Chronic diseases in China
Encyclopedia
Chronic diseases, non-communicable disease
s now account for an estimated 80% of total deaths and 70% of disability-adjusted life years
(DALYs) lost in China
. Cardiovascular diseases, chronic respiratory disease
and cancer
are the leading causes of both death and the burden of disease
, and exposure to risk factor
s is high: more than 300 million men smoke cigarettes
and 160 million adults are hypertensive, most of whom are not being treated. An obesity
epidemic
is imminent, with more than 20% of children aged 7–17 years in big cities now overweight
or obese. Rates of death from chronic disease in middle-aged people are higher in China than in some high-income countries.
In China, as in many other parts of the world, the government has focused on communicable diseases—however, China now has a "double burden" of disease. The prevention of chronic diseases is now receiving a national response commensurate with the burden.
The national cancer prevention and control plan (2004–10) is being implemented, and a national chronic disease prevention and control plan has been completed (in late-2005). Progress has been made in some areas, with current smoking prevalence in men declining at about 1% per year for a decade, and even better results in large demonstration programs. Much remains to be done, and resources and sustainability are major issues. However, the surveillance and intervention mechanisms needed to ameliorate the increasing burden of chronic diseases are developing rapidly, taking account of the lessons learned over the past two decades.
of the population is the major force driving the epidemic
of chronic diseases. In 2000, 7% of the Chinese population were aged 65 years or older, and more than 400 million Chinese adults are now aged 20–39 years. If current trends continue, by 2040 the group aged 65 years and older will have increased to almost 20% of the population. The ageing of the population alone is predicted to produce a 200% increase in deaths from cardiovascular disease
in China between the years 2000 and 2040.
In addition to the ageing of the population, China is experiencing dramatic transformations in many social and economic
conditions that will continue to increase the incidence of major chronic diseases. For example, the country has recorded spectacular economic growth since 1978 and, on average, people's standard of living
is far higher than ever before in the rapidly expanding urban areas. From 1990 to 2000, the proportion of people living in urban settings in China increased from 26% to 36%, the number of cities increased to 663, and the number of towns also soared. It is expected that urbanization in China
will reach 45% by 2010, and 60% by 2030, with an extra 200 million more people expected in the urban areas before 2010. This growth comes at a cost in health terms. For example, a clear relation exists between urbanization and the prevalence of diabetes in China (diabetes defined as diabetic symptoms and a random blood glucose concentration
of 11.1 mmol/L or more, a fasting blood glucose of 7.0 mmol/L or more, or an abnormal result of 2-h oral glucose tolerance test).
The rapid environmental changes that follow urbanization
are increasing the prevalence of the major risk factors for chronic disease. Tobacco use
, unhealthy nutrition
, and physical inactivity
leading to obesity
and hypertension
are already common, and physical inactivity is increasing. The prevalence of current cigarette smoking in men (smoked in the past 30 days) was 57% in 2002, but had fallen from 63% in 1996; less than 3% of women are current smokers. This favorable trend must be continued, because lung cancer
death rates are calculated to have more than doubled in men between 1991 and 1995, and are increasing at 2–5% per year in urban and rural working men aged 15–54 years. The decrease in smoking is the only encouraging risk factor trend, and is consistent with the plateau of tobacco consumption over this same period in the face of a rising adult population, as has occurred in other countries where tobacco taxes have been raised sharply. In 1999 the first Global Youth Tobacco Survey in China showed that 22% of students aged 13–15 years had ever tried to smoke; the current smoking rate was only 5%.
China's first comprehensive survey in the fields of nutrition and health was done in 2002. 71,971 households were chosen from 132 counties of 31 provinces, autonomous regions, and the municipalities, using the Central Government household
census
, and 243,479 people were included in the survey. The prevalence of hypertension (blood pressure 140/90 or higher) in people aged 18 years or older was 19%—a 30% increase since 1991. The prevalence of adult overweight (23%) and obesity (7%) had increased by 39% and 97%, respectively, over a 10-year period.
