues (3).

As to the comparison between China and other countries -- when it comes to "public expenditures on health as a percentage of total health expenditures" -- China's percentage spent on public health issues is just 11% (Ooi, 4). India's is 13%; in Pakistan is it 23%; the U.S. spends 44% on public health; in Brazil it is 49% and Argentina's is 58% (Ooi, 4). As an example of the unfairness of spending on public health in China, a large percentages of the subsidies from the central government go to " ... government and state owned enterprises," whose staff members get "close to full health insurance" (Ooi, 4). Contrast that with what the average persons in rural areas have to deal with (80% pay out of pocket for their health services), and the injustice comes clear.

Moreover, about 50% of poor Chinese people have to borrow to pay for their healthcare, and that number includes 60 million Chinese in poverty (Ooi, 3). Another inequity in China is the fact that the government has authority to set prices for preventative health care; and because the government sets prices " ... below the cost of providing the services ... provides are avoiding those services" (Ooi, 5). Instead, provides tend to prescribe " ... inappropriate drugs and services," including the requirement of "long hospital stays and expensive, usually unnecessary diagnostic tests" (Ooi, 5).

World Health Organization's 2015 Profile on China

Climate change may bring new threats to China, which is already struggling to get control of its serious air pollution problems. Climate change is expected to bring " ... coastal and inland river flooding, increased heat stress, water and food insecurity," and more climate-sensitive diseases (WHO, 2015). Under a "high emissions scenario" (carbon contribution to global climate change) in China and the world, and without huge investments in renewable energy or other mitigations, 23 million Chinese will be negatively impacted by floods.