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There is a crisis brewing in China. I’m not talking about anything military or political. The newly constitutionalized Xi Jinping Thought, a set of principles meant to guide Chinese economic, political, and military expansion in the next two decades, has been silent on the issue of national health care, which may threaten the long-term stability of China.

The first highly public sign of trouble came in a 2013 report published in the Journal of the American Medical Association by Chinese scientists from Peking University and the Chinese Center for Disease Control and Prevention. Their survey of more than 170,000 Chinese adults showed that 10.9 percent have diabetes, higher than the U.S. rate of 9.4 percent.

That percentage may not seem like a lot. But for a country as large as China, with an adult population of 1.1 billion, that means about 120 million people have diabetes, roughly equivalent to half of the entire U.S. adult population. Among the Chinese adults surveyed, a whopping 63.5 percent were unaware of their condition and only 32.2 percent were receiving some form of treatment. Of those being treated, only about half had their blood sugar under control.


Equally concerning is the number of Chinese adults with prediabetes. This intermediate condition often precedes diabetes. People with prediabetes have higher-than-normal levels of blood sugar, but not high enough to be classified as diabetes. In China, about 390 million people — more than the combined populations of the U.S. and Canada — have prediabetes. According to research published in the medical journal the Lancet in 2012, about 5 percent to 10 percent of all people with prediabetes convert to diabetes each year.

There is no cure for diabetes, so treatment involves daily management. And that isn’t cheap. A study published in the Lancet last year estimated the average cost of diabetes treatment through Chinese hospitals is around the equivalent of $3,200 per patient per year. If everyone with diabetes in China was treated at that cost, the annual price tag would be $385 billion per year, about twice the current annual health budget of the Chinese government.


Last year, average annual wages in China were around $12,000, which means that average Chinese citizens cannot pay for diabetes treatment on their own. And as consumer prices slowly increase in China, the health expenses for people with diabetes will likely increase to be more similar to the costs in other countries such as the U.S. ($13,700) and Japan ($6,100).

Diabetes often leads to other health issues such as heart attacks, kidney failure, and amputation, making medical costs even more expensive in the long run if early diagnosis and treatment are not properly implemented. That could pose another problem for China, where there are currently 1.6 physicians per 1,000 people, compared with 2.2 in South Korea and 2.5 in the U.S.

Diabetes is not the only condition that threatens general health in China. High blood pressure (hypertension) is another menace. It’s an important risk factor for heart attack, stroke, other cardiovascular events, and kidney failure. A study jointly published by Yale and the Chinese National Center for Cardiovascular Disease last month in the Lancet showed that about one-third of all Chinese adults have high blood pressure. Of these, less than one-quarter were taking medication for it and only about 5 percent had their blood pressure under control.

The Chinese government has, of course, been aware of these and other health issues. In the last 10 years, it spent more than $900 billion on reforming and upgrading the health system on a national level.

Nevertheless, doctors and scientists like myself can only worry that the new principles enshrined in Xi Jinping Thought focus too much attention on external expansion, military development, and competition with the U.S., leaving an epidemic in the country with fewer resources than it deserves — even though Xi Jinping Thought directly mentions climate change and the need to “improve the well-being of the people.”

One prudent way to do that would be to raise more public awareness about diabetes and high blood pressure, especially since both conditions are generally preventable through lifestyle changes and diet choices. The latter issue of diet is particularly important, given the rapid speed with which the Chinese diet has changed in recent years to include more processed foods, oil, animal fat, and refined sugars.

Justin Fendos, Ph.D., is the associate director of the Tan School of Genetics at Fudan University in Shanghai and a professor at Dongseo University in South Korea.

  • But to encourage the levels of awareness of diseases & self-care might lead to iniative & critical thinking skills about other areas in patients’ lives…
    Something that the current political trends in China’s govt don’t want.

    • Following the disastrous public health [non]response to SARS in 2003, the Chinese Health Minister was sacked, and the world witnessed an unprecedented opening up of China to collaboration on Public Health Emergencies of International Concern. NCD is a global problem, and international cooperation is required to manage the problem. The apparent apathy or ignorance on the part of Chinese leadership regarding this issue is more than a national security concern. In our interconnected world it is a global crisis.

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