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The Economic Development &
Public Health Challenge
in China
Liming Lee M.D., M.P.H
Professor, School of Public Health, Peking University
Outline
Introduction of Health Enterprises in China
Public Health Challenge in China
Future strategy for the challenge
Outline
Introduction of Health Enterprises in China
Public
Health Challenge
in China
 General
Information
 The Characteristics of China Health
Future strategy for the challenge
Enterprises
 Health Policy in China
 Health Care System in China

General Information

The Characteristics of China Health Enterprises

Health Policy in China

Health Care System in China
☼ Area: 9.6 million km2
☼ Total population: 1.27 billion (2000)
☼ Population in rural areas: 63.8％
☼ Administrative: 31 provinces
☼ GDP: 8940.4 billion RMB
☼ Number of health agencies: 330 thousand
☼ Number of health workers: 5.568 million
☼ Number of school of public health: 36
Source: 《China Statistical Yearbook》2001

General Information

The Characteristics of China Health Enterprises

Health Policy in China

Health Care System in China

General Information

The Characteristics of China Health Enterprises

Health Policy in China

Health Care System in China

General Information

The Characteristics of China Health Enterprises

Health Policy in China

Health Care System in China
 1949-1977 Welfare enterprises for the whole
population (Government paid health services)
 1978-1996 Public welfare enterprises
(Government & hospital paid health services)
 1996-now Welfare public enterprises (Government,
Collective & individual paid health services)

