White pa­per re­leased on pub­lic health

Fol­low­ing is the full text of a white pa­per on pub­lic health re­leased on Fri­day by the State Coun­cil In­for­ma­tion Of­fice.

China Daily (Hong Kong) - - FRONT PAGE -

De­vel­op­ment of China’s Pub­lic Health as an Essen­tial El­e­ment of Hu­man Rights

The State Coun­cil In­for­ma­tion Of­fice of the Peo­ple’s Repub­lic of China Septem­ber 2017

First Edi­tion 2017

Con­tents

Pref­ace

I. En­sur­ing Peo­ple’s Right to Health Based on China’s Con­di­tions

II. Con­tin­u­ous Im­prove­ment of Health En­vi­ron­ment and Con­di­tions

III. Pub­lic Health Ser­vice Ca­pa­bil­ity Im­prov­ing Steadily

IV. Great Im­prove­ment in the Qual­ity of Med­i­cal and Health Ser­vices

V. Im­prove­ment of the Na­tional Med­i­cal Se­cu­rity Sys­tem

VI. Sig­nif­i­cant Im­prove­ment in the Health of Spe­cial Groups

VII. Ac­tive Par­tic­i­pa­tion in Global Health Gov­er­nance and In­ter­na­tional Med­i­cal As­sis­tance

Con­clu­sion

Pref­ace

Health is a pre­con­di­tion for the sur­vival of hu­man­ity and the de­vel­op­ment of hu­man so­ci­ety. The right to health is a ba­sic hu­man right rich in con­no­ta­tions. It is the guar­an­tee for a life with dig­nity. Every­one is en­ti­tled to the high­est stan­dard of health, equally avail­able and ac­ces­si­ble

The Com­mu­nist Party of China and the Chi­nese gov­ern­ment have al­ways fo­cused on the peo­ple’s needs while seek­ing the de­vel­op­ment of the na­tion. Putting the peo­ple first, the Party and the gov­ern­ment work to ful­fill the peo­ple’s as­pi­ra­tion for a bet­ter life, and strive to en­hance the peo­ple’s well­be­ing and all-around de­vel­op­ment. China has al­ways put the peo­ple’s health at the top of its pol­icy agenda, work­ing hard to im­prove the peo­ple’s health and fit­ness, and mak­ing uni­ver­sal health and fit­ness a pri­mary goal of de­vel­op­ment. With years of stren­u­ous ef­fort, marked progress has been achieved in mak­ing the Chi­nese peo­ple health­ier — China is no longer the “sick man of East Asia.” China has made con­tin­ued im­prove­ment in boost­ing the over­all strength of its pub­lic health and med­i­cal ser­vices, and in en­hanc­ing the phys­i­cal fit­ness and health con­di­tions of its peo­ple. China has been hailed as a “role model for de­vel­op­ing coun­tries” by the World Health Or­ga­ni­za­tion in recog­ni­tion of its achieve­ments.

Pros­per­ity for all is im­pos­si­ble without health for all. Health for all is a solemn prom­ise to the peo­ple by the CPC and the Chi­nese gov­ern­ment. Since the Party’s 18th Na­tional Congress in Novem­ber 2012, un­der the firm lead­er­ship of the CPC Cen­tral Com­mit­tee with Xi Jin­ping at the core, China has given top pri­or­ity to im­prov­ing the peo­ple’s health, in­cor­po­rat­ing the de­vel­op­ment phi­los­o­phy of in­no­va­tion, co­or­di­na­tion, green de­vel­op­ment, open­ing up and shared ben­e­fits into the pro­mo­tion and pro­tec­tion of the peo­ple’s right to health. Fo­cus­ing on pro­mot­ing healthy life­styles, im­prov­ing health ser­vices, en­hanc­ing med­i­cal se­cu­rity, build­ing a healthy en­vi­ron­ment and de­vel­op­ing the health in­dus­try, China is striv­ing to en­hance pub­lic health and fit­ness, pro­vid­ing full-life-cy­cle med­i­cal and health ser­vices to its peo­ple. With im­prove­ment in the Chi­nese peo­ple’s right to health, China’s hu­man rights have also seen pro­found progress.

I. En­sur­ing Peo­ple’s Right to Health Based on China’s Con­di­tions

China is a large de­vel­op­ing coun­try with 1.3 bil­lion peo­ple. The CPC and the Chi­nese gov­ern­ment have al­ways at­tached great im­por­tance to de­vel­op­ing the med­i­cal and health ser­vices, to trans­form­ing the de­vel­op­ment model of the health sec­tor, and to re­spect­ing and pro­tect­ing cit­i­zens’ right to health. A mech­a­nism based on China’s con­di­tions to en­sure the peo­ple’s right to health has been put in place.

When the Peo­ple’s Repub­lic of China was founded in 1949, China had a weak med­i­cal and health sys­tem due to low lev­els of de­vel­op­ment in its econ­omy and so­ci­ety. The na­tion had only 3,670 med­i­cal and health in­sti­tu­tions, 541,000 health work­ers and 85,000 beds at health in­sti­tu­tions. The aver­age life ex­pectancy was 35 years. To change this sit­u­a­tion, the gov­ern­ment de­voted great ef­forts to de­vel­op­ing the med­i­cal and health ser­vices, and im­ple­mented guide­lines which stip­u­lated that the health ser­vices were to serve vast ma­jor­ity of the peo­ple, that preven­tion should be stressed, that both Western medicine and Tra­di­tional Chi­nese Medicine (TCM) should be uti­lized, and that health pro­mo­tion and peo­ple’s in­volve­ment should be in­cor­po­rated. The peo­ple were mo­bi­lized to carry out health pro­mo­tion pro­grams, and ba­sic knowl­edge about health­care was widely spread. All this greatly en­hanced the peo­ple’s health, and ma­jor break­throughs were made in med­i­cal sciences. Ch­lamy­dia tra­choma­tis was iden­ti­fied for the first time by Chi­nese sci­en­tists; Chi­nese doc­tors per­formed the world’s first re­plan­ta­tion of a sev­ered limb; and artemisinin, an ef­fec­tive cure for malaria, was ex­tracted in a Chi­nese lab­o­ra­tory.

Fol­low­ing the in­tro­duc­tion of the re­form and open­ing-up drive in 1978, to ad­dress prob­lems such as a se­vere short­age of med­i­cal and health re­sources and a lack of ser­vice ca­pa­bil­ity and low ef­fi­ciency, the gov­ern­ment al­lowed mul­ti­chan­nel fi­nanc­ing for the med­i­cal in­dus­try, and en­cour­aged med­i­cal de­vel­op­ment in var­i­ous forms, by in­creas­ing re­source sup­ply, open­ing up the phar­ma­ceu­ti­cals man­u­fac­tur­ing and cir­cu­la­tion mar­ket, de­vel­op­ing the phar­ma­ceu­ti­cal in­dus­try, and pro­mot­ing TCM. Eco­nomic in­cen­tives were adopted to en­cour­age med­i­cal per­son­nel to en­hance their per­for­mance. At the First Na­tional Health Ser­vice Meet­ing in 1996, a de­ci­sion was made on im­ple­ment­ing the guid­ing prin­ci­ples for health ser­vices in the new era, namely, “fo­cus­ing on the ru­ral ar­eas, pri­or­i­tiz­ing preven­tion, equal em­pha­sis on Western medicine and TCM, re­ly­ing on science and ed­u­ca­tion, en­cour­ag­ing pub­lic par­tic­i­pa­tion, pro­mot­ing pub­lic health, and serv­ing so­cial­ist mod­ern­iza­tion.” In 1998, China be­gan to form a so­cial med­i­cal in­surance sys­tem to cover the ba­sic med­i­cal needs of work­ers. In 2000, it set the goal of es­tab­lish­ing an ur­ban med­i­cal and health­care sys­tem in line with the so­cial­ist mar­ket econ­omy, so that the peo­ple could en­joy rea­son­ably priced, high-qual­ity med­i­cal ser­vices, and thus be­come health­ier. In 2002, the gov­ern­ment re­leased the De­ci­sion on Fur­ther En­hanc­ing Health Ser­vices in Ru­ral Ar­eas. Tak­ing into con­sid­er­a­tion the lev­els of eco­nomic and so­cial de­vel­op­ment in ru­ral ar­eas, the gov­ern­ment de­cided to drive health ser­vices re­form to a deeper level, and put in more fund­ing to ru­ral ar­eas, to pro­vide dif­fer­ent lev­els of med­i­cal ser­vices to ru­ral res­i­dents.

In 2003, un­der the firm lead­er­ship of the Party and the gov­ern­ment, the Chi­nese peo­ple, united as one, won a de­ci­sive vic­tory in their com­bat against the se­vere acute res­pi­ra­tory syn­drome pan­demic. Learn­ing a les­son from this ex­pe­ri­ence, the gov­ern­ment took com­pre­hen­sive mea­sures to im­prove pub­lic health ser­vices, and the preven­tion and con­trol of se­ri­ous dis­eases. Marked progress was made in the preven­tion and con­trol sys­tem for se­ri­ous dis­eases, in the response mech­a­nism for pub­lic health emer­gen­cies, in the de­vel­op­ment of com­mu­nity health­care ser­vices in ru­ral and ur­ban ar­eas, and in the new-type ru­ral co­op­er­a­tive med­i­cal care and ba­sic med­i­cal in­surance for ur­ban res­i­dents.

