China’s Agenda 21 - White Paper on China’s Population, Environment, and Development in the 21st Century

China’s Agenda 21 – White Paper on China’s Population, Environment, and Development in the 21^st Century

Date:    Adopted at the Executive Meeting of the State Council of the People’s Republic of China on 25 March 1994

Source:    Adopted at the Executive Meeting of the State Council of the People’s Republic of China on 25 March 1994

Subject:    population, environment, development

Text:

	CHAPTER 6 EDUCATION AND CAPACITY BUILDING FOR SUSTAINABLE DEVELOPMENT INTRODUCTION
	PROGRAMME AREAS Improvement of Management System for Sustainable Development Development of Education Human Resource Development and Capacity Building Science and Technology for Capacity Building Sustainable Development Information Systems Continuous Improvement of China’s Agenda 21
	CHAPTER 7 POPULATION, CONSUMPTION AND SOCIAL SERVICES INTRODUCTION
	PROGRAMME AREAS Control of Population Growth and Improvement of Competence level Establishment of Sustainable Consumption Patterns Actively Developing Social Services and Tertiary Industry
	HEALTH AND SANITATION INTRODUCTION
	PROGRAMME AREAS Meeting Basic Needs for Health Care Minimizing the Impacts of Environmental Pollution on People’s Health Controlling Infectious Diseases Reducing the Harmful Impacts of Endemic Diseases Protecting the Vulnerable Facing the Challenges of Urban Sanitation
	DEVELOPMENT OF SUSTAINABLE HUMAN SETTLEMENTS INTRODUCTION
	PROGRAMME AREAS Management of Urbanization and Human Settlements Construction of Infrastructure and Improvement of Human Settlement Functions Improvement of the Human Settlement Environment Provision of Adequate Shelter for All Promotion of Sustainable Development of the Construction Industry Energy Conservation and Enhancement of Energy Efficient in Human Settlements

CHAPTER 6 EDUCATION AND CAPACITY BUILDING FOR SUSTAINABLE DEVELOPMENT

INTRODUCTION

6.1 China's capacity for sustainable development, an essential guarantee for the successful implementation of China's Agenda 21, is determined to a large extent by the capabilities of its government and people, as well as its ecological and geographical conditions. Specifically, capacity building is based on the interaction of national planning, decision-making, administration, the environment, resources, and scientific, technological and human resources.

6.2 The Government of China has formulated strategic guidelines based on China's actual conditions, whereby economic development, urban and rural construction and environmental protection are being planned for and developed contemporaneously, so as to maximize economic, social and environmental benefits. It is implementing the three major environmental policies of stressing prevention, of "polluter pays" and of intensified management of the environment. In addition, work has been done to strengthen the legal system and to promote the widespread management of land resources. Efforts have been made to make primary and middle school education compulsory so as to raise educational levels. Efforts have also been made to publicize environmental protection so as to raise awareness of environmental protection and to promote scientific and technological research. In addition, much attention has been given to the family planning policy, which is helping to reduce the enormous pressures on the environment caused by population growth and economic development. These undertakings are laying a solid foundation for China's capacity building for sustainable development.

6.3 This chapter, which is linked with all other chapters, is composed of six programme areas:

A. Improvement of Management Systems for Sustainable Development;

B. Development of Education;

C. Human Resource Development and Capacity Building;

D. Science and Technology for Capacity Building;

E. Sustainable Development Information Systems;

F. Continuous Improvement of China's Agenda 21.

PROGRAMME AREAS

A. Improvement of Management System for Sustainable Development
Basis for action

6.4 Currently, the State Planning Commission and the State Science and Technology Commission, which are led by the State Council, are charged with responsibility for the management of China's sustainable development, that is, for the implementation and administration of China's Agenda 21. Other governmental agencies and departments are responsible for various aspects of the work.

6.5 The realization of sustainable development requires an extremely effective management system, in which capacity building for decision-making and for management are crucial. The management of sustainable development requires the comprehensive use of planning, administrative techniques, and legal and economic measures. It requires well-trained decision-makers and managerial personnel. It requires the use of advance management techniques and the establishment and improvement of organizational institutions, so as to form a cohesive management system. At present, a lot of work has been done in these areas, but there is still much work to be done.

6.6 It should be pointed out that the implementation of other programme areas found in this chapter will contribute to the successful realization of objectives contained in this programme area.

Objectives

6.7 Develop a fairly complete management system for sustainable development by the end of this century. This will mean that governments at all levels will have the expertise for decision-making, coordination and management for sustainable development and will have an enhanced capacity for servicing sustainable development.

6.8 Gradually set up coordination and management mechanisms which will promote sustainable development:

The state will organize regular or special meetings for regional or departmental leaders to discuss overall and response strategies for China's sustainable development, to check the progress in the implementation of various strategies and to put forward proposals for solving new problems arising during the implementation process. At each governmental level, that is, the provincial (autonomous region and municipality), prefectural (city) and the county, activities similar to those at the national level are also to be carried out;
Organize the study, formulation and implementation of regional development plans, which will then be subject to periodical review and revision as appropriate.

6.9 The Chinese Government will gradually incorporate China's Agenda 21 into its plan for national economic and social development. Various measures are needed to enhance awareness of sustainable development amongst the people involved in planning, management and decision-making and to upgrade their abilities with respect to making plans for its implementation. Efforts should be made to intensify studies of systems of sustainable development indicators, and sustainable development policies and measures.

6.10 Establish sustainable development research institutions and organizations nation-wide and make full use of existing management research institutions to conduct in-depth and systematic multi-disciplinary studies on sustainable development in order to provide policy advice to administrative and decision-making authorities.

6.11 Implement integrated decision-making based on consideration of economic, social, natural resource and environmental factors:

When making major decisions or proposing key projects, government agencies at all levels should conduct sustainable development impact assessments (SDIA) to see whether or not projects are in accord with the sustainable development requirements of regional development plans;
Enhance transparency in administration and decision-making and establish non-governmental consultancy agencies and a public information network to enable the public and relevant non- governmental organizations to participate more effectively in the process of decision-making;
Systematically monitor and evaluate the development process so that government agencies at all levels can assess the progress of sustainable development;
Rationalize resource allocation through policy coordination.

6.12 Adjust the functions of government so that the government will set and implement the macro-control policies which will promote sustainable development:

Promote the use of effective, practical comprehensive management systems, especially in managing natural resources and the environment; gradually include consideration of natural resources and the environment in the national economic accounting system; establish a system of compensation for the use of resources and a system of compensation for polluting the environment;
Revise and improve existing financial and economic regulations to meet the objectives of sustainable development;
Establish and improve national and local laws and regulations on the environment and development, while encouraging a policy environment favourable to sustainable development;
Encourage the local areas and enterprises to formulate and implement practices and regulations required by a sustainable development accounting system.

6.13 Adjust government functions to strengthen the capacities of government agencies to provide organization, coordination and information services, as well as scientific and technical assistance for sustainable development.

6.14 Use a range of approaches to improve the training of the decision-makers and administrative personnel at all levels in order to enhance their awareness of sustainable development, to raise their theoretical understanding of it and to ensure appropriate decision-making and the smooth implementation of plans and programmes. Conduct regular and systematic training sessions for various levels of planners, administrative personnel and particularly leaders to upgrade skills and to allow for exchanges of management experiences.

6.15 Encourage international cooperation for training so as to continuously introduce new thinking and practices of foreign countries and to train people involved in management and technology.

B. Development of Education
Basis for action

6.16 The key to eliminating poverty through developing the economy is in scientific and technical progress and improving labour skills. The development of education is fundamental to sustainable development.

6.17 The achievements of China's elementary education have been recognized world-wide, with 98% of its children attending school. Compulsory primary education has been popularized in over 90% of China's populated areas. Primary education has been thoroughly popularized over half of all provinces and municipalities. In recent years, the proportion of qualified primary and middle school teachers has been increasing year by year. Yet, the educational system is still faced with many problems: disproportionately low investments in education; a rising dropout rate in primary and middle school, particularly in primary middle school; instability and serious dropouts of the teaching personnel; the failure of educational contents and methodologies to meet current needs for sustainable social and economic development.

