Rising Ailments Growing Threat

July 26, 2011

Klaus Rohland and Michael O'Leary China Daily

A fast growing but neglected epidemic is afflicting China. Non-communicable diseases (NCDs), such as heart attacks and strokes, cancer, chronic obstructive pulmonary diseases, and diabetes, affect individuals and tend to remain a private matter - but the collective impact on society is often severe. These conditions are now the leading causes of premature death, ill health and disability in China, accounting for 69 percent of the total disease burden and more than 80 percent of total annual deaths in the country.

Although China has seen remarkable economic growth and development for more than 30 years, mortality because of NCDs is higher than in other leading G20 countries: for stroke it is four to six times higher than in Japan, the United States and France. For chronic respiratory diseases, it is about 30 times as high as in Japan.

Based on current trends, Chinese people can expect to live only 66 "healthy years" (years free from disease and disability), 10 years less than in some leading G20 countries. The number of NCD cases among Chinese people over 40 will double or even triple over the next two decades, most of this during the next 10 years. Diabetes and high blood pressure will be the most prevalent conditions, while lung cancer cases will increase fivefold.

These and other findings from a new World Bank report "Toward a Healthy and Harmonious Life in China: Stemming the Rising Tide of Non-Communicable Diseases", may seem startling, with profound implications for China's prosperity.

First and foremost, it is the human toll that should concern policymakers when addressing NCDs. But the economic costs are also high. Estimates for China show that improved health status among the population by preventing and controlling the onset of NCDs can result in a 16 percent gain in hours worked and a 20 percent increase in individual income. Tackling NCDs, on top of being a valuable health investment, may thus be seen as an investment in people's productivity and their earnings potential.

The reduction of ill health and premature death and disability because of NCDs in China could also have significant macroeconomic benefits. The reduction of cardiovascular diseases by only 1 percent per year over a 30-year period (2010-2040) could generate an economic value equivalent to 68 percent of China's real GDP in 2010, more than $10.7 trillion. If an effective response is not mounted, it will surely aggravate the economic and social impact of an aging population and a smaller workforce in China. A less healthy workforce and an elderly population that is chronically ill is likely to increase the odds of a future economic slowdown and pose a significant social challenge.

What can be done?

In fact, China is not the only country that faces an increase in NCDs. NCDs present a major challenge to healthcare systems worldwide, because affected people often spend substantial parts of their lives in poor health and in constant need of medical care. Well designed and sustained prevention and treatment efforts are required to reduce the burden of NCDs and control their enormous pressure on the healthcare system.

There is good news. Much of China's NCD burden can be avoided or reasonably well managed if good practices that have been proven effective internationally are adopted, tailored to suit local conditions. Cost-effective policy options exist for adopting a comprehensive multisectoral response to deal with NCDs.

With strong political commitment at the highest levels of government, many of the key challenges for implementing these options can be overcome so that policies and investments in other sectors contribute to the control of the social and health risks associated with NCDs. Building upon ongoing healthcare system reforms, better health outcomes can be generated by redesigning healthcare organizations, financing and service delivery systems.

It may not be widely known, but evidence from successful efforts in developed countries reveals that health improvements occur in a shorter time frame than people commonly believe - within a year or a few years rather than decades - after the elimination of the health risk factors associated with the onset of NCDs.

More than half of NCDs are preventable by modifying lifestyles and reducing risks. This includes efforts to reduce high smoking rates among males, alcohol abuse, and high salt intake. Addressing the problem of growing obesity because of increased consumption of fast foods rich in fat and salt, sugar-rich soft drinks and decreased physical activity in cities, will also help prevent and control the rising tide of NCDs expected over the next 20 years. Together with improved access to quality medicines and medical care for heart disease, stroke, diabetes, cancer, and chronic obstructive pulmonary diseases, the combined set of population-based and healthcare services are cost-effective and proven interventions to reduce the rate of premature mortality, ill health and disability because of NCDs.

Improved health conditions in China will benefit not only individuals and families but also society as a whole and the national economy. And, an effective response by China to address the NCD challenge in the years to come could be a powerful example that would significantly influence the rest of the world.

The World Bank and the World Health Organization, working in partnership with other agencies, stand ready to provide technical and financial support to the Chinese government for an effective and sustainable multisectoral strategy to address the major development challenge posed by NCDs.

Klaus Rohland is the World Bank director for China, and Michael O'Leary is the World Health Organization representative in China.