Rapid Economic Transition Research Articles

The Double Burden of Malnutrition in Asia: A Phenomenon Not to be Dismissed

Developing countries around the world – including those in Asia – are in a state of rapid economic transition as a result of generally improving incomes, increasing industrialization, urbanization, and globalization. This state has given rise to changing lifestyle and diets, from one with high level of physical activity and diets based mostly on plant foods, to one with a higher level of sedentariness, and a diet of increasing energy density, fat and animal foods and less plant foods – a state of nutrition transition. 1 This in turn has led to an increase in overweight and obesity especially in adults, and a consequent rise in chronic diseases such as cardiovascular disease, hypertension, Type 2 diabetes and other so-called “diseases of affluence.”

P2-271 Socioeconomic development and sex differences in ischaemic heart disease mortality. An age-period-cohort analysis of the Hong Kong Chinese

IntroductionAn epidemic of premature ischaemic heart disease (IHD) in men usually emerges with economic development. The Hong Kong Chinese population experienced abrupt macro-environmental change generated by mass migration in the...

Awareness of diabetic retinopathy among diabetic patients in Nepal

Dear Editor, D iabetes mellitus is a chronic disease with increasing prevalence worldwide. Among the total diabetic patients expected in 2030, half will be in Asian countries (Wild et al. 2004). This increase has been attributed to the rapid economic, demographic, and nutritional transition in the developing countries (Wild et al. 2004). Almost one-fourth of people 20 years and older and one-third 40 years and older in urban areas of Nepal exhibited diabetic tendencies in one populationbased study from Nepal (Singh & Bhattarai 2003), and now diabetes is considered as an epidemic health problem there. Urbanization, changing dietary patterns from a rough fiber diet to a more refined one with abundant fatty foods, and an increasingly sedentary life style are likely to contribute to additional cases in the future. Likewise, the tradition of excessive feeding of fatty and sweet foods following delivery appears to have increased obesity and diabetic predisposition in women in Nepalese society (Singh & Bhattarai 2003). Diabetic retinopathy (DR) is one of the common complications of diabetes mellitus. As in developed countries, DR could soon become one of the most common causes for blindness in developing nations like Nepal. Nepal’s situation is compounded by a low literacy rate and presumed lack of awareness of diabetic ocular complications. Since early detection and timely ocular treatment may prevent many of the blinding ocular complication of diabetes, enhanced awareness of these complications among diabetic patients and the general public could be an effective public health measure. Previous population-based and secondary health care level studies from Nepal have shown that only 50% of the diabetic patients were aware of potential diabetic ocular complications (Shrestha et al. 2007; Paudyal et al. 2008). When we surveyed new diabetic patients who presented to a tertiary eye care center in Nepal for ophthalmic evaluation, we found that 37% of patients were unaware of diabetic ocular complications even though a majority of the patients had been referred for further evaluation and management. Our unawareness rate was substantially higher than rates reported in studies from neighboring countries (Saikumar et al. 2007). In our series, almost half of the patients were illiterates who must rely on non-print sources for information on DR. Only half of those who were aware of diabetic ocular problems received their information from primary care physicians or from the referring ophthalmologist. This may reflect the small amount of time physicians and ophthalmologists can devote to discussion of diabetic complications with patients in a developing country with a low doctorto-patient ratio. The other major source of awareness was from family members, especially since one-third of cases had a positive family history in at least one-first-degree relative, presumably due to genetic predisposition and common environmental factors such as food habits and lifestyle. Media (magazines and radio) played a less important role in disseminating information in our patient group, in contrast to the study by Saikumar et al. (2007) in which media was the main source for awareness. This finding emphasizes the need for better media coverage to spread the awareness in our country. Although 51% of the total diabetic patients had a history of diabetes of more than 10 years duration, almost half of the subjects had never even had a fundus evaluation prior to their initial visit to the Tilganga Institute of Ophthalmology. Improved awareness campaigns and increased collaboration with primary-care physicians and comprehensive ophthalmologists to ensure timely and regular referrals of at-risk patients are imperative to reduce DR related blindness in countries such as Nepal.

