This rising East Asian economy—already one of the world’s largest—is approaching a standard of living enjoyed by developed nations. And with this prosperity have come health care challenges similar to those we face in the United States.
Cardiovascular disease, sexually transmitted diseases (STDs), tobacco control, and health care reform were on the minds of Chinese researchers from Peking University (PKU) in Beijing when they visited UNC-Chapel Hill January 30-February 1. They came to discuss solutions to these challenges with their U.S. counterparts at the second annual conference of the PKU-UNC Global Health Forum.
“Finding better ways to provide health care is a critically important challenge for this country and China,” said UNC Chancellor James Moeser at the conference’s opening session. “Our work in particular with international partners is already improving and saving lives both here and around the globe.”
This year’s conference—“Health Crises and Disparities: Working Together on Solutions”—followed the first meeting of the institutions in Beijing in December 2006.
“We need not only the joint hands of organizations, but the collaboration of researchers,” to tackle crises as urgent as health care system reform in China, said PKU Vice President Hai Wen. “We cannot solve the problems solely on our own…we cannot afford the time and lives wasted.”
Through the pooling of knowledge and resources, PKU, UNC and several North Carolina firms specializing in public health, policy research, and pharmaceuticals are already collaborating.
The forum was organized by the Office of International Affairs and the Guanghua School of Management at PKU. It was co-sponsored by RTI International, Quintiles Transnational, Family Health International (FHI), BlueCross BlueShield of North Carolina, the Research Triangle Regional Partnership, and the UNC Center for AIDS Research.
“If you are going to be a global university, you have to work with China,” said Myron Cohen, M.D., director of the UNC Institute for Global Health and Infectious Diseases, a newly formed interdisciplinary research program addressing challenges like preventing syphilis transmission in China, fighting HIV/AIDS in Malawi, and finding a cure for African sleeping sickness.
“We have a privilege because we have very good, long-time collaborators [with the Chinese],” Cohen added. “These are not new relationships created for the purpose of having a forum. The forum is a vehicle for building on these established relationships.”
UNC is partnering with the China Centers for Disease Control and Prevention (CDC) to improve China’s antiretroviral therapy database.
UNC has worked with China’s National Center for STD Prevention and Control through Fogarty International and is a part of the World Health Organization-funded effort to provide rapid syphilis testing in China.
UNC and Beijing Anzhen Hospital are collaborating on the “Bridging the Gap” (BRIG) Project funded by the World Heart Federation to improve the quality of care for coronary heart disease patients in China.
DIALOGUE OF EXPERTS
Heavy-weight intellectuals from both sides of the Pacific were on display on the conference, but their intent was not to toss about lofty hypotheses. They came to discuss concrete change in China and the United States.
Change is needed for a broken system of health care in both countries that would forget the underprivileged, except for the charity of some health providers, said keynote speaker Uwe Reinhardt.
“In some ways what we are doing is angelic, so well-motivated,” said Reinhardt, professor of political economy, economics and public affairs at the Woodrow Wilson School of Public and International Affairs at Princeton University. “But, by our goodness we are in fact allowing the politician to let this system linger, fester.”
So, consider the ethics of your model of health care, he implored his audience: “That is not an arbitrary decision. It really depends on what the social goals are that you posit for your health system….The crucial thing is to set the social goals.”
The featured speakers and panelists at the conference came from academia, business, the government, and non-profit sector. All harped on the common good in public health.
“We wanted to take this idea of global health and, instead of just an academic exercise, make it a dialogue with policy makers, researchers, and the business community,” said Tom Martineau, China projects manager for the UNC Associate Provost for International Affairs.
HIV AND STDs
The HIV epidemic in China continues to expand, but at a slowing rate, said Zhang Fujie, director of the Division of Treatment and Care at China’s National Center for AIDS.
“In recent years, the Chinese government has really paid attention to HIV/AIDS care,” with a comprehensive policy, including free drug therapies for HIV patients, free counseling and testing services, and free education for children orphaned by HIV/AIDS, he said.
However, prevention efforts remain a challenge as the number of public health workers is few and the populations most at risk of HIV infection are difficult to reach .
“We need to be thinking about gender-based interventions,” said RTI’s Wendee Wechsberg, who has researched HIV/AIDS prevention among at-risk, drug-using women.
