When it comes to health, for China the numbers are staggering

by Michael Woodhead
In western countries hardly a week goes by without some disease condition being put in the spotlight in a press release saying "Condition X affects Y million people a year and costs Z million dollars". 
If industry has a stake in the matter then this is usually followed by a statement saying that the Condition X is underdiagnosed and undertreated and if only we used Drug A or Test B then we would avoid prevent much suffering and save the health budget in the the long run.
This sort of thing is now happening with health conditions in China, except the numbers are bigger by a factor of ten or even a hundred. Take osteoporosis, for example. An analysis published this week shows that there are about 2.3 million osteoporotic fractures a year in China, costing $10 billion in health costs. And if you think that's bad, wait until you see their projection for 2050 - the researchers estimate that with the ageing population there will be 6 million fractures a year costing $25 billion. And as predicted, the report's authors say that "screening and intervention policies must urgently be identified in an attempt to minimize the impact of fractures on the health of the burgeoning population as well as the healthcare budget."

A similar dire warning was made this week for hypertension and diabetes in China. An article in the Journal of the American College of Cardiology said that China was facing a cardiovascular disease epidemic as three out of four Chinese people are in poor cardiovascular shape due unhealthy eating, smoking and obesity. On a similar note, a study from Shenyang showed that 50% of older adults had hypertension and poor cholesterol levels. And a report in The Lancet this week shows that China has 300 million smokers and that tobacco causes 1 million premature deaths a year. The numbers are so big they are incomprehensible. And yet at least the Lancet offers a workable solution: cigarette taxes. It says that if cigarette taxes were raised by 50% this would result in 231 million years of life gained over 50 years and also produce an additional US$703 billion in extra tax revenues from the excise tax. The overall effect would be to relieve financial burden on the poor by avoiding diseases such as lung cancer and the consequent medical bills and time off work. But does Xi Jinping have the gumption to increase cigarette taxes?

For yet another set of mind boggling numbers turn to the example of cervical cancer. With no Pap test screening program, tens of thousands of Chinese women develop this disease and die of it each year, even though it is preventable. Western countries have long had screening programs and are now tackling cervical cancer with the HPV vaccine for young women. Some health economists have crunched the numbers for China and estimated that a national vaccination program of HPV vaccine for 9-15 year old girls, between 2006 and 2012 would have prevented 381,000 cervical cancer cases and 212,000 related deaths. They say that a HPV vaccination program could be implemented in China at a cost of about $50 per girl for the whole set of vaccinations and program costs. In total this would cost China about $160 million, but would ultimately prevent hundreds of thousands of deaths from cervical cancer - and also be cost effective.

A final example: stomach cancer. This causes  hundreds of thousands of deaths in China every year. And yet researchers have found that regular use of low dose aspirin could reduce the risk of stomach cancer (and other common cancers such as colorectal cancer) by as much as 40%. In other words, if Chinese people took a regular dose of aspirin they could avoid many fatal cancers, not to mention the protective cardiovascular benefits against stroke and heart attack. Whether these would be outweihed by increased bleeding risk remains to be seen.

I think what I am trying to say here is that when it comes to ill health in China, the numbers are often too large to be imagined. But that also means that measures that produce only modest reductions in rates of disease can also have major impacts on the absolute numbers of illness.

And while talking of high rates, let's return to my favourite bugbear about healthcare in China - the infusion. I have been guilty in the past of blaming backward thinking among the Chinese masses for insisting on having an infusion for every ailment. I hope I haven't hurt the feelings of the Chinese people and perhaps I owe them an apology. A study from a bog standard Hubei hospital shows that a staggering 96% of antibiotics used in the hospital wee given parenterally (ie by injection or infusion rather than orally). The authors of the report contrast this with the rates of about 30% of IV antibiotic use seen in European hospitals.

However, they blame the profit motive among hospital managers for the widespread use of antibiotic infusions - noting that hospitals depend on drug sales for a major part of their income. Therefore it will be interesting to see what happens when the Chinese government tries to eliminate this source of income for hospital by introducing cost price pharmaceutical billing this year (ie not charging a markup).  How will hospitals  fund their services? The government only covers about 20% of their running costs. There are already predictions that costs will be shifted to medical procedures - and trigger even more overservicing.

At least there is some discussion taking place of these kinds of problems and some in the government are acknowledging that there is still a long way to go in health reform. This week a very frank and bleak account of the ills of rural Chinese health system was published. Doctors and hospital managers said quite bluntly that the rural healthcare system in China is being hollowed out - older doctors are retiring, and nobody is taking their place. Young doctors do not want to work in rural hospitals, partly because the ban on commissions from pharmaceuticals means they can make only a tiny income. And patients do not want to be treated in them. And so the county and township hospitals are becoming ghost hospitals - deserted compared to the overcrowded city hospitals, where rural Chinese flock when they have a serious health problem.

Fact of the week: Chinese primary care (community health centre) doctors earn only 3000-4000 yuan a month. Primary care doctors account for only 4% of doctors in China.

