13 Finally, the impact of government policy on health status is assessed with regression analysis using the cross-sectional country level data. In each country, a panel of cross-section (provinces or regions) and different time-series data were utilized. The results in several studies indicate uniformly favorable impact of immunization and water supply on health status in the Philippines, Malaysia and Viet Nam, while sanitation and immunization are more effective in China. Poor country such as Viet Nam faced stricter economic constraints than others in the sample during the period under review, and so improved health status is a result of rising income growth than public health spending. The dissimilar effects of public health spending in Viet Nam also reflects greater importance of other health promoting interventions for reducing infant deaths in a period of deteriorating health infrastructure, high incidence of infectious and water-borne diseases and poor quality of services. (See Technical Annex A).

# Emerging Problems

# Health Transition:

China is now completing its demographic transition from high fertility and mortality rates to low ones. The demographic transition has profoundly influenced the age structure of population and the cause of mortality which has set the stage for epidemiological change. As the population continues to age, the relative frequency of various causes of death changes, causing more chronic diseases to occur among the older population and fewer infectious diseases among the younger population. Figure 7 illustrates that the proportion of older population will rise from 9.5 percent in 1995 to 16 percent in 2020, and the proportion of deaths among this age group will increase from 55 to 65 percent because mortality rates from infectious and childhood diseases are decreasing disproportionately during the same period. By way of illustration, China's close Asian comparators--South Korea, Malaysia, and Thailand--will generally experience similar shifts in the age structure of their population and age pattern of mortality.

# **Changing Risk Factors**

Lifestyle choices for example, cigarette consumption, alcohol intake, as well as such factors as urbanization, environmental pollution, and differences in access to health services are changing the exposure of China's population to the risks of different diseases. As a result, the pattern of disease is becoming more diverse across the provinces and socio-economic groups. Prior to the health transition, fewer diseases were responsible for the majority of deaths; now, with progress in the fight against immunizable diseases and diarrhea, the pattern of disease is increasingly being characterized by a "dilated-polarized epidemiological" regime in which infectious diseases and malnutrition coexist with non-communicable diseases and injuries both across rural and urban areas, and among poor and non-poor regions (Table 3, Annex).

Ironically, this growing diversity has come in the face of several successful public health interventions. New diseases have emerged and have resurfaced old ones.2 Although the prevalence of sexually transmitted diseases (STD) and Acquired Immunodeficiency Syndrome (AIDS) is not yet 2 For example, AIDS is a new disease, but this has brought back tuberculosis, and malaria has become widespread with the diminished vector control programs in several provinces in China.