On April 3, 2014, Karen Eggleston provided testimony before the U.S-China Economic and Security Review Commission at the "Hearing on China’s Healthcare Sector, Drug Safety, and the U.S.-China Trade in Medical Products."

Some of the questions addressed included:

• How has the nature of disease in China changed in recent decades? What kind of burden might it place on China's future development?
• If providers are "inducing" demand by overprescribing drugs, it this a public health crisis in the making?
• Can you outline the pros and cons of market reform in China's healthcare sector? What might be the proper role of the state of improving healthcare delivery?
• Kan bing nan, kan bing gui (inaccessible and unaffordable healthcare) is one of the top concerns of ordinary Chinese. Which groups are most affected? Is this a global problem, what lessons can we learn from China?
• The pharmaceuticals industry features in China's Medium and Long-term Plan for Science and Technology (2006-2020), as well as in more recent measures to promote indigenous innovation and industrial upgrading. Is it fair to say that the Chinese government is prioritizing domestic pharmaceutical companies, which foster economic growth, over the welfare of patients?
• What were major successes and failures of the 2009 healthcare reforms [in China]? How have those reforms been supplemented by more recent measures (e.g. last November's Third Plenum)?
• What aspects of China's healthcare reform should the U.S. government and U.S. companies pay most attention to?

Abstract

Background: Body mass index (BMI) and waist circumference (WC) are used in risk assessment for the development of noncommunicable diseases (NCDs) worldwide. Within a Cambodian population, this study aimed to identify an appropriate BMI and WC cutoff to capture those individuals that are overweight and have an elevated risk of vascular disease.

Methodology/Principal Findings: We used nationally representative cross-sectional data from the STEP survey conducted by the Department of Preventive Medicine, Ministry of Health, Cambodia in 2010. In total, 5,015 subjects between age 25 and 64 years were included in the analyses. Chi-square, Fisher’s Exact test and Student t-test, and multiple logistic regression were performed. Of total, 35.6% (n=1,786) were men, and 64.4% (n=3,229) were women. Mean age was 43.0 years (SD = 11.2 years) and 43.6 years (SD = 10.9 years) for men and women, respectively. Significant association of subjects with hypertension and hypercholesterolemia was found in those with BMI $23.0 kg/m2 and with WC .80.0 cm in both sexes. The Area Under the Curve (AUC) from Receiver Operating Characteristic curves was significantly greater in both sexes (all p-values, 0.001) when BMI of 23.0 kg/m2 was used as the cutoff point for overweight compared to that using WHO BMI classification for overweight (BMI $25.0 kg/m2) for detecting the three cardiovascular risk factors. Similarly, AUC was also significantly higher in men (p-value, 0.001) when using WC of 80.0 cm as the cutoff point for central obesity compared to that recommended by WHO (WC $94.0 cm in men).

Conclusion: Lower cutoffs for BMI and WC should be used to identify of risks of hypertension, diabetes, and hypercholesterolemia for Cambodian aged between 25 and 64 years.

China's population of 1.34 billion is now 50 percent urban, over 13 percent above age 60, and with 118 boys born for every 100 girls. For such a large population at a relatively low level of per capita income, how will aging interact with substantial gender imbalance and rapid urbanization?

Will Demographic Change Slow China’s Rise? In the eponymous article recently published in the Journal of Asia Studies, five Stanford scholars of political science, sociology, and economics based at the Shorenstein Asia-Pacific Research Center — Karen Eggleston, Jean C. Oi, Scott Rozelle, Andrew Walder, and Xueguang Zhou, with a former postdoctoral fellow Ang Sun — discuss how the intertwined demographic changes pose an unprecedented challenge to social and economic governance, contributing to and magnifying the effects of a slower rate of economic growth.

The authors touch upon a wide range of topics of policy import:
· China must overhaul rural education quickly if it is going to avoid producing tens of millions of workers who will be marginalized in the nation's future high-wage, high-skill economy.
· Growth slowdowns are almost always productivity growth slowdowns. Many forces impinge on multi-factor productivity; the stability and predictability of markets and governance are lynchpins. Discontent with widening disparities in China could undermine this fundamental foundation of growth.
· Demographic change will fundamentally challenge the conventional governance structures in China. Efforts to impose a bureaucratic solution to the intertwined social challenges China faces will almost inevitably stoke tensions between the society and the state. In both urban and rural areas, expansion of the bureaucratic state may become the central target of popular contention.
· China's high savings rate is partly explained by low fertility and parents' need to save for their own old-age support. Initiation of rural pensions and significant expansion of health insurance coverage and are examples of the social policy responses that China has undertaken to prepare for “growing old before becoming rich.” But much remains to be done.
· China's increasing burden of chronic disease further exacerbates the growth-slowing potential of a more elderly population and its associated medical expenditure burden.
· Although reducing precautionary savings and increasing domestic consumption as an engine of economic growth are widely acknowledged goals for China's economy, a rapid decline in savings could also imperil China's future economic growth by jeopardizing the current basis of the financial system.
· Demographic change will shape almost every aspect of how China copes with a slowing rate of economic growth, and may play a decisive role in the future social stability of China, with spillover effects for the region and the rest of the world.
The research is one product of a 3-year project analyzing Asian demographic change which will conclude in 2014 with a conference and edited book on demographic change and urbanization in China, in comparative international perspective.