Why China's new anti-smoking campaign will fail

by Michael Woodhead
The Chinese government has recently announced sweeping measures to ban smoking in public areas of government facilities such as offices, schools and sports grounds. Government officials have also been ordered to take the lead in promoting smoking bans. This is a welcome and long overdue move, but without enforcement it won't work. In the past China has enacted many laws and regulations against smoking but they have not been enforced. People smoke with impunity in 'no smoking' areas because there are no inspectors to enforce the rules. There is very little publicity given to the dangers of smoking and the health benefits of quitting - and very little promotion of smoking cessation. China has also lacked smoking cessation services to cater for those who do want to quit.
Tobacco control experts from China and Hong Kong have said that the new measures will require a huge workforce of anti-smoking inspectors to enforce compliance. Take Hong Kong as an example. The city has 650,000 smokers and has needed 100 full-time enforcement officers issuing 8000 fine tickets a year to adequately enforce its 2007 anti-smoking legislation. Based on these figures, with a population of 300,000,000 smokers, China will need 46,000 full-time enforcement officers and about 4 million penalty tickets issued annually to enforce smoking bans. Writing in the American Journal of Epidemiology, Dr Lam Tai Hing and Dr Yao He say China will also need to put funds into publicity and enforcement of anti-smoking campaigns. At present, the ratio of Chinese government expenditure on tobacco control to annual tax revenue is 20 million Yuan to 424 billion Yuan, or 0.005%, which is one of the lowest in the world.
Until more funding and enforcement of anti-smoking measures are implemented, China's smoking cessation clinics will continue to be empty.

Eight medical stories from China you should read

by Michael Woodhead

1. Beijing will start to enforce new anti-smoking laws with 200 yuan on-the-spot fines (up from 10 yuan) for people who smoke in public indoor shared areas, and institutional fines of 30,000 yuan (up from 5000 yuan). Cameras will be used to compensate for the lack of enforcement officers, especially after hours, the city government says.

2. The Chinese government has been accused of withholding medical care from dissidents. An article by Sophie Richardson in the WSJ says civil rights campaigner Cao Shunli is now in intensive care because she was denied access to medical care while detained for her efforts to promote a civil society.

3. A link has been found between damp housing in Shanghai and rates of asthma in children. Researchers from the University of Shanghai for Science and Technology say asthma symptoms could be reduced by 25% by simply keeping a child's window open at night.

4. A vaccine against enterovirus 71 developed by Sinovac Biotech has proved effective against EV71-associated hand, foot, and mouth disease or herpangina in infants and young children, according to a study in 5000 children done by the Jiangsu Provincial Center for Disease Control and Prevention, published in the New England Journal of Medicine.

5. Eating shark fin is not only cruel and bad for the environment, it is also a health hazard because of high mercury levels in the product, researchers from Zhejiang have shown. After testing samples of shark fin they found that up to 33% contained toxic levels of mercury.

6. Antibiotics are widely overused by parents in rural China, with more than 60% dosing their children with antibiotics bought over the counter, Shanghai researchers have found. Most parents were ignorant about how antibiotics worked and had little idea hat they do not help viral infections.

7. Migrant workers have little access to healthcare and many of them put off seeing a doctor for illness, a survey in Shanghai has found. Two thirds of migrant workers said they had never had a medical check up and nearly 40% said they had ignored symptoms because they couldn't get to see a doctor.

8. Health workers in Guangdong have completed a successful pilot trial of a cervical cancer screening program using the ThinPrep cytological system. The program offered Pap test cancer screening to more than 40,000 women, and found that improvements are needed in basic education regarding cervical cancer screening for young and poorly educated women.

My top10 medical stories from China for Saturday 22 February

1. Smoking with a water pipe confers a 'profound' risk of chronic obstructive pulmonary disease (COPD) among people in south west China and also carries a high risk from passive smoking, researchers have shown.

2. Patients with pneumonia of unexplained origin should be promptly investigated for H7N9 risk factors such as exposure to poultry and they should also be given pre-emptive antiviral treatment such as Tamiflu, the Beijing health department has ordered.

3. About 85% of Chinese doctors experience burnout, with those who are younger, unmarried and working in emergcncy medicine having the highest risk of serious burnout, a study shows.

4. Fertility clinics in China need to become more patient-friendly as they are perceived as too impersonal and lacking in transparency and respect for patient informed consent, researchers say.

5. The stigma of mental illness in Chinese culture means that patients with schizophrenia often do not understand their medication and are unwilling to take any anti-psychotic medication, according to a study from the Guangzhou Psychiatric Hospital.

6. H. Pylori infection rates are over 90% among people in their thirties in Jiangsu, which may explain high rates of gastric cancer in the region, say researchers from Nanjing.

7. Babies in Shenyang have increased rates of neurodevelopmental deficits because their mothers were exposed to high levels of organophosphorous pesticides during pregnancy, according to a study in PLOS One.

