Chapter 9 - Health and Sanitation

INTRODUCTION

9.1 In the more than forty years since the founding of the country, China has had significant developments in health care. The level of health of the Chinese people is now in the front ranks of developing countries in the world. However, many difficulties and problems still exist. Problems, such as imbalances in the development of health care, the backwardness of rural health care, challenges with respect to urban sanitation, and the high incidence of some diseases, seriously jeopardize people's health. Other problems, like an overly rapid increase in population, the ageing of the population, environmental pollution, changes in the disease structure, changes in the system of payment for medical treatment, also affect people's health and the development of the health care.

9.2 According to the general aims for economic and social development in the 1990s and into the next century, the overall objectives of China's health work and development are that all people will have access to basic health care, and, in general, everyone will enjoy levels of health care coincident with relatively higher living standards. In concrete terms, these objectives include the following:

• (a) Forming local health care networks which combine primary health care facilities and those offering more comprehensive services, so as to enable urban and rural people to acquire basic medical care services close to home;

  (b) Establishing various forms of health care systems appropriate to existing conditions in China; these will include systems for publicly-funded health care, worker's compensation and employer funded medical care, and general medical insurance, in order to raise people's capacity to bear the financial burden of illness;

  (c) Protecting the environment; reducing the social effects of environmental pollution; improving the quality of drinking water and health conditions for rural people; controlling the sources of urban water pollution, air pollution, industrial waste pollution, and noise pollution;

  (d) Getting the threat of infectious and endemic diseases under basic control; gradually conducting comprehensive prevention campaigns against chronic and non-infectious diseases; paying attention to improving the environment in regions of endemic disease; emphasizing the prevention, as well as the treatment of diseases;

  (e) Setting up broadly-based health care management systems and giving safe and effective guidance for family planning;

  (f) Providing the public with information about nutrition and the healthful preparation of food, physical education, healthy life styles, and other guidance to enable them to stay healthy in body and mind and to strengthen their constitutions.

9.3 Since health and sanitation work interfaces with other areas, references are made to the programme areas of other relevant chapters, in particular Chapters 10, "Development of Sustainable Human Settlements"; 13, "Sustainable Energy Production and Consumption"; 14, "Conservation and Sustainable Use of Natural Resources"; 18, "Protection of the Atmosphere" and 19, "Environmentally Sound Management of Solid Wastes".

9.4 This chapter includes the following six programme areas:

• A. Meeting Basic Needs for Health Care

  B. Minimizing the Impacts of Environmental Pollution on People's Health

  C. Controlling Infectious Diseases

  PROGRAMME AREAS

  
  

  A. Meeting Basic Needs for Health Care

  Basis for action

  9.5 The purpose of providing primary health care services and of meeting basic needs for health care is to serve the whole society and to improve conditions for health, by extending health services as far as possible to every arena of people's work and life, through the extensive participation of government, health administrations, appropriate departments, medical institutions, communities and individuals. It will mainly involve the improvement of health conditions, the prevention and treatment of diseases and the provision of convalescence services, since these are basic requirements for all members of society.

  9.6 With national economic development and continuous improvements in people's living standards, demands on medical services and health care are constantly growing, while the discrepancy between the demand for urban and rural medical services and the supply of health care resources becomes wider. The discrepancies are primarily in the following areas:

  • (a) A shortage of health resources in the rural areas; a reduction of already insufficient investment by the state and collectives for rural health care; the concentration of manpower, materials and funds in large cities; simple, rudimentary medical and health care facilities; limited personnel and low technological levels in rural areas, especially in remote regions and regions where minority nationalities live;

    (b) An uneven distribution of health care resources in cities; over-burdened services in large hospitals; inadequate technical and financial support to small hospitals, which greatly affects their development and makes it difficult for them to undertake work in disease prevention, health care and recuperation;

    (c) Increasingly heavy burdens for disease prevention, health care and convalescence. With the development of the national economy and health care, people's living standards have been rising and conditions for health have greatly improved, however, the incidence of chronic and non-infectious diseases is gradually rising. At the same time, issues such as an ageing population, environmental pollution, the prevention of chronic diseases, health care and convalescence are becoming major public issues, requiring urgent attention and solutions both now and for decades to come.

  Objectives

  9.7 By the year 2000, most villages will have established their own clinics, been equipped with the medicinal herbs of most use in treating both common and endemic diseases, and will have facilities for providing basic medical care; 90% of counties and townships will have established medical facilities for offering primary health care.

