Opportunities to improve public health in China

Traffic safety and public health in China – Past knowledge, current status, and future directions

The 2021 China report of the Lancet Countdown on health and climate change: seizing the window of opportunity

Ensuring healthy lives and promoting well-being are paramount among the priorities outlined in the 17 Sustainable Development Goals (SDGs) established by the United Nations. In China, rural revitalization stands as a pivotal national strategy aimed at fostering prosperity and sustainable development in rural areas. Despite its comprehensive evaluation system, which encompasses industry, ecology, culture, organization, and livelihood, the current index system overlooks the critical dimension of public health in rural areas. The existing body of literature predominantly focuses on the correlation between income and health, leaving a gap in understanding the relationship between income inequality and health from the perspective of villagers. This study addresses this gap by utilizing data from 3,771 villager samples and 302 village samples obtained from the 2019 China Rural Revitalization Survey (CRRS) to explore the correlation between income inequality and public health in China's rural areas. We employ the Ordered Logistic Regression (Ologit) model in the baseline regression and heterogeneity analysis. Additionally, a mediating effect analysis, using the Sobel test, examines the role of villagers' health awareness as a mediating variable in the correlation between income inequality and villagers' health. The empirical findings of this study unveil a statistically significant adverse influence of income inequality on public health in China's rural areas. Furthermore, the research identifies that participation in regular exercise and the attainment of higher education levels serve as effective measures to alleviate the detrimental impact of income inequality on the health of rural residents. Additionally, income inequality is observed to shape villagers' health awareness, thereby influencing their overall health status. The study's outcomes have significant implications for policymakers and governmental authorities, providing valuable insights into some pathways for enhancing public health in rural China. Ultimately, these insights contribute to the broader objective of achieving integrated sustainability in rural China.

LANGUAGE NOTE | Document text in Chinese; abstract also in English.衛生保健制度改革之艱難，主要在於要在諸多因素發展勢頭的相互硑撞中維持衛生保健工作的良性發展。衛生保健改革目標的設定，應當着眼於現實，但又必須顧及長遠。為此，它應當是首先有利於為更多的人群提供最基本的保健服務，同時又 能有力地控制保健費用的增長，有利於控制疾病的發生。只着眼於開源或節流，或者只強調衛生服務組織自身的營運，都可能使衛生保健產生更多的麻煩。多方位的雙層或多層的體制是使衞生保健工作適應各方需要的理想構思，它包含多種雙層或多種多層的內涵。在衛生資源有限的情況下，配給是保證為更多的人群提供保健的有效措施，救援則是其重要的補充。現行的醫療服務體系與為最廣大的人群提供基本的醫療保健服務不適應，也與抑制醫療費用上漲的要求不適應，必需有較大力度的改革。衛生保健改革的選擇，必須是道德的，同時又是理性而現實的。Health care costs soar and become unbearable everywhere in the world. This is not only a problem faced by developed Western countries. It is also a difficult issue for the third world countries such as China. China's health care system needs reform. On the one hand, a great number of people have not been covered by any basic health insurance. On the other hand, however, critical care medicine in high-technology hospitals in urban areas consumes tremendous public health care resources for a very small group of patients. This essay argues that China should appropriately establish multiple goals for its health care reform, based on ethical and reasonable deliberations on China's actual health care situation.First, rationing is crucial in containing health care costs. Public health care resources are limited. It is impossible to satisfy all medical needs for all people at all times. This is especially the case for mainland China, where public resources that can be invested in medical care are scarce. An appropriate goal of China's health care reform should be to provide basic, not luxury, health care for the people. Some luxury medical procedures must be left to individuals for purchase through their own resources.Second, a basic level of health care must be ensured to most people, even if it is impossible to ensure to everyone. It is important for everyone to understand that providing the best care for everyone is practically impossible. The best a government can do is to provide some level of basic care. However, the goal here must be the basic health of all or most people, rather than total care for a small group of people.Third, an appropriate pattern of China's health care should be prevention-oriented and ordinary-treatment-oriented, rather than high-technology-medicine-oriented. Since the early 1980s, many hospitals have relied on high-technology medicine to deal with diseases and to earn more income for themselves at the same time. But high-technology medicine is not panacea, though it is extremely costly. Inexpensive medical prevention is often more effective than high-technology medical procedures.Finally, a rule of rescue should be established in society. Society ought to provide some help for those who need special expensive medical care (such as organ transplantation) and are not able to afford it. The rule of rescue guides our efforts in this direction. Society should organize and establish special foundations to help people in this regard.DOWNLOAD HISTORY | This article has been downloaded 21 times in Digital Commons before migrating into this platform.

