China seems to be far behind with SDG — with the possibility of achieving 12 out of the 28 health-related SDG targets.
Achieving the Sustainable Development Goals (SDG) 2030 seems to be a challenge for China, as we begin the decade of action. Despite its success in achieving the Millennium Development Goals (MDGs), China seems to be far behind with SDG, with the possibility of achieving 12 out of the 28 health-related SDG targets. Among the 193 countries on the SDG Index, China is currently at the 48th position with an overall score of 73.9. The overall score measures a country’s overall progress towards achieving all 17 SDGs. SDG trends, as indicated in figure 1, shows moderate progress for SDG 3 on ‘Good Health and Well-Being.’
Figure 1: SDG Trends in China
The five key challenges faced by China in achieving the 2030 health SDGs are hepatitis, tuberculosis, non-communicable diseases (NCDs), out of pocket spending, and aging.
Figure 2: Proportion of Mortality Due to NCDs and Other Causes in China
Currently, NCDs are China’s biggest health threat accounting for 89 percent (Figure 2) of its 9.98 million annual deaths. The main NCDs in China are cardiovascular diseases (43 percent), cancers (23 percent), chronic respiratory diseases (9 percent), and diabetes mellitus (2 percent). A study on mortality trends among Chinese residents from 2004 to 2016 indicates severe gaps and the chronic non-communicable diseases continue to be a serious health threat.
A World Bank report estimates a triple rise in NCD cases in Chinese population above 40 years by 2030; a doubling of diabetes cases and a five-fold increase in lung cancer. Morbidity and mortality attributable to NCDs are expected to rise by about 50 and 80 percent respectively, by 2030. Studies have found that the consumption of healthy diet and increased physical activity can help in reducing the prevalence of NCDs, which is driven by economic growth, urbanisation, and consumption of westernised diet.
While China has seen significant reduction in malnutrition over last two decades with improved food supply, changes in dietary pattern and unhealthy behaviour have led to rise in NCDs among low-income households. Excessive salt consumption is one of the risk factors for rise of NCDs in China, at 10.5 g per day per person—the highest in the world. On the other hand, tobacco smoking and alcohol consumption have been seen as behavioral risk factors of NCDs in Chinese adults. As the largest producer and consumer of tobacco in the world, China accounts consists of about 316 million smokers, one-third of the total worldwide. About 26.6 percent adults in China are smokers, with vast disparity in men (50.5 percent) and women (2.1 percent) smokers.
Other overlapping risk factors for NCDs include prevalence of hypertension, high blood glucose, overweight/obesity, and high blood cholesterol, that are related to dietary intake. As per China Hypertension Survey, the prevalence of hypertension is 23.2 percent. Diabetes is on the rise, as of 2019, China has the largest number of adult diabetics at 116.4 million, estimated to rise to 140.5 million and 147.2 million by 2030 and 2045, respectively. The overall prevalence of diabetes at 10.9 percent has a health cost of USD 109 billion to the Chinese economy. Overweight and obesity — BMI over 25 is overweight, above 30 is obese — has significantly increased, with more than 50 percent adults being overweight, out of which 16.4 percent are obese. Increased consumption of meat, lower intake of fruits, and less physical activity were some of the factors responsible for the stark rise in overweight. Evidence suggests that low education levels, low-income quintile, alcohol consumption, and smoking are strongly correlated with higher overweight and obesity prevalence, and are detrimental to rise in chronic diseases.
There is rising inequality in income and health in China. As indicative by higher prevalence of hypertension and diabetes among the rich and increased risk in urban households. According to the Global Burden of Disease estimates ‘China’s rapidly ageing population is expected to increase the burden of NCDs by at least 40 percent by 2030.’ The economic impact of NCDs for China is estimated at US$ 27.84 trillion for the period 2012-30 — 4.5 times higher than India (US$ 6.2 trillion) due to its higher income and aging population.
Though the COVID-19 outbreak in 2020 has raised alarms especially for the elderly and people with pre-existing non-communicable diseases, for being at a higher risk of being immunocompromised, the pandemic has put further strain on the country’s healthcare systems, further affecting health service delivery for its people.
The world was already ‘off-track’ to meet the target of healthcare for all by 2030, the COVID-19 pandemic has further set us back. While the crisis presents an enormous challenge for China, but there is also an opportunity to utilise policy interventions and public health programmes to turn the tide on NCDs for reaching 2030 SDGs.
The Healthy China Action (2019-2030) blueprint and action plan aims at decreasing the health effects of second-hand smoking, reducing obesity, increasing overall physical activity, and preventing chronic diseases. More needs to be done to strengthen NCD prevention by addressing the key risk factors and challenges in achieving the health related SDGs. There is a need for concerted efforts, along with a robust monitoring system to track the rise in NCDs. The current challenges call for policy interventions to address inequities to ensure healthcare for all along with strengthened implementation of programmes for promotion of healthy eating and physical activity.
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Dr. Shoba Suri is a Senior Fellow with ORFs Health Initiative. Shoba is a nutritionist with experience in community and clinical research. She has worked on nutrition, ...Read More +