8. Adenovirus has emerged as a significant cause of serious pneumonia in China, with a study showing that 5% of cases are attributable to the virus.

9.  People with tuberculosis are also at high risk of HIV, with rates of around 3% in groups tested in TB patients from Guangxi, Henan and Sichuan, say Chinese researchers.

10. A mediation service for patients involved in medical disputes with hospitals is to be launched in Shanghai and it will be open to patients where compensation claims exceed 30,000 yuan ($2900) regardless of whether the hospital refers them.

TCM fails for migraine | Quit advice ineffective | Rural migrants need HIV help

Chinese herbal medicines ineffective in migraine
Chinese herbal patent medicines are used by about 60% of people in China with migraines, but satisfaction rates with the effects are low, and western medicines prove much more effective, a study from Guangzhou has found. In a survey of 219 patients with migraine, researchers found that 58% had used Chinese patent medicines to treat acute attacks, but only 28% reported being satisfied with the results. About 35% reported being unsatisfied. In contrast, about 60% of patients were satisfied with the response they got from western medicines such as NSAIDs for migraine.  The most commonly used Chinese herbal medicines were ones containing L. wallichii, Dahurian angelica root, and G. elata. Interestingly, few Chinese migraine patients used the triptans, which are recognised internationally as being the most effective treatments for migraine, according to the article in Pain Medicine.
 
Quit advice not working
 Smoking cessation counselling is effective for Chinese smokers who have developed COPD but has little influence on asymptomatic smokers, research from Changsha has found. After receiving smoking cessation counselling, smoking abstinence rates at six months were 40% for people with COPD but only 10% for asymptomatic smokers, according to a research group from the Department of Respiratory Disease at the Second Xiangya Hospital, Central South University, Changsha.

Rural migrants missed in HIV prevention
HIV is likely to spread in China via migrant labourers and housemaids, who have low levels of knowledege about the disease and high rates of unsafe sex, researchers from Fudan University in Shanghai have warned. In a survey of 2700 rural migrants they found that more than 40% were ignorant of the facts and risks of HIV, and  6.2% had engaged in high-risk sex in the past 12 months. Only 3% of migrant workers had access to free HIV screening. Writing in BMC Public Health he researchers said migrants must be targeted with tailored educational programs pitched at a level they can understand. Rural migrants should  also be given free condoms and given access to HIV testing and antiretroviral treatment, they urged.

Vaccine for H7N9 | No smoking in medical centres | Cosmetic surgery boom among young Chinese

Vaccine developed for H7N9
Shanghai researchers say they have developed a "gene vaccine" for the H7N9 avian flu virus for humans that has succeeded in primary animal tests, according to Shanghai Daily. The claim was made by officials at an infection disease research body under the Shanghai Public Health Clinical Center

Now influenza H6 is a threat to humans
Yet another kind of avian influenza virus has been found to pose a threat to human health in China - this time it is H6. Researchers from Lanzhou tested samples from live poultry markets in southern China from 2008–2011 and found that among the 257 H6 strains tested, 87 viruses couldbind to human receptors. They found that there were 30 different H6 genotypes, showing that these viruses are actively circulating and reassorting in nature. "Our study demonstrates that the H6 avian influenza viruses pose a clear threat to human health and emphasizes the need for the continued surveillance and evaluation of the H6 influenza viruses circulating in nature," they concluded in the Journal of Virology.

Subway station radiation not a health threat
Operators of subway stations in cities such as Beijing and Chengdu say the radiation from security scanners poses no threat to human health. The doses from a typical security scan are equal to around 0.007 mSv per year if a person is scanned daily. This is lower than the safety standard of 1 mSv per person a year. Most X-rays are contained within the machines by protective curtains that block X-rays from escaping," and environmental expert told the Beijing Daily.

No smoking rule for medical centres
Doctors have been advised to deliver stronger anti-smoking messages to their patients ,according to ECNS. According to the report, doctors have been told by the National Health and Family Planning Commission to inquire and record the smoking history of patients during their initial diagnosis to help smokers quit. The NHFPC also says that there should be no smoking in medical establishment and medical workers are also asked not to put ashtrays in their offices. The NHFPC also recommends that smoking clinics be set up.


Cosmetic surgery rates highest in young people
Cosmetic surgery and other cosmetic procedures such as ear piercing have become very popular with young people during the holiday period, according to Xinhua. Many stalls in a Shenyang market offered ear, lip, tongue, nose and belly button piercing over the New Year holiday. The operators claimed to be trained nurses but failed to produce any medical license.  A cosmetic surgeon said that there had been a rise in young people undergoing minor surgeries too, with children as young as eight or nine getting double-eyelid surgery to give them the appearance of larger or "Western" eyes.