  9.8 Provincial capital cities will serve as medical servicing and technical guidance centres, and will offer medical treatments, education about disease prevention and health care, and medical training. They will also be involved in scientific research on advanced medical technologies, and by servicing a network of small and medium-sized cities, will spread medical care from capital cities to counties and rural areas.

  9.9 Undertake comprehensive work in disease prevention, health care and convalescence which is appropriate for an ageing population and an evolving structure of diseases, and which is directed against the rising incidence of chronic and non-contagious diseases and of diseases caused by environment factors, life styles, psychological and other social factors.

  9.10 Strengthen quarantines, especially for customs and foodstuffs; strengthen work in prohibiting and counteracting narcotics.

  Activities

  9.11 Improve and strengthen the three-tiered system for urban and rural preventative medicine and health care. Establish comprehensive health care service systems focused on providing primary and basic health care:

  • (a) Improve conditions in township and village clinics; train medical technicians to ensure that they are capable of carrying out medical treatment, health care and preventative medicine work;

    (b) Improve county-level medical institutions and make them centres for providing rural health services and technical guidance;

    (c) Use hospitals as centres, gradually extend services for the prevention of diseases, medical care and convalescence so as to enhance integrated benefits in the utilization of health resources and medical services;

    (d) Improve combining health care with family planning services, and improve the quality of family planning services;

    (e) Develop and popularize medical technologies suitable for rural areas, in order to meet rural people's basic requirements for medical treatment and health care;

    (f) Take basic health care to be fundamentally important, rely on the three-tiered network of medical treatment and health care, and strengthen medical treatment, medical care, disease prevention and control, and emergency services and convalescence;

    (g) Gradually establish and extend community health care systems, from hospitals to residential districts to households; train appropriate personnel.

  9.12 Strengthen ties between urban and rural areas. Establish regional health care systems that rationalize the regional disposition of health care services. Between urban and rural areas, establish technical service networks, which are oriented towards providing grassroots and rural area health care, and which are backed up by services in small and medium-sized cities.

  9.13 Promote the establishment of rural health care systems, and continually enhance the capabilities of rural people to work together to deal with illnesses.

  9.14 Organize and institute quarantine systems. Speed the modernization of quarantine technologies. Encourage people to be active in the prohibition and opposing of narcotics.

  9.15 Cooperate with appropriate international organizations in the construction of the three-tiered urban and rural medical prevention and health care network, particularly with respect to the training of rural doctors, the development of regional medical systems and community health care, and strengthening international cooperation in the prohibition and fight against narcotics.
  

  B. Minimizing the Impacts of Environmental Pollution on People's Health

  Basis for action

  9.16 Pollution by chemicals, radioactive substances and bacteria in the environment seriously threaten people's health. Reduction of the effects of environmental pollution on human health is a very important issue for social development at present and into the 21st century.

  9.17 Air pollution resulting from the burning of coal is the main reason for China's poor quality of indoor and outdoor air. At least 80% of urban dwellers live in a environment which has a very poor quality of air. The burning of coal with a high fluorine content has resulted in endemic coal-burning fluorine poisoning in over 17 provinces, municipalities and autonomous regions in China. In recent years, the supply of water has increased a great deal in urban and rural areas. However, according to a nation-wide investigation into potable water in 1989, 82% of the Chinese people drink water from shallow wells and rivers, 76% of which have been heavily polluted, or where bacteria content exceeds sanitary standards. Approximately 160 million people drink water seriously contaminated by bacteria. There are about 47 million people who do not have sufficient potable water. According to the reliable reports on the breakdown of infectious diseases, the percentage of intestinal diseases rises each year. With the increasing extensive use of radioactive isotopes and X-ray devices, the effects of radioactive substances on human health should not be neglected. Accidental irradiation to personnel engaged in radiation-related work and the public occurs very often. At present, food production is still at a basic stage, where various kinds of biological and chemical contamination are not under control. Food poisoning and other food-related diseases frequently occur and, at present, there is no sufficient guarantee of food security.

  9.18 Poor work environments have resulted in serious occupational diseases. According to statistics from 1949 to the end of 1991, a total number of over 470,000 people have been infected with pneumoconiosis in above-county level state-owned and in collectively-owned enterprises. This number equals the total number of pneumoconiosis found in all other countries in the world during the same period. From present estimates of dust concentrations during production activities, an additional number of 20,000 to 30,000 cases of pneumoconiosis will be added annually in the future. There are over 1,000 serious incidents of occupational poisoning every year, with about 2,000 people being affected. The incidence of occupationally-induced tumours is another issue that awaits urgent attention.

