China – Health Issues

What are the most common health issues and diseases in China?

Over recent decades, China has experienced a profound transformation in the types of conditions that sicken and kill its population. Infectious diseases that once claimed enormous numbers of lives have largely been brought under control, and their place has been taken by non-communicable diseases (NCDs) — conditions driven by ageing, lifestyle choices, and environmental exposures. By 2021, NCDs accounted for 91.0% of all deaths and 86.7% of all disability-adjusted life years (DALYs) recorded in China.

Cardiovascular diseases and cancers stand out as the dominant NCD killers, responsible for 5.1 million and 2.8 million deaths respectively in 2021. These two categories represent by far the greatest health challenge facing China’s population today.

When looking specifically at premature death — measured through years of life lost — the most significant conditions are stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease (COPD), and liver cancer. Cerebrovascular disease is a particularly notable concern: ischaemic stroke alone accounts for roughly 72.8% of all stroke cases, and the burden is not evenly distributed, with clear north–south differences in incidence across the country.

Diabetes has undergone a dramatic rise over the past four decades, shifting from a rare condition to a major public health problem. Driven by an ageing population and profound shifts in how people eat and live, adult diabetes prevalence reached 11.9% in a 2018 survey, while treatment and control rates remained relatively modest at 34.1% and 33.1% respectively.

COPD is similarly widespread: among people aged over 40, the prevalence rate stands at 13.7%, climbing to more than 27% in those aged over 60. The total number of COPD sufferers in China is estimated at around 100 million. Both smoking and air pollution are major contributors, and both remain live concerns across much of the country.

Alzheimer’s disease and related dementias affect an estimated 16.99 million people in China — nearly 30% of the global total. With the population ageing rapidly, dementia has become the fastest-expanding contributor to the national disease burden. Health outcomes also vary markedly by geography: cardiometabolic conditions are most prevalent in Central China, followed by Southwest and East China, while South China and Northwest China report comparatively lower rates.

Is China considered a healthy country? How do health outcomes compare internationally?

China’s average life expectancy reached 79 years in 2024, rising 0.4 years from the previous year, according to the head of the National Health Commission. The scale of progress this represents is remarkable: at the founding of the People’s Republic in 1949, life expectancy stood at just 35 years.

In 2024, China’s life expectancy placed it fourth among 53 upper-middle-income countries and tenth within the G20, and it exceeded the levels recorded in 21 high-income nations. To put this in perspective, the European Union saw life expectancy at birth rise to 81.7 years in 2024 based on preliminary data, while OECD member countries averaged 81.05 years in 2023 — indicating that China continues to close the gap with wealthier peer nations.

Eight of China’s most prosperous municipalities and provinces — Beijing, Tianjin, Shanghai, Shandong, Jiangsu, Zhejiang, Guangdong, and Hainan — have already surpassed the 80-year threshold. This underscores a meaningful gap between the affluent coastal regions and more rural inland areas, where life expectancy tends to lag behind.

China has constructed the world’s largest disease prevention and control network, operating across four tiers: national, provincial, municipal, and county level. Health literacy among Chinese residents climbed from 23.2% in 2020 to 31.9% in 2024. Even so, health officials acknowledge that the country continues to grapple with both infectious and chronic non-communicable diseases, and that considerable scope remains for further gains in life expectancy.

For the most current figures, visit the WHO China country profile or the National Health Commission of China (NHC), both of which update their data periodically.

What infectious diseases or environmental health risks should expats be aware of in China?

According to the NHC, the incidence of infectious diseases including tuberculosis, hepatitis B, and HIV/AIDS has continued to decline or remain contained in China. That said, a number of communicable conditions still deserve serious attention from those arriving from countries where they are uncommon.

Both hepatitis A and hepatitis B are present in China, and vaccination against both is strongly advised before arrival. Hand-foot-and-mouth disease is regularly reported, particularly among children and young adults. Infectious diarrhoea has consistently ranked among the most commonly reported communicable diseases in China in recent years, making food and water hygiene a priority. Tap water is not safe to drink untreated in most parts of the country, and caution is warranted with street food and raw produce. Bottled or filtered water is standard practice for the vast majority of expats.

Japanese encephalitis — a mosquito-borne viral disease — is endemic in rural parts of southern and central China, with the highest risk during summer and early autumn. Rabies is present throughout the country, and anyone planning to spend time in rural areas should speak to their doctor about pre-exposure vaccination. Dengue fever poses a risk in southern provinces such as Guangdong and Yunnan, particularly during warmer months when mosquito activity peaks.

