Prevention must be at the heart of the China's battle with chronic diseases if it is to stop the health and economic timebomb associated with these conditions. Dietary fat and salt intake, smoking, and lack of physical activity must all be targeted. These are the conclusions of authors of the third paper in The Lancet Series on Health System Reform in China, written by Professor Gonghuan Yang, Chinese Centre for Disease Control and Prevention, Beijing, China, and colleagues.
Life expectancy in China increased rapidly from 1950-90, largely due to success in combating infectious diseases; but since 1990 has plateaued due to emergence of chronic disease. Deaths from cerebro-cardiovascular diseases, chronic obstructive pulmonary disease (COPD), and cancers have increased as a proportion of all deaths, from 47.1% in 1973 to 74.1% in 2005. Two major forces are behind this change — first, the aforementioned rapid increase in life expectancy has left China with an ageing population; and second, the even more powerful increase in several high-risk behaviours.
Rapid economic development has seen daily levels of fat in Chinese diets increase by 25% in urban people and nearly 100% in rural people between 1982 and 2002, increasing the risk for cardiovascular disease and cancer; meat consumption has also increased while dietary cereal levels have dropped over the same period. Some 177 million Chinese adults, and 18% of adult men, have high blood pressure (hypertension), with high daily salt intake (over 12g in many people) thought to be a cause. And while overall daily calorie intake has remained largely static 1982-2002, the increase in overweight and obese Chinese people over this period leads to the conclusion that physical activity levels must have decreased. Finally, tobacco remains a scourge of Chinese health — one in three smokers in the world is a Chinese man, with 60% smoking prevalence in the male population. Smoking rates in women are much lower, at around 5%, due to social taboos around women smokers.
The costs surrounding the chronic disease burden are likely to be huge, and will include direct burdens such as hospital and medical costs and care-related travel; and also indirect costs such as lower productivity and premature deaths. The authors say that, as well as reducing out-of-pocket expenses and making sure care is delivered in the most financially effective way, "Prevention first is the best, most important, and most appropriate dictum and relevant strategy for China…The Ministry of Health must develop its skills and capabilities more broadly than the biomedical sciences. For example, hypertension and tobacco can be targeted health priorities. Reduction of salt intake should become a national campaign."
The authors call for the WHO Framework Convention of Tobacco Control, which China has adopted, to be translated into policy. They conclude: "Just as China was able to control infectious diseases within a shorter time than other countries, it has the opportunity today to reduce the time over which chronic diseases take a high health and economic toll in the country…Prevention and control of chronic diseases is a large and complex task, but no more so than many of the challenges that have confronted China in its long history, and especially in the last 50 years."
In an accompanying Comment, Dr Shuiyuan Xiao, Central South University, Changsha, China and Dr Matthew Korman, Stanford University, California, USA, discuss smoking behaviours in China and note that only 3% of women in China smoke cigarettes daily compared with nearly 60% of men. They say "If present smoking trends continue, 100 million Chinese men will die [of smoking related causes] between 2000 and 2050, with many of their family members squandering life savings in desperate attempts at treatment." They believe anthropological study holds practical value for the development of innovative interventions to reduce China's smoking epidemic and attenuate other causes of ill-health and conclude: "Praise was fittingly showered on Beijing for running a smoke-free Olympics. It is time now for men and women of vision to embrace a smoke-free China."
A further spotlight will be on China's chronic disease challenges at the upcoming third Lancet Asia Medical Forum* which takes place from November 14 to 16, 2008, in Beijing. The forum will focus on stroke, the number one cause of death in China.
Professor Gonghuan Yang, Chinese Centre for Disease Control and Prevention, Beijing, China T) +86 10 6301 2327 / +86 13601033911 E) yanggh@chinacdc.cn
Dr Shuiyuan Xiao, Central South University, Changsha, China T) +86-13907494509 E) xiaosy@gmail.com
Notes to editors: * For more information please visit http://www.thelancetforum.com/
Full paper: http://press.thelancet.com/china3.pdf
Journal
The Lancet