Life Expectancy in the China in relationship

to amount spent on healthcare

 INTRODUCTION

The provision of health and social services, as well as pensions, relies heavily on life
expectancy projections. These forecasts are often made for a single nation or a group of nations.
However, even within a nation, there is much variation in mortality and life expectancy.
Subnational planning and priority setting in public health and healthcare systems rely heavily on
local life expectancy predictions (Gallet & Doucouliagos, 2017).

For a country of China's size, provincial-level statistics on life expectancy is especially

useful. Improving life expectancy is a top priority for the 14th Five-Year National Health Plan
and the Healthy China 2030 plan (Ovseiko, 2013). There is still a geographical discrepancy in
how people suffer, even though the health of China's over 1 billion people has improved.
Predictions of life expectancy for regions within a country are even less frequent, and when they
do exist, they often only account for a tiny subset of the population (Ullah et al., 2021).
Subnational life expectancy forecasts should inform the health policy and program creation that
helps a country achieve its health goals.

China's booming post-industrial economy has increased energy consumption, posing

serious challenges to public health and sustainable development. Using conventional fossil fuels
for energy production is associated with adverse health effects and reduced life expectancy
(Imran Shah et al., 2021). According to the United Nations Environment Council, air pollution
kills 7 million people yearly (Mariadas et al., 2023). Carbon monoxide (CO) and carbon dioxide
are two examples of potentially hazardous emissions from fossil fuel power plants. (CO2). Air
pollution and increased CO2 emissions caused by burning fossil fuels to generate electricity
negatively impact environmental quality. In doing so, we contribute to climate change, which
threatens the survival of countless species. Declining life expectancy results from global
warming and increases the likelihood of certain diseases, such as cancer and mental illness
(Caruso et al., 2020). Therefore, there is a need to switch from nonrenewable energy sources
such as coal and oil to renewable energy sources such as solar and biomass to reduce
environmental degradation and potentially extend life expectancy. Although many factors
contribute to the human lifespan, the relationship between renewable Energy and health has been
largely ignored by researchers. As China's economy improved, so did medical care, education,
the environment, hygiene, and sustainable development. Rising living standards and
industrialization in China have increased the need for medical services. The recent increase in
life expectancy is likely due to decades of improved adult literacy and access to clean water,
food, and nutrition (Kabir, 2008). The Chinese government's medical expenses are increasing,
and with the country's growing middle class, so is energy demand.

MAIN DISCUSSION

Health spending and Life Expectancy

China has introduced a series of healthcare changes to improve the general population's
health. In 2009, China launched a comprehensive healthcare reform, pledging to provide all
residents with universal access to basic healthcare facilities. The main goals of the first phase of
reform were to expand public access to social health care and to improve the underlying
infrastructure of the health care system. A second round of government changes focused on
improving healthcare, including lowering drug surcharges, new payment structures, and inpatient
costs (Yip et al., 2019). In recent decades, China has made great strides in ensuring that people
of all income levels have access to quality health care and economic security. However,
questions remain about public satisfaction, cost control, the efficiency of healthcare, Prevention,
and treatment of NCDs, and the quality of care provided.

In China, health-related expenditures rose steadily between 1990 and 2000 before
dropping somewhat in 2001. From 2001 to 2021, the upward trend keeps quite strong. (except
for 2016 and 2017). Health expenditures have been rising, consistent with China's rising standard
of living and GDP. Total healthcare expenditures in China increased from 319 yuan per person in
2000 to 1888 yuan in 2011, a growth rate of 17.4 percent per year. Between 2000 and 2011,
government and social health expenditures expanded fast, with average annual increases of
22.9% and 18.8%, respectively, from 56 yuan to 554 yuan and 92 yuan to 625 yuan (Long et al.,
2013). From 1990 to 2021, life expectancy rose, suggesting that healthcare and economic
development improvements contributed to the country's long-term prosperity. Appendix 1 shows
how healthcare costs and life expectancy have changed over time.

