Chapter 9 - Health and Sanitation
INTRODUCTION
9.4 This chapter includes the following six programme areas:
D. Reducing the Harmful Impacts of Endemic Diseases
Basis for action
9.40 For over 40 years, the Chinese Government has made great efforts to develop manpower and material resources to prevent and treat endemic diseases. Thus far, 430 million people have been treated with iodized salt to prevent Iodine Deficiency Disorder (IDD). Measures have been taken nation-wide to improve water quality and kitchen ventilation to prevent endemic fluorine poisoning. Improving water quality has already benefitted 26 million people. Comprehensive preventive measures against Keshan disease have been taken nation-wide. These include selenium supplements, improving ventilation and eliminating dampness and coldness, improving food, improving sanitation and housing conditions, and these measures have effectively controlled the outbreak and spread of the disease. Comprehensive preventive measures against Kaschin-Beck Disease (KBD), such as "changing cereals, improving water quality and supplementing selenium" have been widely used and have been remarkably successful. In over 80% of the areas where the disease is common, the incidence and the rate of contracting the disease has dropped to the lowest level in history.
9.41 Endemic disease such as the IDD, KBD, endemic fluorine poisoning disease and the Keshan disease are seriously harmful to public health and the quality of population in heavily affected regions. About 425 million people live in iodine deficiency areas. Endemic fluorine poisoning occurs in 1,230 counties and cities in 30 provinces, autonomous regions and municipalities, threatening over 200 million people. Keshan disease is found in over 321 counties and cities in 15 provinces, autonomous regions and municipalities and threatens the health of 50 million people. KBD is found in over 315 counties and cities in 14 provinces, autonomous regions and municipalities, and affects 34 million people. In seriously affected areas, the incidence amongst youth and children is over 50%, and in the most seriously affected areas, over 80%. In recent years, widespread endemic arsenic poisoning has been discovered in Xinjiang, Inner Mongolia and Guizhou.
Objectives
9.42 Strive to eliminate IDD, Keshan disease and KBD by the year 2000 and control endemic fluorine disease and endemic arsenic poisoning by the year 2010. Activities
9.43 At all levels of government, leading groups dealing with endemic diseases will carry out regular research, planning and inspections and will coordinate the efforts of appropriate departments. In areas with a high incidence of endemic diseases, they will include the prevention and treatment of endemic diseases in their poverty alleviation and economic development programmes.
9.44 Prevent and cure endemic diseases through effective preventive measures:
- (a) To prevent and treat IDD, encourage the use
of iodized salt by all, and the use of iodized oil by target groups; establish
and improve monitoring networks;
(b) To prevent and treat endemic fluorine disease, improve wells, use chemical methods to reduce the fluorine content in drinking water and improve kitchen ventilation; treat patients with health food therapy and an integrated regimen of traditional Chinese and western medical therapies and operations to alleviate the pain in the 60% most seriously affected patients and allow for the convalescence of less seriously affected sufferers;
(c) To prevent and treat Keshan disease and KBD, use comprehensive measures such as selenium supplements, improvements for food and nutrition, and encourage soil rejuvenation to increase selenium intake and improve the quality of grain;
(d) Change water sources to prevent treat endemic arsenic poisoning.
9.45 Strengthen the development of manpower resources and enhance capacities for disease prevention. Improve the quality of professional personnel, enhance on-the-job training by having the China Centre for the Prevention of and Research on Endemic Diseases and medical universities and colleges set up training bases throughout the country.
9.46 Organize scientific research and technical personnel working on the prevention and treatment of endemic diseases to tackle key technical problems, such as developing measures for providing iodine supplements for specific groups of people in specific regions; investigating the pathogenesis of cretinism and the relationship between trace elements and IDD; the causes and mechanisms of the Keshan disease and KBD; conduct research into new ways of counteracting selenium and iodine deficiencies, and excesses of fluorine and arsenic; find effective treatments for endemic diseases.
9.47 Encourage international and regional cooperation. Make efforts to solve problems related to personnel training, the provision and utilization of equipment and technologies for prevention, treatment and research. Generate international concern and support for control of endemic diseases in China.
E. Protecting the Vulnerable
Basis for action
9.48 Women, children, the elderly and the handicapped are vulnerable and require special health care. The Chinese Government has always attached great importance to the health care of women and children. To date, the rate of infantile mortality and death during childbirth has decreased sharply, acute infectious diseases amongst children are basically under control, and health and nutritional conditions for children have seen remarkable improvements. The handicapped population in China numbers over 50 million. The Chinese Government pays attention to the employment and social welfare of handicapped people. The employment rate for handicapped people who are able to work is 70% in above-county level cities and towns.
