FIRST DRAFT ---Sophie

To what extent can be the problem of urbanization is met by a policy of sustainable development?

--- the health problems of urbanisation in the People's Republic of China
The majority of the dramatically urbanizing cities probably exists in the least developed countries which has historically originated from demographic and economic transformations over the past few decades. Such a typical phenomenon highlights both adverse and advantage effects on the urban communities constantly. Alternatively, it may as well lead to the housing problem, social crime, traffic congestion or environmental contamination and so on(Vlahov & Galea,2002). [^]A survey of the United Nation(1990), Urbanisation is the growth in the ratio of population migrating from rural areas into the cities and towns. That is, a sleepy city of thousands people has suddenly mushroomed to a swarming areas with millions of heads crowded in the street( Harpham,1994). On this account, sustainable development[,] which was defined as " an attempt to combine growing concerns about a range of environmental issues with socio-economic issues"[,] should be adopted( Hopwood,et al, 2005, p38).
Admittedly, based on the published literature and evidence in the third world, take China for instance, this paper attempts to analyse and evaluate the dimensions of metropolises that affect human health risks as well as the relative sustainable policies which could be conducted by the authorities. Initially, it reveals the potential causes of human chronic morbidity by virtue of the poor health services around expanded cities of China. Secondly, the essential factors will be specifically discussed in terms of communicable and non-communicable diseases, the undeveloped health care services and systems. Then, it looks into the current policies have adopted of sustainable development to municipal cities in China which compared with the U.S medi-care reform; Finally, the perspectives and recommendations for tackling the population diseases will be concluded as far as the cross-national research is concerned. The thesis of [the] whole study is that the more processes of urbanisation, the worse conditions of public well-being. [does that answer the question?]
The People's Republic of China boasts presumably 1.3 billion population, which has occupied the largest proportion of the global populace. Meanwhile, China is confronting the considerable pilgrimage of Urbanisation at present. The rate of urban inhabitants has expanded from 23% to 42% by 2006(UN, 2007). According to China's government survey (2006), it is not an exaggeration to say that this trend will increase further to more than 50% by 2020. In that sense, the Chinese mega-cities are suffering the human health crisis for chronic sickness in terms of environmental (physical and social environment)hazards, a multitude of people, lower income communities and poor national health care systems.

Nevertheless, the rapid scientific innovations in health-medical methods and facilities have significantly disunited the centralized population in urban areas from numerous original infectious diseases which had killed thousands and millions of citizens in historical periods also the industrialization of 18th century in European nations(Rosen, 1993).
-Communicable Diseases

Since the immigration of the demographic shifts from rural to urban regions decades ago, compared with other developing countries China has made vital accomplishment in both preventing and controlling communicable diseases by adopting multi-dimensional measures. Nonetheless, with the advancement of global economy, the rebirth of certain communicable morbid symptoms such as tuberculosis, and sexually transmitted diseases(STDs); acquired immune deficiency syndrome(AIDS) and emerging infectious diseases(EIDs) could probably increase the public concerns about the negative influences on human wholesome in PRC. Nowadays, among with the unmoral behaviours, the figure of citizens infected with STDs has transmitted the constant hazards for infectious communities. "In 2002, the total accumulated cases of 7 kinds of STDs(apart from HIV/AIDS) reported by 31 provinces, autonomous regions, and municipalities directly under the central government were 744,848. The incidence rate of reported STDs was 58.15/100,000(Lee,2004,p331)." [Do you need to quote this?] In addition, it is evaluated by NHO(National Health Organization) in 2002 that at least around 1.2million population have infected with Human Immunodeficiency Virus (HIV) spread magi-cities. Meanwhile, the pestilence of tuberculosis (TB) in China is distinguished by vital plague proportion, vital death rate and highly widespread regions in China(Lee,2004).

In fact of that, there seems to be inevitably to avoid the expansion of communicable or non-communicable diseases in the world, yet the prevention and methods of those diseases are by no means appeared so complex in such process of globalization and urbanization, which could embody the Chinese fighting campaign of Severe Acute Respiratory Syndrome (SARS) in 2003.





