We hope you’re enjoying your summer. We are still in the process of lining up new, exciting speakers for you. In the meantime, we are pleased to invite you to a July 15th one-day conference being organized by International Healthcare Leadership* and the Columbia Global Center on “INCORPORATING PUBLIC HEALTH POLICY INTO HEALTHCARE MANAGEMENT.” This conference will look at implementation of the ongoing healthcare reforms in hospital settings.

Beijing Healthcare Forum很荣幸地邀请各位参加由International Healthcare Leadership* 与 哥伦比亚大学全球中心|东亚中心
在2010年7月15日联合筹办的“公共卫生政策在医疗卫生管理中的应用”一日研讨会。本次会议将着眼于“现行医疗单位中的医疗改革的实践”，并提供平台，促进讨论和心得分享。

The conference kicks off with remarks from Chinese government officials and the American ambassador, John Huntsman. Morning session presentations will be given by faculty from the Columbia University Mailman School of Public Health and by Chinese academics from CEIBS, Peking Union Medical Colleg. The afternoon program includes BHF favorite Prof. Gordon Liu of the China Center for Pharmacoeconomics and Outcomes Research at Beijing University. Wrapping up the day is a panel of distinguished healthcare leaders representing government, hospitals, universities and industry. Speakers will address issues such as health economics, health reform and the use of evidence based systems for evaluation of health policy implementation.

本次会议将由中国政府官员以及美国驻华大使约翰Hustman作为贵宾开场。上午的议程将由美国哥伦比亚大学梅尔曼公共卫生学院，中欧国工商学院和北京协和医学院的教授作专题演讲，下午亦邀请到北京大学光华管理学院的刘国恩教授主讲，其余将有来自中国政府，医院，大学院校和各级产业的代表与会，加入讨论。他们将就卫生经济，卫生改革，以及医疗政策的实施惠予其见解，并欢迎所有与会者加入现场讨论。

Speakers will use both Chinese and English. Formal simultaneous translation service is provided with headsets.

会议将提供正式的同声传译耳机。

Admission, including lunch, is FREE. Registration by July 1st is required (the registration form, with instructions is attached). See below for more details.

入场费，包括午餐，是免费的。需要于2010年7月1 日前报名。其它细节，请参阅以下附件。

Conference details:
JULY 15, 2010
8:00 AM—5:00 PM
Price: FREE! (Registration is necessary)
Registration end date: July 1, 2010
PricewaterhouseCoopers,
26th Floor Tower A
Beijing Fortune Plaza, 7 Dongsanhuan Zhong Road
Chaoyang District, Beijing 10020 PRC

会议细节：
2010 年 7月15日
早上8：00点–下午5：00点
参会方式：免费 （需注册）
报名截止日期：2010年7月1日。
中国北京朝阳区东三环中路7号财富中心A座26楼
普华永道咨询（深圳）有限公司北京分公司

Please complete the registration form and email it to IHLSymposium2010@gmail.com or fax it to (86) 8215.1107 ex. 8006 by 1st July 2010. For any inquiries, please call (86) 134.3943.9115

请您于2010年7月1 日前填写好此表并发送IHLSymposium2010@gmail.com ,或用传真发送(86) 8215.1107 转8006。如果您有任何疑问，可拨打电话 （86) 134.3943.9115

Best regards,
Jared and Ray
高志忠和邓腾

*International Healthcare Leadership is a non-profit organization developed to provide tools needed by healthcare leaders to devise and test coherent health care policy while also providing management tools to improve health care infrastructure.
International Healthcare Leadership是一个非盈利性组织，其目标是为卫生管理者提供制定和评估卫生政策所需的多种工具，同时也提供相应管理工具以改善基础医疗保健设施。

Cross-posted on China Healthcare Blog.

Thanks to Oxfam for making their pictures available including the one used above.

One has to remember, however, that this predominant theory came about almost two decades ago when data in China was scarce, and I am not convinced that new studies have done a good enough job exploring new possibilities.

At base,  I have trouble believing that millions of parents in a culture that’s family centered would do that to their babies. I have said as much in the past.  There are lots of other explanations available, and the Telegraph reports on one today -  the Chinese are having the girls but not reporting them, thereby skewing official numbers.

