Diet-related NCDs in China: more needs to be done

Abstract

Zhang and Gong in their Comment recently published in The Lancet Public Health1Zhang C Gong P Healthy China: from words to actions.Lancet Public Health. 2019; 4: 438-439Summary Full Text Full Text PDF Scopus (14) Google Scholar 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. International public health organisations and experts are calling for a shift from changing individuals to changing the environment for the promotion of healthy eating.2The Task Force on Fiscal Policy for HealthHealth taxes to save lives: employing effective exercise taxes on tabacco, alcohol, and sugary beverages. Bloomberg Philanthropies, New York, NY2019Google Scholar, 3Marteau TM Changing minds about changing behavior.Lancet. 2018; 391: 116-117Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar Evidence for the effectiveness of environmental and upstream interventions, such as regulation, is rapidly accumulating.4Cabrera Escobar MA Veerman JL Tollman SM et al.Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis.BMC Public Health. 2013; 131072Crossref PubMed Scopus (213) Google Scholar, 5Scheelbeek PFD Cornelsen L Marteau TM Smith RD Potential impact on prevalence of obesity in the UK of a 20% price increase in high sugar snacks: modelling study.BMJ. 2019; 366l4786Crossref PubMed Scopus (28) Google Scholar However, China's main strategies for promoting healthy eating focus predominantly on educational or communication interventions targeted at the individual. Upstream interventions, particularly regulatory ones, have little presence within the current action plan. A great body of research has shown that the link between health knowledge and health behaviour is not linear. Downstream interventions that focus on improving people's health awareness and knowledge have not had great effect in improving people's eating behaviours and reducing related NCDs in other countries.3Marteau TM Changing minds about changing behavior.Lancet. 2018; 391: 116-117Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar Is China going to repeat this costly journey? The good news is policy interventions targeting public environments, such as schools and sport centres, have been recommended for the promotion of physical activity within the action plan. Can more be done for the promotion of healthy eating? I declare no competing interests. Healthy China: from words to actionsWith 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.1 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. Full-Text PDF Open Access