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Despite their marked differences in ideology and economic advances, the industrialized and developing countries on the Pacific Rim must join in the same battle to fight their common enemy in the 21st century the threat of chronic diseases.
This was the consensus among representatives of public health institutions and non-government organizations from countries attending a recent conference.
Participants pointed out many countries had made the same mistakes in their pursuit of economic prosperity and scientific and technological advances in the late 20th century.
Medical resources are pumped into the treatment of late-stage diseases rather than the prevention of them. Consequently, public health systems and health infrastructure have long been ignored, and many countries are now suffering serious consequences.
In China, chronic diseases and cancer in particular are offsetting economic achievements. "The overall cost of medical treatment for cancer patients has resulted in a big drain on economic resources," said Dr Qiao Youlin, chief of the Cancer Epidemiology Department of the Cancer Institute at the Chinese Academy of Medical Sciences.
Qiao noted China spends more than 80 billion yuan (US$9.67 billion) annually on cancer treatment. Yet deaths caused by cancers have kept climbing since the 1970s, especially in rural and western China. Currently, cancers claim 1.4-1.5 million lives a year, compared to 700,000 in the 1970s.
That means one in every five deaths in China is caused by cancer, which amounts to an estimated economic loss of more than 14 billion yuan (US$1.69 billion) a year.
"The mortality rate may double to hit 3 million in the next 20 years if we don't shift our focus from treatment to prevention now," Qiao warned.
Dr Lee Hartwell, president of the Fred Hutchinson Cancer Research Centre in the United States, believes health services should shift to focus on early detection and prevention.
"Prevention and early detection are much more effective than the treatment of late-stage disease. In this regard, America doesn't do a good job," said the 2001 Nobel Prize laureate.
Currently, the United States puts almost all of its healthcare resources into treating late-stage illness.
President and Chief Executive of GE Healthcare, Dr William Castell, notes that despite the success developed countries have enjoyed in terms of drugs and treatment in the last century, progress in healthcare is not matching the quickly climbing costs of diseases such as obesity, diabetes, cancer and cardiovascular diseases.
Health is every individual's greatest concern. However, according to Castell, global healthcare policy in the 20th century was directed too much at first world markets, resulting in unfairness.
Over the last two decades, he said, "the industrial model has narrowed further, with the United States accounting for over 50 per cent of the world's healthcare market by value, despite having only 4 per cent of the world's population."
Figures released by the World Health Organization suggest at least 60 per cent of all deaths worldwide are related to cancer and other chronic diseases.
Research has found 43 per cent of cancer-related deaths can be prevented by behaviour changes, such as in smoking and diet, while about one-third of cancer cases are curable if detected and treated early enough.
Unfortunately, said Qiao, there is a big gap between knowledge and practice.
"The technology for detecting and treating some cancers, though proved very mature, is not sufficiently translated into medical practice," he said. "The treatment-oriented approach has eventually led to the negligence of primary prevention, early detection and palliative care."
Dr Michael Birt, director of the Centre for Health and Aging at the National Bureau of Asian Research in the United States, attributes the gap to a lack of communication.
"Scientists meet with scientists, policy-makers with policy-makers and businessmen with businessmen. Now, we want to be inclusive. The whole Pacific Rim should work together towards the same goal promoting an early health model," said Birt, who is familiar with Asian public health matters.
"China doesn't have to tear down an old system, but should use the existing system, use traditional ways of medical prevention to avoid the waste of healthcare resources," Birt said.
Liu Zhongmin, president of Shanghai East Hospital affiliated to Tongji University, suggested disease prevention should proceed from society.
Priority used to be given to infectious instead of chronic diseases so "many common chronic diseases, such as cardiovascular diseases, were neglected although they keep escalating," he said.
China has 50 million cardiovascular disease sufferers. Of them, 20 per cent are at the peak of life and integral parts of the labour force.
"The government must put chronic disease prevention and early detection at the top of its list of priorities. Then you could expect to spend less money to increase labour values and advance public health," Liu said.
As for improving China's public health system, Uwe E Reinhardt, a professor of economics and public affairs at Princeton University, said everyone should have access to healthcare. But there is a huge gap between the ideal and reality.
For the vast majority of poor farmers, Reinhardt believes the old barefoot doctor system could be a good remedy.
"China should pick up the barefoot doctors, have rural doctors trained in tele-medicine, which is connected to higher doctors in big city hospitals. Then people in remote rural areas could get a timely medical and healthcare service," he said.
Theoretically, Reindardt argues, China's restructuring of its healthcare system may take two paths.
"Production in a capitalist way, but distribution with socialist discipline. Public healthcare is a matter of social ethics and should be shared by everyone," he said.
Director-General of WHO Jong-Wook Lee said all countries need to "build up a better healthcare system, get more doctors, nurses and healthcare infrastructure since that is the biggest bottleneck limiting progress."
(China Daily July 15, 2005)
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