  Objectives

  9.19 Protect and improve people's health while developing the economy. Prevent and reduce the incidence of infectious, environmental and occupational diseases, as well as occupational poisoning and food poisoning associated with environmental pollution. Eliminate the potential threat to health from various kinds of environmental pollution. Improve people's physical and mental health by gradually improving their living and working environments, and raising conditions for their material and spiritual lives:

  • (a) Expand systems of legislation for sanitation, sanitation standards, sanitation inspections and monitoring, which are all necessary for security of health;

    (b) Eliminate environmental factors that are damaging to health, and improve the quality of the environment;

    (c) Work out plans for scientific research and monitoring related to the environment and health, encourage the application and popularization of scientific and technological achievements, and facilitate the prevention and treatment of diseases.

  9.20 Gradually improve conditions in work places to create working environments of high standards, so as to reduce the incidence of occupational diseases. Attempt to achieve the following goals: decreasing occupational poisoning due to gradual exposures to harmful substances by around 5% every 5 years; and decreasing illness due to exposure to radiation by around 3% every 5 years.

  Activities

  9.21 Establish and improve legislation for the supervision of sanitation, for sanitary standards, and for systems for supervising and testing sanitary conditions. Details are as follows:

  • (a) Formulate and promulgate sanitation standards, which draw attention to harmful substances in the environment and their relation to human health; establish sanitation standards concerning pesticide residues in foodstuffs, which specifically refer to the kinds of pesticide made in China;

    (b) Establish a supervisory system for sanitation that is scientific, reasonable, practical, and that can be enforced, so that health administration departments at all levels can set up supervisory net- works for sanitation, which are suited to the development of the national economy;

    (c) Establish laws and regulations for occupational health and the protection of labour, with every level of government being responsible for supervising the enforcement of the laws and regulations.

  9.22 Gradually establish mechanisms for coordinating health care with environmental protection. Strengthen policy coordination and information exchange, the coordination of action and improve management capabilities.

  9.23 China will implement the following strategies to reduce harmful environmental factors and raise sanitation levels:

  • (a) By the year 2000, the coverage rate for water supply networks will be raised to over 95% in cities and in rural areas approximately 80% of the water supply will be of potable quality;

    (b) The total number of city dwellers suffering the effects of severe air pollution will be reduced to less than 40%, through adjustments in the fuel structure, extending district heating systems (refer to Chapter 12), installing dust and SO2 elimination equipment in factories and boilers (refer to Chapters 11 and 12), and increasing afforestation (refer Chapter 16);

    (c) In the catering industry, raise the sanitary quality of food; ensure that 85% of urban and 75% of rural catering facilities meet standards of disinfection, and that 95% of foods subjected to selective examination meet sanitary standards;

    (d) Through improvement in the management of industrial and municipal solid wastes, especially with respect to landfill facilities, reduce or eliminate odours, insect breeding and water contamination; by the year 2000, 20 % of wastes should be disposed of in an environmentally- sound way throughout the country, and not less than 10% of total wastes in any one region should be so disposed (refer to Chapter 19);

    (e) Through legislation, control programmes and public awareness campaigns, reduce intakes of pollutants from food, especially for reducing accumulation of heavy metals, pesticides and organic chlorine compounds in human bodies and in the environment;

    (f) Create working environments of high standards; reduce the dangers of dust, hazardous gases, chemicals, noise, etc. to workers' health; improve work place conditions to eliminate both physical and mental hazards to workers; governmental departments should supervise the working environment of enterprises in their sectors;

    (g) Restore the environment in a planned way in the districts where the environment has been severely polluted and public health has been affected.