The effects of healthcare expenditure on the elderly were studied by Lubitz et al. (2003).
If total healthcare costs were the same for healthy and unhealthy seniors, healthy seniors would
outlive their unhealthy counterparts. If health promotion focused on those under the age of 65,
we could extend the lives of the elderly without raising health care costs. Using China as an
example, Zeeshan et al. (2021) investigated the asymmetry between carbon dioxide (CO2)
emissions, environmental pollution, and health expenditure at the household level. Based on their
findings, they hypothesized that rising levels of environmental pollution might lead to higher
healthcare costs. OWUMI & EBOH (2021) analyzed the impact of healthcare expenditures on
longevity in Nigeria. Domestic and international health expenditures were shown to considerably
impact life expectancy gains between 2000 and 2017. Results also showed that an increase of
only one percentage point in Nigeria's overall government health expenditure would lead to a
six-percentage rise in life expectancy there. Life expectancy gains of 63% might be achieved
with a 1% rise in personal health care costs. Life expectancy would increase by 11% if the
government spent only 1% more on health care. Shahbaz et al. (2015) used the example of
Pakistan to examine the factors that affect life expectancy when economic hardship plays a role.
Their findings demonstrated, among other things, that money spent on healthcare directly
correlated with longer life expectancy.

Van and Olaroiu (2017) research looked at the correlation between healthcare
expenditure and longevity in the context of European nations. For all 31 European nations, they
employed cross-sectional data for research. Social protection expenditure, rather than health
spending, was shown to have the greatest impact on longevity. The findings indicated that
Europe's life expectancy might benefit from increased investment in social safety programs.
Health expenditure, rather than other variables like per capita income, education, and access to
clean water, was shown to be the most important factor in determining life expectancy in
underdeveloped nations. Longitudinal research on life expectancy and medical costs in Eastern
Europe was conducted by (Jakovljevic et al., 2015). The study found that healthcare spending
was positively associated with longer life expectancy in the European Union. Healthcare cost,
availability, and results in developed nations were the focus of an investigation by (Anderson &
Poullier, 1999). Their research showed that in developed nations, health expenditure rose
dramatically. Valcarcel (2012) looked at how private health expenditure correlates with life
expectancy for the EU-15. Data were analyzed using multiple regression, and the researchers
found that money spent on private healthcare was correlated with longer life expectancy. They
also noted that health expectancy was related to employment and GDP per capita.

Renewable Energy and Life Expectancy

The literature needs to emphasize investigating the link between longevity and
Renewable Energy. In Europe, it was estimated how using renewable energy sources affected
socioeconomic determinants of health. They used a method called Panel Vector Auto Regression
(PVAR) for these data. Events like modernization and industrialization negatively impacted the
health of Europeans. On the other hand, fossil fuel combustion may lead to environmental
deterioration, harming human health. Renewable sources of Energy might eventually phase out
fossil fuels. Rather than identifying causal links between health and renewable Energy, their
results indicated the expansion of renewable energy consumption and its influence on other
societal elements. From 1998-2020, Shah et al. (2022) studied China's foreign direct investment
(FDI) inflow, mortality, and usage of renewable energy sources. They said a considerable
amount of FDI had been brought into the country over the last several decades. While the influx
of FDI boosted economic growth and development, it also increased CO2 emissions and other
environmental deterioration. They used a nonlinear ARDL strategy using data from 1998-2020.
Their research revealed a link between renewable Energy, longevity, and foreign direct
investment in China.

They also discovered that the use of renewable Energy decreased deaths in China. The
effects of nonrenewable energy use on the quality of life in sub-Saharan African nations were
examined by (Ibrahim et al., 2021). According to their research, nations in sub-Saharan Africa
saw a decline in life expectancy as they increased their use of nonrenewable energy sources. The
relationships between commerce, carbon dioxide emissions, and Chinese life expectancy were
investigated by (Shah et al., 2022). They found that the increased in CO2 emissions due to trade
decreased life expectancy in China. They theorized that if people switched to renewable energy
sources, the environment would improve, and people would live longer. Fiscal decentralization,
commerce, and foreign direct investment (FDI) are just a few of the many variables studied
concerning health spending and outcomes. However, there is a dearth of studies examining how
renewable energy sources affect human health. Therefore, the current body of knowledge has
been expanded to include renewable Energy's implications for lifespan, using China as an
example. (Appendix 2)

Projections of Future Life Expectancy

Life expectancy is expected to continue rising in China, with estimates putting it at 8.3
years by the year 2035 on the Chinese mainland. Life expectancy is expected to rise most rapidly
in Guangdong for women and Tibet for males. Increases in longevity are expected to be greatest
for the elderly, particularly women. (Appendix 3).

