How Prosperity is Making China Unhealthy

The battle to increase the life expectancy of the Chinese citizen has largely been won. Today the average Chinese lives to the age of 73, a few years behind citizens of most developed nations. Now comes the battle against rich food, cigarettes and a growing television habit. These lifestyle choices, made possible by China's economic rise, are killing more and more Chinese every year. A new report, published today in the Lancet medical journal warns of "a health and economic time bomb" that could unravel China's economic miracle unless it shifts its healthcare system towards preventive policies.

The rapidly aging population brought about by tight family planning policies means the country will have to find money to care for a growing numbers of elderly people who are living longer, and suffering chronic diseases like hypertension, heart disease, and stroke (now China's biggest killer). Afflictions common to wealthy Western countries caused three quarters of all deaths in China in 2005, compared to 47 percent in 1973, the report says.

Ironically, improved diet is leading to worse health. Meat consumption is up, but fruit and vegetable intake is down. The Chinese diet now contains more oily food, explains report co-author, Dr. Xiao Shuiyuan of Central South University in Changsha, chairman Mao's hometown. Today's culinary Cultural Revolution runs counter to the hardscrabble, lean living of Mao's 1960s heyday. Levels of fat in rural diets rose 100 percent in the two decades prior to 2002, as Chinese ate more meat, while among city dwellers the increase was 25 percent. "While we see the highest [meat] consumption in urban areas, we do see the biggest [dietary] changes in rural areas," says Sarah Barber, who heads the World Health Organization's (WHO) Health Policy and Systems team in Beijing. (WHO has not contributed to the report, but shares its advocacy of preventive medicine.)

Salt is another big problem, contributing to high levels of stomach cancer, heart disease and stroke. China's adult men typically consume 12 grams of salt a day—twice the country's own dietary guidelines, says Barber. It's no surprise that high blood pressure afflicts 177 million adult Chinese, including 18 percent of adult men. Most salt is added in cooking in the form of soy sauce, but modern retailing has blanketed the country in supermarkets that sell processed foods high in salt and sugar. Back in 1970, one million patients developed high blood pressure each year; today the figure is 7 million, according to Lancet report's lead author Yang Gonghuan, Deputy Director of the Chinese Center for Disease Control and Prevention (CDC). Diabetes is on the rise too, thanks to processed foods. Public health education could make a huge difference in these areas, experts say.

As Chinese eat richer food, they are getting less exercise. Office jobs are producing sedentary lifestyles. Yang warned in state media last year that only one third of Chinese adults take regular exercise and many watch TV—still a novelty in parts of the country—for hours at a stretch. Whereas in 1989 nearly three quarters of Chinese adults had physically strenuous jobs, by 2006 just over half did, says Barber.

Tobacco is another big killer. In the United States and Europe, smoking is highest among the poor, but in China "smoking actually increases with income," says Barber. Sixty percent of Chinese men smoke—and they make up one thirds of the world's smokers. Cigarettes are an ice-breaker in business and a ritual gift, given to every male guest arriving at rural weddings or passed across the table at banquets, where it's common enough to find a packet of cigarettes included in the place setting alongside chopsticks. Chinese consume some 2 trillion cigarettes a year. China has signed on to the 160-nation WHO Framework Convention of Tobacco Control, which will make explicit warnings on tobacco packaging compulsory beginning in Januay 2009 and outlaw all tobacco advertising and sponsorship by 2011. Implementation of the rules is stuck in a bureaucratic limbo as a reorganization of the responsible ministry has been pending since March. The Lancet report urges the full implementation of the Convention.

The trends highlighted in the report promise to be costly. According to the WHO's calculations, premature deaths from heart disease, stroke and diabetes will mean economic losses of $558 billion over the next decade. "The costs surrounding the chronic disease burden will most likely be huge," the Lancet report warns, including not just hospital and medical costs but also lower productivity and premature deaths. "This is a very serious problem," says Barber.

The prescription: preventive medicine. Success in raising life expectancy coupled with diseases of affluence "really has brought pressures on medical insurance" and only a good preventive medicine program can alleviate the strain, says Dr Xiao. The Lancet report—the third in a series on Health System Reform in China—urges the government to promote less salt and more fruit and vegetables in the diet, more exercise, and anti-smoking campaigns.

There are signs that the Chinese may be ready for a change. In the wake of the toxic milk scandal that has sickened 54,000 children, many Chinese are frantic for tips on how to eat healthfully. But they're not sure whose advice to trust—with poison pesticide on beans, arsenic in water, and melamine in milk, nothing seems safe to eat. A month-long official silence over tainted milk during the Olympics didn't help. The government needs to do more than issue dietary advice if it expects to get results.