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Policy dialogue on China's changing burden of disease

This study explores the association between urban developments and health in China, a country that has experienced unprecedented economic growth and consequential rapid urbanisation over the last few decades. Exploiting the Chinese Health and Nutrition Survey, this study analyses the effect of these urban developments on the entire distribution of 11 objectively measured health outcomes related to non-communicable diseases. Quantification of the effects on health distribution is achieved by estimating health distribution in a counter-factual situation in which every individual is exposed to the minimum level of urban development. In decomposing the estimated effect into the part attributable to the observed path through which urban developments change observed health-related behaviours (behavioural effect), and the remaining part which cannot be attributable to this observed path (non-behavioural effect), this study sheds light on the mechanisms underlying how urban developments are associated with health outcomes. The results indicate that urban developments are negatively associated in this regard, especially with health outcomes related to body lipids such as triglycerides and cholesterols, blood pressure and kidney-related biomarkers. Furthermore, the results provide strong evidence of heterogeneity in the degrees of association across the distribution.

The incidence of noncommunicable diseases (NCDs) is rising dramatically throughout the world. Aspects of researches concerned with the improvement and development of prevention and control of NCDs have been conducted. Furthermore, the influence of most determinants of the major NCDs has showed that a broad and deep response involving stakeholders in different sectors is required in the prevention and control of NCDs.

China has experienced an increase in NCDs in a short period compared with many countries. To address the burden of NCDs in China, it is important to learn about the progress that has been made in prevention and control of NCDs in China and worldwide, informed by opinions of stakeholders in different areas.

In 2014, GRAND South developed the NCD Scorecard instrument to evaluate progress of NCD prevention and control in 23 countries through a 2-round Delphi process. The scorecard included 51 indicators in 4 domains: governance, surveillance and research, prevention and risk factors, and health system response. Stakeholders were then selected in the areas of government, nongovernmental organizations, private sectors, and academia to join the NCD Scorecard survey. Indicators of progress were scored by stakeholders from 0 (no activity), 1 (present but not adequate), and 2 (adequate) to 3 (highly adequate) and then the percentage of progress in each domain was calculated, representing the current situation in each country.

There were 14 indicators in the domains of governance and surveillance and research. Of 429 stakeholders worldwide, 41 in China participated in the survey. China scored in the top 5 out of all participating countries in those 2 domains, scoring 67% in governance and 64% in surveillance and research. Indicators on which China scored particularly well included having a well-resourced unit or department responsible for NCDs, having a strong national system for recording the cause of all deaths, and having a system of NCD surveillance. Areas where China had the greatest need for improvement included increasing taxes on tobacco and addressing the needs of the population older than age 70 dying from major NCDs.

In China the burden of disease of NCDs and disabilities remains serious, although China has put significant efforts into its governance and surveillance and research. To improve, further action is needed on reducing tobacco consumption, increasing investment in the national health budget, and increasing the focus on system construction.

China is encountering formidable healthcare challenges brought about by the problem of aging. By 2050, there will be 400 million Chinese citizens aged 65+, 150 million of whom will be 80+. The undesirable consequences of the one-child policy, rural-to-urban migration, and expansion of the population of ‘empty nest’ elders are eroding the traditional family care of the elders, further exacerbating the burden borne by the current public healthcare system. The challenges of geriatric care demand prompt attention by proposing strategies for improvement in several key areas. Major diseases of the elderly that need more attention include chronic non-communicable diseases and mental health disorders. We suggest the establishment of a home care-dominated geriatric care system, and a proactive role for researchers on aging in reforming geriatric care through policy dialogs. We propose ideas for preparation of the impending aging burden and the creation of a nurturing environment conducive to healthy aging in China.

This paper examines the relationship between biomedical policies and entrepreneurial R&D strategies. Public health programs have been unable to provide effective and affordable treatment of infectious diseases for the poor. While governments have become more open to private sector contributions to policy objectives, it is rare to find new ventures commercializing healthcare innovations for neglected diseases. Two case studies of entrepreneurial ventures, in the UK and China, provide evidence on how resource-constrained firms mobilize participants in policy-specific ecosystems to achieve their goals of new vaccine development for tuberculosis. Ecosystem analysis reveals how the innovators’ business models can align their strategies with national policy objectives.