China ‘can show the world the way’

China Daily (Canada) - - PEOPLE -

China is a global eco­nomic power and wants to con­trib­ute more, which shows it is tak­ing up its re­spon­si­bil­i­ties as a global power.”

pres­i­dent of

Ce­cily Liu

China can be a role model for the world in ex­tend­ing the cov­er­age of health­care, and mak­ing it more eq­ui­table, said Lin­coln Chen, pres­i­dent of the China Med­i­cal Board.

The coun­try’s health­care in­surance is be­com­ing in­creas­ingly univer­sal, and as the world in­te­grates eco­nom­i­cally, China is well placed to pass on its ex­per­tise in health­care to de­vel­op­ing coun­tries, Chen told China Daily.

“China started in the 1950s by send­ing med­i­cal teams to de­vel­op­ing coun­tries, and China’s health teams now cover al­most 50 coun­tries. China is also in­tel­lec­tu­ally en­gaged in global health is­sues,” he said.

China dis­patched 55 med­i­cal teams with 3,600 work­ers to nearly 120 med­i­cal cen­ters in re­cip­i­ent coun­tries be­tween 2010 and 2012, ac­cord­ing to the Chi­nese gov­ern­ment. They trained tens of thou­sands of lo­cal med­i­cal staff, which has re­lieved to some ex­tent the short­age of med­i­cal ser­vices in re­cip­i­ent coun­tries.

Over the same pe­riod, China spent 200 mil­lion yuan ($30.7 mil­lion) to pro­vide an­ti­malaria medicines, H1N1 in­fluenza vac­cines and cholera vac­cines free to other de­vel­op­ing coun­tries. It also held train­ing in the preven­tion of in­fec­tious dis­eases.

“China is a global eco­nomic power and wants to con­trib­ute more, which shows it is tak­ing up its re­spon­si­bil­i­ties as a global power,” Chen said.

More­over, med­i­cal aid is rel­e­vant for China’s lead­er­ship in re­gional in­te­gra­tion projects such as the Belt and Road Ini­tia­tive, through which China hopes to fa­cil­i­tate trade and in­vest­ment ex­changes be­tween Europe and Asia through in­fra­struc­ture in­vest­ment.

“You can­not con­struct a high­speed road with­out see­ing the health im­pli­ca­tions, whether it’s pa­tients’ mi­gra­tion, epi­demic dis­ease con­trol or pen­e­tra­tion into back­ward re­gions,” he said.

Chen, who trained as a doc­tor at Har­vard Med­i­cal School, spent his early ca­reer work­ing in hos­pi­tals and on health­care projects around the world be­fore be­com­ing pres­i­dent of the New York-based China Med­i­cal Board 10 years ago.

The board, es­tab­lished in 1914 with fund­ing from the Rock­e­feller Foun­da­tion, works with many Chi­nese med­i­cal schools to pass on ex­per­tise, and pro­vide train­ing and schol­ar­ship. It is the key or­ga­ni­za­tion that fi­nances Pek­ing Union Med­i­cal Col­lege in Bei­jing.

Chen said China’s cur­rent bud­get aid to de­vel­op­ing coun­tries, is bi­ased to­ward build­ing hos­pi­tals and pro­vid­ing med­i­cal teams, but the train­ing of doc­tors and build­ing ex­per­tise are equally valu­able.

For ex­am­ple, when vis­it­ing den­tal and op­ti­cian vo­ca­tional train­ing cen­ters in ru­ral Sichuan prov­ince, he re­al­ized such a model of train­ing could be use­ful to other de­vel­op­ing coun­tries, and should be “more widely prop­a­gated”.

Com­pared with de­vel­oped coun­tries, where den­tists and op­ti­cians re­ceive col­lege de­grees, the vo­ca­tional train­ing model in Sichuan rec­og­nizes that not all den­tists and op­ti­cians have to be as highly ed­u­cated as univer­sity grad­u­ates, as long as the vo­ca­tional train­ing gives them essen­tial skills to per­form their jobs.

China “will be looked to as a world leader in the meet­ing of the Sus­tain­able Devel­op­ment Goals”, Chen said. The 17 goals were es­tab­lished by the United Na­tions Sus­tain­able Devel­op­ment Sum­mit on Sept 25 last year.

Of the 17 goals out­lined, the first six deal with health dis­par­i­ties, pri­mar­ily in de­vel­op­ing coun­tries. They are poverty re­duc­tion, hunger and food se­cu­rity, health, ed­u­ca­tion, gen­der equal­ity, and wa­ter and san­i­ta­tion.

Per­haps this is of no sur­prise con­sid­er­ing that China has made sig­nif­i­cant con­tri­bu­tions to the UN Mil­len­nium Devel­op­ment Goals adopted in 2000, the fore­run­ner of the Sus­tain­able Devel­op­ment Goals, which mainly fo­cused on growth and re­duc­ing poverty.

