Category Archives: Polls

Did The Airpocalypse Make You Want To Leave China?

I must confess that I think airpocalypse is a wonderfully apt and evocative new word. It’s right up there in the expat zeitgeist along with crazy bad and gutter oil as definitive additions to our lexicon. Airpocalypse perfectly encapsulates those miserable, gray January weeks of endlessly beyond index air pollution. Since those dark days, I’ve been inundated with interview requests looking for new angles on this old story. Last month, a slew of them decided there had been a “game changing” mind shift among expats, now suddenly fleeing for the exits to return home. I’ve been asked over and over (New York Times, Wall Street Journal, Christian Science Monitor, Bloomberg Businessweek, Economic Observer, Global Times, Swedish TV) the same question, “have you noticed more patients and expats leaving China since January?”

Before I give my answer, I thought all this was such an unusual media crescendo that I thought I’d ask all of my readers the same question, to assess whether the media is manufacturing its own reality or are they tapping into something real. So please take the poll below and answer one question: Does The Recent Airpocalyptic Pollution Make You Want To Leave China? If you cannot see the poll below, click here to vote.

Regarding my answer to most of these reporters: yes, since January I’ve definitely noticed an uptick in such conversations with many of my patients as well as Beijing friends, both local and expat. Certainly last winter’s air pollution was unusually serious, and I’ve never felt such collective anxiety in Beijing as I felt then. Bulletin boards, TV, radio, Weibo, my blog — the conversations were filled with anxious moms desperately looking for sold out air purifiers; frantic discussions about pollution masks for their children; tense Q&A sessions at multiple embassy and business events.

I myself must admit that while I still intend to live here many more years, even with my newborn son, January’s nightmare was very difficult to gloss over. Health and wellness, and a sense of happiness and fulfillment in life, are much more complex than just one issue such as pollution. Our minds are powerful mediators of our physical health. But daily stress and anxiety from constantly waking up to dangerously grey skies and not being able to send your kids outside… all that stress takes a major toll on your physical health and immune system. Everyone needs hope and silver linings, and I desperately hope dramatic steps can soon be taken to improve this situation.

What do you think? Please leave comments below.

Naples Bay Richard Saint Cyr
Eyes on the prize…

Vote For Your Favorite Alternative To "Crazy Bad"

I was a bit down with the weather last weekend so I started a poll on my Weibo microblog, asking people to choose a new warning label when the US Embassy’s AQI tilts the machine at 500 (which it did again last weekend). It’s now local legend that “crazy bad” had been quickly switched to a more proper “beyond index”, but this newer warning just isn’t very catchy, is it? So now you all can take the poll below and choose a snazzier label. I find that a little black humor now and then can lift the spirits…

AQI 500 US Embassy Crazy Bad
AQI 500 US Embassy Crazy Bad

Readers Respond: “What are your major health issues in Beijing?”

My last question from my recent Health Snapshot internet survey was an open-ended one: “What do you feel are your major health issues in Beijing?” Let’s let our readers take over; all 40+ answers are cut-and-paste verbatim except for a couple changes to protect privacy. (You can read part one, part two, and part three as well). Each paragraph is a new response.

Here we go: “What do you feel are your major health issues in Beijing?”

air quality, but i can’t do anything to fix the air so i try not to worry so much. i’ve chosen to live here and that’s part of the cost.

Not getting hit by cars on bicycle commute. Breathing problems when air pollution gets extremely bad. Non-BJ related: physical therapy, but I’ve found a good practitioner here.

Less environmental than social: the tendency of expat social life to take place in bars, and all that that entails. Casual acceptance of drinking that would be considered problematic back home. Smoking (or second-hand smoke exposure) on top of the already putrid air.

Pollution together with the extreme dryness of the air in winter made me have synusitis every single winter since I am living in Beijing! In general, upper respiratory tract infections alway take take much longer to recover from here in Beijing, certainly because of the same reasons.

injury prevention (I have a 2 & 4 year old)- safety standards are lower or nonexistent compared to the US; food safety; infectious diseases (especially low vaccination rates in expat community)

Air pollution is the top concern. Pesticide on vegitables are another. General hygine is not good in Beijing. I get stressed and frustrated often because of all the basic safety issues.

