The haze, smog and pollution in Beijing never seems to lift completely in the heat of summer, but here are some observations that were clear to me in my first day. I arrived in Beijing, China on Saturday and was immediately greeted by Shaq at the airport, an awesome sight in an empty airport, he is apparently feeling “Buddha Blessed“. In addition to China importing a sports culture (there are more basketball hoops in China than anywhere else in the world according to the Spaulding CEO) they are also importing a culture of food and industrialization/globalization which has massive implications for their health system. Here are some select headlines I saw in China’s national English language paper:

1. China is now Coke’s third largest single market, link [think about this in the context of obesity and chronic diseases in Asia]

2. Ensuring better air quality for the Asian Games, link

3. Vigilante public health supported by the public, link

This last story really caught my attention:
A retired teacher has become an Internet sensation after he lobbed dozens of bricks at cars that ran a red light in Lanzhou, Gansu province. “I just want to catch people’s attention and tell the drivers to think of pedestrians,” the 74-year-old man said. The elderly man, has attracted a lot of attention online, with nearly 400,000 netizens responding to a Sina.com poll. Nearly 80 percent said they supported his actions. A netizen called Biyuding20008 said too many drivers do not follow traffic rules like stopping at red lights and not talking on phones while driving. The man became a crusader for road safety after a female pedestrian was killed in his community last year. “Even when the light is green, drivers just ignore it and don’t slow down for pedestrians,” the man told the paper. In order to punish drivers and draw attention to poor driving habits, the man planned to throw bricks at all cars that ran red lights…

Traffic and road accidents are a major problem in Asia and will be one of the top 5 “disease categories” by 2020. In my first 24 hours I got a glimpse into what China is hurtling towards. In conjunction with the failed climate change talks at the G8, the stakes are huge and China is also dealing with cultural transformation, demographic and employment/labor issues, all happening at warp speed. As the United States is going through a major reset and downturn and continues to buckle under the weight of special interest groups from the financial, food/beverage (from soda to tobacco) and health industries I wonder what lessons China will import from a failed health system in the US as it undergoes it’s own health reform.  Maybe they will need more vigilante public health to make sure they move in the right direction.

Other related posts:

The Power of Image in Public Health Education: China 1930-2004
A Massive Wave of Chronic Disease in China and India
Beijing Olympic Cause Marketing & Global Health Ads
China and Global Health
China is Choking
Trends: Global Pharmaceutical Manufacturing and Investment

We previously mentioned the malaria ad sponsored by ExxonMobil during the Olympics. I have seen this several times now during coverage and said in the original post:

“with regard to ExxonMobil’s commercial on Malaria during prime time, when over 1 Billion people were watching, this might have been the largest audience ever for a global health ad.”

I realized after I said this that I probably made a major miscalculation. The NBC channel broadcast I have been watching is only produced for an American audience. The top estimates I have seen for viewership at a given time hit 66 million people. So while Exxon may have had their ad broadcast across countries and major national networks, it is likely that somewhere between tens and hundreds of millions of people saw their commercial – which is still an impressive number. Thanks to Responsible China I found the youtube version of this ad, which is below. In addition I have also seen GE’s portable re-designed low cost EKG machine advertised several times as well. Despite what you may think about these companies it is better than nothing to see MNC’s promoting social causes. We blogged about the EKG machine previously and the commercial is the first one below, followed by the malaria ad. For another check, definitely check out ResponsibleChina.

[youtube=http://www.youtube.com/watch?v=yB47wx-b6sY]

[youtube=http://www.youtube.com/watch?v=s7qVlbG1i7A]

When most people think of global health they think of infectious diseases and all of the associated images this conjures up (and it is harder to capture provocative images of chronic diseases). However, as we have empahsized before, developing countries are facing a dual burden of both chronic and infectious diseases.

This past Tuesday I was privileged enough to attend the launch of the new Health Affairs issue on global health in China and India. I was joined by an esteemed panel of guests who gave great presentations about various issues facing these two nations. Unfortunately I don’t have time to summarize all of their talks but encourage you to read them in the latest issue. I want to focus on Dr. Somnath Chatterji’s paper because the projections of the aging of China and India are quite stunning and the associated social and economic implications will be profound.

Somnath Chatterji runs the WHO’s Study on Global Ageing and Adult Health (SAGE). Here are some highlights from his paper and quotes I picked up (these are based on my hand written notes, so please forgive any factual mistakes):

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The pace of change is stunning – what took 100 years in France (the graying of the population) is going to take place in 30 years in China/India (I can’t remember which one he specified). “Aging has been on the backburner…but China and India are facing dramatic demographic shifts in very short periods of time”.

