China finds Western ways bring new woes

By David J. Lynch, USA TODAY

http://www.usatoday.com/news/world/...hina-woes_x.htm

China is the fastest-growing market for American goods, an ally in the war on terror and, at the same time, an emerging rival to U.S. pre-eminence in Asia. In coming years, its major cities will host the Olympic Games and a World's Fair while its movie, fashion and sports stars attract growing numbers of fans. China in the 21st century appears poised to reclaim the greatness it enjoyed for thousands of years before it slid into eclipse in the late 1840s. Yet Beijing's leaders face daunting challenges. An authoritarian political system that arbitrarily imprisons those with unpopular views demands reform. Economic vitality and growing regional clout coexist with woes that bedevil all developing countries: environmental degradation, poverty and preventable illnesses. Understanding the world's most populous nation has never been more vital. So throughout this year, USA TODAY will offer an occasional story on contemporary China to illustrate how much has changed and how much remains to be done if this is truly to be "The Chinese Century."

BEIJING — In cities across China, signs of the better life spawned by 25 years of capitalism abound. Gleaming glass towers form proud, modern skylines. Private sedans throng roads once navigated only by bicyclists. Well-dressed men and women stride briskly past ads for foreign brands such as McDonald's and Microsoft.

China today little resembles the impoverished, hermetic land that existed before its leaders began freeing the economy in 1978. But these visible improvements mask the dangers of moving too swiftly from communist scarcity to capitalist abundance. Today's spreading prosperity is redrawing traditional Chinese living patterns to mimic Western habits — for good and ill. (Related graphic: Comparing the USA and China)

There is perhaps no better way to appreciate how much has changed in China than by examining the people themselves. Consider what today's Chinese eat and drink. In a country where man-made famine killed 30 million people as recently as the early 1960s, more than one-fifth of adults are now dangerously overweight or obese. The proportion is expected to approach 40% in two decades.

Washing down all that food, the average Chinese person now drinks more than four times as much alcohol per year as in 1978, the beginning of China's economic opening. Alcoholism — though still low by Western standards — appears to be surging in more prosperous urban areas.

Affluence's effects showing up

As China strives toward its goal of a xiaokang or moderately well-off society, many Chinese are trading a venerable lifestyle that emphasized restraint for something closer to Western indulgence. The public health consequences are as predictable as they are deadly. From 1995 to 2025, deaths from diet-related illnesses such as heart disease, high blood pressure, strokes and adult-onset diabetes are expected to increase 10 times faster than population growth, according to Barry Popkin, a University of North Carolina economist who studies dietary changes in developing countries.

"The increase in life expectancy they've seen could slow down or turn around. Certainly, the burden of health care costs is going to go up immensely," he says. "With China so important economically, this is one of those things that could drag it (down) if they don't deal with it."

These new maladies frequently are overshadowed by the almost endless series of issues vexing China's leaders:

• Economy. Capitalist institutions, including undeveloped capital markets that leave private companies reliant on rickety state banks for financing, are not yet fully developed.

• Politics. China's communist leaders must find a way to keep an expanding and increasingly confident middle-class satisfied within the constraints of a single-party system.

• Environment. In the air, water and land, increasingly urgent environmental worries demand attention. Among them: chronic water shortages in northern cities like Beijing that are prompting an unprecedented $55 billion public works project to redirect water from China's flood-prone south to the arid north.

Still, for the individual, these broad challenges pale alongside the emerging personal hazards. Spreading affluence is spawning "rich man's diseases" unfamiliar to China's already overburdened health care system. After a quarter century of rising living standards, the Chinese are glimpsing the costs of a more Westernized lifestyle.

Sedentary lifestyles

China today is an emerging economic power, eagerly anticipating a national coming-out party at the 2008 Beijing Olympics. This new-found global prominence obscures just how poor and isolated this country was in its doctrinaire communist heyday.

In 1978, when then-Communist Party General Secretary Deng Xiaoping launched market-oriented reforms, the typical city-dweller earned less than $200 annually. There were no private restaurants; many everyday goods were in chronic short supply; most people could consume little more than what they needed to survive.

From a beachhead in four special economic zones along China's coast, Deng gradually expanded permissible capitalist activities. Starting in the 1980s, consumer luxuries such as televisions and stereos as well as labor-saving products such as washing machines and refrigerators became commonplace.