“Condoms are not the answer,” she explained. “In my work, women are not taught how to use male condoms or how to negotiate their use with male partners. So, we need to integrate sexual negotiation into our interventions.”
Meanwhile, other STDs are re-emerging as a public health threat in China but do not receive much attention from the government.
According to national case-reporting systems, syphilis has increased by more than 20 percent since the mid-1990s, reported Chen Xiang-Sheng, director of STD epidemiology at China’s National Center for STD Prevention and Control.
However, “the percentage of the health funds dedicated to STDs in provincial government budgets is 1 to 2 percent of the funds allocated for HIV alone,” Chen said.
One billion people in the world will die from tobacco-related causes in the 21st century unless something changes, said Adam Goldstein, director of the UNC Tobacco Prevention and Evaluation Program.
“Cigarette smoking is not a God-given right to humanity, it is a 20th century epidemic,” Goldstein said. “Thinking of it as a disease, the industry is the vector.”
China, with one-third of the world’s smokers, is the largest producer of cigarettes in the world. Controlling tobacco use has become a major health and economic concern of the Chinese as smoking-related illnesses have caused 1 million deaths a year and cost the country about $5 billion, said Teh-wei Hu, professor emeritus at the University of California at Berkeley School of Public Health.
“I especially want to learn about the success in a tobacco-producing state like North Carolina of tobacco control and crop replacement,” Hu said.
UNC is exploring adapting its tobacco-free campus model to promote physician advocacy and tobacco-free hospitals in China, where nearly half of all male physicians smoke, Goldstein said.
“We’ve done a lot of work mobilizing physicians and NGOs in North Carolina to become leaders and advocates with the public health department for all these changes,” he explained .
Tobacco use leads to chronic illness, a now familiar term in China and the United States.
For example, cardiovascular disease, principally heart disease, has become the top cause of death in China, according to Zhao Dong, deputy director of the Beijing Institute of Heart, Lung, & Blood Vessel Diseases.
In the United States, chronic heart disease already constitutes a major portion of the national disease burden.
“It’s costing $24 billion and a million hospitalizations to take care of heart failure patients,” said Shula Bernard, a senior health services researcher at RTI.
One way to reduce those costs is to improve the quality of patient care at the first incident, said Sidney Smith, director of the UNC Center for Cardiovascular Science and Medicine.
“There’s nothing quite like having a heart attack to make you do something different, or having the physician turn on a saw and open your chest,” Smith said. “It’s a teachable moment.”
Physicians need to take advantage of this moment to educate the patient on behavioral change to prevent further heart attacks, he explained: “Starting patients on a therapy in the hospital seems to have better results.”
HEALTHY POLICY REFORM
Getting patients into the hospital to be treated is another story.
China’s recent prosperity has not translated into cheaper health care for the Chinese people, said Gordon Liu, professor and chair of the department of health economics at PKU and former professor of health economics at the UNC School of Pharmacy.
For example, the cost of a hospital admission would cost nearly 90 percent of the average Chinese citizen’s income for the year, said Liu, the principal investigator on the largest urban health insurance study ever done in China.
“How many people are exposed to that high risk?” he asked rhetorically. “There are 600 million people [in China] without health insurance at all.”
The federal government has spent so much on propelling China’s economic growth that it has left relatively little for social welfare programs, including health, Liu said.
“Without changing the system, it is harder to make changes for disease-specific issues,” he said. “China is hungry for change.”
Preparations for the next conference in the fall in Beijing are already underway, says Tom Martineau.
At the closing ceremony on February 1, Scott Stroup, associate professor of psychiatry in UNC’s School of Medicine, and Barry Popkin, professor of nutrition in the School of Public Health, introduced possible themes for the upcoming conference: mental illness and obesity.
In high- and middle-income countries, like the United States and China, mental disorders account for 17-32 percent of the total burden of illness, Stroup said. Meanwhile, the rise in obesity in China, as in the United States, is well-documented; nearly 30 percent of Chinese are overweight or obese, Popkin said.
The attention paid to these health issues will rise with the help of partnerships like the PKU-UNC Global Health Forum, Cohen predicted.
“If you had this meeting 10 years ago, there would have been 10 people here,” he said. This year’s conference drew more than 300 attendees. “As the University globalizes, and as we see China as a vital partner, I think you’ll see more and more people interested.”
For more information, visit the conference web site at http://www.pkuuncglobalhealthforum.org/