The best science for achieving Healthy China 2030

2016 marks a major milestone in the history of China's health-care reform. Health has been made an explicit national political priority. In August, the Healthy China 2030 plan was officially approved by China's Central Committee, and President Xi Jinping called for putting health at the heart of the country's entire policy making endeavour to ensure the health of the Chinese population. In President Jinping's remarks at the national meeting on health, crucial health issues such as environmental health and meeting the challenges of an ageing society were all addressed. Health-care reform was also acknowledged to be approaching a very difficult stage with tremendous challenges. In response to these challenges, The Lancet today publishes its seventh annual China-themed issue, which will be launched at the second The Lancet-CAMS (Chinese Academy of Medical Sciences) Health Summit on Oct 30–31, 2016, in Beijing. Coincidentally, several key concerns raised in President Jinping's speech are also echoed in the latest China-themed issue. First, Dong Xu and colleagues provide recommendations to accelerate China's contributions to global health from the perspective of several leading universities in China in collaboration with the University of Washington. Notably, the Chinese Consortium of Universities for Global Health was created in 2013, and has expanded to now include 18 member institutions. Chinese universities are called upon to proactively establish stronger partnerships not only with institutions in high-income countries, but also in low-income and middle-income countries. Second, a Review and a Comment in this issue discuss the most concerning environmental health problems—air pollution and unprecedented urbanisation—in China today. Wei-Jie Guan and colleagues review the effect of air pollution on the burden of chronic respiratory diseases in China and highlight several urgent and practical interventions, such as the healthy cities strategy. Despite these recommendations, however, Bing Xu and colleagues contend that the development of healthy cities in China faces challenges from severe environmental pollution, rural to urban migration, and diet and lifestyle changes accompanying rapid urbanisation and industrialisation. Encouragingly, a Lancet Commission on healthy cities in China aims to address these challenges. Led by Peng Gong from Tsinghua University, this Commission is under way and is expected to be published in 2017. It has been 1 year since China formally adopted a universal two-child policy. Yi Zeng and colleagues analyse the potential effects of this policy, and conclude that although the effects should improve health outcomes, the policy may have other effects such as shrinking of the workforce and rapid population ageing, which might not be felt for up to two decades. As such, they argue that more sound policy actions are needed to meet the social and mental health needs of the elderly population. Finally, violence against health professionals in China has repeatedly made headlines during the past decade and is indeed a tragedy for both health professionals and patients. Although the underlying factors for the escalating doctor–patient tensions are complex, one of the key solutions clearly lies in education and training of health professionals. In this issue, Jiming Zhu and colleagues describe and analyse China's health workforce and their clinical residency education, emphasising that the ultimate success of China's ambitious health reform depends on well-educated health professionals who have the clinical, ethical, and human competencies to match the goals for quality and equity in China's health-care system. However, regarding the surgical training of doctors, Yuzhen Jiang and colleagues raise the very interesting question of who will be responsible for China's patients in the future, and point out that the biggest challenge facing young and junior surgical trainees in China is the lack of hands-on learning opportunities. Hence, Chinese senior doctors must take a leading role to cultivate young doctors more actively and efficiently to rebuild a healthy relationship between doctors and patients. The seventh China themed issue provides a unique lens through which to review the progress of China's health-care reform and evidence-based solutions to tackle the most urgent health problems. This effort also represents an ever-deepening engagement between health-care professionals in China and The Lancet family of journals. The Lancet has committed to provide long-term support for local researchers and health professionals. We believe that through bringing together the best scientists in both China and the rest of the world, we can deliver the best medical science. These partnerships can be used as a tool to not only help doctors to practise the best medicine for health for all in China, but also create a fairer and better society. Pursuing excellence in graduate medical education in ChinaUnquestionably, one of China's primary challenges in health-care reform is improving the quality of clinical services.1 Patients who seek quality of care bypass poorly staffed primary care facilities for long