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May 03, 2011

Second thoughts on lessons of children's health in China

Nick Kristof opined a few days ago in the New York Times that while there’s every reason to be critical of China’s human rights record, we should also recognize the country’s achievements, especially in the field of health. The average life expectancy of children born in Shanghai, he points out, is now higher than the average life expectancy for American children. I admire Kristof’s work, both his writing from China a couple of decades ago and he and his wife’s wonderful work on behalf of women’s rights. And I think that in general, we need more analysis that reveals the complexities of China to U.S. readers, who are fed too many sensational and even xenophobic Yellow Peril stories in the mainstream press. But while the stats in his story seem to contrast the two countries, a closer look shows that his snapshot of the present ignores trends toward China and the U.S. becoming more and more alike, and not in a good way.

The apparent difference between Chinese and U.S. children’s health is, in part, an artifact of the two statistics he chooses to compare. Instead of the average Chinese child and average American child, it is the average Shanghainese child versus the average American child. In the U.S., average life expectancy is affected by the tens of millions of poor, uninsured people whose lives have gotten worse since 1980. And in China, a range of policies during this same period have sucked wealth out of rural areas and into cities, widening the wealth gap so that today, even relatively poor urbanites are still far better off than their country cousins. (And as one of China’s wealthiest cities, Shanghai is an increasingly unrepresentative subpopulation.) So yes, China has made admirable strides in children’s health programs, but because—like the U.S.—societal inequality is increasing, not everyone the same chance to benefit.

The other concern I felt while reading Kristof’s piece had to do with an article I had read a few days prior. It was an announcement from McDonald’s Corporation that they would be opening 700 new stores in China over the next two years. In all but the poorest countries, neither starvation nor communicable disease are the real threats to a long and happy life. Instead, people’s lives are shortened (and made more miserable) by non-communicable diseases brought on by the overconsumption of alcohol, tobacco and unhealthy foods. In the U.S., rates of obesity and associated illnesses shot up back in the 1980s, (and along with increasing inequality, have pushed down our life expectancy). But until just a decade ago, China’s diet was hailed as one of the healthiest in the world. Recently, though, China has seen a rapid increase in the consumption of meat, sweets and edible oils—much of it in the form of processed and fast foods—bringing on an obesity epidemic and skyrocketing rates of diabetes. (Alcohol and tobacco abuse are also on the rise.) The McDonald’s expansion in China, part of a fierce war for market share with other international fast food chains, shows that this trend is not slowing. So while there may be many things we can learn from China about children's health, it also appears that China may be following a dietary (and social) trajectory dangerously similar to ours.

Jim Harkness


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