Healthy China: from words to actions
Authors: Chi Zhang, Peng Gong
Journal: The Lancet Public Health (2019)

With the largest population in the world, China has made great achievements in health promotion since the 1950s when the life expectancy was less than 45 years. By 1995, China's life expectancy surpassed 70 years and it is now 76·79 years.1World population reviewLife Expectancy by Country 2019.http://worldpopulationreview.com/countries/life-expectancy-by-country/Date: 2019Date accessed: July 15, 2019Google Scholar The rapid health improvement in the 1960–80s can largely be attributed to the establishment of a relatively cheap and equally accessible primary health-care system and to the National Patriotic Hygienic Movement established in 1952, which successfully improved the environmental living conditions and substantially decreased transmission of infectious diseases. Since the economic reform and open-door policy that took place in 1978, although the economy of China has been growing quickly, the health sector has encountered great difficulties—as evidenced by high out-of-pocket patient spending, inequality in accessibility of quality health care, rising non-communicable disease burden, deteriorating patient–doctor relations, and dissatisfaction among health professionals.2Sun J Ma J Hu G et al.Welfare, wellness, and job satisfaction of Chinese physicians: A national survey of public tertiary hospitals in China.Int J Health Plann Manage. 2017; 32: 270-284Crossref PubMed Scopus (17) Google Scholar These problems led to the 2009 comprehensive health-system reform, which aimed to develop a basic health-care system covering the entire population by 2020.3Xu J Mills A 10 years of China's comprehensive health reform: a systems perspective.Health Policy Plan. 2019; 0: 1-4Google Scholar, 4Gong P Liang S Carlton EJ et al.Urbanisation and health in China.Lancet. 2012; 379: 843-852Summary Full Text Full Text PDF PubMed Scopus (832) Google Scholar Now that 10 years have passed, some progress has been made but some challenges remain, while new ones are emerging. For example, out-of-pocket patient spending dropped from more than 40% of the total health expenditure in 2008, to 28% in 2016, but demands for mental health treatment and long-term care are increasing.3Xu J Mills A 10 years of China's comprehensive health reform: a systems perspective.Health Policy Plan. 2019; 0: 1-4Google Scholar In 2016, the Chinese Government held its highest-level national health conference and subsequently announced the Outline of the Healthy China 2030 Plan. As a major means of the Chinese government to implement the UN 2030 sustainable development goals, health has been elevated to a new height in China. President Xi Jinping put the good health of all Chinese people as the prerequisite for a moderately prosperous society. Health is requested to be included in all policy making. With several essential health targets set, the Outline calls for actions by all sectors towards building a people-centred society—a shift from the previous economy-focused one. However, with a few exceptions in the environmental sector, actions toward healthy China 2030 are not as remarkable as envisioned outside the health sector. It must be recognised that Healthy China is a whole-society effort, the scope of which is far beyond the health sector. Healthy China is also multi-scale in nature, involving individuals, families, organisations such as governmental agencies, enterprises, hospitals, schools, and universities, as well as communities (including villages, townships, and cities). In essence, healthy China is about the wellbeing of people across the entire country. At the individual level, every citizen needs to take part in building healthy China. Little knowledge of health protection measures—such as hygienic habits, maintaining a healthy diet, and disease prevention—needs to be addressed. It is not difficult to understand the knowledge gap in China, given that for a long time China was a poor agricultural country. In 1978, China's urbanisation rate was only 19%.4Gong P Liang S Carlton EJ et al.Urbanisation and health in China.Lancet. 2012; 379: 843-852Summary Full Text Full Text PDF PubMed Scopus (832) Google Scholar In less than 40 years, China's population urbanisation has tripled. Since most of the population in China has spent their childhood in rural areas with quite poor living conditions and hygienic standards, health education has been missing and establishing healthy living habits can be a challenge. Therefore, the knowledge gap in health needs to be filled quickly. Organisations have a crucial role to play in building healthy China. By maintaining healthy work places, organisations can not only protect the health of their workers but also educate them in building healthy homes. To this end, standards for healthy buildings are being created. A wider adoption of healthy building standards and the effort to continue building healthy cities and villages will be critical pathways toward achieving Healthy China 2030 targets.5Yang J Siri JG Remais JV et al.The Tsinghua–Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China.Lancet. 2018; 391: 2140-2184Summary Full Text Full Text PDF PubMed Scopus (114) Google Scholar To achieve the targets of healthy China, the systems-thinking approach must be turned into action.3Xu J Mills A 10 years of China's comprehensive health reform: a systems perspective.Health Policy Plan. 2019; 0: 1-4Google Scholar, 5Yang J Siri JG Remais JV et al.The Tsinghua–Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China.Lancet. 2018; 391: 2140-2184Summary Full Text Full Text PDF PubMed Scopus (114) Google Scholar This is particularly important at the governmental level. Although it is widely known that health is affected by upstream factors in the socioeconomic system and the environment, more coordinated cross-sectoral actions are needed than are currently implemented. For example, the health sector needs to be aware of the conditions of poultry and swine farming to prevent the spread of avian flu or swine viruses. However, the current segregated administration on food production and health in China hampers timely information exchange and disease intervention actions. To make a change, a cross-sectoral regular information-sharing mechanism must be established. In addition, as we enter the big data and digital health era, more open-source social data should be harvested to protect public health.6Liang L Gong P Cong N et al.Assessment of personal exposure to particulate air pollution: the first result of City Health Outlook (CHO) project.BMC Public Health. 2019; 19: 711Crossref PubMed Scopus (27) Google Scholar We were pleased to read the latest release of the Suggestions on Healthy China Actions by the State Council of China. The document lists 15 suggested actions, all advocating disease prevention: health knowledge extension, healthy eating, increasing physical activities, stronger tobacco control, promoting mental health, improving environmental conditions, protecting maternal and infant health, promoting health of school attendants, ensuring occupational health, promoting health of the elderly, preventing cardiovascular diseases, preventing cancer diseases, preventing chronic respiratory system diseases, preventing diabetes diseases, and preventing endemic and infectious diseases. These proposed actions paint a road map to Healthy China 2030. The entire society needs to take part. Finally, a healthier China should be built on the basis of reliable and transparent cross-sectoral information and data sharing, and solid multi-sectoral cooperation. We declare no competing interests. Diet-related NCDs in China: more needs to be doneZhang and Gong in their Comment recently published in The Lancet Public Health1 seem very positive about the latest release of the recommendations for Healthy China Actions by the State Council, noting that it paints a road map to Healthy China 2030. Although the outlined actions represent an important step towards a healthier China, their impact might be small, particularly on diet-related non-communicable diseases (NCDs) such as obesity. Full-Text PDF Open Access