Healthy China 2030,a breakthrough for improving health

Why has Healthy China 2030 been proposed?

China has the largest population in the world, with a population of over 1.37 billion and increasing health-related issues that affect the healthy development of the population in the world. The Chinese government has made remarkable achievements in improving its people’s physical fitness and reducing diseases, especially the first revolution for promoting the whole society to participate in a mass patriotic health campaign that focused on disease prevention and control shortly after the founding of new China. According to World Bank data, China’s per capita life expectancy increased to 66.86 years from 35 during 1950–1980, and China completed the first health revolution within 30 years (1). At the Alma-Ata conference in 1978, the World Health Organization recommended the Chinese health development pattern to the world as a model of primary health care.

However, China still faces various challenges brought by industrialization, urbanization, an aging population, the environment, and changes in lifestyles in spite of its booming economy and an improvement in its people’s well-being. This is a critical period in China’s reform of its health system since the end of the last century. In light of the difficult and/or high cost to access medical services, as well as an increase in the prevalence of chronic disease, there are many health-related issues waiting to be resolved. It is urgent to take effective measures to deal with these changes. In the meantime, other countries, such as the United States, Japan, and Canada have provided successful experiences in formulating and implementing long-term health strategies based on national health system research (2–6). Thus, China has embarked on a long-term health strategy of its own – Healthy China 2030.

What is Healthy China 2030?

Healthy China 2030, released by the Communist Party of China Central Committee and the State Council on 25 October 2016, aims to enhance its people’s health through promoting healthy lifestyles, optimizing health services, improving health security, building a healthy environment, and developing health industries. The plan covers areas such as public health services, environment management, the medical industry, and food and drug safety based on the country’s new development concepts: innovation; environmental concern; coordination; and open and shared growth. To be specific, there are four core principles in the plan. The first puts health as a priority. The concept of health has the priority in social development under certain circumstances. Secondly, there is a focus on innovation. Reform in key areas could be accelerated on the condition of market regulation combined with government leadership. The third principle is to foster scientific development in disease prevention, control and treatment, as well as development of traditional Chinese medicine and Western medicine. In addition, the service mode needs to change to reduce gaps in people’s basic health services. Lastly, fairness and justice require a focus on rural areas, promoting an equal share of the basic medical and health services in all populations.

There are 12 major indices for health in the plan: five health level indices; one healthy life index; three health service and health security indices; two healthy environment indices; and one health industry index (7).

Healthy China 2030 stipulates a number of specific goals to be reached by 2030, such as: increasing Chinese citizens’ life expectancy to 79 years; reducing the infant mortality rate from the current 8.1 per 1,000 to 5 per 1,000 and the mortality rate of children below five years old from 10.7 per 1,000 to 6 per 1,000; and reducing the mortality rate of pregnant and postpartum women from 20.1 out of 100,000 at present to 12 out of 100,000 by 2030. In addition, there should be three registered doctors and 4.7 registered nurses for every 1,000 permanent residents, according to the outline. Tobacco control is also a main goal. According to the outline, the smoking rate of Chinese citizens above 15 years old should be reduced to 20% by 2030.

The plan also aims to further ease people’s financial burden when paying for health and medical treatment. Currently 29.3% of the citizens’ overall health expenditure is paid by individuals – the plan intends to reduce the percentage to 25% by 2030.

Why is Healthy China 2030 of great significance?

Healthy China 2030 is the first medium–long term strategic planning in health at the national level since the founding of new China. Compared with the other documents released before, it has the following significance:

Firstly, it represents an ideological change of government from focusing mostly on economic development to a health-centered coordinated development of economy and ecology. People’s health level is an important symbol of a country because health is crucial to social wealth. China has always paid attention to the people’s health, and now gives full consideration to the whole lifecycle based on the National Primary Public Health Service Equalization Project. Health in all policies (HiAP) in China aims to establish a comprehensive health impact assessment evaluation system for systematically assessing the economic and social development planning and policies, and the impact of certain projects on health, in order to appeal to all sectors to make decisions based on the awareness of the universality and complexity of social determinants of health. HiAP will help China to develop its economy scientifically and in an environmentally friendly way, which is the key for China’s construction of a well-off society.

Secondly, it transforms the health services pattern from disease treatment to health promotion and health management. The plan added that future efforts should focus on promoting healthy lifestyles, optimizing health services, improving health security, building a healthy environment and developing health industries from the view of basic determinants of health. In order to promote and popularize healthy lifestyles, health education will be strengthened and physical exercise will be widely advocated among all citizens who will enjoy various exercise services such as walking trails, exercise centers, and stadiums that hold about 2.3 square sports ground area per capita by 2030. Additionally, the implementation of equalization of basic public health services provides urban and rural residents with guaranteed access to the most effective basic health services. The public health service system will be adjusted and improved, so that ordinary residents will have their health problems diagnosed earlier and so get earlier treatment. The plan also aims to further ease people’s financial burden when paying for health and medical treatment by reducing the percentage of overall health expenditure paid by individuals. Moreover, major policies to fight environmental pollution and make environments healthy, are crucial to disease prevention and health.

