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Abstract
Data on the disease pattern in rural China over the past hundred years show that chronic diseases have now replaced infectious diseases as the major health problems plaguing rural residents. From the perspective of life-course research, taken together with medical anthropology’s emphasis on bio-sociocultural integrity, we can divide chronic diseases into two: the chronic diseases of excessive depletion and the chronic diseases of excessive intake. The former are mainly the result of societal experiences engraved on the body; chronic diseases represented by arthritis and intervertebral disc disease are the marks left on the human body by the “hard times” of the early years. The latter is the result of the transformation of working life in which the abundance of material resources and the reduction of physical exertion occur simultaneously; the rapid arrival of the “good times” mean that bodies that have long suffered from hunger and exhaustion find it hard to adapt. Hypertension and diabetes are the physical manifestations of this distress. Fundamentally, chronic diseases falling into the over-intake category may appear to originate from the sweetness of current life, but they are in fact the physical reproduction of earlier experiences. Our village case study fleshes out this explanatory framework, allowing us to see the complex relationship between social institutions, livelihood patterns, cultural mindsets, bodily habits, and disease.
Notes
1 Prevalence refers to the proportion of old and new cases of a disease in the total population at a given time. The associated incidence, in turn, indicates the frequency of new cases of a disease in a given population over a given period of time. With chronic diseases that are long-lasting and difficult to cure, prevalence is a useful indicator of the spread of the disease and the extent to which it affects people’s health. Incidence can indicate the occurrence of new cases. In the following, prevalence is used in the statistics on chronic diseases and incidence is mainly used in the statistics on epidemic trends and changes in infectious diseases.
2 The mortality rate, also known as crude death rate, refers to the ratio of the number of individuals who died in a certain period of time in a certain area to the total population of that area during the same period.
3 National Health Commission of the People’s Republic of China (formerly Ministry of Health), “2013 National Health Services Survey,” http://www.moh.gov.cn/mohwsbwstjxxzx/ s8211/201610/9f109ff40e9346fca76dd82cecf419ce.shtml, accessed November 3, 2018; “2005 Progress of Disease Prevention and Control in China,” http://www.nhfpc.gov.cn/jkj/s7915v/201504/ d5f3f871e02e4d6e912def7ced719353.shtml, accessed November 4, 2018.
4 See Zhao Jianhua et al., “Changes in the Disease Pattern of Mortality among Ningxia Residents from 1994 to 1999”; G. Yang, Y. Wang and Y. Zeng et al., “Rapid Health Transition in China, 1990-2010: Findings from the Global Burden of Disease Study 2010.”
5 See Wang Xiangpu et al., eds., Dictionary of the Science of Health, p. 351.
6 See A. Dans et al., “The Rise of Chronic Non-communicable Disease in Southeast Asia: Time for Action”; Z. Yang et al., “Human Behaviors Determine Health: Strategic Thoughts on the Prevention of Chronic Non-communicable Diseases in China.”
7 See R. Beaglehole et al., “Priority Actions for the Non-communicable Disease Crisis”; Longde Wang et al., “Preventing Chronic Diseases in China.”
8 See Wang Yanzhong, ed., Survey and Prevention of Chronic Diseases in China; Du Chuang and Zhu Hengpeng, “The Evolutionary Logic of China’s Urban Health Care System.”
9 See Huan Jianli, “Survival Strategies of Rural Sufferers from Chronic Disease: A Field Study Based on Shacun Village Southern Hebei”; Fang Jingwen, “Experience and Existence: The Narrative of Illness of a Village’s Sufferers from Long-term Chronic Disease.”
10 Jing Jun, “The Source of Practice and Localization Process of Modern Preventive Medicine in Rural China: The Ding Xian Experiment.”
11 See Li Jinghan, ed., A Survey of the Social Profile of Dingxian County, pp. 274-275.
12 The Law of the PRC on the Prevention and Control of Infectious Diseases (amended June 29, 2013) divides infectious diseases into three categories: A, B, and C. Of these, Class A refers to plague and cholera, Class B includes infectious atypical pneumonia and AIDS, and Class C includes influenza and leprosy.
