Elizabeth Lucchesini
The demographic dimensions of China mean that any, however minimal, change in the lifestyles of the Chinese translates into large numbers from the point of view of consumption. That is why it is important to catch in advance the information that gradually begins to seep in from that distant world. Susan Ward, who works at Global Demographics Healthcare in Hong Kong, summarizes the most recent statistics and the three key factors that can guarantee access to the Chinese market in the latest issue of Nature reviews Drug discovery. To begin with, a few numbers that give an idea of the extent of the phenomenon: in 2004 the Chinese pharmaceutical market had a growth rate of 28%, at this rate in 2050 it will be the largest world market.
Population age, rapid economic development and urbanization are the driving factors of health demand. Suffice it to say that a chronic disease such as type 2 diabetes was rare up to 20 years ago, its prevalence has doubled in the last 10 years and today it affects about 56.7 million Chinese, a number equivalent to almost the entire population of the Great Britain and double the estimated 20.8 million cases for the United States of America.
The "one child" policy introduced in 1979 now fully manifests its consequences: births (12.7 million in 2007) will be reduced by a third (8.9 million in 2026) while an increase in the average length of life will be observed thanks to the best food and sanitary conditions. The panorama that we should therefore expect will be that of a progressive aging of the population. In 10 years, the 50% of the Chinese will be over 40 and the 25% over 65. In 2026, the under 25 age group will be halved, from 437 million in 2007 to 297 million, while the over 40s will rise from 566 to 740 million.
The policy of containing births is also responsible for a better distribution of state resources dedicated to education, which has made it possible to achieve a high level (98%) of literacy. And these educated kids are now moving to the cities in search of well-paid employment; the growing wave of urbanization (+52% in 2017) has brought with it a 3 times more sedentary lifestyle, exposure to tobacco and alcohol, a diet richer in refined carbohydrates, meat and fats. And in fact, from 1982 to 2002 the cases of obesity increased from 0.6% to 6% while overweight adults increased from 7.1% to 22.8%. Estimates therefore indicate a growth in the prevalence of diabetes cases in urban centers from 32.7 million in 2007 to 56.3 million in 2017, practically an increase of 2.4 million patients a year. Furthermore, considering that in 2007 only 32% was diagnosed in diabetics living in urban centres, a high prevalence of renal and cardiac complications of diabetes must also be expected. The demand for diagnostic and therapeutic options will therefore be enormous, both for diabetes and for other degenerative diseases, including hypertension and breast cancer.
Finally, the economic availability of individuals deserves consideration which, as in all emerging markets, discriminates against the possibility of accessing treatment. In the last twenty years there has been a dramatic shift in spending from the public to the private sector; staying with diabetes: in 1985 just under 40% of the costs were borne by the government and a third fell on social and health insurance; by 2005 patients' 56% was paying out of pocket, while government costs had decreased to 17%. As a result of urbanization