Air pollution, far and away: Have major problems with this, and my coughing rises and falls with the AQI. Allergies, some coming from the pollution, but also from all those willow trees. Basically, Beijing is an all-out assault on my lungs. My wife and I usually eat at home and are careful about buying fruits and vegetables, so this is not as much of an issue for me.

Thank you for focusing on this issue. I have insurance through my job. My son here at a Chinese company has no insurance and we had to switch from your clinic to Peking Union for him, where we felt the drs and nurses were competent and caring.

Definitely air pollution, as the danger is all to obvious every time I look out my window. I worry about food safety, but it’s much harder to gauge the real danger, as the levels of pesticides etc in what I eat aren’t visible.

pollution. This is such a fascinating place to live BUT when the air is amuck my mind goes that way too.

Problems with asthma that developed since coming here, as well the propensity of colds/flus to turn into weeks-long cough nightmares. I’m very concerned about food safety, and will not buy anything that is not organic or imported from a country with real quality standards for food and drink. I will eat out at local restaurants whenever invited by Chinese friends, or will eat whatever they serve me in their homes. But to counterbalance that, I think it very important to eat carefully in my own home and whenever I have charge of the meal.

1) Lack of food/water safety (less concern over getting sick, more concern over heavy metals, pesticides, hormones, antibiotics, etc. doing long term damage) 2) Air quality, but since we won’t be here longer than 3 years, I feel I can live with it. I had asthma the first month here, but soon got over it. 3) Some fear that in the event of a major health issue quality care will not be available, I’ll end up at a local hospital being extorted by doctors, etc. I carry a pocket list in my wallet of preferred hospitals, but if I get wrecked by a car I probably won’t have much choice in where I end up if it’s bad enough.

Air-pollution, not being ‘close’ to the food sources so not in control of their quality, work-load.

pollution. for my health being better in beijing i count this on eating habits. i’m forced to eat better in beijing as opposed to what i would eat in the states.

Lifestyle issues — living like you’re on vacation even if it’s for a decade; Americans unused to European/Chinese levels of smoking, drinking and lacking experience to partake in moderation; stress;

Pediatric health, dubious local meds and wary of doctors getting cuts and over-prescribing/prescribing unecessary meds

I am glad the expat clinics are here for emergencies; I never go there first if needed; Price is an issue; air is better than 15 years ago; I would never see a Chinese dentist; some Chinese doctors are fine, just as foreign doctors, some of both are no good;

Concerns about bicycle safety and suicidal cabdrivers. Overall I’m feeling pretty healthy, and I have regular massages to help stay that way. I miss my doctor back home and know I should have regular physicals here but the expat hospitals are out of my price range and I don’t speak enough Chinese to go to a local clinic. Friends have had horrific experiences even at the ‘best’ expat hospitals so it makes me wary enough to stay away unless I have an emergency.

The symptoms of my anxiety attacks have grown more severe since I’ve arrived. I’ve gained more and more weight. I’m worried that all the pollution will someday come back to haunt me.

Lifestyle – eating and drinking a lot more. Exercise – unappealing to exercise outside, opening hours and quality of reasonably priced gyms.

Lack of testing facilities in Beijing. Many blood tests cannot be done even in hospitals. The expat clinics are so poor on emergency care and their clinical competency is a big question mark.

Definitely the air quality. I live near major arterial routes and I often experience respiratory irritation – it really feels quite unhealthy, though I’m not sure just how unhealthy it is. The other concern is food since I don’t have many options in terms of what I eat. I survive almost entirely by grazing off the various restaurants in my area, which generally tastes good though I’m unsure as to how good living like this is for me long term. Thirdly I have been avoiding doctors after hearing so many horror stories – prohibitively high prices for international clinics and dubious practices (and language barrier) at regular clinics. Cheers for the blog by the way.

Mental health. I love my life here, but honestly, all these nice food, manicures, massages… extravagant lifestyle is only icing on the cake. Not many outside of the expat circle understands how unstable life is in beijing. i.e. relationships, friendship, jobs, etc. it’s a transient environment. Whereas, physical health, the options are available if you make the effort.

Air pollution & long term impacts despite use of air filters, food safety (ie if I get fruit and veggies from any market- expat or local grocery… Is it really safe??) also, possible health impacts of weather manipulation ( ie- seeding the clouds!)

Food and water safety Continuing with usual preventative checks (eg dentist, mammogram etc. ) – too easy to put off here/know where to go Air pollution

I don’t trust organic food so much, that’s why I don’t buy too much. I believe the organic farms are located very close to traditional farms etc etc, making the organic food not so organic. Food safety and air pollution are my major concerns living here.

