Has becoming part of China improved the health of Tibetans?
The Tibetan government in exile would say absolutely not – their figures indicate that 1.2 million Tibetans have died as a result of Chinese occupation.
China says its investments have seen medical improvements for Tibetans, but without health statistics this is hard to verify. Now a survey of Tibetan refugees has provided hard data.
The survey finds that refugees fleeing Tibet have higher levels of depression and anxiety than Tibetans born and raised in relatively stable exile communities in India and Nepal. But even Tibetans born in exile have questionnaire scores that classify them as "depressed".
"The results highlight the cost of the ongoing human-rights crisis within Tibet in human emotional suffering," says lead researcher Charles Raison, from the Emory University School of Medicine, Atlanta, Georgia.
Anonymous answers Since Tibet was invaded by the People's Republic of China in 1949, thousands of Tibetans have settled in northern India and Nepal.
Raison's team used standard psychiatric questionnaires to assess the mental health of 319 Tibetans at Dharamsala and Bir school campuses in the state of Himachal Pradesh, India.
As well as the increased depression among refugees, the team found that Tibetans born in exile also have high levels of depression – higher than that seen in previous studies.
On the Hopkins symptom checklist, a score higher than 1.75 suggests "significant emotional distress".
Raison's team found that people born in Tibet had a score of 2.30 for depression and 2.42 for anxiety. Those born in exile scored 1.92 for depression and 1.86 for anxiety.
Raison says this could be because, unlike before, the questionnaires were anonymised, which might have made students more comfortable sharing such information.
Few doctors The Chinese authorities maintain that health services in Tibet have improved significantly in the past 50 years. In support of this, life expectancy among Tibetans has doubled from only 32 in 1951 to 64 years in 2000.
However, says Kate Saunder at the International Campaign for Tibet, according to the World Bank this increase is about the same for all developing countries over roughly the same period.
"The increase is due to general advances in treatment and the extension of basic healthcare provision the world over," says Saunder. "[China] is a long way from realising its fundamental obligation with regard to provision of healthcare in Tibet."
Sonal Singh, of Wake Forest University School of Medicine, North Carolina, has studied mental health issues of exiled Tibetans, and he agrees with Saunder.
"You only have to look at the epidemic of multi-drug-resistant TB sweeping Tibet, or the fact that they have one of the lowest physician-to-patient ratios in the world, to realise that the situation is not as rosy as the Chinese authorities are saying," he says.