China's medical news headlines for Sunday 19 January

Hepatitis B vaccine given the all clear

The Shenzhen Bio Kangtai hepatitis B vaccine that was linked to the deaths of 17 infants has now been given the all clear by the Chinese state drug authorities. After an investigation the China Food and Drug Administration and the National Health and Family Planning Commission said the vaccine could be used again as no problems have been found with the hepatitis B vaccine. Authorities tested more than 1300 vaccine samples from six batches that were under suspicion. According to the People's Daily, the CFDA said all samples met the quality standards. The NHFPC said the 17 infant deaths were due to other problems, including severe pneumonia, kidney failure and suffocation.

In Guizhou, retired doctors asked to work in rural clinics

Retired medical specialists in Guizhou are being urged to lend their expertise to rural area clinics, according to China Daily. Professor Sun Fa of Guiyang Medical University told a meeting of the Chinese People's Political Consultative Committee that there were about 600 retired doctors from the province's five top hospitals of whom half were healthy enough to work in rural clinics.
He said they could help the more than 40,000 medical staff in township clinics, many of whom have only medical qualifications from secondary colleges or no degree at all.

Guangdong plans for baby boom

The new two-child family planning policy will not pose a big challenge to public services such as medical care, a top health and family planning official from Guangdong province has said.
Zhang Feng, the former director of the Guangdong population and family planning commission, said 1.1 million to 1.2 million babies are  born in the province each year. and the new policy will see about 130,000 more babies each year. "The baby boom will bring little social impact," he said at the province's annual legislative meeting.

China's smoking ban is unrealistic, says NBC report

A report by Ed Flanagan of the American NBC News says that the recent anti-smoking measures announced by the Chinese government may be as unsuccessful as previous attempts. The article says China has 350 million smokers and the habit is deeply ingrained in society. Previous attempts to curb smoking resulted in "No Smoking' signs being put up but they were widely ignored, says Flanagan. He says the Chinese media have given no details of how the new policy will be enforced. The move also face resistance from the powerful tobacco industry in China, he adds.

 New Yorker profiles China's gene factory BGI in Shenzhen

The New Yorker has an in-depth profile of the gene factory B.G.I., (Beijing Genomics Institute), which is said to be the world’s largest genetic-research centre, located in Shenzhen. The report by Michael Specter says BGI has 178 machines to sequence DNA, and produces at least a quarter of the world’s genomic data. This could help provide new solutions to disease and other areas such as agriculture, he writes.

Medical news in China's media

HIV is one of several conditions newly listed as occupational diseases for police and  medical workers, meaning that those who develop the illness will be eligible for work-related injury insurance reimbursement. Other new conditions covered are leukasmus, blast exposure hearing damage, and ocular burns (such as to the cornea, lens of the eye or retina) caused by laser light and frostbite, according to Women of China.

The city of Lanzhou in Gansu has adopted tough new anti-smoking measures in public places. New legislation specifies "non-smoking" indoor areas, including medical institutions, schools, government office buildings, public dining places, and public transport carriers. Smokers, face fines from 50 to 200 yuan, according to the Peoples Daily.

Police in Henan broke up a fake medicine production ring that placed fake-drug ads on the radio and the internet and used bogus medical experts to talk with patients.According to CRI the fake drug operation had earned the fraudsters 300 million yuan

And in the China Daily, psychiatrists are reported to be looking at links between China's terrible smog problems and mental health. Clinicians say studies are needed on the negative impact of smoggy days on anxiety and depression due to lack of sunlight and production of the hormone melatonin.

29 Shanghai hospitals busted for allowing smoking

Twenty-nine local hospitals were blacklisted for failing to control smoking on the premises after undercover checks by authorities on some 400 medical facilities. But the hospitals said without any legal protection they can’t stop people from smoking.
Those blacklisted include three well-known maternity hospitals, one leading pediatric hospital and some big hospitals. The list was put up on the official microblog of local health authority and the city government yesterday.
The authorities faulted the hospitals for lack of no-smoking signs, especially on the stairs, elevators, corridors and restrooms, and a lack of staff to deal with people smoking on the premises.
Patients’ families were found smoking outside surgery rooms and some hospitals had staff smoking inside their offices. Designated smoking areas were also an area of concern.
Some hospitals had indoor smoking areas while others allowed people to smoke outdoors but  were too close to people.

Party officials ordered to lead by example in anti-smoking efforts

by Michael Woodhead
Deng Xiaoping was famous for chain smoking Panda brand cigarettes, but if he was still around he'd be disciplined and subject to "criticism from the masses" under new regulations that require all Party officials to set a good example in fighting the "evil influence" of tobacco.
A new directive from the Communist Party Central Committee Office and the State Council orders Party members and government officials ('ganbu') to take the lead in enforcing smoking bans in public areas, government buildings and also during government business. Officials are expected to act as model examples and to strictly uphold no smoking policies to maintain the image  and reputation of the Party, the edict states.
The directive orders pubic officials to take serious note of the importance attached by the leadership to the non-smoking policies for public areas. As well as setting an example by refraining from smoking themselves, officials are also expected to actively implement and monitor programmes to enforce the smoking bans.
The no-smoking policies apply to public areas in schools, colleges, sports facilities, and cultural venues, as well as transport facilities such as airports. Officials are ordered to ensure that No Smoking signs are displayed prominently and that bans are actively enforced. Government officials are also expected to ensure that no smoking policies are implemented in government buildings - including areas such as corridors, bathrooms, stairways, reception halls and canteens.
The directive also forbids officials from smoking while on government business and from offering or supplying cigarettes to others or encouraging others to smoke while on government business.
Officials "at all levels" who fail to observe the new rules will be subject to disciplinary action and undergo criticism, the directive says. Officials can also expect to be subject to the 'supervision of the masses and public opinion", it warns.