Objectives

6.18 Improve the educational system; continue to strengthen primary education; vigorously develop vocational education; actively promote adult education and higher education; encourage self-study; implement The National Program for Educational Reform and Development, so as to build a group of far-sighted leaders and decision-makers, a contingent of highly-skilled scientific and technological workers in various fields and a large labour force with specific skills and scientific and cultural knowledge.

Activities

6.19 The National Program for Educational Reform and Development should be implemented. In the national economic and social development plans, investment for education will be guaranteed and will be graduate increased with the development of economy. Great efforts will be made to strengthen primary education and to develop vocational, technical, adult, and high education. Engineering 211 for high education will be implemented.

6.20 Continue to insist and perfect the system of collecting educational funds in various fund raising approaches and taking government subsidies as the main source of revenue. With the steady development of the economy, there should be a continuous increase of educational input. Ensure the density of input. Encourage enterprises, social organizations and individuals to contribute financial support or the collection of funds for education.

6.21 Encourage the idea of sustainable development in students' thinking. Incorporate information about natural resources, ecology, the environment and sustainable development into primary school nature courses and middle school geography classes. Offer courses on Development and the environment in institutions of higher learning, set up additional courses for postgraduates with majors closely related to sustainable development, such as environmental science, so as to include elements of sustainable development in the curricula throughout the whole educational system, ranging from primary to tertiary education.

6.22 Energetically strengthen elementary education, generally popularize nine-year compulsory education and eliminate illiteracy among the young and middle-aged. Roughly meet the requirement of preschool education in large and middle cities. Actively develop preschool in the vast rural areas. Attach importance to the education and training in border, remote and poor regions. Gradually reduce the differences of educated levels between girls and boys and among people of different nationalities or living in different regions.

6.23 The structure of middle school education will be ameliorated to strengthen the construction of vocational and technical senior middle schools. By the year 2000, enrolment and student number in vocational schools will be maintained to an average of 60% of senior high school students nationwide. The network for vocational education and training will be established and improved. The personnel administrative system of "training prior to employment and training necessary for employment" will be applied. On-the-job training and continuous training programmes will be vigorously developed to enable employees to constantly upgrade their knowledge and to improve their skills.

6.24 Place emphasis on the building of key institutes of higher learning and key majors in order to meet the needs of the 21st century. Strengthen the training of high level talents. Positively promote the construction of information networks among universities and the exchanges of international information.

6.25 Strengthen the dissemination and popularization of scientific knowledge. Publish popular science books. Encourage the raising of the level of people's cultural and scientific understanding through public education using mass media, viz., the press, films, radio and television, and through offering various kinds of short-term training courses. Raise people's awareness of the issues of sustainable development and their understanding of the urgent need for sustainable development.

6.26 Increase pay for teachers and intellectuals and improve their working and living conditions.

C. Human Resource Development and Capacity Building
Basis for action

6.27 China has a huge population, yet its workers have relatively low levels of cultural and scientific education. In 1989, among those workers whose technical skills levels were graded, 71% were graded class 1 to 3.23% class 4 to 6 and only 2% for class 7 to 8, the highest. Rural people have even lower educational levels, and 24% are illiterate. This is an important problem which needs to be considered when addressing various issues. China has a large labour force, with over one hundred million surplus labourers in the countryside alone. This figure will reach about two hundred million by the year 2000, which not only will result in a tremendous waste of human resources, but also will result in an increased burden for society due to the greater consumption of resources. Therefore, the development and use of China’s labour force and human resources are important for sustainable development capacity building.

Objectives

6.28 Comprehensively utilize human resources. Expand job opportunities and offer new areas for employment. Promote full employment and make use of talented people to meet the demands for human resources in achieving sustainable development.

Activities

6.29 Develop community economies, in particular through the development of tertiary industries, and village and township enterprises so as to provide a wide range of job opportunities for rural youth. Establish a labour services market to promote employment and the rational use of talents. Organize and attract surplus rural labourers to engage in labour-intensive industries, such as ecological projects(e.g. planting trees and grass) and other public works construction projects(e.g. building roads), while improving education and technical training.

6.30 Stress the important role of intellectual resources for sustainable development through radio, televisions and films, in order to allow knowledge and intellectuals their rightful positions in society, and to enhance the whole nation’s awareness of the importance of science, technology and ability. Create social environment in which education is taken seriously, and teachers and talent are respected. Strengthen the management of talented people, by promoting their rational utilization so as to take advantage of individual’s special skills and strengths.

6.31 Support the study and popularization of sustainable knowledge and production skills. Encourage craftsmen and other people of ability to make use of their talents and special skills as a means of alleviating poverty and enriching themselves. Encourage them to pass on their technical skills and knowledge to others.

6.32 Establish training agencies at local levels to enhance professional and technical training . Provide communities with the latest training materials. Introduce successful activities, programmes and projects in the area of human resources development and capacity building to these communities. Emphasize training in practical technologies and skills for rural people; continuously upgrade training techniques and increase training efficiency.

6.33 Improve pay and conditions for intellectuals. Adopt incentive measures. Create a liberal environment. Organize the tackling of key problems in science and technology. Provide opportunities for retraining in an effort to tap the enthusiasm and creativity of scientific and technical personnel, and to build up a larger contingent of personnel trained in science and technology.

6.34 Improve the system for cadre training to create a group of educated and resourceful decision-makers and leaders, who have a sense of historical responsibility and strategic thinking, who have organizational abilities and who keep up abreast of developments in order to strengthen the decision-making and organizational abilities of all levels of government.

6.35 Open up farther to the outside world and improve the domestic work environment so as to attract those studying overseas to come back to serve the motherland. Through technical assistance and international cooperation, take advantage of foreign intellectual resources for China's sustainable development and construction, while exporting labour services in accordance with the demands of foreign labour service markets.

D. Science and Technology for Capacity Building
Basis for action

6.36 Science and technology are important components of aggregate national strength and one of the fundamental bases for sustainable development. Without the support of advanced science and technology, the objective of sustainable development cannot be realized. The scientific thesis that science and technology constitute a fundamental productive force has been universally accepted in China.

6.37 Continuous advances in science and technology can effectively provide support for the formulation of policies for sustainable development, can promote the upgrading of the management for sustainable development, can deepen humankind's understanding of the relationship between man and nature, can expand the supply and availability of natural resources, can enhance the utilization and economic benefits of resources, can provide effective means for the protection of the environment and natural resources. These capacities are critical to alleviating the contradictions among China's population and economic growth and limited resources, while attempting to expand the environment's capacity for sustainability and to improve the quality of life, thereby realizing the strategic objectives of sustainable development.

6.38 Vigorously promote scientific and technological progress and practice scientific and democratic decision-making; build the national economy by relying on scientific and technological advances to improve economic efficiency and by improving the quality of the labour force; keep in the forefront of developments in high technology, while endeavouring to make breakthroughs; train and build up a well-structured and capable contingent of science and technology personnel.

6.39 Implement the Outline for Long-term and Medium-term Scientific and Technology Development, the National Plan for Key Scientific and Technological Projects, the National Programme for High-tech Research and Development Projects, the National Plan for Key Industrial Experimental Projects, the National Plan for Key Technical Development Projects, the National Plan for the Construction of Key Laboratories, the National Plan for the Construction of an Engineering Research Centre, the National Plan for Key Projects, the Torch Plan, the Sparkling Plan and the Plan for the Popularization of Key Scientific and Technological Achievements.

6.40 Develop effective guidelines and policies to attract and encourage large numbers of talented people to engage in science and technology for sustainable development and to build up a well-organized and able contingent of scientific researchers.

6.41 Constantly improve the system for protecting intellectual property and for legislating on science and technology; use government to guide policy to organize management, and to organize scientific and technological collaboration for tackling difficult problems; enhance the building of the support system for scientific research and services by improving research sites, laboratories, experimental facilities and library facilities.

6.42 Conduct studies on the basic theories of sustainable development and develop a theory of sustainable development appropriate to the Chinese situation.