The Shanghaiist notes that if three million babies are hidden each year, then we’re well on our way for accounting for the bulk of missing children.

China’s one-child policy has been in place since 1978 in an attempt to stem the growth of the world’s largest population. Between the traditional desire to have a boy, and the one-child policy, China should produce a surfeit of 30 million men by 2020.

Yet research by Liang Zhongtang, a demographer and former member of the expert committee of China’s National Population and Family Planning Commission, finds that people might be hiding roughly 3 million babies from the government each year… at least until they’re old enough to be revealed with little repercussion.

He notes that “In 1990, the national census recorded 23 million births. But by the 2000 census, there were 26 million ten-year-old children, an increase of three million… Normally, you would expect there to be fewer ten-year-olds than newborns, because of infant mortality.”

Coupled our calculations that the boy-girl imbalance rate is actually being reduced, this news means that there’s some hope yet for all the single guys in China.

Here is the full Telegraph article in case the link goes dead.

Saratu is absolutely right – this is very good Damjan bait.  Let the record show that I just referred to myself in the third person for the first time in print.  This must mean that the link is good enough to trigger an out of body experience.

As her eyes darted around the appropriately named Jolly nightclub and bar, she admitted that she faced an uphill struggle. The competition is ferocious. Apart from a solitary Chinese man, quietly sipping a beer at the bar and a group of young men playing pool, the favourite after-work drinking hole is overflowing with groups of young women, chatting excitedly.

“It is early, Chinese men work hard and come later, they not lazy like Tanzanians,” Zaina said. “Problem is many, many girls; me not really their type. I am tall and slim. They prefer small, fat ladies with paler skins,” she said, confiding with a whisper that some of the girls were busy applying skin-lightening ointment. “They buy it in Congo — we call them the Michael Jacksons.”

What a perfect name.  Just like Michael Jackson, these ladies aren’t fooling anybody.  But, when a country is as poor as Tanzania, then anything is worth a shot, right?  Maybe not.  If the attitudes I’ve observed in China are anything to go on, mixed marriages will not last past the expiration date on those Chinese men’s passports.  Better figure out a way to make them stay in Tanzania.

Thank you austinhk for making your flickr stream available for commons use.

Highlights from the article:

• TEVA’s aiming for $31B in sales by 2015.
• between 1999 and 2010, profits shot up from $135M to $2B.
• their adjacent warehouse has radio signals embedded into the factory floor which guide forklifts between the tall shelves, since aisles are too narrow for human navigation.
• TEVA executives shun extravagance or artifice.
• costs are all rigorously evaluated against how they contribute to the bottom line. If they don’t make significant improvements to TEVA’s profit position, they’re axed.
• the company is the US generic drugs leader, with a shippable production of over 60 billion pills per year.

And China fans, here’s the paragraph (emphasis mine) relating to our purposes:

“…the company['s]…commitment to quality remains such that, unlike some of its competitors, it isn’t moving operations to India or China in pursuit of cheaper manufacturing. (Teva’s manufacturing centers are primarily in Israel, the United States and Europe.)”

Yes, despite the lack of media coverage, the H1N1 flu is still out there.  So stay clean!  Wash those hands, and make sure that you wash your vegetables.  The use of Night Soil Fertilizer is widespread in China, as well as rural areas all over Southeast Asia .  This means that everything you eat should be cooked.  If you want to stay updated, then RSS feed the WHO website.

Here’s a more specific update for the Asian region, as provided by the WHO.

“In Asia, the most active areas of pandemic influenza virus transmission are in parts of South and Southeast Asia, particularly in Bangladesh, Malaysia, and Singapore. In Malaysia, limited data suggests that a second period of active pandemic influenza virus transmission has been occurring since early April 2010, but overall activity may have recently stabilized and does not appear to exceed pandemic influenza activity seen during an earlier period of transmission lasting from July until early September 2009. In Singapore, levels of ARI have remained elevated since mid April 2010; during the most recent reporting week, levels of ARI exceeded the epidemic threshold and the proportion of patients with ILI testing positive for pandemic influenza virus infection was 39%. In Bangladesh increased co-circulation of pandemic influenza and seasonal influenza type B viruses has been detected since mid April 2010 but now appears to have stabilized. Low level circulation of pandemic influenza continues to persist in Thailand and in the western and southern parts of India; sporadic detection of pandemic influenza continue to be reported in Cambodia and in the Philippines. In East Asia, only sporadic detections of pandemic influenza virus are being reported; seasonal influenza type B viruses have been predominant in this region, however circulation appears to be declining in China and the Republic of Korea.”

