INTRODUCTION

9.1 In the more than forty years since the founding of the country, China has had significant developments in health care. The level of health of the Chinese people is now in the front ranks of developing countries in the world. However, many difficulties and problems still exist. Problems, such as imbalances in the development of health care, the backwardness of rural health care, challenges with respect to urban sanitation, and the high incidence of some diseases, seriously jeopardize people's health. Other problems, like an overly rapid increase in population, the ageing of the population, environmental pollution, changes in the disease structure, changes in the system of payment for medical treatment, also affect people's health and the development of the health care.

9.2 According to the general aims for economic and social development in the 1990s and into the next century, the overall objectives of China's health work and development are that all people will have access to basic health care, and, in general, everyone will enjoy levels of health care coincident with relatively higher living standards. In concrete terms, these objectives include the following:

(a) Forming local health care networks which combine primary health care facilities and those offering more comprehensive services, so as to enable urban and rural people to acquire basic medical care services close to home;

(b) Establishing various forms of health care systems appropriate to existing conditions in China; these will include systems for publicly-funded health care, worker's compensation and employer funded medical care, and general medical insurance, in order to raise people's capacity to bear the financial burden of illness;

(c) Protecting the environment; reducing the social effects of environmental pollution; improving the quality of drinking water and health conditions for rural people; controlling the sources of urban water pollution, air pollution, industrial waste pollution, and noise pollution;

(d) Getting the threat of infectious and endemic diseases under basic control; gradually conducting comprehensive prevention campaigns against chronic and non-infectious diseases; paying attention to improving the environment in regions of endemic disease; emphasizing the prevention, as well as the treatment of diseases;

(e) Setting up broadly-based health care management systems and giving safe and effective guidance for family planning;

(f) Providing the public with information about nutrition and the healthful preparation of food, physical education, healthy life styles, and other guidance to enable them to stay healthy in body and mind and to strengthen their constitutions.

9.3 Since health and sanitation work interfaces with other areas, references are made to the program areas of other relevant chapters, in particular Chapters 10, "Development of Sustainable Human Settlements"; 13, "Sustainable Energy Production and Consumption"; 14, "Conservation and Sustainable Use of Natural Resources"; 18, "Protection of the Atmosphere" and 19, "Environmentally Sound Management of Solid Wastes".

9.4 This chapter includes the following six program areas:

PROGRAM AREAS

A. Meeting Basic Needs for Health Care

Basis for action

9.5 The purpose of providing primary health care services and of meeting basic needs for health care is to serve the whole society and to improve conditions for health, by extending health services as far as possible to every arena of people's work and life, through the extensive participation of government, health administrations, appropriate departments, medical institutions, communities and individuals. It will mainly involve the improvement of health conditions, the prevention and treatment of diseases and the provision of convalescence services, since these are basic requirements for all members of society.

9.6 With national economic development and continuous improvements in people's living standards, demands on medical services and health care are constantly growing, while the discrepancy between the demand for urban and rural medical services and the supply of health care resources becomes wider. The discrepancies are primarily in the following areas:

(a) A shortage of health resources in the rural areas; a reduction of already insufficient investment by the state and collectives for rural health care; the concentration of manpower, materials and funds in large cities; simple, rudimentary medical and health care facilities; limited personnel and low technological levels in rural areas, especially in remote regions and regions where minority nationalities live;

(b) An uneven distribution of health care resources in cities; over-burdened services in large hospitals; inadequate technical and financial support to small hospitals, which greatly affects their development and makes it difficult for them to undertake work in disease prevention, health care and recuperation;

(c) Increasingly heavy burdens for disease prevention, health care and convalescence. With the development of the national economy and health care, people's living standards have been rising and conditions for health have greatly improved, however, the incidence of chronic and non-infectious diseases is gradually rising. At the same time, issues such as an ageing population, environmental pollution, the prevention of chronic diseases, health care and convalescence are becoming major public issues, requiring urgent attention and solutions both now and for decades to come.

Objectives

9.7 By the year 2000, most villages will have established their own clinics, been equipped with the medicinal herbs of most use in treating both common and endemic diseases, and will have facilities for providing basic medical care; 90% of counties and townships will have established medical facilities for offering primary health care.

