Issue
Chinese people generally are living longer, healthier lives; average life expectancy has risen to 71 years. But national averages mask regional disparities, with higher mortality rates prevalent in poor rural regions, especially Western China. From 1990 to 2000, for example, the infant mortality rate fell from 65 to 31 per, and under-five mortality dropped from 61 to 40 per 1,000 live births. Mortality rates for infants and children under five were 30 per 1,000 live births and 35 per 1,000 live births respectively in 2001. Yet despite this impressive drop, marked differences still exist between health indicators in the cities and those in the countryside. Under-five mortality is just 16.3 in cities, for example, but more than 40 per 1,000 live births in rural areas. China is facing a double challenge. The first might be categorized as “unfinished business”—the need to reduce disparities in health status between China's relatively affluent urban population and people living in remote rural areas, particularly ethnic minorities. This challenge must be overcame to ensure the right of every Chinese child to survival, protection and development. It is also necessary if China is to reach the Millennium Development Goals (MDGs) by 2015. The second challenge is the need to address emerging issues related to lifestyle, such as HIV and non-communicable diseases. These issues encompass child injuries and traffic accidents, tobacco and substance abuse, and overnutrition. Unfinished Business: Disparities in Meeting the MDGs To address the first challenge and wrap up its “unfinished business,” China must decrease the burden of communicable diseases and mother-and-child health problems affecting poor and remote populations and ethnic minorities. Overall, infectious diseases still account for most diseases in children, particularly in poorer regions. Neonatal morbidity represents an increasing share of child mortality and is the leading cause of child disability. Neonatal mortality now represents more than 60 percent of child mortality overall, and progress on reducing this figure has stalled over the last couple of years. The main causes are poor access to, or poor quality of, obstetrical or neonatal care. Cerebral palsy and other disabilities linked to poor neonatal care represent a staggering 25 percent of all child disabilities. In the last decade, China's maternal mortality ratio (MMR) has dropped from 89 to 53 deaths per 100,000 live births, while hospital delivery rates have increased from 45 percent in 1990 to 73 percent in 2000. Again, however, the national figures conceal a great disparity between the Eastern and Western provinces and between urban and rural areas. In 2000, the MMR in Shanghai was 9.6 per 100,000 live births, while in Tibet and Xinjiang it was 466 and 161 respectively. Maternal haemorrhage and sepsis, both potentially preventable, account for the majority of maternal deaths. Maternal death rates are highest in those with least access to antenatal and intrapartum care: women living in the Western provinces, the poor, and migrant workers. These rates are closely correlated with neonatal mortality and disability. Emerging Issues The second main challenge facing China is the need to address the emerging pattern of non-communicable diseases linked with lifestyle and environmental pollution, while at the same time addressing emerging issues related to economic shifts, changing behaviors, and urbanization. Tackling this challenge will require a different strategy than the unfinished business described above. While reducing disparities in child and maternal mortality will require improving access to and quality of an essential package of care, and improving household preventive and caring practices, addressing these newly emerging behavioral challenges will require interventions focusing on the promotion of healthy lifestyles, social policy, and safe environments. In other words, China must go beyond the improvement of equitable access, toward better health promotion and improved legislation.
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