Smoking cessation drugs are not available in China

Clinics to help smokers kick the habit are facing medication shortages.
A combination of behavioral intervention and medication can significantly increase the chances of a person quitting cigarettes, health experts said.
"Many can quit through just intervention, such as consulting a doctor or calling a hotline," said Fu Dongbo, a specialist with the World Health Organization.
"But for those heavily dependant, medication is an option, including nicotine replacement therapy."
Not many opt for the latter, though, judging by the 2010 Global Adult Tobacco Survey of China.
Based on 13,354 interviews nationwide, the study found 36.4 percent had tried to stop smoking in the previous 12 months, but less than 9 percent of them had used assistance, such as medication.
Part of the reason could be that Chinese smokers do not fully understand cessation therapy, according to a report by the WHO Collaborating Center for Tobacco or Health, based at Beijing's Chaoyang Hospital.

Smoking cessation clinics in China are underused, face closure

Any smoker will tell you that kicking the habit is tough. Given the fact that medical journal The Lancet estimates China has over 300 million smokers, one would think that facilities designed to help them quit would be popular.

Despite the fact that lung cancer rates in China are soaring and the number of lung cancer patients could reach 1 million by 2025, the prospects of "smoking cessation" clinics around the country are looking dim.

"The clinic opens once a week and it is rarely visited. It would be counted as 'too many' if three smokers showed up. Sometimes I question whether we are wasting medical resources here," an anonymous doctor working with a smoking cessation clinic in Shanghai told the Global Times.

Despite the low traffic, Xiao Dan, a research fellow with the World Health Organization Collaborating Center for Tobacco and Health based in Beijing Chaoyang Hospital, said that utilization rates are increasing. The smoking cessation clinic affiliated with her hospital was first launched in 1996 and now sees roughly 1,000 patients a year, an increase over previous years.

But even if usage is slowly increasing, smoking cessation clinics across the country face the strong likelihood of being shut down. Zhongda Hospital in Nanjing, Jiangsu Province, is close to being shut down with only two or three smokers coming in every month over the past three years, according to the Nanjing-based Xinhua Daily. Four out of nine smoking cessation clinics in Kunming, Yunnan Province have already been shut down, the Kunming Daily reported.

Zhi Xiuyi, head of the Lung Cancer Treatment Center of Xuanwu Hospital in Beijing, said that a key problem facing these clinics is that few smokers willingly seek professional help. Many smokers reached by the Global Times said they were unaware of the clinics. They said that because smoking itself is not a disease, they would not visit a clinic for it and would rather deal with the habit on their own.

Doctors reached by the Global Times pointed out that most patients only agree to go to the clinics after they develop smoking-related health problems. "There is not enough publicity about us and many smokers are not aware that they are addicted to cigarettes. Some are ignorant of the hazards of smoking. Our patients usually come to us for a consult after noticing our logo at hospitals," said Xiao, adding that the government only offers limited support, which means that additional costs are a deterrent to patients, and that clinics do not have the necessary equipment.

"It can cost up to 3,000 yuan ($492) for a three-month course of treatment at a clinic. Since some medicines are not included in the health care system, these fees may have further hindered the clinics' development," Zhi said. He also argued that the system should at least cover the medical expenses of smoking cessation treatment for those suffering from cardiovascular or respiratory diseases, as smoking would worsen their health.

Yang Gonghuan, former deputy director of the Chinese Center for Disease Control and Prevention, said that 91.4 percent of Chinese smokers have not received any services on smoking cessation and the relapse rate is 30 percent, the People's Daily reported.

In 2012, Chen Zhu, former health minister, said that health care reform should promote reductions of tobacco use by including smoking cessation medicines into the system. The Beijing municipal government was mulling this plan in October, the Nandu Daily reported.

Source: Global Times

Chinese medical news from the journals

Almost one in three Staphylococcus aureus strains found in humans by Yangzhou researchers were methicillin-resistant S. aureus (MRSA), with most being hospital-acquired MRSA. The superbugs were also found in food and animal samples. Writing in the journal Foodborne Pathogens and Diseases, the researchers say infection with multidrug-resistant MRSA strains acquired from food, animal, and human sources might also become a significant problem for human medicine.

One in four Chinese people with epilepsy has poor adherence to their anti-epilepsy medication and 70% have only moderate compliance, a new study shows. The reasons for nonadherence included forgetfulness (54%), being seizure-free for a period (49%), and fear of adverse drug effects (28%).
Epilepsy and Behavior.

