Chronic disease in China is focus of seminar at Stanford Center at Peking University

In the summer of 2015, Stanford researcher Randall Stafford, MD, PhD, seized on a unique opportunity to partner with colleagues in China, where traditional medicine is based on a concept of wellness. Within the setting of the historic Peking University, he organized a graduate-level seminar on disease prevention, hoping to explore what it means to be well and to collaborate on research in a country where chronic disease has become epidemic.

“Culturally there is a foundation for thinking about quality of life that is most evident within traditional Chinese medicine — the whole person, balance and the need to pay attention to the quality of life as something that precedes disease,” said Stafford, a professor of medicine at the Stanford Prevention Research Center. “It’s a big contrast with Western medicine, which focuses on acute disease and doesn’t really value prevention. That concept of wellness resonates with people in China, perhaps more so than in the United States.”

In June of this year, Stafford returned to the 4-year-old Stanford Center at Peking University, recruiting colleagues Judith Prochaska, PhD, MPH, and Michael Baiocchi, PhD, to lead a group of 15 students from both Stanford and China on prevention research issues. During the three-week seminar, the faculty members conducted lectures and small-group discussions on how to promote changes in behavior that can help prevent cancer and heart disease, as well as on China’s changing health-care system, research practices and how to design studies.

China has by far the largest number of deaths in the world due to cancer, heart disease and stroke, in part because of lifestyle and behavior factors, such as increased cigarette smoking, obesity, alcohol consumption and sedentary lifestyles. Stafford said the burden of chronic disease in the country, especially in large cities like Beijing, is rapidly catching up to levels in the United States and other Western nations.

He said China is dealing with many of the same issues as other emerging economies: how to balance economic growth with globalized lifestyles and environmental degradation, which can contribute to poor health.

“There’s been much investment in developing a skilled workforce, particularly through a large university system. But the population’s ability to be productive is compromised by the fact that many people are getting sick and developing chronic diseases in their middle years, just when that investment in training should be paying off,” Stafford said. “There definitely is a huge interest and urgency in chronic disease prevention.”

A health-care system in transition

Prochaska, an associate professor of medicine, said a minority of people in China access primary care and instead go directly to hospital clinics if they need medical attention. Together, the faculty and students visited a primary care clinic that is serving as a model of change in a national move to shift more of the care burden to these clinics.

That transition to a different model of care offers the country a number of important opportunities, including possible improvements in how it stores and uses health information, Baiocchi said. Currently, China has no established system of electronic medical records, he said.

“Now that China is changing how they are delivering care, they will have an opportunity to structure their data and record it in their health-care system,” said Baiocchi, an assistant professor of medicine. “They could become the dominant place for health research.”

For me personally, having the opportunity to learn more about Chinese culture is really valuable, regardless of where I end up practicing.

Prochaska, who is an expert on smoking behavior, said tobacco use is a major health issue for the country, which is the world’s largest maker of cigarettes, producing over 2 trillion a year with over 900 different brands. She said half of all men smoke cigarettes, which can cost as little as 75 cents a pack.

While in Beijing, she and her colleagues were able to connect with researchers at the city’s main cancer hospital, with whom they will collaborate on a study on tobacco prevalence and cancer risk. The hospital manages cancer records for the whole city and has extensive data on each cancer patient, including information on the environment and the characteristics of the community in which they live. This will enable the researchers to look at how these environmental factors contribute to cancer incidence, Stafford said.

“This is an opportunity for us to have access to these great data and to be a partner in the analysis to look at the data in a new way,” he said.

The seminar offered many opportunities for cross-cultural interactions, said Stanford medical student Carlie Arbaugh, who was one of the participants. In addition to classroom sessions, she explored the rich history of Beijing, which proved to be a living laboratory of learning.

Lots of smokers

“One thing I found pretty striking was that the topics we discussed in class were things I saw when I was walking through the city or riding the subway,” Arbaugh said. “The smoking rate is incredibly high among men in China, while very low for women. I saw a lot of men smoking. As for diet, I noticed a discrepancy between food here and in China in terms of oil and salt content. Salt consumption in the U.S. is high and in China it’s even higher. The food was delicious, but I was always very thirsty after I ate.”

She said exposure to an entirely new culture will help inform training at Stanford and future medical practice.

“For me personally, having the opportunity to learn more about Chinese culture is really valuable, regardless of where I end up practicing, as I want to work with underserved communities in the U.S. or abroad,” Arbaugh said. “And I can already start applying what I learned. There are many Chinese patients at Stanford Hospital, as well the Cardinal Free Clinics, where I work. Now I feel I’ll be able to connect with those patients a little better.”

The seminar concluded with a public event at which the faculty discussed their ongoing research interests and students presented their team projects on proposed solutions to prevention problems. For instance, Arbaugh said she and her teammates tackled the problem of weight gain among male college students in China by proposing a phone app to track fruit and vegetable intake and activity levels, as well as a first-year class for university students about exercise, nutrition, stress management and sleep.

Prochaska said the Stanford Center at Peking University presented an opportunity for faculty to teach at a world-renowned campus in a beautiful, historic, cross-cultural setting. Peking University is one of the pre-eminent academic institutions in China.

“It is truly a unique opportunity for Stanford to make a bridge to the East in science and for personal enrichment in terms of seeing another culture,” she said. “I highly encourage faculty to take advantage of the opportunity.”

Baiocchi also said he was inspired by the unique setting of the seminar and by the challenges of being in a foreign environment.

“I found myself asking different kinds of questions,” he said. “You’re still very much in an academic environment, but you have a mixture of new challenges and some distance from your day-to-day activities. So it was extremely productive.”

Stafford said the Beijing campus is a valuable resource that is underutilized by Stanford faculty and students.

“We really do live in a world where health is now a global issue, and Americans remain very isolated and unaware of what’s going on in the rest of the world,” he said. “I think that needs to change.”