In 2009, China launched a new round of re­form of the med­i­cal and health­care sys­tem. With the re­lease of the Opin­ions on Deep­en­ing Re­form of the Med­i­cal and Health­care Sys­tem, the gov­ern­ment de­liv­ered a mes­sage that the ba­sic med­i­cal and health­care sys­tem should be avail­able to all cit­i­zens as a pub­lic prod­uct. The non­profit na­ture of pub­lic med­i­cal and health­care was made clear. In the doc­u­ment it was pro­posed that China would de­velop the “four sys­tems” of pub­lic health, med­i­cal ser­vices, med­i­cal se­cu­rity and drug sup­ply and the “eight sup­port­ing mech­a­nisms” of med­i­cal and health­care man­age­ment, op­er­a­tion, in­vest­ment, pric­ing, su­per­vi­sion, tech­nol­ogy and per­son­nel, in­for­ma­tion, and law­based de­vel­op­ment, in an ef­fort to form a ba­sic med­i­cal and health­care sys­tem and pro­mote the all-around, bal­anced, and sus­tain­able de­vel­op­ment of the health sec­tor. Soon after that, China is­sued the Plan for Re­form­ing Key Ar­eas of the Med­i­cal and Health­care Sys­tem (2009-2011) and Plan for Deep­en­ing Re­form of the Med­i­cal and Health­care Sys­tem dur­ing the 12th FiveYear Plan Pe­riod (2011-2015). In th­ese two doc­u­ments, the gov­ern­ment set the goals of the re­form, which were ac­cel­er­at­ing the ba­sic med­i­cal se­cu­rity sys­tem, im­prov­ing com­mu­nity-level med­i­cal and health­care ser­vices, and pro­mot­ing equal ac­cess to ba­sic pub­lic health ser­vices.

Since 2012 China has re­dou­bled its ef­fort to re­form the med­i­cal and health­care sys­tem; it has ac­cel­er­ated the com­pre­hen­sive re­form of pub­lic hos­pi­tals and the price re­form of drugs and med­i­cal ser­vice; it has also im­ple­mented se­ri­ous ill­ness in­surance poli­cies cov­er­ing both ur­ban and ru­ral res­i­dents, adopted a multi-layer di­ag­no­sis and treat­ment mech­a­nism, and im­proved the poli­cies re­gard­ing the pro­duc­tion, dis­tri­bu­tion and use of drugs. On Oc­to­ber 29, 2015, en­hanc­ing pub­lic health and fit­ness was for­mally in­tro­duced in the com­mu­niqué of the Fifth Ple­nary Ses­sion of the 18th CPC Cen­tral Com­mit­tee. In Au­gust 2016, at the Na­tional Health and Fit­ness Con­fer­ence, it was stated that the gov­ern­ment will “fol­low the cor­rect guide­lines for pro­mot­ing health and fit­ness ser­vices, fo­cus on lower-level med­i­cal in­sti­tu­tions, strive to re­form and make in­no­va­tions in the med­i­cal sec­tor, pri­or­i­tize dis­ease preven­tion, lay equal em­pha­sis on Western medicine and TCM, in­cor­po­rate health pro­mo­tion in all poli­cies, and in­volve all cit­i­zens in pro­mot­ing pub­lic health and thereby bring health ben­e­fits to all.” In Oc­to­ber 2016, the state is­sued “Healthy China 2030” Plan­ning Out­line, a guid­ing doc­u­ment on pro­mot­ing pub­lic health and fit­ness, with plans to make the Chi­nese peo­ple health­ier.

The de­vel­op­ment in the field of health ser­vices has brought con­crete ben­e­fits to the Chi­nese peo­ple. The aver­age life ex­pectancy of the Chi­nese rose to 76.5 years in 2016 from 67.9 years in 1981; ma­ter­nal mor­tal­ity dropped from 88.9 per 100,000 per­sons in 1990 to 19.9 per 100,000 per­sons in 2016; and in­fant mor­tal­ity de­clined from 34.7 per 1,000 in 1981 to 7.5 per 1,000 in 2016. The main health indi­ca­tors of the Chi­nese are gen­er­ally bet­ter than the aver­age level of mid­dle- and high-in­come coun­tries, and China has achieved the UN’s Mil­len­nium Goals in this re­gard ahead of sched­ule. Fur­ther­more, China has es­tab­lished a com­plete med­i­cal and health sys­tem that is guided by the Con­sti­tu­tion, based on civil laws and reg­u­la­tions, laws and ad­min­is­tra­tive reg­u­la­tions on health, and lo­cal reg­u­la­tions, and di­rected by the out­lines, pro­grams, and plans of the health sec­tor. The sys­tem has proved ef­fec­tive in main­tain­ing sound doc­tor-pa­tient re­la­tions, ad­dress­ing med­i­cal dis­putes with im­par­tial­ity, and en­sur­ing cit­i­zens’ right to health.

The re­form of the med­i­cal sec­tor has pro­duced no­tice­able re­sults. Within a short pe­riod of time, China was able to achieve the fol­low­ing: de­vel­op­ing the world’s largest ba­sic med­i­cal in­surance net­work that cov­ers all cit­i­zens, pro­vid­ing in­surance for pa­tients of se­ri­ous dis­eases, en­abling pa­tients to re­ceive emer­gency med­i­cal ser­vices, and im­prov­ing med­i­cal as­sis­tance. All this has pro­vided in­sti­tu­tional guar­an­tee that pa­tients have ac­cess to med­i­cal ser­vices. The state has gained ef­fec­tive con­trol over se­ri­ous in­fec­tious dis­eases, has kept the spread of AIDS at a low level, has achieved the tu­ber­cu­lo­sis con­trol target of the UN’s Mil­len­nium Goals ahead of sched­ule, has re­duced the num­ber of schis­to­some in­fec­tions to the low­est level in his­tory, and be­came a po­lio-free coun­try in 2000. China set up the world’s largest on­line di­rect re­port­ing sys­tem of no­ti­fi­able epi­demics and pub­lic health emer­gen­cies in 2015, and the aver­age re­port­ing time has been short­ened to four hours from five days be­fore the in­tro­duc­tion of the sys­tem.

Sig­nif­i­cant progress has been made in de­vel­op­ing a sys­tem of med­i­cal and health­care ser­vices. A ba­sic med­i­cal ser­vices net­work cov­er­ing both ur­ban and ru­ral ar­eas has been put in place, with 980,000 med­i­cal and health in­sti­tu­tions at all lev­els, 11 mil­lion health work­ers, and seven mil­lion beds at med­i­cal in­sti­tu­tions. The state has in­creased its ef­forts to foster more med­i­cal pro­fes­sion­als. A stan­dard­iza­tion train­ing sys­tem for res­i­dent doc­tors is be­ing es­tab­lished, and out­stand­ing fig­ures such as No­bel Prize lau­re­ate in Phys­i­ol­ogy or Medicine Tu Youyou have made sig­nif­i­cant con­tri­bu­tions to so­ci­ety. As more so­cial re­sources flow into the med­i­cal sec­tor, pri­vate hos­pi­tals now ac­count for over 57 per­cent of all hos­pi­tals, mak­ing med­i­cal ser­vices more di­verse. China’s med­i­cal and health emer­gency res­cue ca­pa­bil­ity is among the world’s best. It stood the se­vere test of the Ebola epi­demic, block­ing all in­fec­tious sources from out­side its ter­ri­tory and achieved zero in­fec­tion while Chi­nese med­i­cal teams went on as­sis­tance mis­sions in Africa.

After many years of hard work, a new stage has been reached in China’s med­i­cal and health ser­vices. This has not only made the Chi­nese peo­ple health­ier, but has also cre­ated a model suited to the coun­try’s pre­vail­ing con­di­tions that is able to en­sure peo­ple’s right to health. This model has the fol­low­ing fea­tures:

 Ikbhkbmb­sbg` a^Zema Zg] _bmg^ll' The gov­ern­ment places peo­ple’s health at the fore­front of its de­vel­op­ment strate­gies, based on China’s pre­vail­ing re­al­ity, in­cor­po­rates the aware­ness of main­tain­ing and im­prov­ing peo­ple’s health into the de­ci­sion­mak­ing process of poli­cies and the for­mu­la­tion and im­ple­men­ta­tion of laws and reg­u­la­tions, and strives to achieve sound and co­or­di­nated de­vel­op­ment be­tween healthy life­styles, work­ing con­di­tions, the nat­u­ral en­vi­ron­ment, and the econ­omy and so­ci­ety.