Rotovirus and norovirus are the two most common causative agents for diarrhoea and vomiting in Chinese infants, a study from southeastren China has found. Rotovirus tended to cause more prolonged, frequent and severe illness and the viruses were seasonal, the study published in Pediatrics Infectious Diseases journal showed.

Smoking is a major risk factor for nonalcoholic fatty liver disease, especially in obese people, a Shanghai study has found. People who smoked and had a high BMI had a nine-fold higher risk of nonalcoholic fatty liver disease, their study in the Journal of Epidemiology showed. Passive smoking was also associated with a  25% increased risk of the disease, say researchers from the Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine.

China has made progress in the prevention and control of major non-communicable diseases but there are still large action gaps in the fight against epidemic non-communicable diseases according to members of the Subcommittee of the Non-Communicable Diseases, the Expert Committee on Disease Control and Prevention established by China’s Ministry of Health.
Global Health Action.

Chinese people who have a more varied diet and especially a diet rich in fruit have a much reduced risk of bladder cancer, a study in Cancer Causes and Control shows

Type 2 diabetes is associated with the increased risk of  liver cancer within five years after diagnosis in Chinese population, researchers at the State Key Laboratory of Oncogene and Related Genes and the Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine have shown.  Writing in Annals of Oncology, they say the finding suggests that hyperinsulinaemia rather than hyperglycaemia is more likely to be a primary mediator for this association.

Smoking cessation efforts not easy when four out of ten doctors smoke

by Debra Bruno
Dr. Dan Xiao sits in a small office in a quiet corridor inside Beijing’s Chaoyang Hospital. As a doctor and medical researcher, her job is to convince 1.3 billion Chinese citizens that smoking is bad for their health. The room next to hers houses a national smoking-cessation hotline, a toll-free number that has been set up since 2004.
Over the course of an afternoon, the phone rings just once.
That might not be as troubling without another piece of information: China is home to somewhere between 300 and 350 million smokers. Cigarettes in China are cheap and plentiful, and many Chinese don’t even fully understand that smoking is likely to shorten their lifespans. There’s actually a popular myth that tobacco harms other nationalities, but not Chinese people, Xiao says. In 2009, the World Health Organization reported that only 37 percent of Chinese smokers knew that smoking caused heart disease.
There’s actually a popular myth that tobacco harms other nationalities, but not Chinese people.
Xiao’s battle is so steeply uphill that her first goal is to convince doctors that they should quit smoking. Up until only a few years ago, six out of ten Chinese doctors smoked. Today the rate is closer to 40 percent, a number that still brings to mind the U.S. of the 1940s and 1950s, when the majority of doctors smoked and cigarette companies used doctors in their advertisements.
Xiao’s second goal also has a quixotic feel: she wants to make all Chinese hospitals smoke-free. Chinese law required that all hospitals officially be smoke-free by the end of 2011, but that rule – like many in China concerning tobacco – has been laxly enforced. Xiao says that between 2008 and 2010, 40 hospitals in large cities have banned smoking inside their walls, compared to a total of more than 20,000 hospitals nationwide. "The local leading hospitals can set an example to other hospitals," she hopes.
China’s largest tobacco manufacturer is part of a perverse system that is both tobacco’s watchdog and guardian. The China National Tobacco Corp., which produces 2.3 trillion cigarettes a year, is a state-owned enterprise that is part of the State Tobacco Monopoly Administration, which in turn is part of the Ministry of Industry and Information Technology. A recent report from the U.S. National Institutes of Health noted that the China National Tobacco Corp. requires the local tobacco companies under its jurisdiction to produce a certain number of cheap cigarettes each year, and then subsidizes those companies to make up for lost profits. As a result, cigarettes in China cost as little as 5 RMB (80 cents) a pack.
A recent report from the Brookings Institution pointed to Chinese tobacco’s political connections: the brother of incoming executive vice premier Li Keqiang has been the deputy director of the State Tobacco Monopoly Administration since 2003.
Besides the tacit state support, there are demographic factors at work. Cigarettes are still a common gift, especially in business relationships, where most meetings end with a round of gift-giving. And women, who traditionally have not smoked in China, are picking up the habit far faster than men.
The result is a shocking rise in chronic obstructive pulmonary disease and lung cancer. Donald Sin of the University of British Columbia projects that by 2030, COPD will kill 3 million Chinese people a year. In November, the Beijing Health Bureau said that lung cancer had jumped 56 percent in the ten years from 2001 to 2010.
Of course, smoking is just part of what’s ruining the lungs of the Chinese: A study published by Peking University and Greenpeace in December pointed to as many as 8,572 premature deaths caused by air pollution in 2012, and that figure came from of survey of just four major Chinese cities.
One glimmer of hope appears with China’s new leadership. Peng Liyuan, the folk singer wife of new party secretary Xi Jingping, is reported to be an ambassador for the Chinese Association on Tobacco Control. But since China’s new first lady has been chiefly out of the public eye after her husband’s rise, it doesn’t appear likely she’ll take on any Michelle Obama-like projects to encourage healthier living.
Source: The Atlantic Cities

