In recent times, China has sustained significant economic expansion and at the same time has greatly improved the health status for the majority of the population. These achievements have been a model for developing countries worldwide. Gains in the health sector, however, are being curtailed by the environmental consequences of the economic expansion of the country. To continue the country's rapid economic growth while at the same time protecting people's health is one of the main challenges facing Chinese authorities today.
In the last two decades, China has had an average economic growth of 9.4%. For the last 50 years it has also made impressive advances in public health, improving health care and tackling infectious diseases with remarkably good results. The average life expectancy is now 71.8 years, up from 35 in 1949. Immunisation coverage is over 95% for those under one.
From 1960 to 2003 the infant mortality rate fell from 150 to 30 per 1,000 live births, and the under-five mortality rate dropped from 225 to 37 per 1,000 live births during the same period. Both rates are used as indicators of access to basic health services. At the same time, there has been a rapid increase in community service networks, which provide basic health services to the population.
Despite those advances, however, China still faces important health challenges, many of which are caused by a polluted environment. Today, coal provides over 65% of the country's energy. To keep pace with growth dirtier coal —- causing greater pollution — is used.
Most factories built before 1980 lack pollution control equipment and are fuelled by coal, which is the main source of air pollution in the country. It has been estimated that 15% of deaths in China are due to poor air quality. Water pollution is another serious environmental concern. Sewage and agricultural waste contaminate water supplies, and provoke a host of waterborne illnesses.
In addition, rivers that are used as a source of drinking water become contaminated with heavy metals including lead, cadmium and arsenic from industrial discharges, negatively affecting people's health.
The impact of water pollution on human health has been estimated in $3.9bn a year. At the same time, nearly half of China's 640 most important cities face serious water shortages.
Toxic compounds in air and water affect the health of children and adults alike. However, because children are still growing and their immune system and detoxification mechanisms are not fully developed, toxic agents have a more serious impact on them than in adults.
It is estimated that half of the country's population consumes water contaminated with animal and human waste that exceeds permissible levels. Water pollution increases the rate of liver and stomach cancers.
Health problems are aggravated by the incapacity of the government to provide adequate health care to the population, particularly those living in rural areas.
As a result of the reforms introduced in the health sector, the old national public health system which had responded to the most basic health needs of the population was dissolved, and left the majority of the population unprotected. It is estimated that close to 80% of the rural population lacks health insurance.
The consequences of pollution in China, the world's most populous nation with over 1.3bn people, impact not only that country but also its neighbours. There is fear that as a result of pollution in the heavily contaminated Yangtze River fish stocks can be decimated.
At the same time, China's carbon dioxide emissions are an important cause of global warming. Although the US today surpasses China as a greenhouse gas producer, if current trends continue China may become number one by 2025. Chinese authorities have been trying to limit the damage caused by environmental pollution and have set guidelines in a document entitled 'Priority Activities for Sustainable Development'.
However, despite new policies and regulations, compliance remains low. On a World Bank list of 20 cities with the worst air quality, 16 of them are Chinese cities. At the same time, 40% of Chinese cities suffer from medium to high-levels of air pollution.
According to a World Bank assessment, projected health effects of air pollution in urban China by 2020 will include: 600,000 premature deaths in urban areas, 9mn person-year lost because of pollution-related illness, 20mn cases of respiratory illness per year, 5.5mn cases of chronic bronchitis and health damages valued at 13% of its GDP.
Those effects should be added to the intrinsic weakness of China's health system.
China needs to continue developing energy-efficient technologies, implementing cheap and environmentally-responsible transportation systems and at the same time stringently enforce its own environmental regulations.
According to the US-based Worldwatch Institute, many Chinese officials now recognise that the resource-intensive model of economic growth is no longer a good option for China. It is now time to develop new energy options to move the country solidly into the 21st century.
Dr Cesar Chelala is an international public health consultant and the author of Environmental Impact on Child Health, a publication of the Pan American Health Organisation.
© 2007 The Gulf Times