Of particular note is the rapidly developing epidemic of obesity
in Chinese children. The overall prevalence rates of overweight plus obesity in 2000 among students in six sites (Beijing
, Tianjin
, and Shanghai
cities and Hebei
, Liaoning
, and Shandong
provinces) increased from 1–2% in 1985 to 25% for boys aged 7–9 years, 25% for boys aged 10–12 years, 17% for girls aged 7–9 years, and 14% for girls aged 10–12 years. In 2002, prevalence rates in children aged 7–17 years varied from 13% overweight and 8% obese in a range of big cities to 2% overweight and less than 1% obese in a range of rural sites.
). Chronic diseases are threatening this progress and exposing individuals and their families and communities to stresses. Some citizens newly emerged from poverty may find their families plunged again into it as one of their members falls victim to catastrophic illness such as stroke
or cancer
. In a 2003 survey, 30% of poor households attributed their poverty to health-care costs. Overall, 79% of rural dwellers and 45% of urban citizens have no health insurance
, and the prevalence of citizens who could not afford medical treatment rose from 32% to 39% in rural areas, and from 32% to 36% in urban areas, between 1993 and 2003.
The economic consequences of chronic diseases for China are serious. For cardiovascular disease
alone, Chinese people aged 35–64 years lost 6.7 million years of productive
life during the year 2000 at a cost to the country of around US$30 billion. Only a quarter of this cost was estimated to be direct health-care costs. If current trends continue the total of years of productive life lost in this age range in China is estimated to increase to 10.5 million by 2030. It is estimated that in 2005 China will lose about $18 billion in national income from the effects of heart disease, stroke, and diabetes on labor supplies and savings. The cumulative loss over the period 2005–2015 would be about $556 billion.
registries
began in 1963 in Shanghai
, and data from registries led to some of the first programs that addressed chronic diseases in China. For example, mortality from cervical cancer
in the Jing'an county of Jiangxi
province decreased to 9.6 per 100 000 in 1985 from 42.0 per 100 000 in 1974, at least in part a result of the introduction of the "early detection, early diagnosis and early treatment" of cervical cancer (Kong L, unpublished). Cancer has led the way in chronic disease control initiatives. In 2003, the Ministry of Health of the People's Republic of China, which is responsible for health policy, completed a national cancer control plan on the basis of expert opinions in diverse fields. Some elements of the Program of Cancer Prevention and Control in China (2004–2010) are now being implemented, for example with rapid diagnosis and screening
trials for cervical cancer.
Between 1991 and 2000, a community-based intervention trial on management of diabetes and hypertension
was done in an urban population of 300,000 in three cities (Beijing
, Shanghai
, and Changsha). The most notable outcomes were that the incidence of stroke decreased by 52% in men and 53% in women, and the mortality rate
of stroke fell by 54% overall.
In 1995, the World Bank
Loan Health VII: China Disease Prevention Project—health promotion
component (1996–2002) began in seven cities: Beijing
, Tianjin
, Shanghai
, Chengdu
, Luoyang
, Liuzhou
and Weihai
, and some regions of Yunnan
province. The program covered about 90 million people. To date, among the chronic diseases outcomes reported are an overall reduction of 15% in the prevalence of male adult cigarette smokers, and in Beijing substantial increases in hypertension detection and treatment with a fall in cardiovascular disease death rates of more than 15% in the last year of the project (Wu Z, Director, Beijing Institute of Heart, Lung and Blood Vessel Diseases, personal communication).
Based on the experience of this project, the Ministry of Health began establishing demonstration sites for chronic disease prevention and control nationwide in 1997. There are currently 32 community-based sites and the major activities include community diagnosis, community mobilization, development of integrated community interventions (smoking control, healthy diet, physical activity, hypertension prevention, mental health, prevention and control of cardiovascular disease, diabetes, cancer, chronic respiratory disease), training, and evaluations of interventions.
in the 160 million hypertensive adults, and help more than 300 million adult male smokers to quit. Although no current data are available about smokers' intentions to quit (see Smoking cessation
), the Health VII project achieved an overall quit rate of 25% in men over a 6-year period. Progress is also being made with the control of hypertension, and the mortality rate from cardiovascular disease halved in hypertensive patients over a 3-year period in the Shanghai demonstration sites (Kong L, unpublished).
