Global health efforts and opportunities related to the Belt and Road Initiative
Authors: Peng Jia, Youfa Wang
Journal: The Lancet Global Health (2019)

The Belt and Road Initiative (also known as the Silk Road Economic Belt and the 21st century Maritime Silk Road), proposed by China in 2013 with the aim of connecting Asia–Pacific and the European Economic Areas, was implemented in 2017.1Hu R Liu R Hu N China's Belt and Road Initiative from a global health perspective.Lancet Glob Health. 2017; 5: e752-e753Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 2Horton R Offline: are China's global ambitions good for global health?.Lancet. 2018; 390: 2752Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar A meeting held in Beijing on Aug 18, 2017,3Tang 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 (62) Google Scholar released a key message on establishing collaborative platforms and sharing human wellbeing to delegates from about 20 Belt and Road countries (figure and appendix). To respond to the initiative and promote international collaboration for global health, efforts have been made in Xi'an, China (the starting point of the Silk Road Economic Belt) and in Rotterdam, Netherlands (the endpoint of the Belt). Xi'an Jiaotong University led the establishment of the University Alliance of the Silk Road (UASR) in 2015, which includes 150 universities from 38 countries. The university's Global Health Institute was established to help achieve key national development strategies including the Belt and Road Initiative and to promote international collaboration in health fields. The university's Global Health Institute has led and hosted two Belt and Road Initiative Global Health International Congresses. The first was held on Sept 24–27, 2017, co-hosted by the Chinese Preventive Medicine Association—Chinese Society on Global Health. Approximately 400 delegates from 26 countries attended the congress and about 100 invited speakers from 14 countries presented, including leaders and experts from WHO and UNICEF. At the conference, the UASR Health Sub-Alliance was formally established as a cooperative platform to facilitate global health research, academic exchange, and training.4Wang Y Sun X Wang L et al.International Collaboration to Promote Global Health: the 2017 Belt and Road Initiative Global Health International Congress and 2017 Chinese Preventive Medicine Association—Chinese Society on Global Health Annual Meeting.Glob Health J. 2018; 1: 32-41Google Scholar The second congress was held on Nov 23–26, 2018, co-hosted by the university's Global Health Institute and the UASR Health Sub-Alliance. Approximately 500 delegates from 29 countries worldwide attended; about 100 invited leaders and experts from 17 countries, WHO, and UNICEF presented a wide range of health research such as non-communicable diseases (NCDs), childhood obesity, healthy life expectancy, health care accessibility, and environmental health issues in Belt and Road countries. The 1st International Symposium on Lifecourse Epidemiology and Spatial Science (ISLES) was held on July 16–20, 2018, in Leiden, Netherlands. The directors of the Department of NCD Surveillance of the Chinese Center for Disease Control and Prevention and of the Department of NCD Determinants in the Netherlands Institute for Public Health and the Environment shared their work on NCD control and prevention in their countries, such as tobacco control and negotiations with the food industry for salt reduction in processed foods. A multidisciplinary expert panel, including leaders of 15 renowned global health programmes, identified emerging research opportunities and challenges brought by the Belt and Road Initiative, including emergence and re-emergence of infectious diseases caused by increasing international travels;5Tatem AJ Jia P Ordanovich D et al.The geography of imported malaria to non-endemic countries: a meta-analysis of nationally reported statistics.Lancet Infect Dis. 2017; 17: 98-107Summary Full Text Full Text PDF PubMed Scopus (124) Google Scholar cross-border health service delivery and hospitalisation, which will require physicians to understand the heterogeneity of health determinants across populations;6Legido-Quigley H Passarani I Knai C et al.Cross-border healthcare in the European Union: clarifying patients' rights.BMJ. 2011; 342: d296Crossref PubMed Scopus (29) Google Scholar current data bottlenecks when measuring exposome;7Jia P Stein A Using remote sensing technology to measure environmental determinants of non-communicable diseases.Int J Epidemiol. 2017; 46: 1343-1344Crossref PubMed Scopus (35) Google Scholar, 8Stingone JA Buck Louis GM Nakayama SF et al.Toward greater implementation of the exposome research paradigm within environmental epidemiology.Annu Rev Public Health. 2017; 38: 315-327Crossref PubMed Scopus (60) Google Scholar complicated mechanisms between the environment and NCDs;9Jia P Xue H Yin L Stein A Wang M Wang Y Spatial technologies in obesity research: current applications and future promise.Trends Endocrinol Metab. 