China: nutrition guiding light or ticking time bomb?
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Version 0 of 1. China was the Global Nutrition Report’s star performer. It was one of only two countries (the other being South Korea) that posted levels of stunting, women’s anaemia and overweight adults that were all below indications of a very serious public health risk. China’s numbers are staggering. In the past 10 years GDP per capita has tripled, mortality rates for the under-fives have declined from 37 per 1,000 to 14, and the percentage of the under-fives who are short for their age has declined from 22% to 9%. But how long will China remain the star performer? Tellingly, China is off course for two goals: women’s anaemia and overweight rates of children under five. While the anaemia rates are troubling (at just under 20% of women of reproductive age) they are close to European rates (for western Europe it is 18%) and they don’t seem to be on the increase. Of greater concern in the future are the rapid increases in overweight and obesity in China. While the rates of overweight adults in China are less than half the rates of the UK (and the rates of obesity are about a fifth of the UK’s), the rates for children less than 20 years of age are much closer: for boys and girls under 20 years in the UK the overweight rate is 26% and 29% respectively, while for China the corresponding numbers are 23% and 14%. It is this body-mass time bomb that is the most worrying aspect of China’s nutrition status. High body-mass is a risk factor for a range of diseases such as diabetes and some forms of heart disease. In fact it is a top ten risk factor for east Asia. Will we see UK–level rates of obesity in these adults in China in 15 years time? One of the authorities on China’s obesity rates, Barry Popkin, estimates that obesity lowered China’s Gross National Product (GNP) by 3.6% in 2000 and, given projections of income, urbanisation and diet globalisation, that it will grow and in doing so, will lower GNP by 8.8% in 2025. Some projections estimate just over 2 billion of the world’s population will be obese in 2030 and that one third of them will live in China. Not only would this have a crippling effect on the health of China’s people, its health systems and its economy, it would pose a real risk to efforts to address the remaining undernutrition issues – stunting in under-fives has been level at 9% for the past five or six years – as public and private health resources get allocated to chronic disease management rather than addressing malnutrition. But it is not too late. China has the opportunity and the means to show the rest of the world how to slow and reverse the apparent tsunami of obesity. It has the opportunity because the problem is not yet unmanageable and its economy is strong. This generates policy possibilities. It has the means, because of the strong ability of the state to shape the environment to make it less ‘obesogenic’: to make healthy choices easier and more likely. And make no mistake about it – the world needs China to succeed. Obese people tend to consume more of the types of foods that have a higher carbon footprint such as meat, sugar and dairy. There are diets – vegetarian, Mediterranean and pescetarian for example – that are healthier for the planet and for humans. China needs to draw on traditional eating habits and move towards its own 21st century version of a healthier diet – we all have a stake in that. But there is another reason we look to China. Europe, North America, Australasia, North Africa and the Middle East are struggling to find solutions to their much more serious obesity problems. Perhaps China, which invented the compass many years before the rest of the world, can chart a common course to reducing obesity for us all, before it is too late. Lawrence Haddad, co-chair of the Global Nutrition Report. Follow @l_haddad on Twitter. Join our community of development professionals and humanitarians. Follow@GuardianGDP on Twitter. |