Figure 0: Diabetes in China -National Well-Being Hazards
''a: Urban diabetic prevalence rates in 2007. b: If all patients diagnosed with diabetes had access to a treatment costing 50 cents a day (with a patient compliance of 60%) the market value would increase from US$1.1billion to $1.7 billion by 2017''(Ward, 2008)
-Non-communicable Diseases
Owing to the industrialization, enlarged aging procedures and conduction of the morbid lifestyles, the metropolitan cities have been suffering such the noncommunicable diseases as diabetes, mental problems, cardiovascular illness, and chronic obstructive pulmonary disease (COPD). It is the most distinct public health issues that can affect the destroyed human health-systems and the considerable medical expenditures(Lee,2004).

According to a National Survey of 2002, approximately 20 million diabetes and 17.7 million people are diagnosed with COPD; the number of the people with high blood pressure is over 100 million in Chinese cities. In that sense, the dramatically growing non-communicable diseases could pose the great threat to the health of inhabitants especially the young working communities within varies urban areas, not to mention about the exceedingly high medical fees for such epidemic in the People's Republic of China(Lee,2004).
Indeed, the mental well-being is regarded as an essential issue of human health. Paradoxically, the majority of adolescents and youngsters are endangering the mental problems subconsciously in China currently. "Bad familial environment and social ethos, improper education style, unhealthy media function, and increasingly greater scholastic pressures have made them become the 'psychologically fragile generation(Lee,2004,p332)'. The Chinese youth mental research of recent years indicated that the number of Chinese young mental patients was 24%. Furthermore, the proportion of students with such diseases in universities was 29%; while the rate of younger people in high schools was 36% (China Internet Inf. Cent. 2003). [I don't believe it can be that high.]

-Undeveloped health care services and systems
Perhaps it is also worth pointing out that the unbalanced distributions of national health care services and systems in different cities, particularly, the divergence of medical-care levels and organizations in China. When it mentioned about the health resources issues, we can not ignore the fact that the most population are living in China, the least insufficient health resources to be allocated in an equal way. Although a few of urban areas have seen the unprecedented changes of public health systems and technologies which could attain such levels of developed countries as Beijing, Shanghai and other coastal cities; On the contrary, certain inland or western areas are apparently lack of advanced medical equipments even or the professional doctors in order to meet the patients satisfactions(Lee, 2004).

Among with these problems, in some degree, the Chinese policies and regulations of health subsidies or welfares seem unreasonable. Government can provide some free and excellent health services, nevertheless, owing to the scarce of medical funding, most of people should pay for high prices but primary health services or basic social welfares within the back grounds of excessively huge health demands of the urban citizens. Thus, Lee.L (2004) have claimed that "China was ranked 188th out of 191 member states in terms of 'fairness of financial contribution' and was regarded as one of the most unfair countries on the 'financial burden' of health systems in the World Health Report 2000."


-Approaches to Tackle the Health Jeopardy in Mega-cities

-Existing Chinese Policies

The well-being of the mankind is currently a crucial concern for Chinese governments, which have already implemented three holistic strategies and perspectives on health(Corvalán et al,1999).

The first round of Chinese urban health insurance policy can be traced back to 1960s when co-existed the Labour Insurance Schemes(LIS), and the Government Insurance Schemes (GIS). LIS applied for the enterprises' staffs while GIS just for the employees of the official establishments or governments. Whenever those people were injured or infected diseases, they can obtain 75%-95% subsidies from the government without any contributions to the public health system(Zheng,Jong, et al,2010). Moreover, the Chinese authorities have funded the stated-owned medical care systems controlled by the Ministry of Central Health. But the biggest obstacle to doing service is the heave burden of national medical costs.

With the improvement of medical systems and the growth of employees, the central government can not afford the huge expenditures of public health any more. Mainly, majority of urban residents did not have the chances of medical aids or the health insurances during 1951-1978(Zheng&Jong,et al, 2010).
-The Second Round Reform
Accordingly, as the opening reform policy and market-oriented system have conducted, the state government adopted the second reform of ill-functional plan since the 1980s forwards. The amendment of urban health documents described that both employees and employers should pay the health insurance fees in order to transform the collective responsibility into individual protection. "In January 1997, the Central Committee and the State Council opened the start of proceedings on health reform by claiming they would reform the health insurance system, the health service system, and the production and circulation of drugs. In 1998, this reform on urban employee basic health insurance system was implemented over the entire country(Zheng&Jong,et al, 2010, p405)." [paraphrase this] Indeed, such a new cohesive reform strategy as "the urban employee basic health insurance scheme(BHIS)" has provided the well-around services for civilians(Xu&Wang, et al, 2007).
-The new wave health reform is an ongoing process

