An ageing population is placing a massive strain on China’s health system, with chronic illness on the rise among its citizens who are living years longer than their parents’ generation.
Life expectancy has risen to 76, up from just 59 in 1970. By 2050, it is estimated that 25 per cent of China’s population will be over 65, adding challenges to the health system.
Australian researchers have been playing a leading role in examining chronic illness patterns and health system responses in China, as well as identifying the behavioural risks in the prevention and management of these illnesses in older people.
Federation University Professor of Healthcare Dr Colette Browning, who has worked extensively in China, recently edited a special journal issue on the subject which has been presented at the Australian National University as part of an International Alliance of Research Universities symposium.
One of the papers in the issue – a diabetes self-management clinical trial which ran in Beijing – evolved from a trial first run in Australia.
“In Australia, this was a diabetes management program which we evaluated as part of a Federal Government initiative to promote the self-management of chronic illnesses. Here it was called the Good Life Club,” Professor Browning said.
“We adapted it for China where it's called the Happy Life Club. In China we trained coaches in behaviour change techniques who then worked with clients in partnership to help increase physical activity, appropriate nutrition and diet and better self-management of diabetes.”
Behavioural risks like smoking, alcohol consumption, sedentary behaviour and poor diet contribute to the challenges of managing diabetes and other chronic conditions.
Professor Browning said the program had a strong impact on the way diabetes was managed in China, with many doctors and nursing staff taking part in the training in Beijing and other cities.
“For effective diabetes management you need a good relationship with your healthcare provider to work together around behaviour change because the evidence around that is very strong now – engaging in physical activity and managing your diet and weight contribute to better management of diabetes and hence better quality of life,” Professor Browning said.
More recently, Professor Browning has been working with government agencies on aged care policy and primary care policy in China to ensure primary healthcare systems are geared up to deal with ageing populations and the increased prevalence of chronic conditions.
“What China has done over the last 15 or more years is recognise that they need a good primary healthcare system. Traditionally hospitals were the name of the game in China and they still are to a certain extent – people turn up the big hospitals for routine health problems when we would go to a GP,” Professor Browning said.
“So what they've been doing is trying to increase their general practice and primary care workforce to have a system a bit more like what we have, encouraging citizens to visit a GP, a primary care practitioner in their community rather than going to a tertiary hospital.”
“A lot of work has been around the training of that workforce to be more like what we see in Western primary healthcare settings. We have had a lot of doctors visit Australia from Shenzhen for example, to experience how our system works and engage in training. Of course, the learnings are a two-way street. Our visits expose us to different systems and expand our understanding of cultural influences on health.”
Professor Browning said that the emphasis on primary care in China’s health policies was now seeing an increase in the training of the primary care workforce to better manage chronic illnesses within that sector. Previously many older residents would present to hospital with a poorly managed condition when it was more difficult to manage.
“It’s a big job, we’re talking about the training of millions of GPs – it’s hard to imagine how many we're talking about.” Professor Colette Browning
"They have been looking to countries with more mature primary care systems for advice. What I’ve been doing in Shenzhen is around that, helping them understand how the system works here and what skills that general practitioners need but you can't just transplant one system into another.”
“They are also looking to upskill their nurses to help deal with things like aged care and chronic disease management. I have been working with nurses in China to develop quality systems and standards to promote best practice. I am looking forward to Federation’s ongoing involvement in this international collaboration.”