While China was absorbing all the best that the "West" had to export to it over the past three decades (credit cards, MTV, inflation, apps, youtube), it was also importing the worst. Such as a sedentary, lazy lifestyle which at a massive social scale, usually has one inevitable conclusion - diabetes. And even as the world is focused on all the other pending crashes China has to offer: housing, credit, demographic, it has been largely ignorant of what is rapidly becoming a "catastrophic" epidemic. According to Bloomberg [7], which cites just released findings in the Journal of the American Medical Association, "the most comprehensive nationwide survey for diabetes ever conducted in China shows 11.6 percent of adults, or 114 million, has the disease. This means that another 22 million diabetics, or the population of Australia, have been added to a 2007 estimate and means almost one in three diabetes sufferers globally is in China. By comparison in America "only" 11.3% of the population have been diagnosed with diabetes.
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The bigger problem for China, unlike other "developed" countries that have a healthcare safety net to provide government assistance to a pathologically sicker, more obese population - one of the primary drivers for America's unsustainable healthcare government outlays as can be seen on the chart below - China has none, and to create it would require the kind of structural reform that China has been tentatively engaging in for years yet never fully implemented.
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So just how "catastrophic" is China's diabetes problem? Bloomberg explains [7]:
Chinese are developing the metabolic disease at a lower body mass index than Americans, the researchers found, meaning that changes in diet and physical activity stoked by rapid economic development are resulting in an earlier onset of the obesity-linked disease. The epidemic will worsen with 40 percent of 18-to-29-year-olds on the verge of developing diabetes, which increases the risk of stroke, heart attack and kidney failure.
“Diabetes in China has become a catastrophe,” said Paul Zimmet, honorary president of the International Diabetes Federation and director emeritus of the BakerIDI Heart and Diabetes Institute in Melbourne. “The booming economy in China has brought with it a medical problem which could bankrupt the health system. The big question is the capacity in China to deal with a health problem of such magnitude.”
China overtakes the US in diabetes:
Yesterday’s report is based on a survey of a nationally representative sample of 98,658 Chinese adults in 2010. A similar survey in 2007 pegged diabetes prevalence at 9.7 percent, or 92.4 million adults. The latest results means diabetes is now more common in China than in the U.S., where 11.3 percent of adults are diabetic.
The Brussels-based International Diabetes Federation estimates there are 371 million people worldwide with the disease, including 92.3 million in China.
The increase in the prevalence of diabetes in China, estimated at about 1 percent in 1980, has been “unparalleled globally,” Zimmet said in a telephone interview.
“China is now among the countries with the highest diabetes prevalence in Asia and has the largest absolute disease burden of diabetes in the world,” wrote authors led by Guang Ning in the laboratory for endocrine and metabolic diseases at the National Health and Family Planning Commission. “Poor nutrition in utero and early life combined with over-nutrition in later life may contribute to the accelerated epidemic of diabetes in China.”
But if 114 million is catastrophic, what adjective will be used when the nearly half a billion already with high glucose levels develop the disease? Just how massive would the healthcare safety net have to be to deal with the fall out of hundreds of billions in annual healthcare needs?
The study incorporated measurements of glycated hemoglobin A, or HbA, into its diagnosis, adopting updated guidelines from the American Diabetes Association, in addition to tests used in earlier studies: glucose readings taken after patients fasted for a period of time, and a measurement of the amount of sugar in the blood two hours after patients consumed a sweet drink.
The added criteria may have partly contributed to the increased prevalence, Guang and colleagues wrote. The scientists estimate half of adults in China, or
493.4 million people, have higher-than-normal blood glucose levels, which put them in a pre-diabetic state.
“These data document a rapid increase in diabetes in the Chinese population,” according to the study’s authors, who include researchers from Beijing’s Chinese Center for Disease Control and Prevention and Johns Hopkins University in Maryland. “Diabetes may have reached an alert level in the Chinese general population, with the potential for a major epidemic of diabetes-related complications, including cardiovascular disease, stroke, and chronic kidney disease.”
And since nearly two-thirds of those with diabetes have no idea they are sick, it is possible that the real number of Chinese diabetics is over 300 million, or almost as much as is estimated total global sufferers.
Almost two-thirds of patients treated for diabetes didn’t have adequate blood-sugar control, the authors found. For every person in China diagnosed with diabetes, at least two more will be unaware they have it.
Why are so many Chinese suddenly falling sick? Same reason as in America: behavioral changes, in this case affecting primarily a population that is even more susceptible than westerners.
“Rapid lifestyle changes in China have caused rising trends in obesity, and that is now bringing out the abnormality of a people biologically more vulnerable to diabetes,” Juliana Chan, a professor of medicine and therapeutics at the Chinese University of Hong Kong, said in a telephone interview.
As in the rest of Asia, the burden of diabetes is falling disproportionately on the young and middle-aged, the authors said. Pre-diabetes was present in 40 percent of adults ages 18 to 29, and 47 percent among those 30 to 39.
Finally, the costs of prevention, and failing that, for hundreds of millions sick, will be obviously staggering:
China’s rising prevalence of diabetes has strained its health services and helped fuel a 20 percent-a-year growth in drug sales, stoking the need for newer and costlier medications from companies including Merck & Co., Novo Nordisk A/S and Sanofi.
China’s government is trying to fight the scourge by expanding basic medical coverage, buying more medicines in bulk to lower costs, and conducting a corruption probe of international drugmakers, including GlaxoSmithKline Plc.
Which begs the question: is the recent crackdown on western healthcare providers merely a salvo in what will be a "quid pro quo" in which China will allow the large western pharma companies access to the massive Chinese market on the condition that these companies fund a portion of the preventative healthcare needs of the Chinese population? If so, and since the Glaxos of the world thrive on obese, sick people (bribes or not), we doubt this "catastrophe" will have a very happy ending.
And just to get a sense of the scale of the global diabetes epidemic, here is a reminder from AFP [10]:
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