Climate change and China’s mega urban regions

China’s mega urban regions are focal points of economic development and environmental concerns. This paper positions four mega urban regions (i.e., the Yangtze River Delta, the Pearl River Delta, the Bohai Bay Area, and the South-eastern Fujian Province) along China’s coast into the national economy and elaborates their development challenges and planning innovations. Mega urban regions in China are spatial consequences of rapid economic transition. They deserve close scrutiny and demands for innovative planning responses in order to maintain their key role in driving economic growth but limiting their greenhouse gas emission.

Thailand's Work and Health Transition.

Thailand has experienced a rapid economic transition from agriculture to industry and services, and from informal to formal employment. It has much less state regulation and worker representation relative to developed nations, who underwent these transitions more slowly and sequentially, decades earlier. We examine the strengthening of Thai government policy and legislation affecting worker's health, responding to international norms, a new democratic constitution, fear of foreign importer embargos and several fatal workplace disasters. We identify key challenges remaining for Thai policy makers, including legislation enforcement and the measurement of impacts on worker's mental and physical health.

Evolution of Taiwan’s health care system

This study aims to present an overview of the evolutionary policy process in reforming the health care system in Taiwan, through dissecting the forces of knowledge, social-cultural context, economic resources and political system. We further identify factors, which had a significant impact on health care reform policies in Taiwan through illustrative policy examples. One of the most illuminating examples highlighted is the design and implementation of a single-payer National Health Insurance (NHI) program in 1995, after nearly five years of planning efforts (1988-1993) and a two-year legislative marathon. The NHI is one of the most popular social programs ever undertaken in the history of Taiwan, which greatly enhances financial protection against unexpected medical expenses and assures access to health services. Nonetheless, health care reform still has an unfinished agenda. Despite high satisfaction ratings, Taiwan's health care system today is encountering mounting pressure for new reforms as a result of its rapidly aging population, economic stagnation, and imbalanced NHI checkbook. Although there may exist some heterogeneous system characteristics and challenges among different health care systems around the world, Taiwan's experiences in reforming its health care system for the past few decades may provide valuable lessons for countries going through rapid economic and political transition.

The Psychometric Evaluation of the Satisfaction with Life Scale Using a Nationally Representative Sample of China

This study examined the psychometric properties of the Satisfaction with Life Scale (SWLS) in terms of internal consistency reliability, factorial validity, and measurement invariance across gender, age, residential region (metropolitan area/county town/rural area), educational level, and household income with a nationally representative sample of 4,795 participants in China. The percentages of male (47.0%) and female (53.0%) participants were about equal, and the mean age was 38.56 years (SD = 11.87). The results show that the SWLS has a high internal consistency reliability, a one-factor structure (with a wording effect on Items 4 and 5), strict invariance across gender, partial strict invariance across education (Items 1, 2 and 3), and partial strong invariance across age, income (Items 1, 2 and 3) and residential region (Items 1 and 2). The non-invariance of some items across age and region is discussed in terms of the rapid economic and social transitions of China in the past three decades.

Integrating and Prioritizing Environmental Risks in China's Risk Management Discourse

Human society faces a growing number of risks, including both natural disasters and risks that stem from human behavior. This is particularly true in China, which is experiencing rapid social, economic and political transitions. Since the 1970s, China's modernization process has been accompanied by the emergence of an increasing number of man-made risks, in particular environmental pollution, but until very recently, a risk management system did not exist in China. Society was woken up by a series of disasters and accidents, including SARS in 2003, followed by the explosion of avian flu and the chemical spill in the Songhua River in 2005. The last incident in particular finally kicked off the development of a national risk management system (specifically an emergency response system) in China. This paper analyses the status quo of the legislation, institutions and mechanisms for risk management in China and identifies opportunities and strategies for prioritizing and integrating environmental and health risks into the emerging system. The study concludes that although a series of alarming incidents have succeeded in putting risk management issues at the top of the public and political agenda, currently risk management in China can be characterized as reactive and compartmentalized, with a lack of prioritization and integration of policy efforts and resources. There is also a danger that the traditional state-centered approach may fail to create an effective risk management system, which requires improved transparency, accountability, and cross-sectoral coordination. The paper concludes with the proposal of strategies that might enable the environmental authorities to be more effective and reduce their marginalization and isolation.

