Army-Baylor University
Graduate Program in Health Care Administration
China Country
Report
Presented to Dr. A.
David Mangelsdorff
In
partial fulfillment of the requirements for
HCA
5312: Issues in International Health
By
MAJ
Jonathan Edwards, CPT Brian Freidline, CPT Alan Jones
Ft
Sam Houston, TX
21
February, 2006
Introduction
China is located in the heart of the Asian
continent covering 9.6 million kilometers which is slightly small than the United States. China boarders
many countries as well as possesses 14,500 kilometers of coastline which makes
it a great candidate for international trade. Much of the western portion of China is
uninhabited due to the desert, mountains and weather of that region. The
country has many resources and a growing economy that has the potential to
improve the quality of life for its citizens.
China has all
aspects of weather and temperatures ranging from cold in the north to tropical
weather in the south. Precipitation occurs more in the east than in the desert
west and is peaked with monsoons in the summer causing frequent floods. The
eastern part of the country is where cultivation is predominant, but is being
challenged in recent years with the high urbanization that is occurring in Chinese
cities particularly in the eastern region of the country. This urbanization
detracts from agriculture in two ways by drawing poor urbanites from the
country and by consuming prime farmland for growing cities.
China has a
long and rich historical past dating back four thousand years. It has been
known for its diverse ethnicities that make up the Chinese civilization with 55
recognized today (Library of Congress, 2006). China has had a very prosperous
past as the superior nation in the region and led to disregard for adopting
change. The desire of China
to resist change became a liability when confronted with challenges of western
powers. Early in the century, China’s
growing population became a burden with a growing labor force and led to an
insufficient industrialization of the nation to provide sufficient economic
freedom. It also led to shortages of land and discontentment of the people and
corruption as the country was unable to compete with peers to include western
nations who were becoming more prevalent for trade. The later part of the
century has undertaken great change to influence China’s decisions for economic
reform which has resulted in a significant growth in GDP and the health status
of the nation. China’s peer
nations in the region are largely Japan,
South Korea, and Taiwan as they have the strongest economies in
the region; however South Korea,
Japan, and Russia maintain political influence in the
region as peers of China.
Demographics
According to the CIA World
Factbook, China’s
population was estimated in 2005 to be the largest single country population in
the world at 1.3 billion. This is roughly one fifth of the world population.
This high number becomes more obvious when looking at the number of large
cities that make up China
with 48 cities in 1999 having a population more than half a million to a
million and 37 cities with populations exceeding one million. According to
wikipedia, China
had a population density in urban areas of 320 persons per square kilometer and
as low as 109 in rural areas in 1986. The cities of Macau and Hong
Kong are among the most densely populated cities in the world with
densities of 16,521/km2 and 6,206/km2 respectively
(wikipedia, 2006). The lowest number of 109 is more than three times higher
than the United States
has today. The higher number is relatively comparable with the more highly
urbanized regions in the world which are predominantly in Asia.
While there are countries with higher population densities, China’s
population density is particularly disturbing due to the large area with
extremely high population densities in the eastern and southeastern part of the
country. These areas are of particular concern as they are also the primary
areas where industrialization and urbanization are taking place. The high
population density particularly results from the poor environmental regulation
of new industries emerging in China.
China’s
population age breakdown currently is made up of 21.4% under 14 years of age,
71% between 15 and 64, and 7.6% is 65 or older (CIA World Factbook, 2006). This
age breakdown is of particular concern as China’s fertility rate is 1.72
indicating a decline in population growth. This coupled with an average life
expectancy of 72.27 years and increasing, and a high proportion of males to female’s
rate that may be as high as 20% more males than females indicates a dramatic
shift in a working age labor pool by the year of 2050. Approximately 30% of
Chinas population is expected to be 65 or older by 2050. There are also
additional confounders of government regulation of the number of children
families may have and a poor immigration rate that will put China in a situation where drastic
reform will need to occur to address such issues.
China is an
extremely diverse country in terms of ethnicities. The Han Chinese make up
91.9% of the population and as many as 54 other ethnicities make up the
remaining 8.1%. Though many religions still exist in China, the country is officially
atheist. Muslims represent approximately 1%-2% of the population and Christians
represent approximately 3%-4% of the population while the rest of the
population is predominantly Taoist or Buddhist (CIA World Factbook).
National
Disasters
While
flooding is frequent in China and is the most frequent natural disaster, there
are other serious noteworthy events such as the 1928 drought that killed three
million, the 1909 Manchurian plague epidemic claiming one and a half million
lives and multiple earthquakes occurring in 1920, 1927, and 1976 each claiming
approximately 200,000 lives. Regardless of all natural disasters, flooding has
been the most frequent typically affecting millions to hundreds of millions
annually and claiming the worst human loss of 3.7 million in the 1931 flood
(EM-DAT, 2006).
