In addition to economic development, China is undergoing dramatic healthcare reform, including government-sponsored healthcare in rural areas [55, 56] . Declines in the incidence of pneumonia are likely attributable to the implementation of pneumonia intervention measures, such as technical training for village doctors, health education to parents, improved pneumonia surveillance and case management, and the use of vaccines against pneumonia in the routine immunization program (namely measles and pertussis). The improved detection and recognition of pneumonias following the SARS, avian influenza and 2009 influenza H1N1 epidemics could lead to more cases of pneumonia being promptly identified and treated. Large scale programs to introduce less polluting cookstoves in China have led to decreases in lung cancer and chronic obstructive pulmonary disease [57, 58] ; studies from other countries suggest that reductions in exposure to indoor air pollution from solid fuels used for cooking can also lead to fewer cases of pneumonia [59] . Other strategies, including better access to care, improved hygiene, and better nutrition may need strengthening to effectively reduce the incidence of pneumonia in China [60] .