Chinese Nurses' Perceptions of Heart Health Issues Facing Women in China

China is in a state of rapid economic growth and epidemiological transition. Morbidity and mortality relating to heart disease in women have increased dramatically. The aim of this study was to obtain the views of nurses regarding heart health issues for women in contemporary China. : This study used focus group interviews. Convenience sampling was used to recruit nurses working in acute care hospitals in metropolitan China. Five focus groups containing 28 female participants were conducted. Focus groups were moderated by 2 bilingual Chinese nurses, audiotaped, and analyzed using thematic analysis. Four themes emerged from the focus group data: (1) mixed perceptions of disease burden in women, (2) modern life impacts upon women's health, (3) need for focus on prevention and coordination, and (4) education and support are keys to driving healthcare improvements. Heart disease, as a significant health issue for women in China, is underappreciated among Chinese nurses.

Reaching every district - development and testing of a health micro-planning strategy for reaching difficult to reach populations in Mongolia

Since the 1990s, Mongolia has undergone a rapid social and economic transition with migration to the urban areas of the national capital Ulaanbaatar. The main reasons for the migration are social sector decline in rural areas and the potential for employment opportunities in urban areas. There are also new internal patterns of migration in rural and remote areas relating to recent developments in the economic sector. Despite recent innovations in health system management in Mongolia, in some urban and rural and remote locations health services are not sufficiently accessed by the most socially and economically disadvantaged populations. These concerns provided the motivation for the Ministry of Health of Mongolia and development partners to attempt to access the most difficult to reach populations through the development of a micro-planning process referred to as the 'Reaching Every District strategy' (RED). This article describes and analyses RED micro-planning processes and content, and highlights the lessons learned. The main source of data for this planning system development was in the development and testing of the micro-planning process in Byanzurkh District, Ulaanbaatar in June 2008. The principal intervention developed and trialed was a health micro-planning strategy for improved access to immunization and maternal and child health services for difficult to reach populations. The planning methodology was a problem-solving approach progressing from health mapping to barrier analysis, to activity planning and costing and finally to monitoring and evaluation. Main success factors in the development of the planning methodology were the use of barrier analysis and mapping approaches for data analysis and problem solving at the local level, and re-orientation of management approaches from 'inspection' to supportive supervision. Additionally, although the RED strategy is intended to be an immunization-specific intervention internationally, evidence from the development and trial of the process in Mongolia indicates its potential for wider health systems applications. This is particularly so for detecting and responding to the maternal and child health service needs of the more difficult to reach sub-populations.

Partnerships for Sustainable Development in China: Adaptation of a Global Governance Instrument

Hybrid governance instruments such as public-private partnerships are increasingly applied in so-called emerging countries, in particular Brazil, India and China (the 'BRICs'). With a more diverse set of influential political actors involved in global governance, the question arises whether existing global governance institutions are effective and legitimate. This paper focuses on partnerships in China's sustainable development. China has witnessed rapid economic transition from a plan economy to a market economy. In the course of these developments, China faces increasing ecological stress and social inequity. Reform and intensification of China's sustainable development governance seems necessary. Are partnerships the road to go? Does China successfully appropriate the partnership model and integrate it into its domestic governance? This paper discusses how Partnerships for Sustainable Development were brokered at the 2002 Worlds Summit for Sustainable Development, in spite of initial resistance by developing countries; and whether a prevalent partnership model is emerging in China.

Coker R, Atun R, McKee M (editors). Health Systems and the Challenge of Communicable Diseases; Experiences from Europe and Latin America.