“I think the most im­por­tant as­pect of achiev­ing ef­fi­ciency and eq­uity in health­care cov­er­age is to al­low peo­ple to drive for­ward the agenda of their own coun­tries,” Chen said.

“China re­spects the sovereignty of other coun­tries, so the next step would be in­vest­ing in the ca­pac­ity of tal­ented lead­ers in other coun­tries.”

On top of pro­vid­ing aid and de­vel­op­ing ta­lent in other economies, China would also cre­ate many ben­e­fits if it can fa­cil­i­tate pub­lic health dis­cus­sions among de­vel­op­ing coun­tries and use its in­flu­ence to make de­vel­op­ing coun­tries’ key con­cerns heard.

One such ex­am­ple of con­cern could be the health im­pli­ca­tions of the US-led Trans-Pa­cific Partnership agree­ment on de­vel­op­ing economies, as TPP has a con­ser­va­tive stance on in­tel­lec­tual prop­erty pro­tec­tion that could lead to pro­tec­tive mea­sures that re­duce the ac­ces­si­bil­ity of drugs to de­vel­op­ing coun­tries, he said.

Chen said he is hope­ful about changes to health­care in China, be­liev­ing they can lead to in­creas­ingly more eq­ui­table univer­sal cov­er­age.

“The cur­rent health­care re­form be­gan in the ’90s, cov­er­ing such ar­eas as in­surance pro­tec­tion, pri­mary health­care, pub­lic health, phar­ma­ceu­ti­cals, and re­forms of ma­jor hos­pi­tals. The re­forms are mak­ing some progress be­cause the gov­ern­ment gives pri­or­ity to health­care,” he said.

In more re­cent years, the Chi­nese gov­ern­ment’s pro­posed health­care re­form agenda has fo­cused on in­creas­ing in­surance cov­er­age, im­prov­ing pri­mary care and en­cour­ag­ing pri­vate sec­tor pro­vi­sion of health­care to com­ple­ment pub­lic pro­vi­sion, all of which are fo­cus points of China’s 13th Five-Year Plan (2016-20).

Chen said he sees one key chal­lenge for China’s re­forms be­ing the build­ing of the pri­mary care sys­tem.

There is a short­age of qual­i­fied general prac­ti­tion­ers, and the pay in­cen­tives in this sec­tor are in­suf­fi­cient, es­pe­cially to motivate general prac­ti­tion­ers to move to grass­roots ru­ral clin­ics.

“The big hos­pi­tals are flooded with pa­tients, most of whom could have their con­di­tions taken care of at lower lev­els. Pri­mary care and big hos­pi­tals are two sides of the same coin that need to be smoothed out over the com­ing years.”

Talk­ing to doc­tors at hos­pi­tals has made him re­al­ize that they are of­ten un­der heavy stress from the pa­tient load, which can be as high as 50 pa­tients in half a day.

“There are too many pa­tients, with lim­ited time for ex­am­i­na­tions and di­ag­no­sis, and doc­tor-pa­tient com­mu­ni­ca­tion can be poor. This then leads from the pa­tients’ per­spec­tive to lack­ing trust in doc­tors and hos­pi­tals. This is es­pe­cially the case when they feel they are get­ting over­charged and have long wait times.”

Chen sees China’s in­creas­ing in­surance cov­er­age as en­cour­ag­ing, es­pe­cially the gov­ern­ment’s ef­forts to fo­cus on ex­tend­ing cov­er­age to ru­ral cit­i­zens, eth­nic groups and other low­in­come com­mu­ni­ties.

The Chi­nese gov­ern­ment’s method for chan­nel­ing fund­ing into pri­mary health­care by mak­ing in­surance re­im­burse­ment for cer­tain treat­ments avail­able only at the pri­mary level is also en­cour­ag­ing, Chen said.

The pol­icy means pa­tients who by­pass pri­mary level clin­ics and re­ceive treat­ment at big hos­pi­tals will need to pay more.

An­other key change that could dra­mat­i­cally lead to China’s health­care im­prov­ing is the devel­op­ment of a mul­ti­dis­ci­plinary ap­proach to health­care ed­u­ca­tion, he said.

“Today China’s med­i­cal schools fo­cus strictly on the tech­ni­cal­i­ties of dis­eases, but ed­u­ca­tion needs to rec­og­nize that other fac­tors like food, ed­u­ca­tion and en­vi­ron­ment also af­fect pub­lic health.”

This is par­tic­u­larly true as China is ex­pe­ri­enc­ing fewer risks in in­fec­tious dis­eases and more prob­lems with ill­nesses that pre­dom­i­nate in de­vel­oped economies such as obe­sity, di­a­betes and cancer.

Con­tact the writer at ce­cily.liu@mail.chi­nadai­lyuk.com

CE­CILY LIU / CHINA DAILY

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