“Health in China”的意思、由来-开放百科全书

An emphasis on public health and preventive treatment characterized health policy from the beginning of the 1950s. At that time the party began to mobilize the population to engage in mass "patriotic health campaigns" aimed at improving the low level of environmental sanitation and hygiene and attacking certain diseases. One of the best examples of this approach was the mass assaults on the "four pests"—rats, sparrows, flies, and mosquitoes—and on schistosoma-carrying snails. Particular efforts were devoted in the health campaigns to improving water quality through such measures as deep-well construction and human-waste treatment. Only in the larger cities had human waste been centrally disposed. In the countryside, where "night soil" has always been collected and applied to the fields as fertilizer, it was a major source of disease. Since the 1950s, rudimentary treatments such as storage in pits, composting, and mixture with chemicals have been implemented. As a result of preventive efforts, such epidemic diseases as cholera, bubonic plague, typhoid fever, and scarlet fever have almost been eradicated. The mass mobilization approach proved particularly successful in the fight against syphilis, which was reportedly eliminated by the 1960s. The incidence of other infectious and parasitic diseases was reduced and controlled.

Political turmoil and famine following the failure of the Great Leap Forward led to starvation of 20 million people in China. Beginning in 1961 the recovery had more moderate policies inaugurated by President Liu Shaoqi ended starvation and improved nutrition. The coming of the Cultural Revolution weakened epidemic control, causing a rebound in epidemic diseases and malnutrition in some areas.

Barefoot doctors were a good contribution to primary health systems in China during the Cultural Revolution (1964–1976). It encompasses all principles stated in primary health care. Community participation is possible because the team is composed from village health workers in the area. There’s equity because it was more available and combined western and tradition medicines. Intersectoral coordination is achieved by preventative measures rather than curative. Lastly it’s comprehensive using rural practices rather than urban ones.^[1]

The "barefoot doctor system" was based in the people's communes. With the disappearance of the people's communes, the barefoot doctor system lost its base and funding. The decollectivization of agriculture resulted in a decreased desire on the part of the rural populations to support the collective welfare system, of which health care was a part. In 1984 surveys showed that only 40 to 45 percent of the rural population was covered by an organized cooperative medical system, as compared with 80 to 90 percent in 1979.

This shift entailed a number of important consequences for rural health care. The lack of financial resources for the cooperatives resulted in a decrease in the number of barefoot doctors, which meant that health education and primary and home care suffered and that in some villages sanitation and water supplies were checked less frequently. Also, the failure of the cooperative health care system limited the funds available for continuing education for barefoot doctors, thereby hindering their ability to provide adequate preventive and curative services. The costs of medical treatment increased, deterring some patients from obtaining necessary medical attention. If the patients could not pay for services received, then the financial responsibility fell on the hospitals and commune health centers, in some cases creating large debts.

Consequently, in the post-Mao era of modernization, the rural areas were forced to adapt to a changing health care environment. Many barefoot doctors went into private practice, operating on a fee-for-service basis and charging for medication. But soon farmers demanded better medical services as their incomes increased, bypassing the barefoot doctors and going straight to the commune health centers or county hospitals. A number of barefoot doctors left the medical profession after discovering that they could earn a better living from farming, and their services were not replaced. The leaders of brigades, through which local health care was administered, also found farming to be more lucrative than their salaried positions, and many of them left their jobs. Many of the cooperative medical programs collapsed. Farmers in some brigades established voluntary health-insurance programs but had difficulty organizing and administering them.

Their income for many basic medical services limited by regulations, Chinese grassroots health care providers have supported themselves by charging for giving injections and selling medicines. This has led to a serious problem of disease spread through health care as patients received too many injections and injections by unsterilized needles. Corruption and disregard for the rights of patients have become serious problems in the Chinese health care system.

The Chinese economist, Yang Fan, wrote in 2001 that lip service being given to the old socialist health care system and deliberately ignoring and failing to regulate the actual private health care system is a serious failing of the Chinese health care system. "The old argument that "health is a kind of welfare to save lives and assist the injured" is so far removed from reality that things are really more like its opposite. The welfare health system supported by public funds essentially exists in name only. People have to pay for most medical services on their own. Considering health to be still a "welfare activity" has for some time been a major obstacle to the development of proper physician - patient relationship and to the law applicable to that relationship."^[2]

Despite the decline of the public health care system during the first decade of the reform era, Chinese health improved sharply as a result of greatly improved nutrition, especially in rural areas, and the recovery of the epidemic control system, which had been neglected during the Cultural Revolution.

