Print“But by defining chronic diseases, such as diabetes, as an economic rather than a health problem, the World Bank sees solutions and responsibilities for addressing the issue well outside of the healthcare sector.”
The signs of prosperity are everywhere in China in tobacco, alcohol, sugar, salt, and fat. The latest evidence of the economic miracle in China comes in a study published in the Journal of the American Medical Association that estimates that 11.6 percent of the adult population or 113.9 million people in China have diabetes. What’s more, 50.1 percent or 493.4 million are estimated to have prediabetes, a condition of impaired glucose tolerance that demonstrates some of the symptoms of the full blown disease. China now has the dubious distinction of being home to the greatest number of people with diabetes.
The study, based on blood samples drawn from nearly 100,000 Chinese adults, is particularly alarming because a 2007 report estimated the prevalence of the disease at 9.7 percent and the percent of the population with prediabetes at 15.5 percent. As Juliana Chan of the Hong Kong Institute of Diabetes and Obesity wrote in an accompanying editorial, “the epidemic of diabetes and prediabetes in China has shown no sign of abating.”
The World Bank, concerned about the rising threat of non-communicable diseases in China in 2011 issued a report on what China needed to do to address the problem. The report is notable—not only for China, but for the United States and elsewhere—because of the case it makes for the economic toll the burden of chronic disease threatens to take and why solutions must extend well beyond the healthcare sector.
For China, its population is a victim of its prosperity. Diabetes and other noncommunicable diseases have been fueled by such things as urbanization, rising incomes, pollution, greater fat intake, fast food, sugar-rich soft drinks, and increasing physical inactivity. All those things come with an economic engine chugging away and wealth spreading.
Consider cardiovascular disease, a major consequence of diabetes. If China could reduce the incidence of cardiovascular disease by 1 percent over a 30-year period, that would create an economic value of $10.7 trillion—equivalent to 68 percent of China’s GDP in 2010. The flipside is that failure to address the problem will be complicated by an aging population and a shrinking ratio of healthy workers to sicker non-working dependents and create a significant economic and social challenge.
Part of the problem China faces in addressing diabetes and other chronic diseases is that its healthcare system is ill-equipped to do so. It’s been focused on inpatient rather than outpatient care and needs to focus on primary care. Spending on outpatient care as a total percentage of healthcare expenditures fell to 32.5 percent in 2009 from 37.8 percent in 2005 and government and insurance initiatives have been skewed toward inpatient care. The World Bank makes several recommendations to shift incentives and resources to emphasize primary care and new healthcare models to provide access to curative and preventative care; long-term, patient-centric care; and comprehensive and coordinated care.
But by defining chronic diseases, such as diabetes, as an economic rather than a health problem, the World Bank sees solutions and responsibilities for addressing the issue well outside of the healthcare sector. This includes not just policies, such as taxing unhealthy foods and subsidizing healthy ones, but looking across sectors to prevent and control these diseases by doing such things as encouraging or mandating real estate developers include physical exercise facilities, private sector workplaces institute wellness programs, schools provide food and nutrition programs, or cities improve public infrastructure for walking and cycling, and public agencies regulate the production and marketing of unhealthy foods.
Chronic diseases are complex, but so too are their effects, which extend beyond the individuals who must contend with them. They require complex solutions and not only China, but other countries, such as the United States, would be wise to look at chronic disease as much more than a healthcare problem in search of a healthcare solution.
September 06, 2013
http://www.burrillreport.com/article-the_new_china_syndrome.html
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