China has just ratified the Framework Convention of Tobacco Control. During the past two decades, action has included: in-depth dissemination of tobacco control information and health education; the development of a series of tobacco control laws, regulations and rules; the formation of a tobacco control network; the organization of workshops and symposiums; the progressive limitation and banning of tobacco advertisements; mass campaigns on tobacco control; tobacco control in youth; and support for and participation in the negotiation of the WHO Framework Convention of Tobacco Control. The 2008 Olympics is to be smoke free.
To improve the nutrition
and health condition of the Chinese people, the government has been developing and promulgating a series of policies, and implementing many projects. A major focus is on primary schools, and demonstration projects are achieving encouraging reductions in the prevalence of childhood obesity. For example, in a project in four Chinese cities, the prevalence of obesity in grade 3 and 4 boys (aged 8–14 years) was reduced from 21% to 14% in 1 year (Tian B, National Health Education Institute, personal communication).
To meet the huge challenge of chronic diseases the Ministry of Health of China, with the support of WHO, and in cooperation with relevant sectors, has been developing the first medium and long-term high level national plan for chronic disease control and prevention (2005–15). This plan will mandate an integrated and comprehensive approach to the control and prevention of cardiovascular disease, cancer, chronic respiratory disease, and diabetes. There will be priority actions in at least four areas: adult male smoking
, hypertension
, overweight
and obesity
, and capacity building
for chronic disease control.
and population based interventions. A national chronic disease control network is being built. At present, almost all provincial-level CDCs have a specified chronic disease responsibility and mission with the development of personnel and financing. Prefecture-level CDCs have been established in most provinces, and CDC staff are being appointed at lower regional levels—eg, in counties.
Comprehensive disease surveillance has been done in China through the National Disease Surveillance Points System, which was founded in 1978, primarily to report on communicable diseases, with some chronic disease responsibilities. The system was expanded and adjusted to improve its representativeness of China as a whole in 2004. The revised system includes 150 disease surveillance sites. Current initiatives of the system include upgrading cause of death registration so each disease surveillance point will function as a population mortality register for its designated site. The NCNCD is now responsible for the Disease Surveillance Points System, which is the major national resource for surveillance of chronic disease.
Following the framework of the WHO STEPs Surveillance system, the first National Risk Factor Surveillance Survey was done in August, 2004, with a sample size of 33,180 individuals from 942 villages or sub-communities, 314 towns or communities in 79 counties or districts in the Disease Surveillance Points System. The data was analyzed, and a complete report was published in late 2005. A national system of risk factor
surveillance is being developed, in which regional risk factor surveys, carried out by trained provincial and regional CDC staff according to national standards
, are an important component.
, the rapid growth of obesity in the next generation will affect Chinese morbidity and mortality in the second half of this century, unless action is taken. The social and economic consequences will be very serious if China fails to achieve control of these risk factors as soon as possible. Demonstration projects have shown that chronic disease risk factors can be controlled in China. The challenge for the national government is to scale up these interventions, and build capacity for effective national chronic disease control programs.
Non-communicable disease
A non-communicable disease, or NCD, is a medical condition or disease which is non-infectious. NCDs are diseases of long duration and generally slow progression. They include heart disease, stroke, cancer, asthma, diabetes, chronic kidney disease, osteoporosis, Alzheimer's disease, cataracts, and...
s now account for an estimated 80% of total deaths and 70% of disability-adjusted life years
Disability-adjusted life years
The disability-adjusted life year is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. Originally developed by Harvard University for the World Bank in 1990, the World Health Organization subsequently adopted the method in 2000...
(DALYs) lost in China
People's Republic of China
China , officially the People's Republic of China , is the most populous country in the world, with over 1.3 billion citizens. Located in East Asia, the country covers approximately 9.6 million square kilometres...
