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China’s achievements in health and life expectancy over the past four decades have far exceeded what could be expected for a country at its stage of economic development, according to a recent World Bank evaluation. Behind these dramatic gains in public health was an extraordinary campaign for the Chinese people carried out by the central government, which provided family planning, childhood immunization, accessible primary health care (particularly for mothers and children), improved nutrition, infectious disease control, better education, and improvements in housing and sanitation. (See Most Chinese Have Safe Water and Sanitation.) Morbidity and mortality from infectious diseases continue to decline on average in most areas of China, although in remote and poor regions, the levels of communicable disease remain much higher than the national averages. The overall success of these programs can be attributed to the central government’s approach of adopting the best of traditional methods and wedding these with modern methods. For instance, a campaign to eradicate major public health scourges, such as diphtheria and syphilis, succeeded in large part because it involved vast numbers of traditional doctors in the rural areas [83].
| Most Chinese Have Safe Water and Sanitation | ||||||
| Access to Safe Drinking Water and Sanitation Among Selected Countries in Asia, 1990 | ||||||
| PERCENTAGE OF THE POPULATION WITH ACCESS TO
| ||||||
|---|---|---|---|---|---|---|
| SAFE DRINKING WATER
|
SANITATIONa
| |||||
| COUNTRY | URBAN | RURAL | TOTAL | URBAN | RURAL | TOTAL |
| China | 87 | 68 | 72 | 100 | 81 | 85 |
| India | 86 | 69 | 73 | 44 | 3 | 14 |
| Indonesia | 35 | 33 | 34 | 79 | 30 | 45 |
| Sri Lanka | 80 | 55 | 60 | 68 | 45 | 50 |
| Japan | 100 | 85 | 96 | 100 | 100 | 100 |
Source: The World Bank, Clear Water, Blue Skies: China’s Environment in the New Century (The World Bank, Washington, D.C., 1997), Table 2.2, p. 20. Notes: a. Assumes that residents have access to water for washing and that sewage is removed from the house through outdoor latrines, night-soil collection systems, or flush toilets. | ||||||
Along with rising income and improved literacy rates, the era of reform has brought more environmental awareness to the Chinese people. A few recent studies in China showed that as communities have become wealthier and better educated, the public has begun to push for stronger regulations and enforcement [84]. The increase in media coverage of pollution accidents has contributed to the public’s awareness. A popular saying in China’s developed eastern region is, “The house is new, the money is enough, but the water is foul and the life is short” [85].
How will China set priorities to prevent environmental exposures and protect public health? Although the government has already begun to address particulate and SO2 emissions, much remains to be done. While regulatory standards will likely reduce emissions from power plants and state-regulated industries, smaller residential sources and TVE industries will continue to threaten air quality. Residential coal burning for cooking and heating will continue to be a major source of exposure until there is more universal adoption of cleaner fuels. Even though the government has focused some attention on mobile source pollution, it will be a difficult problem to address, given the rapid expansion of the fleet of vehicles.
83. “Decision on Public Health Reform and Development by the Central Committee of the Chinese Communist Party and the State Council,” People’s Daily (February 18, 1997, Beijing), p. 1.
84. Op. cit. 12, p. 13.
85. Report of the 4th National Conference on Environmental Protection, (China Environmental Sciences Press, Beijing, 1996), p. 32.