In the past three decades, China has seen a staggering rate of urbanisation, and this shift from rural to urban has important public-health consequences. Its urban population has grown from 191 million in 1980 to 622 million in 2009, largely because of rural-to-urban migration. In 2012, the proportion of the population living in urban areas overtook that living in rural areas for the first time ever. The third paper in The Lancet themed issue on China looks at what this means for the country's public health. Justin V Remais at the Rollins School of Public Health, Emory University, Atlanta, GA, USA, and colleagues, say that while there are health benefits of urbanisation resulting from better access to services and higher salaries in urban areas, the health risks are substantial.
One danger is that migrants fall through the gaps in health-care systems. The authors say: "The absence of continuous health-care coverage of rural-to-urban migrants puts many at risk of a dual infectious disease burden. Migrants can be exposed to pathogens associated with rural poverty (eg, soil-transmitted helminths) and diseases associated with crowded, urban environments such as tuberculosis."
As well infectious diseases, changing lifestyles raise risks of chronic diseases. "Urbanisation has led to changes in patterns of human activity, diet, and social structures in China, with profound implications for non-communicable diseases—eg, diabetes, cardiovascular disease, cancer, and neuro-psychiatric disorders", they add.
The increasing population pressure on cities exacerbates environmental pollution, as for instance more urban-dwellers lead to more cars on the road, which contributes greatly to poor air quality in cities. Road traffic and occupational accidents are major sources of ill health as well, especially for rural-to-urban migrants.
The authors offer solutions to help address these problems, calling for "innovative health policies that address the needs of new urban residents while providing health services for people (especially older people and the very young) who remain in rural areas." Indeed, the authors argue for policies that address the health-care needs of an increasingly mobile population, adding that "health-care providers must be aware of the dual urban–rural disease risks faced by these populations."
"Although China's rapid economic growth over the past two decades has brought many benefits, raised incomes, and pulled hundreds of millions out of poverty, the adverse health consequences of urbanisation pose major policy challenges and threaten to put additional pressure on the country's overstrained health services. Minimisation of these adverse effects, and indeed maximisation of the benefits, will require development of key infrastructure, improved awareness among policymakers of the health risks associated with urbanisation, and innovative policies on the part of urban planners and regulators to ensure safe and healthy urban life in China," conclude the authors.
For Dr Justin V Remais, Rollins School of Public Health, Emory University, Atlanta, GA, USA, please contact Jennifer Johnson, Media Relations. T) +1 404 727 5696 (office) / +1 404 441 5929 (cell) E) jrjohn9@emory.edu
Journal
The Lancet