 ?h\nlbg` hg ik^o^gmbhg' The fo­cus on health­care has been shifted from treat­ing ill­nesses to en­hanc­ing peo­ple’s health. Equal em­pha­sis is put on dis­ease preven­tion and treat­ment, and the well-be­ing of both mind and body. Western medicine and TCM have been made com­ple­men­tary to each other. More ef­forts have been fo­cused on the preven­tion and con­trol of chronic, en­demic and oc­cu­pa­tional dis­eases. In or­der to re­duce the oc­cur­rences of ill­nesses, China’s med­i­cal sec­tor is striv­ing to learn more about the pat­terns and de­vel­op­ment of health-re­lated is­sues, em­pha­siz­ing early di­ag­no­sis, treat­ment and re­cov­ery.

 Ghgikh_bm l^kob\^l' The ba­sic med­i­cal and health­care ser­vices will con­tinue to be ba­si­cally non­profit, and made avail­able to all cit­i­zens as a pub­lic prod­uct. Pub­lic hos­pi­tals are the pil­lar of the med­i­cal ser­vice sys­tem, and steps will be taken to en­sure uni­ver­sal ac­cess to pub­lic-health ser­vices.

 >jnZebmr Zg] [^g^_bm _hk Zee' The state will con­tinue to en­sure full cov­er­age of health and med­i­cal ser­vices. Fo­cus­ing on ru­ral ar­eas and com­mu­ni­ties, the gaps in health con­di­tions be­tween ur­ban and ru­ral ar­eas, be­tween dif­fer­ent lo­cal­i­ties and be­tween dif­fer­ent groups will be grad­u­ally nar­rowed, so that every­one has equal ac­cess to ba­sic health ser­vices.  Ngbo^klZe iZkmb\biZmbhg Zg] laZkbg`

h_ [^g^_bml' The gov­ern­ment will con­tinue to as­sume the lead­ing role, while pri­vate or­ga­ni­za­tions and in­di­vid­u­als are en­cour­aged to par­tic­i­pate. The goal is to in­volve all

cit­i­zens in the build­ing and de­vel­op­ment of the med­i­cal care sys­tem, with the ben­e­fits jointly shared by all. The gov­ern­ment will ap­pro­pri­ately han­dle its re­la­tion­ship with the mar­ket, so that the for­mer can play its due role in the ba­sic med­i­cal and health­care sec­tor and that the mar­ket can pro­vide more choices in the non­ba­sic med­i­cal care sec­tor.

II. Con­tin­u­ous Im­prove­ment of Health En­vi­ron­ment and Con­di­tions

China is keen to pro­mote a healthy life­style, na­tional fit­ness and health ed­u­ca­tion, pro­tect food and drink­ing wa­ter safety, and im­prove the en­vi­ron­ment for pro­duc­tion, peo­ple’s life, ecol­ogy and so­ci­ety in or­der to bet­ter guar­an­tee the Chi­nese peo­ple’s right to health.

=^o^ehibg` Z a^Ze­mar eb_^lmre^' In 2007, China launched the Healthy Life­style for All cam­paign, call­ing on the Chi­nese peo­ple to de­velop a healthy diet and en­gage in phys­i­cal ex­er­cises, ad­vo­cat­ing healthy life­style ideas, cre­at­ing a sup­port­ing en­vi­ron­ment for a healthy life­style, and en­hanc­ing the peo­ple’s aware­ness and be­hav­ioral abil­i­ties to de­velop a healthy life­style. By the end of 2016, the cam­paign had cov­ered 81.87 per­cent of coun­ties (dis­tricts) across the coun­try. China pub­lished the Chi­nese Di­etary Guide­lines (2016) that pro­vides healthy di­etary guid­ance to the Chi­nese peo­ple in gen­eral, and to chil­dren and the el­derly in par­tic­u­lar to help them de­velop a bal­anced diet and nutri­tion ab­sorp­tion; the gov­ern­ment has in­ten­si­fied mon­i­tor­ing of the Chi­nese peo­ple’s nu­tri­tional sta­tus and health con­di­tions while keep­ing track of, and is­sue in­for­ma­tion about chronic dis­eases and the peo­ple’s nu­tri­tional sta­tus; it urges the Chi­nese peo­ple to re­duce their salt in­take, and pub­li­cizes in­for­ma­tion on how to pre­vent and con­trol high blood pres­sure; it has adopted mea­sures to im­prove the nu­tri­tional sta­tus of key pop­u­la­tions and in­sti­tuted a nu­tri­tional im­prove­ment plan for com­pul­sory ed­u­ca­tion stu­dents in ru­ral ar­eas as well as nu­tri­tional im­prove­ment pro­grams for chil­dren in poverty-stricken ar­eas; the gov­ern­ment is con­tin­u­ing to tighten con­trol on the use of tobacco and im­ple­ment the WHO Frame­work Con­ven­tion on Tobacco Con­trol. In 2014, Shen­zhen be­gan to ac­ti­vate the Reg­u­la­tions of the Shen­zhen Spe­cial Eco­nomic Zone on Smok­ing Con­trol; in 2015, Bei­jing im­ple­mented the Bei­jing Reg­u­la­tion on Smok­ing Con­trol; in 2017, Shang­hai en­acted re­vised Reg­u­la­tions of Shang­hai Mu­nic­i­pal­ity on Smok­ing Con­trol in Pub­lic Places, ban­ning in­door smok­ing in pub­lic ar­eas. By the end of 2016, 18 ci­ties had adopted reg­u­la­tions on a smoke-free en­vi­ron­ment, cov­er­ing one tenth of the pop­u­la­tion. @bobg` _nee ieZr mh gZmb­hgZe iarlb\Ze

_bmg^ll' Phys­i­cal fit­ness has be­come a na­tional strat­egy, and the work re­gard­ing peo­ple’s phys­i­cal fit­ness has been in­cluded in eco­nomic and so­cial de­vel­op­ment plans, fis­cal bud­gets and an­nual work re­ports of gov­ern­ments at all lev­els. A de­vel­op­ment tra­jec­tory of na­tion­wide phys­i­cal fit­ness “led by the gov­ern­ment, co­or­di­nated among rel­e­vant sec­tors and par­tic­i­pated by all” has taken shape. Since the Na­tional Fit­ness Reg­u­la­tions were pro­mul­gated in 2009, 16 prov­inces and ten ma­jor ci­ties have worked out lo­cal reg­u­la­tions on fit­ness for all, and all of the coun­try’s 31 prov­inces, au­ton­o­mous re­gions and mu­nic­i­pal­i­ties di­rectly un­der the cen­tral gov­ern­ment have worked out provin­cial-level fit­ness-for-all pro­grams. Since 2009, Au­gust 8 has be­come Na­tional Fit­ness Day in China. From 2011 to 2014, 3,405 fit­ness cen­ters, 9,447 com­mu­nity mul­ti­pur­pose sports play­grounds, 2,366 sports parks, 24,879 fit­ness squares and 878 out­door camps were es­tab­lished na­tion­wide, with 1.69 mil­lion out­door fit­ness fa­cil­i­ties in­stalled. Phys­i­cal fit­ness venues and fa­cil­i­ties can be found in com­mu­ni­ties (ad­min­is­tra­tive vil­lages), sub-dis­tricts (towns and town­ships), coun­ties (dis­tricts) and ci­ties (pre­fec­tures).

By the end of 2015, up to 33.9 per­cent of the whole pop­u­la­tion en­gaged in phys­i­cal ex­er­cises on a reg­u­lar ba­sis; the per capita sports venue area reached 1.57 square me­ters; the cov­er­age rate of sports as­so­ci­a­tions at county level and above was 72 per­cent; the num­ber of var­i­ous kinds of ju­ve­nile sports clubs was 7,147; ev­ery ten thou­sand peo­ple shared three fit­ness cen­ters on aver­age, and thus a pop­u­lar na­tional fit­ness net­work was ba­si­cally formed. Ikhfhmbg` gZmb­hgZe a^Zema ^]n\Z&

mbhg' Pub­lic­ity me­dia, such as news­pa­pers, tele­vi­sion, ra­dio, the in­ter­net and other forms of new me­dia are uti­lized for pub­lic health pub­lic­ity, ed­u­ca­tion and con­sul­ta­tion to help peo­ple de­velop a self-tai­lored and self-dis­ci­plined healthy life­style. China cel­e­brates Na­tional En­vi­ron­ment and Health Pub­lic­ity Week ev­ery year; it has pro­mul­gated the En­vi­ron­ment and Health Lit­er­acy of the Chi­nese Cit­i­zens (Trial) and a code of con­duct for Chi­nese cit­i­zens with the slo­gan