While
China
suffers natural disasters annually, it also suffers many technological
disasters. Most frequently china looses thousands annually from coal mining and
petroleum accidents. These numbers may be attributable to the increasing needs
of china’s energy needs to meet their rapidly expanding economy in recent
years. Many other industrial accidents that have been increasing in recent
years may be attributable to the rapidly growing industrialization transforming
from a higher history of transportation accidents of the past.
Armed forces
China’s
national defense is an important part of the country’s success and
prosperity. The Chinese Army’s major
missions are to actively participate in and support the nation’s economic
construction, to uphold the absolute leadership of the Communist Party of China
(CPC), and provide contributions to its modernization, security, and stability
(Government White Papers). In the past 5 years, there have been no major
conflicts involving China.
However, the ongoing conflict over the control of Taiwan resurfaces periodically. Taiwan
wants to be an independent country. China
claims Taiwan falls under
its control and will attack Taiwan
should they attempt to declare independence.
The Chinese military branches
consist of the People's Liberation Army (PLA): comprised of ground forces, Navy
(which includes naval infantry and naval aviation), Air Force, Artillery Corps
(strategic missile force), People's Armed Police Force, and militia. The PLA is
organized into seven military area commands nationwide. The age for which
Chinese can join for compulsory military service is between 18-22 years of age
and for a 24-month service obligation.
There is no minimum age requirement for Chinese voluntary service. Women
who are 17 and can meet requirements for specific military jobs can also join.
The total numbers of male manpower available for military service between ages
15-49 is 379,524,688. Those fit for military service in the same category are
208,143,352. The expenditures for China’s military are $67.49 billion
a year. This accounts for approximately 4.3% of the country’s total GDP (CIA
World Factbook).
Healthcare System
The
total health expenditures for China
as a % of GDP is 5.8% which is 97th of 189 countries
(NationMaster.com). However, China’s
healthcare system is seriously struggling. It operates as a private healthcare
system and as of 2003, 44% of urban residents and 79% of rural residents did
not have any form of medical or health insurance. The country is now starting
to require premium sharing between employees and employers, but it is often not
enforced. Premiums equivalent to 8% of monthly payroll will be credited to a
designated account. The employee contributes 2% and the employing enterprise
tops up another 6%. The employee’s entire contribution plus 30% of the employer’s
contribution will be deposited into the employee’s individual account
(Blumenthal & Hsiao, 2005).
China’s healthcare system has not
always had the problems it does today. From 1952-1982, China’s healthcare system was
showing significant improvements. The number of skilled physicians was
increasing, hospitals were becoming more advanced, and life expectancy numbers
were improving. The entire healthcare system was originally under the control
of the Ministry of Health (MOH). The MHO was responsible for all facets of China’s
health policy and it originally functioned as a three tiered system. The first
tier was made up of barefoot doctors working out of village medical centers.
Tier 2 was comprised of township health centers which functioned as the main
outpatient clinics. The two lower tiers made up the rural health system and
provided most of the county’s healthcare. Tier 3 is for the most seriously ill
patients and is staffed with senior doctors who have 5 year medical school degrees
(Country Studies/Area Handbook Series, 1998).
Several bad decisions in the
early 1980’s caused the current healthcare turmoil. The central government
reduced spending on health care from 32% to 15%. Public hospitals and China’s
public health system both were decentralized and started to focus on mostly
revenue generating activities and the bottom line instead of focusing on health
education, maternal child health, and the controlling of epidemics. The final
devastating event was the privatization of the agricultural economy. This
caused 900 million peasants in rural areas to become uninsured and it happened
basically overnight. China
is currently trying to fix the healthcare system. They are currently working
with the Harvard School of Public Health faculty to test alternative models
that cover prevention, primary care, and insurance protection. The Chinese
government has also launched experiments in selected areas to try new
healthcare strategies (Blumenthal & Hsiao, 2005).
Traditional
Chinese medicine is as popular and valued as it has been for thousands of years
and is gaining new respect among several western medical researchers. It is
also frequently called alternative medicine. It is focused on body manipulation
and noninvasive therapeutic intervention methods. It involves six major
components which are: acupuncture, tui na, moxibustion, cupping, herbology, and
exercise (Answers.com, 2006).
HIV/AIDS
has infected 840,000 individuals in China, with a total of 44,000
deaths resulting from the disease. China’s infant mortality rate is
24.18 deaths per 1,000 live births. Life expectancy rates at birth for males
and females are 70.7 and 74.1 years respectively (CIA World Factbook). The top
three causes of death in China
are cancer, cerebrovascular disease, and heart diseases. The most common
cancers are: stomach, esophagus, liver, lung, and colon-rectum (Country
Studies/Area Handbook Series, 1998). China’s
suicide rate is the highest in the world at 230 per million people. The world
average is only 100 per million. China has the highest rates of
female suicides in the world. It is one of very few countries who have women
accounting for more than half of the suicides committed (Association for
Asian Research, 2003).
