Demographics

China is the most populous country in the world, with an estimated 1.3 billion citizens. Population growth rates have slowed and life expectancy has risen in recent decades (Figure 1).[1] While a child born in China in the 1950s could expect to live 46 years, one born in 2000 could expect to live for over 71 years.

Fig 1. Life expectancy at birth and total fertility rates, 1950-1955 to 2025-2030 projections


Rapid success in reducing fertility, however, has had several important impacts. First, the 2000 census estimates that 117 boys were born for every 100 girls for first births, but this ratio quickly rises to 152 for every 100 for second births.[2] In addition, China's population is ageing rapidly. One in four people living in the country in 2035 will be aged 60 years or older.[3] Population ageing leads to a shift towards chronic diseases and disabilities and pressures on the health system to address more complex health conditions that generate higher costs. In addition, the tradition of providing long-term care at home for elderly parents and grandparents will be challenged in the light of the one-child policy

Fig 2. Population of China by age group (%), 1964, 2000, 2035


In line with the Government’s policy to accelerate urbanization, half of the population will be living in urban areas by 2030 (Figure 3),[4] placing great pressure on water, air and electricity resources.

Fig 3. Urban population (%), 1970, 2000, 2030

Political situation

China's 11^th Five Year Plan (2006-2010) forms the basis of the Government's current economic and social development efforts. In continuity with the 10^th Five Year Plan, the 11^th Plan aims to sustain the rapid and steady development of China's ‘socialist market economy’ while, in addition, aiming to achieve the ‘five balances’:

• Balance between urban and rural development : The gap between urban and rural areas increased during the 1990s for some important economic and health indicators
• Balance in regional development: The Government is promoting development in the western regions in an effort to address the regional imbalances that have grown over time.
• Balance in social and economic development: The Government has made a commitment to focus more on social issues, including poverty, education, medical care and public health, in its overall goal to build a well-rounded better-off society and achieve socialist modernization.
• Balance between human beings and nature: Industry, agriculture and humans are competing for scarce resources, including water and air.
• Balance between domestic and international development: This balance promotes international cooperation and emphasizes the importance of fulfilling international commitments.

The 11^th Plan includes two key quantitative targets:

• to achieve an annual gross domestic product (GDP) growth rate of 7.5%, with the goal of doubling 2000 GDP per capita by 2010; and
• to reduce energy consumption per unit of GDP by 20%, and the total discharge of major pollutants by 10%, by 2010.

It also includes a number of strategic priorities and major tasks, including: rebalancing China's pattern of growth; deepening reforms and opening up further to the outside world; constructing a ‘new socialist countryside’; promoting more balanced development among the different regions; and increasing capacity for independent innovation.

To enable a larger proportion of the population to take advantage of the opportunities afforded by economic growth, future programmes aim to reduce poverty; develop the education, health, technology, scientific and cultural fields, among others; and strengthen the social safety net. The Plan is referred to as a ‘people's agenda’ because it focuses on inclusive social development that will make a measurable difference in people’s lives by 2020.

Socioeconomic situation

China has made impressive gains in improving living standards, reducing poverty and maintaining strong economic growth since initiating market reforms in 1979. GDP averaged a real annual growth rate of 10% during the period from 1979 to 2006. During 1979-1984, economic growth was driven by the shift of labour from agriculture to rural industry. Between 1985 and 1992, growth benefited from improved efficiency in capital allocation stemming from price liberalization and from opening up to foreign trade. Further opening up of the economy to foreign direct investment in the 1990s stimulated technological progress. China’s real GDP grew at a rate of 11.4% in 2007 and is projected to continue growing at a rate of 9.6% in 2008. Current growth is driven by investment, consumption and exports.

China’s earlier high health standards have played a pivotal role in the country’s economic success. Impressive growth performance has been correlated with reductions in poverty and advancements in social development. Using the standard international poverty line of US$ 1 per day, an estimated 400 million people in China have been lifted out of poverty over the past 30 years. This is primarily a result of the liberalization of agriculture and other rural industries. At China’s official poverty line, the rural population living in absolute poverty with an annual per capita net income below 668 Yuan (US$ 87) decreased from 250 million in 1978 (31% of the rural population) to 24 million in 2005 (3% of the rural population). New estimates of poverty using purchasing power parity (PPP) suggest even greater gains in poverty from 71%-77% in 1981 to 13%-17%. By whatever measure, China alone has accounted for over 75% of poverty reduction in the developing world over the last 30 years.

The linkages between health and economic growth intensify as China seeks to sustain economic growth. The benefits of this growth, however, have not been shared equally and gaps exist in socioeconomic indicators between geographic regions, rich and poor households, urban and rural residents, and migrant and resident populations within cities. Up to 30% of poor people state that health is the single most important cause of their poverty. Ill-health can lead to poverty through reduced earning capacity and high out-of-pocket medical expenses that can be financially catastrophic. Poor health contributes to cycles of poverty that reduce physical capacity and erode economic productivity.

Vulnerabilities and hazards

China’s socioeconomic development is based on a sound footing, as the Government continues to enhance its macroeconomic, structural and social policies. The key economic challenge is to rebalance the economy to further strengthen sustainable economic and social development. The State Council's 2007 document on stimulating the service sector sets the stage for future policy action, and many new policy initiatives support equitable growth.

Health vulnerabilities arise as the by-product of changes in social and economic development. Urbanization, environmental damage, and increasing tobacco consumption and motor vehicles have resulted in a high prevalence of risk factors for chronic diseases. Some 23% of the population is overweight and 160 million people are suffering from hypertension, most of whom are between the ages of 18 and 59 years. Diabetes prevalence is projected to double by 2030 to more than 42 million cases. Some 350 million people smoke in China. Smoking prevalence is 66% among men and 3% among women, and uptake is occurring at younger ages. Smoking is a primary contributor to lung cancer mortality, estimated at more than 300 000 deaths annually. It is projected that, by 2020, tobacco use will account for one-third of all deaths—among which half will occur between the ages of 35 and 64 years.

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