University of Southern California
PM 565, Emerging Trends in Global Health
Jonathan M. Samet, M.D., M.S.
Heather Wipfli, Ph.D.
Increased consumption of fats and decreases in physical activity among urban Chinese youths has resulted in massive gains in weight and put individuals at a higher risk of chronic non-communicable diseases (Yang et al., 2008). This is due in part to modernization of urban Chinese society where a growing reliance on cars and computers promote sedentary behaviors and greater access to fattier foods lead to weight gain. In addition, cultural values and customs regarding physical activity and nutrition in urban China may additionally augment the detrimental effects of Chinese urbanization. In this paper, we will explore how a combination of modernization and practiced cultural values puts urban Chinese youth at a higher risk of non-communicable disease.
Modernization has fostered a sedentary lifestyle for Chinese youths as fewer playgrounds, and abundant use of cars and computers have driven children inside (Adab & MacFarlane, 1998; Wu, 2006; Yang et al., 2008). Surveys in Hong Kong indicated that 10% of girls and 23% of boys between the ages 6 and 18 were overweight. (Hui, 2001). With the growing accessibility and need for computer resources, children find themselves working on homework more often than they are going out to play. In fact, a review of Health and Physical Activity in Hong Kong revealed that children living in the city received only two physical education classes a week, making the children of Hong Kong “the most inactive primary level schoolchildren in the world” (Adab & MacFarlane, 1998; Hui, 2001; Lau, Lee, & Ransdell, 2007).
This inattention to physical education alludes to a greater cultural element at work in Chinese culture: Confucius. In China, a cultural emphasis on scholastic achievement trivializes physical activity as an unnecessary distraction for children (Adab & Macfarlane, 1998). A study by Lau, Lee, and Ransdell (2007) suggested that this belief may be rooted in the Confucian philosophy that esteems knowledge above any object, currency or activity. These beliefs are equally evident in the home as parents discourage children from participating in physical exercise or household chores so that they can better concentrate on their studies (Tudor-Locke, Ainsworth, Adair, Du, & Popkin, 2003). Although Chinese children are more likely to participate in physical activity if it has been modeled and enjoyed by their fathers and encouraged by their mothers, many parents forgo this socialization for the presumed academic benefit of their child. (Lau et al., 2007).
Youth dietary patterns have undergone a massive transformation with modernization as traditional Chinese diets have been overpowered by greater accessibility to cheap, high-fat foods (Yang et al., 2008). The introduction and diffusion of fast food chains such as KFC and McDonald’s restaurants have dramatically altered the make up of Chinese nutrition (Cheng, 2003). At the end of 2008, there were 1,012 McDonalds restaurants in China with more 60,000 employees (McDonalds Corporation, 2008). With increased numbers of mothers working, the low cost and speed of fast food has become a practical solution to feeding children on the go (Popkin & Gordon-Larsen, 2004). As a result, China’s youth is consuming increased levels of meat, edible oil and fat on a daily basis (Popkin & Gordon-Larsen, 2004; Yang et al., 2008).
This move towards high fat foods in Chinese culture is part of a larger “nutrition transition” that occurs on a country-to-country basis (Popkin & Gordon-Larsen, 2004). A nutrition transition requires first that the rates of high fertility and mortality decline (Omran, 1971). Second, a country’s patterns of infectious diseases associated with famine, malnutrition and poor sanitation shift with urbanization that is marked with a rise in non-communicable and chronic diseases (Omran, 1971). As many Chinese transition from a standard of famine and malnutrition, the introduction of large, inexpensive portions of food is considered a blessing. Parents and grandparents have been feeding their children excessively with high-fat foods believing that a large size in youth is indicative of height, health and strength later in life (Jiangxiong et al., 2007; MacLeod, 2007).
Cigarette smoking is another risky behavior associated with noncommunicable chronic diseases in urban China. China is the largest consumer of tobacco in the world (Yang et al., 2008). In 2002, more than 60% of Chinese men older than 25 were smokers who consumed up to 15 cigarettes each day (Yang et al.). Like the consumption of food and physical exercise, tobacco consumption is another behavior that is regulated by customs and tradition. For instance, it is customary and polite to give cigarettes as gifts in business transactions (Hu et al., 2006). In addition, in China it is considered disrespectful to refuse cigarettes upon their offer (Hu).
There are some benefits to the continued influence of culture on health that is notably absent in American culture. In a study by Jahns, Siega-Riz, and Popkin (2001), findings showed that Chinese parents exerted greater control over what their children consumed each day, resulting in a mere 11% of Chinese children who snack; a miniscule statistic compared to 91% of US children who receive a majority of their calories from snacks each day (Jahns et al.). In the instance of Confucian philosophy, an emphasis on education often provokes Chinese parents to limit the amount of “screen time” consumed by their children (Waller, Du, & Popkin, 2003). In China, children spend 5.1 hours a week watching television and 0.3 hours a week playing video games (Waller et al.). When compared to their age-matched American counterparts whose screen time weighs in at 23 hours and 7.3 hours watching television and playing video games respectively, the Chinese appear to be ahead (Waller et al.).
Because of their inclusion in every day health behaviors, health education programs should account for potential cultural barriers and capitalize on other social themes. For instance, the emphasis on education in Chinese culture suggests that it would be effective to educate parents and youths on the benefits of physical activity with respect to educational attainment. In contrast to the common parental belief that participation in physical fitness has a deleterious impact on academic achievement, research shows that Hong Kong school children with high grades frequently participate in physical activity (Lindner, 1999). When designing public health appeals for parents whose methods strictly adhere to Confucian philosophy, officials should target altering a fathers’ attitudes towards physical exercise; this message could directly impact the child’s attitudes and emulation of the behavior (Lau, Lee & Ransdell, 2007).
These examples and recommendations for application exemplify the influence of cultural values and customs on health behaviors. An understanding of this information can benefit health professionals as they better understand the mediating effects of culture on health. Health professionals can potentially enhance prevention and education measures by gaining an enhanced proficiency in cultural mediators through community focus groups and literature reviews.
Modernization and cultural values combine to increase the risk of chronic non-communicable diseases among youths living in urban China. With growing technology, fast food and urbanization abound, health professionals should recognize the pertinence of culture in the performance of health behaviors. These examples should serve as a exemplar of the interaction between health and culture, which should be accounted for in the design of health programs not only in China, but internationally.
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