Division between urban and rural areas hinders China’s efforts to reduce smoking | China

TExperts have warned that the tyranny of distance and widening social division in China is seriously hampering attempts to control an “epidemic” of diseases such as lung cancer, despite billions being spent on healthcare.

Health and social outcomes differ greatly between urban and rural areas, and between rich and poor, causing such concern in Beijing that President Xi Jinping has made raising “common prosperity” a slogan for his attempt to rule for an unprecedented third term.

Shi Chen, associate professor of health policy and economics at Yale University, says the health care system favors profit-driven hospitals rather than local family doctors, and the skewed private health insurance system punishes those who live in the districts, trapping many families. in poverty.

“Health care is a huge burden,” Xi Chen says. One-third of people experience high health care expenditures in their lifetime, which is defined as spending more than 10% of their income on health care. Insurance usually covers only 66% of the costs. Then people face a big problem.

There is a big difference. If you are in an urban area, insurance will cover much of the cost. Rural people, much less. Because insurance policies tend toward paying for inpatient care, physicians tend to enroll patients for hospital care when it is not necessary, which increases the burden on the system.”

This approach is forcing society into a huge healthcare bill that is feeding the growing social divide. China has greatly expanded its hospitals, but more than half of its hospitals are private, which means doctors are often paid according to profits, so they are more interested in promoting treatment-based care than a preventative or early intervention approach.

Focusing on hospitals rather than local family doctors means that people with advanced health problems are not seen early enough and then end up in hospital when their illnesses are much worse, incurring more costs and increasing inequality.

Decades to remove smoke

No case illustrates China’s double-edged sword of rising disease levels and inequality better than smoking-related diseases such as lung cancer, stroke, emphysema, and other respiratory problems.

China is experiencing a “lung cancer epidemic of an unprecedented scale,” says Mark Parascandula, an epidemiologist at the US National Cancer Institute, and the government in Beijing is acutely aware of the health risks it poses. Smoking-related diseases already cause at least 1.4 million Chinese deaths each year.

The government has begun a concerted effort to encourage people to kick the habit by banning smoking in many public areas in major cities, in workplaces, and on public transportation. The Action Plan for Healthy China, launched in 2019, outlined a comprehensive list of such regulatory actions as well as promoting better education about risks.

However, regional disparities, differences between large and small cities and different attitudes mean that the impact on smoking is still incomplete. Smoking is prohibited on the country’s prestigious high-speed train services, but the custom is still allowed on many non-high-speed trains and other public transportation. It is also banned in restaurants and bars, although many small towns may have exceptions, but are not yet banned in government facilities.

Likewise, workplace bans are unpopular in small towns, underscoring the growing social gap between China’s more advanced urban areas and their storied rural population of 600 million. According to the latest Global Adult Tobacco Survey, 51% of Chinese adults have been exposed to secondhand smoke at work and 45% have the same problem at home.

Professor Bernard Stewart, an expert in the causes of cancer at the University of New South Wales in Sydney, says the message about cancer risk may not have spread across China.

Cancer is the most terrifying disease [in the west]. But I don’t know if this is true in China. The link between cancer and smoking has certainly been proven there and is probably well known to all middle-class Chinese. But it may not have its effect here.”

No matter what strategy China uses, the health effects of high smoking rates will be felt over the decades.

“The health consequences of smoking tobacco can develop over a long period,” Parascandola says. Even if they succeed in reducing smoking, the high prevalence means that millions of people are at high risk of outcomes such as lung cancer.

“Look at the US, UK and Australia… Smoking prevalence declined in the 1970s and 1980s. But we are only seeing the effect in terms of reducing lung cancer deaths. Even with measures in place in China, it will take time before we see an impact on mortality. Lung Cancer “.

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