January 11, 2019 | Erin Bluvas, bluvase@sc.edu

The December issue of the American Journal of Public Health contains a section focused on Public Health in China with articles on topics such as health priorities and a comparison between the health status of the United States and China. It also includes an editorial by epidemiology and biostatistics professor Jihong Liu and Stella Yu (Center for Global Health and Health Policy) on prioritizing the top health issues in China beyond 2018 from a health equity perspective.

As the most populous country in the world with 1.4 billion residents, China has experienced rapid economic growth—particularly since the government established market reform policy in the early 1980s. As a result of this 35-year period of growth, China has become an upper-middle income country.

Today, Chinese people are living longer and healthier lives. Basic health insurance coverage has reached 95 percent and life expectancy at birth has increased by 8.6 years over the past 35 years to reach 76.5 years in 2017. Despite these advances, Chinese residents experience significant health disparities based on residence (rural vs urban), ethnicity, income status and geographic region.

For example, the neonatal mortality rate was two times higher in rural areas (6.9 deaths per 1,000 live births) compared to urban areas (3.5 deaths per 1,000 live births) in 2014. In that same year, infant mortality rates were more than two times higher in rural areas (10.7 deaths per 1,000 live births) than in urban areas (4.8 deaths per 1,000 live births).

In their paper, Liu and Yu outline a number of contributing factors to the health issues facing Chinese residents. High out-of-pocket medical expenditures have become a significant challenge, particularly for senior citizens and those living in poverty. They further note that the older adult population in China is increasing rapidly. Nearly 14 percent of the country’s residents were ages 65 years or older in 2011, and that figure is projected to climb to 35 percent by 2050.

“Against this backdrop, it appears that China will face challenges in further improving its health indicators, an important national goal of Healthy China 2030,” says Liu. 

The authors point to Healthy China 2030 for strategies and concrete action plans for how to achieve specific health objectives. They also discuss the merits and weaknesses of studies that seek to shed light on the challenges China faces as well as make suggestions for alternative approaches.