SCMP Wednesday, February 21, 2001

Cities besieged by cancer


Beyond the door of the cancer ward where 71-year-old Li Dizhong lies weak after an operation on a growth in his liver, his doctor shakes his head, and mutters out of earshot.
"Most of them die within six months unless we catch them early - otherwise it is hopeless," whispers Dr Ru Tao of the Tianjin Cancer Treatment Hospital. The well-equipped hospital with 843 beds is the best hope for the 25,000 people dying of cancer almost every year in this city of four million.
"The cancer rate is high in Tianjin and growing fast," admits the hospital's deputy director of medical research, Professor Wang Qingsheng. Cancer is now the leading cause of death in the city although he rejects the term "epidemic".
Only a privileged handful like Li Dizhong, a retired professor from the city's prestigious Aviation Institute, are given a bed in the hospital, and for the rest the onset of the illness imposes a crushing burden on their families.
The minimum cost of treatment is around 15,000 yuan (about HK$13,700) but Professor Wang says many end up spending as much as 100,000 yuan. "Most patients cannot afford the fees - they end up selling their houses and all their personal belongings.
Lung cancer is the most common type of cancer but Professor Wang has noticed strikingly high numbers of patients with liver, stomach and intestinal cancers. The illness is particularly prevalent among those in their prime of life, aged between 35 and 64, who live in China's smoky industrial centres.
"People say the pollution cuts the average life-span of people in Chongqing by five to six years and in Tianjin by three to four years. I notice that the patients are getting younger and younger."
With the majority of the state-owned enterprises running losses in the 1990s, few are able to pay the heavy compensation costs for cancer treatment for their employees, even when it is available. Consequently, Tianjin officials encouraged cancer patients to take up qi gong as a cheap form of alternative treatment. Li Dizhong took up qi gong to fight the cancer. "Chinese people believe in it. We think it will strengthen our bodies," he says.
The hospital forbids patients from performing exercises while they are being treated but the city has set up "Recovery Centres" where cancer patients sing, dance and do qi gong exercises.
Cities all over China helped encourage the rage for qi gong exercise groups at the beginning of the early 1990s and fostered the belief in its ability to treat cancer as well as, or better than, expensive techniques of Western medicine.
Tianjin became a stronghold of the Falun Gong, whose founder Li Hongzhi promised his followers they could be cured without incurring costly medical bills. When the Tianjin television broadcasting centre criticised Mr Li's claims more than two years ago, 3,000 people descended on the building in a mass protest.
The Zhong Gong movement attracted almost as many followers across China and its founder Zhang Hongbao, now under detention in Guam, advocated the training of a qi gong master for every family.
The Chinese Government's struggle to smash the power of qi gong masters like Li Hongzhi and Zhang Hongbao, and the sharp rise in cancer and other health problems in urban China are both linked to environmental neglect.
Recent studies claim that 700 million Chinese consume drinking water contaminated with levels of animal and human waste that do not meet the minimum state drinking-water standards. A further 162 million are affected by air pollution.
"China's modernisation has been unique in combining traditional environmental health risks, such as sewage irrigation, with modern environmental health risks, such as increased use of pesticides and fertilisers, creating a double health burden," wrote the authors of a recent report entitled Water Pollution and Human Health.
It found that deaths from liver and gastric cancers account for roughly 40 per cent of all deaths from malignant growths, a far higher rate than in wealthy countries or other developing nations. The World Health Organisation assumes that 25 per cent of cancer is generally caused by environmental factors.
Tianjin, which is short of water, has allowed waste water from its 5,000 factories to be used for irrigation, even though it contains untreated toxic metals like cadmium or zinc. The report cited tests carried out in the Dongxiang area of Tianjin - where sewage mixed with industrial waste water has been used for irrigation over 30 years - which found carcinogens had accumulated in soil, groundwater and vegetation.
"It is difficult to get enough data to make the link, there is a lack of epidemiological studies," says Dr Wang Yi, a senior research fellow at the Chinese Academy of Sciences, who helped write the report. "There was some research in the 1980s with foreign funding but recently it has been discouraged. I think a lot is being covered up."
Information that is available suggests a severe nationwide problem. In nearby Baoding, a 1994 study found that rates of oesophageal and liver cancer were three times higher than the national average.
A similar survey around Shenyang, Liaoning province, also found cancer rates three times higher than average, and still higher rates where industrial waste water was diverted to irrigate fields. The studies showed areas with the highest cancer mortality rates appeared to be the ones with the most polluted surface water.
Research carried out near townships in Jiangsu province near polluted lakes also linked very high rates of spontaneous abortions, premature and stillbirths to water pollution. A study on birth defects and retarded children living near Weishan Lake in Shandong revealed the identical link.
Chongqing is the largest source of organic water pollution along the Yangtze River, pouring a billion tonnes of waste into the river each year. Only 13 per cent of the waste is treated. As a result, intestinal infectious diseases such as hepatitis A and dysentery have incidence rates some 50 per cent higher than the national average.
Cities like Tianjin and Chongqing rejected proposals to invest in water-treatment plants in a desire to concentrate resources on short-term projects. Dr Wang predicts that the problems caused by water pollution will worsen in the next decade, but believes air pollution has been even more damaging to health. In urban areas, an average of 35.6 out of every 100,000 people now die of lung cancer, while the rate of death due to respiratory diseases has increased by almost 25 per cent over the past 10 years.
Tianjin's air is bad enough, but residents in Chongqing suffer even worse. Local officials denied that any studies had been carried out, but anyone who has stayed there for a few days finds that almost everyone lives with hacking coughs.
A World Bank report ranked Chongqing worst out of 23 large cities in China for sulphur dioxide levels and eighth for levels of suspended air particles. In 1994, sulphur dioxide levels were put at 5.5 times higher than the World Health Organisation's safety standard. Every month about 16 tonnes of soot accumulate over each square kilometre of the city.
Some experts in Chongqing put the annual damage caused by air pollution at about two billion yuan, a sum equal to the city's annual revenue.
Across China, respiratory disease accounts for about 25 per cent of all deaths.
Jasper Becker ( ) is the Post's Beijing bureau chief.