9.49 At present, there is still a wide discrepancy between demand and supply of health care services for women and children in China. In particular, there are many problems in developing health care for women and children and in the better protection of the vulnerable. According to the third national census in 1981, the rate of infantile mortality was 3.47%. According to statistics in 1989, the rate for gravida and puerperal deaths was 94.7 per 100,000, with it reaching 1,000 per 100,000 in some counties. The high rate of gravida, parturient and puerperal mortality in rural families results from the lack of capacity for handling urgent and high-risk cases during delivery and the shortage of vehicles for transportation. The proportion of rural women suffering from gynaecological diseases is high, and generally speaking, they do not have access to timely physical examinations and treatments. Serious malnutrition of children resulting from food deficiencies has basically been controlled, however, the growth rate of children under five in China is still far behind the standards prescribed by the World Health Organization. Some level of malnutrition still exists amongst 21% of children, and the incidence of diseases associated with poor nutrition is still very high.
9.50 China's expenditure of funds for the health care of women and children constitutes only a small part of total funds expended. A lack of financial resources has led to inadequate long-term inputs, and primarily accounts for the difficulties in providing health care services for women and children and in the protection of the vulnerable.
9.51 China is a large, developing country with a huge vulnerable population. 22% of the world's children under 5 live in China. The results of national monitoring in 1988 indicated that the incidence of neonatal defects was 1.307%. Throughout the country, about 300,000 neonates with deformities visible to the naked eye are born annually.
9.52 During the last 40 years, the average life span has been increased, there has been an increase in the elderly component of the population, and the absolute number of older people is increasing rapidly. It is estimated that by the year 2000, people older than 60 and 65 will constitute 11.5% and 9% respectively of the total population in China's urban areas.
Objectives
9.53 Increase financial inputs in health care for women and children; establish modern health care for women and children; meet the increasing demands for health care and the protection of women and children; control the major diseases afflicting women and children; reduce the deaths in pregnancy, during childbirth, and in infants and children by over 50%; reduce the incidence of malnutrition and deformity in children; raise the proportion infants being breasted and the proportion of hospitalized births in rural areas to over 80%; in remote, rural poverty-stricken areas, over 95% of deliveries should be attended by trained midwives or doctors; provide services for gynaecological examinations for rural women; try to make all indicators of health in women and children reach or surpass the level of moderately developed countries; provide handicapped people with more opportunities for employment so that their livelihoods are secured; provide the elderly with necessary health services and raise the level of treatment for diseases. Activities
9.54 Provide pre-marital counselling, childbirth counselling, health care for pregnant women and puerperants, antenatal diagnoses, and screening for diseases in newborns, in order to reduce the birth of handicapped children and to improve the quality of the population.
9.55 Increase public welfare facilities, such as enterprises for handicapped people and homes for the elderly. This is to be done in order to provide people with opportunities for employment and to assist with arrangements for their lives.
9.56 Establish and improve the urban and rural health care systems; provide physical examination and consultation services for mental hygiene, convalescence and geriatrics for urban and rural residents.
9.57 Set up urban first-aid centres and first-aid networks; provide timely medical treatment for people with chronic diseases and to the elderly, who are frequently stricken by severe conditions, such as cerebral apoplexy and coronary diseases.
9.58 Depend on governments at all levels; strengthen their responsibilities for implementing the policy of prevention first; provide a system of integrated prevention and treatment orientated to rural areas.
9.59 Be involved in a range of international cooperative projects to strengthen international links and introduce international information, qualified personnel, technologies, funds and advanced managerial experiences through financial aid, joint-ventures and cooperation, so as to accelerate the development of the health care for women and children in China.
9.60 Intensify the monitoring of growth in children, in order to discover in a timely way, high risk factors leading to malnutrition and severely malnourished children so that they can be given nutritional treatments.
9.61 Formulate national plans to prevent obstetrical haemorrhages, acute respiratory infections, diarrhoea, malnutrition of children, and to devise a national programme for promoting breast-feeding. The Ministry of Public Health will be responsible for its organization, implementation, supervision, examination and evaluation.
9.62 Maintain a high rate of planned immunizations.
F. Facing the Challenges of Urban Sanitation
Basis for action
9.63 With the acceleration of urbanization in China, urban sanitation is facing the following problems:
- (a) Environmental pollution problems caused by
rapid industrial development will be difficult to solve once and for all.
