Strengthening public health for a Healthy China

The Lancet Public Health

DECEMBER 01, 2021
Didier Marti/Getty Images

China’s rapid socioeconomic and demographic changes will profoundly affect the health and wellbeing of its population. 

Preparing the health system and public health responses to old threats and new challenges will be crucial for the country to deliver on its promises-Healthy China 2030. 

This issue of The Lancet Public Health is dedicated to the health of the 1·4 billion people in China, featuring the best research from China and highlighting the most pressing public health issues.

Today, non-communicable diseases are the leading causes of morbidity and mortality in China. 

A series of Articles on cancer, stroke, and injury highlight how tackling risk factors and addressing consistent disparities are important. 

To understand cancer survival disparities in China, Hongmei Zeng and colleagues looked at stage at diagnosis for five common cancers and report differences between men and women and large disparities between rural and urban areas-with important implications for cancer awareness, screening, early detection, and access to care. 

  • China accounts for nearly half of global new cases of gastric cancer. 
  • Ling Yang and colleagues estimate that about 80% of cases of non-cardia gastric cancer and 60% of cases of cardia gastric cancer in China each year could be attributable to Helicobacter pylori infection, and recommend that population-based H pylori screening and eradication be considered for gastric cancer prevention.

This issue also features two analyses from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. 

Qingfeng Ma and colleagues report the burden of stroke and its risk factors. 

In 2019, the burden of stroke remained high with 3·94 million new stroke cases, but age-standardised incidence and mortality rates have decreased since 1990. 

Importantly, this high burden can be reduced through effective prevention strategies against its main risk factors: high blood pressure, air pollution, smoking, and diet. 

Pengpeng Ye and colleagues report the burden of falls in older people. Falls are the leading cause of injury-related mortality in older adults. 

Between 1990 and 2019, the incidence of falls in people aged 60 years or older increased substantially in China, underlying the urgent need to invest in fall prevention strategies to minimise risks and tackle an increasing absolute burden as the population ages.

Indeed, in 2020, the number of individuals aged 60 years and older in China stood at 264 million and is projected to grow to more than 300 million individuals-nearly a fifth of the population-by 2025. 

Such demographic change could overburden China’s health system. Life expectancy is increasing rapidly, particularly in Hong Kong-as described by Michael Ni and colleagues in their careful dissection of the reasons behind Hong Kong’s highest life expectancy at birth. 

While gain in life expectancy is a key indicator of population health, it is crucial to differentiate it from healthy ageing and to factor in the consequent increased demands on health and social care systems.

Alongside healthy longevity, climate change and its centrality to health and wellbeing is probably one of the most important issues that needs much more attention and commitments in China. 

The 2021 China report of the Lancet Countdown on health and climate change unambiguously reaffirms that climate-related health threats are worsening in China and outlines opportunities for a post-COVID-19 green recovery.

Whereas the past 2 years have been marked by COVID-19, fighting traditional infectious diseases remains important for public health in China. 

In June, 2021, China was certified malaria-free by WHO after decades of dedicated efforts and culturally targeted approaches as recalled by Jun Cao and colleagues. 

However, the country is still far from achieving WHO End TB targets, warn Qian Long and colleagues in their Health Policy focused on the health system challenges that impede such success.

China’s health system is still very much disease oriented. Junfang Xu and colleagues detail how to improve China’s public health system to prevent and respond to traditional and emerging public health predicaments. 

Finally, this year’s China issue clearly shows that equity and inclusivity in China’s public health approach are urgently needed to tackle the social determinants of health (as discussed by Zhicheng Wang and colleagues); in particular for rural populations, transgender people (as reviewed by Yezhe Lin and colleagues) and other minority groups, and older people (as discussed by Xin-fa Zhou and Lu Chen in their Comment). 

A more equitable and inclusive healthy China should be the Government’s priority.

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