13 Data from the National Health Commission, ed., China Health Statistical Yearbook (2018), p. 253.
14 The data sources of , and and are given together below. The rural data for 1985 and urban data for 1986 are from the Editorial Office of the China Health Yearbook, China Health Yearbook (1987); data for 1993 to 2013 are from the National Health Commission of the PRC (formerly the Ministry of Health), “An Analytical Report of the National Health Services Survey”; and data for 2008 to 2013 are also from the National Health Commission, ed., China Health Statistical Yearbook (2018), pp. 238-240. Disease names and data formats follow the data source.
15 See Yu Xinzhong, “An Analysis of Jiangnan’s Successful Handling of Epidemic Disease in the Qing Dynasty: The Response of the Qing State and Society to the Plague”; Cao Shuji, “State and Local Public Health: Centering on the 1918 Pneumonic Plague Epidemic in Shanxi.”
16 Margaret Chan Fung Fu-chun, “Prevention Is the Best Option to Tackle Non-Communicable Diseases,” https://www.who.int/dg/speeches/2010/ncdnet_forum_20100224/zh/, accessed December 7, 2018.
17 S. Xiao and M. Kohrman, “Anthropology in China’s Health Promotion and Tobacco”; E. Mendenhall et al., “Speaking through Diabetes: Rethinking the Significance of Lay Discourses on Diabetes.”
18 S. Ferzacca, “Diabetes and Culture”; Qiao Yucheng, “Mismatch: The Pathophysiological Basis of the Soaring Incidence of Chronic Diseases in Contemporary People: Based on Diet-Physical Activity-Gene Interactions in the Human Planning Process”; Peter Gluckman and Mark Hansen, Mismatch: Why Our World No Longer Fits Our Bodies.
19 M. Rock, “Sweet Blood and Social Suffering: Rethinking Cause-effect Relationships in Diabetes, Distress, and Duress”; E. Mendenhal et al., “Non-communicable Disease Syndemics: Poverty, Depression, and Diabetes among Low-income Populations”; Arthur Kleinman, Social Origins of Distress and Disease.
20 J. Lynch and G.D. Smith, “A Life Course Approach to Chronic Disease Epidemiology”; K.U. Mayer, “New Directions in Life Course Research.”
21 Shi Zhilei and Wu Zhiming, “Long-term Effects of Early Life Hardship on Health Inequality: The Life Course and Double Cumulative Disadvantage.”
22 Sun Wenzhong and Diao Pengfei, “Life Course and Cumulative Disadvantage: A Study of Health Risks among the Elderly Poor in Rural Areas.”
23 Data from the Shangzhai Village Committee.
24 These data are from the former Shangzhai village clinic.
25 Liu Yafei, “Do Childhood Hunger Experiences Affect Health in Old Age?”.
26 J.V. Neel, “Diabetes Mellitus: A ‘Thrifty’ Genotype Rendered Detrimental by ‘Progress?’”; C.N. Hales and D.J.P. Barker, “Type 2 (Non-Insulin-Dependent) Diabetes Mellitus: The Thrifty Phenotype Hypothesis.”
27 Shi Jianeng et al., eds., Records of the Eight Villages of Dupo Town, p. 82.
28 The 2013 survey shows that the proportion of overweight and obese people in China’s rural population was 26.9 percent. See National Health Commission of the PRC (formerly Ministry of Health), “National Health Services Survey 2013.”
29 S.J. Ulijaszek and H. Lofink, “Obesity in Biocultural Perspective.”
30 S. Du et al., “Rapid Income Growth Adversely Affects Diet Quality in China—Particularly for the Poor!”.
31 National Health Commission of the PRC (formerly National Health and Family Planning Commission), “Introduction to the Report on Nutrition and Chronic Disease Status of Chinese Residents (2015) by the Health and Family Planning Commission,” http://www.gov.cn/xinwen/2015-06/30/ content_2887030.htm.
32 Quoted from Sidney Mintz, Sweetness and Power: The Place of Sugar in Modern History, p. 20.
33 Kwang-chih Chang, “Food in Chinese Culture: Anthropological and Historical Perspectives,” in Eugene N. Anderson, The Food of China, p. 257