. Cardiovascular diseases, chronic respiratory disease
Chronic Respiratory Disease
Chronic Respiratory Disease is a peer-reviewed academic journal that publishes papers four times a year in the field of Palliative Medicine. The journal's editors are Mike Morgan , Carolyn Rochester and Sally Singh...
and cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
are the leading causes of both death and the burden of disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
, and exposure to risk factor
Risk factor
In epidemiology, a risk factor is a variable associated with an increased risk of disease or infection. Sometimes, determinant is also used, being a variable associated with either increased or decreased risk.-Correlation vs causation:...
s is high: more than 300 million men smoke cigarettes
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
and 160 million adults are hypertensive, most of whom are not being treated. An obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...
is imminent, with more than 20% of children aged 7–17 years in big cities now overweight
Overweight
Overweight is generally defined as having more body fat than is optimally healthy. Being overweight is a common condition, especially where food supplies are plentiful and lifestyles are sedentary...
or obese. Rates of death from chronic disease in middle-aged people are higher in China than in some high-income countries.
In China, as in many other parts of the world, the government has focused on communicable diseases—however, China now has a "double burden" of disease. The prevention of chronic diseases is now receiving a national response commensurate with the burden.
The national cancer prevention and control plan (2004–10) is being implemented, and a national chronic disease prevention and control plan has been completed (in late-2005). Progress has been made in some areas, with current smoking prevalence in men declining at about 1% per year for a decade, and even better results in large demonstration programs. Much remains to be done, and resources and sustainability are major issues. However, the surveillance and intervention mechanisms needed to ameliorate the increasing burden of chronic diseases are developing rapidly, taking account of the lessons learned over the past two decades.
Epidemiology
The ageingAgeing
Ageing or aging is the accumulation of changes in a person over time. Ageing in humans refers to a multidimensional process of physical, psychological, and social change. Some dimensions of ageing grow and expand over time, while others decline...
of the population is the major force driving the epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...
of chronic diseases. In 2000, 7% of the Chinese population were aged 65 years or older, and more than 400 million Chinese adults are now aged 20–39 years. If current trends continue, by 2040 the group aged 65 years and older will have increased to almost 20% of the population. The ageing of the population alone is predicted to produce a 200% increase in deaths from cardiovascular disease
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
in China between the years 2000 and 2040.
In addition to the ageing of the population, China is experiencing dramatic transformations in many social and economic
Economy of the People's Republic of China
The People's Republic of China ranks since 2010 as the world's second largest economy after the United States. It has been the world's fastest-growing major economy, with consistent growth rates of around 10% over the past 30 years. China is also the largest exporter and second largest importer of...
conditions that will continue to increase the incidence of major chronic diseases. For example, the country has recorded spectacular economic growth since 1978 and, on average, people's standard of living
Standard of living in the People's Republic of China
Before 1949 the Chinese economy was characterized by widespread poverty, extreme income inequalities, and endemic insecurity of livelihood. By means of centralized economic planning, the People's Republic was able to redistribute national income so as to provide the entire population with at least...
is far higher than ever before in the rapidly expanding urban areas. From 1990 to 2000, the proportion of people living in urban settings in China increased from 26% to 36%, the number of cities increased to 663, and the number of towns also soared. It is expected that urbanization in China
Urbanization in China
Urbanization in the People's Republic of China increased in speed following the initiation of the reform and opening policy. By the end of 2010, the mainland of the People's Republic of China had a total urban population of 665.57 million or 49.68 percent of the total population.The rural-to-urban...
will reach 45% by 2010, and 60% by 2030, with an extra 200 million more people expected in the urban areas before 2010. This growth comes at a cost in health terms. For example, a clear relation exists between urbanization and the prevalence of diabetes in China (diabetes defined as diabetic symptoms and a random blood glucose concentration
Blood sugar
The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL...
of 11.1 mmol/L or more, a fasting blood glucose of 7.0 mmol/L or more, or an abnormal result of 2-h oral glucose tolerance test).
