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

I heard this fascinating case study on indigenously driven innovation and how this rural community has come together to tackle obesity. Don’t read the story, listen to it. We need more stories like this from the local community level (see our previous post on the global obesity index).

BMI is far from a perfect measure of obesity and can be misleading – but you get the picture below (via Miscellanea). Also check out our previous obesity related posts:

A Massive Wave of Chronic Disease in China and India, link

The 88 Worst Fast Food Items, link

Scientific American on Food, Fat and Famine, link

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.

The “a Calorie Counter” site came up with this catchy and interesting analysis of the worst fast food joints as determined by the worst trans fat offenders (hat tip to Big Picture). As the post states – “The absolute worst ingredient your food could possibly contain is trans fat. Maybe you’ve heard of it? ” The top offenders, ranked by the numbers of times they appeared in the top 88, were:

• Jack in the Box: 24 times
• Burger King: 16 times
• White Castle: 16 times
• A&W: 10 times
• Dairy Queen: 8 times

For the exact listing of specific meals and fast food chains check out “a Calorie Counter” here.

Currently, everyone knows that the US is the leading fast food market in the world as you can see in the below graphic from WorldMapper (via Creative Class). The scary thing about this picture is that it is apparently sourced from a McDonald’s campaign absurdly and insultingly called “One World – One Taste“, which begs the question of whether some fast food chains are engaging in a type of food genocide. The fact that the US is the largest market, only means that so called emerging markets represent a largely untapped source of growth for various chains. The growth will be explosive, India alone is witnessing 40% growth in this area (via Siliconeer, search for “fast food” on this page).

We did a previous post on obesity in developing countries that you can see for more sources along with the WHO page on this issue… For additional fast food facts you can check out the Yale’s Rudd Center for Food Policy and Obesity, here are some select ones:

• Two-thirds of all cardiovascular deaths occur in developing countries.
• Approximately 20,000 new food and beverage products are introduced into the market each year.
• In some parts of Africa, overweight children outnumber malnourished children three to one.
• Of America’s 15 top-rated hospitals, 6 have fast food franchises in the lobby.

An account manager from Scientific American’s PR firm let me know about their latest issue on Obesity and Malnutrition (many thanks to Scott for the email) which you should check out. This special issue focuses on “Food, Fat and Famine” and has some of the world’s leading experts writing for the issue (Barry Popkin, world food prize laureate Per Pinstrup-Andersen, and others) along with a bonus article by Jeffery Sachs. I got a chance to quickly skim the introduction to the issue and this line struck me (paraphrased from memory): “For the first time in the world’s history the number of obese people has surpassed the undernourished” (roughly 1.3 billion vs 1 billion).

The shift to sedentary lifestyles (use of mopeds vs bikes) and drive to “Westernization” (fast food, sweetners, mass produced food, urbanization) is dramatically altering the landscape and will lead to a substantial rise in chronic diseases. As Barry Popkin says in his excellent article, The World is Fat, these changes have “paved the way for a public health catastrophe”. A couple of facts from Popkin’s article about the radical change that has taken place in Mexico in just 20 yeras:

-1989: Less than 10% of Mexicans were considered overweight
-2006: Over 66% of Mexican men and women are overweight or obese
-1990: Diabetes was almost non-existent in Mexico, not so today

The above rapid change maybe compounded in developing regions where evolution may have altered genetic makeup such that people in those regions have a greater ability to store fat due to the need to conserve in times of famine. Add in the lack of access to drugs, obesity leads to greater rates of diabetes and hypertension and in China for example, only 1/3 of hypertension patients receive medications. This issue is fascinating and I highly recommend perusing it. For a blog that posts on obesity in general as well as other issues, I would recommend the Med Journal Watch. Unfortunately the online links below only have free abstracts and not full articles, but you will get a decent sense of the article content:

The Global Paradox of Obesity and Malnutrition
A Question of Sustenance, abstract
Globalization ushered in a world in which more than a billion are overfed. Yet 800 million or so still suffer from hunger’s persistent scourge

The World Is Fat, abstract
How can the poorest countries fight obesity?

Still Hungry, abstract
One eighth of the world does not have enough to eat

Sowing a Gene Revolution, abstract
A new green revolution based on genetically modified crops could help reduce poverty and hunger, but only if formidable institutional challenges are met

Is Your Food Contaminated?, abstract
New approaches to protect the food supply

Sustainable Developments: Breaking the Poverty Trap by Jeffrey D. Sachs, abstract
Targeted investments can trump a region’s geographic disadvantages