On April 2009, the People's Republic of China has funded $124 billion to the new round health reform plan for the next 3 years. It aimed at overhauling the national medi-care systems, lower costs but higher quality sevices as well as covering the universal wholesome. Meanwhile, the principles of such a new reform were concerned about "Cost, Quality, Efficiency, and Equity(Lawrence, 2009). "The National State Council claimed that the government would do its utmost to guarantee the weaken community which refers to the poor patients, infants, women and seniors could receive the priority of medical aids and services as soon as possible all around the country. Although flooding migrants rushed into cities nowadays, the gap of health-care systems between urban and rural regions can not be disregarded.


Figure 1: Medical Insurance Coverage in China from 2003 to 2008
(International Social Security Association ISSA, 2009)
-Compared with U.S. Reform Policy
The recent history of the American healthcare system which has undergone the fundamental changes and challenges over the last seven decades may provide a good example for China and other developing countries. Especially, a prominent event of medicare services is the delivery shift the patient-centered medical home(PCMH) in 2007(Diane & Stephen, 2009). "Crafted by the primary care professional organizations in 2007, the model has been endorsed by a broad coalition of health care stakeholders, including all of the major national health plans, most of the Fortune 500 companies, consumer organizations and labor unions, the American Medical Association, and a total of 17 specialty societies. Currently, 22 multistakeholder demonstration pilot projects are under way in 14 states, and the Centers for Medicare & Medicaid Services will conduct Medicare demonstration pilot projects in 400 practices in 8 regional sites in 2009. Twenty bills promoting the PCMH concept have been introduced in 10 states(Diane & Stephen, 2009, p2038-2039)." [too much quotation]

While the election of American president Barack Obama consented the new health reform bills in 2009. Since the big failure of the medi-care reform in 1993, this plan has gradually from some degrees, resolved "3 persistent problems: the uninsured, the high and rapidly increasing cost of care, and significant lapses in quality(Victor& Fuchs, 2009, p963)."

-How can we evaluate the policies of Chinese health hazards? Can those existed measures be sustainable?

Therefore, the more development of urbanisation, the worse environment of human wholesome in the year to come .

China's urban resolutions which can tackle the short-run human health hazards. Apart from them, the negative effects may be probably exposed in the future subsequently, for instance, unsufficient provision of urgent medical reserves; lack of supervision and laboratory ability; changeable series of workforces; deficiency of competent environment; morbid reporting scheme, which can cause a retardation in news transmission; plus shortage of health funds(Lee, 2004).
-Urbanization & Humanization

Notwithstanding, as the improvement of urbanization and industralization, the health crisis which human have to deal with seems to be practical complicated than ever. China's public well-being may as well meet the excessive human requests for medical services which should combine the powerful administration and efficient health services distributed equally in varies provinces of PRC.

Hence, the health institutions or charitable organizations could provide comprehensive health (mental&physical) education and consultation. if the National Health System can directly or indirectly embody the features of 'information, technification, globalization and humanization', our people will likely live in a harmonious circumstances whenever social-environment or physical-environment with sustainable development universally(Lee, 2004). [was this his conlusion or yours?]


Bibliography:

China Internet Inf. Cent. (2003). '30 million adolescents in China were in mental health.' Accessed in: [http://www.china.com.cn/chinese/kuaixun/261608.htm ]

Diane & Stephen, (2009) 'The Patient-Centered Medical Home: Will It Stand the Test of Health Reform?' The Journal of the American Medical Association, Vol.301, No. 19

Harpham,(1994) 'Urbanization and mental health in developing countries', Social Science Medicine, Vol.39, No.2, pp.233-245
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ISSA, (2005) Chines health-care reforms move toward universal coverage
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United Nation (1990) 'Urbanization and the effects'

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Vlahov & Galea,(2002) 'Urbanization, Urbanicity and Health', The New York Academy of Medicine, Vol.79, No.4, Supplement 1

Ward, (2008) 'Diabetes in China: prevalence, market value and affordability of treatment', Nature Review Drug Discovery 7, 383

Zheng H, Jong M, Koppenjan J, (2010) 'Applying Policy Network Theory to Policy-Making China: The Case of Urban Health Insurance Reform', Public Administration, Vol.88, No.2, pp398-417