The rapid environmental changes that follow urbanization
Urbanization
Urbanization, urbanisation or urban drift is the physical growth of urban areas as a result of global change. The United Nations projected that half of the world's population would live in urban areas at the end of 2008....
are increasing the prevalence of the major risk factors for chronic disease. Tobacco use
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
, unhealthy nutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, and physical inactivity
Physical exercise
Physical exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, as well as for the purpose of...
leading to obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
and hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
are already common, and physical inactivity is increasing. The prevalence of current cigarette smoking in men (smoked in the past 30 days) was 57% in 2002, but had fallen from 63% in 1996; less than 3% of women are current smokers. This favorable trend must be continued, because lung cancer
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
death rates are calculated to have more than doubled in men between 1991 and 1995, and are increasing at 2–5% per year in urban and rural working men aged 15–54 years. The decrease in smoking is the only encouraging risk factor trend, and is consistent with the plateau of tobacco consumption over this same period in the face of a rising adult population, as has occurred in other countries where tobacco taxes have been raised sharply. In 1999 the first Global Youth Tobacco Survey in China showed that 22% of students aged 13–15 years had ever tried to smoke; the current smoking rate was only 5%.
China's first comprehensive survey in the fields of nutrition and health was done in 2002. 71,971 households were chosen from 132 counties of 31 provinces, autonomous regions, and the municipalities, using the Central Government household
Household
The household is "the basic residential unit in which economic production, consumption, inheritance, child rearing, and shelter are organized and carried out"; [the household] "may or may not be synonymous with family"....
census
Census
A census is the procedure of systematically acquiring and recording information about the members of a given population. It is a regularly occurring and official count of a particular population. The term is used mostly in connection with national population and housing censuses; other common...
, and 243,479 people were included in the survey. The prevalence of hypertension (blood pressure 140/90 or higher) in people aged 18 years or older was 19%—a 30% increase since 1991. The prevalence of adult overweight (23%) and obesity (7%) had increased by 39% and 97%, respectively, over a 10-year period.
Of particular note is the rapidly developing epidemic of obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
in Chinese children. The overall prevalence rates of overweight plus obesity in 2000 among students in six sites (Beijing
Beijing
Beijing , also known as Peking , is the capital of the People's Republic of China and one of the most populous cities in the world, with a population of 19,612,368 as of 2010. The city is the country's political, cultural, and educational center, and home to the headquarters for most of China's...
, Tianjin
Tianjin
' is a metropolis in northern China and one of the five national central cities of the People's Republic of China. It is governed as a direct-controlled municipality, one of four such designations, and is, thus, under direct administration of the central government...
, and Shanghai
Shanghai
Shanghai is the largest city by population in China and the largest city proper in the world. It is one of the four province-level municipalities in the People's Republic of China, with a total population of over 23 million as of 2010...
cities and Hebei
Hebei
' is a province of the People's Republic of China in the North China region. Its one-character abbreviation is "" , named after Ji Province, a Han Dynasty province that included what is now southern Hebei...
, Liaoning
Liaoning
' is a province of the People's Republic of China, located in the northeast of the country. Its one-character abbreviation is "辽" , a name taken from the Liao River that flows through the province. "Níng" means "peace"...
, and Shandong
Shandong
' is a Province located on the eastern coast of the People's Republic of China. Shandong has played a major role in Chinese history from the beginning of Chinese civilization along the lower reaches of the Yellow River and served as a pivotal cultural and religious site for Taoism, Chinese...
provinces) increased from 1–2% in 1985 to 25% for boys aged 7–9 years, 25% for boys aged 10–12 years, 17% for girls aged 7–9 years, and 14% for girls aged 10–12 years. In 2002, prevalence rates in children aged 7–17 years varied from 13% overweight and 8% obese in a range of big cities to 2% overweight and less than 1% obese in a range of rural sites.
Economic consequences of chronic diseases
Over the past 25 years, China has made progress in reducing the number of people living in poverty from 250 million at the start of its reform process in 1978 to 29 million in 2001 (the Chinese poverty income standard is lower than the US$1 per day standardPoverty threshold
The poverty threshold, or poverty line, is the minimum level of income deemed necessary to achieve an adequate standard of living in a given country...
