China: health takes priority

Abstract

In 2013, the Lancet issue on China called for three steps to tackle China's health challenges: understand the underlying causes for the rapid health transitions; support innovative, robust, and transparent research; and establish and implement sound health policies. This month, at China's highest-profile national health conference in 20 years, President Xi Jinping has placed health at the heart of all policy making and called for full protection of every citizen's health by stating: “an all-around moderately prosperous society cannot be achieved without the people's all-round health”. His words signal a new approach to development in China. In the past 67 years, the country's priorities have switched from securing political stability to intense economic development. Now, a major goal of government will be to ensure the health of the population through the improvement, protection, and maintenance of the entire health system, including its social, economic, political, cultural, and ecological determinants. Although China has made substantial gains in health, several areas will need special attention if all-round health is to be achieved. The main issues affecting China are chronic diseases such as hypertension and diabetes, and their risk factors, such as smoking and obesity; addressing these threats will require a combination of prevention and treatment, and the latter will only be facilitated through increasing coverage by family doctors. Although these goals are laudable, it is difficult to put into place mechanisms for implementing “health for all” policies, especially for other ministries that have different priorities; doing so will require unprecedented political will. Furthermore, orienting towards prevention is difficult; increasing family doctor coverage and community-based solutions mentioned in Xi's speech will be crucial to ensuring this happens. President Xi has heeded the message at the core of our 2013 issue: “Achieving better health outcomes should not be limited to the health sector”. His recognition that health is affected by upstream factors in the wider economy, environment, and working conditions signals a welcome new focus on social determinants of health and public health in China. COPD therapy: if two is good, is three better?Drug therapy for chronic obstructive pulmonary disease (COPD) is simple in principle. Treatment aims to maximise airway calibre and open closed airways to promote lung deflation at rest and during exercise. Additionally, the risk of exacerbations should be minimised either by improved lung mechanics, decreasing the burden of airway pathogens, or reducing the chronic inflammation that characterises COPD. The principles might be clear but the practice has become complex with a plethora of similar drugs delivered alone or in combination once or twice daily. Full-Text PDF