9.8 Provincial capital cities will serve as medical servicing and technical guidance centers, and will offer medical treatments, education about disease prevention and health care, and medical training. They will also be involved in scientific research on advanced medical technologies, and by servicing a network of small and medium-sized cities, will spread medical care from capital cities to counties and rural areas.

9.9 Undertake comprehensive work in disease prevention, health care and convalescence which is appropriate for an ageing population and an evolving structure of diseases, and which is directed against the rising incidence of chronic and non-contagious diseases and of diseases caused by environment factors, life styles, psychological and other social factors.

9.10 Strengthen quarantines, especially for customs and foodstuffs; strengthen work in prohibiting and counteracting narcotics.

Activities

9.11 Improve and strengthen the three-tiered system for urban and rural preventative medicine and health care. Establish comprehensive health care service systems focused on providing primary and basic health care:

(a) Improve conditions in township and village clinics; train medical technicians to ensure that they are capable of carrying out medical treatment, health care and preventative medicine work;

(b) Improve county-level medical institutions and make them centers for providing rural health services and technical guidance;

(c) Use hospitals as centers, gradually extend services for the prevention of diseases, medical care and convalescence so as to enhance integrated benefits in the utilization of health resources and medical services;

(d) Improve combining health care with family planning services, and improve the quality of family planning services;

(e) Develop and popularize medical technologies suitable for rural areas, in order to meet rural people's basic requirements for medical treatment and health care;

(f) Take basic health care to be fundamentally important, rely on the three-tiered network of medical treatment and health care, and strengthen medical treatment, medical care, disease prevention and control, and emergency services and convalescence;

(g) Gradually establish and extend community health care systems, from hospitals to residential districts to households; train appropriate personnel.

9.12 Strengthen ties between urban and rural areas. Establish regional health care systems that rationalize the regional disposition of health care services. Between urban and rural areas, establish technical service networks, which are oriented towards providing grassroots and rural area health care, and which are backed up by services in small and medium-sized cities.

9.13 Promote the establishment of rural health care systems, and continually enhance the capabilities of rural people to work together to deal with illnesses.

9.14 Organize and institute quarantine systems. Speed the modernization of quarantine technologies. Encourage people to be active in the prohibition and opposing of narcotics.

9.15 Cooperate with appropriate international organizations in the construction of the three-tiered urban and rural medical prevention and health care network, particularly with respect to the training of rural doctors, the development of regional medical systems and community health care, and strengthening international cooperation in the prohibition and fight against narcotics.

B. Minimizing the Impacts of Environmental Pollution on People's Health

Basis for action

9.16 Pollution by chemicals, radioactive substances and bacteria in the environment seriously threaten people's health. Reduction of the effects of environmental pollution on human health is a very important issue for social development at present and into the 21st century.

9.17 Air pollution resulting from the burning of coal is the main reason for China's poor quality of indoor and outdoor air. At least 80% of urban dwellers live in a environment which has a very poor quality of air. The burning of coal with a high fluorine content has resulted in endemic coal-burning fluorine poisoning in over 17 provinces, municipalities and autonomous regions in China. In recent years, the supply of water has increased a great deal in urban and rural areas. However, according to a nation-wide investigation into potable water in 1989, 82% of the Chinese people drink water from shallow wells and rivers, 76% of which have been heavily polluted, or where bacteria content exceeds sanitary standards. Approximately 160 million people drink water seriously contaminated by bacteria. There are about 47 million people who do not have sufficient potable water. According to the reliable reports on the breakdown of infectious diseases, the percentage of intestinal diseases rises each year. With the increasing extensive use of radioactive isotopes and X-ray devices, the effects of radioactive substances on human health should not be neglected. Accidental irradiation to personnel engaged in radiation-related work and the public occurs very often. At present, food production is still at a basic stage, where various kinds of biological and chemical contamination are not under control. Food poisoning and other food-related diseases frequently occur and, at present, there is no sufficient guarantee of food security.

9.18 Poor work environments have resulted in serious occupational diseases. According to statistics from 1949 to the end of 1991, a total number of over 470,000 people have been infected with pneumoconiosis in above-county level state-owned and in collectively-owned enterprises. This number equals the total number of pneumoconiosis found in all other countries in the world during the same period. From present estimates of dust concentrations during production activities, an additional number of 20,000 to 30,000 cases of pneumoconiosis will be added annually in the future. There are over 1,000 serious incidents of occupational poisoning every year, with about 2,000 people being affected. The incidence of occupationally-induced tumors is another issue that awaits urgent attention.

