July 26, 2011

Growing ‘Epidemic’ of Heart Attacks, Strokes, Cancer, Diabetes Threatens China’s Economic and Social Well-Being

The World Bank reports that based on current trends, the Chinese can expect to live only 66 “healthy years” (years free from disease and disability), ten years less than in some leading G-20 countries

Non-communicable chronic diseases (NCDs) are the leading cause of death in China, accounting for close to 70 percent of the disease burden and over 80 percent of the 10.3 million deaths caused by all diseases annually. The four leading NCDs in China are cardiovascular diseases (CVDs), diabetes, cancer and chronic obstructive pulmonary diseases (COPDs).

NCD mortality in China is higher than in other leading G-20 countries: for stroke it is four to six times higher than in Japan, the United States and France, and for COPD mortality is about 30 times as high as in Japan.

From 2010 to 2030, the total years lost due to NCD morbidity and mortality are expected to increase significantly. Population aging could compound the NCD burden by at least 40 percent by 2030 if effective measures are not taken to prevent and control NCDs and promote healthy aging.

The 48 page report Toward a Healthy and Harmonious Life in China: Stemming the Rising Tide of Non-Communicable Diseases was prepared in coordination with the Chinese Ministry of Health and the World Health Organization, based on assessments conducted by the World Bank in 2008-2010.

The number of cases of cardiovascular diseases, chronic obstructive pulmonary diseases, diabetes and lung cancer among Chinese people over 40 will double or even triple over the next two decades if effective prevention and control strategies are not implemented.

A substantial, avoidable economic burden is associated with NCDs. For example, estimates for China done for the report indicate that the economic benefit of reducing CVD mortality by 1 percent per year over a 30-year period (2010–2040) could generate an economic value equivalent to 68 percent of China’s real GDP in 2010, or more than US$ 10.7 trillion.

Over 50 percent of the NCD burden is preventable by modifying health and biological risk factors. Tobacco use; harmful alcohol use; poor diet, particularly high consumption of fast foods rich in fat and salt and sugar-rich soft drinks; and physical inactivity are the main risk factors.

Four sets of population-wide and high-risk, group-based preventive interventions are estimated to deliver the greatest value for investments needed at different levels of available resources in China. These preventive intervention sets can be implemented separately; however, combinations of different sets of interventions lead to economies of scale and more value for money. With full implementation of the combined set of interventions, one could expect 600–800 million DALYs or lost years averted annually over a period of ten years with an expenditure of about $220 per capita per year. This is about 45–60 percent of the estimated total NCD burden of about 1.4 billion in 2010.

• Implementation of tobacco control measures—including higher taxation and prices for cigarettes, and banning smoking in public places and advertisement of tobacco products—would prevent 10 million DALYs lost annually at only a few cents (US) or less than 0.04 yuan per capita per year.

• At a doubling of resources, a few additional cents (US) or around 0.07 yuan per capita, a combination of anti-tobacco measures with interventions for controlling alcohol abuse, e.g., increasing tax and banning advertising, would help avert an additional 40 million DALYs lost annually.

• At about US$ 13 or 90 yuan per high-risk individual, the combined implementation of anti-smoking and alcohol abuse measures, along with preventive interventions—e.g., screening of and treatment for individuals with elevated blood cholesterol levels—would help prevent about 85 million DALYs lost per year.

• US$ 220 or 1500 yuan per high-risk individual annually is required to add a next set of cost-effective interventions, i.e., in high-risk groups, cardiovascular risk assessment and management and preventive treatment with multidrug regimes (statin, aspirin and two or three blood pressure-lowering drugs). The total cost would be over US$ 26.5 billion or 180 billion yuan annually (less than 10 percent of the total health expenditure in 2010), and the total annual DALYs lost averted would be around an additional 500 million.

• The first two groups of interventions could be financed through the priority public health programs for NCDs and implemented at the national level. The third and fourth groups can be financed through health insurance schemes.

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