). Chronic diseases are threatening this progress and exposing individuals and their families and communities to stresses. Some citizens newly emerged from poverty may find their families plunged again into it as one of their members falls victim to catastrophic illness such as stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
or cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
. In a 2003 survey, 30% of poor households attributed their poverty to health-care costs. Overall, 79% of rural dwellers and 45% of urban citizens have no health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
, and the prevalence of citizens who could not afford medical treatment rose from 32% to 39% in rural areas, and from 32% to 36% in urban areas, between 1993 and 2003.
The economic consequences of chronic diseases for China are serious. For cardiovascular disease
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
alone, Chinese people aged 35–64 years lost 6.7 million years of productive
Productivity
Productivity is a measure of the efficiency of production. Productivity is a ratio of what is produced to what is required to produce it. Usually this ratio is in the form of an average, expressing the total output divided by the total input...
life during the year 2000 at a cost to the country of around US$30 billion. Only a quarter of this cost was estimated to be direct health-care costs. If current trends continue the total of years of productive life lost in this age range in China is estimated to increase to 10.5 million by 2030. It is estimated that in 2005 China will lose about $18 billion in national income from the effects of heart disease, stroke, and diabetes on labor supplies and savings. The cumulative loss over the period 2005–2015 would be about $556 billion.
Progress in chronic disease prevention and control
The establishment of Chinese cancerCancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
registries
Registry
-Computing:* Windows Registry, a database of configuration settings in Microsoft Windows operating systems* Domain name registry, an organization that manages the registration of top-level internet domain names...
began in 1963 in Shanghai
Shanghai
Shanghai is the largest city by population in China and the largest city proper in the world. It is one of the four province-level municipalities in the People's Republic of China, with a total population of over 23 million as of 2010...
, and data from registries led to some of the first programs that addressed chronic diseases in China. For example, mortality from cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
in the Jing'an county of Jiangxi
Jiangxi
' is a southern province in the People's Republic of China. Spanning from the banks of the Yangtze River in the north into hillier areas in the south, it shares a border with Anhui to the north, Zhejiang to the northeast, Fujian to the east, Guangdong to the south, Hunan to the west, and Hubei to...
province decreased to 9.6 per 100 000 in 1985 from 42.0 per 100 000 in 1974, at least in part a result of the introduction of the "early detection, early diagnosis and early treatment" of cervical cancer (Kong L, unpublished). Cancer has led the way in chronic disease control initiatives. In 2003, the Ministry of Health of the People's Republic of China, which is responsible for health policy, completed a national cancer control plan on the basis of expert opinions in diverse fields. Some elements of the Program of Cancer Prevention and Control in China (2004–2010) are now being implemented, for example with rapid diagnosis and screening
Cancer screening
Cancer screening aims to detect cancer before symptoms appear. This may involve blood tests, urine tests, other tests, or medical imaging. The benefits of screening in terms of cancer prevention, early detection and subsequent treatment must be weighed against any harms.Universal screening, mass...
trials for cervical cancer.
Between 1991 and 2000, a community-based intervention trial on management of diabetes and hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
was done in an urban population of 300,000 in three cities (Beijing
Beijing
Beijing , also known as Peking , is the capital of the People's Republic of China and one of the most populous cities in the world, with a population of 19,612,368 as of 2010. The city is the country's political, cultural, and educational center, and home to the headquarters for most of China's...
, Shanghai
Shanghai
Shanghai is the largest city by population in China and the largest city proper in the world. It is one of the four province-level municipalities in the People's Republic of China, with a total population of over 23 million as of 2010...
, and Changsha). The most notable outcomes were that the incidence of stroke decreased by 52% in men and 53% in women, and the mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
of stroke fell by 54% overall.
In 1995, the World Bank
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...
Loan Health VII: China Disease Prevention Project—health promotion
Health promotion
Health promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"...
component (1996–2002) began in seven cities: Beijing
Beijing
Beijing , also known as Peking , is the capital of the People's Republic of China and one of the most populous cities in the world, with a population of 19,612,368 as of 2010. The city is the country's political, cultural, and educational center, and home to the headquarters for most of China's...
