Taipei City has a surface area of 271km2, and a population density of 10,000 people per square kilometer. Taipei City’s Da-an District (大安) has 27,500 people crammed into every square kilometer, making it densely overcrowded, badly polluted and noisy.
On the surface, life seems hard for Taipei residents. If we look at Taitung County on the other hand, it has the impressive East Rift Valley, a scenic coast and a land area of 3,515km2, making it Taiwan’s longest and narrowest county. It measures 166km from north to south, making up 40 percent of Taiwan’s total length. However, the county only has 64 people for every square kilometer, giving it the lowest population density of any county.
Taitung seems to be a large and sparsely populated area with a good natural environment. Many imagine that people living there lead long, happy lives akin to those in the Mediterranean. However, there is often a large difference between reality and imagination.
The majority of Taitung residents are not living lives full of enjoyment and bliss. The average life expectancy in Taipei is higher than 82 years of age, the highest in Taiwan. In Taitung, however, the average life expectancy is only 74. Taitung is only one hour away from Taipei by air, but the average life expectancy of people living in Taipei 25 years ago was higher than that of those now living in Taitung.
In 2011, average household income in Taipei was higher than NT$1.31 million (US$44,200), while incomes in Taitung County only just exceeded NT$670,000. In other words, the average household income in Taipei is almost double that of Taitung County. More than 13 percent of Taitung’s population is older than 65, which is also higher than Taipei, which means that Taitung is experiencing the effects of “brain drain” and a quickly aging population. In simple terms, Taipei beats Taitung three to zero, as those living in Taipei are younger, live longer and have more money.
If we look at these two places in terms of health issues, Taipei has 174 licensed medical practitioners per square kilometer, while the same figure in Taitung is only 0.62. In Taipei, there are 17.7 doctors per 1,000 people, including both western and Chinese medicine, whereas in Taitung the same figure is 9.6. Taipei has a long list of renowned medical centers, while Taitung’s highest-level hospital is the Taitung Branch of Mackay Memorial Hospital, a regional teaching hospital. There is also one more regional teaching hospital and four regional hospitals. Of these hospitals, five are concentrated in Taitung City. As soon as one leaves the city, medical services become very scarce.
There is a high prevalence of mental disorders in Taitung County, and among the Tao people on Orchid Island (蘭嶼), it is as high as five times that of Taiwan proper. One-third of Taitung’s inhabitants are Aborigines and the three leading causes of death among Aborigines are death by accident or in natural disasters, malignant tumors and chronic liver disease. Accidental deaths among Aborigines are two-and-a-half times higher than in other areas in Taiwan, chronic liver disease is more than four times higher and tuberculosis is more than six times higher. Deaths caused by other illnesses including cerebral vessel diseases, heart disease, diabetes, respiratory disease, kidney disease, as well as suicide are also one-and-a-half times that of other areas of Taiwan. In addition, the proportion of Taitung residents who have had their National Health Insurance cards canceled is high, and Taitung also leads Taiwan in terms of obesity.
According to the Guinness World Records, Taitung holds the record for the number of children born to one mother, 24. Women giving birth at age 50, having eight children by their mid-30s and 16-year-old mothers are nothing new in Taitung. While quality of life could be much better in Taitung, it would seem that the people living there have healthy sex lives, as the fertility levels of teenage women is more than double that of Taiwan’s average. The county also leads Taiwan in terms of the number of children born out of wedlock.
Taitung does not need to encourage people to have children, but birth is all that is encouraged via the National Health Insurance system, as it does not subsidize vasectomies, intrauterine contraceptive devices or oral contraceptives, which is not only unreasonable, but also backward. The urban and rural divide has seen youth pregnancies, fertility rates and children born out of wedlock increase in the Taitung region, and this is obviously linked to the severe lack of sex education, contraceptive methods and abortion services there.
Chiang Sheng is an attending physician in the Department of Obstetrics and Gynecology at Mackay Memorial Hospital.
Translated by Drew Cameron