The killer diseases associated with the pressures of the capitalist boardroom are coming to China along with the modernization that is starting to thrust the nation into the ranks of the world's industrial leaders.
Hypertension, strokes and heart attacks are soaring. Chinese health officials say. There are strong indications that even alcoholism -- officially labeled as a disease of capitalism and claimed to be virtually nonexistent in China -- is more common that generally thought and is on the rise.
Moreover, a new mass propaganda campaign against smoking, which also has spread in recent years, has had little success so far.
At the Zhingua Hospital in Shanghai, patients with high blood pressure, mostly middle-aged men, waited in long lines for diagnostic tests and treatment in the sweltering heat of a recent summer afternoon.
"Hypertension is a large problem here," said Dr. Lu Daoyen to visiting American medical students. "The patients have to wait quite a long time."
"Its incidence is definitely higher recently," added a colleague, "and it is especially common among city people and some national minorities."
This rise in hypertension, Chinese doctors believe, is the driving force behind a dramatic leap in cardiovascular disease deaths during the last 20 years.
Annual heart attack deaths jumped by 60 percent, from 73.8 per 100,000 people during 1955-59 to 118.4 during 1974-78 in the Shihzhingshan district of Peking, researchers at the city's Fuwai Hospital and Cardiovascular Institute reported. Stroke mortality more than doubled during the same period, from 43.1 to 97.3 per 100,000.
Between the two five-year periods, they said, heart attack surged from third to first as a cause of death in the district, while stroke jumped from seventh to second.
During the later period, more than 50 percent of the deaths in the district were due to some cardiovascular cause. The same is true in the United States. Heart attack, in this nation where obese people seem as rare as cheeseburgers and fries, was far less frequent than in America, but stroke was more common, a fact Fuwai doctors said they could not account for.
Hypertension also has skyrocketed in Shihzhingshan, said Dr. Wu Yingkai, director of Fuwai, and this has paralleled the district's rapid economic modernization.
Since blood pressure figures from the 1955-59 period are not available, Fuwai doctors could not show this directly. But they cited 1974-78 data showing sharp differences in hypertension incidence between occupational groups.
While the overall hypertension frequency for the 66,000 people screened was 8.11 percent, the rate was 15.6 among drivers, whose frenetic horn-honking, and sudden stops and starts make New York cabbies seem tame by comparison, and more than 10 percent for workers at several factories.
In contrast, hypertension incidence was only 4 percent among agricultural workers at the People's Commune, and, noted one epidemiologist with a shy chuckle, only 3.1 percent at a research institute. Modernization, the doctors contended, has meant the swelling of high incidence categories and thus an overall rise in hypertension frequency.
The parallel between hypertension and industrialization in China is further supported by Fuwai's 1977 data from several northern provinces. among more than 200,000 city dwellers tested, the incidence of the potentially deadly ailment was 7.5 percent. But only 3.9 percent of almost 600,000 rural residents examined suffered from high blood pressure. Furthermore, among urbanites, a marked rise of hypertension incidence with age started in people over 45, while in the countryside a similar rise was delayed for about 10 years.
Doctors at Fuwai and elsewhere seemed genuinely enthusiastic about sharing all the statistics they had on cardiovascular disease incidence. But they were less willing to talk about why these killer illnesses are on the rise.
It is a politically sensitive question. The statistics point clearly to the new pressures of an industrial, urbanized lifestyle. Diet has not changed much, and obesity remains rare.
"The people are busier than before in production and other work," said a Zhinghua doctor, "and they are more tense and nervous."
But Communists claim that there are two key sources of such tension in capitalist societies -- the alienation of workers from the product of their labors and the tie between an individual's efforts and his reward -- which are absent in communism.
If the Chinese have erased these emotional pressures, then why a jump in the illnesses of tension?
A Frindship Hospital cardiologist laughed nervously, then clenched his teeth. "I don't like to talk about this," he said. "It is a contradiction. A few years ago we could never have talked about it with a foreigner. Even now, it is difficult to talk about it among ourselves."
He did not offer an answer. And conspicuously missing from the Fuwai presentation was any effort to explain the dramatic rise in cardiovascular disease that the institute has documented so well.
But Chinese health policymakers have decided that the key to defeating the killer cardiovascular diseases lies in attacking high blood pressure.
A national "mass movement" against hypertension has been launched, modeled after China's internationally lauded prevention campaigns against infectious disease.
Television and radio programs, pamphlets, and posters urge the Chinese people to eat less salt and animal fat, exercise regularly, stop smoking and worry less. Health officials are mobilizing medical workers in hopitals, factories and communes across the nation for massive screening programs designed to identify both individual cases and hotspots of high incidence.
Leading cardiovascular experts have joined the Ministry of Public Health in advising the Ministry of Agriculture on what foods to grow and urging industry leaders to create less pressured lifestyles for their workers, doctors at several inititutions said.
But this broadside assault, frustrated medical workers said, has had little success thus far.
"With infectious disease, we know the [cause] and we can control it," said a Fuwai cardiologist. "But with hypertension, we don't know the [cause ]. It's very difficult to control it.
"We try to organize the whole country -- every brigade and every barefoot doctor -- to take blood pressure," he said. "But as for prevention -- changing lifestyle -- that's not an easy job. We can only try to find people with the disease and control it with drugs."
Efforts to identify and attack hypertension hotspots are often hampered by poor availability of pertinent information due to the decentralization of China's health care system, medical workers say.
While the Chinese today openly discuss their cardiovascular disease problem, they vehemently deny a significant incidence of alcoholism.
Beer is freely available, at least in the cities, sold under brand names such as "Shanghai," "Tsingtao," and "peking." and at Fuwai, doctors reported that cardiomyopathy, a weakening of heart muscle, has become very common in heavily populated, industrialized northeast China. In the United States, alcoholism is a major cause of cardiomyopathy.
Asked why this heart problem has become commonplace, one doctor replied, "We don't know the cause.Maybe there are dietary factors, maybe it's environmental."
"What about too much beer?" suggested a questioner.
"It's hard to say," he answered with a grin.
China's status as the world's number one consumer of tobacco remains untouched by a curiously lukewarm propaganda campaign against smoking. Dr. Zheng Geru, deputy director of the bureau of foreign affairs of the Ministry of Public Health, acknowledged in an interview in Peking that the campaign is less than a full scale war.
"We are trying to publicize it in newspapers and trying to use other media," he said. "You could end it [smoking] absolutely," by banning the growth of tobacco and the manufacture of cigarettes, "but we will not. If there's nobody to buy the cigarettes, then the cigarette factories will be closed, and the people will have to make something else."
Asked whether this capitalist sounding policy resulted from pressure from tobacco growing communes and cigarette factories, Zheng said there can be no such pressure based upon "economic value" from special interests in a socialist society. 'but he said there is "ideological" resistance to the antismoking movement from cigarette makers stemming from "habit."