The Heavy Burden of Chronic Disease
In 2010, chronic disease accounted for 85% of all deaths in China; 45% of chronic-disease deaths occurred before age 70; and chronic disease caused 70% of the total disease burden.
It is estimated that in 2010 China had over 200 million people with hypertension, 120 million with obesity, 97 million with diabetes, and 33 million with high cholesterol—over 65% of them among the working-age population aged 18–59. These conditions are characterized by large patient numbers, high medical costs, long duration, and great service demand. 47% of Chinese men smoke; 80% of Chinese households exceed recommended per-capita salt and cooking-oil intake; 50% of residents eat insufficient fruit and vegetables; and only 11.9% of adults over 18 exercise regularly—making the burden of chronic disease and death over the next 20–30 years still more severe.
China's chronic-disease burden is rising rapidly. From 2004–2005, the crude mortality from malignant tumors was up 83.13% compared with 1973–1975 and up 25.51% compared with 1990–1992. Tumor incidence is rising fast, and cancer is projected to become China's leading cause of death by 2030. The United States, by contrast, having launched a national cancer-prevention movement, saw its malignant-tumor incidence and mortality fall by about 20% from the 1991 peak by 2009. (Source: Li Liming et al., Epidemiology, 3rd ed., vol. 3.)
The World Health Organization defines chronic diseases as "those of long duration and generally slow progression"; the US CDC defines them as "long-lasting conditions that usually are not cured and rarely resolve on their own." By these definitions, malignant tumors, diabetes, cardiovascular and cerebrovascular disease, obesity, hypertension, and mental disorders are all chronic diseases. In China all are rising rapidly, especially malignant tumors and mental disorders. Mental disorders already account for a quarter of the total economic burden of disease; among the ten diseases imposing the greatest social burden, four are mental disorders. (Source: Fan Jianxiong, Geng Diqin et al., Psychiatry, 2nd ed.)
Chronic disease is becoming the greatest burden dragging down Chinese society and families; many households are crippled or semi-crippled by it. Poor families in particular, once a member develops a chronic disease, find their finances stretched thin. China's doctor-patient disputes also most often arise from chronic illness.
Most chronic diseases are preventable, because they are closely tied to lifestyle, diet, education, and poor environment. Preventing chronic disease costs far less than treating it and improves health far more.
Yet compared with the medical institutions that treat disease, the public-health institutions central to prevention receive far too little attention. China's hospitals have expanded rapidly in number and beds, but investment in disease prevention and control has not kept pace.
Those doing health-education work also earn far less than clinicians. Government spending on preventive care as a share of GDP is very low; residents' awareness of prevention is weak; even early cancer screening remains at an early stage. When private capital enters the big-health industry, it is drawn to high-return clinical treatment, not to the thankless work of prevention.
Disease prevention sometimes also conflicts with government interests. In China, many tobacco companies are state-owned and important sources of local revenue. From a prevention standpoint we should restrict, even suppress, the tobacco industry, but that directly touches government interests; we have yet to see the resolve for such a painful cut.
No country has been generous in preventive investment; the COVID-19 outbreak is the result of the world's neglect of preventive medicine. Public-health professionals are generally underpaid, and governments keep cutting public-health budgets. Before COVID-19, the US government was already cutting CDC positions to ease the burden on the state.
As living standards improve, lifestyles change. Meat makes up a growing share of human food, fruit and vegetables a shrinking share; technological progress reduces the need for heavy physical labor. So a series of chronic diseases linked to obesity and high cholesterol are rising worldwide.
Technological and civilizational progress has not improved human mental health; it has raised the incidence of mental disorders. China's mental-disease prevalence reaches 17.5%, and depression and anxiety are becoming very common. Yet China is not the highest-prevalence country; some developed nations have higher rates of both mental illness and cancer than developing ones.
Over 2,000 years ago, the Buddha listed "illness" among the Eight Sufferings of life (birth, old age, illness, death, separation from the loved, union with the hated, not getting what one wants, and the flourishing of the five aggregates). From modern psychiatry's view, four of these—separation, union with the hated, unfulfilled desire, and the flourishing aggregates—are largely sufferings caused by mental disorders. Currently only about 10% of mental illnesses have a clearly identifiable cause; 90% remain of unclear etiology.
Humanity has reached an age where health must be the first priority. Disease prevention should begin in childhood, because many diseases grow from lifestyle habits. Obesity, diabetes, hypertension, high cholesterol, and some cancers are linked to diet and exercise habits, which, once set in early childhood, are lifelong. Many mental illnesses are also tied to the childhood environment and upbringing.
We must awaken nationwide health awareness to lower chronic-disease prevalence and ease the economic burden on society and families. The efforts of dedicated people matter, but more important is greater societal investment in prevention.