General Information

The Characteristics of China Health Enterprises

Health Policy in China

Health Care System in China
♪ Stress the health work in the rural areas
♪ Put the prevention first
♪ Lay equal stress in the Western and Chinese
traditional medicine
♪ Rely on the science and education
♪ Mobilize the participation of the whole society
Dec.1996 the health meeting of China Center Gov.
The organization structure of Chinese health system
State Department
Government of
Provincial, Municipal,
Autonomous Region
Regional Administrative
Office
Government of
Municipal, County,
District
Township
government, Subdistrict Office
Villagers’ committee,
Neighborhood
residents’ committee
The Ministry of Health
CAMS
China CDC
FDA
PUMC
The Bureau of Health
Specialized Hospital
Local CDC
MCH Hospital (Clinic)
Drug Inspection Station
Medical college or university
The Board of Health
The Board
(department) of Health
Three tiered
prevention and
health care
system
Specialized hospital
Anti-epidemic station
MCH Hospital (Clinic)
Drug Inspection Station
General Public Hospital
Anti-epidemic Station
Endemic Disease Prevention Station
MCH Care Center (Clinic)
Secondary Health School
Township hospital (clinic)
District health center(outpatient clinic)
MCH care center
Village health station
Red Cross health station
Outline
Introduction of Health Enterprises in China
Public Health Challenge in China
 Population
Dynamics
Future
strategy for the
challenge
 Double Burdens of Diseases
 Urbanization and Industrialization
 Behavioral Risk Factors
 Unreasonable of Resource Allocation
The proportion of senile population (≥60 years old)
1999
China 126 million
Asia 314 million
World 593 million
2050
China 410 million
Asia 1.24 billion
World 1.97 billion
Trend of Population and Aging
2015
(0.1 Billion)
18
Aging 14%
16
14
1949
12
Total 0.058 billion
10 8%
Aging
2000
8
Total 0.126 billion
Aging 10%
6
4
2050
Aging 25%
2
01953
1964
1995
1982
1990
2000
2015
2050
Most of the aging population is living
in the rural area
The proportion of aging population living in the
rural and urban area in developing countries
urban
34%
rural
66%
The family support system is weak
4
2
1
4-2-1 syndrome
Outline
Introduction of Health Enterprises in China
Public Health Challenge in China
 Population
Future
strategy forDynamics
the challenge
 Double Burdens of Diseases
 Urbanization and Industrialization
 Behavioral Risk Factors
 Unreasonable of Resource Allocation
Increasingly serious threats from…
Communicable diseases
Re-emerging: TB, STD, plague, cholera…
Emerging: AIDS, SARS…
Non-communicable diseases (NCD)
Stroke, cancer, CHD, diabetes, chronic obstructive
pulmonary diseases (COPD), mental diseases…
Main communicable diseases
The Incidence Rate of Communicable Diseases in China,
1965~1998
Incidence Rate（1/100,000）
8000
7061/100 thus.
6000
4000
2000
195/100 thus.
0
1965
1975
1985
1995
1.Communicable Diseases
The Proportion of Different Communicable Diseases
by Etiology in China, 1950’s-2002’s (%)
Transmitted
by sex or
blood
2002
2000
Gastrointestinal
Year
1995
1990-
Respiratory
19801970-
Vector-borne and
natural endemic
196019500
10
20
30
40
50
(%)
60
70
80
90
100
Main communicable diseases
The first 10 communicable diseases, 2003
Tendency of Death Pattern, China, 1954-1998
900
800
Injuries &
poisoning
Others
CDR（ 1/100,000）
700
600
500
400
Non-communicable
diseases
300
200
100
Communicable,
maternal and
child diseases
0
1954
1957
1963 1975
1980
1985
1990 1995
1998
2.Non-communicable diseases
Mortality rate of Leading Causes of
Death in China(2003)
Injury & Poisoning
32.55
21.54
Heart disease
45.53
Diseases of the
Respiratory System
Urban
Rural
76.23
77.29
70.86
Cerebrovascular
disease
89.89
105.40
Malignant neoplasms
134.54
95.68
0
20
40
60
80
(1/100,000)
100
120
140
160
Outline
Introduction of Health Enterprises in China
Public Health Challenge in China
 Population
Future
strategy fordynamics
the challenge
 Double burdens of diseases
 Urbanization and industrialization
 Behavioral risk factors
 Unreasonable of resource allocation
China 55 Anniversary
The overall capacity
Annual average growth rate of…
GDP 9.3%
GDP per capita 8.2%
Year 2003…
GDP RMB 11669 billion
GDP per capita $1000
Foreign exchange reserve $403 billion
China 55 Anniversary
Industry rapidly developing
% of GDP: 44.4% (Year 2002)
Value added of industry: RMB 5361.2 billion
(12.6%) (Year 2003)
Natural Environment Destroy
 Pollution from waste water, waste gas, waste residue
 Devastation of forest vegetative cover and the loss of
soil and water
 Eutrophication of the water bodies
China 55 Anniversary
Energy production (Year 2002)
Total energy production:
139000 (10,000 tons of SCE)
Coal
70.7%
Crude oil
17.2%
Natural gas
3.2%
Hydro-power 8.9%
Occupational Health Issues
Occupational diseases
Occupational accidents
China 55 Anniversary
Transportation
Newly built railways 1210 km
Newly built double-Tracking Length 1443 km
Length of Railways in Operation 72 thousand km
Length of highways 1.77 million km
Expressway 25 thousand km
Private cars in urban 7.7 million units
Traffic Accidents
China 55 Anniversary
Number of major durable consumer goods owned
per 100 urban households at the Year 2002-end
Refrigerator (set)
Color Television Set (set)
87.38
126.38
Video-recorder (set)
18.43
Air conditioner (unit)
51.10
Oven (unit)
30.91
Mobile telephone (unit)
62.89
Personal computer (set)
20.63
Living Environment Pollution
Building decoration materials pollution
Electromagnetic pollution
Light pollution
China 55 Anniversary
Peasant Out-Migration increasing
Number of
laborer in rural:
485 million
Number of
peasant outmigration: 99
million
Health issues of floating population
Unsanitary living environment
Poor immunization protection
Unhealthy behavior
Be difficult to manage
Outline
Introduction of Health Enterprises in China
Public Health Challenge in China
 Population