Health Concerns
Severe
Acute Respiratory Syndrome (SARS) has been a serious health scare for East Asia countries. China has had a total of 5,327
cases of SARS. Of those cases, 349 individuals have died for a fatality ratio
of 7%. Currently there is no cure in the form of western medicine in dealing
with SARS. Some prescriptions have gained popularity for the initial treatment
of the syndrome, but it still does not help with the prevention of SARS
(NationMaster.com). The avian influenza has also affected China over the last 3 years. Normally,
influenza viruses are highly species-specific and the viruses stay true to that
species. Mutations can cause the virus to spill over into other species such as
humans which is a major public health concern (World Health Organization,
2006).
Visitor Information
Anyone
traveling to East Asia and China
should first find out the CDC recommended vaccines. For travel to China,
the CDC recommends vaccinations hepatitis A and B; Rabies; Japanese
encephalitis; typhoid; as needed boosters for tetanus-diphtheria, measles, and
one-time dose of polio. Travelers to China may be at risk for malaria in
rural areas and should take an antimalarial drug. Still another area of caution
is the illicit drugs in China.
China
is the major trans-shipment point for heroin produced in the golden triangle.
There is also a growing domestic drug abuse problem which includes chemical
precursors and methamphetamines. Where drugs are prevalent, crime also follows.
Individuals must be cognizant of this fact and remain vigilant (Deployment
Link, 2005).
Water
China
has a serious problem with their water quality and usage. Chinese scientists
say that wasted resources and pollution are the major causes of China’s
water shortage, and this problem will turn into a major crisis by the mid 21st
century. China
has more than 2,800 billion cu.m. of water, but only a per-capita share of
2,700 cu.m., a fourth of the world’s average.
China’s
rivers are polluted to a varying extent, and five percent of them have serious
pollution problems. The result is China has 700 million people
consuming drinking water contaminated with levels of animal and human
excrements that exceed maximum permissible levels by as much as 86% in rural
areas and 28% in urban areas. China
needs to look at constructing more wastewater treatment plants or put in place
some alternative wastewater treatment strategies (The Water Treatment Resource
Center, 2006).
Energy
China is the second largest energy consumer
after the United States.
Coal is China’s
primary energy consumption. It is the largest consumer and producer of coal in
the world and its demand for coal continues to grow. China is also a significant factor
in the oil markets. In 2004, total demand for oil was 6.5 million barrels per
day and is estimated to reach 14.5 by 2025. China
has exceeded Japan
as the world’s second largest petroleum consumer. China uses only 3 percent of
natural gas for its energy consumption (Energy Information Agency, 2005).
Conclusion
China
is an impressive country with a unique culture, strong military, and growing
economy. However, China
still has many areas of concern. The most critical is its major problem with
the overall healthcare system and taking care of the medical needs of its
citizens. China
also has a dreadful problem with its air and water pollution. There is still
tension between China and Taiwan
over who has ultimate control of the island.
References
Answers.com. (n.d.). Traditional
Chinese medicine. Retrieved on February 14, 2006, from
http://www.answers.com/topic/traditional-chinese-medicine
Association for Asian Research.
(2003). China suicide rate is 2.3 times the global average.
Retrieved
on February 10, 2006, from http://www.asianresearch.org/articles/1697.html
Blumenthal, D., & Hsiao, W. (2005, September
15). Privatization and its discontents. The
New
England Journal of Medicine. 1165-1170.
Census.gov
(2006). China.
Retrieved February 19, 2006 from
www.census.gov/ipc/www/idbpyr.html
Deployment Link. (n.d.). Retrieved February 12,
2006, from
http://deploymentlink.osd.mil/deploy/info/east_asia/index.shtml
EM-DAT
(2006). China.
Retrieved February 19, 2006 from http://www.em-dat.net
Energy Information Agency. (2005). China country analysis brief.
Retrieved on February 10,
2006,
from http://www.eia.doe.gov/emeu/cabs/china.html
Library of
Congress (2006). China.
Retrieved February 19, 2006 from
http://lcweb2.loc.gov/frd/cs/cntoc.html
Nation Master (n.d.). Retrieved February 10, 2006,
from
http://www.nationmaster.com/country/ch
OECD (2006).
China.
Retrieved February 19, 2006 from
http://www.oecd.org/countrieslist/0,3025,en_33873108_33844430_1_1_1_1_1,00.html
The CIA
World Factbook (2006). China.
Retrieved February 19, 2006 from
http://www.odci.gov/cia/publications/factbook/geos/ch.html
The Water
Treatment Resource
Center. (2006). China's
water crisis blamed on waste and
pollution. Retrieved on February 12, 2006, from http://www.clo2.com/index.html
Wikipedia
(2006). China.
Retrieved February 19, 2006 from
http://en.wikipedia.org/wiki/Main_Page
World Health Organization. (2006). Avian
influenza-fact sheet. Retrieved February 12, 2006,
from http://www.who.int/mediacentre/factsheets/avian_influenza/en/index.html#countries
U.S. Department
of State (2006). China.
Retrieved February 19, 2006 from
http://www.state.gov/r/pa/ei/bgn/18902.htm