Memo: Pollution and Food Safety and their Impact on Health Inequality in Modern China

Smog in Shanghai


China’s rapid economic growth since the start of the reform and opening period in 1978 has lifted hundreds of millions of people out of poverty and made vast improvements to the quality of life for the majority of Chinese citizens. However, rapid economic development comes at a price. In the push to industrialise, environmental standards and social safety nets were ignored or cast aside in the race to achieve higher GDP growth rates.

Healthcare Provision — From Socialism to Reform & Opening

Nowhere was this more evident than in the countryside. During the Mao era, the Chinese health care system, through ‘barefoot doctors’ and the ‘Cooperative Medical System’ covered ‘over 90% of the rural population’ (Tang, et al., 2008) ). Through comprehensive health insurance, heavy investment and immunization policies, the system ‘achieved enormous improvements [..] infant mortality fell from 200 to 34 per 1,000 live births, and life expectancy increased from about 35 to 68 years’ (Blumenthal & Hsiao, 2005)

This changed with the onset of the reform and opening period however, and a widening gap between healthcare provision, and therefore outcomes, for the rural and urban population of China began to emerge. The central government’s decision to end the Cooperative Medical System and shift ‘responsibility for funding healthcare services to provincial and local authorities’ meant that as the economic development of reform and opening gathered pace, a ‘major and growing’ disparity emerged between the wealthy coastal provinces and the rural provinces. (Blumenthal & Hsiao, 2005) During the last two decades of the 20th century, ‘less than 10% of the rural population’ had insurance coverage (Tang, et al., 2008) , as compared to ‘49% of urban Chinese’ (Blumenthal & Hsiao, 2005).

Pollution & Food Safety Issues in developing China

The reform and opening period led to huge new emerging healthcare issues just as healthcare access was curtailed for a large portion of the population, and these issues persist in modern China. Economic development and industrialization have been accompanied by massive problems with; air pollution (indoor and outdoor), water pollution and food safety issues.

Indoor air pollution arises through the use of biomass fuel and coal for cooking and heating and releases ‘concentrations of respirable particles and carbon monoxide more than ten times higher than health-based standards’ Without modern heating and cooking methods, this disproportionately affects rural residents, causing an estimated ‘420,000 premature deaths yearly’ (Zhang, et al., 2010) Without access to medical insurance, accessing treatment for the respiratory infections and diseases that arise from these toxins can be near-impossible, especially since the ‘Western style, high tech care’ needed to treat many of these chronic diseases can only be accessed by the ‘newly rich Chinese’. (Blumenthal & Hsiao, 2005)

Outdoor air pollution is another huge environmental issue, whose pollutants lead to significant health issues, primarily for urban residents and those living near industrial facilities. For urban residents, the ‘growing transport sector’, with ‘more than 1,000 vehicles added to Beijing’s streets’ daily builds to the existing ‘3.5 million vehicles’ and creates a ‘photochemical smog’ which severely affects cardiorespiratory functions leading to an estimated ‘470,000 premature deaths’ per year (Zhang, et al., 2010) Cities in the Beijing economic corridor, such as Shijiazhuang and Baoding, are the most air-polluted cities in China and there has been links drawn between the smog and ‘adverse birth outcomes’ (Jing, 2015) (Zhang, et al., 2010)

However, while urban populations grapple with air pollution, rural populations have even more pressing problems. Nowhere is the inequality more evident between rural and urban populations than in access to clean water and water pollution issues. Industrial water pollution is a chronic issue in rapidly developing China, and was ‘especially severe in rural areas’, with more than ‘300 million people [relying] on hazardous drinking water sources.’ Water scarcity in certain regions has also led ‘populations to use contaminated sources’. Although there has been ‘large reported reductions in yearly emissions of arsenic and mercury’, these toxins are directly linked to cancers of the digestive system in the population. (Zhang, et al., 2010) Again, the disparity between rural and urban populations is large, with ‘safe drinking water available to 96% of the population of large cities but to less than 30% in poor rural areas.’ (Tang, et al., 2008)

Food safety is another huge issue in developing China. Even though ‘food contamination and poisoning’ incidents have been ‘exposed in succession for two decades’, they ‘show no signs of declining’. The most infamous of these was the Sanlu tainted milk formula scandal, in which a chemical, melamine, was used to thin out baby formula, leading to ‘six deaths, 51,900 hospitalisations of children with serious kidney problems, and 24,900 cases of children suffering from other problems’ (Yan, 2012)