“Breathe the same air and get it done to­gether” to im­prove air qual­ity and in­ten­sify pub­lic­ity and ed­u­ca­tion through ba­sic pub­lic health ser­vices and health ed­u­ca­tion, health lit­er­acy pro­mo­tion cam­paigns, the “Healthy Chi­nese” and “TCM in China” ini­tia­tives, and ma­jor theme-day pub­lic health pub­lic­ity. Health aware­ness in both ur­ban and ru­ral ar­eas rose to 10.25 per­cent in 2015 from 6.48 per­cent in 2008. Vig­or­ously pur­su­ing en­vi­ron­men­tal

im­prove­ment. Joint pol­lu­tion preven­tion and con­trol be­tween dif­fer­ent re­gions has been en­hanced; air qual­ity mon­i­tor­ing fa­cil­i­ties at county and district lev­els in the Bei­jing-Tian­jin-He­bei re­gion, the Yangtze River Delta and the Pearl River Delta func­tion as a net­work; a net­work mon­i­tor­ing particle mat­ter (PM) and pho­to­chem­i­cal pol­lu­tants in the Bei­jing-Tian­jin-He­bei re­gion and neigh­bor­ing ar­eas is in full op­er­a­tion. From 2011 to 2015, the na­tion­wide chem­i­cal oxy­gen de­mand, emis­sions of am­mo­nia ni­tro­gen, sul­fur diox­ide, and ni­tro­gen ox­ide de­creased by 12.9 per­cent, 13 per­cent, 18 per­cent and 18.6 per­cent, re­spec­tively. In 2016, the PM 2.5 aver­age con­cen­tra­tion dropped by 6.0 per­cent year on year and the num­ber of days with ex­cel­lent and good air qual­ity in­creased by 2.1 per­cent­age points year on year in 338 ci­ties at the pre­fec­tural level and above. In 2013, China en­acted the Air Pol­lu­tion Preven­tion and Con­trol Ac­tion Plan; from 2014 to 2016, about 16 mil­lion heav­i­ly­pol­lut­ing ve­hi­cles and old ve­hi­cles that couldn’t meet the en­vi­ron­men­tal pro­tec­tion stan­dards were elim­i­nated; all coal-fired gen­er­a­tors have re­al­ized desul­fu­r­iza­tion and den­i­tri­fi­ca­tion; ul­tralow emis­sions have been en­cour­aged, and by March 2017 coal­fired gen­er­a­tors of about 500 mil­lion kw had been im­proved to achieve ul­tralow emis­sions; the Ac­tion Plan for the Preven­tion and Con­trol of Soil Pol­lu­tion has been en­acted, and a com­pre­hen­sive sur­vey of soil pol­lu­tion has been launched; the Rules on En­vi­ron­men­tal Man­age­ment of the Soil of Con­tam­i­nated Sites (Trial) have been pro­mul­gated. A fund for soil pol­lu­tion preven­tion and con­trol has been set up, and from 2016 to 2017, RMB15 bil­lion was ear­marked by the gov­ern­ment for this pur­pose. A na­tional soil en­vi­ron­ment net­work has been pri­mar­ily es­tab­lished, with 22,000 ba­sic mon­i­tor­ing spots and about 15,000 risk-mon­i­tor­ing sta­tions; the Ac­tion Plan for the Preven­tion and Con­trol of Wa­ter Pol­lu­tion has been pro­moted and com­pletely im­ple­mented; the com­pre­hen­sive man­age­ment of the en­vi­ron­ment sur­round­ing the river val­leys has been en­hanced; the en­vi­ron­men­tal pro­tec­tion of the Yangtze River Eco­nomic Belt has been pur­sued, and the in­ves­ti­ga­tion of black and odor­ous wa­ter bod­ies in ur­ban ar­eas has been car­ried out; in 2016, ac­cord­ing to the state-con­trolled mon­i­tor­ing bod­ies of sur­face wa­ter, the pro­por­tion of such spots of Grades I-III reached 67.8 per­cent, while that of in­fe­rior wa­ter bod­ies of Grade V dropped to 8.6 per­cent.

Progress in com­pre­hen­sive man­age­ment of en­vi­ron­men­tal hy­giene in ur­ban and ru­ral ar­eas. The China Healthy Ci­ties and Towns Ini­tia­tive is be­ing pur­sued to largely im­prove liv­ing con­di­tions in ur­ban and ru­ral ar­eas. Ac­cord­ing to a sur­vey in 2012, since the ini­tia­tive was in­tro­duced, the pro­por­tion of stan­dard­ized fairs and mar­kets had risen to 60.6 per­cent from 35.2 per­cent, and the per­cent of res­i­dents who are sat­is­fied with ur­ban ameni­ties and the en­vi­ron­ment in­creased from 30 per­cent to 98 per­cent, with 98 per­cent of them sat­is­fied with the ef­fect of the ini­tia­tive. By the end of 2015, the sewage treat­ment rate in ur­ban ar­eas had in­creased to 92 per­cent while the pol­lu­tion-free treat­ment rate of house­hold garbage in ur­ban built-up ar­eas had reached 94.1 per­cent. Com­pre­hen­sive en­vi­ron­men­tal im­prove­ment had been car­ried out in 78,000 vil­lages, ben­e­fit­ing over 140 mil­lion peo­ple in ru­ral ar­eas; waste treat­ment and re­source uti­liza­tion fa­cil­i­ties had been in­stalled in 61,000 large-scale live­stock and poul­try farms. By the end of 2016, the treat­ment rate of house­hold garbage in ru­ral ar­eas was around 60 per­cent, and the pro­por­tion of ad­min­is­tra­tive vil­lages with sewage treat­ment had reached 22 per­cent. In 2016, 80.4 per­cent of ru­ral house­holds use toi­lets while the rate was 71.7 per­cent in 2012; in some prov­inces in the more de­vel­oped eastern ar­eas the fig­ure was 90 per­cent or higher. Drink­ing wa­ter safety is­sues in ru­ral ar­eas ba­si­cally solved. From 2006 to 2010, the in­vest­ment in safe drink­ing wa­ter projects in ru­ral ar­eas reached RMB105.3 bil­lion, pro­vid­ing safe drink­ing wa­ter to 212 mil­lion ru­ral res­i­dents in 190,000 ad­min­is­tra­tive vil­lages. From 2011 to 2015, RMB121.5 bil­lion from the cen­tral gov­ern­ment and over RMB60 bil­lion from lo­cal gov­ern­ments were ap­pro­pri­ated for safe drink­ing wa­ter projects in ru­ral ar­eas. By the end of 2016, the safe drink­ing wa­ter mon­i­tor­ing cov­ered over 85 per­cent of ru­ral vil­lages, and up to 82 per­cent of ru­ral res­i­dents en­joy cen­tral­ized wa­ter sup­ply. The state has al­lo­cated funds to ar­eas with par­tic­u­lar dif­fi­cul­ties, and raised the sub­sidy stan­dards, such as by ap­pro­pri­at­ing RMB495 mil­lion to pro­vide safe drink­ing wa­ter to over 1,400 monas­ter­ies, 32,300 monks and nuns and 60,000 other res­i­dents with tem­po­rary needs in the Ti­bet au­ton­o­mous re­gion. En­hanc­ing oc­cu­pa­tional health man­age­ment. In 2011, China re­vised the Law of the Peo­ple’s Repub­lic of China on Preven­tion and Con­trol of Oc­cu­pa­tional Dis­eases. Cam­paigns were launched to con­trol and re­duce the haz­ards as­so­ci­ated with fine dust and toxic stuff dur­ing pro­duc­tion pro­cesses

in par­tic­u­lar sec­tors, such as quartz sand pro­cess­ing, as­bestos min­ing and as­bestosprod­uct man­u­fac­tur­ing, gold min­ing, cement man­u­fac­tur­ing, stone-ma­te­rial pro­cess­ing, ce­ram­ics and re­frac­tory-ma­te­rial pro­duc­tion. Cor­po­ra­tions are urged to in­crease in­vest­ment to im­prove pro­duc­tion pro­cesses and pro­tec­tion mea­sures for em­ploy­ees. Op­er­a­tional en­vi­ron­ment and con­di­tions at work­places have been pri­mar­ily im­proved. By the end of 2016, the gov­ern­ment, in ac­cor­dance with the law, had pun­ished the cor­po­ra­tions that re­fused or failed to im­prove their oc­cu­pa­tional health man­age­ment, de­mand­ing 1,524 cor­po­ra­tions to sus­pend pro­duc­tion for rec­ti­fi­ca­tion, shut­ting down 1,576 cor­po­ra­tions in response to pub­lic de­mand, and elim­i­nat­ing 426 il­le­gal en­ter­prises. The gov­ern­ment has in­ten­si­fied su­per­vi­sion and in­spec­tion on oc­cu­pa­tional health man­age­ment of em­ploy­ers. From 2013 to 2016, the num­ber of cor­po­ra­tions na­tion­wide that had been brought un­der gov­ern­ment su­per­vi­sion and in­spec­tion in­creased from 229,000 to 395,000, up by 72.5 per­cent.

Tougher con­trol of food safety. In 2015, China re­vised the Food Safety Law. In 2016, reg­u­la­tory agen­cies at all lev­els con­ducted in­spec­tions of the food pro­duc­tion process of 521,000 food pro­duc­ers, 15,000 food ad­di­tive pro­duc­ers, and 72,000 food pro­cess­ing work­shops. As for the selling of food prod­ucts, reg­u­la­tory agen­cies at all lev­els con­ducted in­spec­tions of 12.093 mil­lion busi­nesses, and 8.869 mil­lion cater­ing ser­vices. In 2016, com­pe­tent au­thor­i­ties con­ducted ran­dom in­spec­tions on 257,000 food sam­ples, of which 96.8 per­cent met the re­quired stan­dards, and prop­erly set­tled sev­eral food safety in­ci­dents, in­clud­ing one in­volv­ing the sale of coun­ter­feit in­fant for­mu­las.