Thirdly, the government will play a leading role and the whole public will be mobilized to participate. The health of the whole society cannot leave out the efforts of everyone, despite leadership coming from the administrative department of health. ‘To construct jointly and to enjoy together’ is the basic route of Healthy China 2030. Every sector, including health-relevant departments and social organizations, will be united in the construction under the economic and social development plans and some of the leading policies or measures. As for individuals, improving health literacy and leading healthy lifestyles to prevent disease will benefit the whole society. Lastly, a new health industry will be encouraged. Multiple sources of information will open a bigger market for the fitness and leisure industry, rehabilitation and assistive products industry, and other health-related industries. The State Council has issued a plan to develop the fitness and leisure industry, including daily fitness activities, outdoor sports, sports tourism, and Internet Plus, setting up a goal to increase the output of the sector to more than three trillion yuan ($442.5 billion) by 2025 (8). Additionally, by 2030, 16 trillion yuan will be allocated to expand and construct the health promotion industry, for example, by developing cultural industries like the press and publishing, radio and television, digital animation, as well as specializing in sports fitness, keeping traditional Chinese medicine in counseling, rehabilitation and nursing services, providing people with a variety of higher quality health services to meet an increasing variety of health requirements (7).

Where could Healthy China 2030 improve from a health promotion perspective?

Healthy China 2030 is not only an important effort to improve people’s health, but also plays a role in China’s engagement in global health governance and implementation of the country’s commitment to the United Nations 2030 Agenda for Sustainable Development. Beyond these, there are some points that need to be further discussed from a health promotion perspective.

One of the key aspects of health promotion embodied in the Ottawa Charter 1986 definition is that it is a ‘process of enabling people to gain control over their health’. This implies participation in decisions that affect their health. Leading a healthy lifestyle needs to be facilitated by improved housing, food and water, air quality, transportation, and other social and environmental factors (9). Additionally, other studies have shown that developing personal skills (including the actions of health education, health communications, and training and skills development) is an ineffective strategy if implemented in isolation from other strategies. Personal skills development must be combined with other strategies for effectiveness (10). In the United States, a broad-based, public engagement initiative, with thousands of citizens helping to shape every step has always been the principle of Healthy People 2020 (11). However, in the Chinese context, it is very challenging to achieve because of a host of factors. Although the language of citizen participation is used, citizens can merely get involved through developing their personal health skills, doing physical activities and keeping a heathy behavior in a certain range. For example, fossil fuels are still the choice of many factories and the vast Chinese rural areas, even though the combustion of these fossil fuels can produce sulfur dioxide and nitrogen dioxide pollution of the environment. Chinese citizens protect themselves from severe air pollution mostly by wearing masks and staying inside, which are palliative strategies. There have been other dilemmas associated with economic development that affect quality of life. There are many kinds of entertainment and recreation for city dwellers nowadays, but in some rural areas, especially northwestern China, the basic survival problem is still not resolved, not to mention leading a healthy life. From a health promotion perspective, creating structural-level conditions to support health and increasing access to goods, products and services are needed to ensure the effectiveness of personal skills, especially in rural areas (10).

There are also contradictions set up by focusing on healthy lifestyles – for example, many food, tobacco, and alcohol industries will lose money when people reduce consumption of these products. China signed the Framework Convention on Tobacco Control at the 56th World Health Organization Assembly in 2003. The effects of tobacco control actions are not admirable after years of struggling. One of the professors from the China University of Political Science and Law believed that the biggest obstacles to tobacco control stem mainly from tobacco companies and other interest groups, which used the revenue generated from taxation of tobacco products as an excuse to continue pursuing profit and putting the tobacco control work into an obscure position (12). Therefore, having the focus restricted to healthy lifestyles is an ineffective strategy to maintain health. There are challenges of putting so much weight on individual lifestyle change in Healthy China 2030. Policies to restrict the sale of tobacco, alcohol, and salty and highly sugared products would go further to reduce related diseases than expecting individuals to combat temptation on a daily basis. However, Healthy China 2030 lacks clear policies or rules for consumption of these products or restrictions on these industries (7).

As for policies, the plan set plenty of goals or actions from a medical view, including the medical care system, technology, quality and level of medical practice, food and medicine, medically-related fitness, and so on. Improvements to the environment are mainly focused on public safety, pollution from air, water and soil, but in a guiding way. Although HiAP is advocated in China, attention is rarely paid to other social sectors except health sectors. Solid policies and relevant laws concerning healthy food, and reducing tobacco consumption, air pollution, soil and water pollution are still waiting to be carried out. What we have are regulations which are weak in the current social context.

Other challenges still remain, for some of the indicators lack accurate calculation. For example, a life expectancy of 79 nationally is the goal by 2030, but specialized guidance is missing for large and medium-sized cities whose life expectancy is close to or has already reached 80. Premature death caused by major noncommunicable diseases is not considered as an indicator for disease surveillance in China, which is important for the evaluation of the burden of noncommunicable diseases.

Therefore, to improve public health in the construction of Healthy China 2030, integrated health promotion strategies need to focus on the following rules: 1) participation and engagement of all people in decisions that affect their lives; 2) political commitment, funding and infrastructure for a broad range of social policy and health promotion actions; and 3) all strategies require attention to the socio-environmental context (10).