New opportunities for China in global health
Authors: Lincoln Chen, Minhui Yang
Journal: The Lancet Global Health (2018)

In the 5 years since the launch of The Lancet Global Health, China has emerged as a major player in global health. In April, 2018, a new International Development Cooperation Agency (IDCA) was launched in China,1Xinhua NetChina unveils int'l development cooperation agency.http://www.xinhuanet.com/english/2018-04/18/c_137120544.htmDate accessed: May 2, 2018Google Scholar after deliberation by the country's 19th party congress in October, 2017, and endorsement by the National People's Congress in March, 2018. Similar to the US Agency for International Development and the UK Department for International Development, China's IDCA will be responsible for coordinating and managing the country's foreign aid policy, both financing and implementation. The agency is linked directly to the Chinese state council, the government's multiministerial coordinating body. Up until now, China's health ministry has played mostly a technical role in executing overseas health projects designed by the ministry of commerce. The new agency is important because China has arisen rapidly as a global economic power. Marking 40 years since the opening of the Chinese economy, on April 10, 2018, President Xi Jinping at the Boao Forum in Hainan Province underscored that China had become the world's second largest economy, the largest industrial producer, the largest trader of goods, and the holder of the largest foreign exchange reserve.2Trading economicsChina Foreign Exchange Reserves.http://www.tradingeconomics.com/china/foreign-exchange-reservesDate accessed: May 2, 2018Google Scholar Over the past four decades, China's gross domestic product (GDP) has averaged an annual growth rate of 9·5%, accounting for more than a third of the total world economic growth, and more than 700 million Chinese people have been lifted out of poverty.3Highlights of Xi's keynote speech at Boao Forum.http://www.chinadaily.com.cn/a/201804/10/WS5acc15a6a3105cdcf6517259_12.htmlDate accessed: May 25, 2018Google Scholar Xi also declared that China plans to act as a Da Guo (great country)—ie, an emerging power in world affairs.4Xinhua NetPresident Xi Jinpin's keynote speech on the opening ceremony of BOAO forum for Asia annual conference.http://www.xinhuanet.com/politics/2018-04/10/c_1122659873.htmDate: 2018Date accessed: May 3, 2018Google Scholar The IDCA will offer development assistance, but data about Chinese aid have not yet been published. Crudely estimated, China's aid is still low compared with other countries—0·04% of GDP versus the UN standard donation of 0·7% of GDP.5Tang K Li Z Li W Chen L China's Silk Road and global health.Lancet. 2017; 390: 2595-2601Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar China's foreign aid has therefore not been robust in comparison with other major donors, but it has been increasing markedly at 21·8% annually.6Zhang J Chinese Foreign Assistance, Explained.https://www.brookings.edu/blog/order-from-chaos/2016/07/19/chinese-foreign-assistance-explained/Date accessed: May 2, 2018Google Scholar China's donated aid of US $7 billion in 2013, if the growth trajectory of 2008–13 is maintained, could triple to more than $21 billion by the end of 2018. Two-thirds of China's aid is channelled bilaterally to developing countries in Africa and Asia; however, China has joined and contributed to most multilateral organisations and programmes such as WHO's Belt and Road Initiative that focuses on health.7An B WHO, China sign pact establishing health Silk Road.http://www.chinadaily.com.cn/business/2017wef/2017-01/19/content_27993857.htmDate accessed: May 25, 2018Google Scholar China has also been developing its own multilateral investment vehicles, beyond traditional mechanisms.8Ikenberry G Lim D China's emerging institutional statecraft.https://www.brookings.edu/research/chinas-emerging-institutional-statecraft/Date accessed: May 2, 2018Google Scholar The Belt and Road Initiative has emerged as the major theme of China's global engagement,9State CouncilPeople's Republic of ChinaAction plan on the belt and road initiative.http://english.gov.cn/archive/publications/2015/03/30/content_281475080249035.htmDate accessed: May 2, 2018Google Scholar prioritising trade, commerce, and infrastructure (rail, roads, bridges, and ports). With two geographical corridors (the land-based economic belt and the 21st-century maritime road) connecting China to Asia, Africa, and Europe, the BRI covers 65 countries containing 70% of the world's population, 30% of the world's GDP, and 75% world energy reserves. Such connectivity