China study links dementia to passive smoking

A study by scientists in China has found a link between passive smoking and syndromes of dementia.
The study of nearly 6,000 people in five provinces in China reveals that people exposed to passive smoking have a significantly increased risk of severe dementia syndromes.
Passive smoking, also known as 'second-hand' smoke or environmental tobacco smoke (ETS), is known to cause serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. However, until now it has been uncertain whether ETS increases the risk of dementia, mainly due to lack of research. Previous studies have shown an association between ETS and cognitive impairment, but this is the first to find a significant link with dementia syndromes.
The study, published in Occupational and Environmental Medicine, is a collaboration between scientists at King's College London and Anhui Medical University, China, along with colleagues in the UK and USA.
According to the World Health Organization (WHO), nearly 80 percent of the more than one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest; but only 11 percent of the world's population are protected by comprehensive smoke-free laws.
China is the largest consumer of tobacco in the world, with 350 million smokers. Since 2006, the Chinese government has actively promoted the introduction of smoke-free environments in hospitals, schools, on public transport and in other public places, but implementation has not been widespread.
Recent data show that the prevalence of passive smoking is still high, with over 50 percent of people exposed to environmental tobacco smoke on a daily basis. China also has the highest number of dementia sufferers in the world, with increasing rates of new cases as the population ages.
Dr Ruoling Chen, senior lecturer in public health from King's College London, and colleagues interviewed 5,921 people aged over 60 in the rural and urban communities of Anhui, Guangdong, Heilongjiang, Shanghai and Shanxi to characterise their levels of ETS exposure, smoking habits and assess levels of dementia syndromes.
They found that 10 percent of the group had severe dementia syndromes. This was significantly related to exposure level and duration of passive smoking. The associations with severe syndromes were found in people who had never smoked and in former and current smokers.
The data from the Anhui cohort, which were collected at baseline in 2001-03 for dementia syndromes and in the follow up in 2007-08 for ETS exposure and dementia, further excluded the possibility that dementia syndromes caused people to be more exposed to environmental tobacco smoke.
Dr Ruoling Chen, also a visiting professor at Anhui Medical University said: 'Passive smoking should be considered an important risk factor for severe dementia syndromes, as this study in China shows. Avoiding exposure to ETS may reduce the risk of severe dementia syndromes.
'China, along with many other countries, now has a significantly ageing population, so dementia has a significant impact not only on the patients but on their families and carers. It's a huge burden on society.'
The findings from this study, together with a second recent study by Chen and colleagues published in Alzheimer's & Dementia on the links between passive smoking and Alzheimer's disease, strengthen the case for public health measures to protect people from exposure to environmental tobacco smoke.
'At present, we know that about 90 percent of the world's population live in countries without smoke-free public areas. More campaigns against tobacco exposure in the general population will help decrease the risk of severe dementia syndromes and reduce the dementia epidemic worldwide.'
He added: 'The increased risk of severe dementia syndromes in those exposed to passive smoking is similar to increased risk of coronary heart disease -- suggesting that urgent preventive measures should be taken, not just in China but many other countries.'
Source: Science Daily

National smoking control laws on NPC agenda

China's top legislature is considering the country's first national tobacco control law, according to a report released Wednesday.
It is "quite necessary" to enact laws to control the dangers of smoking, says the report adopted at last Friday's closing session of a bimonthly meeting of the National People's Congress (NPC) Standing Committee, adding that such laws should be included in future legislation work plans after proper preparation.
China is the world's largest tobacco-producing and -consuming country, with more than 300 million smokers and another 740 million people exposed to second-hand smoke, according to official statistics released in May.
However, only a few provinces and cities have enacted local legislation on public smoking bans, and no special law has been adopted at the national level.
During the NPC's plenary session in March, 90 NPC deputies submitted three bills on drafting a law on the prevention and control of tobacco hazards, according to the report from the Education, Science, Culture and Health Committee (ESCHC) of the NPC.
It also specifies that 139 deputies put forward another four bills calling for new laws on smoke-free public areas.
The ESCHC suggested that central administrative authorities in charge of related issues carefully study the bills and promptly carry out the research and investigation work necessary for drafting, it says.
China ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2003, pledging measures to curb tobacco use.
Read more: Shanghai Daily

The central government has pledged to introduce a public smoking ban in its 12th Five-year Plan (2011-2015) period.