Coker R, Atun R, McKee M (editors). Health Systems and the Challenge of Communicable Diseases; Experiences from Europe and Latin America. Maidenhead, UK: Open University Press, 2008. ISBN13: 9780335233656, 266 pp, £70.00 (hardcover) . The break-up of the Soviet Union and the change of regimes in the countries of Central and Eastern Europe around 1990 had significant consequences for health and health services in these parts of the world. This in turn let to a rise in research in these areas. Initially this research was centred around the London School of Hygiene and Tropical Medicine in collaboration with scientists from the countries involved and was primarily financed by grants from NGO foundations, such as The Soros Foundation. Eventually, this work became an integral part of the European Observatory on Health Systems and Policies, which is now behind the production of the present book. Just one on a long list of highly relevant publications on health services. The editors start the first chapter of this magnificent book by the following sentence: ‘This book is about countries undergoing rapid political, economic and social transition.’ True, many of the well-presented examples in subsequent chapters deal …

Determinants of family size in a Gulf Arab state: a comparison between two areas

The rapid economic transition in the Gulf Arab countries has resulted in marked changes in fertility and marriage patterns and a decrease in the number of children per family. Yet little is known about the determinants of family size in urban and less urban areas. A cross-sectional study was carried out on 450 Kuwaiti women aged 20-60 years who attended health care centres in Al Asima and Al Jahra governorates. A semi-structured questionnaire was administered through face-to-face interview which included variables on socio-demographic characteristics, family size, actual and ideal spacing, marriage related variables, health conditions and utilization of health services. Both univariate and multivariate analyses were performed to identify the factors that affect family size. The socio-economic indicators were significantly better in Al Asima, the capital, than in Al Jahra, a less urbanized area. On average, family size for the total sample was 5.97 +/- 0.114 with a larger size (6.27 +/- 0.242) in Al Jahra than in Al Asima (5.80 +/- 0.118) but without a significant difference. Al Jahra women reported a larger number of deliveries and past pregnancies but a lower usage of contraceptive measures. The total fertility rate was 3.65 in Al Asima, 3.84 in Al Jahra and 3.71 births per woman in the total population. Family size was inversely related to the educational level of women and their husbands. Currently employed women had a smaller family size (5.22 +/- 0.119) than the unemployed (6.81 +/- 0.187); p < 0.0005. Health problems in the interviewee or her husband played a minor role in the decision to have more children. Families where the husband was the decision-maker on the number of children had a significantly larger family size (6.91 +/- 0.451) than families where the couple both participated in the decision (5.83 +/- 0.129; p = 0.032). The duration of marriage, ideal number of children, age of women at last delivery, number of rooms and the crowding index had significant positive effects on family size, whereas age at first delivery, duration between two consecutive pregnancies and history of past abortions were inversely related to family size in the stepwise multiple regression analysis. Although women in the less urbanized areas in the Gulf Arab populations are more disadvantaged with respect to socio-economic characteristics than women in the more urbanized areas, there were no significant differences in family size in these contrasting communities. The impact of socio-demographic characteristics on family size was minor compared to factors related to fertility and the husband's desire to have more children. Fertility and family planning policies should consider these issues in order to promote more effective programmes.