Objectives

9.19 Protect and improve people's health while developing the economy. Prevent and reduce the incidence of infectious, environmental and occupational diseases, as well as occupational poisoning and food poisoning associated with environmental pollution. Eliminate the potential threat to health from various kinds of environmental pollution. Improve people's physical and mental health by gradually improving their living and working environments, and raising conditions for their material and spiritual lives:

(a) Expand systems of legislation for sanitation, sanitation standards, sanitation inspections and monitoring, which are all necessary for security of health;

(b) Eliminate environmental factors that are damaging to health, and improve the quality of the environment;

(c) Work out plans for scientific research and monitoring related to the environment and health, encourage the application and popularization of scientific and technological achievements, and facilitate the prevention and treatment of diseases.

9.20 Gradually improve conditions in work places to create working environments of high standards, so as to reduce the incidence of occupational diseases. Attempt to achieve the following goals: decreasing occupational poisoning due to gradual exposures to harmful substances by around 5% every 5 years; and decreasing illness due to exposure to radiation by around 3% every 5 years.

Activities

9.21 Establish and improve legislation for the supervision of sanitation, for sanitary standards, and for systems for supervising and testing sanitary conditions. Details are as follows:

(a) Formulate and promulgate sanitation standards, which draw attention to harmful substances in the environment and their relation to human health; establish sanitation standards concerning pesticide residues in foodstuffs, which specifically refer to the kinds of pesticide made in China;

(b) Establish a supervisory system for sanitation that is scientific, reasonable, practical, and that can be enforced, so that health administration departments at all levels can set up supervisory net- works for sanitation, which are suited to the development of the national economy;

(c) Establish laws and regulations for occupational health and the protection of labor, with every level of government being responsible for supervising the enforcement of the laws and regulations.

9.22 Gradually establish mechanisms for coordinating health care with environmental protection. Strengthen policy coordination and information exchange, the coordination of action and improve management capabilities.

9.23 China will implement the following strategies to reduce harmful environmental factors and raise sanitation levels:

(a) By the year 2000, the coverage rate for water supply networks will be raised to over 95% in cities and in rural areas approximately 80% of the water supply will be of potable quality;

(b) The total number of city dwellers suffering the effects of severe air pollution will be reduced to less than 40%, through adjustments in the fuel structure, extending district heating systems (refer to Chapter 12), installing dust and SO2 elimination equipment in factories and boilers (refer to Chapters 11 and 12), and increasing afforestation (refer Chapter 16);

(c) In the catering industry, raise the sanitary quality of food; ensure that 85% of urban and 75% of rural catering facilities meet standards of disinfections, and that 95% of foods subjected to selective examination meet sanitary standards;

(d) Through improvement in the management of industrial and municipal solid wastes, especially with respect to landfill facilities, reduce or eliminate odors, insect breeding and water contamination; by the year 2000, 20 % of wastes should be disposed of in an environmentally- sound way throughout the country, and not less than 10% of total wastes in any one region should be so disposed (refer to Chapter 19);

(e) Through legislation, control programs and public awareness campaigns, reduce intakes of pollutants from food, especially for reducing accumulation of heavy metals, pesticides and organic chlorine compounds in human bodies and in the environment;

(f) Create working environments of high standards; reduce the dangers of dust, hazardous gases, chemicals, noise, etc. to workers' health; improve work place conditions to eliminate both physical and mental hazards to workers; governmental departments should supervise the working environment of enterprises in their sectors;

(g) Restore the environment in a planned way in the districts where the environment has been severely polluted and public health has been affected.

9.24 Strengthen the system for monitoring and testing for sanitation, enhance supervisory capabilities for environmental quality, control hazardous conditions:

(a) Conduct national monitoring of quality of potable water and tests for water-borne diseases;

(b) Conduct selective monitoring of indoor air quality in various types of houses using various kinds of fuels;

(c) Set up monitoring stations to monitor and test environmentally-sound disposal of solid wastes and hospital waste water;

(d) The rate for sites using radioactive substances meeting safe standards should reach 95%; monitoring and testing for radiation will be conducted within a radius of 50 kilometers of nuclear power stations;

(e) The coverage rate for testing for sanitary food-by-food inspection departments will reach 100%;

(f) Set up monitoring stations in provinces and cities, where occupational diseases occur most frequently. Stations will be established to monitor and test workers health in 95% of industries; 70% of industries examined for dust and hazardous substances should meet standards;

(g) Conduct biological surveys on the impacts of environmental pollutants on human health and on the load capacity of human bodies; conduct regular biological surveys on the content of lead, cadmium, arsenic, mercury, and organic chlorides in humans;

(h) Monitor diseases caused by environmental pollution in key polluted industrial areas, and set up no less than 10 monitoring stations.

