Urban-rural divide hampers China’s efforts to cut smoking | Porcelain

The tyranny of distance and the enormous social division in Porcelain they are seriously hampering attempts to control an “epidemic” of diseases such as lung cancer, despite billions being spent on health care, experts warn.

Health and social outcomes vary widely between urban and rural areas, between rich and poor, causing so much alarm in Beijing that President Xi Jinping has made increasing “common prosperity” the watchword of his bid to govern for a unprecedented third term.

Xi Chen, an associate professor of health economics and politics at Yale, says the health system favors for-profit hospitals over local family doctors, and a biased private health insurance system penalizes who live in the regions, trapping many families in poverty.

“Medical care is a major burden,” says Xi Chen. “A third of people face catastrophic health expenditure in their lifetime, defined as spending more than 10% of their income on health care. Insurance typically only covers 66% of costs. So people have a big problem.

“There is a huge disparity. If you are in an urban area, insurance will cover much of the cost. People in rural areas, much less. Because insurance policies are skewed toward paying for hospital care, doctors tend to sign patients up for hospital care when it might not be needed, adding to the burden on the system.”

This approach leads to society with a huge health care bill that fuels the growing social gap. China has massively expanded its hospitalsbut more than half are private, meaning doctors are often paid according to profit, so they are more interested in promoting treatment-based care than a preventative approach or of early intervention.

The focus on hospitals rather than local GPs means that people with developing health problems are not seen early enough and then end up showing up in hospital when their illnesses are much worse, incurring more costs and fueling the inequalities.

Decades for the smoke to clear

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

Mark Parascandola, an epidemiologist at the US National Cancer Institute, says China is experiencing “an epidemic of lung cancer on an unprecedented scale,” and the government in Beijing is well aware of the health dangers it poses. . Smoking-related diseases already account for at least 1.4 million Chinese lives each year.

The government has begun to make a concerted effort to encourage people to kick the habit by banning smoking in many public areas of large cities and in workplaces and on public transport. Their Healthy China Action PlanLaunched in 2019, it outlined a comprehensive list of such regulatory measures and promoted better education about the dangers.

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

Similarly, workplace bans have been unpopular in smaller cities, underscoring the growing social divide between China’s most advanced urbanized areas and its vast rural population of 600 million people. According to the latest global survey on adult smoking51% of Chinese adults were exposed to passive smoking at work and 45% had the same problem at home.

Professor Bernard Stewart, an expert on cancer causes at the University of New South Wales in Sydney, says the message about the danger of cancer may not have penetrated all of China.

Cancer is the most feared disease [in the west]. But I don’t know if that’s true in China,” she says. “The link between cancer and smoking is definitely established there and is perhaps known to all middle-class Chinese. But it may not have the impact it has here.”

Regardless of the strategy China uses, the health impacts of its high smoking rates will play out over decades.

“The health consequences of smoking can play out for a long time,” says Parascandola. “Even if they do manage to reduce smoking, the high prevalence means that millions of people are at high risk of outcomes such as lung cancer.

“Look at the US, the UK, Australia… smoking prevalence went down in the ’70s and ’80s. But we don’t see the impact until much more recently in terms of lung cancer death reduction. Even with the measures in place in China, it will be some time before we see an impact on lung cancer deaths.”

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