Health Indicators

Some measures used to indicate health include Total Fertility Rate, Infant Mortality Rate, Life Expectancy, Crude Birth and Death Rate. As of 2017, China has a Total Fertility Rate of 1.6 children born per woman, an Infant Mortality rate of 10 deaths per 1000 live births, Crude Birth Rate of 13 births per 1000 people and a Death Rate of 7 deaths per 1000 people^[3]^[4]. Since 1949, China had a huge improvement in population's health. There are health related parameters:

In general, all indices showed improvement except the drop around 1960 due to the failure of the Great Leap Forward, which led to starvation of tens of millions of people. From 1950 to 2012, life expectancy nearly doubled (41.6-75.1). Total Fertility Rate changed from 5.3 to 1.7 which mainly caused by One-child policy. Infant Mortality rate and Under-5 mortality rate went down sharply. Though there is no data from 1963 to 1967, we can see the trend. The gap between IMR and U5MR became smaller and smaller, which indicates health in children has been promoted.

Maternal Mortality Ratio isn't showed in the graph due to having insufficient data, but it did go down from 164.5(1980) to 26.5(2011).

One-Child Policy

Created in 1979, under Deng Xiaoping, the One-Child Policy incentivized families to have children later and to only have one child or risk penalization.^[6] The One-Child Policy was a program created by the Chinese government as a reaction to the increasing population during the 1970s, that was thought to have negatively impacted China's economic growth. Implementation of the program included rewarding families who followed the program, fining families who resisted the policy, offering birth control/ contraceptives, and in some cases forced abortions.^[7] The policy was unevenly implemented throughout China and was easier established in urban areas rather than rural, because of ideals about family size and gender preferences. Prior to the One-Child Policy, the Chinese government had encouraged families to have more children in order to increase the future workforce, however, this promotion made the population of China in the 1970s increase at an alarming rate.^[8] Additionally, voluntary programs, involving family planning and contraceptive use, were proposed before the One-Child Policy was fully enforced.^[7]

The One-Child Policy was successful in halting China's increasing population and decreased both the birth rate and population, However, the harsh enforcement of the policy created long-term changes to some of China's health indicators. For instance, favoring males over female children lead to many forced abortions, infanticide and abandoned female children which have led to an imbalance of men to women in China.^[9] Additionally, birth rates and rate of natural increase have decreased as a result of the One-Child Policy^[10]

Other Consequences of the One-Child Policy include difficulties accessing education and employment as a result of being an undocumented birth.^[7]

Dependency Ratio

China's dependency ratio is unfavorable because of the policy and its elderly population (65+) will outgrow the working aged people. The elderly population in China is highly reliant on the working aged people for support and the number of dependents (children 0-14, adults 65+) are increasing compared to the number of working aged people. China's population is aging and the number of children born is less than the replacement rate.^[10]

Medical issues in China

Smoking

Smoking related illnesses killed 1.2 million in the People's Republic of China; however, the state tobacco monopoly, the China National Tobacco Corporation, supplies 7 to 10% of government revenues, as of 2011, 600 billion yuan, about 100 billion US dollars.^[11]

Sex education, contraception, and women's health

The Basic Health Services Project piloted strategies to ensure equitable access to China's rural health system; health outcomes for women improved significantly, with substantial declines in maternal mortality due to increased coverage of maternal health services.^[14]

SARS

Although not identified until later, China’s first case of a new, highly contagious disease, severe acute respiratory syndrome (SARS), occurred in Guangdong in November 2002, and within three months the Ministry of Health reported 300 SARS cases and five deaths in the province. Dr. Jiang Yanyong exposed the level of danger the SARS outbreak posed to China.^[15]^[16] By May 2003, some 8,000 cases of SARS had been reported worldwide; about 66 percent of the cases and 349 deaths occurred in China alone. By early summer 2003, the SARS epidemic had ceased. A vaccine was developed and first-round testing on human volunteers completed in 2004.

The 2002 SARS in China demonstrated at once the decline of the PRC epidemic reporting system, the deadly consequences of secrecy on health matters and, on the positive side, the ability of the Chinese central government to command a massive mobilization of resources once its attention is focused on one particular issue. Despite the suppression of news regarding the outbreak during the early stages of the epidemic, the outbreak was soon contained and cases of SARS failed to emerge.^[17] Obsessive secrecy seriously delayed the isolation of SARS by Chinese scientists.^[18] On 18 May 2004, the World Health Organization announced the PRC free of further cases of SARS.^[19]

Hepatitis B

Work with the CDC has created goals of decelerating the spread of Hepatitis B through Immunization efforts^[20]