, Tianjin
Tianjin
' is a metropolis in northern China and one of the five national central cities of the People's Republic of China. It is governed as a direct-controlled municipality, one of four such designations, and is, thus, under direct administration of the central government...
, Shanghai
Shanghai
Shanghai is the largest city by population in China and the largest city proper in the world. It is one of the four province-level municipalities in the People's Republic of China, with a total population of over 23 million as of 2010...
, Chengdu
Chengdu
Chengdu , formerly transliterated Chengtu, is the capital of Sichuan province in Southwest China. It holds sub-provincial administrative status...
, Luoyang
Luoyang
Luoyang is a prefecture-level city in western Henan province of Central China. It borders the provincial capital of Zhengzhou to the east, Pingdingshan to the southeast, Nanyang to the south, Sanmenxia to the west, Jiyuan to the north, and Jiaozuo to the northeast.Situated on the central plain of...
, Liuzhou
Liuzhou
-History:thumb|Liuchow in 1945.Liuzhou has a history of more than 2,100 years. The city was founded in 111 B.C. when it was known as Tanzhong....
and Weihai
Weihai
Weihai is a city in eastern Shandong Province, People's Republic of China. It is the easternmost prefecture-level city of the province and a major seaport. Between 1898 and 1930, the town was a British colony known as Weihaiwei or the Weihai Garrison , and sometimes as Port Edward...
, and some regions of Yunnan
Yunnan
Yunnan is a province of the People's Republic of China, located in the far southwest of the country spanning approximately and with a population of 45.7 million . The capital of the province is Kunming. The province borders Burma, Laos, and Vietnam.Yunnan is situated in a mountainous area, with...
province. The program covered about 90 million people. To date, among the chronic diseases outcomes reported are an overall reduction of 15% in the prevalence of male adult cigarette smokers, and in Beijing substantial increases in hypertension detection and treatment with a fall in cardiovascular disease death rates of more than 15% in the last year of the project (Wu Z, Director, Beijing Institute of Heart, Lung and Blood Vessel Diseases, personal communication).
Based on the experience of this project, the Ministry of Health began establishing demonstration sites for chronic disease prevention and control nationwide in 1997. There are currently 32 community-based sites and the major activities include community diagnosis, community mobilization, development of integrated community interventions (smoking control, healthy diet, physical activity, hypertension prevention, mental health, prevention and control of cardiovascular disease, diabetes, cancer, chronic respiratory disease), training, and evaluations of interventions.
Current policy activities
Risk factor patterns and demographic trends show that the most important priorities for chronic disease prevention in China are to control blood pressureBlood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
in the 160 million hypertensive adults, and help more than 300 million adult male smokers to quit. Although no current data are available about smokers' intentions to quit (see Smoking cessation
Smoking cessation
Smoking cessation is the process of discontinuing the practice of inhaling a smoked substance. This article focuses exclusively on cessation of tobacco smoking; however, the methods described may apply to cessation of smoking other substances that can be difficult to stop using due to the...
), the Health VII project achieved an overall quit rate of 25% in men over a 6-year period. Progress is also being made with the control of hypertension, and the mortality rate from cardiovascular disease halved in hypertensive patients over a 3-year period in the Shanghai demonstration sites (Kong L, unpublished).
China has just ratified the Framework Convention of Tobacco Control. During the past two decades, action has included: in-depth dissemination of tobacco control information and health education; the development of a series of tobacco control laws, regulations and rules; the formation of a tobacco control network; the organization of workshops and symposiums; the progressive limitation and banning of tobacco advertisements; mass campaigns on tobacco control; tobacco control in youth; and support for and participation in the negotiation of the WHO Framework Convention of Tobacco Control. The 2008 Olympics is to be smoke free.
To improve the nutrition
Nutrition
Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....
and health condition of the Chinese people, the government has been developing and promulgating a series of policies, and implementing many projects. A major focus is on primary schools, and demonstration projects are achieving encouraging reductions in the prevalence of childhood obesity. For example, in a project in four Chinese cities, the prevalence of obesity in grade 3 and 4 boys (aged 8–14 years) was reduced from 21% to 14% in 1 year (Tian B, National Health Education Institute, personal communication).
