Health November 2009

How I Survived China

Our man in Beijing returns home, with lungs only somewhat the worse for wear.
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Ashley Cooper/Aurora Photos

For a while I thought China was killing me. But that was unfair.

Through my wife’s and my first year in Shanghai, I felt worse by the day. Tired, achy, surly, weak. And that’s not even counting the hospital stay with IV-drip antibiotics, after I naively drank bottled water in a Buddhist-run vegetarian restaurant—and on the way out saw a waiter filling the “Evian” bottles from a hose. Friends we’d known in our pre-China life did pitying double takes when they came to visit. Surely the ochre skies and suspect sanitation of China were to blame?

Actually, no. On a trip back to America, I learned that I felt sick because I was. Just before moving, I’d apparently developed an odd endocrine disorder that makes people tired, achy, surly, weak. No space for details, but: if your doctor tells you that very high blood-calcium levels may indicate an abnormal parathyroid gland, listen up! On a later U.S. trip, after we’d moved from Shanghai to Beijing, I had an operation that resolved the problem. I went back to China feeling better than I had in years.

But like most outsiders who have spent time there, I naturally wondered: now that I’d recovered, would smoky urban China start killing me for real? The health situation for ordinary Chinese people is obviously no joke. After stalling, the Chinese government recently accepted a World Bank estimate that some 750,000 of its people die prematurely each year just from air pollution. Alarming upsurges in birth defects and cancer rates are reported even in the state-controlled press.

How long could outsiders live in big, polluted Chinese cities before facing the same actuarial risks as the people who’d grown up there? Now that foreigners have business, cultural, and sheer-fascination reasons to spend time in China, should those opaque skies scare them away? While we were in China, my wife and I joked with friends that now was the time to take up smoking, since our lungs would never know the difference. After returning to the U.S., I decided to ask doctors and public-health experts how much long-term damage foreigners do themselves in exchange for the experience and opportunity of China. This was no one’s idea of a comprehensive survey—and informants still working in China asked me not to use their names—but I was struck by three recurring themes.

The first one was, It’s really bad! As a foreign-trained doctor in Beijing put it, “Just using your eyes, you know this can’t be good for anybody.” Another way to know this is via a clandestine air-quality station that the U.S. Embassy has built in Beijing. The Chinese government does not report, and may not even measure, what other countries consider the most dangerous form of air pollution: PM2.5, the smallest particulate matter, tiny enough to work its way deep into the alveoli. Instead, Chinese reports cover only the grosser PM10 particulates, which are less dangerous but more unsightly, because they make the air dark and turn your handkerchief black if you blow your nose. (Spitting on the street: routine in China. Blowing your nose into a handkerchief: something no cultured person would do.) These unauthorized PM2.5 readings, sent out on a Twitter stream (BeijingAir), show the pollution in Beijing routinely to be in the “Very Unhealthy” or “Hazardous” range, not seen in U.S. cities in decades. I’ve heard from friends about persistent coughs and blood tests that show traces of heavy metals. “I encourage people with children not to consider extended tours in China,” a Western-trained doctor said. “Those little lungs.”

But the second theme was, You get over it. If anyone has done a systematic study of returned expats or longtime residents to see the health consequences of living in China, no one I spoke with had heard of it. The anecdotal evidence that health experts offered to me suggested that most people bounce back if they return to healthier settings. (Longtime expats: watch out!) There is no folklore of a Chinese burden comparable to Gulf War syndrome or Agent Orange, sickening waves of foreigners long after their in-country exposure. I asked about large companies, universities, and government missions that sent outsiders to China. In each case I heard that a handful of people got sick early and asked to leave, but most grumbled, had respiratory problems—and seemed to be okay later on.

This led to the final message, Worry about something else! This had both negative and positive elements. The negative was the reality that the big threat to foreigners was not in the air but on the streets. “I tell my patients, the most important ‘medical’ step you can take is to put on a seat belt in a car, wear a helmet on a bike, and run for your life in crosswalks,” a Chinese doctor said. Road safety is that bad. For the foreign diplomatic corps, the leading cause of death is traffic accidents. I worried every day about being mowed down by a bus, since they don’t stop at lights. My wife was run over in Beijing by a motor scooter that was going the opposite way down an eight-lane one-way road and was running a red light too. She’s fine now; the driver roared away, still against traffic, as soon as he climbed back on the bike.

The positive aspect is, there’s a lot to take your mind off your health. “I am amazed at how well people do here, considering,” another Western-trained doctor said. “It is an exciting place. It’s a historic time. People seem to feel alive.” That made sense when I heard it—in China I had felt terrible, but alive—and makes me say that foreigners who want to go should not be deterred. They could even work on the environmental problems affecting the billion-plus permanent residents.

James Fallows is an Atlantic national correspondent; his blog is at jamesfallows.theatlantic.com.
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James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. His latest book is China Airborne. More

James Fallows is based in Washington as a national correspondent for The Atlantic. He has worked for the magazine for nearly 30 years and in that time has also lived in Seattle, Berkeley, Austin, Tokyo, Kuala Lumpur, Shanghai, and Beijing. He was raised in Redlands, California, received his undergraduate degree in American history and literature from Harvard, and received a graduate degree in economics from Oxford as a Rhodes scholar. In addition to working for The Atlantic, he has spent two years as chief White House speechwriter for Jimmy Carter, two years as the editor of US News & World Report, and six months as a program designer at Microsoft. He is an instrument-rated private pilot. He is also now the chair in U.S. media at the U.S. Studies Centre at the University of Sydney, in Australia.

Fallows has been a finalist for the National Magazine Award five times and has won once; he has also won the American Book Award for nonfiction and a N.Y. Emmy award for the documentary series Doing Business in China. He was the founding chairman of the New America Foundation. His recent books Blind Into Baghdad (2006) and Postcards From Tomorrow Square (2009) are based on his writings for The Atlantic. His latest book is China Airborne. He is married to Deborah Fallows, author of the recent book Dreaming in Chinese. They have two married sons.

Fallows welcomes and frequently quotes from reader mail sent via the "Email" button below. Unless you specify otherwise, we consider any incoming mail available for possible quotation -- but not with the sender's real name unless you explicitly state that it may be used. If you are wondering why Fallows does not use a "Comments" field below his posts, please see previous explanations here and here.
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