6.43 Conduct studies on the selection of sustainable technologies, on risk assessment and on indicator systems; develop a mature assessment system for sustainable development and a rational technological and economic system for sustainable development.

6.44 Develop a well-structured scientific and technological system for basic research, applied research and engineering design; strengthen new and high-tech research for sustainable development.

6.45 Deepen reforms in scientific and technological systems; develop the market for technology; promote the popularization of scientific and technological achievements; establish a coordinated programme of scientific research, technological development, production and marketing.

6.46 Promote extensive exchange and cooperation among scientific researchers in all fields and from all parts of the country, particularly with respect to interdisciplinary exchanges and cooperation, conduct studies on science and technology for sustainable development; enhance exchanges and collaboration in the fields of scientific research, teaching and production; encourage the use of technological advances and developments by enterprises.

6.47 Strengthen international cooperation, promote the exchange of scientific and technical information both at home and abroad and follow closely the latest international scientific developments. Actively seek support from the international community through various channels, in order to cooperate in international scientific and technological activities and exchanges of personnel and achievements. At the same tune, assimilate and upgrade advanced technologies imported from overseas.

E. Sustainable Development Information Systems
Basis for action

6.48 Sustainable development is an ongoing process, so it is essential that information can be accessed at any given time, to provide feedback so that adjustments can be made as necessary. It is difficult to arrive at correct decisions with insufficient information. As far as sustainable development is concerned, everyone is both an information supplier and user. Therefore, the establishment of a sustainable development information system involves a broad range of areas.

6.49 Currently, various government agencies and different localities have already established information centres and the state has also set up an broadly-based national information centre. These provide an existing foundation for the development of information system for sustainable development.

6.50 In the development of and information system for sustainable development, consideration should be given not only to the quantity and completeness of information but also to its quality and consistency.

6.51 By the year 2000, gradually establish a rich information network for sustainable development to which people can have easy access and from which departments and agencies concerned can conveniently obtain the latest, most comprehensive information and statistical indicators about sustainable development.

6.52 Identify the framework, standards and necessary features of an information system for sustainable development.

6.53 Conduct a technical assessment and comparison of China's existing information systems, which could be used to support sustainable development; identify problems and suggest ways for improving those systems to provide the basis upon which an information system and statistical indicators for sustainable development can be established.

6.54 Establish China's sustainable development information network for exchanges with foreign countries through the UNDP-sponsored "Sustainable Development Network".

6.55 Formulate legislation or a system to govern China's information network for sustainable development; promote the formation of information sharing systems to ensure access by all government agencies, non-governmental organizations and the general public and to ensure the exchange of information.

6.56 Develop and adopt modern instruments for information collection, transmission, management, analysis and processing; develop the high-technologies for geography information systems, remote sensing, satellite communications and computer networks and their application.

F. Continuous Improvement of China's Agenda 21
Basis for action

6.57 China's Agenda 21 is providing the strategic framework for China's sustainable development, within which various programmes of all departments and localities can be coordinated and implemented in accordance with the principles of sustainable development. The implementation of China's Agenda 21 is a long-term, gradual process, therefore, it is necessary to continually improve the Agenda and to identify priorities for work in different development phases in accordance with changing circumstances. The priority programmes for China's Agenda 21 are directly derived from China's Agenda 21 As a result, they serve to transform China's Agenda 21, a strategic framework, to a phased, (operational programme of priority projects, which combine pressing issues which need to be solved, capacity building, key technologies and demonstration projects for China's sustainable development.

6.58 It should be pointed out that the implementation of activities in other relevant programme areas will contribute to the realization of the objectives of this programme area.

Objectives

6.59 Ensure that by the year 2000, the objectives of sustainable development are included in China's major development strategies and objectives. In accordance with the changes in various aspects and priorities of work in different stages, China's Agenda 21 and its Priority Programmes will devise new objectives as time proceeds.

6.60 Conduct research on the concept, theories behind and policies for impact assessments for sustainable development; improve capabilities for multi-disciplinary and comprehensive analyses and for solving problems; analyze and evaluate the results of different policies for development and provide policy advice to the relevant authorities.

6.61 Organize consultations amongst various departments at regular intervals to discuss and evaluate relevant strategies and implementation issues regarding sustainable development; provide policy advice to decision-making authorities; continue to improve China's Agenda 21 and its Priority Programmes.

6.62 Ensure the full participation of the public and all sectors of society, so as to fully reflect people's wishes and the requirements of the times in China's Agenda 21 and its Priority Programmes and to obtain public support.

6.63 Focus on the objectives of this programme area; maintain close contact and cooperation with other countries and international organizations in an effort to continually learn about important developments and common practices from the international community in its pursuit of sustainable development.

CHAPTER 7 POPULATION, CONSUMPTION AND SOCIAL SERVICES

INTRODUCTION

7.1 Full consideration should be given to the population factor at all planning and decision-making stages. The relationship between population, resources, environment and development should be appropriately coordinated so as to lessen population pressures, which is an important aspect of ensuring sustainable social and economic development in the socialist modernization drive.

7.2 China has made well-known achievements with regard to population control due to her positive and effective population control policies and family planning management and services. Nevertheless, three major problems (viz., the extremely large population base, low levels of competence, and the unbalanced population structure) are now and will continue to be urgent issues for a rather long time in the future.

7.3 Changes in consumption patterns, like population growth, play an important role in the sustainable development of the economy. Rational consumption patterns not only benefit a growing national economy, but also reduce various pressures arising from population growth and protect and improve the environment upon which humankind depends. Unfortunately, however, the rapid growth of population together with non-sustainable consumption has become a tremendous burden on the supply of limited energy and resources. In particular, low-efficiency but high-consuming production and irrational domestic consumption have caused severe damage to the environment, thus affecting the conditions for improving living standards and even for sustaining human life itself.

7.4 Based on an enhanced understanding of the aforementioned issues, the Chinese Government plans to take necessary measures and actions to alter traditional irrational consumption practices and encourage more reasonable and sustainable consumption behaviour. Special attention should be focused on consumption in poverty-stricken and backward areas. Strategies should be developed to change inappropriate consumption patterns and lessen the burden on resources and the environment, so as to improve economic development and living standards and to alleviate poverty.

7.5 The Chinese Government has determined that striving for a sustainable, rapid and healthy development of national economy is a strategic goal. "Continuously improving living standards, strictly controlling population growth and strengthening environmental protection" has become fundamental tasks to be completed during the accelerated process of reform and opening up to promote economic development and all-round social progress. Family planning and environmental protection are regarded as basic national policies.

7.6 To satisfy the needs of a growing population, the Chinese Government attaches great importance to improving people's food, clothing and housing conditions, to enriching entertainment, physical education, health care, as well as to the development of tertiary industries and social services in order to provide people with full and convenient services. As the national economy rapidly develops, these demands will become more urgent.

7.7 Population, consumption and social services involve a wide range of issues and aspects. Therefore this chapter is interrelated with or cross-referenced to other chapters, therefore it should be studied with other chapters in mind. While drawing up programme areas, due consideration should be given to issues such as employment, human resources development, urbanization of population, health care, the protection of women and children, average per capita consumption, consumption structure, etc.. Similarly, in the preparation and execution of the other programme areas, the impacts of population, consumption and social conditions should also be taken into account.

7.8 The following 3 programme areas are included in this chapter:

A. Control of Population Growth and Improvement of Competence Level;

B. Establishment of Sustainable Consumption Patterns;

C. Actively Developing Social Services and Tertiary Industry.

PROGRAMME AREAS

A. Control of Population Growth and Improvement of Competence Level
Basis for action

7.9 As a developing country with a large population, China is faced with the arduous tasks of dealing in a coordinated way with population control, resource utilization, environmental protection and economic development.

7.10 In the 1990's, China is facing its third peak in the birth-rate since the founding of the People's Republic of China. It is estimated that the Chinese population will approach 1.3 billion by the year 2000 and 1.5-1.6 billion by the middle of the next century.