This issue brings up another aspect of inequality and how it links to mother’s education and infant mortality. Since ‘educated women more actively pursue health-enhancing activities’ and ‘are more likely to take advantage of new medical innovations’ (Song & Burgard, 2011), ‘death rates in children younger than 5 years ranged from 10 per 1000 in the most affluent large cities to 64 per 1000 in poor rural areas’ (Tang, et al., 2008) reflecting the fact that those mothers whose children are at risk from these food safety issues and chronic diseases may be least able to access the medical services that their children need. As numerous studies have shown, lower socio-economic status is ‘associated with lower life expectancy, higher overall mortality rates and higher rates of infant and perinatal mortality’ (Link & Phelan, 1995)

Solving these Issues

The Beijing government has begun to seriously look at these issues in recent times, noting the ‘contradictions and problems’ that a market economy brings to healthcare provision in a country of 1.4 billion people, one that had near-universal healthcare provision in the past. Some initiatives have included ‘revamped’ drug and pharmaceutical policies, ‘rigorous’ academic studies, ‘effective correction of market failure’ and promotion of ‘universal coverage of essential health care’ (Tang, et al., 2008). In order to reduce the urban/rural healthcare coverage disparity, urban residents are now required to pay a portion of their income into a ‘medical savings account’ while rural residents are being provided with a ‘rudimentary safety net’ of basic coverage, albeit far behind what is on offer to urban Chinese. (Blumenthal & Hsiao, 2005)

Specific measures aimed at tackling air and water pollution, and related food safety issues, have had mixed results. In the run up to the Beijing Olympic Games in 2008, ‘air quality was substantially improved’, with ‘daily average concentrations’ of the top contributors to smog down by around 45–50% on a similar period in 2007. (Zhang, et al., 2010) While this had proven health benefits for the urban population, the extent to which measures such as once-off factor closures and the use of odd/even number day licence plate rules can be replicated on a long term basis is open to debate. As the 2013 ‘Airpocolypse’ event showed, air pollution is still a huge issue in urban China (Jing, 2015), even after these measures were put in place.

Food safety is acutely linked to issues with water pollution and these must be tackled concurrently. ‘Emissions of inorganic mercury [lead] to high mercury concentrations in fish’, with China responsible for about ‘28% of the total’ of these worldwide mercury emissions. There have been recent efforts to address these issues, including ‘construction of more than 60,000 industrial waste water treatment plants’ (Zhang, et al., 2010) and the ‘promulgation of [a] 2009 Food Safety Law’ (Yan, 2012)


It is evident that the rapid pace of China’s economic transformation has caused significant environmental and ecological impact which has translated into health issues that have disproportionately affected rural and poor Chinese citizens. Although the government has made efforts to reverse these trends in recent times, the lifting of universal healthcare coverage post-reform and opening led to a widening gap in healthcare access and outcomes for urban and rural Chinese citizens. The chronic illnesses and diseases, such as respiratory failure and cancers, caused by pollution and degradation of the water base linked to China’s industrialization, require preventative and long-term care healthcare access. While the basic coverage introduced in the early 2000’s for rural citizens was a step in the right direction to address the huge urban/rural disparity, further provision of services for poor and rural citizens are required if China is to tackle the huge healthcare issues it faces in the future.

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Blumenthal, D., & Hsiao, W. (2005). Privatization and Its Discontents — The Evolving Chinese Health Care System. The New England Journal of Medicine.

Jing, C. (Director). (2015). Under the Dome [Motion Picture].

Link, B., & Phelan, J. (1995). Social Conditions As Fundamental Causes of Disease. Journal of Health and Social Behaviour, 80–94.

Song, S., & Burgard, S. (2011). Dynamics of Inequality: Mother’s Educaiton and Infant Mortality in China, 1970–2001. Journal of Health and Social Behaviour, 349–364.

Tang, S., Meng, Q., Chen, L., Bekedam, H., Evans, T., & Whitehead, M. (2008, October 20). Tackling the challenges to health equity in China. Health System Reform in China 1 —

Yan, Y. (2012). Food Safety and Social Risk in Contemporary China. The Journal of Asian Studies, 705–729.

Zhang, J., Mauzerall, D., Zhu, T., Liang, S., Ezzati, M., & Remais, J. (2010, March 27). Environmental health in China: progress towards clean air and safe water. The Lancet.

Irish — interested in History (war, genocide, famine), Geopolitics (relations with China), Business of Football. Schwarzman Scholar 2019

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