Glossing Over the Complexity of Water

Although we applaud the recognition given by Science to Freshwater Resources, the recent Special Section (25 Aug., pp. [1067][1]–1090) missed an opportunity to highlight the multifaceted nature of water resources research. Framing “the” water problem as a search to quench a universal thirst (“A thirsty world”) glosses over critical differences in the causes of, and thus the solutions to, water problems across regions. It forces the discussion into the domains of supply augmentation and engineering and marginalizes underlying drivers of “thirst” such as rapid urbanization, economic transitions, geopolitical factors, or poverty. Lack of access to water in many African countries, for example, is less the outcome of a first-order water scarcity than of a second-order scarcity of social resources ([1][2]). As the News story “Running out of water—and time” (J. Bohannon, p. 1085) suggests, Gaza suffers at least as much from geopolitical factors that inhibit access to money and nearby water as from the “environmental problem” of “running out of water.” Water transfers or desalination help overcome local/regional scarcity, but with important environmental, social, and economic costs (“Going against the flow,” R. Stone, H. Jia, News Focus, p. 1034; “Desalination freshens up,” R. F. Service, News, p. 1088). For example, Israel's water management is becoming “sustainable” (“Seeking sustainability: Israel's evolving water management strategy,” A. Tal, Perspective, p. 1081) only from a narrow technical perspective that treats as exogenous the growth in its arid south and neglects the environmental and third party impacts of overexploiting the Jordan River. Firstorder scarcity metrics (“Global hydrological cycles and world water resources,” T. Oki, S. Kanae, Review, p. 1068), especially global ones, overlook such specificities and are of limited policy use. The interdisciplinary water research community has shifted its attention to context-specific and proactive approaches such as watershed management, ecological engineering, demand management, reallocation, and collaborative/adaptive planning ([2][3]). We understand that the Special Section was not meant to be an exhaustive review of freshwater issues. But institutional, political, and economic options deserve more than cursory mention in Science , since it is primarily these, rather than technical fixes alone, that “offer a measure of hope for the future” (“A thirsty world,” J. Yeston et al. , p. 1067). 1. 1.[↵][4]1. J. Lundqvist, 2. M. Falkenmark, 3. C. Folke, 4. L. Gordon, 5. L. Ohlsson , New Dimensions in Water Security (UN Food and Agriculture Organization, Rome, 2000)(FAO AGL/MISC/25/2000. 2. 2.[↵][5]1. P. H. Gleick , Water Int. 25, 127 (2000). [OpenUrl][6][CrossRef][7][Web of Science][8] 3. 3.The Letter was written with input from the ERG Water Group. [1]: /lookup/doi/10.1126/science.313.5790.1067 [2]: #ref-1 [3]: #ref-2 [4]: #xref-ref-1-1 View reference 1. in text [5]: #xref-ref-2-1 View reference 2. in text [6]: {openurl}?query=rft.jtitle%253DWater%2BInt.%26rft.volume%253D25%26rft.spage%253D127%26rft.atitle%253DWATER%2BINT%26rft_id%253Dinfo%253Adoi%252F10.1080%252F02508060008686804%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: /lookup/external-ref?access_num=10.1080/02508060008686804&link_type=DOI [8]: /lookup/external-ref?access_num=000085987900013&link_type=ISI

Ideological Reform and Political Legitimacy in China: Challenges in the Post-Jiang Era

As a Socialist country undergoing rapid social and economic transition, China presents a revealing case study on the role of ideology in the process of institutional change. Based on Douglass North’s theory of institutional change and on David Beetham’s theory of political legitimation, this paper argues that recent ideological reforms have been a crucial factor in sustaining the legitimacy of Communist party rule. Ideological change is conceived as a path-dependent process which helps to stabilize the social perception of transition and to frame the party’s modernization achievements. At the same time, the dominant role of ideology makes the Chinese party-state, despite its economic success, more vulnerable to legitimacy crises compared to other authoritarian regimes.

Gender‐specific mortality associated with alcohol consumption in Poland in transition*

To show the impact of rapid political and economic transitions on alcohol consumption and associated mortality in different socio-demographic segments of the Polish society, with particular focus on gender differences. Two causes of death associated with drinking (liver diseases and alcohol poisoning) are investigated. Mortality time series 1986-2002 are analysed against consumption estimates and population drinking survey data. Poland 1986-2002. General adult population. Age-standardized annual and 3-year death rates were calculated for age, gender and place of residence subgroups. For education, age-standardized relative frequency of deaths or proportional mortality in four basic educational levels was calculated. Alcohol-related mortality shows great variability in response to substantial changes in alcohol consumption. Patterns of mortality and their magnitude of change correspond with average alcohol consumption and are therefore different for men and women, for different age and educational groups and in urban and rural areas. Level of education, however, may affect alcohol-related mortality more strongly than overall alcohol intake, particularly with regard to acute consequences of drinking. The Polish experience illustrates that the impact of rapid political and economic transitions on alcohol consumption and associated mortality is highly differentiated and specific to gender and social class.