It provides opportunities for leadership development, policy advocacy, partnerships, and improvement of community mobilization skills. With 33 million people living with HIV today, the Candlelight continues to serve as an important intervention for global solidarity, breaking down barriers, and giving hope to new generations.

The Chinese Ministry of Health and UNAIDS estimate that China had 560,000 to 920,000 living HIV carriers, and 97,000 to 112,000 AIDS patients by the end of 2009 (Xinhua, 2009). These are large numbers yet the spread of HIV/AIDS is a commonly underestimated and misunderstood problem, in the Middle Kingdom.

The notion that the Candlelight movement helps “solidarity”, “breaks down barriers” and “gives hope to new generations” is almost a sacrosanct notion, in China. When one looks at the literature surrounding HIV/AIDS in China, it’s rather surprising to learn that Shanghai is running a Candlelight Memorial for the 5th consecutive year. It’s surprising because China has a horrendous record of stigma and discrimination against people living with HIV/AIDS. Despite the official lifting of the ban on foreigners with HIV/AIDS, enforcement of the law appears to remain unchanged, and one has to wonder was lies behind the glitz and glamour of Shanghai’s 5th memorial. UNAIDS, the United Nations Programme on HIV/AIDS, recently released a ‘Stigma Report’ on China. If you want to see the full report, check it out here. I’ve compiled a few choice cuts that exemplify the upsetting state of discrimination against people living with HIV/AIDS (PLHIV)

How PLHIV sufferers feel in China

• More than half of respondents were worried about being insulted or threatened, and almost one quarter worried about being physically attacked.
• 50.5% feel like they have/will lose friends because of their illness
• 53.7% feel like they have/will experience people distancing themselves from them
• 58.1% isolate themselves from society due to self-stigma
• Over half of women and 40% of men have considered committing suicide since being infected.

The right of confidentiality of PLHIV in China

• Almost half of respondents (49.8%), whose friends or neighbours were aware of their status, said that these people have been told about their HIV status without their consent.
• Even worse, 15.3% of respondents said that a healthcare professional had told other people without their consent!

Discrimination against PLHIV in China

• 41.7 percent of respondents report having faced some type of HIV-related discrimination.
• 12.1 percent of respondents had been refused medical care at least once since they were tested positive.
• Of female respondents who were married or who had had sexual partners since being infected, 11.9 percent had been pressurised into terminating a pregnancy by medical staff/family planning department staff.
• Of those respondents with children, 9.1 percent said that their children, who were not necessarily HIV positive themselves, had been forced to leave school because of the HIV status of their parents.

These are just a few of the shocking statistics found by the survey. I’ve never been disgusted by reading official papers (they’re rather sterile), but I have to admit this is the first. Especially the portions of the paper dealing with instances of confidentiality breaches by certain medical staff. The poor moral decisions of some Chinese doctors are reasonably well-known in the healthcare world, but this level of ignorance and disrespect completely trumps accepting ‘hong bao‘ and typical ‘antibiotics-with-everything’ practices.

Outside of the UNAIDS Stigma Report, the picture is pretty much the same, albeit with a human face.

Yanqiu Rachel Zhou’s 2007 article for Social Science & Medicine entitled; ‘‘If you get AIDS, You have to endure it alone: Understanding the social constructions of HIV/AIDS in China”, was a qualitative study of 21 PLHIV in Beijing (Zhou, 2007). While it’s always advisable to look at cold hard facts, healthcare is about people and it’s refreshing to see an anecdotal side to compliment the UNAIDS’s much more representative, but sterile, sample.