To meet the huge challenge of chronic diseases the Ministry of Health of China, with the support of WHO, and in cooperation with relevant sectors, has been developing the first medium and long-term high level national plan for chronic disease control and prevention (2005–15). This plan will mandate an integrated and comprehensive approach to the control and prevention of cardiovascular disease, cancer, chronic respiratory disease, and diabetes. There will be priority actions in at least four areas: adult male smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
, hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, overweight
Overweight
Overweight is generally defined as having more body fat than is optimally healthy. Being overweight is a common condition, especially where food supplies are plentiful and lifestyles are sedentary...
and obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
, and capacity building
Capacity building
Capacity building also referred to as capacity development is a conceptual approach to development that focuses on understanding the obstacles that inhibit people, governments, international organizations and non-governmental organizations from realizing their developmental goals while enhancing...
for chronic disease control.
Surveillance and information systems
The National Center for Chronic and Non-communicable Disease Control and Prevention (NCNCD) was established in 2002, under the leadership of the Chinese Center for Disease Prevention and Control (CDC), which is the technical counterpart of the Ministry of Health. NCNCD is the institution for chronic disease prevention and control at the national level and is responsible for surveillanceClinical surveillance
Clinical surveillance refers to the surveillance of health data about a clinical syndrome that has a significant impact on public health, which is then used to drive decisions about health policy and health education...
and population based interventions. A national chronic disease control network is being built. At present, almost all provincial-level CDCs have a specified chronic disease responsibility and mission with the development of personnel and financing. Prefecture-level CDCs have been established in most provinces, and CDC staff are being appointed at lower regional levels—eg, in counties.
Comprehensive disease surveillance has been done in China through the National Disease Surveillance Points System, which was founded in 1978, primarily to report on communicable diseases, with some chronic disease responsibilities. The system was expanded and adjusted to improve its representativeness of China as a whole in 2004. The revised system includes 150 disease surveillance sites. Current initiatives of the system include upgrading cause of death registration so each disease surveillance point will function as a population mortality register for its designated site. The NCNCD is now responsible for the Disease Surveillance Points System, which is the major national resource for surveillance of chronic disease.
Following the framework of the WHO STEPs Surveillance system, the first National Risk Factor Surveillance Survey was done in August, 2004, with a sample size of 33,180 individuals from 942 villages or sub-communities, 314 towns or communities in 79 counties or districts in the Disease Surveillance Points System. The data was analyzed, and a complete report was published in late 2005. A national system of risk factor
Risk factor
In epidemiology, a risk factor is a variable associated with an increased risk of disease or infection. Sometimes, determinant is also used, being a variable associated with either increased or decreased risk.-Correlation vs causation:...
surveillance is being developed, in which regional risk factor surveys, carried out by trained provincial and regional CDC staff according to national standards
Guobiao
Guóbiāo is usually the phonetic transcription of the word "National Standards" in Chinese.It could mean any of the standards issued by the Standardization Administration of China , the Chinese National Committee of the ISO and IEC....
, are an important component.
Challenges
The most pressing problems in the prevention of chronic disease in China relate to tobacco use and high blood pressure. Although the current generation of adults is at relatively low risk of the diseases associated with obesityObesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
, the rapid growth of obesity in the next generation will affect Chinese morbidity and mortality in the second half of this century, unless action is taken. The social and economic consequences will be very serious if China fails to achieve control of these risk factors as soon as possible. Demonstration projects have shown that chronic disease risk factors can be controlled in China. The challenge for the national government is to scale up these interventions, and build capacity for effective national chronic disease control programs.
External links
- Kadoorie Study of Chronic Disease in China (KSCDC)
- Cohort Profile: The Kadoorie Study of Chronic Disease in China (KSCDC) International Journal of Epidemiology 2005 34(6):1243-1249; doi:10.1093/ije/dyi174