will facilitate the movement of goods and people—but will also facilitate movement of diseases. That might be why health security from infectious diseases has assumed priority. China showed a heightened response to the Ebola virus emergency, signalling its priority for health security. Scarred by the 2003–04 SARS pandemic when trade was paralysed and economic loss was great, China wants to avoid epidemics constraining trade and economy.9State CouncilPeople's Republic of ChinaAction plan on the belt and road initiative.http://english.gov.cn/archive/publications/2015/03/30/content_281475080249035.htmDate accessed: May 2, 2018Google Scholar In August, 2017, China hosted an international conference about health on the Silk Road. The resulting Beijing Communique announced a plethora of activities to be promoted through four networks—public health, policy research, hospital alliance, and health industry.10National Health and Family Planning Commission. Beijing Communique, Silk Road-Belt high level health conference, August 2017.Google Scholar The biggest challenge for China is how to improve the quality of its global health engagement. Similar to most countries, China has mixed motivations for providing foreign aid. Chinese medical teams in the 1960s were humanitarian services provided as an expression of geopolitical solidarity with African and Asian countries as a part of non-aligned movement. China's current bias leans towards commercial trade. Most of China's aid is towards infrastructure (72·4%) and supplies (15·0%), with 80% going to Africa and Asia.11State CouncilPeople's Republic of ChinaWhite paper of China's foreign aid.http://www.gov.cn/zhengce/2014-07/10/content_2715467.htmDate: 2014Date accessed: May 4, 2018Google Scholar China has not yet articulated a strategy based on a health-dominated vision for global health. The new agency offers China a fresh opportunity. Linked to the state council, not within the ministry of commerce or the ministry of foreign affairs, health mandates could play a stronger role. A vice health minister has been designated in charge of global health. The national health commission's department of international health cooperation is being shifted from coordinating receipt of foreign aid to donation of Chinese aid, and China's Centre for Disease Control has established a new centre of global health. Ultimately, China's performance will depend upon governmental experience, and medical universities' research and training in global health. China has begun several major partnerships to advance its global health work. For instance, the UK's Department for International Development (DFID) made a farsighted move of giving a final aid grant to China on the condition that it focused on global health. DFID envisioned that China would shift from recipient to donor country, and that the grant would help to accelerate the transition. Foreign universities have also been contributing, especially the London School of Hygiene and Tropical Medicine, US universities (Harvard University, University of Washington, Emory, and Johns Hopkins), and others. The China Medical Board has also been seeding global health capacity in several Chinese universities, such as the Global Health Institutes (Xi'an Jiaotong University and Fudan University), the Global Health undergraduate degree at Wuhan University, and the Global Health Department at Peking University Health Science Center; however, China does not have many global health-care professionals with direct work experience in developing countries, a gap that will need to be remedied if China is to enhance the quality of, and show leadership in its global health engagement. To keep abreast of and strengthen Chinese leadership in meeting these rapidly unfolding developments, journals such as Lancet Global Health could consider a special series by Chinese authors on key aspects of China's engagement, including promotion of publications by Chinese scholars. LC is president and MY is the programme manager of the China Medical Board. 5 years laterA lot can happen in 5 years. In many parts of the world, so much can happen that a child's reaching that milestone age is a cause for celebration. In 5 years, a medical student can receive her basic training and start treating patients. 5-year action plans are common components of global health programmes, this timeframe being considered adequate to optimise the use of available funds and implement strategies. 5 years is also the amount of time granted a newly-elected WHO Director-General to reform the institution, set priorities, and orient the global health agenda to make a difference. Full-Text PDF Open Access