All respondents in Zhou’s study experienced feeling “awkward”, “faceless”, “ashamed”, and/or “inferior”. ‘Guo‘, one of the subjects, claimed that his wife divorced him because of the stigma of his condition:

“[My wife] didn’t accept these three words [i.e. ai zi bing, HIV/AIDS]. These words sound awful. I never thought I would get this disease, either. … When [one] hears these words, the first thing that comes to one’s mind is that you must have some immoral relationships outside [your marriage]. You get this disease only because you have promiscuous behaviours. …Not only she thinks this way, most people think this way. According to the old Beijing saying, this is a dirty disease. One’s reputation is not good if one gets it.”

Other quotes from the study include:

While people with other incurable or infectious diseases are visited by their families when they are hospitalized, it is not always the case for [the respondents]. ‘‘I think only people living with HIV/AIDS can understand such pain.’’ Guo commented: ‘‘If I had cancer, I could tell people about that. But if you get AIDS, you cannot tell anyone about it. You have to endure it alone.’’
…
Jing became extremely cautious after hearing of his friend’s experience of being mistreated by a dentist: when the man disclosed his HIV serostatus when he went to have teeth removed, the dentist promptly put down all his instruments and left. Han’s story of being rejected for surgery by a hospital was also well known among [PLHIV] and increased their nervousness about disclosure.
…
Despite his knowledge about HIV transmission, for instance, Yu had not dared to kiss or hug his daughter since his diagnosis 7 years before, and he washed his hands so much they looked blanched.
…

At least publicly, Chinese authorities do recognize these problems. Deputy Health Minister; Dr. Huang Jiefu said that the government will work harder to remove the stigma and discrimination against PLHIV, but admitted that it would be “difficult”. As mentioned in Zhou’s (2007) report, there are many misconceptions about the virus. Huang stated that:

The biggest obstacle is that there is not enough education or publicity about AIDS. Society does not know enough about the disease, and people think you can get it just from touch, talking, shaking hands or eating together. That is a huge problem.

Huang (Reuters, 2009)

Huang is correct. The widespread ignorance regarding HIV/AIDS will be extremely difficult to overcome. Being misinformed is an excuse for the masses, but there’s much more to the China’s problems with HIV/AIDS awareness. For one thing, high levels of discrimination are reported amongst medical staff (26%), government officials (35.3%) and teachers (36.2%) (from the UNAIDS Stigma Index report). These people set the example for the rest of society.

As Kathleens5 (an upscale restaurant in the centre of Shanghai) holds the 5th Candlelight Memorial, complete with a cocktail party, charity auction and gala dinner one starts to think that it will take more than a grass-roots movement/corporate event at a fancy restaurant to bring about an environment in which Chinese HIV/AIDS sufferers feel safe to call their home.

UNAIDS, in cooperation with Chinese NBA star Yao Ming and the Ministry of Health, have launched an anti-stigma video campaign (UNAIDS, 2009b) to educate the masses. In order to really change things, however, much more is needed in the field of sex education. It’s unpleasant to suggest such a laissez-faire approach, but I think that time is the best cure for China, in this case . HIV/AIDS is still a relatively new disease (especially in China) and China’s sex education programs were late in addressing basic fundamentals about sexually transmitted diseases, contraception and non-traditional lifestyles. Entire generations have grown up knowing little about the most basic facts about safe sex. I believe that the only way Chinese society will come to accept HIV/AIDS is when the younger, more modern generations grow up and have children of their own.

So for now, AIDS awareness is likely to help somewhat. In the cities, where Candlelight Memorials and video campaigns take place, there is definitely an attempt to remove the stigma of HIV/AIDS and improve the well-being of those who suffer from the illness. These methods will likely resonate with China’s youth, who partake in more contemporary sex education and help reinforce the message. On the other hand, discrimination is so deeply ingrained in China’s society that I think time will have to take its course and the older generations, without comprehensive sex education and ‘less traditional’ values, will be much more slow to adapt to the changing opinions of HIV/AIDS in the country.

