China to curb spitting as tuberculosis rises

China is making new efforts to curb spitting in the city of Guangzhou by introducing a penalty system which could lead to public-housing tenants being evicted. The move against anti-social behaviour also targets illegal parking illegally, drying laundry on fences and urinating in public. More serious offences include throwing rubbish out of upper floors or storing flammable or explosive material. Offenders gathering 20 points within two years will be evicted.

The Guangzhou Land and House Management Bureau says on its website it has "borrowed the ideas from the advanced experience of Hong Kong on public housing management" in an attempt to "build a civilised, hygienic, safe and harmonious community environment." It hasn't met with much approval from the public however. Some Chinese people say the plan represents "discrimination against the poor" [BBC].

Spitting in public is commonplace in China despite several government campaigns attempting to stop the habit. People can even be seen spitting on buses, onto floors of restaurants as well as pavements. While seen as unsightly and a disgusting habit by many in the West, spitting also poses a serious health concern.

The most common harmful bacteria in a sputum culture are those that can cause bronchitis or pneumonia (Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Klebsiella pneumoniae, and Chlamydia pneumoniae). It can also harbour the tuberculosis bacteria (Mycobacterium tuberculosis) which is becoming an increasing problem across the country.

Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when people who have the disease cough, sneeze, or spit. Atypical pneumonia can also be spread by respiratory droplets.

China is now only second to India in numbers of people suffering the respiratory disease. And new drug-resistant forms of the disease are now beginning to drain the country's health budget. Further problems occur when patients  fail to follow treatment regimens and take substandard drugs or stop treatment too early. If the tuberculosis bacteria is not fully eliminated, it can mutate, resurge later and become resistant to the small arsenal of drugs that can fight the disease [Reuters / Telegraph].

Currently there are nearly 4.5 million Tuberculosis cases in China and on average  1.4 million people fall ill with the disease every year. In 2008 at least 160,000 people were killed by tuberculosis in China alone. In comparison, the much feared A/H1N1 pandemic has killed only 13,663 worldwide, 659 of which were in China [Wikipedia]. Tuberculosis, also called TB, phthisis, consumption, and nicknamed the white plague, is the most common infectious disease in the world today. If left untreated, more than 50% will die in a few years time. It causes about 2-3 million deaths per year out of 9-10 million cases and is especially prevalent in undeveloped, tropical countries.

In the West tuberculosis changed social attitudes towards spitting.In the Middle Ages spitting was part of everyday life, and at all levels of society. By the early 1700s, spitting had become seen as something which should be concealed, and by 1859 many viewed the spitting on the floor or street as vulgar, especially in mixed company. Spittoons were used openly during the nineteenth century to provide an acceptable outlet for spitters. But even spittoons became far less common after the influenza epidemic of 1918.

Tuberculosis, or "consumption" as it was commonly known, caused the most widespread public concern in the 19th and early 20th centuries as an endemic disease of the urban poor. In 1815, one in four deaths in England was caused by tuberculosis. By 1918 one in six deaths in France were still caused by the disease. After it was established in the 1880s that the disease was contagious, tuberculosis was made a notifiable disease in Britain and there were campaigns to stop spitting in public places. The infected poor were also pressured into entering sanatoria that resembled prisons; the sanatoria for the middle and upper classes offered excellent care and constant medical attention.

It has been suggested by some health organisations that spitting does not pose a great risk. In a leaflet published by the NHS in Britain they say spitting is "unlikely to spread tuberculosis" [PDF]. Nevertheless the bacteria can survive a significant time outside the host and may even be resilient to mild disinfectants. With at least a third of the world's population believed to be carrying the disease the discouragement of spitting and lining the streets with bacteria is surely to be encouraged, whether it appears to discriminate or not. After all tuberculosis does not discriminate who it infects.

tvnewswatch, Beijing, China