At the same time, hundreds of millions of people swapped the rigors of farm life for more sedentary jobs on assembly lines or in offices. People who once walked or bicycled long distances to work increasingly began driving. In 1985, there were fewer than 1,100 private cars in Beijing. Today, there are more than 2 million. As people grew wealthier — and less active — they ate fewer vitamin- and fiber-rich cereals and more meat, chicken and eggs. And they began using pricey, and fattening, vegetable oil to stir-fry more elaborate meals. "In the past, we had meat, but not as much as now. For instance, if we had four dishes, three would be vegetables and one would be meat. Today, it's the opposite," says Zhang Shuying, 56, a Beijing homemaker.

Over the past 20 years, the amount of fat in the diet has more than doubled. In cities like Beijing, where fast-food restaurants such as KFC have proliferated, one-third of the calories in the typical diet now comes from fat — an amount equal to the USA's unhealthy levels. Even vegetables have been corrupted. One popular dish that makes doctors cringe is zha qiehe, eggplant stuffed with pork and then fried.

Today's lavish diets once would have seemed unattainable for China. During and after "The Great Leap Forward" of 1958-60, Mao Zedong's disastrous bid for overnight modernization, famine devastated the countryside. Harvests failed as peasants were diverted from farming into a misguided effort to produce steel in backyard furnaces.

Now, for the first time, many Chinese find they must struggle to avoid gaining weight. "My parents never had any weight problem," says Liang Yong, 25. "When they were young, they couldn't get enough food. According to them, the stuff they ate then was worse than what you'd feed pigs now."

In the 1970s, Liang's parents ran a small shop in the central Chinese city of Chongqing. They survived on a diet of wild vegetables and sweet potatoes. The couple was so poor they rarely could afford rice. But by the time Liang was born in 1979, times were better. He grew up snacking between meals and eating pretty much at will. "I eat a lot of rice and a lot of candy," he says. "It doesn't matter what kind of candy. If it's sweet, I like it."

By late 1999, when he entered the Aimin Fat Reduction Hospital in Tianjin, Liang weighed 455 pounds. The hospital, which opened in 1992, placed him on an exercise program and treated him with acupuncture and traditional Chinese medicines. Over the next four years, he lost 220 pounds.

Standing just over 5 feet tall, Liang remains pudgy — like a growing number of Chinese adults. From 1989 through 1997, the percentage of overweight males in China almost tripled. By 2025, more than 38% of Chinese adults will be fighting the battle of the bulge, according to Popkin.

Those figures pale in comparison with the United States, where an estimated 60% of all adults are overweight. But for China, the emergence of a weight problem represents a change without precedent in the country's modern history. Dietary and lifestyle changes that emerged in the United States over several generations of industrialization have swept urban China in just one.

His countrymen's swelling waistlines are no mystery to Liang, who still hopes to lose another 50 pounds. "Life is getting better," he says. "That's why they're getting fat."

Imported beers, breweries

Seated at a table in the rear of Nashville, an intimate, Western-themed bar, four friends enjoy a drink and quiet conversation. In the next room, a guitarist reprises old Sting songs. The shelves behind the bar hold bottles of Budweiser, Heineken and about a dozen other imported beers and liquors such as Glenfiddich scotch and Grand Marnier cognac.

Hao Jun, 30, one of the patrons, used to come to this same spot in the late 1980s, when it was home to a neighborhood market. For 1 kuai (a little more than 12 cents), he could buy enough vegetables to last all day. "Now, one glass of this Boddington's (ale) that we're drinking costs 50 kuai," Hao says.

Before Deng's economic reforms, alcohol supplies were limited. But as the economy welcomed foreign investment, breweries sprang up in almost every Chinese province. By 1981, beer output was 91 times what it had been when the communists seized control in 1949, according to the World Health Organization.

Increased supplies of alcohol, together with rising disposable income, have spurred drinking. The WHO — measuring consumption by the amount of the intoxicating agent ethyl alcohol people ingest — found the typical Chinese person consumed 176 ounces of ethyl alcohol in 2000. That was a 320% jump since 1978. Actual consumption likely is about one-third higher, since the WHO's figure doesn't include homemade brews produced in rural stills.

"I'm convinced China is on track for major alcohol problems," says Ian Newman, professor of health education at the University of Nebraska-Lincoln. "Per-capita consumption of alcohol is going up as fast as anywhere in the world."

The consequences can be seen down a narrow hutong, or alley, in downtown Beijing. Inside a traditional, gray courtyard-style building stands a rare treatment center for the capital's growing ranks of problem drinkers.

At the end of the 1970s, alcoholism care like that offered here by Anding Hospital was virtually unknown. But demand for such services has risen sharply during China's decade-long boom. Last year, the program treated roughly 300 people, almost three times the figure from two years earlier. The vast majority are men. But in 2000, for the first time, the center began seeing female alcoholics.