References

Global Health Council (2010) http://www.globalhealth.org/

Huang, J. (2009) China AIDS sufferers face widespread discrimination: UN. Reuters. http://www.reuters.com/article/idUSTRE5AQ0GR20091127

International AIDS Candlelight Memorial (2010) http://www.candlelightmemorial.org/

Kathleens5 (2010) Candlelight Memorial Remembrance Day. http://charity.kathleens5.com/

UNAIDS (2009) The China Sigma Index Report http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2009/20091127_stigma.asp

UNAIDS (2009b) UNAIDS Executive Director, Yao Ming and Government launch campaign against discrimination in China http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2009/20091127_stigma.asp

Xinhua News (2009) Wen encourages HIV/AIDS sufferers. http://www.china.org.cn/china/2009-12/02/content_18990412.htm

Zhou, Y.R. (2007) ‘‘If you get AIDS, You have to endure it alone’’: Understanding the social constructions of HIV/AIDS in China . Social Science & Medicine, 65, pp. 284-295.

The other media-friendly part of the report is this bit about syphilis infections being driven by prostitutes, gay men, and social stigma:

“[F]emale sex workers and men who have sex with men disproportionately bear the burden of the Chinese syphilis epidemic, in part because unsafe sexual practices in these populations are driving the rate of infection and in part because the stigma attached to their sexual behaviors discourages them from obtaining needed care. In China, at least one third of men who have sex with men are married, and the transmission of syphilis to their wives and then children is an important consideration,”

Fair enough, but that’s really shortchanging the most interesting information.

The figures presented in the report are uniquely interesting not because of who’s having sex with whom, but because of what changed from 2004 till now.

The first thing to understand is that syphilis is completely curable.  And, congenital syphilis, which affects newborn babies, is completely preventable, even after a woman with syphilis is already pregnant.   Detection, too, is straight forward, and detection kits themselves are portable, meaning syphilis testing doesn’t require highly trained medical personnel or hospital rooms.

Syphilis, in short, is really a wimpy disease when stacked up against other STDs, like HIV, Herpes, and genital warts.  By the same logic, syphilis is a big problem only in places where public health infrastructure has big problems.  In place where the public health structure is even moderately effective, syphilis is controlled, and conversely, it thrives where public health measures are weak, like  in the mining towns of  South Africa or the rural regions of the Southern United States.

The second thing to understand is that China’s syphilis flare up is really weird.  Only five years ago, in 2004, China’s syphilis rate was commendable and on par with that of America and other Western countries.   There were probably just as many men having sex with prostitutes and other men then as there are now.  So, again, who is having sex with whom is not the big issue.

The difference between 2004 and now is that China started presenting it’s public face to the world.  If 1978 marked the era of China’s opening, then 2004′s awarding of the Olympics to Beijing marked the era of China’s entrance into world society.    The interesting story that the figures tell then, is how China’s entrance into world society negatively impacted the country’s public health.

Prostitutes and gay men have been persecuted against for a long time, in China, not just since 2004.  The difference after 2004 is that police and other regulators in China’s Olympic and Expo cities were put under a lot of pressure to ‘clean up the streets’ for international cameras.  And they did this by pushing prostitution and gay men further underground, not to mention forcing migrants back to the countrysides and cleaning up the streets of homeless men and women.  That’s what we’re seeing reflected in the New England Journal of Medicine report.  And this crackdown on prostitution is at least representative of China’s historic treatment of prostitution since 1978, though I have no similar information for the treatment of gay men.  Crackdowns happen in waves every few years, and in the intermittent periods its allowed to exist relatively unchecked.

In this case, the crackdowns probably led to a rise in syphilis, and I’m sure a whole host of other pathogen baddies we haven’t had the time to check up on yet.

Since January, BON has made significant progress.  It relaunched with much improved programming in April, and is currently being broadcast on cable television, in a handful of America’s East Coast cities, including New York, with talks underway to expand into Los Angeles.

Two days ago, BON reported on China’s health reforms:

It’s the most accurate summary of the reforms I have seen in the media and includes a candid interview with one of China’s health authorities.   (One tiny correction to Beijing University Research Fellow, Ray Deng’s remarks: a Chinese hospital would never fire it’s chief if things weren’t going well.  In China, if something goes wrong at a hospital, the chief is never fired).

To cut down on loading time, I posted the video on Youtube after downloading it from the BON website, but  my transfer made it so that the audio and video are off.  If you want to download the full news report that includes the report, go here, it’s at 10:05.

