From obesity to diabetes, China cannot afford to put its epidemic of chronic diseases on the back burner
Efforts to tackle the escalating prevalence in non-communicable diseases, the leading cause of deaths, were waylaid, first by Covid-19, then the economic slowdown
Beyond the health crisis of an overweight, disproportionately diabetic population with rising cardiovascular deaths is a brewing social crisis as health budgets are strained
Like many visitors to China, I was enticed by its delectable cuisine. “You seem to have had a change in body shape,” a friend teased. Upon returning to the US, I was astonished to learn I had put on 7lbs (3.2kg) in a mere three weeks.
As I strive to shed those pounds on the treadmill, I reflect on the health implications for those in China facing the allure of a rich diet laden with salt, sugar and fat – the leading risk factors for obesity, cardiovascular diseases, diabetes and cancer.
A recent report from the second China Obesity Congress in Beijing underlined my concerns about China’s escalating obesity problem. The five-year study, encompassing data from more than 20 provinces and cities, noted that the number of patients undergoing weight loss and metabolic surgeries reached 10,000 in the three years from 2019 to 2021.
Alarmingly, it took only one year, from 2021 to 2022, to reach the next 10,000. This trend aligns with a National Health Commission report, which showed adult obesity rates had more than doubled from 7.1 per cent in 2002 to 16.4 per cent in 2020. The report further indicated that over half of adults, or more than half a billion people, in China were overweight.
Unsurprisingly, China’s diabetes burden is rising. In 2021, the country recorded 141 million adults with diabetes, a staggering quarter of the global total, despite China accounting for only 17.7 per cent of the world population. Notably, although the US adult obesity rate of 42.4 per cent is significantly higher than China’s 16.4 per cent, diabetics account for just 11.3 per cent of the US population, only marginally above China’s 10 per cent.
A Lancet study anticipates a significant surge in the diabetes burden from 2020 to 2030. By 2030, according to a Chinese report, it is estimated that health expenditures related to overweight and obesity will comprise roughly 22 per cent of China’s total health spending.
Chinese students stretch after swimming at a camp for overweight children on July 15, 2014 in Beijing. Photo: Getty Images
This spike in diabetes is but a fragment of the broader issue: the escalating prevalence of non-communicable diseases in China. Such diseases were already the leading cause of death in China before Covid-19, accounting for 88 per cent of all fatalities and more than 70 per cent of total diseases. In 2019, cardiovascular diseases alone were responsible for 47 per cent of rural deaths and 44 per cent of urban deaths.
As far back as 2017, the government had introduced plans to mitigate the risk factors for non-communicable diseases and significantly alleviate their burden by 2025. In 2019, the Healthy China Initiative was launched to reduce the premature mortality rate from major non-communicable diseases from 18.5 per cent in 2015 to below 15.9 per cent by 2022.
Then the Covid-19 pandemic hit, distracting the health authorities and accelerating health problems. Given the high prevalence of non-communicable diseases, many were at increased risk of severe Covid-19 complications. The zero-Covid policy of strict and prolonged lockdowns also led to heightened stress, anxiety and weight gain while reducing physical activity, all of which amplified the risk and impact of non-communicable diseases.
Furthermore, measures like closing hospitals or repurposing them for exclusive Covid-19 treatment meant patients with non-communicable diseases received limited care. This was associated with an increase in preventable deaths related to non-communicable diseases; urban fatalities from cerebrovascular and cardiovascular diseases alone rose by 700,000 in 2020-21 versus 2019.
The zero-Covid policy was so effective that it made other pivotal public health interventions seem less urgent, such as vaccinating the elderly and introducing more effective vaccines and treatments. This left China ill-prepared when it shifted away from the policy last December.
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China’s Covid crisis: What went wrong and how bad is it? | Talking Post with Yonden Lhatoo
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Consequently, a substantial number of patients with non-communicable diseases, especially the elderly, fell victim to the viral wave. Leaked cremation data suggests there were 1.5 million Covid-related deaths in the first quarter of this year alone. With December included, actual numbers may be higher.
As Covid-19 ceases to be a public health emergency, China stands at a critical juncture in confronting its mounting crisis in non-communicable diseases. An estimated 330 million Chinese suffer from some form of cardiovascular disease, including 13 million stroke patients, 11.4 million with coronary heart disease and 245 million with hypertension. In the Chinese village I spent my childhood in, nearly everybody over the age of 60 is seemingly grappling with cardiovascular disease, with many unable to care for themselves.
China’s 2022 report on cardiovascular health and diseases candidly acknowledged that due to rapid population ageing and widespread unhealthy lifestyles, cases of cardiovascular disease and related deaths are expected to continue to rise.
In the aftermath of Covid-19, it is increasingly clear that the prevention and control of non-communicable diseases have been collateral damage amid China’s economic slowdown. Three years of spending on Covid-19 controls have strained the budgets of many local authorities while fiscal revenues struggle to grow in the tepid economic recovery.
Economic concerns now overshadow public health in government priorities, as evidenced by the dearth of central policy statements on the matter. Local governments, mired in debt and displaying limited initiative, are also grappling with a fiscal crunch that hinders their ability to address the epidemic.
Financially strapped local governments such as those in Wuhan and Dalian have opted to curtail healthcare spending by trimming the medical benefit allowance for retirees. As subsequent protests in these cities suggest, the concealed toll of China’s economic slowdown could manifest as more than just another health crisis.
For a nation that met Covid-19 with such determination, relegating non-communicable diseases to the back burner is a price it simply cannot afford to pay.
Yanzhong Huang is a senior fellow for global health at the Council on Foreign Relations, and a professor at the School of Diplomacy and International Relations, Seton Hall University