For a long time, oral disease is one of the major problems of the public health for its high prevalence and incidence throughout the world, which is especially true for low-income populations. Since China's economic reform in 1978, great changes have taken place in China. These changes have significant impact on and have been reflected in oral disease trends in China.This paper provides an overview and assessment of the oral health status in China. It focuses on changes in the nation's demographic profile, in the marketplace, the oral disease status and trends. The paper also suggests some possible measures and strategies for bettering oral health in future China.

Contrary to what most alarmist reports would imply, China has not witnessed a measurable decline in the overall public health status. What explains the continuous improvement in some important domains of public health despite the pertinacious pricing, financing and institutional‐behavioral problems in China's health system change? This study provides a political economy analysis of the role the local Chinese state played in rural public health provision during the reform era. Through comparative case studies, statistical analysis, and formal modeling, the study shows that state capacity is a principal factor setting the parameters for rural public health in China. It also suggests that the post‐Mao reforms, while generating strong disincentives for the provision of public services, unleashed forces that lay down the institutional bases for sustained state engagement in the health sector.

To examine the healthcare policy and the nursing profession in China and to share insights learned from that country, which can be used to inform health-policy decision makers in the US. Despite their significant cultural, political, and historical differences, many healthcare issues are the same for China and the US. Both countries face rising healthcare costs and widening disparities between wealthy and poor individuals, and between urban and rural sectors. Some of the ideas that can be gleaned from China's healthcare system include rewarding physicians for prescribing preventive services; using trained laypeople as gatekeepers to the healthcare system in rural areas; communicating to the public and to health-policy decision makers the importance of nurses so that staffing, work conditions, and professional status can be improved; and including nurses in health-policy decisions. Lessons learned from China's healthcare policy and healthcare system have implications for public health policy change that could lead to improved patient outcomes in the US. The current changing global health environment calls for healthcare providers to learn from and work with our international neighbors to improve health outcomes for all patients.

Decades of gross domestic product-focused economic development has not only made China the world’s second largest economy, but has also led to massive environmental problems, including air pollution, which has been shown to lead to multiple adverse health outcomes. This review paper aims to contribute a better understanding regarding the interactive relationships between ambient air pollution and public health in China, based on a literature review from international journals, public data from government agencies and relevant reports from international organisations. Various studies have been conducted regarding air pollution and public health in China and their outcomes, which are valuable for further investigations and policymaking. However, current knowledge regarding air pollution and public health is still inadequate and has become a key barrier to supporting recommendations for further policymaking. This is despite the fact that China has launched relevant laws, regulations and standards and built about 106 national monitoring sites. Finally, two recommendations in particular are proposed: to enable public participation and improving the executive power of the government for reducing air pollution and to improve public health in China.

This chapter provides a brief review of the development of the healthcare and social security system in China, and the use of specific public health terms and expressions in different historical periods in the country. English translations of selected original Chinese health materials are provided to demonstrate the features and characteristics of the developing Chinese healthcare system since the mid-twentieth century. Discussion on the Chinese health research context and the international health research environment is developed using keyword analysis of Chinese and English publications, a research method which is widely used in corpus linguistics and corpus translation studies.