Future
strategy forDynamics
the challenge
 Double Burdens of Diseases
 Urbanization and Industrialization
 Behavioral Risk Factors
 Unreasonable of resource allocation
Smoking
Tobacco Epidemic in China
Approximately 320 million smokers in China. (1996)
The prevalence of smoking among 15 years old and
above was 35.10%.
60% smokers have never contemplated quitting.
The majority of the population is involuntarily
exposed to tobacco smoke (53.5%).
Smoking
Tobacco Epidemic in China
61% of adults believed that tobacco use was
of a little or no harm to their health.
The average age at which smoking starts is 20
years old.
Smoking already causing about 750,000
deaths a year and predicting that this will rise
to three million a year.
Smoking
The smoking behavior comparison of
Chinese aged 15+ between 1984 and 1996
Average number of cigarettes smoked per day
(piece)
The average age at which smoking starts(years)
General smoking rate(% )
Male smoking rate(% )
Female smoking rate(% )
1984
1996
13
23
33.88
60.01
7.04
15
20
35.10
63.00
3.80
Smoking
Economics of tobacco in China
China is the world’s leading producer of tobacco.
Cigarette tax revenue in China was 31.0 billion RMB
in 1992, 65.0 billion RMB in 1997, average
representing 10.0% of total government revenue.
Smoking
Production and Marketing of tobacco in China
4000
3500
3000
2500
Production
2000
Marketing
1500
1000
500
98
19
95
19
90
19
85
19
80
19
75
19
70
19
65
19
60
19
55
19
19
49
0
Source:The Report of Tobacco in China
Smoking
Trend of Tobacco Sales & Mortality in
Chinese Pop, 1996
2500
2000
Volume of Sales£¨Billion£©
Mortality(1/100,000)
Lung Cancer
Volume of Sales
50
40
1500
30
1000
20
500
10
0
0
1981
1986
1991
Year
1996
Drinking
Source: 《China Statistical Yearbook》2003
Drinking
The frequency of drinking
Male
Female
≤1/month
2-4/month
2-3/week
4-5/week
≥1/day
Drinking
The Drinking Type
Male
High degree white spirit
Beer
Female
Wine
Beer
Low degree white spirit
Drinking
The proportion of heavy drinkers to the
whole drinking population
87.5%
Heavy drinkers(≥50ml/day)
Moderate drinkers(<50ml/day)
12.5%
Physical Exercise
The average sedentary time per day during free time
24.0
21.0
18.0
Hours
15.0
12.0
9.0
6.0
3.2
2.2
2.5
3.0
0.0
City
Rural
Total
Physical Exercise
The proportion of persons taking exercises
100.0
90.0
80.0
70.0
60.0
(%)
50.0
40.0
25.7
30.0
23.3
24.5
20.0
10.0
0.0
Male
Female
Total
Overweight & Obesity
The long-term trend of the prevalence of overweight
and obesity in China
17.5
18
16
Prevalence (%)
14
1992
2002
36.7%
12.8
12
10
8
83.9%
6
3.1
4
2
0
Overweight
Obesity
5.7
Overweight & Obesity
The prevalence of Chinese overweight and
obesity by age in 2002
Overweight
Obesity
22.8
25
prevalence (%)
20
17.5
15
10
7.1
5.7
5
0
4.5
3.4
2.1
2.0
0-
18
7Age (Years)
Diagnostic criteria:
<7 years old: (WHO Z score reference) 2<WHZ≤3 overweight, WHZ>3 obesity
7-17 years old : BMI≥p85 overweight, BMI≥p95 obesity
≥18 years old : 24≦BMI<28 overweight, BMI≥28 obesity
Total
Hypertension
The comparisons among 4 times of National
Hypertension Survey
20
17.65
18
Prevalence (%)
16
13.58
14
12.3
12
9.4
10
7.73 7.5
8
6
: Nominal
prevalence with
different diagnostic
criteria.
5.11
4
2
0
1959
1979
1991
2002
: Age-adjusted
standardized
prevalence. The
diagnostic criteria was
unified with
SBP≥141mmHg and/or
DBP≥91mmHg
regardless of whether
taking medication
within 2 weeks (the
criterion in 1979).
• 与1991年相比，患病率的相对增长量为30.9%，患病
人数的绝对增长量为9千万人。
Hypertension
The rates of awareness, treatment and control of
hypertension between 1991 and 2002
35
1991
30.2
30
2000
26.6
24.7
Rate (%)
25
20
15
12.2
10
6.1
5
2.9
0
Awareness
Treatment
Control
Diabetes
In Chinese aged 18 or above years old:
Prevalence of…
Diabetes: 2.6%
Impaired fasting glucose: 1.9%
Number of patients…
Diabetes: 23 million
Impaired fasting glucose: 17 million
Diabetes
The prevalence of diabetes by areas in 2002
7
Male
6.35 6.19
Female
6
Prevalence (%)
5
4.10
4
3.43
3
2.42
1.98
2
1.72
1.92
2.18
2.49
0.84 0.85
1
0
Large cities Medium and
small cities
1st class
rural areas
2nd class
rural areas
3rd class
rural areas
4th class
rural areas
Diagnostic criterion: (1) FBG≥7.0 mmol/l; or (2) OGTT≥11.1 mmol/l; or(3) ever been diagnosed by
county or above level hospital and receive treatment then.
Outline
Introduction of Health Enterprises in China
Public Health Challenge in China
 Population
Future
strategy forDynamics
the challenge
 Double Burdens of Diseases
 Urbanization and Industrialization
 Behavioral Risk Factors
 Unreasonable of Resource Allocation
Unreasonable Health Resource Allocation
1991
Distribution of
Resource%
Urban
Rural
1997
Distribution of
Resource%
26 .4
80.7
29.9
73.6
19.3
70.1
Population%
Population%
53.5
46.7
Unbalanced development of health enterprises
West
East
42.5
45
40
35
29.6
27.4
30
22.5
25
20
14.8
10.3
15
10
5
0
City
Rural
West
Middle
East
46
50
45
Infant mortality (1/1,000)
Mortality rate of communicable
diseases (1/100,000)
Middle
40
35
30
25
20
23
22
17
14
15
12
10
5
0
City
Rural
World Health Report 2000 Selected Indicators
Attainment of Goals
Performance
Responsiveness
Fairness in
financial
contribution
On level of
health
Overall
health
system
24
1
54-55
72
37
Sweden
4
10
12-15
21
23
Japan
1
6
8-11
9
10
China
82
88-89
188
61
144
Thailand
100
33
128-130
102
47
Health level
DALY
USA
Outline
Introduction of Health Enterprises in China
Public Health Challenge in China
Future strategy for the challenge
 Public Health New Concept
 Development of Future Public Health
1.Public health new concept
Public policy
Government leadership and support
Law & regulation development
Public health
Multi-sectoral collaboration
Full social involvement
2.Development of future public health
Capacity building
Bridging the gap between
clinic medicien and public
health
Construction of public health
information system
Evidence based decision
making
Health education
Thank you!