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Asian Region
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Development of Chinse Rural Health Vice Minister of health, P.R.China China is a developing country with a big population in the world. Agriculture is the basis of the nation, and rural residents constitute the majority of the whole population. Both the ecomany and the culture background factors rural areas. 2 . Prevention and treatment of various &seases. The population in China is big, and there are also many diseases. Through efforts for 50 years, infectious and endemic diseases, which seriously endangered the health of people have been controlled, but are not stable. These diseases will break out again if their control is relaxed a bit. We are facing a second health revolution now. The statistical results of 1998 showed that the mortality of rural residents was 6.21 % among them, 4.34% died before they were five year old, 1.98% died between the ages of 5 and 19, 3 2.96% died between 20 and 64, and 60.72% died at the age of 65 or over. The first ten-rank order of death causes were: (1) diseases of respiratory system 142.061101, (2) cerebrovascular diseases, 1 1 3.051 101; (3) malignant tumors 105.57/101, (4) heart diseases, 80.071101, (5) trauma and poisoning 69.221101, (6) diseases of the digestive system 24.801101, (7) diseases of the urogenital system 9.201101, (8) pulmonary tuberculosis 8.521101, (9) diseases of newborn 1172.331101 and (10) infectious diseases (not including pulmonary tuberculosis), 6.4911 01. The first ten death causes accounted for 91.43% of the total death. 3. lhe demandfor service at multi-levels. The people's demand for medical and health service increased in proportion to the continual raise in the economic level. Chinese experts have analyzed the data of the two investigations into health service conducted in 1993 and 1998. The results showed that the income elastic coefficient of medi- cal services for urban and rural residents was 33% in cities and 17% in rural communities. The mean- ing of this index was that if the income of urban With a rapid increase in industrialization and urbanization during the second half of the 1950s residents was doubled, demand for medical services would increase by 113; if the income of rural residents is doubled, demand for medical services would increase by 116. At present, the consumption level of rural residents in China could be divided into three levels: the people whose expenditure was 3,000 Yuan and upwards accounted for 17.7%, 2,500 Yuan or so accounted for 24.3%, and 2,000 Yuan accounted for 58%. 4. Compensation through various channels shrunk. The fund of rural health was shared by the nation, collectives and individuals that participated in the cooperative medical services, and the formula was formed in the shared amount. After reform and opening, the former formula has been thrown into confusion and the new formula has not been established because of transformation of the economic system and social structure. Therefore, the problems in two aspects emerged. One was the serious deficit of some medical institutions at the county, township and village levels. Some insfitutions could hardly survive. The other was a sharp rise in the total expenses of social health. The average annual increase was 201/o and upwards, which was hardly born by the nation, enterprises and individuals. The indices of medical efficiency in many medical institutions at the county, township and village level showed signs of a decrease. This is a dilemma, which has to be gone through in the period of transformation of the economic system. The health of peasants in China still depends on public policy to improve the health condifions with the mode of effectiveness and equality in the economy in the future. Special Lecture II The Global Strategy for NCD Prevention and Control Jie Chen With a rapid increase in insustrilzation and The second half 1950s in Japan, air, water, and soil pollution caused b, environmental chemicals have become increasingly pronounced throughout the country. These types of environmental pollution resulted in high levels of major pollutants, such as sulfur dioxide (SO.) and dust and soot, in the air of industrial areas and large cities. A large number of persons exposed mainly to the air pollutant have resulted in chronic obstructive pulmonary diseases such as the Yokkaichi asthma of Yokohama asthma. Effluents from industries and mines have also polluted river and marine waters, polluting fish as well as rice paddy. Furtherfnore, these effluents including toxicants have often resulted in bioaccumulation and rnagffification in these living systems. Chronic diseases resulting from these pollution pathways were manifested in diseases such as the widely known Mnamata disease and Itai-Itai disease. As is widely known, these two diseases were caused by ingestion over a long period of fish contaminated by methyiniercury, and rice contaminated by cadmium (Cd), respectively. These diseases are different from those induced by air pollution as they mainly affected residents residing in agricultural and fishing villages. The research on airborne fluoride, which has long become my life work, is also related to environmental problems found in agricultural villages. The occurrence of atmospheric fluoride at extremely low levels, even as low as parts per billion (ppb), can result in fluoride accumulation in many agricultural crops. Consumption of nuoride-contaminated vegetation by domestic animals and humans can result in serious chronic fluoride poisoning. In essence, such an environ- mental problem was shown to begin and end with plants, and it was possible to protect against injury to human's health. The environmental problem that has become a global concern in the recent years is the threat by endocdne-disrupting chemicals or environ- mental hormones. Currently, about 70 chemicals are suspected of being capable of inducing endo- cdne disruption. Among these are many chlorin- ated herbicides and insecticides. Dioxin in pardcu- lar has been detected in various ecosystems, and even in human blood and milk. Previously found to be a contaminant of herbicides, dioxin is now known to be formed mainly in relatively small- scale incinerators involved in combustion at low temperature of waste materials and garbage in rural areas. It