China Healthcare … and you think the U.S. has problems??
August 7th, 2009 by Kent KedlI have been living and/or working in China for over 20 years and have been witness to one of the world’s most amazing phenomena … the aging of the population. Why is that so amazing in China? Well, just 50 years ago the life expectancy of the average Chinese person was 35 years old; today it is 72. In the past 10 years, life expectancy has been raised over 2 years. And why are people living longer? There are a number of reasons, but the major factor is is that people are getting better healthcare. But the cure to the Chinese people’s improved lifestyles is also the disease. Do the math: more than a billion population living nearly twice as long as their great-grandparents, equals some very, very large health care needs.
The attached Podcast is starting a series on Chinese healthcare but I will just highlight some of the issues here.
It is common knowledge that the low levels of consumer spending here and high savings rates compared to more developed economies – the average Chinese citizen saves 35-40% of their total income – is due largely to the fact that the Chinese social safety net has huge holes in it. In the old days of the planned economy in China, healthcare – such as it was – was a given, part of the so-called “iron rice bowl” of guaranteed supports which included housing, schooling and healthcare along with a basic (and low) salary. Well, as the economy has opened up and more capitalistic structures and systems have been allowed to bloom in China, this iron rice bowl has started to crack and, for most people, disintegrate completely. And the economic planners in China, giddy from the incredible wealth and its associated global power, focused more on the exo-structure rather than the infrastructure in China’s development.
There is a running joke among some of my China-phile friends that, if you hear a so-called expert start his or her speech with the phrase, “China is a big country”, you should immediately discount anything you hear from that point on … pointing out the obvious is not a good way to begin.
Still, this must be the foundation for any discussion on the social welfare system in China, that this is just a MASSIVE country, both in terms of geography (the physical size of the U.S.) and population (1.3 billion people, more than triple the U.S.) and this scale has a lot to do with how things do or don’t get done. Comparisons are often made between China and Japan or the “Four Tigers” of Asia (Taiwan, Singapore, Hong Kong and Korea), looking at how these early Asian economies developed versus what and how China is doing today. While certainly some comparisons can (and should be) made, the fact remains that China’s scale sets it apart from the others – its like the difference between driving a Jet-ski and a super tanker – both are navigating some of the same waters, both have somewhat similar methods of propulsion and steering, but the simple differences in volume and mass make for VERY different sailing experiences!
Let’s look at some age breakdowns … in 2000, it was estimated that 7% of the population was 65 and older. If current trends continue, by the year 2040 that group of 65 and older will have increased to almost 20% of the population. And a population skewed older will have greater need for healthcare of all kinds. The aging of the population alone is predicted to produce a 200% increase in deaths from cardiovascular disease in China between the years 2000 and 2040.
Now, where are these people all living? A majority of China’s population – albeit a shrinking one – lives in rural areas, in small towns and villages, far from the infrastructure of the cities. In 2010, about 55% of China’s population will live in rural areas.
However, this is rapidly changing and China will add about 150 million people to its urban areas over the next ten years, making for about a 50/50 urban/rural split by 2020. That means that China’s cities, many already bursting at the seams, will be additionally challenged to provide for their populations. We’ve talked before in these Podcasts about the growth in consumer activity in China’s so-called Tier 3 and 4 cities … but these cities still have between 1 and 3 million people in them! This is NOT what we in the West are used to. My own hometown – the Twin Cities of Minneapolis and St. Paul in Minnesota – has about 2.85 million people and is estimated to be the 16th largest metropolitan area in the U.S. (and notice that it takes us combining TWO cities together to do this!). But in China, that population would barely get us into the top 100 cities! Granted, we Minnesotans – with our German and Scandinavian ethnic heritages and our great bread, beer and cheese – are an order of magnitude larger than the average Chinese person so it feels more crowded in Minnesota. But for sheer measurements of “people per square meter”, China is the clear leader, if not necessarily the winner.
One of the benefits of improved lifestyles is better food … and “better” often means “more fattening.” In 1982, Chinese citizens consumed, on average, about 48 grams of fat per day … in 2002, that figure was up to 76 grams for urban dwellers. This exceeds the World Health Organization’s recommended level by over 30%. Some statistics put the number of the overweight and obese in China at over 200 million people. These new diets are leading to an increase in the so-called “modern” chronic diseases such as hypertension, diabetes and heart disease. In the past couple of years, diet programs from Jenny Craig, Weight Watchers and hundreds of China look-alikes have sprouted up all over China, pursuing, particularly, the young female population by telling them that they won’t be happy until they look like this retouched photo of a movie-star who has 7 personal trainers, the God-given metabolism of a wolverine and several liposuctions under her ever-tightening belt. I have even seen adds aimed at parents of chubby kids … you can bring them to fast food during the week and to a “fat camp” on the weekend.
A running joke among some of my friends in China is to walk into a restaurant and ask for a non-smoking table. “Non-smoking” just means that there is not an ashtray on the table and that YOU should not smoke there … but everyone around you, at all points of the compass, will be belching smoke like an iron smelter. Needless to say, smoking is VERY prevalent in China … an estimated 1/3 of the world’s 1.3 billion smokers are in China.
The prevalence of smoking has actually dropped in China … it was 63% among men in 1996 but then fell to “only” 48% in 2002. Culturally speaking, smoking among women is not very popular … only an estimated 3% of Chinese women smoke, but that is changing as well as younger, more “modern” women are taking up the habit.
And when you see smoke, you think “cancer” … and that is certainly happening in China. Reliable statistics here are MUCH more difficult to come by (given that the biggest supporter and supplier of tobacco products in China are state-owned enterprises), but some random data points (and the experience of smoking deaths in the West) can lead us to some pretty clear conclusions.
Lung cancer is expected to increase by nearly 2 times, resulting in over 100 million lung cancer patients in China by the year 2015. Cancers of all kinds are growing in China. Today, about 300,000 patients die each year of primary liver cancer in China … this is a rate 24 times higher than the United States. Cardiovascular disease, chronic respiratory disease and cancer are, by far, the leading causes of death in China.
Stay tuned to these pages as we explore more about the Chinese healthcare system. And check out today’s Podcast which goes into this subject in much more detail.
