Healthcare

Sick and the City

Epidemic follows rural migrants. Why urbanisation worries health experts

So far 430,000 have been infected

China’s policymakers have a dream. In it, the economy soars on the back of consumption by hundreds of millions of peasant farmers who have moved to the cities. Whether that dream will come true still remains to be seen, but there are already signs that reality may not be so pleasant. An epidemic of hand, foot and mouth disease – an intestinal virus – is sweeping the country for the third year in a row, highlighting the dangers to public health posed by China’s unprecedented urbanisation.
The disease hits young children hardest. So far, 430,000 have been infected and 260 have died nationwide. And the numbers are rising. It may not be considered a serious illness in Western countries, but that’s not the case for China’s urban poor, who usually don’t have adequate access to healthcare and sanitation.
The so-called ‘migrant workers’ are credited with making China’s export boom possible, but far from finding city streets paved with gold, heady property prices and poor wages means that they are often forced to live in the cheapest housing available. For many that means slum housing on the outskirts of town. There, poor sanitation and malnutrition combine to create the ideal conditions for germs to spread.
Most of these city newcomers don’t have ‘urban residency’ papers (hukou), which prevents them accessing government benefits and services like public hospitals. City governments often don’t provide them with public toilets, drinking water, or waste disposal, Wang Quanyi, a researcher at the Beijing Centre for Disease Control told Caixin Magazine.
“Hand, foot and mouth disease in China has become epidemic,” warned Ministry of Health spokesperson Deng Haihua, who adds the  virus which can be highly contagious, and causes fever, rash and sores. “The situation for prevention and control is very serious.” Mild strains may clear up in a couple of weeks, but serious cases can cause brain damage or death if left untreated. And since a mistaken diagnosis can prove fatal, raising awareness of the disease is crucial. One recent casualty, Zhu Kangjia was just 14 months old when he succumbed to the infection. Despite showing symptoms, Zhu was misdiagnosed as having a respiratory tract infection and sent home, where he died the following day.
The 2008 epidemic shook the infectious disease community, and brought about measures to raise awareness and monitor its spread. But despite those efforts, infection rates and fatalities are on the rise. Liu Min, an epidemiology professor at Peking University, thinks that’s mainly because the authorities now collate better information. “We’re now doing a much better job of discovering and monitoring cases,” he told the Associated Press, “Lots of cases and deaths now can be traced to [the] disease.”
Doctors recommend frequently washing hands and avoiding infected people to reduce the chances of catching the bug. But it’s advice some migrant families can’t afford to follow. The main treatment for severe cases, gamma globulin, costs nearly $100 a dose and isn’t covered by most insurers, according to Outlook Weekly magazine. Some parents who can’t afford to pay for their child’s treatment take them out of the hospital early – increasing the danger of the virus spreading.
The movement of millions of people out of the Chinese countryside is perhaps the largest peacetime migration in history. From just 7% in 1949, as much as half the population is expected to be living in cities by the end of this year. Officials are encouraging ever more to make the move, but the cities may not be ready.
As more country folk arrive each day, improvements in  sanitation and living conditions are needed to keep epidemics like hand, foot and mouth at bay. n

China’s policymakers have a dream. In it, the economy soars on the back of consumption by hundreds of millions of peasant farmers who have moved to the cities. Whether that dream will come true still remains to be seen, but there are already signs that reality may not be so pleasant. An epidemic of hand, foot and mouth disease – an intestinal virus – is sweeping the country for the third year in a row, highlighting the dangers to public health posed by China’s unprecedented urbanisation.

The disease hits young children hardest. So far, 430,000 have been infected and 260 have died nationwide. And the numbers are rising. It may not be considered a serious illness in Western countries, but that’s not the case for China’s urban poor, who usually don’t have adequate access to healthcare and sanitation.

The so-called ‘migrant workers’ are credited with making China’s export boom possible, but far from finding city streets paved with gold, heady property prices and poor wages means that they are often forced to live in the cheapest housing available. For many that means slum housing on the outskirts of town. There, poor sanitation and malnutrition combine to create the ideal conditions for germs to spread.

Most of these city newcomers don’t have ‘urban residency’ papers (hukou), which prevents them accessing government benefits and services like public hospitals. City governments often don’t provide them with public toilets, drinking water, or waste disposal, Wang Quanyi, a researcher at the Beijing Centre for Disease Control told Caixin Magazine.

“Hand, foot and mouth disease in China has become epidemic,” warned Ministry of Health spokesperson Deng Haihua, who adds the virus which can be highly contagious, and causes fever, rash and sores. “The situation for prevention and control is very serious.” Mild strains may clear up in a couple of weeks, but serious cases can cause brain damage or death if left untreated. And since a mistaken diagnosis can prove fatal, raising awareness of the disease is crucial. One recent casualty, Zhu Kangjia was just 14 months old when he succumbed to the infection. Despite showing symptoms, Zhu was misdiagnosed as having a respiratory tract infection and sent home, where he died the following day.

The 2008 epidemic shook the infectious disease community, and brought about measures to raise awareness and monitor its spread. But despite those efforts, infection rates and fatalities are on the rise. Liu Min, an epidemiology professor at Peking University, thinks that’s mainly because the authorities now collate better information. “We’re now doing a much better job of discovering and monitoring cases,” he told the Associated Press, “Lots of cases and deaths now can be traced to [the] disease.”

Doctors recommend frequently washing hands and avoiding infected people to reduce the chances of catching the bug. But it’s advice some migrant families can’t afford to follow. The main treatment for severe cases, gamma globulin, costs nearly $100 a dose and isn’t covered by most insurers, according to Outlook Weekly magazine. Some parents who can’t afford to pay for their child’s treatment take them out of the hospital early – increasing the danger of the virus spreading.

The movement of millions of people out of the Chinese countryside is perhaps the largest peacetime migration in history. From just 7% in 1949, as much as half the population is expected to be living in cities by the end of this year. Officials are encouraging ever more to make the move, but the cities may not be ready.

As more country folk arrive each day, improvements in sanitation and living conditions are needed to keep epidemics like hand, foot and mouth at bay.


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