HIV and AIDS

The AIDS disaster of Henan in the mid-1990s is estimated to be the largest man-made health catastrophe, affecting five-hundred thousand to one million persons. It was also in Hebei, Anhui, Shanxi, Shaanxi, Hubei and Guizhou.^[21] HIV was transmitted via blood sale. Blood plasma mixture from several persons was returned so that same person could give blood up to 11 times a day.^[22] The disaster was only recognized in 2000 and found out abroad in 2001. Pensioner Gao Yaojie sold her house to deliver data leaflets of HIV to people, while officials tried to prevent her. Some local officials and politicians were involved in the blood sale. In 2003 only 2.6% of Chinese knew that a condom could protect from AIDS.^[23]

China blocked by police protest over ineffective drug treatments, cancelled meetings on HIV groups, closured office of the AIDS organization, and detained or put under house arrest prominent AIDS activists such as 2005 Reebok Human Rights Award winner Li Dan, eighty-year-old AIDS activist Dr. Gao Yaojie, and the husband-and-wife HIV activist team of Hu Jia (activist) and Zeng Jinyan.^[24]

China, similar to other nations with migrant and socially mobile populations, has experienced increased incidences of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). By the mid-1980s, some Chinese physicians recognized HIV and AIDS as a serious health threat but considered it to be a "foreign problem". As of mid-1987 only two Chinese citizens had died from AIDS and monitoring of foreigners had begun. Following a 1987 regional World Health Organization meeting, the Chinese government announced it would join the global fight against AIDS, which would involve quarantine inspection of people entering China from abroad, medical supervision of people vulnerable to AIDS, and establishment of AIDS laboratories in coastal cities. Within China, the rapid increase in venereal disease, prostitution and drug addiction, internal migration since the 1980s and poorly supervised plasma collection practices, especially by the Henan provincial authorities, created conditions for a serious outbreak of HIV in the early 1990s.^[25]^[26]^[27]

As of 2005 about 1 million Chinese have been infected with HIV, leading to about 150,000 AIDS deaths. Projections are for about 10 million cases by 2010 if nothing is done. Effective preventive measures have become a priority at the highest levels of the government, but progress is slow. A promising pilot program exists in Gejiu partially funded by international donors.

Tuberculosis

Tuberculosis is a major public health problem in China, which has the world's second largest tuberculosis epidemic (after India). Progress in tuberculosis control was slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and multidrug-resistant tuberculosis was a major problem. These signs of inadequate tuberculosis control can be linked to a malfunctioning health system. Prevalent smoking aggravates its spread.

Leprosy

Leprosy, also known as Hansen's disease, was officially eliminated at the national level in China by 1982, meaning prevalence is lower than 1 in 100,000. There are 3,510 active cases today. Though leprosy has been brought under control in general, the situation in some areas is worsening, according to China’s Ministry of Health.^[28]

Mental health

100 million Chinese people have mental illnesses that are varying degrees of intensity.^[29] Currently, dilemmas such as human rights versus political control, community integration versus community control, diversity versus centrally, huge demand but inadequate services seem to challenge the further development of the mental health service in the PRC. China has 17,000 certified psychologists, which is ten percent of that of other developed countries per capita.^[29]

Nutrition

In the 2000–2002 period, China had one of the highest per capita caloric intakes in Asia, second only to South Korea and higher than countries such as Japan, Malaysia, and Indonesia. In 2003, daily per capita caloric intake was 2,940 (vegetable products 78%, animal products 22%); 125% of FAO recommended minimum requirement.

Malnutrition among rural children

China has been developing rapidly for the past 30 years. Though it has uplifted a huge number of people out of poverty, many social issues still remain unsolved. One of them is malnutrition among rural children in China. The problem has diminished but still remains a pertinent national issue. In a survey done in 1998, the stunting rate among children in China was 22 percent and was as high as 46 percent in poor provinces.^[30]^[31] This shows the huge disparity between urban and rural areas. In 2002, Svedberg found that stunting rate in rural areas of China was 15 percent, reflecting that a substantial number of children still suffer from malnutrition.^[32] Another study by Chen shows that malnutrition has dropped from 1990 to 1995 but regional differences are still huge, particularly in rural areas.^[33]

In a recent report by The Rural Education Action Project on children in rural China, many were found to be suffering from basic health problems. 34% have iron deficiency anaemia and 40 percent are infected with intestinal worms.^[34] Many of these children do not have proper or sufficient nutrition. Often, this causes them not being able to fully reap the benefits of education, which can be a ticket out of poverty.

