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China's environmental health challenges
World Report
China’s environmental health challenges In China’s Henan Province, locals believe that their health is being threatened by the foul waters that flow into the local river—one of the dirtiest in the country. Although official data are hard to come by, clusters of cancer cases have appeared alongside the river basin. Jonathan Watts reports.
www.thelancet.com Vol 372 October 25, 2008
swathe of southeastern Henan Province and adjoining areas of Anhui, where poor local governments were in such a rush to industrialise that they accepted and protected heavily polluting companies, such as paper mills, tanneries, and chemical plants.
“20 years ago, we only read about nasal and eye cancer in medical journals. Now we are getting even unusual cases like these.” The full scale of health catastrophe caused by pollution is still not fully known. In the past 5 years, pioneering Chinese journalists have investigated the belt of “cancer villages” along the Huai river basin, including tributaries such as the Yun. But official data are hard to come by, locals are often intimidated, and several nongovernmental organisations and local reporters were reluctant to talk on the record. In the most notorious of the villages, Huangmengying, the national media revealed that 114 of the 2400 population died of cancer
between 1991 and 2004. Along stretches of the river, the cancer rate was more than twice the national average when the epidemic was at its worst. These statistics and exposés of several other cancer villages in heavily industrialised areas across China have set alarm bells ringing about the longterm environmental health costs of breakneck economic development. The debate continues today. Noncommunicable diseases are the main cause of death in China and cancer is the biggest cause of death of people in cities (25% of the total death rate) and the second biggest cause of death for people in villages (21% of the total death rate). A 2007 survey by the Chinese Academy of Medical Sciences’ Cancer Research Institute showed that death rates from cancer were increasing. “The main reason behind the rising number of cancer cases is that pollution of the environment, water, and air is getting worse day by day”, Chen Zhizhou of the Academy told the local media. “Many chemical and industrial enterprises are built along rivers so that they can dump
Getty Images
In the poor district of Xiangcheng city, residents are not sure whether to worry more about the health risks of the polluted air or the contaminated water. Nestling between a coal-fired power plant and a monosodium glutamate factory, they have good reason to be concerned. For much of the past 10 years, the Yun river that runs near to their homes has been fouled by chemicals, while the air above, they say, is sometimes tinted green on especially smoggy days. At the local Industry Primary School, everything from window sills to tree leaves is coated in fine black dust. “The rich folk have already moved out. Just a couple of hundred families remain”, says one local woman, who gives only her surname Yuan. “Of those left behind, almost everyone over the age of 40 has some kind of disease…We have complained about the pollution but no one cares. Our county is too remote and too poor.” Many believe that the pollution has fatal consequences. A short distance downstream at Shi Zhuang village, Shi Yingzhong—a factory worker—is mourning the death of his father from cancer last year. The illness was a financial disaster for an already poor family, which is now saddled with unpaid debts from the father’s 200 000 yuan (US$29 285) chemotherapy bill over the past 3 years. He is resigned rather than angry, but he has no doubt about the cause of his father’s death. “It was the polluted water”, he says. “We used to drink from a well just 4 metres deep. Then the water became dirty so we had to go deeper and deeper. Now it is more than 40 metres, but the water is still not clean.” For more than a decade, a similar story could be heard across a vast
Linfen in Shanxi Province, next to Henan, has been dubbed the most polluted city in the world
1451
Jonathan Watts
World Report
Locals say the Sha river—a tributary of the Huai—is less polluted than in the past
the waste into water easily.” The environment agency says that half the country’s chemical factories pose environmental risks. Excessive use of fertilisers and pesticides also pollute underground water. The central government is aware of the problems and has promised to make improvements in the environment and health care a central focus of its scientific development policy, which aims to balance economic growth with the wellbeing of the nation. In an interview with The Lancet, Health Minister Chen Zhu said that the environmental health challenges were immense. “The rapid economic growth is a kind of double-edged sword. Yes, people are richer and the government has more money to invest in the protection of workers and occupational safety. But on the other hand occupational diseases are increasing so it is a very complicated issue”, he said. “When industry grows you have more CO₂, more contamination of water and air. The issue is how to readapt the structure of our economy. How to use new technologies. And more importantly how to educate entrepreneurs to respect the life of the people. “ A visit to some of the “cancer villages” of Henan reveals the efforts that the government has made to address the problem of environmental health, and the challenges that remain. 1452
One of China’s poorest provinces, Henan is home to 98 million people— making it bigger than any European nation. Despite its historical reputation as the cradle of Han Chinese civilisation, this huge population has put immense pressure on natural resources. Arriving in Zhengzhou airport, the haze is so dense that it is a surprise when the plane bumps down on to the runway. The terminal buildings, just a couple of hundred yards away, are almost invisible. The grey skies continue for the 2·5 h drive south to Shenqiu county, which has the greatest cluster of cancer villages. It is farming rather than factories that causes the smog, as peasants in field after field disobey government regulations by burning off the stalks in the corn fields after harvest. This seasonal burn produces choking skies, but the real health concern is the legacy of the local government’s push to industrialise. Environmental health fears are evident across the region. At the Jieshou People’s Hospital just across the provincial border with Anhui, the duty doctor, Zhang Baoxin, has no doubt that pollution is hurting the health of local people. In his 21 years in the post, Zhang says he has seen a steady rise in cancer cases. “20 years ago, we only read about nasal and eye cancer in medical journals. Now we are getting even unusual cases like these”, he says. But many others say that the situation is better than it was 4 years ago because several of the dirtiest factories—tanneries and paper mills—have been shut down. There are fishermen on the Sha river, where the water is neither stinking nor black as reported in the past. At Mungjian village, the Government has financed new wells that reach clean aquifers— though the safe water is a staggering 500 metres below the surface. The old well, which was 30 metres below ground, is still polluted. “A frog would die if it jumped in there”, said a local farmer who gave only his surname Wang. “But things are getting better.
