Health Challenges in China

Professor Sian Griffiths, Chinese University of Hong Kong, China

Problems of an ageing society, of pollution, of surveillance for communicable disease and the constant threat of new emerging disease and of lifestyle related diseases are significant public health challenges in China.  Having emerged as a global economic force, and although retaining elements of a transitional economy, China is increasingly supporting less developed societies particularly in Africa. At the same time Chinese political leaders are engaged in the  maintaining the impetus of the progressive urban economy whilst seeking to redistribute wealth and opportunity, including better education, health and housing, to the poorer rural communities which still exist there.

Economic growth has produced a growth in inequity. The World Bank has estimated a 50 per cent increase in the Gini coefficient between 1982 to 2002.  This figure confirms that increasing inequity exists for both rural and urban poor, rural migrants and land expropriated farmers.

Marketisation of health services means that large gaps exist in health care. The heavy reliance on fee-for-service systems as well as producing inefficiencies and skewing supply, inevitably favours the better off.  This has sometimes fuelled social unrest, especially in rural areas, where there is no safety net. Most rural people struggle to find accessible and affordable health care.  There has also been a detrimental effect on public health programmes, affecting preventive programmes and surveillance of communicable disease. In response, a campaign to create a ‘new socialist country side’ has been launched, making development of health care systems including public health a priority for local government, although the funding base for this expansion remains unclear.

As highlighted in the China Human Development Report, the challenge for modernizing China is not just to promote economic growth but to achieve overall social progress, setting  policy goals which seek more balanced development among regions and between rural and urban areas, create greater employment opportunities, provide better education and produce a robust public health system.