The Southern Baltic Sea and its coast in transition

This special feature is based on results of an interdisciplinary priority program of the German Federal Environmental Foundation (Deutsche Bundesstiftung Umwelt, DBU) called “die sudliche Ostsee und ihre Kuste im Wandel” (the Southern Baltic Sean and its coast in transition). The Baltic Sea is the world’s largest brackish-water body (area 415.00 km 2 , volume ca. 22.000 km 3 ). The long coast-line (20.000 km) is shared by 9 nations, with 70 millions inhabitants in the coastal zone and 100 millions inhabitants in the hydrological catchment region. As a geologically young and relatively shallow sea-basin, the Baltic Sea is an area of rapid environmental change. It is characterised by pronounced environmental gradients and a pronounced importance of the sea-land interface for the functioning of the entire Baltic Sea system. The density of human settlement, particularly along the southern coast, and the almost enclosed basin of the Baltic Sea make it particularly sensitive to anthropogenic impact and changes in human utilisation of the sea, its coast and its catchment. In addition to the usual, more gradual changes of human impact along the northern Baltic coast, the southern Baltic coast and its catchment have witnessed the collapse of the socialist economic system with its associated rapid economic transitions. Our main study region, the coast of Mecklenburg-Vorpommern (the coastal state in eastern Germany) may serve as a paradigmatic example with its transition from an economy dominated by industry and agriculture to an economy dominated by tourism. Understanding the ecosystem consequences of such changes, predicting future trends and developing strategies for sustainable use requires research across a wide range of time-scales, from the geological scale (coastal

Longitudinal study of child immunization determinants in China

This paper exploits longitudinal data and methods to study the determinants of child immunization in 1990s China. Many countries such as China are experiencing rapid economic transitions characterized by declining public health expenditures, privatizing health-care sectors, increased inequality and high income growth. It is still poorly understood how such changes affect utilization of preventive health care. Data from three waves of the China Health and Nutrition Survey were used to examine the immunization effects of child, household, and community health facility characteristics, as well as changes of such effects over time. Results indicate that gender and wealth differentials in immunization increased during China's transition, though these effects were small. The most important determinants were service price and maternal education. Wealth effects were minimal, indicating that the long-run effect of economic transition on immunization rates may depend crucially on the extent to which more rapid economic growth leads to increased educational investments. Methodologically, the paper finds substantial bias from standard cross-sectional models in contrast to panel data approaches, adding to the case for expanded collection of longitudinal health data in developing countries.

Variation in Chinese population health related quality of life: Results from a EuroQol study in Beijing, China

The purpose of this study is to measure Chinese population health related quality of life (HRQoL) using European quality of life (EQ-5D) instrument, to examine the validity of EQ-5D in measuring Chinese population HRQoL, to explore the relationships between EQ-5D and other health determinants, and to display the similarities and differences of HRQoL between the Chinese population and the populations of other countries. The data used in this study includes 2994 respondents whose age are 12 years and older, which is from the 2000 Beijing Household Health Survey. Univariate and bivariate analyses have been used to examine the level of HRQoL and the relationships between HRQoL and other variables. Multi-variate analyses have been used to explore the relationships between the EQ-5D Visual Analogue Scale (VAS) and the EQ-5D five dimension indicators. There are four principal findings from this study. First, the EQ-5D instrument is a valid measure for Chinese HRQoL, but with a significant ceiling effect. Second, Pain/ Discomfort and Anxiety/Depression are the major Chinese HRQoL problems and the extents of these problems differ in subgroup populations. Third, typically mean scores are lower for older age group; this is observed at lower ages in the Chinese population than in populations from developed countries. Fourth, Chinese HRQoL has strong association relationship with population socio-economic status (SES), which might imply that issues brought on by the rapid economic transition have both positive and negative impacts on Chinese HRQoL.

The environmental industry in transitional China: barriers and opportunities between state and market

The environmental industry has been cited as a crucial industrial sector that developed parallel to the increasing focus on ecological and environmental issues in the modernisation process. Notwithstanding its rapid growth in recent years, China's environmental industry is still immature in comparison with that of developed countries. A review of the development of China's environmental industry points at several fundamental constraints. Both at national and regional levels, barriers relate to the demand side and the supply side of environmental industry, linked to rapid economic and social transitions. In addition, political constraints for innovation in environmental industry relate to the underlying administrative hierarchy and governmental regulation.