7.11 With this continuous growth in total population, the labour force will be increasing steadily. A relatively higher rate of economic development must be maintained and more job opportunities should be created to meet the demands of the increasing labour force. There is an urgent need to formulate strategies and take actions to deal with the disparity between greater supply of and less demand for labour.

7.12 A decrease in the birth rate is changing the age structure of the population, and there will be a tendency towards an ageing population. By the end of 1991, the Chinese population at or above 60 years old stood at 100 million. By the turn of the century, the number will be 130 million, or approximately 10 per cent of the total population.

7.13 A large proportion of the Chinese population has a relatively low level of education. The semi-illiterate and illiterate population numbers over 180 million (1990), 36% of which are employed in rural areas. Therefore, improvement of education is fundamental to rural people being able shake off poverty and live a more comfortable life.

7.14 In the last 20 years, the Chinese Government has taken a series of measures and achieved remarkable progress in areas such as reducing the pressures imposed by population growth upon the environment, increasing public awareness of population policies, raising contraception rate, improving prenatal care and birth practices, improving education and health care for children, and improving educational levels throughout the country.

7.15 Since the 1980's, the reform and opening-up process has given rise to population flows and migrations. Such movements prove to be both necessary and beneficial to economic prosperity and social progress. Therefore, corresponding strategies and measures should taken to better steer and manage the floating segment of the population, to coordinate distribution of population and availability of resources in urban and rural areas, and to better deal with new and difficult problems encountered in the urbanization process.

7.16 In rural areas, and particularly in poverty-stricken areas, special efforts should be devoted to family planning issues, such as, the prevention of early marriages and of early and excessive births, and of marriages between close relatives. At the same time, measures should be taken to transform in a fundamental way backward educational conditions and to raise educational levels.

Objectives

7.17 Every effort will be made to keep the average annual rate of population growth within 1.25 per cent by the year 2000. The total birth rate will be reduced from 2.3 in 1990 to below 2.0, the average birth rate in developed countries at present. It is expected that the Chinese population will be stabilized at around 1.5 or 1.6 billion by the middle of next century. The population policy includes genetic counselling, childbirth counselling, and education about child-rearing practices with the aim of improving general health and educational levels. Research will be conducted on the problems associated with an ageing population.

7.18 By the end of the century, illiteracy amongst young and middle-aged women will be basically eliminated, and the goal of 9 years of compulsory education will be basically achieved. At the same time, levels of education throughout the country will be improved by enhancing various forms of education and vocational training, including the education of women and children.

7.19 Population control policy and environmental protection:

The family planning policy will be continued so as to reach the objectives for population control. Based on China's present condition and level of economic development, consideration must be given to the control of the birth rate, to raising health and educational levels, and to the solution of problems associated with an ageing population. A comprehensive plan will be formulated for achieving rational growth, improving levels of competence and optimizing the composition of the population;

Research and analysis on the current population, including the migrant population, will be conducted in order to provide a sound basis for making decisions on issues such as population control, job creation and urbanization. Inter-sectorial collaboration will be strengthened, and more opportunities for educational activities and exchanges of information amongst people from different backgrounds will be presented in order to increase public awareness of opportunities to participate in the control of population;

Government capabilities in terms of population management will be strengthened through clear definition of obligations and the adoption of well-coordinated management mechanisms.

7.20 Family planning and health care of women and children:

The quality of family planning services will continue to be improved and new effective contraceptives will be widely introduced. Various kinds of high-quality services and information about family-planning and the health care of women and children will be provided to all married couples. Prenatal and postnatal care will be improved. Special attention will be paid to couples in backward areas to ensure their regular acquisition of information about contraception, contraceptive devices and technical services as required;

Family planning should be combined with the health care of women and children; activities will be encouraged to create happy and harmonious families; the implementation of family planning policies must be closely related with activities in improving living standards;

There should be better training of personnel engaged in family planning and health care work so as to improve their efficiency in providing family planning services by increasing their knowledge base and their mastery of new techniques;

Family planning should be closely linked to poverty alleviation efforts in poor regions; poor households that have strictly followed family planning practices should be favoured and rewarded.

7.21 Education and raising levels of competence:

Educational opportunities for women should be increased and improving the conditions for women to be educated should receive particular attention; scientific and technical training should be provided to women of childbearing age, together with information about birth control policies, women should be encouraged to take an active part in social and economic activities and to voluntarily engage in family planning;

Men should be encouraged to share more family responsibilities, particularly, for family planning;

Cultural and educational activities should be further expanded in rural areas, and rural people's educational levels should be raised; traditional concepts about childbearing should be altered to lower birth rates and to avoid endogamous marriages;

Efforts should be made to promote ethical and moral education and to encourage good social ethics; efforts should also be made to gradually educate people in urban and rural areas about environmental protection, improving ecological systems, and the rational use of resources, and to increase public awareness of population issues and the protection of natural resources and the environment.

7.22 Ageing population and development of human resources:

Economic development in local communities should be promoted; the structure of production in rural areas should be improved; guidance should be provided for the development of the township and village enterprises (TVE); there should be active promotion of the development of tertiary industries. Adequate opportunities for employment should be provided to women so they can improve their economic status;

Research should be conducted on how to develop and utilize the ever-increasing labour forces; research should especially consider the inter-relationship between surplus labour in the countryside, the migrant population, the urbanization of the population and the development of TVE enterprises. Measures should be taken to make rational and efficient use of both human and natural resources;

A social security system should be established for elderly people. A well-organized network providing medical care and social services to the elderly in local communities should be further improved. Efforts should be made to put in place a comprehensive social security system in order to better deal with the problems associated with an ageing population.

7.23 Establishment and improvement of overall data collection and information systems:

An information and management system for population statistics and indicators should be established based on computerized data-banks at national, regional and local (counties, towns and villages) levels so that population data and related information can be effectively distributed to guide and improve family planning management and services at grass-root levels. An integrated national decision-making support system (DSS) and an artificial intelligence system will be established gradually;

Techniques for collecting high-quality data will be improved and research on developing technology for objectively evaluating the quality of population data will be conducted. Efforts will be made to train more qualified population management staff;

International cooperation and academic exchanges should be strengthened in order to establish and develop standards for data formatting and software, to ensure that data-banks are compatible with those in information centres found in other countries so that their data can be accessed at both national and regional levels.

7.24 Formulation and evaluation of policies:

Consideration should be given to the demand for natural resources, the generation of wastes and balancing ecological systems, when policies concerning human settlements are being formulated;

In the process of working on environmental protection and economic development, governments at all levels should take into account both the direct and indirect impacts of population fluctuations and evaluate their influence on population characteristics;

When formulating economic policies, due consideration should be given to the impact of an ageing population on labour supply, the demand for resources, family incomes and support capabilities;

There should be policies to guide the migrant population and studies should be made on problems associated with population migration and shifts in labour forces in order to prevent the over-concentration of the population in urban areas and to reduce massive pressures on the environment;

When various policies and programmes resulting from environmental degradation or destruction are being formulated, special attention should be paid to the protection of women and the disabled.

7.25 Regional cooperation and the exchange of experiences:

Experimental zones for pilot projects on coordinating the population and the environment should be established; successful experiences should be publicized and the areas which coordinating the development of the Chinese population and the environment should be gradually enlarged.

There should be long term nationwide monitoring to evaluate the effectiveness of incorporating population policies into national policies, and to determine trends existing in the coordinated development of the population and the environment.

B. Establishment of Sustainable Consumption Patterns
Basis for action

7.26 Since the founding of the People's Republic of China, people's consumption patterns have been changing from having the basics towards having a more comfortable life. On the whole, consumption by the Chinese people is still at a low level. Per capita income in China is rather low. According to statistics in the World Bank's development report of 1991, China's GNP in 1989 was US$ 350 per capita (using 1980 exchange rates), thereby placing China in the category of countries with a lower-middle level of annual income.

7.27 Consumption trends in China are not always appropriate and consumption patterns are somewhat lopsided. This is most apparent in the fact that food consumption still dominates, while consumption in recreational and other areas is relatively low; there is a problematic relationship between population growth and diminishing resource availability. On a per capita basis, the availability of natural resources, such as fresh water, farmlands, forests, and mineral resources, is far below the world average. In particular, there is a sharp reduction of non-renewable natural resources, which is severely hindering the sustainable development of the national economy. China is facing growing pressures as people's consumption levels are rising.