Among environmental health concerns, air quality stands out as one of the most consequential for expats. The World Bank estimates that the health costs associated with air pollution in China total approximately 3.8% of GDP per year — equivalent to around $720 billion in 2024. Northern cities, including Beijing and much of Hebei province, have historically been worst affected by fine particulate matter (PM2.5), which carries well-documented links to respiratory and cardiovascular disease. Meaningful improvements have been achieved since China’s clean-air action plans were introduced, yet pollution remains a significant issue in many urban and industrial locations. Expats living with asthma, COPD, or heart conditions should take particular care. Air quality apps and real-time monitoring tools, such as AQI China, are used routinely by residents to keep track of daily pollution levels.

Before relocating, consult the vaccination guidance published by your home country’s official travel health authority — such as the US CDC, the UK’s NHS Travel Health, or an equivalent national body — as well as WHO China and the NHC. Recommendations can shift, especially in the wake of disease outbreaks, so always check for the most recent advice.

Is smoking common in China, and what are the laws around it?

China is the single largest producer and consumer of tobacco anywhere in the world, home to more than 300 million smokers — close to a third of the entire global total. More than half of adult men in China currently smoke, and approximately one in every three cigarettes consumed globally is lit in China. This dwarfs smoking rates in many other countries: in Australia, the UK, and Germany, for example, adult smoking prevalence generally falls somewhere in the range of 10–25%.

In 2024, overall smoking prevalence among adults aged 15 and older stood at 23.2% for current smokers and 20.3% for daily smokers. The gender divide is striking: while roughly 2% of women in China smoke, nearly half of all adult men are regular cigarette smokers.

More than 700 million non-smokers in China — including around 180 million children — are exposed to second-hand smoke at least once a day in an average week. This passive exposure is estimated to cause approximately 100,000 deaths annually. In 2022, the second-hand smoke exposure rate among non-smoking adults aged 15 and above was recorded at 52.4%.

Tobacco control legislation in China is a patchwork of regional rules rather than a single national framework. As of May 2024, 24 province-level divisions have enacted their own tobacco control regulations, and 254 cities have introduced municipal-level measures, according to the China Association on Tobacco Control for Health. A unified national tobacco control law setting out binding enforcement mechanisms and penalties has yet to be passed.

A number of major cities — Beijing, Shanghai, and Shenzhen among them — have introduced clearly defined bans on smoking in public spaces, with fines of several hundred yuan for violations. Shanghai’s comprehensive smoke-free legislation, introduced in 2017, was found to reduce the number of current smokers by 8.4% and cut daily consumption by 4.4%. The “Healthy China Initiative (2019–2030)” identifies tobacco control as a dedicated priority area and sets a target of extending comprehensive smoke-free environment protections to 80% or more of the population by 2030.

Expats arriving from countries with strict nationwide bans — Ireland, New Zealand, and the UK, for instance — may find the situation in China feels considerably more permissive. In practice, exposure to second-hand smoke in restaurants, bars, and some workplaces remains a common experience outside the most progressive cities. Seeking out specifically smoke-free venues and requesting non-smoking areas where available are sensible habits if this is a health concern for you.

Is obesity or poor diet a significant health concern in China?

Decades of rapid economic growth and sweeping urbanisation have reshaped what Chinese people eat, and the consequences for public health are becoming increasingly visible. Overweight and obesity rates are climbing steeply, and while they have not yet reached the levels seen in countries such as the United States or the UK, the upward trajectory has made this a recognised national priority.

Although urban areas with higher incomes, better access to healthcare, and higher educational attainment tend to show lower rates of chronic disease, evidence indicates that the traditional gap between urban and rural areas for conditions such as obesity and hypertension is narrowing — a consequence of rapid urbanisation and rising incomes spreading more widely across the country.

Research published in The Lancet has documented a sharp increase in childhood obesity in China, with complex patterns shaped by socioeconomic status and the urban-rural divide. The links between obesity and non-communicable disease are well established: data from the China Kadoorie Biobank shows that people who were obese in early adulthood face a 58% higher risk of developing cardiovascular disease later in life.

Traditional Chinese diets — built around vegetables, rice, and relatively restrained quantities of meat — are broadly considered healthful. However, unhealthy eating habits and insufficient physical activity are now recognised as significant drivers of China’s growing chronic disease burden, particularly as urbanisation accelerates and income inequality in health risk deepens. The spread of highly processed foods, sugary drinks, and more frequent dining out has altered the diets of urban populations considerably.

The Chinese government has introduced a series of public health measures under its “Healthy China 2030” framework, targeting obesity, encouraging physical activity, and strengthening nutritional education. Initiatives aim to expand family doctor services, improve health promotion, and bring weight, blood pressure, blood lipids, and blood glucose under better control. For expats, leaning into a locally inspired diet rich in fresh vegetables and whole grains can offer genuine health benefits — though those accustomed to heavily processed foods from home may need time to adjust.

What are the mental health attitudes and services like in China?