can, therefore, become a rural, rather than an urban, environmental problem. In ex- pedmental animals, dioxin has been reported as carcinogenic and teratogenic, and is injurious to reproductive systems, although similar toxic effects have not been confirmed in humans. Evaluation of the problem of endocrine- disrupting chemicals is extremely difficult in that they occur in trace amounts at the ppt level, in the order of 1 1 1000 compared with the environmental toxicants that have been known. An active world- wide research on these chemicals has just begun, and the problem involving human health threaten- ed by these chemicals will probably become the most important environmental issue of concern extending to the 2 1 st century. Special Lecture III The Global Strategy for NCD Prevention and Control Jie Chen Executive Director, Noncommunicable Diseases, WHO The second half of the 20th century witnessed major health transitions in the world, Socioeco- nomic and technological changes profoundly altered life expectancy and ways of living. The most important health transifl on has been the rising burden of noncomrnunicable diseases (NCDs). At the close ot- the century, ttic clevelopeci as well as the developing countries share large absolute burdens of NCDs as a common feature. In the developing countries the proportional and absolute burdens are sharply rising and are projected to soon become the leading contributors to death and disability. As these countries struggle to control the spread of infectious diseases, they are also facing an explosion of chronic diseases, both in urban and rural areas, which are much more expensive to treat and frequently impossible to cure. And there is far worse to come, In the developing world, home to 80% of the world's population, the disease burden from NCDs is pro- jected to increase from about 40% today to over 70% by 2020. Yet most of these countries neither have the resources, trained personnel nor the health service infrastructure that will be needed to cope with this new epidemic of diseases. The major NCDs include cardiovascular diseases (CVD), cancer, diabetes, and asthma. CVD affects people from urban and rural areas and all economic groups. In 1998, there were over seven million deaths from coronary heart disease, over five million of them in low and middle- income countries. Every year, over five million persons die as a result of stroke, over 800/o of them in developing countries. Hypertension, another CVD affects one in five of the adult population worldwide and is widespread in rural and urban population. Cancer is another major NCD. In 1998, over one million people died of cancer, over five million of thern in low- and middle-income countries. Diabetes affects up to 150 million people and seems to be considerably more prevalent in certain developing and disadvantaged populations than in developed countries. An estimated 100-150 million people suffer from asthma. The disease imposes a large social and economic burden particularly among under- privileged populations. , Even as NCDs are rapidly advancing across the globe there now exists a vast body of know- ledge about their causation (risk factors and determinants) as well as of effective measures for their prevention and control. It is a challenge to apply this knowledge on a global plane to mitigate the menace of NCDs and avert much of the anticipated suffering. At the same time research must keep apace, both to enable the appropriate use of cost-effective interventions and to generate new knowledge that can fill critical information gaps in large parts of the world. The World Health Organization recognized the global threat posed by NCDs and the need to provide urgent and effective public health re- sponses that integrate a broad array of measures for the prevention, surveillance and management of NCDS. The Fifty-flrst World Health Assembly, meeting in May 1998, requested the Director General of WHO to develop a global strategy for prevention and control of noncommunicable diseases, in consultation with member states and the agencies and professional organizations concerned, to give priority to such activities to help member states develop corresponding national policies and programs. In pursuance of this, a review was undertaken by WHO, in consultation with member states and several international agencies and nongov- ernmental organizations, for the development of a Global Strategy for Prevention and Control of noncommunicable diseases, incorporating the guiding principles on which national programs should be based and identifying the components and levels of implementation of these programs. The proposed strategy for NCD prevention and control embodies the principles enunciated in the new corporate strategy of WHO. The strategy is based on a review of international experience in the area of NCO prevention and control and re- presents comprehensive approaches that include the role of other partners at the global level. It is action-oriented and includes an implementation plan that addresses both policy and cocrational issues. In addition to exwnining the global burden of NCDS, the strategy sets guiding principles for NCD control at the global level with emphasis on multisectoral action for health. It covers the strengthening of primary prevention and health promotion, setting priorities and cost-effective approaches to control risk factors and diseases developing a global surveillance in work and build- ing epidemiological assessment and monitoring system, developing evidence-based guidelines for disease management promoting capacity building and education and developing an agenda for ap- plied research. In the global struggle against NCDs partner- ships with member states, international agencies,nongovernmental organizations and the private sector is an important component of the Strategy. Another important component of the strategy is the emphasis on community mobilization, strong community involvement and on reducing inequali- ties in relation to disease prevention and health care. The presentation will focus on the methodol- ogy adopted to develop the Global Strategy and will describe its major components. Emphasis will ; be given to the situation in rural and appropriate strategies to prevent and control NCDs in developing populations. Cover Page Asian Region Special Lecture Topics Papers Next |