7.28 Increases in levels of consumption and adjustments in proportions of expenditure should be based on rational consumption patterns. China will not follow the development model of industrialized countries which have achieved high economic growth and lifestyles through high consumption at the expense of high use of natural resources and serious environmental pollution. China will develop in accordance with her own realities. Appropriate consumption and a low energy-consuming production system should take form in a gradual manner and eventually the Chinese people's standard of living will become rise, based on a more positive and rational approach to consumption.

7.29 By the year 2000, people's lives should be more comfortable. By then, there should be no further per capita increase in consumption of energy and raw materials, and there should be a reduction in the pollution of the environment by hazardous wastes.

7.30 Adjustments in spending patterns and diversification in consumption should be encouraged so that consumption requirements for different living standards will be basically met.

7.31 The principle of payment according to one's work should be practised while taking due consideration of equal opportunity and efficiency. Action should be taken to minimize differences in levels of consumption, to narrow the gap between the rich and poor and to pursue a shared prosperity.

7.32 Productive forces should be developed to establish an efficient system of production involving low energy consumption and less pollution, so that the quantity, quality and diversity of resources for sustaining life can be improved.

7.33 A product structure which appropriately matches rational consumption patterns should be developed in order to:

Expand value-added food processing, increase the production of nutritious and green food so as to raise the quality and nutritional levels of foods;

Develop the production of durable consumer goods and broaden consumption; promote the sale of new consumer goods;

Actively explore the potential in rural markets for durable consumer goods;

Encourage a moderate growth in vehicles for transportation, vigorously develop the construction industry;

Promote development in townships and villages and the commercialization of housing; increase per capita residential space;

Through centralized planning, emphasize improvements in the quality, decoration and convenience of rural housing; work to construct well-laid out and clean new towns, with well-equipped facilities and convenient transportation;

Vigorously encourage the development of tertiary industries so as to make people's lives more comfortable and convenient.

7.34 Reform of the present distribution system should be promoted to solve problems resulting from the unfair distribution of incomes and social resources, and to engender positive attitudes to work. The principle of payment according to one's work should be supplemented by other means of distribution as required, and, consideration should also be given to distribution based on fairness and efficiency. The main points of reform include:

Lifting price controls on agricultural products, agricultural by-products and raw materials, thereby strengthening the market system;

Reforming the financial and taxation systems in order to narrow income gaps between urban and rural areas, between low and high income groups, and between the eastern, central and western regions of China;

Readjusting the distribution of income between central and local governments, between the state and enterprises, and between enterprises and individuals to ensure that the central government has adequate financial resources; rationally combine taxation with the distribution of profits and link income with individual performance in enterprises;

Stabilizing incomes, supplementing basic wages with housing and price subsidies, and guaranteeing adequate basic wages;

Increasing the transparency of personal incomes so that excessively high incomes can be adjusted through taxation.

7.35 The government should guide and promote improvements in individual expenditure patterns, as well as encouraging diversity in spending. It is proposed that:

Tax and other measures be used to control consumption of unhealthy products such as cigarettes and hard liquor and to encourage thrift while discouraging waste;

Rational consumption be promoted by formulating appropriate policies to control spending by government agencies and enterprises;

The structure of enterprises be adjusted to hasten the development of tertiary industries, to increase jobs and individual incomes, to improve living standards of people, and to meet their needs.

C. Actively Developing Social Services and Tertiary Industry
Basis for action

7.36 With the opening and reform process and an accelerated pace of economic development, social services and tertiary industries are playing an increasingly important role in people's lives.

7.37 Before 1990, China had 17,413,000 service establishments, 56,000 industrial enterprises within the commercial sector, 117,000 receiving depots for resource reclamation employing 36,390,000 people. There were 170,000 financial institutions, with approximately 2,000,000 staff. Total insured value reached 17.5 billion yuan, covering a wide range of sectors such as industry, agriculture, business, foreign trade, science and technology, culture, education, sports, etc. In the last 10 years, tourism has undergone a rapid development, and 249 tourist attractions and 14 sightseeing routes are now open to world visitors. In 1992, tourism earned US$ 4 billion from 38,116,100 foreign tourists and 330 million domestic tourists. Tourism in China is a relatively mature industry. A comparatively well-developed meteorological service system has been set up across the country. The information industry and consultative services are developing rapidly. At present, the service industry has a variety of economic sectors, traditional businesses have been revived, new businesses are being established at a rapid pace and trans-sectorial groups of enterprises are coming into being one after another. All these are playing important roles in flourishing markets, speeding up the distribution of commodities, improving quality of people's lives, building up the state's financial resources, earning foreign currency and giving fresh impetus to the development of national economy.

7.38 For the time being, tertiary industry in China constitutes a small portion of total GNP, far behind that in developed countries and in many developing countries as well. With the rapid development of the national economy, tertiary industries should also grow. Developing commercial, financial, insurance, tourism, legal, accounting, auditing and social services are fundamental for guaranteeing sustainable development.

7.39 At present, the major problems hindering the development of tertiary industries in China are outmoded ways of thinking, lack of policy guidance, weak management, lack of well-trained service staff and incomplete service networks.

Objectives

7.40 The objectives for development in social services and tertiary industries in China are as follows:

Raising the level of social and specialized services; forming service networks; improving efficiency and quality of services; creating more job opportunities; providing favourable conditions for readjustments in economic structures, for the transformation of enterprises and for restructuring government agencies and institutions; facilitating and enriching people's physical and cultural lives;

Accelerating the development of tertiary industries, and increasing their proportion of GNP.

Activities

7.41 The Decision of the State Council and Central Committee of the Communist Party on Acceleration of Tertiary Industries should be implemented.

7.42 Commercial and commodity circulation sectors should increase their marketing abilities and improve the retail trade system. A wholesale network for industrial and agricultural products and by- products should be established. Efforts should be made to increase capacities for storage and transportation and to accelerate the establishment of a goods distribution network. The construction and operation of environmental protection facilities should be facilitated and noise pollution should be controlled.

7.43 New routes for tourist attractions should be opened up, and tourist resources should be protected to promote pollution-free and environmentally-sound tourism. Tourist-oriented road transportation facilities, airports and related services (including catering establishments) should be constructed. Appropriate ways should be found to solve problems in sewage disposal, refuse collection, goods transportation, waste disposal and to strictly control sources of hazardous pollution at scenic spots,

7.44 Efforts should be made to strengthen management of the catering sector, to enforce laws and regulations with regard to sanitary conditions and food quality, to improve the quality of services, and to encourage healthy, nutritious and pollutant-free green food.

7.45 The exchange of goods in the market should be better organized through establishing a comprehensive distribution network and also establishing a system for managing and regulating the circulation of goods and for ensuring the elimination of counterfeits and inferior products.

7.46 Social insurance should be further developed, and special attention should be paid to the elderly and to disaster insurance. A social security system should be established.

7.47 A financial system, appropriate to the social system and including a sound stock market to promote the development of the financial sector, should be established in China.

7.48 Pollution resulting from the development of tertiary industries should be controlled, particularly in such trades as animal-slaughtering (waste water), storage (pesticides), food processing, catering and manufacturing which emits toxic gases.

7.49 The information industry will be greatly improved through the formulation of favourable policies and regulations; in particular, the process for establishing a basic national geographical information system should be accelerated and an information service system will be created for providing necessary scientific, technological and managerial information to both urban and rural users.

7.50 Legal, accounting, auditing, and other consultation services should be developed.

HEALTH AND SANITATION

INTRODUCTION

9.1 In the more than forty years since the founding of the country, China has had significant developments in health care. The level of health of the Chinese people is now in the front ranks of developing countries in the world. However, many difficulties and problems still exist. Problems, such as imbalances in the development of health care, the backwardness of rural health care, challenges with respect to urban sanitation, and the high incidence of some diseases, seriously jeopardize people's health. Other problems, like an overly rapid increase in population, the ageing of the population, environmental pollution, changes in the disease structure, changes in the system of payment for medical treatment, also affect people's health and the development of the health care.