Mental health occupies a significant but frequently underacknowledged place in China’s public health landscape. Historically, cultural factors — concerns about stigma, the importance of saving face, and a tendency to manage personal difficulties within the family unit — have discouraged many people from seeking formal professional support. Although awareness has grown considerably, especially among younger people in cities, stigma continues to be a real obstacle for many who might benefit from care.

Mental health stands alongside conditions such as childhood obesity, diabetes, hypertension, and tuberculosis as one of the areas where China faces its steepest challenges. Many of these problems are worsening due largely to behavioural risk factors and uneven access to affordable care.

China enacted a national mental health law in 2013, establishing a framework covering mental health services, voluntary treatment, and patients’ rights. Psychiatric services exist within the hospital system, but community-based mental health care — the kind that underpins systems in countries such as the Netherlands, Australia, and Canada — remains relatively underdeveloped, and the ratio of mental health professionals to the general population is low by international standards.

For expats, finding mental health support in a preferred language is a genuine challenge, particularly outside of the country’s major urban centres. In Beijing, Shanghai, Guangzhou, and Shenzhen, international hospitals and private clinics often employ counsellors and psychiatrists who can work in languages other than Mandarin. These services, however, can be expensive, making comprehensive health insurance — with mental health coverage explicitly included — an important consideration. Online therapy platforms have expanded significantly in China in recent years and can offer a more accessible entry point for many people.

The stresses inherent in international relocation — cultural adjustment, language barriers, social isolation, and demanding work conditions — put expats at heightened risk of anxiety and low mood. Building social connections early, engaging with expat community networks, and ensuring that mental health is covered by your insurance before you leave are all steps worth taking proactively.

Are there any health risks specific to expats living in China?

Expats in China encounter a combination of health challenges that differ in important ways from those faced by local residents. Some are tied to the physical environment; others stem from the psychological and social pressures of living abroad. Understanding these risks — and taking concrete steps to address them — can make a meaningful difference to your health and quality of life over the long term.

Air quality and respiratory health. Prolonged exposure to elevated PM2.5 concentrations is among the most serious physical health risks for expats, particularly in northern and heavily industrialised cities. Anyone with an existing respiratory or cardiovascular condition should seek medical advice before relocating. Many long-term expats use air purifiers at home and wear N95-rated masks during episodes of high pollution. Checking local AQI readings daily is a widely adopted habit.

Food and water safety. Tap water is not safe to drink untreated anywhere in China. Bottled and filtered water is cheap and easy to obtain, and is used as a matter of course by both locals and expats. Food safety standards have improved substantially, but some caution with street food — and making sure produce is properly washed or cooked — remains sensible, particularly in the early weeks after arrival when the gut is still adjusting to new microbial environments.

Climate and altitude adjustment. China’s sheer size means its climate ranges from tropical in Hainan to extreme cold in Heilongjiang, and from humid subtropical conditions in Guangzhou to high-altitude terrain in Tibet and Qinghai. Those moving to areas above 2,500 metres should be aware of the risk of altitude sickness and allow adequate time to acclimatise rather than pushing physical limits too soon.

Health insurance and registration. By the end of 2024, 1.327 billion Chinese people — over 95% of the population — had joined the basic medical insurance scheme. However, China’s health insurance operates along a social insurance model rather than a universal NHS-style system, and foreign residents are not automatically covered at the same level. Access to international-standard hospitals without private insurance can prove costly. Expats should arrange comprehensive international health cover before arriving and identify both a local clinic and an international hospital in their city of residence.

Vaccinations and pre-departure screening. Beyond routine immunisations, expats should review their vaccination status for hepatitis A and B, typhoid, Japanese encephalitis, and influenza before departure. A thorough pre-departure health check is advisable. It is also worth noting which medications you currently take, as some that are available over the counter in other countries may require a prescription in China, or may be difficult or impossible to source locally.

1. Visit your doctor or travel health clinic at least 6–8 weeks before departure to discuss vaccinations and any health considerations specific to your destination region.
2. Arrange comprehensive health insurance that covers hospitalisation, emergency evacuation, mental health, and pre-existing conditions where possible.
3. Register with a local clinic or international hospital soon after arriving in your new city.
4. Set up a home water filtration system or arrange bottled water delivery to ensure safe drinking water from day one.
5. Download an air quality monitoring app (such as AQI China or similar) and consider purchasing an air purifier for your home.
6. Locate the nearest pharmacy and hospital emergency department and save relevant contact numbers before you need them.

Where can expats find reliable health information and services in China?

Finding trustworthy health information in China can be difficult for those without strong Mandarin skills. Sticking to official and well-established sources — and checking them regularly — is the safest approach, since vaccination requirements, public health guidelines, and healthcare policies can shift without much warning.

Official Chinese sources:

• National Health Commission of China (NHC) — the central government authority overseeing public health policy, disease surveillance, and healthcare regulation. Its English-language website publishes key announcements and statistical data.
• Chinese Center for Disease Control and Prevention (China CDC) — the source for epidemiological data, outbreak notifications, and public health advisories.