9.25 Establish information networks. Strengthen quality control for the collection of information, statistics and analysis. Establish databases for various types of information:

(a) Data base on environmental pollutants. Collect information on the distribution, scale, nature and degree of pollutants. Those pollutants which are widespread, which are seriously harmful to health and which are difficult to eliminate will be chosen as priority targets for monitoring, so as to provide a scientific basis for environmental medicine and treatment;

(b) Data base on poisoning and diseases caused by environmental pollution accidents. Report through computer networks on public poisonings or sudden incidence of diseases. The rate of reporting should exceed 80%;

(c) Data base on occupational diseases. The coverage rate of occupational health files in enterprises above county level should reach 95-100%, and in township enterprises, 60%.

9.26 Compile and analyze the data collected and the results of research, and publish the findings in order to educate people so that they can improve their ability to look after their own health. Inform and guide authorities in other sectors to take necessary measures to alleviate health hazards and environmental pollution.

9.27 Conduct research on the impact of environmental pollution on human health and measures to counteract those impacts; publicize the results of the research regarding:

(a) The impact of rare elements in the environment on human health;

(b) The relationships between air pollution, and in particular, indoor air pollution, with lung cancer, respiratory diseases and diseases of the nervous system;

(c) The relationship between toxic chemicals in water and food, and digestive cancer and cardiovascular diseases;

(d) The impact of environmental and ecological changes (such as acid rain, global warming and ozone layer depletion) on health;

(e) The ecological impacts and potential health threats of synthetic chemicals;

(f) Methods for formulating sanitary standards for carcinogens and evaluation of the risks of substances causing debilitation;

(g) Through biological monitoring, a study of immunities and of genetics, develop indicators which measure the effects of environmental factors on human health;

(h) Research on economic losses caused by health affected by environment pollution.

9.28 Human resources development:

(a) Allow medical management personnel and medical technicians to work effectively; continually offer them opportunities to upgrade their knowledge and skills so as to improve their work proficiency and efficiency;

(b) Offer new courses in regulations for hygiene, environmental medicine, and the economics of hygiene in medical universities and colleges, so as to ensure that trained personnel can meet the needs of economic construction and for the administration of hygiene regulations throughout the country;

(c) Strengthen cooperation amongst departments of health care, environmental protection and public education. Conduct massive campaigns concerning the environment and health to help people be aware of the relationship between the environment and health.

C. Controlling Infectious Diseases

Basis for action

9.29 China is a developing country, in which infectious diseases will remain a major concern for a long period of time. Giving priority to the prevention of and effective control of infectious diseases, and thereby improving conditions for people's health is essential for guiding the work of China's medical services and health care and an important foundation for ensuring the sustainable development of the national economy.

9.30 Some infectious diseases have effectively been brought under control following research into infectious diseases, the development and use of the inoculations, treatments, preventative measures, traditional Chinese medicine and the establishment of health care networks. Nevertheless, many infectious diseases, like cholera, viral hepatitis, leptospirosis, diarrhoea, schistosomiasis, malaria, haemorrhagic fever, encephalitis B, and tuberculosis, are still seriously affecting human health. The incidence of venereal diseases and AIDS is growing.

Objectives

9.31 Specific objectives:

(a) Wipe out infantile paralysis and eliminate native wild toxic strains in China by the year 2000;

(b) Eliminate infantile tetanus by 1995 and reduce the incidence of measles by 50 - 70% during the 21st century;

(c) Cut the incidence of viral hepatitis by 50%. Eliminate hepatitis A in the early 21st century, and reduce the antigen-carrying rate of hepatitis B from the present 10% down to less than 1%. Eliminate hepatitis E in the 21st century, and reduce the virus-carrying rate of hepatitis C down to less than 1%;

(d) By the year 2000, retard the rate of increase in AIDS infection and the number of AIDS patients. During the 21st century, through global efforts, current trends indicating increases in the rate of AIDS infection will be curbed. Retard the rise in incidence of gonorrhoea and syphilis until the year 2000 and then decrease it with each passing year;