9.2 According to the general aims for economic and social development in the 1990s and into the next century, the overall objectives of China's health work and development are that all people will have access to basic health care, and, in general, everyone will enjoy levels of health care coincident with relatively higher living standards. In concrete terms, these objectives include the following:

Forming local health care networks which combine primary health care facilities and those offering more comprehensive services, so as to enable urban and rural people to acquire basic medical care services close to home;

Establishing various forms of health care systems appropriate to existing conditions in China; these will include systems for publicly-funded health care, worker's compensation and employer funded medical care, and general medical insurance, in order to raise people's capacity to bear the financial burden of illness;

Protecting the environment; reducing the social effects of environmental pollution; improving the quality of drinking water and health conditions for rural people; controlling the sources of urban water pollution, air pollution, industrial waste pollution, and noise pollution;

Getting the threat of infectious and endemic diseases under basic control; gradually conducting comprehensive prevention campaigns against chronic and non-infectious diseases; paying attention to improving the environment in regions of endemic disease; emphasizing the prevention, as well as the treatment of diseases;

Setting up broadly-based health care management systems and giving safe and effective guidance for family planning;

Providing the public with information about nutrition and the healthful preparation of food, physical education, healthy life styles, and other guidance to enable them to stay healthy in body and mind and to strengthen their constitutions.

9.3 Since health and sanitation work interfaces with other areas, references are made to the programme areas of other relevant chapters, in particular Chapters 10, "Development of Sustainable Human Settlements"; 13, "Sustainable Energy Production and Consumption"; 14, "Conservation and Sustainable Use of Natural Resources"; 18, "Protection of the Atmosphere" and 19, "Environmentally Sound Management of Solid Wastes".

9.4 This chapter includes the following six programme areas:

A. Meeting Basic Needs for Health Care;

B. Minimizing the Impacts of Environmental Pollution on People's Health;

C. Controlling Infectious Diseases;

D. Reducing the Harmful Impacts of Endemic Diseases;

E. Protecting the Vulnerable;

F. Facing the Challenges of Urban Sanitation.

PROGRAMME AREAS

A. Meeting Basic Needs for Health Care
Basis for action

9.5 The purpose of providing primary health care services and of meeting basic needs for health care is to serve the whole society and to improve conditions for health, by extending health services as far as possible to every arena of people's work and life, through the extensive participation of government, health administrations, appropriate departments, medical institutions, communities and individuals. It will mainly involve the improvement of health conditions, the prevention and treatment of diseases and the provision of convalescence services, since these are basic requirements for all members of society.

9.6 With national economic development and continuous improvements in people's living standards, demands on medical services and health care are constantly growing, while the discrepancy between the demand for urban and rural medical services' and the supply of health care resources becomes wider. The discrepancies are primarily in the following areas:

A shortage of health resources in the rural areas; a reduction of already insufficient investment by the state and collectives for rural health care; the concentration of manpower, materials and funds in large cities; simple, rudimentary medical and health care facilities; limited personnel and low technological levels in rural areas, especially in remote regions and regions where minority nationalities live;

An uneven distribution of health care resources in cities; over-burdened services in large hospitals; inadequate technical and financial support to small hospitals, which greatly affects their development and makes it difficult for them to undertake work in disease prevention, health CMC and recuperation;

Increasingly heavy burdens for disease prevention, health care and convalescence. With the development of the national economy and health care, people's living standards have been rising and conditions for health have greatly improved, however, the incidence of chronic and non-infectious diseases is gradually rising. At the same time, issues such as an ageing population, environmental pollution, the prevention of chronic diseases, health care and convalescence are becoming major public issues, requiring urgent attention and solutions both now and for decades to come.

Objectives

9.7 By the year 2000, most villages will have established their own clinics, been equipped with the medicinal herbs of most use in treating both common and endemic diseases, and will have facilities for providing basic medical care; 90% of counties and townships will have established medical facilities for offering primary health care.

9.8 Provincial capital cities will serve as medical servicing and technical guidance centres, and will offer medical treatments, education about disease prevention and health care, and medical training. They will also be involved in scientific research on advanced medical technologies, and by servicing a network of small and medium-sized cities, will spread medical care from capital cities to counties and rural areas.

9.9 Undertake comprehensive work in disease prevention, health care and convalescence which is appropriate for an ageing population and an evolving structure of diseases, and which is directed against the rising incidence of chronic and non-contagious diseases and of diseases caused by environment factors, life styles, psychological and other social factors.

9.10 Strengthen quarantines, especially for customs and foodstuffs; strengthen work in prohibiting and counteracting narcotics.

9.11 Improve and strengthen the three-tiered system for urban and rural preventative medicine and health care. Establish comprehensive health care service systems focused on providing primary and basic health care:

Improve conditions in township and village clinics; train medical technicians to ensure that they are capable of carrying out medical treatment, health care and preventative medicine work;

Improve county-level medical institutions and make them centres for providing rural health services and technical guidance;

Use hospitals as centres, gradually extend services for the prevention of diseases, medical care and convalescence so as to enhance integrated benefits in the utilization of health resources and medical services;

Improve combining health care with family planning services, and improve the quality of family planning services;

Develop and popularize medical technologies suitable for rural areas, in order to meet rural people's basic requirements for medical treatment and health care;

Take basic health care to be fundamentally important, rely on the three-tiered network of medical treatment and health care, and strengthen medical treatment, medical care, disease prevention and control, and emergency services and convalescence;

Gradually establish and extend community health care systems, from hospitals to residential districts to households; train appropriate personnel.

9.12 Strengthen ties between urban and rural areas. Establish regional health care systems that rationalize the regional disposition of health care services. Between urban and rural areas, establish technical service networks, which are oriented towards providing grassroots and rural area health care, and which are backed up by services in small and medium-sized cities.

9.13 Promote the establishment of rural health care systems, and continually enhance the capabilities of rural people to work together to deal with illnesses.

9.14 Organize and institute quarantine systems. Speed the modernization of quarantine technologies. Encourage people to be active in the prohibition and opposing of narcotics.

9.15 Cooperate with appropriate international organizations in the construction of the three-tiered urban and rural medical prevention and health care network, particularly with respect to the training of rural doctors, the development of regional medical systems and community health care, and strengthening international cooperation in the prohibition and fight against narcotics.

B. Minimizing the Impacts of Environmental Pollution on People's Health
Basis for action

9.16 Pollution by chemicals, radioactive substances and bacteria in the environment seriously threaten people's health. Reduction of the effects of environmental pollution on human health is a very important issue for social development at present and into the 21st century.

9.17 Air pollution resulting from the burning of coal is the main reason for China's poor quality of indoor and outdoor air. At least 80% of urban dwellers live in an environment which has a very poor quality of air. The burning of coal with a high fluorine content has resulted in endemic coal-burning fluorine poisoning in over 17 provinces, municipalities and autonomous regions in China. In recent years, the supply of water has increased a great deal in urban and rural areas. However, according to a nation-wide investigation into potable water in 1989, 82% of the Chinese people drink water from shallow wells and rivers, 76% of which have been heavily polluted, or where bacteria content exceeds sanitary standards. Approximately 160 million people drink water seriously contaminated by bacteria. There are about 47 million people who do not have sufficient potable water. According to the reliable reports on the breakdown of infectious diseases, the percentage of intestinal diseases rises each year.

With the increasing extensive use of radioactive isotopes and X-ray devices, the effects of radioactive substances on human health should not be neglected. Accidental irradiation to personnel engaged in radiation-related work and the public occurs very often. At present, food production is still at a basic stage, where various kinds of biological and chemical contamination are not under control. Food poisoning and other food-related diseases frequently occur and, at present, there is no sufficient guarantee of food security.

