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China's health reforms revisited
Editorial
China’s health reforms revisited
www.thelancet.com Vol 375 March 27, 2010
Center for Disease Control and Prevention, which included aggressive case finding, vaccine development, and mass vaccination at a speed and scale unparalleled elsewhere. Areas from the 2008 Series that have already seen improvement are greater recognition of migrant workers’ health and introduction of a national organdonor scheme. Furthermore, research output has surged and Nan-Shan Zhong’s PEACE study was voted a Lancet paper of the year for 2008. But inevitably there is unfinished business. Smoking is China’s greatest public health hazard, yet tobacco control efforts are timid and implementation lacks conviction. Ethics, including research conduct and governance, remain a concern. Contamination of infant milk formulas with melamine contributed to continuing disquiet about China’s Food and Drug Administration. And little progress has been seen in human rights or access to general information. The latter point—access to reliable information—is a key determinant for the quality of health care that people in China can expect. Information about health in China is a central theme in today’s Lancet. In Igor Rudan and colleagues’ Article on causes of death in Chinese children under the age of 5 years, a wealth of information was obtained from public databases. This observation should encourage further use of data sources in China and, as Zulfi Bhutta mentions in his Comment, validation of findings. Junfeng Zhang and coauthors’ report on environmental health would not have been possible without recourse to abundant measures of pollution. In other areas, such as incentives for health providers, information is scarcer. Here additional scientific evaluations, such as that by Winnie Yip and colleagues, are required. To evaluate the continuing health-system reforms effectively and efficiently requires a focused approach to metrics, such as that described by Yan Gou and co-authors in their Comment. Whether monitoring child survival, environmental health, or health-system strengthening, China’s outcomes will be judged by the quality, comprehensiveness, availability, and transparency of data reported. This in turn will influence the authority with which the country speaks as a G20 leader. Today’s Lancet provides baselines for comparison in future issues of the journal as we mark China’s progress in health-system reform. ■ The Lancet
The printed journal includes an image merely for illustration AP
In October, 2008, The Lancet Series on Health-care reform in China was launched at The Great Hall of the People in Beijing. The Series described the challenges ahead and envisioned that solutions would be Chinese in origin and nature. At that time we pledged our long-term support to local researchers and health professionals, and extended an invitation for submissions that would contribute to improving health care in China. 18 months later we revisit health care in China with a conference that assesses early signals from the country’s reforms and documents The Lancet’s commitment to the region. This week’s issue and online Comments, compiled in collaboration with the China Medical Board, provide a snapshot of achievements and challenges. Working with the China Medical Board and other colleagues in China has had a profound influence on The Lancet and the platform that we provide to convene individuals and institutions committed to improving health equity and outcomes throughout the AsiaPacific region. For example, a conference on pandemic influenza A H1N1, held in Beijing in August, 2009, by The Lancet Infectious Diseases in collaboration with the Chinese Ministry of Health, brought together health ministers and government officials from 20 countries to share best practice and discuss unified strategies. We acknowledge that as a global medical journal, The Lancet should address matters of importance to health across Asia. To do so with even greater engagement, we have appointed The Lancet’s first Asia Editor, Helena Wang, based in Beijing. Additionally, several initiatives over the coming years, such as The Lancet Oncology’s Asia Oncology Summit in Indonesia on April 9–11, will improve our understanding of and response to health needs in the region. 18 months makes a narrow lens to evaluate healthcare reform for 1·3 billion people, but during this period events have tested the Chinese Government’s will and shown how crucial reform is and how well some parts of the health system have responded. The global financial downturn emphasised the catastrophic cost of medical care for people without insurance in many countries, while at the same time showing China’s unique strength in having a resilient economy that can sustain investment in health. Another step forward was the vigorous response to influenza A H1N1 by the Chinese
See Comment pages 1055, 1056 and 1058 See Perspectives pages 1071, 1073, and 1074 See Articles page 1083 See Review pages 1110 and 1120 See Online/Comment DOI:10.1016/S01406736(10)60003-7, DOI:10.1016/S01406736(10)60241-3, DOI:10.1016/S01406736(10)60398-4