(e) Strengthen cholera prevention so that, by the year 2000, it will no longer be spreading, and by the middle of the 21st century, it will no longer be prevalent;

(f) Reduce the incidence of bacillary dysentery to an incidence rate of 30 to 50 per 100 thousand people during the early 21st century;

(g) By the year 2000, reduce the incidence of tuberculosis to an incidence rate of 114 per 100 thousand of people in cities and 266 per 100 thousand people in the rural areas;

(h) Reduce the incidence of schistosomiasis in the affected regions to below 5% by the year 2000.

Activities

9.32 Strengthen the monitoring and control of infectious diseases:

(a) Formulate plans for the monitoring and treatment of municipal faeces and hospital sewage; the implementation of plans should be supervised by environmental protection agencies;

(b) Strengthen existing monitoring stations for diseases, such as haemorrhagic fever, epidemic encephalitis, schistosomiasis, malaria, filariasis, kala-azar, anthracene and leptospirosis; improve monitoring measures; ensure full prevention measures against the existence, spread and outbreaks of infectious diseases.

9.33 Expand the system of inoculations:

(a) Consolidate and expand the immunization system so as to maintain the current inoculation rate of over 85% of children being immunized against poliomyelitis, hepatitis B, measles, Bacilli Calmette-Guerin (BCG) and diphtheria;

(b) Gradually include the encephalitis B vaccine and the epidemic encephalitis vaccine into the planned immune inoculation system in order to control encephalitis B and epidemic encephalomyelitis.

9.34 Control AIDS, enteric and entomophilous infectious diseases:

(a) Devise objectives for the AIDS prevention and control plans, with a view to preventing the spread of HIV;

(b) Strengthen the administration and supervision of food hygiene to ensure that food offered for consumption meets standards;

(c) Accelerate improvements to water supplies in rural areas and to the management of the disinfections of city tap water to ensure that drinking water meets hygienic standards so that the spread of enteric infectious diseases can be controlled;

(d) Decrease the incidence of leptospirosis through the widespread use of agricultural machinery; include the changing of the natural sources of epidemics into the overall plan for environment and development.

9.35 Control parasitic diseases:

(a) Include monitoring important parasitic diseases into the national infectious diseases monitoring system; strengthen the administration of the monitoring system and improve the forecasting system for the incidence of these diseases;

(b) Enhance health education; raise public awareness of their own role in protection against diseases and in disease prevention.

9.36 Strengthen cooperation amongst departments concerned. The prevention and control of infectious diseases can be achieved only through close cooperation with women's federations, trade unions, and the governmental departments concerned with education, health, agriculture, city planning, water conservancy, commerce, the chemical industry and the media.

9.37 Control environmental factors contributing to infectious diseases. Some infectious diseases are closely related to environmental factors. Enteric infectious diseases can be effectively prevented and entomophilous infectious diseases reduced through having safe water supplies, the disinfections of sewage, the sound management of food hygiene, the appropriate disposal of garbage and the killing of mosquitoes and flies. Transformation of the environment and elimination of oncomelania can effectively prevent schistosomiasis.

9.38 Support scientific research:

(a) Strengthen and broaden multi-disciplinary research; conduct joint research and cooperation in epidemiology, immunology, molecular biology, social medical science, social economics, and environmental medicine in order to work out approaches for the control of infectious disease;

(b) Improve existing vaccines for poliomyelitis, measles, hepatitis B, hepatitis A and the pertussis-diphtheria-tetanus triple vaccine; develop genetic engineering vaccines so as to improve immunity effectiveness; conduct research and development of genetic engineering vaccines for enteric infectious diseases, such as cholera, dysentery and typhoid fever.

9.39 The emphasis of China's health and sanitation work is on the control of infectious diseases. It is of vital significance to secure international financial aid for doing this. The cooperation and support of the international community for funding, equipment, technologies and training are needed in the prevention and cure of viral hepatitis, diarrhoea, AIDS, entomophilous infectious diseases, tuberculosis, parasitises and diseases associated with the immunization of children.

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 benefited 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 programs.

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 counseling, childbirth counseling, 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 centers 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 program 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 cannot 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 neighbors 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 tumors, 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 programs, 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, behaviorism, 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 behaviors 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.