waits in congested hospitals. Unsatisfactory quality of care is a major source of conflict between patients and doctors. Health inequity in China is due less to a shortage of health-care workers and more to abundant yet poorly educated service providers, especially in rural areas. That is why seven Chinese Government ministries in 2013 jointly launched the Standardized Residency Training (SRT) programme, which consists of 3 years of residency training after 5 years of medical school. Full-Text PDF Harnessing China's universities for global healthIn 1963, China's medical teams became its signature programme for international health outreach work.1 15 years later, the so-called barefoot doctor approach for training locals in basic medical care2 inspired the global primary health care initiative at Alma-Ata.3 Since 2015, China has launched a series of international programmes: the Cape Town Declaration;1 a new global development fund with an initial US$2 billion;4 and the “six 100s” initiative, which aims to make available 100 programmes for poverty reduction, agricultural cooperation, trade promotion, and environment protection in addition to 100 new hospitals and clinics and 100 schools and vocational projects. Full-Text PDF Healthy cities in China: a Lancet CommissionThe year 2016 marks the 30th anniversary of the concept of healthy cities, which has been promoted by WHO since 1986.1 The movement started in Europe as a way to put health high on the political, social, and economic agendas of cities. It represents a mindset shift from a health-care system centred on disease treatment to one that combines treatment, prevention, promotion of health policy, and a transferral of responsibility from health professionals to the entire society, with an emphasis on the role of local governments. Full-Text PDF Doctors in China: improving quality through modernisation of residency educationThere is growing recognition that the ultimate success of China's ambitious health reform (enacted in 2009) and higher education reform (1998) depends on well educated health professionals who have the clinical, ethical, and human competencies necessary for the provision of quality services. In this Review, we describe and analyse graduate education of doctors in China by discussing the country's health workforce and their clinical residency education. China has launched a new system called the 5 + 3 (5 year undergraduate and 3 year residency [standardised residency training]), which aims to set national quality standards. Full-Text PDF The effects of China's universal two-child policyIn October, 2015, China's one-child policy was replaced by a universal two-child policy. The effects of the new policy are inevitably speculative, but predictions can be made based on recent trends. The population increase will be relatively small, peaking at 1·45 billion in 2029 (compared with a peak of 1·4 billion in 2023 if the one-child policy continued). The new policy will allow almost all Chinese people to have their preferred number of children. The benefits of the new policy include: a large reduction in abortions of unapproved pregnancies, virtual elimination of the problem of unregistered children, and a more normal sex ratio. Full-Text PDF Impact of air pollution on the burden of chronic respiratory diseases in China: time for urgent actionIn China, where air pollution has become a major threat to public health, public awareness of the detrimental effects of air pollution on respiratory health is increasing—particularly in relation to haze days. Air pollutant emission levels in China remain substantially higher than are those in developed countries. Moreover, industry, traffic, and household biomass combustion have become major sources of air pollutant emissions, with substantial spatial and temporal variations. In this Review, we focus on the major constituents of air pollutants and their impacts on chronic respiratory diseases. Full-Text PDF Who will be wielding the lancet for China's patients in the future?Access to high-quality surgical treatment is an indispensable part of a well-functioning health-care system, and as the Amsterdam Declaration on Essential Surgical Care1 has recently emphasised, there are important shortfalls in surgical service in many parts of the world. In recognition of this fact, the Chinese government has made notable recent efforts to standardise surgical training programmes, as part of the National Health and Family Planning Commission's (NHFPC) complete set of model residency training programmes. Full-Text PDF Winnie Yip: tracking health policy and economics in ChinaAlthough not born into an academic family—her father was a Hong Kong businessman—it didn't take Winnie Yip long to discover the rewards of learning. And at the best institutions. A degree in economics from the University of California, Berkeley, was followed, in 1994, by a PhD at the Massachusetts Institute of Technology. Then it was research at Harvard and Oxford and now Harvard again—this time as its newly appointed Professor of the Practice of International Health Policy and Economics. The reward she's acquired over this time is an international reputation in both these topics. Full-Text PDF