5 years ago, we used to be a cancer village. Everyone knew someone who had cancer. But now there is a big change. It is like two different worlds. The environment is much better.” It is hard to verify. A mood of secrecy still surrounds the villages in the area. According to local journalists, villagers are intimidated by state security officers and police if they speak to the media. An official with the Shenqiu local authority would only talk on condition of anonymity. He declined to provide figures, but he insisted the worst was over. “We have done all we can to tighten wastewater management and close the worst polluting factories and power plants.” He said that the only contamination now was from a tannery and the monosodium glutamate factory upriver, which was not in Shenqiu’s jurisdiction. “But in the past 2 years our water quality has risen to a safe standard. Just in case, we offer health checks to residents and cover part of their medical fees.” The improvement is from a low base, but it may signal that China has turned a corner in dealing with the health risks posed by pollution. Even so, there is still a long way to go to improve environmental health. In a widely-leaked draft report last year, the World Bank estimated that 750 000 people die annually from all forms of pollution. Controversially, that number disappeared from the final document. The Chinese Government—a report co-author—has challenged the methodology used to assess the casualties and is expected to announce a revised figure soon. It may just be an accounting tweak, but World Bank officials are unhappy about the change. The cancer villages of Henan are similarly plagued by secrecy. If progress really has been made, such secrecy should be not be necessary. If China wants to clean up, it needs a transparent as well as a pollution-free environment.
Jonathan Watts www.thelancet.com Vol 372 October 25, 2008
China’s environmental health challenges In China’s Henan Province, locals believe that their health is being threatened by the foul waters that flow into the local river—one of the dirtiest in the country. Although official data are hard to come by, clusters of cancer cases have appeared alongside the river basin. Jonathan Watts reports.
www.thelancet.com Vol 372 October 25, 2008
swathe of southeastern Henan Province and adjoining areas of Anhui, where poor local governments were in such a rush to industrialise that they accepted and protected heavily polluting companies, such as paper mills, tanneries, and chemical plants.
“20 years ago, we only read about nasal and eye cancer in medical journals. Now we are getting even unusual cases like these.” The full scale of health catastrophe caused by pollution is still not fully known. In the past 5 years, pioneering Chinese journalists have investigated the belt of “cancer villages” along the Huai river basin, including tributaries such as the Yun. But official data are hard to come by, locals are often intimidated, and several nongovernmental organisations and local reporters were reluctant to talk on the record. In the most notorious of the villages, Huangmengying, the national media revealed that 114 of the 2400 population died of cancer
between 1991 and 2004. Along stretches of the river, the cancer rate was more than twice the national average when the epidemic was at its worst. These statistics and exposés of several other cancer villages in heavily industrialised areas across China have set alarm bells ringing about the longterm environmental health costs of breakneck economic development. The debate continues today. Noncommunicable diseases are the main cause of death in China and cancer is the biggest cause of death of people in cities (25% of the total death rate) and the second biggest cause of death for people in villages (21% of the total death rate). A 2007 survey by the Chinese Academy of Medical Sciences’ Cancer Research Institute showed that death rates from cancer were increasing. “The main reason behind the rising number of cancer cases is that pollution of the environment, water, and air is getting worse day by day”, Chen Zhizhou of the Academy told the local media. “Many chemical and industrial enterprises are built along rivers so that they can dump
Getty Images
In the poor district of Xiangcheng city, residents are not sure whether to worry more about the health risks of the polluted air or the contaminated water. Nestling between a coal-fired power plant and a monosodium glutamate factory, they have good reason to be concerned. For much of the past 10 years, the Yun river that runs near to their homes has been fouled by chemicals, while the air above, they say, is sometimes tinted green on especially smoggy days. At the local Industry Primary School, everything from window sills to tree leaves is coated in fine black dust. “The rich folk have already moved out. Just a couple of hundred families remain”, says one local woman, who gives only her surname Yuan. “Of those left behind, almost everyone over the age of 40 has some kind of disease…We have complained about the pollution but no one cares. Our county is too remote and too poor.” Many believe that the pollution has fatal consequences. A short distance downstream at Shi Zhuang village, Shi Yingzhong—a factory worker—is mourning the death of his father from cancer last year. The illness was a financial disaster for an already poor family, which is now saddled with unpaid debts from the father’s 200 000 yuan (US$29 285) chemotherapy bill over the past 3 years. He is resigned rather than angry, but he has no doubt about the cause of his father’s death. “It was the polluted water”, he says. “We used to drink from a well just 4 metres deep. Then the water became dirty so we had to go deeper and deeper. Now it is more than 40 metres, but the water is still not clean.” For more than a decade, a similar story could be heard across a vast