Smoking makes CABG a waste of time - Shanghai study

Smoking cessation even a year prior to coronary artery bypass grafting (CABG) surgery does not fully normalize the changes smoking has made to the saphenous (leg) veins used for the surgery and may lead to later graft failure, according to a study published in The Annals of Thoracic Surgery.
Sun Yongxin, MD and colleagues from Zhongshan Hospital at Fudan University in Shanghai, China, analyzed heart surgery outcomes in 208 patients undergoing elective CABG surgery. After dividing the patients into six groups based on the current quantity smoked and previous smoking status, the researchers found that heavy smoking noticeably increased matrix metalloproteinase enzyme levels in the saphenous vein. These enzymes have been linked to vein graft failure.
The researchers also found that while dysregulation of enzymes may gradually normalize after smoking cessation, a noticeable vein recovery needs at least 6 months, and vein enzymes do not completely return to normal levels even after 1 year.
"Although recovery after smoking cessation appears somewhat disappointing, it illustrates exactly the importance of prompt smoking cessation for patients who will receive CABG," the researchers wrote.
Read more: News Medical

China launches national anti-smoking plan

Anti-smoking plan aims to cut China's smoking rate to 25% of population by 2015

China has published a plan to reduce the world’s largest population of smokers as part of a 2005 treaty, without implementing recommendations such as warning labels that include photos of rotten teeth and diseased lungs.
China plans to cut the number of smokers to 25 percent of the population by 2015 from 28.1 percent in 2010, according to the plan published by the Ministry of Industry and Information Technology yesterday, seven years after the country signed the treaty that recommends the graphic warning labels.
The government will “comprehensively” prohibit smoking in public places and ban ads, promotion and sponsorship by tobacco companies, according to the plan. There is no mention of tax rates in the plan.
China has more than 300 million smokers, including half the adult male population, and about 740 million people are exposed to second-hand smoke risks, the ministry said. The tobacco industry accounts for 20 million jobs and contributed 6 percent of fiscal revenues in 2010, the ministry said.
“The plan carries a heavy smell of cigarettes,” Wu Yiqun, a director at the Beijing-based ThinkTank Research Center for Health Development. “It’s a compromise result between the tobacco industry and the Health Ministry, and it seems the tobacco side has the upper hand.” The State Tobacco Monopoly Administration was involved in the plan’s preparation.
Wu, a former deputy director at the Chinese Center for Disease Control and Prevention, singled out the lack of graphic photos as a weakness. Australia, Canada and most European Union members have introduced such warnings or have agreed to do so, according to the World Health Organization website.
“It means China’s tobacco control efforts will be weak compared to mainstream international practices,” Wu said. The lack of any plan to increase taxes on tobacco is another weakness, she said.
The WHO recommended in March that China should almost triple excise taxes on tobacco products to 70 percent from 26 percent, to dissuade young people from taking up the habit. Half of the country’s smokers spend 5 yuan (80 cents) or less for a packet of 20 cigarettes, the WHO said.
Smoking, which is linked to 1 million deaths a year in China, is endangering the labor force, Health Minister Chen Zhu said in April.
Using cigarettes as gifts or gestures of friendship is still a popular practice in the country, and many poor regions rely on the industry to generate jobs and fiscal revenue, the industry ministry said.
Cigarette production and consumption in China both increased by 3 percent last year, according to data from Bloomberg Industries. China’s share of world cigarette consumption increased to 40 percent last year from 35 percent in 2006. Consumption in the rest of the world has declined steadily since 2000.
The brother of Chinese Vice Premier Li Keqiang should be removed from his post as a top official in China’s state-owned tobacco monopoly to avoid conflicts of interest, according to a report published by the Washington-based Brookings Institution in October. Li last month took the No.2 position in China’s new leadership and is now oversees public health.
China’s new tobacco plan was jointly prepared by the ministries of industry, health, finance and foreign affairs; and the general administrations of tobacco, customs, safety and industry and commerce.
Source: Bloomberg

Half of pregnant women affected by passive smoking

According to reports released by the World Health Organization in Beijing on November 6, Global Adult Tobacco Survey (referred to as "GATS") data show that more than half of women of childbearing age are often exposed to passive smoking. The GATS survey results from the WHO in China and the United States Center for Disease Control showed that more than 50% of Chinese women of childbearing age  often inhale secondhand smoke in the workplace. In the home, passive smoking is more serious, with nearly three-quarters of the rural women exposed to  smoking at home, while more than half of urban women are exposed to  smoking at home.The data also show that among 14 developing countries, China's 15-49year-old female passive smoking rate is highest. Lan Ruiming, WHO representative in China, said, "for women of childbearing age, passive smoking can harm reproductive health, such as the emergence of symptoms of pregnancy complications, premature fetus and infant death."

Read more: Southern Weekend

WHO calls on China to increase tax on cigarettes

A 1 yuan increase in the price of each pack of cigarettes could decrease the consumption of cigarettes in China by 3 billion packs a year, reduce the number of smokers in the country by 3.42 million and increase the government's annual revenue by 97.5 billion yuan to 129 billion yuan. That is billions of dollars of additional revenue that could be reinvested for the benefit of the people of China.
A tobacco tax increase that raises the retail price of cigarettes would be a "win-win" for China, not least for those millions of boys and young men whose lives will otherwise be lost because of this killer.
(Michael O'Leary  is WHO representative in China)

Read more: China Daily