Katherine A. Mason, Infectious Change: Reinventing Chinese Public Health After an Epidemic. Stanford: Stanford University Press, 2016. 272 pp.Severe acute respiratory syndrome (SARS) first appeared in late 2002 in southern China. Symptoms of infection with the novel coronavirus include high fever, body aches, and a dry, nonproductive cough. A proportion of cases require intensive care services, including mechanical ventilation. Fatalities not uncommon. Following cases reported in Guangdong Province and Hong Kong during February-March 2003, more cases emerged in Beijing and farther afield, with infected travelers seeding hotspots in global centers such as Toronto, Singapore, and Hanoi. By the end of July 2003, more than 8,000 suspected and confirmed cases of were identified in 29 countries, resulting in 774 deaths.In Infectious Change, Katherine A. Mason provides a captivating analysis of public health in China in the wake of SARS. Mason's research is situated at the regional epicenter of the pandemic, in the city of Tianmai (pseudonym), nestled on the border with Hong Kong. Once a conglomeration of quiet fishing villages, Tianmai rapidly developed through statesponsored economic liberalization initiated in the early 1980s. Now a thriving megapolis, Mason takes Tianmai as representative of China's future: busy, mobile, and cosmopolitan (32). Working from the Tianmai Center for Disease Control and Prevention (CDC), Mason is ideally placed to research the reinvention of public health in China after SARS, and her work is further informed by public health experts in Guangzhou, Hong Kong, and Beijing.Mason locates her analysis of public health in China after within the intersection between the literature on governance, science studies, public health ethics, and the global. Broadly, she examines the tension between service and governance during an era of scientization and global health. This tension exposes new problematics in the lives, work, and aspirations of public health professionals, as they seek to serve commons locally and afar. Mason's work also offers an important underrepresented vantage to understand global health, one that is neither from the perspective of the drivers of global health nor from the recipients of global health assistance. Mason's Chinese informants are non-Western, but they aspire in some ways to be included in the Western world (28). She argues that local public health professionals' efforts to serve and govern must be understood within both local and global webs of engagement. Her work follows as a skillful navigation of disparate fields of engagement, local and non-local, which in combination provides a comprehensive, grounded analysis of public health practices in China.Mason begins by laying down the historical and contextual foundation from which to understand what is meant by a reinventing of Chinese public health. Soon after the founding of the People's Republic in 1949, China implemented a public health system drawing on Soviet expertise. The public health system focused on improving hygiene and sanitation, with the aim of eliminating the primary causes of morbidity and mortality. Since the market reforms initiated in the late 1970s and 1980s, the public health system, like many other public services, was dismantled. Funding was dramatically reduced, health insurance coverage levels plummeted, and marketization painted a new healthcare landscape. By the turn of the century, Chinese officials sought to reincarnate public health as a modern, science-driven system, fashioned after the US CDC. The emergence of dovetailed with reforms already underway, and as Mason aptly points out, SARS and the [Chinese] CDC system were 'co-produced' (13), as SARS ultimately functioned...to provide not so much a threat or a push but an opportunity (33).Mason's work captures the tensions, aspirations, and possibilities engendered by this critical turning point. …

The Annual Report on Cardiovascular Health and Diseases in China (2022) intricate landscape of cardiovascular health in China. This section dissects cardiovascular risk factors in China which including hypertension, dyslipidemia, diabetes mellitus, chronic kidney disease, metabolic syndrome and air pollution. Hypertension prevalence has steadily increased in China, with efforts to control it facing challenges in achieving optimal rates, especially in rural areas. Interventions like salt substitutes and intensive blood pressure control show promise but need improvement. Abnormal lipid levels, indicative of dyslipidemia, have risen significantly, posing a risk for cardiovascular diseases. Despite efforts, many patients struggle to achieve target lipid levels, necessitating improved treatment strategies. Both type 1 and type 2 diabetes mellitus affect millions of adults in China, with long-term complications adding to the disease burden. Early intervention and effective management are crucial to mitigate its impact. Prevalent among older adults, chronic kidney disease is associated with diabetes mellitus, hypertension, and cardiovascular diseases, necessitating comprehensive management approaches. The prevalence of metabolic syndrome, characterized by a cluster of risk factors, has increased in both adults and adolescents, calling for lifestyle modifications and public health interventions. Ambient and household air pollution remain significant environmental risk factors, despite some improvements in air quality. Continued efforts to reduce emissions are essential for mitigating associated health risks. Addressing these risk factors requires a multifaceted approach, including public health initiatives, policy interventions, and individual-level strategies to promote healthy lifestyles and reduce environmental exposures. Surveillance and research efforts are crucial for monitoring trends and developing effective strategies to lessen the burden of cardiovascular diseases in China.