If this report is any indication of future BON beat reporting, then I am very excited. BON’s beat reporters are already the most impressive part of their organization.  They are drawn from the ranks of China’s expat magazines as well as other more international organizations: A-type personalities who came to China for exactly this kind of opportunity, but ended up working in other sectors because, when they came, the opportunity they wanted to find didn’t exist.  Their even-handed and thorough reporting thus far is a testament to their enthusiasm for real journalism.

The tweet I sent to Nicholas Kristoff was in response to a tweet he sent out about the FBI bungling the Times Square investigation.  I was prompted to write it because of the excellent Atlantic Monthly article I linked to which details how, a few years ago, Kristoff used his Op-Ed space in the New York times to falsely accuse a man of being the Anthrax Letter terrorist.

Consider this my easy answer to writing a column today.

RT @niubi The Buildings that Crumbled 2 Dust _Caixin “Catastrophic destruction from quakes..often comes from poor construction” http://bit.ly/au497C about 13 hours ago via bit.ly

Inspiring RT @aimeenbarnes Fascinating piece on dreaming about, and writing ‘The Big One.’ http://ow.ly/1Hhea Must read for writers. about 2 hours ago via web

@whonews Re:WHO China commendation. It appears that announcement of the HIV ban not yet being enforced – http://bit.ly/cJuOmW about 2 hours ago via web in reply to whonews

N.Korean Hospitals Now Linked By Video-conference! http://bit.ly/9e1kQR Thank you @gtowna for the heads up! about 22 hours ago via web

Boom for city’s trash markets @ellachou Shanghai Expo vistors leave 190 tons garbage per day! http://goo.gl/nkWs | this gotta be a record about 23 hours ago via web

Dear @nytimes the fed ex ad on your home page is not allowing me to access your content. Not doing much for you or them. 1:06 AM May 5th via web

New Post. Response to @wolfgroupasia, NGOs in China: Room for more freedom or are the rules set in stone? http://bit.ly/dnXrX2 12:32 AM May 5th via web

@UMichLaw Can rising L1s expect to get the latest quadrangle copy in the mail? 10:12 PM May 4th via web in reply to UMichLaw

RT @wolfgroupasia: You Need Us: Making Room for NGOs in China: http://wp.me/pgrML-i

“North Korea formally launched a medical videoconference network Tuesday aimed at giving smaller, rural hospitals access to specialists in the capital Pyongyang with the help of the World Health Organization.

WHO has been providing cameras, computers and other equipment to North Korea to help the reclusive, impoverished country connect a main hospital in Pyongyang with medical facilities in 10 provinces. The system is designed to allow doctors to talk to each other to provide additional services to rural patients.”

I reported on this yesterday, wondering why WHO Director-General Margaret Chan was overselling North Korea’s non existent healthcare system. Keeping with the theme, the unveiling of this 11 computer-strong network (1 central hospital + 10 provinical clinics = 11 computers) was in all likelihood a Pyongyang theater production for assembled Red Cross, Red Crescent, and WHO dignitaries.  Still, I’m willing to stifle my laughter and treat it as a sign of progress in a country that doesn’t have working street lamps.

Trying to stifle….

Trying to stifle…

Trying to stifle…

No good.  I have to take a deep breath. It’s impossible to take it seriously.  The news is so out of place, isn’t it? North Korea’s average expenditure on health per person is somewhere around 50$, and statements like this in the official WHO country health status report from 2007 make it sound like there are no medical personnel in the country:

Essential expertise such as for handling complications of pregnancy
and childbirth, treatment of severe infection in children, injuries
and acute surgery, are sometimes compromised.Hospital infection
control procedures require strengthening.

If there’s no expertise to handle births, infections, injuries, and surgeries, what are you left with?

If, however, despite all of North Korea’s obvious human tragedies and resource shortages, this hospital teleconference thing  turns out to be an early sign of things that come, could we find ourselves fifteen years from now talking about how North Korea leapfrogged the telephone and went straight to Skype?  Could there be a Skype Revolution?  A Vonage Victory?  New York Times headlines that read, “they don’t have shoes, but do have iPads!”

Thank you to (stephan) for cc’ing his content on flickr.