  9.24 Strengthen the system for monitoring and testing for sanitation, enhance supervisory capabilities for environmental quality, control hazardous conditions:

  • (a) Conduct national monitoring of quality of potable water and tests for water-borne diseases;

    (b) Conduct selective monitoring of indoor air quality in various types of houses using various kinds of fuels;

    (c) Set up monitoring stations to monitor and test environmentally-sound disposal of solid wastes and hospital waste water;

    (d) The rate for sites using radioactive substances meeting safe standards should reach 95%; monitoring and testing for radiation will be conducted within a radius of 50 kilometres of nuclear power stations;

    (e) The coverage rate for testing for sanitary food by food inspection departments will reach 100%;

    (f) Set up monitoring stations in provinces and cities, where occupational diseases occur most frequently. Stations will be established to monitor and test workers health in 95% of industries; 70% of industries examined for dust and hazardous substances should meet standards;

    (g) Conduct biological surveys on the impacts of environmental pollutants on human health and on the load capacity of human bodies; conduct regular biological surveys on the content of lead, cadmium, arsenic, mercury, and organic chlorides in humans;

    (h) Monitor diseases caused by environmental pollution in key polluted industrial areas, and set up no less than 10 monitoring stations.

  9.25 Establish information networks. Strengthen quality control for the collection of information, statistics and analysis. Establish data bases for various types of information:

  • (a) Data base on environmental pollutants. Collect information on the distribution, scale, nature and degree of pollutants. Those pollutants which are widespread, which are seriously harmful to health and which are difficult to eliminate will be chosen as priority targets for monitoring, so as to provide a scientific basis for environmental medicine and treatment;

    (b) Data base on poisoning and diseases caused by environmental pollution accidents. Report through computer networks on public poisonings or sudden incidence of diseases. The rate of reporting should exceed 80%;

    (c) Data base on occupational diseases. The coverage rate of occupational health files in enterprises above county level should reach 95-100%, and in township enterprises, 60%.

  9.26 Compile and analyze the data collected and the results of research, and publish the findings in order to educate people so that they can improve their ability to look after their own health. Inform and guide authorities in other sectors to take necessary measures to alleviate health hazards and environmental pollution.

  9.27 Conduct research on the impact of environmental pollution on human health and measures to counteract those impacts; publicize the results of the research regarding:

  • (a) The impact of rare elements in the environment on human health;

    (b) The relationships between air pollution, and in particular, indoor air pollution, with lung cancer, respiratory diseases and diseases of the nervous system;

    (c) The relationship between toxic chemicals in water and food, and digestive cancer and cardiovascular diseases;

    (d) The impact of environmental and ecological changes (such as acid rain, global warming and ozone layer depletion) on health;

    (e) The ecological impacts and potential health threats of synthetic chemicals;

    (f) Methods for formulating sanitary standards for carcinogens and evaluation of the risks of substances causing debilitation;

    (g) Through biological monitoring, a study of immunities and of genetics, develop indicators which measure the effects of environmental factors on human health;

    (h) Research on economic losses caused by health affected by environment pollution.

  9.28 Human resources development:

  • (a) Allow medical management personnel and medical technicians to work effectively; continually offer them opportunities to upgrade their knowledge and skills so as to improve their work proficiency and efficiency;

    (b) Offer new courses in regulations for hygiene, environmental medicine, and the economics of hygiene in medical universities and colleges, so as to ensure that trained personnel can meet the needs of economic construction and for the administration of hygiene regulations throughout the country;

    (c) Strengthen cooperation amongst departments of health care, environmental protection and public education. Conduct massive campaigns concerning the environment and health to help people be aware of the relationship between the environment and health.

  C. Controlling Infectious Diseases

  Basis for action

  9.29 China is a developing country, in which infectious diseases will remain a major concern for a long period of time. Giving priority to the prevention of and effective control of infectious diseases, and thereby improving conditions for people's health is essential for guiding the work of China's medical services and health care and an important foundation for ensuring the sustainable development of the national economy.

  9.30 Some infectious diseases have effectively been brought under control following research into infectious diseases, the development and use of the inoculations, treatments, preventative measures, traditional Chinese medicine and the establishment of health care networks. Nevertheless, many infectious diseases, like cholera, viral hepatitis, leptospirosis, diarrhoea, schistosomiasis, malaria, haemorrhagic fever, encephalitis B, and tuberculosis, are still seriously affecting human health. The incidence of venereal diseases and AIDS is growing.