The capacity of cities to provide sanitary services can not meet demands
resulting from rapid developments in urbanization. There is an overall
deterioration of living environments, high densities of buildings and population,
crowded residential areas and transportation facilities, and serious over-loading
of city services;
(b) Social and economic development and urbanization have greatly changed social and environmental conditions. Busy and demanding lifestyles caused by involvement in social and economic activities, a competitive environment, frequent changes of professions, possible unemployment, changes in the residential environments, smaller families, and alienation from neighbours and relatives, all have profound influences on people's health and lead to a high incidence of diseases;
(c) The incidence of chronic diseases, cardiovascular diseases, malignant tumours, and mental disorders in urban areas is higher than that in rural areas and it is increasing annually. Every year, an additional 2 million people will develop severe psychoses due to declines in their capacities for psychological endurance. Increasing average lifespan and controlling birth rates has resulted in a trend towards a rapidly increasing older population. The aging of the population increases demands for more health care services, medical treatment and other services for the elderly;
(d) The diseases associated with urbanization are not caused simply by a certain kind of pathogen, but rather, a combination of biological, environmental, social, psychological and other factors. Thus, health care services will no longer concentrate solely medical treatments, instead, they should try to improve various conditions affecting public health, educate people about how to minimize risks from environmental pollution, occupational diseases and improper nutrition, about how to have a healthy lifestyle, and how to solve their social, psychological and physical problems by using the medical and health care services.
Objectives
9.64 Gradually improve the systems for sanitary standards in city planning and housing; gradually establish and develop supervisory systems for ensuring preventive sanitation in urban construction.
9.65 Improve basic city sanitation facilities (see also, Chapter 10, "Development of Sustainable Human Settlements"); improve the coverage rate for mental health, psychological consultancy, and convalescent treatment services to around 90%.
9.66 Prevent the spread of diseases by reducing the incidence of viral hepatitis, bacillary dysentery, tuberculosis, and other diseases; control the incidence and spread of AIDS and venereal diseases.
9.67 Conduct health education campaigns on health, first-aid, and the prevention of chronic and venereal diseases.
9.68 Control the proportion of male smokers above 15 to below 50%, and female smokers to below 5%; prohibit youngsters and students under 15 from smoking.
Activities
9.69 Establish coordination committees for city sanitation which are led by municipal governments and which involve the departments of sanitation, planning, finance, science and technology, medical prevention and care, city planning, municipal construction, environmental sanitation and environmental protection. The main functions of the committee will be to:
- (a) Direct and manage the work of city sanitation,
draft short and long term programmes, policies and strategies for city
sanitation, and implement sanitation plans for cities and rural areas;
(b) Evaluate the impacts of urban construction projects on health, and supervise for considerations of preventive sanitation. Ensure the rational distribution and location of construction projects; ensure that disposal of harmful materials is in accord with national standards, so as to avoid harmful impacts on the environment and on the basic resources for sustainable development.
9.70 Conduct research on urbanization and human health:
- (a) Conduct technical research on the prevention,
diagnosis and treatment of and recuperation from diseases associated with
urbanization, resulting from socio-economic, environmental, cultural and
population factors and psychological pressures; cooperative research should
be conducted by the biological sciences, behavioursim, sociology, psychology,
clinical medicine and so on;
(b) Conduct research on the prevention of chronic diseases, and seek effective cures for chronic diseases;
(c) Guided by theories of urban ecosystems, study the present situation, structures and characteristics of urban ecosystems and their evolutionary laws, so as to reveal the relationship between economic development, resource utilization, environmental pollution and human health, to provide the foundation and methodologies for making policies for the integrated renovation of the urban environments.
9.71 Promote community health education to enhance health awareness; master knowledge on the prevention, treatment and convalescence for major diseases; foster positive social attitudes, and eliminate unsanitary behaviours and habits. Prevent and eradicate pathogenic organisms.
9.72 Broaden knowledge and specializations amongst doctors; emphasize the training of general practitioners, while at the same time, training doctors who specialize in psychology, sociology, psychosis and recuperation. New specialized courses on psychological consultancy, psychological health, community medicine, environmental medicine and convalescent medicine should be offered in universities and colleges of medical sciences.
9.73 Formulate guidelines for the ideal constitution of diet and food consumption; conduct research on and develop factory-made food; develop nutritional supplements and food additives with Chinese characteristics; and develop food appropriate to the natural resources and traditional tastes of our country.
9.74 Conduct international and regional exchanges of information on urban sanitation and introduce advanced technologies and appropriate equipment for urban sanitation from foreign countries.
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