I suspect I have heavy metal poisoning as I have all the symptoms. My friend who has been here ten years, got tested overseas last week and was asked if she worked with heavy metals as her toxicity was so high…she’s is marketing!

Availability of alternative treatments like Naturopathy, NAET, certain herbs and vitamins, etc. are limited.

I don’t really feel I have any additional health issues by living in Beijing. While I worry a bit about the pollution, I don’t go out on very bad days and don’t believe it will cause long term health effects. Maybe I have a bit more stress here.

Major Health Issues…crossing the street, getting “clean” food (ie. not with recycled oil, workers actually washing their hands, keeping raw meat refrigerated, etc…), access to excellent ICU in case something terrible happened (we had a friend that almost died from a 60ft drop rock climbing and BUFH couldn’t help him. Had to be flighted to Hong Kong for actual treatment, almost 13 hours later.), being concerned that the paint chipping in our apt is full of lead, concerned about actually how safe is our water (we buy it for 10kuai for the huge water jug 18.9L), and of course the pollution. Oh and I’m neutral about the organic food because is it really organic?

A little more doctors who can explain in English will be better


Air & food (incl. faked food such as fake bottled water)

Air pollution and escaping from the city.

Air quality (I’m have asthma), food safety

Airways – due to pollution

Allergies, Hay fever

Allergies, strep throat, neck pain

Breathing issues, persistent cough

Cheap booze…

Depression in winter, food & pollution, road safety,

Finding suitable natural alternatives to western meds

Food quality, toxic substances encountered in everyday life, air pollution.

I am more concerned about the possible long-term effect of exposure to such bad air quality.

No health issues – never been healthier !

Not knowing if I can trust that things are what they say they are

Organic food in China? Really? Hmm Which official organism control that? Hmm


Pollution, outdoor exercise, worry over insecurity

Problems with my throat, coughing, dry, painfull

Respiratory health; Pollution, dust etc Food cleanliness

Smoking + Pollution Healthy/non-Chinese food is pricey.

air food safety dishonesty about everything … aka fake products

air and water pollution, distrust about the food quality

air pollution

air pollution is my major concern. water my second.

pollution and stress

pollution and traffic safety

sexual diseases? air quality?

the coufing, the pollution

the general lack of hygiene is a major issue

"How Satisfied Are You With Your Expat Clinic?" — Survey Says…

A couple days ago I published part one of the results from my recently finished Health Snapshot Beijing 2010 survey. I wanted to get a sense of where expats were going for healthcare, as well as how they felt about their experiences. So I asked a few questions focused on Beijing expats’ use of all clinics, both expat and local. Here are the results…

Question 5: Where do you usually get your healthcare?

This was a multiple-choice question (75 responders, 88 answers), so the pie chart’s percentages are a bit off, but I will give the exact details here. Overall, the expat clinics were easily the most popular places for healthcare, with 71% of responders choosing one of them. But a large percentage (27%) of responders went to local Chinese hospitals; this was evenly divided between their VIP departments and their regular wards. I wasn’t too surprised that 8% went to a local Traditional Chinese Medicine (“TCM”) clinic.

My impression here is that the numbers aren’t too surprising. Most/many expats have work-related health insurance which covers the expat clinics, and most people find comfort in clinics similar to what they had back at home. Plus, the language barriers at local clinics would also deter many. But at the same time, a large group (35%) have been to local clinics and TCM clinics as well, so clearly there is a big mixture. Here’s the chart:

But this begs the question — how much do people actually like their expat clinic? Let’s find out next…

Question 6: How satisfied are you with your expat clinic?

A large majority of people (63%) were either “very satisfied” or “satisfied” with their expat clinic experiences. I was actually surprised that only 9% were  with their experiences. One third of responders were neutral.

I find this positive response very encouraging, both professionally for me since I work at one of these clinics, but also on a personal level as it’s quietly reassuring that an overwhelming majority of Beijingers aren’t disappointed in their health care clinics. It’s comforting to know that most of us, so far from our native lands, feel fairly safe in getting good health care during our years in Beijing. Here’s the pie chart:

But what about the 23% who do not get  healthcare from expat clinics? How do they feel about their local clinics? Let’s find out…

Question 7: How satisfied are you with your visits in local hospitals?