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China’s health reforms revisited
www.thelancet.com Vol 375 March 27, 2010
Center for Disease Control and Prevention, which included aggressive case finding, vaccine development, and mass vaccination at a speed and scale unparalleled elsewhere. Areas from the 2008 Series that have already seen improvement are greater recognition of migrant workers’ health and introduction of a national organdonor scheme. Furthermore, research output has surged and Nan-Shan Zhong’s PEACE study was voted a Lancet paper of the year for 2008. But inevitably there is unfinished business. Smoking is China’s greatest public health hazard, yet tobacco control efforts are timid and implementation lacks conviction. Ethics, including research conduct and governance, remain a concern. Contamination of infant milk formulas with melamine contributed to continuing disquiet about China’s Food and Drug Administration. And little progress has been seen in human rights or access to general information. The latter point—access to reliable information—is a key determinant for the quality of health care that people in China can expect. Information about health in China is a central theme in today’s Lancet. In Igor Rudan and colleagues’ Article on causes of death in Chinese children under the age of 5 years, a wealth of information was obtained from public databases. This observation should encourage further use of data sources in China and, as Zulfi Bhutta mentions in his Comment, validation of findings. Junfeng Zhang and coauthors’ report on environmental health would not have been possible without recourse to abundant measures of pollution. In other areas, such as incentives for health providers, information is scarcer. Here additional scientific evaluations, such as that by Winnie Yip and colleagues, are required. To evaluate the continuing health-system reforms effectively and efficiently requires a focused approach to metrics, such as that described by Yan Gou and co-authors in their Comment. Whether monitoring child survival, environmental health, or health-system strengthening, China’s outcomes will be judged by the quality, comprehensiveness, availability, and transparency of data reported. This in turn will influence the authority with which the country speaks as a G20 leader. Today’s Lancet provides baselines for comparison in future issues of the journal as we mark China’s progress in health-system reform. ■ The Lancet
The printed journal includes an image merely for illustration AP
In October, 2008, The Lancet Series on Health-care reform in China was launched at The Great Hall of the People in Beijing. The Series described the challenges ahead and envisioned that solutions would be Chinese in origin and nature. At that time we pledged our long-term support to local researchers and health professionals, and extended an invitation for submissions that would contribute to improving health care in China. 18 months later we revisit health care in China with a conference that assesses early signals from the country’s reforms and documents The Lancet’s commitment to the region. This week’s issue and online Comments, compiled in collaboration with the China Medical Board, provide a snapshot of achievements and challenges. Working with the China Medical Board and other colleagues in China has had a profound influence on The Lancet and the platform that we provide to convene individuals and institutions committed to improving health equity and outcomes throughout the AsiaPacific region. For example, a conference on pandemic influenza A H1N1, held in Beijing in August, 2009, by The Lancet Infectious Diseases in collaboration with the Chinese Ministry of Health, brought together health ministers and government officials from 20 countries to share best practice and discuss unified strategies. We acknowledge that as a global medical journal, The Lancet should address matters of importance to health across Asia. To do so with even greater engagement, we have appointed The Lancet’s first Asia Editor, Helena Wang, based in Beijing. Additionally, several initiatives over the coming years, such as The Lancet Oncology’s Asia Oncology Summit in Indonesia on April 9–11, will improve our understanding of and response to health needs in the region. 18 months makes a narrow lens to evaluate healthcare reform for 1·3 billion people, but during this period events have tested the Chinese Government’s will and shown how crucial reform is and how well some parts of the health system have responded. The global financial downturn emphasised the catastrophic cost of medical care for people without insurance in many countries, while at the same time showing China’s unique strength in having a resilient economy that can sustain investment in health. Another step forward was the vigorous response to influenza A H1N1 by the Chinese
See Comment pages 1055, 1056 and 1058 See Perspectives pages 1071, 1073, and 1074 See Articles page 1083 See Review pages 1110 and 1120 See Online/Comment DOI:10.1016/S01406736(10)60003-7, DOI:10.1016/S01406736(10)60241-3, DOI:10.1016/S01406736(10)60398-4
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