SINCE CHINA is a great country with a population of more than 600 million and a territory as big as the United States, its accomplishments in medicine and public health during the last 10 years are worthy of study. To cope with the demand of national industrialization and reconstruction, much attention has been paid to public health and medicine in an effort to prevent disease and promote health and thus increase productivity. Since public health practice is closely related to political systems and governmental structures, in addition to indicating actual achievements, it serves as an indirect reflection of the political and socioeconomic status of present-day China. The main sources of the information in this article are various medical and public health journals published in Chinese and English during the past 10 years. The Chinese Medical Journal of the Chinese Medical Association has a complete English edition. Also, many journals of the various medical specialties print English abstracts. English translations of scattered articles from original Chinese medical publications have been published by the U.S. Department of Commerce in the past 2 years. They are valuable to scientists interested in the details of research in specific fields. It is the primary intention of the author to evaluate critically achievements in medicine and public health in China during the past decade rather than review the literature. Also, I will emphasize achievements and new developments unfamiliar to the Western World and the future trends of medicine and public health in China. Most Chinese and English language publications issued in China have been reviewed as well as reports from nonChinese sources.

Establishing a national health city is an important national policy aimed at optimizing urban environment and improving residents' health. A rigorous evaluation of the policy's impact on China's public health is imperative. Such an evaluation would provide a scientific foundation for the continuous improvement of the policy and enhance the overall health of the population. Based on the panel data of 84 prefecture-level cities in China from 2011 to 2023, this study takes healthy cities as a quasi-natural experiment, and employs a DID model to deeply explore the impact of the National Health City Campaign (NHCC) on public health in China. The research indicates that the policy has led to a decline in mortality rates and has contributed to the enhancement of public health in China to a certain extent. The impact of the NHCC varies across different regions, economic development levels, and population sizes. In addition, this study determined that the NHCC is capable of achieving substantial enhancements in public health levels by promoting the optimization and upgrading of industrial structure. The impact of the sewage treatment rate on public health levels is found to be regulatory in nature. This study is instrumental in enhancing public health policy, providing a theoretical foundation for the development of a healthy city, and plays a pivotal role in the promotion of the Healthy China Initiative.

This chapter briefly reviews the history of public health in China. It then discusses the emerging challenges, describes some of the responses to these public health challenges, and outlines the prospects for public health in China.

The Annual Report on Cardiovascular Health and Diseases in China (2022) intricate landscape of cardiovascular health in China. This is the third section of the report with a specific focus on community-based prevention and treatment of cardiovascular diseases (CVD). This section of the report underscores the importance of initiatives outlined in the "Healthy China 2030 Plan," emphasizing the comprehensive prevention and control strategy for chronic diseases. A key aspect of this plan involves the establishment of national demonstration areas aimed at comprehensive prevention and control of chronic diseases. By 2020, 488 such areas had been set up across China, surpassing the initial target and covering a significant proportion of counties and districts. The report highlights the successful implementation of these strategies in Lishan district, Anshan city, where demonstration areas for comprehensive prevention and control of chronic diseases were launched in 2013. Over the course of seven years, the number of healthy units increased substantially, leading to improvements in managing risk factors for CVD among residents. Significant reductions in prevalence rates of overweight, obesity, smoking, passive smoking, and drinking were observed, along with the development of healthier behaviors among residents. Similarly, Qiaokou district in Wuhan City, designated as a national demonstration area in 2014, implemented comprehensive public health promotion initiatives. Notably, special clinics for hypertension intervention were established, contributing to an increase in self-reported rates of hypertension, a slight decrease in prevalence, and a remarkable improvement in the control rate among treated patients. Overall, these efforts underscore the effectiveness of community-based approaches in driving positive health outcomes and advancing the comprehensive prevention and control of chronic diseases, particularly cardiovascular diseases, in China.