Health a casualty in race to riches

BY ALFRED OEHLERS*

The worst of the severe acute respiratory syndrome virus has apparently passed for some countries. But for others, and China in particular, the horrors are only just emerging. There, the number of cases is known to be far higher than previously thought.

The virus is spreading across the country rapidly, with more than 100 new cases daily. Deaths from the disease are climbing. The public authorities seem almost impotent in the face of the virus, and will appear increasingly so as it mutates further and develops resistance to treatments.

The severity of the situation in China may offer some important lessons to New Zealand.

It is perhaps no accident that the virus should have emerged first in China, wreaking the havoc that is now unfolding. For the past 20 years or more, China has plunged headlong into an accelerated process of market deregulation, economic modernisation and integration with the world economy.

Guided by Deng Xiao Peng's dictum, "to be rich is glorious", much has been sacrificed in this single-minded pursuit of wealth.

One major casualty has been public health. It is a myth that China's health system is well resourced and readily available to all. As a result of the restructuring of the past few decades, a two-tiered system has emerged. The best care is reserved for the rich or well-connected, while most have to make do with services run on paltry provisioning.

Consequently, the public health system in China has been incapable of undertaking much-needed initiatives in preventive care. As the present situation amply demonstrates, it has not been able to deal effectively with the outbreak of an infectious disease. Because it is poorly resourced and access is inequitable, a localised outbreak soon escalated into a major crisis.

This deterioration in the public health system occurred at a time it was probably most needed. Under the impact of deregulation and marketisation, citizens have virtually been told to make the best of whatever they can.

Many have done well as a result, and fabulously so. But for the vast majority, getting rich has been nothing more than a mirage. Unemployment, whether open or hidden, is rife in China.

Those lucky enough to have jobs struggle to make ends meet on meagre incomes. Many hold down two or more jobs to survive. Long hours are worked in often cramped and unsafe conditions. Time off and holidays are luxuries that many workers forgo.

As a result of this combination of unrelenting work, rising stress, inadequate nutrition and insufficient rest, immunity levels in the Chinese workforce have been deteriorating steadily.

Correspondingly, the susceptibility of vast numbers of the population to infectious diseases has been rising. When Sars broke out, it found fertile ground in which to spread.

Apart from declining immunity levels, the overcrowded living conditions typical of many Chinese cities may also have been a further factor helping the spread of the virus. In the major coastal cities, millions of workers are packed into cramped, unhealthy quarters, improperly serviced by the most basic amenities.

Under such conditions, infectious diseases thrive. The outbreak of Sars in Guangdong was a disaster waiting to happen.

What lessons are there for New Zealand in all this?

The Chinese experience shows we neglect our public health system at our peril. Yes, the pursuit of economic growth is a priority. But so, too, is a well-resourced public health system capable of providing effective preventive care, as well as subsequent treatment, should crises arise.

It should be noted that this certainly does not exclude the possibility of a private system developing in parallel to the public. But a comprehensive public system remains essential because it will form the backbone of any response to a health crisis while also guaranteeing equitable access to such a critical service.

The Sars outbreak alerts us to the dangers of an uncompromising pursuit of economic growth. In light of what has happened in China, there is a strong case to be made for a more measured approach, balancing the undoubted gains from such growth with its negative implications.

Throwing caution aside in a reckless race to achieve some arbitrary and narrow measure of economic efficiency or attainment is nothing short of foolish.

Equally questionable is the uncritical rush to embrace global market forces in this process. The competitive pressures that are unleashed generate incredible stresses and impose highly onerous demands on workforces. These eventually take their toll, with significant repercussions for society.

The Sars outbreak in China should make us think carefully about the direction and shape of our cities - Auckland, in particular.

For better or worse, there has been a tendency to look favourably on high- and medium-density housing. While city planners no doubt have done so after a full consideration of all relevant issues, have the public health implications of such close living been adequately explored?

These considerations do not have to rule out the possibility of such higher-density living. But they do draw attention to a wider range of issues that planners should consider.

* Alfred Oehlers is an associate professor in economics at the Auckland University of Technology.