III. Pub­lic Health Ser­vice Ca­pa­bil­ity Im­prov­ing Steadily

The Chi­nese gov­ern­ment gives pri­or­ity to preven­tion while com­bin­ing preven­tion with treat­ment, and makes great ef­forts to en­sure the peo­ple’s equal ac­cess to pub­lic health ser­vices. It de­votes great ef­forts to pre­vent­ing and con­trol­ling epi­demic, chronic and en­demic dis­eases, strength­en­ing the quick response ca­pac­ity on pub­lic health emer­gen­cies, and de­vel­op­ing an in­creas­ingly equal and uni­ver­sal ba­sic pub­lic health ser­vice sys­tem. The cov­er­age of ba­sic pub­lic health ser­vices has been fur­ther ex­panded.

The gov­ern­ment has ex­tended free vac­ci­na­tions from chil­dren only to adults. By the end of 2015 the vac­ci­na­tion rate of ev­ery town or township was at least 90 per­cent and the in­ci­dence of and mor­tal­ity from dis­eases that can be pre­vented by pro­grammed vac­cines had fallen to the low­est level ever. From 2010 to 2017, the state sub­sidy for ba­sic pub­lic health ser­vices has in­creased from RMB15 to RMB50 per per­son, and the ser­vices have also ex­panded from 41 in nine cat­e­gories to 47 in 12 cat­e­gories. The 12 cat­e­gories span a per­son’s life cir­cle, in­clud­ing cit­i­zens’ health ar­chives, health ed­u­ca­tion, vac­ci­na­tion, chil­dren’s health man­age­ment, preg­nancy and ma­ter­nity health man­age­ment, el­derly peo­ple’s health man­age­ment, health man­age­ment of chron­i­cally ill pa­tients, man­age­ment of pa­tients with se­vere men­tal dis­or­ders, health man­age­ment of tu­ber­cu­lo­sis pa­tients, TCM health man­age­ment, re­port­ing and han­dling of epi­demic dis­eases and pub­lic health emer­gen­cies, and as­sist­ing man­age­ment and su­per­vi­sion on health and fam­ily plan­ning. By the end of 2016, the gov­ern­ment had set up dig­i­tal health ar­chives for 76.9 per­cent of Chi­nese cit­i­zens, cov­er­ing 90.23 mil­lion hyper­ten­sion pa­tients and 27.81 mil­lion di­a­betes suf­fer­ers. At the same time, 91.6 per­cent of preg­nant and ly­ing-in women and 91.1 per­cent of chil­dren un­der the age of three were brought un­der sys­tem­atic man­age­ment.

The scope of ben­e­fi­cia­ries of the ba­sic pub­lic health ser­vices has ex­panded steadily. By 2012, China had elim­i­nated tetanus among all new­born ba­bies. In 2014 through in­jec­tion of hep­ati­tis B vac­cine to new­born ba­bies, the preva­lence of hep­ati­tis B sur­face anti­gen in chil­dren un­der five years of age de­creased from 9.67 per­cent in 1992 to 0.32 per­cent in 2014, achiev­ing the WHO’s goal of re­duc­ing that fig­ure to be­low 1 per­cent three years ahead of sched­ule. An in­creas­ing num­ber of the float­ing pop­u­la­tion now have bet­ter ac­cess to ba­sic pub­lic health ser­vices. Epi­demic dis­eases have been ef­fec­tively pre­vented and con­trolled among them, and more than 90 per­cent of their chil­dren have re­ceived vac­ci­na­tions. Aim­ing at se­ri­ous dis­eases, ma­jor risk fac­tors af­fect­ing health and key groups, the state has for­mu­lated and im­ple­mented ma­jor pub­lic health ser­vice projects that cover nearly 200 mil­lion peo­ple, such as hep­ati­tis B vac­ci­na­tion for peo­ple un­der 15 years of age who missed the vac­ci­na­tion ear­lier, nutri­tion im­prove­ment for chil­dren in im­pov­er­ished ar­eas, fa­cil­i­tat­ing ru­ral preg­nant women’s de­liv­ery in hos­pi­tal, screen­ing for cer­vi­cal and breast can­cers among women in ru­ral ar­eas, and con­struc­tion of hy­gienic toi­let in ru­ral ar­eas. In 2009 the gov­ern­ment launched the Re­gain­ing Eyesight Pro­gram for a Mil­lion Im­pov­er­ished Cataract Pa­tients, and had sub­si­dized surgery for more than 1.75 mil­lion cataract pa­tients by the end of 2013. The abil­ity to con­trol epi­demic dis­eases has con­tin­u­ously im­proved. The Chi­nese gov­ern­ment has es­tab­lished the world’s largest on­line di­rect re­port­ing sys­tem for no­ti­fi­able epi­demic dis­eases and pub­lic health emer­gen­cies. Re­ported in­ci­dence of epi­demic dis­eases has dropped by 19.4 per­cent. The early de­tec­tion and early warn­ing ca­pac­i­ties have been fur­ther im­proved. The epi­demic dis­ease re­port­ing sys­tem cov­ers 71,000 med­i­cal in­sti­tu­tions, with 160,000 users and nine mil­lion an­nual in­di­vid­ual re­ports. In 2016, the re­ported in­ci­dence and death rate of epi­demic dis­eases in cat­e­gories A and B was con­trolled be­low 215.7/100,000 and 1.31/100,000, re­spec­tively. The state has set up a lab­o­ra­tory net­work com­prised of dis­ease con­trol and preven­tion in­sti­tu­tions at na­tional, provin­cial, city and county lev­els. The in­fluenza, po­liomyeli­tis, measles and menin­gi­tis B labs of the Chi­nese Cen­ter for Dis­ease Con­trol and Preven­tion have be­come WHO ref­er­ence labs. On the whole, the epi­demics are un­der con­trol and there has been no wide­spread epi­demic in China. The spread of HIV re­mains at a low level, and its rapid growth in cer­tain ar­eas has been checked. The ef­forts to pre­vent and treat tu­ber­cu­lo­sis have achieved good re­sults, with a cure rate of over 90 per­cent. In 2016, the re­ported in­ci­dence of tu­ber­cu­lo­sis had de­creased by 12.6 per­cent com­pared to 2011, and the mor­tal­ity rate from tu­ber­cu­lo­sis had dropped to 2.3 per 100,000 pa­tients, reach­ing the level of de­vel­oped coun­tries. In the same year, there were 3,189 malaria cases re­ported na­tion­wide, with only three do­mes­ti­cally in­fected. This was much lower than the 4,262 cases in 2010. The dis­ease has now been erad­i­cated in over 80 per­cent coun­ties that once had a wide­spread malaria prob­lem. The preven­tion and treat­ment of ma­jor par­a­sitic dis­eases have achieved solid re­sults. By the end of 2016, the trans­mis­sion of schis­to­so­mi­a­sis was brought un­der con­trol in all the 453 coun­ties where it once had been wide­spread.