9.18 Poor work environments have resulted in serious occupational diseases. According to statistics from 1949 to the end of 1991, a total number of over 470,000 people have been infected with pneumoconiosis in above-county level state-owned and in collectively-owned enterprises. This number equals the total number of pneumoconiosis found in all other countries in the world during the same period. From present estimates of dust concentrations during production activities, an additional number of 20,000 to 30,000 cases of pneumoconiosis will be added annually in the future. There are over 1,000 serious incidents of occupational poisoning every year, with about 2,000 people being affected. The incidence of occupationally-induced tumours is another issue that awaits urgent attention.

Objectives

9.19 Protect and improve people's health while developing the economy. Prevent and reduce the incidence of infectious, environmental and occupational diseases, as well as occupational poisoning and food poisoning associated with environmental pollution. Eliminate the potential threat to health from various kinds of environmental pollution. Improve people's physical and mental health by gradually improving their living and working environments, and raising conditions for their material and spiritual lives:

Expand systems of legislation for sanitation, sanitation standards, sanitation inspections and monitoring, which are all necessary for security of health;

Eliminate environmental factors that are damaging to health, and improve the quality of the environment;

Work out plans for scientific research and monitoring related to the environment and health, encourage the application and popularization of scientific and technological achievements, and facilitate the prevention and treatment of diseases.

9.20 Gradually improve conditions in work places to create working environments of high standards, so as to reduce the incidence of occupational diseases. Attempt to achieve the following goals: decreasing occupational poisoning due to gradual exposures to harmful substances by around 5% every 5 years; and decreasing illness due to exposure to radiation by around 3% every 5 years.

9.21 Establish and improve legislation for the supervision of sanitation, for sanitary standards, and for systems for supervising and testing sanitary conditions. Details are as follows:

Formulate and promulgate sanitation standards, which draw attention to harmful substances in the environment and their relation to human health; establish sanitation standards concerning pesticide residues in foodstuffs' which specifically refer to the kinds of pesticide made in China;

Establish a supervisory system for sanitation that is scientific, reasonable, practical, and that can be enforced, so that health administration departments at all levels can set up supervisory net- works for sanitation, which are suited to the development of the national economy;

Establish laws and regulations for occupational health and the protection of labour, with every level of government being responsible for supervising the enforcement of the laws and regulations.

9.22 Gradually establish mechanisms for coordinating health care with environmental protection. Strengthen policy coordination and information exchange, the coordination of action and improve management capabilities.

9.23 China will implement the following strategies to reduce harmful environmental factors and raise sanitation levels:

By the year 2000, the coverage rate for water supply networks will be raised to over 95% in cities and in rural areas approximately 80% of the water supply will be of potable quality;

The total number of city dwellers suffering the effects of severe air pollution will be reduced to less than 40%, through adjustments in the fuel structure, extending district heating systems (refer to Chapter 12), installing dust and SO2 elimination equipment in factories and boilers (refer to Chapters II and 12), and increasing forestations (refer Chapter 16);

In the catering industry, raise the sanitary quality of food; ensure that 85% of urban and 75% of rural catering facilities meet standards of disinfections, and that 95% of foods subjected to selective examination meet sanitary standards;

Through improvement in the management of industrial and municipal solid wastes, especially with respect to landfill facilities, reduce or eliminate odours, insect breeding and water contamination; by the year 2000, 20% of wastes should be disposed of in an environmentally- sound way throughout the country, and not less than 10% of total wastes in any one region should be so disposed (refer to Chapter 19);

Through legislation, control programmes and public awareness campaigns, reduce intakes of pollutants from food, especially for reducing accumulation of heavy metals, pesticides lad organic chlorine compounds in human bodies and in the environment;

Create working environments of high standards; reduce the dangers of dust, hazardous gases, chemicals, noise, etc. to workers' health; improve work place conditions to physical and mental hazards to workers; governmental departments should supervise the working environment of enterprises in their sectors;

Restore the environment in a planned way in the districts where the environment has been severely polluted and public health has been affected.

9.24 Strengthen the system for monitoring and testing for sanitation, enhance supervisory capabilities for environmental quality, control hazardous conditions:

Conduct national monitoring of quality of potable water and tests for water-home diseases;

Conduct selective monitoring of indoor air quality in various types of houses using various kinds of fuels;

Set up monitoring stations to monitor and test environmentally-sound disposal of solid wastes and hospital waste water;

The rate for sites using radioactive substances meeting safe standards should reach 95%; monitoring and testing for radiation will be conducted within a radius of 50 kilometres of nuclear power stations;

The coverage rate for testing for sanitary food by food inspection departments will reach 100%;

Set up monitoring stations in provinces and cities, where occupational diseases occur most frequently. Stations will be established to monitor and test workers health in 95% of industries; 70% of industries examined for dust and hazardous substances should meet standards;

Conduct biological surveys on the impacts of environmental pollutants on human health and on the load capacity of human bodies; conduct regular biological surveys on the content of lead, cadmium, arsenic, mercury, and organic chlorides in humans;

Monitor diseases caused by environmental pollution in key polluted industrial areas, and set up no less than 10 monitoring stations.

9.25 Establish information networks. Strengthen quality control for the collection of information, statistics and analysis. Establish data bases for various types of information:

Data base on environmental pollutants. Collect information on the distribution, scale, nature and degree of pollutants. Those pollutants which are widespread, which are seriously harmful to health and which are difficult to eliminate will be chosen as priority targets for monitoring, so as to provide a scientific basis for environmental medicine and treatment;

Data base on poisoning and diseases caused by environmental pollution accidents. Report through computer networks on public poisonings or sudden incidence of diseases. The rate of reporting should exceed 80%;

Data base on occupational diseases. The coverage rate of occupational health files in enterprises above county level should reach 95-100%, and in township enterprises, 60%.

9.26 Compile and analyze the data collected and the results of research, and publish the findings in order to educate people so that they can improve their ability to look after their own health. Inform and guide authorities in other sectors to take necessary measures to alleviate health hazards and environmental pollution.

9.27 Conduct research on the impact of environmental pollution on human health and measures to counteract those impacts; publicize the results of the research regarding:

The impact of rare elements in the environment on human health;

The relationships between air pollution, and in particular, indoor air pollution, with lung cancer, respiratory diseases and diseases of the nervous system;

The relationship between toxic chemicals in water and food, and digestive cancer and cardiovascular diseases;

The impact of environmental and ecological changes (such as acid rain, global warming arid ozone layer depletion) on health;

The ecological impacts and potential health threats of synthetic chemicals;

Methods for formulating sanitary standards for carcinogens and evaluation of the: risks of substances causing debilitation;

Through biological monitoring, a study of immunities and of genetics, develop indicators which measure the effects of environmental factors on human health;

Research on economic losses caused by health affected by environment pollution.

9.28 Human resources development:

Allow medical management personnel and medical technicians to work effectively; continually offer them opportunities to upgrade their knowledge and skills so as to improve their work proficiency and efficiency;

Offer new courses in regulations for hygiene, environmental medicine, and the economics of hygiene in medical universities and colleges, so as to ensure that trained personnel can meet the needs of economic construction and for the administration of hygiene regulations throughout the country;

Strengthen cooperation amongst departments of health care, environmental protection and public education. Conduct massive campaigns concerning the environment and health to help people be aware of the relationship between the environment and health.

C. Controlling Infectious Diseases
Basis for action

9.29 China is a developing country, in which infectious diseases will remain a major concern for a long period of time. Giving priority to the prevention of and effective control of infectious diseases, and thereby improving conditions for people's health is essential for guiding the work of China's medical services and health care and an important foundation for ensuring the sustainable development of the national economy.

9.30 Some infectious diseases have effectively been brought under control following research into infectious diseases, the development and use of the inoculations, treatments, preventative measures, traditional Chinese medicine and the establishment of health care networks. Nevertheless, many infectious diseases, like cholera, viral hepatitis, leptospirosis, diarrhoea, schistosomiasis, malaria, haemorrhagic fever, encephalitis B, and tuberculosis, are still seriously affecting human health. The incidence of venereal diseases and AIDS is growing.