  Objectives

  9.31 Specific objectives:

  • (a) Wipe out infantile paralysis and eliminate native wild toxic strains in China by the year 2000;

    (b) Eliminate infantile tetanus by 1995 and reduce the incidence of measles by 50 - 70% during the 21st century;

    (c) Cut the incidence of viral hepatitis by 50%. Eliminate hepatitis A in the early 21st century, and reduce the antigen-carrying rate of hepatitis B from the present 10% down to less than 1%. Eliminate hepatitis E in the 21st century, and reduce the virus-carrying rate of hepatitis C down to less than 1%;

    (d) By the year 2000, retard the rate of increase in AIDS infection and the number of AIDS patients. During the 21st century, through global efforts, current trends indicating increases in the rate of AIDS infection will be curbed. Retard the rise in incidence of gonorrhoea and syphilis until the year 2000 and then decrease it with each passing year;

    (e) Strengthen cholera prevention so that, by the year 2000, it will no longer be spreading, and by the middle of the 21st century, it will no longer be prevalent;

    (f) Reduce the incidence of bacillary dysentery to an incidence rate of 30 to 50 per 100 thousand people during the early 21st century;

    (g) By the year 2000, reduce the incidence of tuberculosis to an incidence rate of 114 per 100 thousand of people in cities and 266 per 100 thousand people in the rural areas;

    (h) Reduce the incidence of schistosomiasis in the affected regions to below 5% by the year 2000.

  Activities

  9.32 Strengthen the monitoring and control of infectious diseases:

  • (a) Formulate plans for the monitoring and treatment of municipal faeces and hospital sewage; the implementation of plans should be supervised by environmental protection agencies;

    (b) Strengthen existing monitoring stations for diseases, such as haemorrhagic fever, epidemic encephalitis, schistosomiasis, malaria, filariasis, kala-azar, anthracene and leptospirosis; improve monitoring measures; ensure full prevention measures against the existence, spread and outbreaks of infectious diseases.

  9.33 Expand the system of inoculations:

  • (a) Consolidate and expand the immunization system so as to maintain the current inoculation rate of over 85% of children being immunized against poliomyelitis, hepatitis B, measles, Bacilli Calmette-Guerin (BCG) and diphtheria;

    (b) Gradually include the encephalitis B vaccine and the epidemic encephalitis vaccine into the planned immune inoculation system in order to control encephalitis B and epidemic encephalomyelitis.

  9.34 Control AIDS, enteric and entomophilous infectious diseases:

  • (a) Devise objectives for the AIDS prevention and control plans, with a view to preventing the spread of HIV;

    (b) Strengthen the administration and supervision of food hygiene to ensure that food offered for consumption meets standards;

    (c) Accelerate improvements to water supplies in rural areas and to the management of the disinfection of city tap water to ensure that drinking water meets hygienic standards so that the spread of enteric infectious diseases can be controlled;

    (d) Decrease the incidence of leptospirosis through the widespread use of agricultural machinery; include the changing of the natural sources of epidemics into the overall plan for environment and development.

  9.35 Control parasitic diseases:

  • (a) Include monitoring important parasitic diseases into the national infectious diseases monitoring system; strengthen the administration of the monitoring system and improve the forecasting system for the incidence of these diseases;

    (b) Enhance health education; raise public awareness of their own role in protection against diseases and in disease prevention.

  9.36 Strengthen cooperation amongst departments concerned. The prevention and control of infectious diseases can be achieved only through close cooperation with women's federations, trade unions, and the governmental departments concerned with education, health, agriculture, city planning, water conservancy, commerce, the chemical industry and the media.

  9.37 Control environmental factors contributing to infectious diseases. Some infectious diseases are closely related to environmental factors. Enteric infectious diseases can be effectively prevented and entomophilous infectious diseases reduced through having safe water supplies, the disinfection of sewage, the sound management of food hygiene, the appropriate disposal of garbage and the killing of mosquitoes and flies. Transformation of the environment and elimination of oncomelania can effectively prevent schistosomiasis.

  9.38 Support scientific research:

  • (a) Strengthen and broaden multi-disciplinary research; conduct joint research and cooperation in epidemiology, immunology, molecular biology, social medical science, social economics, and environmental medicine in order to work out approaches for the control of infectious disease;

    (b) Improve existing vaccines for poliomyelitis, measles, hepatitis B, hepatitis A and the pertussis-diphtheria-tetanus triple vaccine; develop genetic engineering vaccines so as to improve immunity effectiveness; conduct research and development of genetic engineering vaccines for enteric infectious diseases, such as cholera, dysentery and typhoid fever.

  9.39 The emphasis of China's health and sanitation work is on the control of infectious diseases. It is of vital significance to secure international financial aid for doing this. The cooperation and support of the international community for funding, equipment, technologies and training are needed in the prevention and cure of viral hepatitis, diarrhoea, AIDS, entomophilous infectious diseases, tuberculosis, parasitises and diseases associated with the immunization of children.

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