The ef­fects of China’s prac­tice in pre­vent­ing and con­trol­ling chronic dis­eases have re­mark­ably im­proved. China has set up a mon­i­tor­ing net­work for chronic dis­eases and risk fac­tors. As a ba­sic pub­lic health ser­vice, the health man­age­ment of the aged and hyper­ten­sion or di­a­betes pa­tients is pro­vided free to the pub­lic. The state runs many ser­vices, like screen­ing for cere­bral apoplexy and car­dio­vas­cu­lar dis­ease, com­pre­hen­sive oral dis­ease in­ter­ven­tion, and early di­ag­no­sis and treat­ment of can­cer. By the end of 2016, the ser­vice of screen­ing for and in­ter­ven­tion of cere­bral apoplexy had been pro­vided to more than 6.1 mil­lion peo­ple, 820,000 of whom were found to be at high risk, and 952,000 fol­lowup in­ter­ven­tions were con­ducted. Early screen­ing and com­pre­hen­sive in­ter­ven­tion of car­dio­vas­cu­lar dis­ease had been pro­vided to 3.389 mil­lion peo­ple, 776,000 of whom were found to be at high risk, and 524,000 fol­low-up in­ter­ven­tions were con­ducted. Com­pre­hen­sive oral dis­ease in­ter­ven­tion had pro­vided free oral ex­am­i­na­tion to 100 mil­lion chil­dren. A to­tal of 5.168 mil­lion chil­dren re­ceived free den­tal sealants treat­ment and 2.229 mil­lion chil­dren re­ceived free lo­cal flu­o­ride var­nish treat­ment. The early di­ag­no­sis and treat­ment of can­cer ser­vice had been pro­vided to 2.14 mil­lion high-risk peo­ple. Some 55,000 can­cer pa­tients were di­ag­nosed through this ser­vice, and the over­all early di­ag­no­sis rate reached 80 per­cent or above. The spread of en­demic dis­eases is un­der ef­fec­tive con­trol. By the end of 2015, 90.8 per­cent of coun­ties whose wa­ter sources con­tained ex­cess io­dine had reached the bench­mark that 90 per­cent of salt con­sumed was io­dine-free, and 94.2 per­cent of the na­tion’s coun­ties had erad­i­cated io­dine de­fi­ciency, rank­ing among the top of all 128 coun­tries and re­gions of­fi­cially us­ing iodized salt. Kaschin-Beck dis­ease has been erad­i­cated in 95.4 per­cent of vil­lages where it was once wide­spread, and Ke­shan dis­ease has been put un­der con­trol in 94.2 per­cent of the coun­ties where it was once preva­lent. In the coun­ties that suf­fered from en­demic flu­o­ro­sis caused by coal burn­ing, 98.4 per­cent of coal stoves have been trans­formed, and in the ar­eas suf­fer­ing from drink­ing wa­ter-caused en­demic flu­o­ro­sis, 93.6 per­cent of the ru­ral pop­u­la­tion now have ac­cess to de-flu­o­ri­dated drink­ing wa­ter. Ar­eas suf­fer­ing from ar­senic poi­son­ing through coal burn­ing have had their stoves trans­formed, and all peo­ple in wa­ter-re­lated ar­senic poi­son­ing ar­eas now have ac­cess to safe drink­ing wa­ter. Men­tal health ser­vices have been im­proved con­stantly. The state is­sued the Men­tal Health Law of the Peo­ple’s Repub­lic of China, putting the re­lated work within the le­gal frame­work. At the end of 2015, China had 2,936 men­tal health in­sti­tu­tions with 433,000 beds — in­creases of 77.9 per­cent and 89.9 per­cent, re­spec­tively com­pared with 2010. There were 27,700 prac­tic­ing (as­sis­tant) psy­chi­a­trists na­tion­wide, an in­crease of 20.2 per­cent over the 23,100 at the end of 2012. Se­vere men­tal dis­or­ders have been in­cluded as se­ri­ous dis­eases un­der the new type of ru­ral co­op­er­a­tive med­i­cal care and ba­sic med­i­cal in­surance for non­work­ing ur­ban res­i­dents. The cen­tral gov­ern­ment has pro­vided sub­si­dies to lo­cal hos­pi­tals to help with the man­age­ment of and treat­ment for se­vere men­tal dis­or­ders. Spe­cial aid and treat­ment poli­cies have been drawn up in some lo­cal ar­eas. The pa­tients’ ex­pen­di­tures have been greatly re­duced. The gov­ern­ment has en­hanced the man­age­ment of pa­tients with se­vere men­tal dis­or­ders, in­clud­ing case re­port­ing and reg­is­tra­tion, as­sis­tance and treat­ment. Be­tween 2012 and 2016, the num­ber of reg­is­tered pa­tients with se­vere men­tal ill­nesses in­creased from 3.08 mil­lion to 5.4 mil­lion na­tion­wide. From 59.1 per­cent to 88.7 per­cent, more and more pa­tients were put un­der man­age­ment. The state has en­hanced the in­ter­ven­tion in com­mon men­tal dis­or­ders or psy­cho­log­i­cal prob­lems, like de­pres­sion and anx­i­ety. It has in­ten­si­fied the ef­forts to promptly de­tect and treat psy­cho­log­i­cal prob­lems among

key groups, built up the psy­cho­log­i­cal in­ter­ven­tion ca­pac­ity in emer­gency events, and pro­moted the com­mu­nity re­ha­bil­i­ta­tion ser­vices for men­tal dis­or­ders.

The abil­ity to quickly re­spond to pub­lic health emer­gen­cies has been strength­ened in a com­pre­hen­sive way. The le­gal sys­tem for emer­gency response has taken ini­tial shape, and the response mech­a­nism has been op­ti­mized. Thirty-six na­tional teams and nearly 20,000 lo­cal teams, with over 200,000 mem­bers for four cat­e­gories of emer­gen­cies, have been set up in dif­fer­ent re­gions. In 2014, China’s core pub­lic health emer­gency response ca­pac­ity achieved 91.5 per­cent of the re­quire­ments of the In­ter­na­tional Health Reg­u­la­tions, bet­ter than the world’s aver­age of 70 per­cent. In re­cent years the state has ac­cel­er­ated the con­struc­tion of a pub­lic health emer­gency response sys­tem, which not only ef­fec­tively han­dled such epi­demic emer­gen­cies as hu­man in­fec­tions of the avian in­fluenza A (H7N9) virus, Ebola hem­or­rhagic fever, Mid­dle East res­pi­ra­tory syn­drome and Zika fever, but also promptly car­ried out emer­gency med­i­cal res­cue and post-dis­as­ter epi­demic preven­tion in such dis­as­ters and ac­ci­dents as the 2008 Wenchuan earth­quake and the 2015 Tian­jin Port ex­plo­sions.

IV. Great Im­prove­ment in the Qual­ity of Med­i­cal and Health Ser­vices

China is com­mit­ted to im­prov­ing the ac­ces­si­bil­ity and con­ve­nience of med­i­cal and health re­sources, and the qual­ity and ef­fi­ciency of med­i­cal ser­vices at the same time. It aims to ac­cel­er­ate the build­ing of an in­te­grated med­i­cal and health ser­vice sys­tem of good qual­ity and high ef­fi­ciency, and im­prove the medicine sup­ply sys­tem. More and more peo­ple are sat­is­fied with their vis­its to hos­pi­tals.

The re­source fac­tors of the med­i­cal and health-ser­vice sys­tem keep in­creas­ing. From 2011 to 2015, China in­vested RMB42 bil­lion to sup­port the build­ing of 1,500 county-level hos­pi­tals, 18,000 town and township health cen­ters, and more than 100,000 vil­lage clin­ics and com­mu­nity health cen­ters. By the end of 2016, there were 983,394 med­i­cal and health in­sti­tu­tions in China, among which 29,140 were hos­pi­tals (12,708 pub­lic hos­pi­tals and 16,432 pri­vate ones), 36,795 town and township health cen­ters, 34,327 com­mu­nity health cen­ters (sta­tions), 3,481 dis­ease preven­tion and con­trol cen­ters, 2,986 health in­spec­tion in­sti­tutes (cen­ters), and 638,763 vil­lage clin­ics; there were also 5.291 mil­lion items of med­i­cal equip­ment each worth RMB10,000 or more, among which 125,000 were worth more than RMB1 mil­lion each. In 2016, the num­ber of beds in med­i­cal in­sti­tu­tions in­creased by 395,000 com­pared with 2015 — 5.37 beds for ev­ery 1,000 peo­ple; the num­ber of beds in hos­pi­tals in­creased by 358,000. There were 266 hos­pi­tals of eth­nic health­care, with 26,484 beds, pro­vid­ing 9.687 mil­lion treat­ment ses­sions an­nu­ally, and the num­ber of dis­charged pa­tients reached 588,000.

Health per­son­nel op­ti­mized. China has built a med­i­cal ed­u­ca­tion sys­tem of the largest scale in the world. By the end of 2016, there were 922 med­i­cal col­leges and uni­ver­si­ties in China, 1,564 sec­ondary schools with med­i­cal cour­ses, 238 or­ga­ni­za­tions grant­ing mas­ter’s de­grees, and 92 grant­ing doc­toral de­grees. The num­ber of stu­dents at th­ese schools had reached 3.95 mil­lion, among whom 1.14 mil­lion were stu­dents of clin­i­cal ma­jors and 1.8 mil­lion of nurs­ing ma­jors. Four­teen ed­u­ca­tional in­sti­tu­tions now of­fer spe­cial­ties in eth­nic health­care, and re­search into eth­nic health­care in TCM ma­jors, with about 170,000 stu­dents. TCM col­leges in Yun­nan, Guangxi and Guizhou of­fer un­der­grad­u­ate spe­cial­ties of health­care of the Dai, Zhuang and Miao peo­ples. Some eth­nic-health­care col­leges and TCM col­leges co­op­er­ate to cul­ti­vate per­son­nel spe­cial­iz­ing in eth­nic health­care. By the end of 2016, the num­ber of health work­ers to­taled 11.173 mil­lion, with 8.454 mil­lion tech­ni­cal per­son­nel, and 2.31 physi­cians for ev­ery 1,000 peo­ple; prac­tic­ing (as­sis­tant) physi­cians with a col­lege de­gree or above made up 81.2 per­cent of the to­tal. The num­ber of high-cal­iber pro­fes­sion­als is in­creas­ing year by year. The num­ber of nurses for ev­ery 1,000 peo­ple has reached 2.54, and the ra­tio of doc­tors to nurses has reached 1:1.1. The non­govern­men­tal sec­tors op­er­at­ing hos­pi­tals are grow­ing. China sup­ports non­govern­men­tal sec­tors in start­ing non­profit med­i­cal in­sti­tu­tions, and pro­motes equal treat­ment be­tween non­profit pri­vate hos­pi­tals and pub­lic hos­pi­tals. We en­cour­age physi­cians to make use of their spare time, and re­tired physi­cians to work in com­mu­nity med­i­cal and health in­sti­tu­tions or open clin­ics. Pri­vate hos­pi­tals now ac­count for more than 57 per­cent of all hos­pi­tals, the num­ber of beds in med­i­cal and health in­sti­tu­tions op­er­ated by non­govern­men­tal sec­tors has in­creased by 81 per­cent com­pared with 2011, and their out­pa­tient vis­its take up 22 per­cent of the to­tal in China. Now, of the physi­cians who have ob­tained li­censes that give them per­mis­sion to work for more than one or­ga­ni­za­tion, more than 70 per­cent also work in med­i­cal in­sti­tu­tions op­er­ated by non­govern­men­tal sec­tors. Com­mu­nity and ru­ral med­i­cal con­di­tions fur­ther im­prove. China gives pri­or­ity to com­mu­nity and ru­ral med­i­cal de­vel­op­ment in terms of the es­tab­lish­ment of med­i­cal and health sys­tems, the set­ting up of med­i­cal ser­vice in­sti­tu­tions and the team build­ing of med­i­cal ser­vice per­son­nel. It takes county-level hos­pi­tals as the med­i­cal and health cen­ters of the county, and places them at the core of the three-tier ru­ral