International organisations:

• WHO China Office — publishes independent health data, country profiles, and updates on infectious disease activity within China.

Expat-focused health services: International hospitals in major cities — among them Beijing United Family Hospital, Shanghai United Family Hospital, Raffles Medical, and Parkway Health — provide services across multiple languages and are well versed in the needs of foreign residents. Many offer pre-arrival consultations and can help coordinate care with providers in your home country.

Home country travel health authorities: Both before and after your move, consult the travel health advice issued by your own government — these sources provide country-specific vaccination schedules, disease outbreak alerts, and safety guidance tailored to individual medical histories. Examples include US CDC Travel Health Notices, the UK’s NHS TravelHealthPro, and comparable services in other countries.

Bear in mind that specific figures, fees, vaccination requirements, and health regulations in China are subject to change. Always verify current information directly through official channels rather than relying solely on third-party websites or online community forums, particularly for time-sensitive decisions such as pre-travel vaccinations or health insurance arrangements.

Frequently Asked Questions About Health Issues in China

Is it safe to drink tap water in China?

No — tap water in China is not safe to drink directly in the great majority of cities and regions, even where it has been technically treated. Most residents and expats use bottled water, boil their tap water before drinking, or run it through a home filtration system. Bottled water is inexpensive and available everywhere across the country.

What vaccinations do I need before moving to China?

Core recommended vaccinations typically include hepatitis A and B, typhoid, Japanese encephalitis (particularly for those who will be living near or visiting rural areas), influenza, and ensuring that routine immunisations such as MMR and tetanus are current. Rabies vaccination may also be recommended in some cases. Requirements and recommendations differ by destination region and individual health profile, so consult a travel health clinic or your home country’s official travel health authority at least 6–8 weeks before departure and always check for the most up-to-date guidance, as recommendations can change.

How serious is air pollution in China, and how can I protect myself?

Air pollution — and fine particulate matter (PM2.5) in particular — remains a meaningful health concern in many Chinese cities, above all in northern and industrial areas. Quality has improved substantially since major clean-air initiatives were launched, but conditions vary considerably by city, season, and weather. Practical protective measures include checking daily AQI data through an app, running high-quality air purifiers at home and at work, wearing N95-rated masks on days when pollution is elevated, and discussing any additional personal risk with your doctor if you have a pre-existing respiratory or heart condition.

Can expats access China’s public healthcare system?

Foreign residents holding a valid work permit and employment contract may be enrolled in China’s basic social health insurance scheme through their employer, though the coverage available may fall short of what many expats are accustomed to, particularly for access to international-standard facilities. In practice, most expats take out private international health insurance to use international hospitals and clinics, which offer multi-language services and greater familiarity with the needs of foreign patients. Review your insurance policy carefully and thoroughly before making the move.

Is mental health support available for expats in China?

In major cities — particularly Beijing, Shanghai, Guangzhou, and Shenzhen — mental health services are available through international hospitals and private clinics, and some practitioners can offer sessions in languages other than Mandarin. Outside these centres, provision can be thin and expensive without solid insurance coverage. Online therapy platforms are growing in availability and offer greater flexibility for many people. Establishing social connections and community networks early in your time in China is strongly recommended as a proactive form of support.

How prevalent is smoking in China, and will I encounter second-hand smoke?

In 2024, smoking prevalence among adults aged 15 and above in China was 23.2% overall, with around half of all adult men being current smokers. In 2022, the second-hand smoke exposure rate among non-smoking adults stood at 52.4%. Many major cities have introduced smoke-free rules covering a range of public spaces, though enforcement varies. Expats who are sensitive to smoke should look for designated smoke-free venues and consider home air purification.

Are there significant regional health differences within China?

Yes, and substantially so. Cerebrovascular disease shows clear north–south disparities across the country. Northern cities have historically suffered higher levels of air pollution and colder climates associated with respiratory conditions. Southern and tropical regions carry greater risk from vector-borne illnesses such as dengue. High-altitude areas including Tibet present unique altitude-related health challenges. Life expectancy also differs by province, with wealthier coastal regions consistently ahead of rural inland areas. It is worth researching the specific region you are moving to rather than approaching China as a single, uniform health environment.

What are the main diet-related health risks I should know about in China?

Traditional Chinese cuisine — featuring abundant vegetables, rice, and moderate quantities of lean protein — is broadly regarded as nutritious. However, many restaurant and prepared dishes can be high in sodium, refined carbohydrates, and cooking oil, which over time contributes to hypertension and cardiovascular risk. Rates of diabetes and overweight are rising, especially in urban areas. Prioritising fresh vegetables and whole grains while limiting heavily processed or very salty foods is a sensible long-term approach to staying healthy in China.