Compared to a previous study (807 years for both sexes) and the United Nations' (811
years for both sexes and 789 years for men), our projections for life expectancy in mainland
China are generally similar, though ours are higher for women than the UN's (835 years for
women). Perhaps the use of various research approaches accounts for some of this difference.
Using long-term original data (the UN utilized the last seven decades), the UN's technique would
create longer-term estimates; nevertheless, this projection could be more cautious, particularly
for women in China (with bigger changes in the life expectancy curve trajectory). (Appendix 4
and 5). At the provincial level in mainland China, women in some provinces (such as Beijing,
Guangdong, Zhejiang, and Shanghai) have a high probability of living to be 90 or older, a
milestone that was once thought impossible by some researchers but is now within the realm of
possibility, according to most demographers. (Huaxia, 2021).

The health care system in China has advanced greatly in recent decades. The leading
causes of death in China are cardiovascular disease, chronic respiratory disease, and cancer, but
increases in life expectancy have been linked to lower fertility rates and fewer infant deaths in
recent years. These gains in life expectancy may be related to recent advancements in public
health such more public financing for health, increased access to health care, less health
disparity, higher levels of education, and better nutritional status. (Vollset et al., 2020).

The average lifespan varies considerably throughout the provinces of mainland China.
The country's socioeconomic development level and illness burden are very variable. Life
expectancy has lately surpassed that of South Korea and the United States, and the social
development level in certain regions is on par with that of high-income nations. A high
prevalence of infectious illnesses and infant mortality, as well as cerebrovascular disease,
stomach cancer, and traffic injuries, are typical of low-income nations, although this is not the
case in all provinces.

Furthermore, the degree of urbanization differs throughout provinces (with certain

western provinces having lower rates of urbanisation), and the income and health care and
education opportunities of urban inhabitants are greater. Life expectancy has historically varied
by location due to these factors. Life expectancy is rising rapidly in certain western regions, and
this trend is projected to continue. (eg, the life expectancy of men in Tibet is expected to increase
substantially). The disparities in life expectancy across countries and regions could be mitigated
by these improvements. Some of the richer eastern provinces (such as Beijing and Shanghai) are
forecast to maintain the highest life expectancies in the nation. (Appendix 7). The illness load is
lower and medical resources are better in some states compared to others. Consistent with past
trends, the anticipated gender disparity in life expectancy is widening in most provinces.
Noncommunicable illnesses (such as respiratory and circulatory disorders), cancer (such as lung
cancer, liver cancer, and stomach cancer), and external causes account for the majority of
fatalities that separate the sexes today. (eg, traffic accidents and suicide). In China, males and
females followed divergent patterns with regard to risk factors for various illnesses (such as
smoking).

Longer life expectancies need for more funding for health care and social programs. The
fact that healthy life expectancy is rising at a slower rate than life expectancy in China suggests
the need for approaches across the life course to prevent or delay the onset of chronic diseases to
promote healthy longevity, which could lead to an increase in non-healthy life expectancy (i.e.
years lived with disability). Tobacco and alcohol use reduction, enhanced nutrition and exercise,
and obesity management are just a few examples of the kinds of health education and economic
initiatives that may be implemented to encourage healthy aging. There is a growing population
of elderly people, many of whom are dealing with numerous health issues and may be unable to
move without assistance. It is important to think about integrated care in community settings or
even at home, as well as making necessary adjustments to the physical environment and
transportation services. (Appendix 10). Prioritization of resources and actions may be aided by
differences in life expectancy across locations, especially when taken in conjunction with
demographics, population comorbidities, and existing studies. Differentiating regional policies
and decreasing the disparity in life expectancy across areas are both crucial. Importantly, a
longer life span will put more strain on government programs like social security and pensions,
highlighting the need of preparation. (Appendix 6).

This study's strength lies in the fact that we utilized the BMA framework to combine the
forecast results of numerous models, which is more trustworthy than the prediction of a single
model, and that we employed the greatest epidemiological and demographic mortality data for
mainland China and its provinces.