Linfen in Shanxi Province, next to Henan, has been dubbed the most polluted city in the world
1451
Jonathan Watts
World Report
Locals say the Sha river—a tributary of the Huai—is less polluted than in the past
the waste into water easily.” The environment agency says that half the country’s chemical factories pose environmental risks. Excessive use of fertilisers and pesticides also pollute underground water. The central government is aware of the problems and has promised to make improvements in the environment and health care a central focus of its scientific development policy, which aims to balance economic growth with the wellbeing of the nation. In an interview with The Lancet, Health Minister Chen Zhu said that the environmental health challenges were immense. “The rapid economic growth is a kind of double-edged sword. Yes, people are richer and the government has more money to invest in the protection of workers and occupational safety. But on the other hand occupational diseases are increasing so it is a very complicated issue”, he said. “When industry grows you have more CO₂, more contamination of water and air. The issue is how to readapt the structure of our economy. How to use new technologies. And more importantly how to educate entrepreneurs to respect the life of the people. “ A visit to some of the “cancer villages” of Henan reveals the efforts that the government has made to address the problem of environmental health, and the challenges that remain. 1452
One of China’s poorest provinces, Henan is home to 98 million people— making it bigger than any European nation. Despite its historical reputation as the cradle of Han Chinese civilisation, this huge population has put immense pressure on natural resources. Arriving in Zhengzhou airport, the haze is so dense that it is a surprise when the plane bumps down on to the runway. The terminal buildings, just a couple of hundred yards away, are almost invisible. The grey skies continue for the 2·5 h drive south to Shenqiu county, which has the greatest cluster of cancer villages. It is farming rather than factories that causes the smog, as peasants in field after field disobey government regulations by burning off the stalks in the corn fields after harvest. This seasonal burn produces choking skies, but the real health concern is the legacy of the local government’s push to industrialise. Environmental health fears are evident across the region. At the Jieshou People’s Hospital just across the provincial border with Anhui, the duty doctor, Zhang Baoxin, has no doubt that pollution is hurting the health of local people. In his 21 years in the post, Zhang says he has seen a steady rise in cancer cases. “20 years ago, we only read about nasal and eye cancer in medical journals. Now we are getting even unusual cases like these”, he says. But many others say that the situation is better than it was 4 years ago because several of the dirtiest factories—tanneries and paper mills—have been shut down. There are fishermen on the Sha river, where the water is neither stinking nor black as reported in the past. At Mungjian village, the Government has financed new wells that reach clean aquifers— though the safe water is a staggering 500 metres below the surface. The old well, which was 30 metres below ground, is still polluted. “A frog would die if it jumped in there”, said a local farmer who gave only his surname Wang. “But things are getting better.
5 years ago, we used to be a cancer village. Everyone knew someone who had cancer. But now there is a big change. It is like two different worlds. The environment is much better.” It is hard to verify. A mood of secrecy still surrounds the villages in the area. According to local journalists, villagers are intimidated by state security officers and police if they speak to the media. An official with the Shenqiu local authority would only talk on condition of anonymity. He declined to provide figures, but he insisted the worst was over. “We have done all we can to tighten wastewater management and close the worst polluting factories and power plants.” He said that the only contamination now was from a tannery and the monosodium glutamate factory upriver, which was not in Shenqiu’s jurisdiction. “But in the past 2 years our water quality has risen to a safe standard. Just in case, we offer health checks to residents and cover part of their medical fees.” The improvement is from a low base, but it may signal that China has turned a corner in dealing with the health risks posed by pollution. Even so, there is still a long way to go to improve environmental health. In a widely-leaked draft report last year, the World Bank estimated that 750 000 people die annually from all forms of pollution. Controversially, that number disappeared from the final document. The Chinese Government—a report co-author—has challenged the methodology used to assess the casualties and is expected to announce a revised figure soon. It may just be an accounting tweak, but World Bank officials are unhappy about the change. The cancer villages of Henan are similarly plagued by secrecy. If progress really has been made, such secrecy should be not be necessary. If China wants to clean up, it needs a transparent as well as a pollution-free environment.
Jonathan Watts www.thelancet.com Vol 372 October 25, 2008