"A lot of women have been freed from housework and are able to work," says Sheng Lixia, the program's director. "They have more money; they're free to do what they want and they have more contact with society."

Alcoholism not so rare now

National alcoholism statistics are spotty. The most recent figure that Sheng can cite is from 1993, when the number of Chinese alcoholics was already 10 times the 1983 number. Still, the government has been slow to recognize the potential seriousness of alcohol abuse. Only within the past couple of years has the state's medical insurance program begun paying the $845 cost of inpatient treatment.

About three years ago, in response to China's rising alcohol use, the first Alcoholics Anonymous chapters appeared in Beijing and Shanghai.

In a hotel in the capital's Dongsi district, a small room is filled with a mixed crowd of locals and expatriate Westerners.

Over cups of weak tea, 14 people — all but two are men — sit in a semicircle. One Chinese man wears a neat, three-piece blue business suit. An American sports black cowboy boots.

On the walls, inspirational posters, pink for English, blue for Chinese, offer solace: "One day at a time ... You are not alone ... It can be done."

The men and women talk about their most recent struggles to stay sober, with their words translated from Chinese into English and vice versa. After the 90-minute meeting, the man in the business suit, who insists on being identified in print only by his nickname of Zhao Yiping ("Finds A Bottle"), explains how he fell under alcohol's spell.

Like millions of other urbanites, Zhao was exiled to the countryside during the decade-long upheaval of China's Cultural Revolution. On the farm, he developed a taste for fiery Chinese spirits.

"We didn't drink every day because our income was very low and we couldn't afford to," he says.

But by the mid-1980s, Zhao was in charge of purchasing for a state-run auto repair factory. The job required frequent, heavy-drinking dinners with clients, and vendors often gave him gifts of a clear, 130-proof liquor called er guotou.

In 1992, Zhao was hospitalized at a psychiatric facility after his boss told him heavy drinking was hurting his performance.

After a 15-day stay, he returned to his job and stayed sober for six months before resuming drinking.

By 1994, he was back in the hospital, the second of 11 hospitalizations from 1992 to 2003.

"At first, when I started to drink, it didn't affect anybody else. It didn't affect my job," Zhao says. "But then I started to call my wife bad names and it affected my family."

Seven years ago, Zhao's wife divorced him. She's told him she'll come back if he can stay sober for three years. Thanks to AA, Zhao, 54, has been sober for five months.

Alcoholism remains an unfamiliar malady for China, so those struggling with the disease often feel obliged to hide their condition. "Sometimes, people ask me to drink and I tell them I can't drink. If I drink there's going to be a big problem," Zhao says. "Some people understand. But a lot of people still don't understand that drinking can be a problem."

A problem of the future

For now, drinking is a problem more of tomorrow than of today. Most Chinese remain light drinkers by global standards. Drinking alone is rare and most drinking accompanies a meal. "Most of the time, we drink because we go out with friends," says Hao. "It's not drinking for the sake of drinking."

That may explain why Chinese officials so far have not done much to address the country's growing alcohol consumption.

There is no legal drinking age in China and television advertising of liquor is common, unlike in the United States, where it is prohibited.

Still, based on experience elsewhere, as drinking becomes more pervasive, China is likely to experience higher levels of liver and sexually transmitted diseases, violence, work absenteeism and fatal traffic accidents. One Chinese insurance company last summer even began selling a special policy for people who often drive drunk, which critics assailed as encouraging more drunken driving.

If nothing is done to halt the spread of unhealthy eating and drinking, China will face substantial financial costs. In 1995, China spent almost $12 billion to treat diet-related diseases. Popkin says that by 2025, that figure is likely to increase by at least 25%. Heart disease, strokes and adult-onset diabetes, linked to unhealthy diet and inactivity, already are on the rise.

If China achieves its goal of quadrupling the size of the economy by 2020, its people will enjoy a standard of living roughly comparable to that of the West in 1990. But as it rushes to duplicate the comfort and convenience of life in the developed world, China risks copying the Western lifestyle's worst attributes, some Chinese health professionals are warning.

In January, officials began training doctors throughout China to apply new national guidelines aimed at achieving a healthier diet. And Beijing newspapers are full of ads promoting quick-acting diet plans that use a "secret formula" to strip away excess fat.

"This is the right time to do something," says Chen Chunming of the Chinese Center for Disease Control and Prevention. "If we take action now, we're not going to repeat the experience of the Western world."