A Lancet Commission Report has just been released that focuses on urban health in Chinese cities. With the recent history of rapid urbanization in China causing a range of health issues, the report looks for ways to build urban health into ongoing efforts to support the Healthy China 2030 targets. I had an opportunity to speak to Professor Peng Gong of Tsinghua University, one of the lead authors of this report and an expert on environmental health. His vision for urban health transcends academic and governmental silos and perfectly embodies the principles of Geohealth as a discipline.
In a nutshell, what is the state of health in urban China?
China has been in a period of rapid economic growth since the economic reform in 1978 and one feature of this has been the world’s largest population migration from rural to urban areas. Over the past 40 years, the Chinese government pioneered the healthy cities movement, mainly targeted at improving sanitary conditions in urban areas. This and many other efforts have substantially improved the living conditions of urban residents, resulting in a six to seven-year longer life expectancy over rural dwellers.
On the other hand, the economic growth and migration has created mega cities, which face serious environmental problems including heavily polluted water and air, each with a knock-on effect on human health.
Rapid urban sprawl without proper land planning has left the state struggling to keep pace with the provision of physical and medical infrastructure to support the growing population.
The adaptation of ‘western lifestyles’ by a majority of urban citizens have created other health-related problems, while the disease patterns have changed from a society dominated by infectious disease to one where non-communicable diseases prevail.
Does the average Chinese person have much of an understanding of how environmental conditions impact their personal health?
There is now much better awareness about the consequences of poor environmental conditions on health. This is particularly true since the air pollution event in early 2013 in Beijing triggered by the hourly measurements of fine particulates in the air from a monitor on the rooftop of the American Embassy. Now a daily warning of poor air quality is broadcast like a weather forecast via the internet and mobile phones. This has helped people to decide when to wear air masks.
What is spent on healthcare in China and how has it changed?
Compared to other major economies in the world, the percentage of government expenditure on health is relatively low in China: according to the World Health Organization, 10% in 2014, compared with 19% in Germany and 21% in the United States. According to the Chinese National Social Yearbook, three-quarters of the national total is spent in urban areas; a total of 2.6 trillion yuan (US $439.4 billion) in 2014.
At the turn of the century, health costs were shouldered mostly by individuals – 59% of costs in 2000, dropping to 32% by 2014 – but the government has been spending steadily more on the public health care system. For example, a major reform in 2009 sought to realize universal health coverage.
At city level, the health care sector is expanding and being made more efficient. Efforts are also underway to streamline the health insurance system and improve the affordability of health care. Finally, health services are made increasingly available to underserved groups, such as migrants.
Nevertheless, there is still room for improvement. For example, in a comparative study of females of reproductive age conducted in eight cities in the Pearl River Delta, migrants were found to be less covered by health insurance and enjoy less free health care than those with permanent urban residence.
Who should be responsible for urban health?
At city government level, urban health is far beyond the responsibility of the health department alone. There is a need for better cooperation among different departments in the design, building, and management of healthy cities. I think that health considerations should be integrated into all governmental policies.
The private sector now employs approximately 80 per cent of urban residents and generates 60 per cent of national GDP so has an enormous influence on the health of employees and communities. Thus, companies should also take some responsibility for addressing urban health and environmental impacts. Moreover, there is emerging evidence that corporate involvement and investment in public health can create valuable business opportunities.
I am optimistic about the growing contribution of private enterprises to employee health and their increasing contribution to society as the economy continues to grow in the future.
Meanwhile, citizens need to be encouraged to have healthier lifestyles, including being more active and having a good diet. A prevention-centered approach to urban health that requires the coordinated efforts from both the public and private sectors, as well as individuals, could ensure progress toward healthier cities.
Is there available and accessible data for these different parties to work together?
Data sharing is a great challenge in China. Of course, there are data barriers built around different governmental agencies, which is not unique to China. In addition, it is rare for the private sector to share data but companies in possession of big data could play an important role in complementing governmental agency data.
For example, one of the difficulties with preparing the report was a lack of geographically-detailed epidemiological data from governmental agencies, which prevented us from employing prediction models to project future epidemiological trends. As a trial, we sought a collaboration with the internet company Baidu to explore their query data related to various kinds of diseases.
A better approach would be the integrated use of both official disease reporting data and social data collected by private companies. At present, the best one can do is to develop bilateral agreements on exclusive data use. Thus, one of our recommendations is to promote inter-sectoral cooperation.
What are your reflections on the completion of this report?
It took almost two years to put together this report. It was a great experience to work with a team composed of interdisciplinary scholars including geographers, atmospheric scientists, medical doctors, social scientists, urban planners, and computer specialists. Learning about these diverse perspectives was most enjoyable.
Megacities and urban health challenges are not unique to China but, as the largest developing country in the world, there are many valuable experiences from China’s urbanization that should be documented as a reference for other developing nations. I sincerely hope that successful stories can be duplicated while failure stories can be avoided in the future.
—Gabriel Filippelli, Editor-in-Chief, GeoHealth, and Center for Urban Health, Indiana University-Purdue University Indianapolis; email: [email protected], with Peng Gong, Ministry of Education Key Laboratory for Earth System Modeling, Tsinghua University, Beijing