med­i­cal and health ser­vice net­work at the county, township and vil­lage lev­els. It fo­cuses on the op­er­a­tion of one or two county-level hos­pi­tals (in­clud­ing TCM hos­pi­tals) in each county (city). Now al­most ev­ery town or township has a health cen­ter, ev­ery ad­min­is­tra­tive vil­lage has a vil­lage clinic, and ev­ery 1,000 ru­ral res­i­dents have a vil­lage doc­tor. Med­i­cal and health ser­vice sup­ply is be­com­ing more re­fined and tar­geted.

China has es­tab­lished a mech­a­nism for se­ri­ous ill­ness preven­tion and con­trol that com­bines pro­fes­sional pub­lic health in­sti­tu­tions, gen­eral and spe­cial­ized hos­pi­tals, and com­mu­nity med­i­cal and health in­sti­tu­tions. We are en­hanc­ing the mech­a­nism for in­for­ma­tion shar­ing and in­ter­con­nec­tion, pro­mot­ing the in­te­grated de­vel­op­ment of chronic dis­ease preven­tion, con­trol and man­age­ment, and re­al­iz­ing the com­bi­na­tion of treat­ment and preven­tion. We are build­ing a com­pre­hen­sive clas­si­fied di­ag­no­sis and treat­ment sys­tem, guid­ing the for­ma­tion of a ra­tio­nal med­i­cal treat­ment or­der fea­tur­ing pri­mary treat­ment at the com­mu­nity level, two-way trans­fer treat­ment, in­ter­con­nec­tion be­tween dif­fer­ent lev­els and dif­fer­ent treat­ments for acute and chronic dis­eases, and im­prov­ing the ser­vice chain of treat­ment, re­ha­bil­i­ta­tion and long-term care. The di­ag­no­sis and treat­ment rate based on ap­point­ments in Grade III hos­pi­tals has reached 38.6 per­cent, and nearly 400 med­i­cal in­sti­tu­tions have set up am­bu­la­tory surgery cen­ters. We are also pro­vid­ing fam­ily physi­cian con­tracted ser­vices. More than 80 per­cent of cit­i­zens are sat­is­fied with the skills and at­ti­tude of fam­ily physi­cians. The peo­ple’s ser­vice ex­pe­ri­ence has greatly im­proved. The qual­ity and the safety level of med­i­cal ser­vices con­tin­ues to rise. We have for­mu­lated Med­i­cal Qual­ity Man­age­ment Mea­sures, grad­u­ally es­tab­lished and im­proved the med­i­cal qual­ity man­age­ment and con­trol sys­tem, re­leased qual­ity con­trol indi­ca­tors, and con­ducted in­for­ma­tion­al­ized qual­ity mon­i­tor­ing and feed­back. We have pro­moted clin­i­cal path­way man­age­ment (CPM) by de­vel­op­ing 1,212 clin­i­cal path­ways, which cover al­most all com­mon and fre­quently oc­cur­ring dis­eases. We have re­leased and im­ple­mented the Na­tional Ac­tion Plan to Con­tain An­timi­cro­bial Re­sis­tance (2016-2020), to re­solve the prob­lem of an­timi­cro­bial re­sis­tance in a com­pre­hen­sive way. We have also strength­ened su­per­vi­sion over pre­scrip­tion and drug use. In 2016, the rate of in­pa­tients us­ing an­tibac­te­rial drugs was 37.5 per­cent, 21.9 per­cent­age points lower than in 2011; the us­age rate in out­pa­tient pre­scrip­tions was 8.7 per­cent, a de­crease of 8.5 per­cent­age points com­pared with the rate in 2011. Med­i­cal li­a­bil­ity in­surance cov­ers more than 90 per­cent of hos­pi­tals at Grade II and above. We at­tach great im­por­tance to blood safety and sup­ply. By the end of 2015, we had re­al­ized the full cov­er­age of nu­cleic acid tests in blood sta­tions, with a blood safety level equiv­a­lent to that of de­vel­oped coun­tries. We also en­cour­age vol­un­tary un­paid blood do­na­tions and ra­tio­nal clin­i­cal use of blood. In 2016, 14 mil­lion peo­ple do­nated blood gratis, an in­crease of 6.1 per­cent over 2015 and al­most sat­is­fy­ing the de­mand for clin­i­cal blood use. Do­na­tion has be­come the main source of or­gans for trans­plants. The drug sup­ply se­cu­rity sys­tem

keeps im­prov­ing. This sys­tem, based on the na­tional ba­sic drug sys­tem, has made great head­way. Since the im­ple­men­ta­tion of the pol­icy, the prices of ba­sic drugs have dropped by about 30 per­cent on aver­age, and ba­sic drugs have been sold in com­mu­nity-level med­i­cal and health in­sti­tu­tions with zero markup, eas­ing the fi­nan­cial bur­den on pa­tients. We ini­ti­ated the first round of pi­lot projects of na­tional drug price ne­go­ti­a­tion, re­duc­ing the pur­chas­ing prices of drugs for hep­ati­tis B and non-small-cell lung can­cer by over 50 per­cent, mak­ing them the low­est in the world. By the end of 2016, the pa­tients’ ex­penses had been re­duced by nearly RMB100 mil­lion. We have also im­proved the pol­icy that en­sures drug sup­ply for rare dis­eases, and in­creased the free sup­ply of spe­cial drugs, for in­stance, drugs for the preven­tion and treat­ment of HIV/AIDS. China en­cour­ages med­i­cal and phar­ma­ceu­ti­cal in­no­va­tion, launch­ing a key project named the Na­tional New Drug In­no­va­tion Pro­gram. From 2011 to 2015, 323 in­no­va­tive drugs in China were ap­proved for clin­i­cal re­search, 16 in­no­va­tive drugs in­clud­ing Ico­tinib Hy­drochlo­ride Tablets were ap­proved for pro­duc­tion, 139 new chem­i­cal generic drugs en­tered the mar­ket, a to­tal of more than 600 Ac­tive Phar­ma­ceu­ti­cal In­gre­di­ents (API) and over 60 phar­ma­ceu­ti­cal com­pa­nies reached the in­ter­na­tional ad­vanced GMP stan­dard, and a num­ber of large med­i­cal equip­ment such as PET-CT and 128MSCT, and ad­vanced im­plantable prod­ucts in­clud­ing brain pace­maker, bio­pros­thetic valve and ar­ti­fi­cial cochlea have been ap­proved and en­tered the mar­ket. We have pro­moted the build­ing of a mod­ern med­i­cal and phar­ma­ceu­ti­cal dis­tri­bu­tion net­work that cov­ers both the ur­ban and ru­ral ar­eas, and strength­ened drug sup­ply se­cu­rity at the com­mu­nity level and in re­mote ar­eas. TCM is re­ceiv­ing more sup­port from the gov­ern­ment. From 2013 to 2015, China in­vested a spe­cial fund of RMB4.6 bil­lion to sup­port the ca­pac­ity build­ing of TCM. In 2016, it is­sued the Out­line of the Strate­gic Plan on the De­vel­op­ment of Tra­di­tional Chi­nese Medicine (2016-2030). The rev­enue gen­er­ated by Chi­nese medicine pro­duc­ers each with turnover over RMB20 mil­lion per an­num reached RMB865.3 bil­lion in that

year, ac­count­ing for about one third of the to­tal rev­enue gen­er­ated by all the drug pro­duc­ers each with turnover over RMB20 mil­lion per an­num in China. Since 2011, 49 achieve­ments in TCM sci­en­tific re­search have re­ceived na­tional science and tech­nol­ogy awards. Artemisinin, medicines for cur­ing acute promye­lo­cytic leukemia and other TCM and Western medicine re­search find­ings have at­tracted world­wide at­ten­tion.