This was a more mixed response: of those who had been to local clinics and hospitals (53 out of 75), 42% were happy with their experience, 25% were neutral, and 34% were unhappy. But the enthusiasm was muted: 7% were “very satisfied”, which is lower than the 18% who were “very satisfied” with expat clinics. And 13% were “very dissatisfied”, a bit higher than the 3% regarding their expat clinic.

The Bottom Line?

Again, these results aren’t too surprising overall. It was predictable that expats would be more satisfied at expat clinics. Still, I think the findings are reassuring for us, that the majority of Beijing expats feel they are getting good healthcare. The major follow-up question, which I did not ask, is why is this so?

I would also love to know other things, such as:

  • How many people have insurance?
  • How many would go to expat clinics if they could afford it? Or, the opposite — how many go to local clinics because they cannot afford expat clinics?
  • What’s your main reason for going to local clinics: convenience? Finances? Philosophy?
  • Is your expat clinic better or worse than your clinic back at home?

What would you want to know more about? Let me know in the comment section below.

Next Survey Post, Part 3: air pollution and food safety: major problems or massive hype?

"I am healthier in Beijing than my home country": Agree or Disagree? Survey Says…

I’ve closed the results for my Health Snapshot Beijing 2010, and the results are in. Many thanks to the 75 readers who filled out the form! Let’s go straight to the results.

Question 1: How Long Have You Lived in Beijing?

This wasn’t too surprising; about 50% have been in Beijing for under 3 years. One in four are long-termers, having lived here over 5 years. It confirms what I see in clinic all the time; a massive turnover of expats, which you would expect with most expats here on limited yearly work contracts. Still, it’s comforting that 25% have really settled down here and made this their new long-term home.

Question 2: What’s Your Native Country?

The top country was the US, with 38%, followed by Australia with 10%, then a group of European countries, followed by a smattering of others — for a total of 21 countries reported.

OK, let’s get to the more interesting questions:

Question 3: “I am healthier in Beijing than my home country”: do you agree or not?

I wasn’t too sure what to expect with this question; I recently wrote a lot about what I call “expatitis”, as I felt that I saw more ill health among my patients than I had thought I’d see. I was hoping that my viewpoint may be a bit too skewed, but the survey results showed a strong trend that most responders indeed felt more unhealthy here. It wasn’t even close: 64% felt less healthy in Beijing, while only 19% felt more healthy here. In fact, 24% strongly felt unhealthier here. This question was very polarizing, as only 18% were neutral.

So, more than half of responders felt more unhealthy here in Beijing. This brings up the next obvious question: why do they feel more unhealthy? What are the main causes of this? Is it environmental, or personal, or work-related? The follow-up questions help to address this, but honestly this is such a surprisingly large response that it deserves a future, more comprehensive survey to delve deeper.


Question 4: “My mental health (stress, depression, anxiety, insomnia, etc) is better here in Beijing when compared to my home country”: do you agree or not?

The overall mental health picture wasn’t nearly as bad as the previous question’s negative findings. Only 41% of responders felt their mental status was worse here in Beijing, while 26% felt better mental health. A large proportion (36%) were neutral. Therefore, a majority (61%) were neutral or positive about their mental health while here in Beijing. I find this to be encouraging news as I had expected worse numbers.

But, that 41% is still a big percentage of responders who feel worse living here, which of course makes their overall expat experience far tougher…

A Short Disclaimer (AKA The Fine Print…)

I will be reviewing the remaining answers in other posts, but firstly I should explain that readers shouldn’t read too deeply into this survey, as it is far from a scientifically rigorous study. Firstly, I doubt it’s a very accurate sample of the actual expat population, as only readers of this blog and a couple other internet groups knew about the survey. And of course, being written in English, it excludes all those expats who don’t read English. In public health statistical terms, the sampling was not randomized so the results can’t be assumed to speak too accurately for the 170,000 reported Beijing expats. Plus, the sample size of 75 is too small to really get an accurate margin of error (11.3%, when a much more ideal margin of 5% would require at least 384 responses).

Having said all that, I still think it’s a good start and does help answer some basic questions I had about Beijingers’ health perceptions. And it definitely gives me a lot of leads for a more comprehensive follow-up survey. As always, I welcome your feedback in the comments section below.

Next Post: Expat Clinics and Local Clinics: Which Are Better?