China scores top marks in health commitment: WHO

Margaret Chan, director-general of WHO, addresses at the opening ceremony of the 9th Global Conference on Health Promotion in Shanghai, Nov. 21. (Photo/Xinhua)

From Nov. 21 to 24, the world's weightiest conference on health promotion was held for the first time in China, the country with the world's biggest population and thus the toughest health challenge.

The 9th Global Conference on Health Promotion is currently wrapping up in Shanghai. Led by the World Health Organization (WHO), the conference convenes every four years and rotates host cities for each event. This year, 1,200 participants – including WHO officials and experts, health ministers and Health City mayors – gathered from 126 countries and regions. Solutions for a number of serious issues concerning global health promotion and equality have been discussed, with China playing a central role.

With a per capita GDP of $8,016 in 2015, according to China's National Bureau of Statistics, China is still inarguably a developing country, and it is fighting an uphill battle to lift its levels of national health.

A 2016 report by WHO showed that China is plagued by a high density of fine particulate matter (PM2.5), and the prevalence of cigarettes in China is much greater than the world average. The percentage of China's population with improved sanitation is lower than in emerging economy counterparts Argentina and Brazil. Its density of skilled health professionals is about average among West Pacific countries.

But despite health challenges including and ranging beyond the ones mentioned above, China has made commendable efforts in improving national health, winning accolades from world health officials.

On the conference's opening day, Chinese Premier Li Keqiang, Vice Premier Liu Yandong and Health Chief Li Bin reported China's health progress to WHO Chief Margaret Chan and other attendees.

A few impressive numbers stood out in the report. In just over 25 years, China's total health expenditure increased from merely 11 billion RMB ($1.59 billion) in 1978 to 4.05 trillion RMB ($586 billion) in 2015. The country's basic health insurance system now covers 95 percent of its population, or more than 1.3 billion people – more than the entire population of the African continent. Its national life expectancy has risen from 64 in 1980 to the current 76.3. The rural maternal death rate and rural infant mortality rate have dropped by 77 percent and 84 percent respectively in the past 25 years.

In an 10-minute exclusive interview with People's Daily online, WHO representative to China, Dr. Bernhard Schwartländer, used the word "stellar" three times, while sharing his opinion of China's progress.

"China has lifted hundreds of millions of people out of poverty. Of course, poverty is very much linked to health and the health status of the population. We have seen, over the last generation, a cut in maternal mortality by fourfold. And today, a person living in Shanghai can expect to live longer on average than a person living in the United States of America. These are massive achievements that China has seen," Schwartländer said.

In the interview, he rated China's efforts in curbing child mortality, its vaccine system and hepatitis B control as "outstanding in the whole world," and stated that health insurance coverage in China "is a real success story that we have hardly seen in other countries."

"Virtually every child now born in China – wherever they live, in the eastern cities, in the western part, where people are very poor and very often in rural areas – they [have] basic coverage of vaccines. Also, hepatitis B used to be very prevalent in China, but the young generation born today is virtually hepatitis B-free, which is a stellar success and the best practice in the world," he said.

At the conference, China reiterated its commitment to the "Health China 2030" blueprint. Released in October, the blueprint's 29 chapters set out measurable and ambitious health targets to be achieved by 2030, along with strict guidelines for public health services, environment management and many more sectors.

Schwartländer said he is "very confident" about China realizing its targets. The top reason he cited for that confidence is the nation's strong leadership.

"China's massive increase of expenditures in the health system has led to the coverage of many health services, which are now at a level that we see in many Western countries, richer countries. This is a reflection on the political leadership.

"Also in this conference, we have seen such a dramatic expression of the leadership – that Premier Li Keqiang came to open this meeting, that President Xi Jinping himself has made health a centerpiece of his work. So China clearly has strong leadership. And that, of course, gives great confidence," he said.

His point was echoed by Shin Young-soo, WHO regional director for the West Pacific. In an interview with People's Daily Online, when asked to rate China's efforts in health development on a scale of one to 100, Shin said, "In terms of China's political commitment to improving national health, I can give, very easily, 100. I have never seen – I have worked with many, many different countries, but this great country's top leaders came into the public, declaring that health is a precondition of the country's economic development. That is a very, very strong commitment.

"Based on this commitment, you started to have the 2030 [blueprint] and whole national programs have been planned out. A huge mobilization of national resources [has been made] to restore the national health infrastructure and system, and wonderful achievements in rural health," Shin continued.

Bumpy road ahead

"[The] biggest success comes with challenges as well," Schwartländer noted.

Despite their praise for and confidence in a healthier future for China, WHO officials suggested ways to solve some of the challenges facing the country.

"One of the challenges we see today is, China has a very weak primary care system – that is, the care system in places where people are living. Everyone who gets sick runs to an overcrowded hospital to get care. Maybe they don't need the hospital, because the care they need could be much better delivered by a family doctor living in that community. So that's one of the most important things we have to take on, to ensure that we build a very strong primary care system, " Schwartländer noted.

He continued, "Right now, [there are] still many people whose insurance packages don't cover everything they need. Especially some of the more expensive treatments, like [for] cancer, are not included yet in this insurance package. We have been working very closely with the Chinese government and also insurance companies to make sure that, step by step, they can increase the package ... So not only will everybody have basic access, but what is included – what they can get without having to pay their own money – will increase over time."

Shin commented that China needs to do more in terms of building a tobacco-free society and tackling environmental pollution, the latter of which is already a strong commitment for China, he noted. But he expressed a very tolerant view of the current shortfallings.

"To achieve better health of Chinese people, China needs more time to consolidate what it has achieved. The negative effects are, simply put, the cost of social and economic development. Because China has been developing unprecedentedly in our old world, in a very short time you have become a big economic power. [This] creates a lot of pollution, more people start to live in urban areas, which requires efforts in sanitation and safe water, and urbanization is also creating a new lifestyle. Some [aspects] are not good. People start to eat hamburgers, but traditional Chinese eating is much better.

"This is the process of development. You have developed, then you found a lot of side effects, then you fix them for more development… China has started to identify this issue and work hard on how to solve it. Eventually, I am sure China will settle these issues," Shin said.

Global Cooperation

Shin believes that many of China's experiences can be shared with or exported to foreign countries.

"Many, many countries in the world are carefully watching China. Because this is a huge population, people want to know how you try to improve yourself. So many developing countries are following in China's tracks, like Vietnam and some other Asian countries, watching what China is doing. The Chinese should be very proud of this."

Schwartländer also acknowledged China's overseas health efforts.

"China has been at the lead helping the World Health Organization, for example, to tackle Ebola. Many people died in Africa. China was one of the first to send doctors and nurses and hospitals that could be built in tents, to the places where Ebola was a very, very bad problem. That's the starting point for a new way of collaborating internationally.

"China has been the first country that actually has qualified for what we call the emergency medical team, which will be part of a larger network of such teams that WHO can call upon in case emergencies happen somewhere in the world. They can be quickly dispatched and help our efforts to overcome the crisis," he said.