Objectives

9.31 Specific objectives:

Wipe out infantile paralysis and eliminate native wild toxic strains in China by the year 2000;

Eliminate infantile tetanus by 1995 and reduce the incidence of measles by 50 - 70% during the 21st century;

Cut the incidence of viral hepatitis by 50%. Eliminate hepatitis A in the early 21st century, and reduce the antigen-carrying rate of hepatitis B from the present 10% down to less than 1%. Eliminate hepatitis E in the 21st century, and reduce the virus-carrying rate of hepatitis C down to less than 1%;

By the year 2000, retard the rate of increase in AIDS infection and the number of AIDS patients. During the 21st century, through global efforts, current trends indicating increases in the rate of AIDS infection will be curbed. Retard the rise in incidence of gonorrhoea and syphilis until the year 2000 and then decrease it with each passing year;

Strengthen cholera prevention so that, by the year 2000, it will no longer be spreading, and by the middle of the 21st century, it will no longer be prevalent;

Reduce the incidence of bacillary dysentery to an incidence rate of 30 to 50 per 100 thousand people during the early 21st century;

By the year 2000, reduce the incidence of tuberculosis to an incidence rate of 114 per 100 thousand of people in cities and 266 per 100 thousand people in the rural areas;

Reduce the incidence of schistosomiasis in the affected regions to below 5% by the year 2000.

9.32 Strengthen the monitoring and control of infectious diseases:

Formulate plans for the monitoring and treatment of municipal faeces and hospital sewage; the implementation of plans should be supervised by environmental protection agencies;

Strengthen existing monitoring stations for diseases, such as haemorrhagic fever, epidemmic encephalitis, schistosomiasis, malaria, filariasis, kala-azar, anthracene and leptospirosis; improve monitoring measures; ensure full prevention measures against the existence, spread and outbreaks of infectious diseases.

9.33 Expand the system of inoculations:

Consolidate and expand the immunization system so as to maintain the current inoculation rate of over 85% of children being immunized against poliomyelitis, hepatitis B, measles, bacilli Calmette-Guerin (BCG) and diphtheria;

Gradually include the encephalitis B vaccine and the epidemic encephalitis vaccine into the planned immune inoculation system in order to control encephalitis B and epidemic encephalomyelitis.

9.34 Control AIDS, enteric and entomophilous infectious diseases:

Devise objectives for the AIDS prevention and control plans, with a view to preventing the spread of HIV;

Strengthen the administration and supervision of food hygiene to ensure that food offered for consumption meets standards;

Accelerate improvements to water supplies in rural areas and to the management of the disinfection of city tap water to ensure that drinking water meets hygienic standards so that the spread of enteric infectious diseases can be controlled;

Decrease the incidence of leptospirosis through the widespread use of agricultural machinery; include the changing of the natural sources of epidemics into the overall plan for environment and development.

9.35 Control parasitic diseases:

Include monitoring important parasitic diseases into the national infectious diseases monitoring system; strengthen the administration of the monitoring system and improve the forecasting system for the incidence of these diseases;

Enhance health education; raise public awareness of their own role in protection against diseases and in disease prevention.

9.36 Strengthen cooperation amongst departments concerned. The prevention and control of infectious diseases can be achieved only through close cooperation with women's federations, trade unions, and the governmental departments concerned with education, health, agriculture, city planning, water conservancy, commerce, the chemical industry and the media.

9.37 Control environmental factors contributing to infectious diseases. Some infectious diseases are closely related to environmental factors. Enteric infectious diseases can be effectively prevented and entomophilous infectious diseases reduced through having safe water supplies, the disinfection of sewage, the sound management of food hygiene, the appropriate disposal of garbage and the killing of mosquitoes and flies. Transformation of the environment and elimination of oncomelania can effectively prevent schistosomiasis.

9.38 Support scientific research:

Strengthen and broaden multi-disciplinary research; conduct joint research and cooperation in epidemiology, immunology, molecular biology, social medical science, social economics, mid environmental medicine in order to work out approaches for the control of infectious disease;

Improve existing vaccines for poliomyelitis, measles, hepatitis B, hepatitis A and the pertussis-diphtheria-tetanus triple vaccine; develop genetic engineering vaccines so as to improve immunity effectiveness; conduct research and development of genetic engineering vaccine for enteric infectious diseases, such as cholera, dysentery and typhoid fever.

9.39 The emphasis of China's health and sanitation work is on the control of infectious diseases. It is of vital significance to secure international financial aid for doing this. The cooperation and support of the international community for funding, equipment, technologies and training are needed in the prevention and cure of viral hepatitis, diarrhoea, AIDS, entomophilous infectious diseases, tuberculosis, parasitises and diseases associated with the immunization of children.

D. Reducing the Harmful Impacts of Endemic Diseases
Basis of action

9.40 For over 40 years, the Chinese Government has made great efforts to develop manpower and material resources to prevent and treat endemic diseases. Thus far, 430 million people have been treated with iodized salt to prevent Iodine Deficiency Disorder (IDD). Measures have been taken nation-wide to improve water quality and kitchen ventilation to prevent endemic fluorine poisoning. Improving water quality has already benefited 26 million people. Comprehensive preventive measures against keshan disease have been taken nation-wide. These include selenium supplements, improving ventilation and criminating dampness and coldness, improving food, improving sanitation and housing conditions, and these measures have effectively controlled the outbreak and spread of the disease. Comprehensive preventive measures against Kaschin-Beck Disease (KBD), such as "changing cereals, improving water quality and supplementing selenium" have been widely used and have been remarkably successful. In over 80% of the areas where the disease is common, the incidence and the rate of contracting the disease has dropped to the lowest level in history.

9.41 Endemic disease such as the IDD, KBD, endemic fluorine poisoning disease and the keshan disease are seriously harmful to public health and the quality of population in heavily affected regions. About 425 million people live in iodine deficiency areas. Endemic fluorine poisoning occurs in 1,230 counties and cities in 30 provinces, autonomous regions and municipalities, threatening over 200 million people. Keshan disease is found in over 321 counties and cities in 15 provinces, autonomous regions and municipalities and threatens the health of 50 million people. KBD is found in over 315 counties and cities in 14 provinces, autonomous regions and municipalities, and affects 34 million people. In seriously affected areas, the incidence amongst youth and children is over 50%, and in the most seriously affected areas, over 80%. In recent years, widespread endemic arsenic poisoning has been discovered to Xinjiang, Inner Mongolia and Guizhou.

Objectives

9.42 Strive to eliminate IDD, Keshan disease and KBD by the year 2000 and control endemic fluorine disease and endemic arsenic poisoning by the year 2010.

9.43 At all levels of government, leading groups dealing with endemic diseases will carry out regular research, planning and inspections and will coordinate the efforts of appropriate departments. In areas with a high incidence of endemic diseases, they will include the prevention and treatment of endemic diseases in their poverty alleviation and economic development programmes.

9.44 Prevent and cure endemic diseases through effective preventive measures:

To prevent and treat IDD, encourage the use of iodized salt by all, and the use of iodized oil by target groups; establish and improve monitoring networks;

To prevent and treat endemic fluorine disease, improve wells, use chemical methods to reduce the fluorine content in drinking water and improve kitchen ventilation; treat patients with health food therapy and an integrated regimen of traditional Chinese and western medical therapies and operations to alleviate the pain in the 60% most seriously affected patients and allow for the convalescence of less seriously affected sufferers;

To prevent and treat Keshan disease and KBD, use comprehensive measures such as selenium supplements, improvements for food and nutrition, and encourage soil rejuvenation to increase selenium intake and improve the quality of grain;

Change water sources to prevent treat endemic arsenic poisoning.

9.45 Strengthen the development of manpower resources and enhance capacities for disease prevention. Improve the quality of professional personnel, enhance on-the-job training by having the China Centre for the Prevention of and Research on Endemic Diseases and medical universities and colleges set up training bases throughout the country.

9.46 Organize scientific research and technical personnel working on the prevention and treatment of endemic diseases to tackle key technical problems, such as developing measures for providing iodine supplements for specific groups of people in specific regions; investigating the pathogenesis of cretinism and the relationship between trace elements and IDD; the causes and mechanisms of the Keshan disease and KBD; conduct research into new ways of counteracting selenium and iodine deficiencies, and excesses of fluorine and arsenic; find effec