Tuesday, December 14, 2010

Sinicized French Fries: Physical Activity, Diet and Disease in 21st Century China

The Political Economy of Chinese Food
The rapid globalization of China’s economy that has accompanied its industrialization and economic expansion in the post Mao era has resonated in the global consciousness, with iconic imagery such as the (now closed) Starbucks in the heart of Beijing’s Forbidden City. Just as the rise in car ownership and car culture have lead to a decrease in bicycle use and physical activity, the influx of fast food by international corporations is similarly impacting dietary habits, with profound effect on the health and future of China.

Though I tend to avoid eating fast food, during a recent breakfast at a bustling Beijing McDonalds I meditated over diet and chronic disease in 21st century China. 

With 24 hour home delivery, McDonald’s golden arches and popular hamburgers have arrived at China’s doorstep.  Famously, YUM brands’ massive profits have made their marketing of Kentucky Fried Chicken and Pizza Hut a model for foreigners hoping to make money in China.

With a reputation for higher, international standards of hygiene, and certain exotic premium to familiar food like spicy chicken, KFC has not only become the leader in Chinese fast food.  It has been described to me as a cultural space in small cities across the country where the aspiring middle class people can meet and and taste something representative of international opportunity in the new China. 

Its worth noting that a Chinese Pizza Hut would be almost unrecognizable to Americans.  Over coffee and tiramisu another American health researcher pointed out escargot and other high end options on the Pizza Hut menu that seem unimaginable at the American counterpart.

Fast Food and Public Health 
After a recent talk by American CDC head Dr. Thomas Friedan at the Chinese Center for Disease Control,  repeated questions from the audience addressed an anxiety about the rise of fast food consumption in China.  One malaria specialist expressed concern that his son preferred KFC to all other food, wondering how much this food was introducing transaturated fats and other unhealthy nutrition to the Chinese diet.  He asked how Friedan’s experience changing food health policy in New York (for example banning trans fats) could inform Chinese policy.  Another student researcher pointed out that candy manufacturers such as Mars have stated a desire to increase Chinese consumption of sweets and candy (traditionally lower than in Western countries) because China represents such a large growth opportunity.

The influence of such corporations raises some interesting contradictions.  A recent Conference on Physical Activity and Health was sponsored by Coca-Cola and Nestle with a special presentation by representatives from Nestle about their work place exercise policy.

The lunch offered to participants at a recent China CDC interdepartmental sports and exercise competition included of Kentucky Fried Chicken and a snickers bar.  Medical literature has established that these types of food choices and the environment that promotes them contributes to the obesity epidemic.  The literature has also begun describing the late rise of childhood obesity in China and other developing countries.

Chinese Tobacco and Salt
China of course has its own health problems related to domestic culinary and corporate culture.  The tobacco industry, domestically controlled by a Chinese government monopoly, makes huge profits, while Chinese smoking prevalence is among the highest in the world.  In corporate culture, cigarettes form a fundamental currency for “pulling guanxi” (拉关系) and developing business relationships.  As Dr. Friedan noted in his speech, they are often given as gifts when different professionals or businessmen meet.  Smoking cigarettes is a essential punctuation of business negotiations, at the beginning middle and end.   Though China has recently instituted some limitations on smoking (such as in hospitals), the persistence of cigarettes in the majority of public spaces, including the bathrooms of China CDC, show how rooted this suicidal habit is in modern Chinese culture.

While New York under Friedan and other parts of the world have used taxes to limit smoking access, the Chinese government interests in tobacco profits make such options especially politically complicated in China. 

Chinese food is also notoriously high in salt (as well as oil).  Chinese rates of hypertension are astronomical and constitute, according to some health researchers, the greatest public health issue in China at the moment.  Research into salt reduction and substitution are hot topics for research in China now.

As smoking cessation is politically difficult in China, salt reduction is technically more difficult, requiring gradual reduction in salt use in package food, restaurant food and household cooking.

As Dr. Friedan said at his lecture, though China still does far better than the U.S.A. and other countries when it comes to childhood obesity, they are starting to take the worst of both worlds.  The high fat diet of processed and fast foods developed by Western corporations, as well as the more traditional habits of a high salt and heavy tobacco use.  Such habits are sure to add to the chronic disease burden of China's aging population.

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