2019; 30: 211-223Summary Full Text Full Text PDF PubMed Scopus (45) Google Scholar and new risk factors for NCDs because of infrastructure, cultural, and technological exchange (eg, importation of foods and behaviours because individuals' exposure to food environments is not limited within neighbourhoods as a result of online ordering and fast delivery).10Balicer RD Luengo-Oroz M Cohen-Stavi C et al.Using big data for non-communicable disease surveillance.Lancet Diabetes Endocrinol. 2018; 6: 595-598Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar Among the opportunities discussed during the 1st ISLES, two national-level endeavours, the Big Data Platform for Epidemiological Surveillance of NCDs (BPES) in China and Geoscience and the Health Cohort Consortium (GECCO) in the Netherlands, have the potential to collaborate through the International Initiative on Spatial Lifecourse Epidemiology (ISLE)11Jia P Spatial lifecourse epidemiology.Lancet Planet Health. 2019; 3: e57-e59Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar to form a Sino–Dutch NCD research consortium, on the basis of an open and pragmatic partnership for comprehensive cooperation between the two countries. The partnership was initiated in 2014, after a state visit to Netherlands by the Chinese President and intensified in 2018, during a reciprocal visit to China by the Dutch King. BPES will link multiple sources of health data with dynamic environmental data across China, including health surveillance data, health insurance data, electronic hospital records, cancer registries, and death registries. GECCO will enrich more than 20 Dutch cohort studies countrywide with spatial data, enabling research on environmental determinants of lifestyle behaviours and NCDs. The collaboration between BPES and GECCO can shed light on NCD risk factors across the lifecourse and forecast NCD epidemic trends, with important public health implications not only in Belt and Road countries, but also worldwide. Additionally, ISLE is taking advantage of advanced spatial technologies to establish a large spatiotemporal dataset of multiple dimensions of environmental exposures since 1980 to present over the Eurasian continent.12Jia P Stein A James P et al.Earth Observation: investigating noncommunicable diseases from space.Annu Rev Public Health. 2019; 40: 85-104Crossref PubMed Scopus (38) Google Scholar The Xi'an Jiaotong University Global Health Institute has been doing research in multiple countries, including projects funded by UNICEF, the US-based China Medical Board, and National Institutes of Health.3Tang 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 (62) Google Scholar, 13Wang Y Zhou Z Zhao Y et al.Disparities in health burden, health-care facilities, and resources among countries in China's Belt and Road Initiative: a mixed methods study.Lancet. 2017; 390: S85Summary Full Text Full Text PDF PubMed Google Scholar These efforts, which will be expended in the coming years as more partners join, will facilitate the study and solving of many serious and emerging public health concerns within and beyond country boarders such as the complex relationships between policy and environmental factors, behaviours, and health outcomes across Belt and Road countries—all of which have diverse cultures, religions, lifestyles, economic development, physical environments, and disease burdens. These offer unprecedented promise for international collaboration to build a "community of human destiny".14The Chinese Central Commission for Discipline InspectionWhat is a community of human destiny?.http://www.ccdi.gov.cn/special/zmsjd/zm19da_zm19da/201801/t20180116_161970.htmlDate: Jan 17, 2018Date accessed: April 4, 2019Google Scholar This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on May 21, 2019 This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on May 21, 2019 We declare no competing interests. This work was partly supported by the University of Twente and Xi'an Jiaotong University, and by research grants from the International Strategic Partnerships (grant CvB-UIT-3513\S&B), the US-based China Medical Board (grant 16-262), and UNICEF. Peng Jia, director of the International Initiative on Spatial Lifecourse Epidemiology (ISLE), thanks Lorentz Centre, the Netherlands Organisation for Scientific Research, the Royal Netherlands Academy of Arts and Sciences, the Chinese Centre for Disease Control and Prevention, and the West China School of Public Health of Sichuan University for funding ISLE and supporting its research activities. Download .pdf (.38 MB) Help with pdf files Supplementary appendix Correction to Lancet Glob Health 2019; 7: e703–05Jia P, Wang Y. Global health efforts and opportunities related to the Belt and Road Initiative. Lancet Glob Health 2019; 7: e703–05—In this Comment, in the figure the title of the key has been changed to "Number of conferences attended"; the explanation of the map colour coding has been removed from the figure key; and Taiwan has been added to the figure map. The appendix has been reformatted. These corrections have been made as of May 21, 2019. Full-Text PDF Open Access