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Offline: The jasmine health revolution
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Offline: The jasmine health revolution
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You don’t expect medical students to wear military uniforms. But a small group of students was neatly attired in formal military dress when we met at Changhai Hospital last week. As an affiliated hospital to the Second Military Medical University in Shanghai, uniforms are an unexceptional part of the culture. The word “military” is a misnomer though. Patients (and doctors) with no military background at all come from all over the nation to this well-equipped, state-of-the-art academic medical centre in the educational heartland of the city (Fudan and Tongji Universities are close by). We talked about the big challenges facing Chinese medicine. Conflicts with patients were a common concern. China’s economic success has raised public expectations. When medicine cannot fully deliver, doctors sometimes pay with their lives. Added to which, the status of doctors in Chinese society is not high. The students wished their government could do more to build “friendship” between doctors and patients.
Corbis
*
Bloomberg via Getty Images
China’s health minister, Chen Zhu, is not oblivious to these anxieties. In 2007, President Hu Jintao declared to the 17th Congress of the Communist Party of China that the government would achieve primary health care for all by 2020. In 2009, the details of his plans were announced. Over 3 years, the focus of the Ministry of Health would be on universal access to health insurance, a national essential drug system, improved primary health care, equitable access to public health services, and pilots of hospital reforms. China’s Government put aside US$124 billion to pay for all this. Chen Zhu has called health care a “humanitarian principle” and “a basic human right”. The health reforms are a “systematic social project”. Part of that project is to raise the social status of health professionals, especially those working in primary care, as well as improve their career development, training programmes, and benefits. Will the 2020 deadline be met? It is ambitious, but I would not bet against it. *
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One question asked at the end of a meeting with over 250 Changhai doctors was how The Lancet differed from the New England Journal of Medicine. This is potentially dangerous ground. But I did ask myself later what the answer might be. When I look at submissions of research 796
papers, for example, does the NEJM differ very much from us? We may have more in common than some think. In 2010, we received 4264 research articles. 1464 came from the USA and the UK, with the USA ahead by 244. When I say “came from”, I mean that the submitting author has selected a main country of origin for the work. The third biggest contributor of research was China (307 papers). India slid in at number 11 (101). We like to think of ourselves as a global journal. And from the point of view of research, in some ways we are—centres of gravity in Europe and north America certainly, but with a rapidly growing counterbalance from Asia. But in other ways we are hardly global at all. Sub-Saharan Africa made up only 3·6% of research papers submitted to us in 2010. The biggest contributor was South Africa (31). Latin America made up just 1·9% of research submissions, led by Brazil (36). The Middle-East had a very shallow footprint indeed—only 1·3% of research papers, with Iran (20) ahead by a long way. But what an astonishing performance by China. * I spent a final morning in Shanghai at the city’s large and impressive public library. There you will find dozens of Chinese medical journals, many of them in English and most of them unseen in the West. One you may see, Frontiers of Medicine in China. Launched in 2007, it was indexed by Medline last year. The journal is a “strictly peer-reviewed” general medical journal. Its content is a mix of clinical and basic research, reviews, and editorials. It has an aspiration that goes well beyond science. In the opening editorial of 2010, the editors wrote that they are “determined to play [their] role in accelerating the pace [of health-care reform] by turning knowledge into action and translating science into practice”. That issue contained a challenging interview with Chen Zhu. As medical students at Changhai Hospital contemplate their future careers, they are entering a period of intense change, one characterised by optimism as well as some concern. While parts of the Middle East erupted in a violent fight for freedom last week, in China there was talk of a jasmine revolution. There is a health revolution too, one that a new generation of medical students will surely take a part in leading. Richard Horton [email protected]
www.thelancet.com Vol 377 March 5, 2011
Offline: The jasmine health revolution
Getty Images
You don’t expect medical students to wear military uniforms. But a small group of students was neatly attired in formal military dress when we met at Changhai Hospital last week. As an affiliated hospital to the Second Military Medical University in Shanghai, uniforms are an unexceptional part of the culture. The word “military” is a misnomer though. Patients (and doctors) with no military background at all come from all over the nation to this well-equipped, state-of-the-art academic medical centre in the educational heartland of the city (Fudan and Tongji Universities are close by). We talked about the big challenges facing Chinese medicine. Conflicts with patients were a common concern. China’s economic success has raised public expectations. When medicine cannot fully deliver, doctors sometimes pay with their lives. Added to which, the status of doctors in Chinese society is not high. The students wished their government could do more to build “friendship” between doctors and patients.
Corbis
*
Bloomberg via Getty Images
China’s health minister, Chen Zhu, is not oblivious to these anxieties. In 2007, President Hu Jintao declared to the 17th Congress of the Communist Party of China that the government would achieve primary health care for all by 2020. In 2009, the details of his plans were announced. Over 3 years, the focus of the Ministry of Health would be on universal access to health insurance, a national essential drug system, improved primary health care, equitable access to public health services, and pilots of hospital reforms. China’s Government put aside US$124 billion to pay for all this. Chen Zhu has called health care a “humanitarian principle” and “a basic human right”. The health reforms are a “systematic social project”. Part of that project is to raise the social status of health professionals, especially those working in primary care, as well as improve their career development, training programmes, and benefits. Will the 2020 deadline be met? It is ambitious, but I would not bet against it. *
Photolibrary
One question asked at the end of a meeting with over 250 Changhai doctors was how The Lancet differed from the New England Journal of Medicine. This is potentially dangerous ground. But I did ask myself later what the answer might be. When I look at submissions of research 796
papers, for example, does the NEJM differ very much from us? We may have more in common than some think. In 2010, we received 4264 research articles. 1464 came from the USA and the UK, with the USA ahead by 244. When I say “came from”, I mean that the submitting author has selected a main country of origin for the work. The third biggest contributor of research was China (307 papers). India slid in at number 11 (101). We like to think of ourselves as a global journal. And from the point of view of research, in some ways we are—centres of gravity in Europe and north America certainly, but with a rapidly growing counterbalance from Asia. But in other ways we are hardly global at all. Sub-Saharan Africa made up only 3·6% of research papers submitted to us in 2010. The biggest contributor was South Africa (31). Latin America made up just 1·9% of research submissions, led by Brazil (36). The Middle-East had a very shallow footprint indeed—only 1·3% of research papers, with Iran (20) ahead by a long way. But what an astonishing performance by China. * I spent a final morning in Shanghai at the city’s large and impressive public library. There you will find dozens of Chinese medical journals, many of them in English and most of them unseen in the West. One you may see, Frontiers of Medicine in China. Launched in 2007, it was indexed by Medline last year. The journal is a “strictly peer-reviewed” general medical journal. Its content is a mix of clinical and basic research, reviews, and editorials. It has an aspiration that goes well beyond science. In the opening editorial of 2010, the editors wrote that they are “determined to play [their] role in accelerating the pace [of health-care reform] by turning knowledge into action and translating science into practice”. That issue contained a challenging interview with Chen Zhu. As medical students at Changhai Hospital contemplate their future careers, they are entering a period of intense change, one characterised by optimism as well as some concern. While parts of the Middle East erupted in a violent fight for freedom last week, in China there was talk of a jasmine revolution. There is a health revolution too, one that a new generation of medical students will surely take a part in leading. Richard Horton [email protected]
www.thelancet.com Vol 377 March 5, 2011