By 2030, 65.6 percent of the Chinese and 45.4 percent of the Indian health burden are projected to be borne by older adults.

By 2019 in China and 2042 in India, the proportion of people age sixty and older will exceed that of people ages 0–14.

Within the next 20 years there will be 42 million diabetics in China and 80 Million in India.

“In four decades 40% of the worlds elderly population will be in China and India…these countries are getting older before they get richer”.

“Traditionally, people think of chronic diseases as diseases of the of the rich, this is probably not going to be true for China and India…we really need longitudinal data to track this”.

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There are dozens of issues that come to mind when hearing these projections, some of which include – access, who will get access to care? how will the delivery system be set up for this? where will the focus be (primary care?)? how will this be financed at both health system level and a household level – how much payment will be borne by the patient? can we use capacity developed for tackling infectious diseases for chronic diseases (a very different ballgame in some ways)? what will be the role of the private sector? if the private sector gets involved heavily to sell their drugs and devices in this  new “market” – will that lead to better infrastructure for delivery and distribution of medical supplies? how will this impact the economic growth of these countries? There are many more pressing questions, but I will stop here.

Another one of the articles in this global health issue is on obesity in China. This paper is authored by one of world’s leading experts in nutrition (Barry Popkin). We covered some of this before in a recent issue of Scientific American and here is the link for the new paper. Kudos to Health Affairs for the issue and to Burness Communications for a well run launch.

Partly because of my recent visit to Beijing I am fascinated by what is happening in/with China. In addition, because China is now front and center stage and because they play such an important role in the lives of those living not only in the West (see living without “Made in China”, via Treehugger; Amazon book) but for those in various regions (see Africa and China) there are substantial implications to what happens in China on many important levels (global business & finance, global health, global environmental conditions). With the 2008 Olympics just around the corner, you will only hear more and more about these issues and hopefully the media blitz will have some positive impact on governance and policy issues going forward. With that I want to highlight what prominent bloggers have been recently talking about with respect to China and health/global health issues with a couple of articles mixed in:

• China’s Ticking Gender Bomb, Wired blog

• What Do China’s Scandals Mean For Public Health? Epidemix blog

• Mounting Poverty, Health Risks for China’s Sex Workers, Think Girl

• China to ban tobacco advertising from 2011, Forbes

• China health threat: much bigger than paint, Zenbowl over at Daily Kos

• Drug trials made in China, Rx Brandweek blog

• Top Ten Posts on China, Health Care and Globalization, AJFortin.com

• Red Package Health Care in China, AJFortin #1 post

• The Great Leap Backward? Sept/Oct 2007 Foreign Affairs, credit to Sustainable Dreams blog

• Weekly Roundup on PharmAsia news, PharmAsia blog

Bonus: The Atlantic, audio photo essay on “Made in China”, worth a quick look, link

Great article in the NY Times about China’s pollution, a country where cancer is now the leading cause of death. As the article mentions, China unlike any of the industrialized nations will be forced to deal with this extremely serious problem while they are still a poor country. The catch 22 is that this may curb China’s development and hence also its future. This NY Times feature article includes additional audio and visual material. Below are some highlights from the article:

As China Roars, Pollution Reaches Deadly Extremes, NY Times
No country in history has emerged as a major industrial power without creating a legacy of environmental damage that can take decades and big dollops of public wealth to undo…its pollution problem has shattered all precedents. Environmental degradation is now so severe, with such stark domestic and international repercussions,

Public health is reeling. Pollution has made cancer China’s leading cause of death, the Ministry of Health says. Ambient air pollution alone is blamed for hundreds of thousands of deaths each year. Nearly 500 million people lack access to safe drinking water…

Chinese cities often seem wrapped in a toxic gray shroud. Only 1 percent of the country’s 560 million city dwellers breathe air considered safe by the European Union…China is choking on its own success.

China’s problem has become the world’s problem. Sulfur dioxide and nitrogen oxides spewed by China’s coal-fired power plants fall as acid rain on Seoul, South Korea, and Tokyo. Much of the particulate pollution over Los Angeles originates in China, according to the Journal of Geophysical Research…

Other sources and perspectives:
In China, Global Environmental Injustice Kills Millions, It’s Getting Hot in Here

China is choking on growth, China Law Blog

As China Roars, Pollution Reaches Deadly Extremes, 8Asians

China’s Pollution Problem – Our Pollution Problem? Working Life (Labor Research Association)