One possible reason for poor nutrition in rural areas is that agricultural produce can fetch a decent price, and thus is often sold rather than kept for personal consumption. Rural families would not consume eggs that their hen lay but will sell it in the market for about 20 yuan per kilogram.^[35] The money will then be spent on books or food like instant noodles which lack nutrition value compared to an egg. A girl named Wang Jing in China has a bowl of pork only once every five to six weeks, compared to urban children who have a vast array of food chains to choose from.

A survey conducted by China’s Ministry of Health showed the kind of food consumed by rural households. 30 percent consume meat less than once a month. 23 percent consume rice or egg less than once a month.

In a 2008 Report on Chinese Children Nutrition and Health Conditions, West China still has 7.6 million poor children who were shorter and weigh lesser than urban children. These rural children were also shorter by 4 centimetres and 0.6 kilograms lighter than World Health Organisation standards.^[35] It can be concluded that children in West China still lack quality nutrition.

Epidemiological studies

The most comprehensive epidemiological study of nutrition ever conducted was the China-Oxford-Cornell Study on Dietary, Lifestyle and Disease Mortality Characteristics in 65 Rural Chinese Counties, known as the "China Project", which began in 1983.^[36] Its findings are discussed in The China Study by T. Colin Campbell.

Iodine deficiency

Infection from animals

The first known human contraction of Avian Influenza (bird flu), after contact with live poultry in February 2018, was diagnosed to a woman living in the Jiangsu Province of China.^[38]

Pig-human transmission of the Streptococcus suis bacteria was reported in 2005, which led to 38 deaths in and around Sichuan province, an unusually high number. Although the bacteria exists in other pig rearing countries, the pig-human transmission has only been reported in China.^[39]

Hygiene and sanitation

Many of China's water sources, including underground sources and rivers, have been heavily polluted because of industry and economic growth. Increased exposure to polluted water and air has created "cancer villages" and further health and environmental problems.^[40] A majority of groundwater and shallow wells surveyed in China showed signs of heavy pollution, by measuring nitrate levels which indicate water contamination^[40]

By 2002, 92 percent of the urban population and 8 percent of the rural population had access to an improved water supply, and 69 percent of the urban population and 32 percent of the rural population had access to improved sanitation facilities.{{citation needed|date=January 2019}}

Although China has made great efforts of making sanitary facilities and safe water more accessible, there are water and sanitation disparities all over China. As of 2012, sanitary facilities were available to 69% of the Chinese people and 71% of water in China is piped, yet it is still difficult preserving drinking water that is affordable and efficient at a communal level. Additionally, water in both urban and rural areas of China are still vulnerable to disease, pollution, and contamination, with rural areas at higher risk of sewage contamination.^[41]

The lack of sanitation in multiple areas of China has affected many student for decades. An absence of modern-day toilets and hand washing areas have directly affected students nationwide. The lack of reliable drinking water and sanitation areas, along with many others health issues, has directly led to 1/3 of young students in China having intestinal parasites.^[42]

The Patriotic Health Campaign, first started in the 1950s, are campaigns aimed to improve sanitation and hygiene in China. UNICEF also plans to incorporate government programs and policies in order to improve normal health standards in China. The programs and policies are used to teach students about basic hygiene and form campaigns encouraging people to wash their hands with soap instead of water only.^[42]

WHO in China

The World Health Organization (WHO) Constitution came into force on 7 April 1948, and China has been a Member since the beginning.

The WHO China office has increased its scope of activities significantly in recent years, especially following the major SARS outbreak of 2003. The role of WHO China is to provide support for the government's health programs, working closely with the Ministry of Health and other partners within the government, as well as with UN agencies and other organizations.

China's government with WHO assistance and support has strengthened public health in the nation. The current Five Year Plan incorporates public health in a significant way. The government has acknowledged that even as millions upon millions of citizens are prospering amid the country's economic boom, millions of others are lagging behind, with healthcare many cannot afford. The challenge for China is to strengthen its health care system across the spectrum, to reduce the disparities and create a more equitable situation regarding access to health care services for the population at large.

At the same time, in an ever-interconnected world, China has embraced its responsibility to global public health, including the strengthening of surveillance systems aimed at swiftly identifying and tackling the threat of infectious diseases such as SARS and avian influenza. Another major challenge is the epidemic of HIV/AIDS, a key priority for China.

The staff of the WHO Office in China are working with their national counterparts in the following areas:

In addition, WHO technical experts in specialty areas can be made available on a short-term basis, when requested by the Chinese government. China is an active, contributing member of WHO, and has made valuable contributions to global and regional health policy. Technical experts from China have contributed to WHO through their membership on various WHO technical expert advisory committees and groups.

See also

References

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Post-1949 history