Some nations' life expectancies have been impacted by the appearance of COVID-19 in
late 2019. Life expectancy losses should be mitigated by increased immunization against
COVID-19 and infection-acquired immunity.38, 39 Using the influenza pandemic of 1918–1920
as an example, we may not see major changes in death or life expectancy.40 Second, while we
aggregated the most complete data sources, the accuracy of our estimations may be impacted by
the fact that certain primary data sources (e.g., the Disease Surveillance Point system) cover
fewer districts and nations in impoverished and distant provinces at early stages. In recent years,
we've given more weight to the data in the prediction process, which may have helped lessen the
prediction bias. Third, although our life expectancy predictions performed a better job of
accounting for uncertainty in model selection and improving predictive validity, it's possible that
certain critical health situations were overlooked since our projection model didn't account for
health risk factors like smoking. We expanded our estimate to 2040 and compared it to the
results of a well-known, large-scale research that took health risk factors into account. Our
estimates for mainland China's life expectancy were quite close to the other study's. Lastly, we
did not present distinct projections for rural and urban life expectancy. Rural and urban regions
should also be included in future research due to the disparity in health burden between them.

CONCLUSION

Although life expectancy and general health continue to rise in China, it is important to
focus on the prevalence of NCDs, particularly among those aged 30–69. Meanwhile, the future
health objectives of the Healthy China Action will be aided by effective management of risk
factors. China is also spending more on healthcare through encouraging healthy living. There
have been programs in China to get people to exercise more, eat better, and give up bad habits
like smoking and drinking. The public as a whole may benefit from these efforts' emphasis on
chronic illness prevention.

Life expectancy in China is predicted to reach 79.95 years in 2030, thanks to the
country's rapid economic growth and the increase in the health of its citizens. The target date of
2030 is in danger if the risk factors are not effectively mitigated. The findings accord with those
of our study group. There has been a slowing in the pace of improvement in Chinese citizens'
health and life expectancy. It was predicted to grow by around one year every five years from
2015 to 2025 and then by roughly 0.75 years every five years from 2025 to 2050. There has been
a notable slowing in life expectancy improvements in the United States, the United Kingdom,
France, Germany, Sweden, and the Netherlands since 2011. Possible root cause: sluggish
progress in reducing the death rate of the elderly. Dementia and Alzheimer's disease fatalities are
on the rise, but advances in CVD mortality rates have stalled. Obesity and diabetes are on the
increase, even though several risk factors, such as smoking, alcohol misuse, high blood pressure,
and cholesterol levels, are on the decrease. According to this research, life expectancy in China is
projected to increase rapidly and steadily until 2050, provided that risk factors are well managed.
(Appendix 9, 8).

If China is serious about increasing its population's longevity, it must prioritize healthcare
spending. China can increase the quality of healthcare services while decreasing healthcare costs
if it increases health insurance coverage, invests more in R&D, makes better use of technology,
and encourages healthy lives. In addition, healthcare expenditures may boost economic
development and open up new horizons. That's why it's so important for the Chinese government
to keep spending money on healthcare; it's an investment in the future of the country.
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Appendix 1: Life Expectancy and Health spending in China Source: Primary: world bank
Indicator

Secondary: Liu, Hui, and Kaiyang Zhong. 2022. “Relationship between Health Spending, Life
Expectancy and Renewable Energy in China: A New Evidence from the VECM
Approach.” Frontiers in Public Health 10 (October).
https://doi.org/10.3389/fpubh.2022.993546.
Appendix 2: Renewable Energy and Life Expectancy Source: world bank Indicator
Liu, Hui, and Kaiyang Zhong. 2022. “Relationship between Health Spending, Life Expectancy
and Renewable Energy in China: A New Evidence from the VECM Approach.”
Frontiers in Public Health 10 (October). https://doi.org/10.3389/fpubh.2022.993546

Appendix 3: Trends and projection of Life expectancy in China Source: Liu, Hui, and
Kaiyang Zhong. 2022. “Relationship between Health Spending, Life Expectancy and
Renewable Energy in China: A New Evidence from the VECM Approach.” Frontiers in
Public Health 10 (October). https://doi.org/10.3389/fpubh.2022.993546.
Appendix 4: Projected life
expectancy in different
provinces of China
Source: (Bai et al., 2023)

Appendix 5:
Projected life expectancy in different provinces of China Source: (Bai et al., 2023)

Appendix 6: Projected changes in Life Expectancy (Bai et al., 2023)

Appendix 7: Contribution towards gain in life expectancy (Bai et al., 2023)
Appendix 8: Predicted Life Expectancy (Liu et al., 2022)

Appendix 9: Trends in premature mortality rate (Liu et al., 2022)

Appendix 10: Projection of deaths due to major diseases (Wang et al., 2012)