V. Im­prove­ment of the Na­tional Med­i­cal Se­cu­rity Sys­tem

China has been vig­or­ously im­prov­ing its na­tional med­i­cal se­cu­rity sys­tem. Now a mul­ti­lay­ered and wide-rang­ing med­i­cal se­cu­rity sys­tem cov­ers the whole pop­u­la­tion, mainly sup­ported by ba­sic med­i­cal se­cu­rity, and sup­ple­mented by var­i­ous forms of sup­ple­men­tary in­surance and commercial health in­surance. The coun­try has pre­lim­i­nar­ily re­al­ized ba­sic health­care for ev­ery cit­i­zen. Ba­sic med­i­cal in­surance cov­ers all ur­ban and ru­ral res­i­dents. The whole pop­u­la­tion is now cov­ered by med­i­cal in­surance, which is mainly com­posed of ba­sic med­i­cal in­surance for work­ing ur­ban res­i­dents, ba­sic med­i­cal in­surance for non­work­ing ur­ban res­i­dents, and the new type of ru­ral co­op­er­a­tive med­i­cal care. By the end of 2016 ba­sic med­i­cal in­surance had more than 1.3 bil­lion re­cip­i­ents na­tion­wide — a cov­er­age of above 95 per­cent. In 2016 China of­fi­cially in­te­grated ba­sic med­i­cal in­surance for non­work­ing ur­ban res­i­dents and the new type of ru­ral co­op­er­a­tive med­i­cal care, to unify in­surance cov­er­age, fund­ing poli­cies, in­sured treat­ment, re­im­burse­ment cat­a­logs, man­age­ment of con­tracted med­i­cal in­sti­tu­tions and fund man­age­ment. In this way, the sys­tem of ba­sic med­i­cal in­surance for ur­ban and ru­ral res­i­dents was es­tab­lished step by step, so that ur­ban and ru­ral res­i­dents now en­joy equal ac­cess to ba­sic med­i­cal in­surance.

Sup­port for ba­sic med­i­cal in­surance schemes and its sus­tain­abil­ity have been in­creas­ing. The in­come and ex­pen­di­ture of the ba­sic med­i­cal in­surance fund for work­ing ur­ban res­i­dents in 2016 were RMB1,027.4 bil­lion and RMB828.7 bil­lion re­spec­tively — RMB421.2 bil­lion and RMB341.9 bil­lion more than those of 2012, rep­re­sent­ing an an­nual in­crease of 15.7 per­cent and 15.6 per­cent on aver­age. The in­come and ex­pen­di­ture of the ba­sic med­i­cal in­surance fund for non­work­ing ur­ban res­i­dents were RMB281.1 bil­lion and RMB248 bil­lion, re­spec­tively — RMB193.4 bil­lion and RMB180.5 bil­lion more than those of 2012. In 2017 gov­ern­ment sub­si­dies for ba­sic med­i­cal in­surance for non­work­ing ur­ban and ru­ral res­i­dents are in­creased, with an­nual per capita sub­si­dies at all lev­els reach­ing RMB450. Ba­sic med­i­cal in­surance ben­e­fits have

been im­proved. In 2016 the pay­ment caps of the ba­sic med­i­cal in­surance for work­ing ur­ban res­i­dents and for non­work­ing ur­ban res­i­dents were six times lo­cal em­ploy­ees’ aver­age salary of the year and lo­cal res­i­dents’ per capita dis­pos­able in­come of the year, re­spec­tively; in­pa­tient re­im­burse­ment rates from ba­sic med­i­cal in­surance were about 80 per­cent and 70 per­cent, re­spec­tively. In 2017 out­pa­tient and in­pa­tient re­im­burse­ment rates from the new type of ru­ral co­op­er­a­tive med­i­cal care scheme are about 50 per­cent and 70 per­cent, re­spec­tively. The Na­tional Medicine List for Ba­sic Med­i­cal In­surance, In­dus­trial In­jury In­surance and Ma­ter­nity In­surance (2017) in­cludes 2,535 items of Western medicines and Chi­nese patent medicines, with 339 more medicines than those in the pre­vi­ous list, or an in­crease of 15 per­cent, al­most in­clud­ing all ther­a­peu­tic medicines in the Na­tional Essen­tial Medicine List (2012). As for ex­pen­sive patent medicines with high clin­i­cal value, the gov­ern­ment or­ga­nized talks on medicines cov­ered by the in­surance and added 36 items to the Na­tional Essen­tial Medicine List (2012) for the treat­ment of ma­lig­nant tu­mors, and some rare and chronic dis­eases. Some newly added re­ha­bil­i­ta­tion treat­ments are now cov­ered by ba­sic med­i­cal in­surance. Forms of re­im­burse­ments from ba­sic med­i­cal in­surance have been im­proved.

More than 70 per­cent of re­gions in China are ex­plor­ing new forms of pay­ment from ba­sic med­i­cal in­surance, such as pay­ment by a cer­tain cat­e­gory of dis­ease, by cap­i­ta­tion or by Di­ag­no­sis Re­lated Groups (DRGs). The coun­try has been build­ing a na­tional net­work of ba­sic med­i­cal in­surance, pro­mot­ing cross-prov­ince real-time re­im­burse­ment from ba­sic med­i­cal in­surance, and the use of all-pur­pose card. By the end of Au­gust 2017, real-time re­im­burse­ments had been re­al­ized for all ar­eas cov­ered by ba­sic med­i­cal in­surance across the coun­try; real-time re­im­burse­ments for cross-re­gion in­pa­tient med­i­cal ex­penses within the same prov­ince had been ba­si­cally re­al­ized in the coun­try. A na­tional real-time re­im­burse­ment net­work for cross-prov­ince in­pa­tient ex­penses has been put in place, and all prov­inces (in­clud­ing Xin­jiang Pro­duc­tion and Con­struc­tion Corps) have joined the na­tional net­work of cross-prov­ince re­im­burse­ment of ba­sic med­i­cal in­surance. By the end of Au­gust 2017, China had a to­tal of 6,616 des­ig­nated med­i­cal in­sti­tu­tions for real-time re­im­burse­ments of cross-prov­ince in­pa­tient ex­penses. Se­ri­ous ill­ness in­surance for ur­ban and ru­ral res­i­dents has been im­proved.

China has im­ple­mented se­ri­ous ill­ness in­surance for ur­ban and ru­ral res­i­dents, aim­ing to cover large med­i­cal ex­penses, and im­prove med­i­cal se­cu­rity for se­ri­ous ill­nesses. By the end of 2015 se­ri­ous ill­ness in­surance for ur­ban and ru­ral res­i­dents cov­ered all re­cip­i­ents of ba­sic med­i­cal in­surance. In

2016 se­ri­ous ill­ness in­surance cov­ered more than 1 bil­lion ur­ban and ru­ral res­i­dents; ac­cord­ing to provin­cial poli­cies, the se­ri­ous ill­ness in­surance re­im­burse­ment rates shall be more than 50 per­cent, and the ac­tual re­im­burse­ment ra­tio was raised by 10 to 15 per­cent­age points. Med­i­cal as­sis­tance mech­a­nisms have

made marked progress. A med­i­cal as­sis­tance pol­icy frame­work has been es­tab­lished; med­i­cal as­sis­tance pro­grams dove­tail nicely with se­ri­ous ill­ness in­surance schemes; and med­i­cal as­sis­tance cri­te­ria and ca­pac­ity have be­come con­sis­tent in both ur­ban and ru­ral ar­eas. Med­i­cal as­sis­tance re­cip­i­ents have been ex­panded from sub­sis­tence al­lowance re­cip­i­ents and peo­ple in dire poverty to the poverty-stricken pop­u­la­tion, low-in­come house­hold mem­bers and crit­i­cally-ill pa­tients in ill­ness-stricken poor fam­i­lies. Trade unions at all lev­els have been or­ga­niz­ing em­ploy­ees’ mu­tual aid for med­i­cal ex­penses, to help em­ploy­ees with se­ri­ous ill­nesses and re­duce their fi­nan­cial bur­den. In 2016 China ap­pro­pri­ated RMB15.5 bil­lion in med­i­cal as­sis­tance sub­si­dies (ex­clud­ing ill­ness emer­gency as­sis­tance sub­si­dies), 92 per­cent of which went to cen­tral and western re­gions, and poverty-stricken ar­eas, as­sisted 82.565 mil­lion cases, and helped 55.604 mil­lion peo­ple with fi­nan­cial dif­fi­cul­ties to re­ceive ba­sic med­i­cal in­surance. The pro­por­tion of in­pa­tient re­cip­i­ents within the an­nual limit ex­ceeded 70 per­cent. Med­i­cal as­sis­tance ser­vices have be­come more con­ve­nient, as 93 per­cent of the coun­try has re­al­ized one-stop re­im­burse­ment from med­i­cal as­sis­tance funds and ba­sic med­i­cal in­surance. In 2013 China set up an ill­ness emer­gency as­sis­tance fund to help uniden­ti­fied pa­tients who need im­me­di­ate treat­ment, or iden­ti­fied pa­tients who can­not af­ford the re­lated med­i­cal ex­penses. By June 2017 some 640,000 pa­tients had re­ceived help from the fund.

Med­i­cal se­cu­rity for the ru­ral poverty-stricken pop­u­la­tion has been im­proved. In 2016 China started to im­ple­ment poverty re­lief through health­care. Now the ru­ral poverty-stricken pop­u­la­tion is fully cov­ered by both ba­sic med­i­cal in­surance and se­ri­ous ill­ness in­surance for ur­ban and ru­ral res­i­dents. The in­pa­tient re­im­burse­ment rates for the ru­ral poverty-stricken pop­u­la­tion have been raised by more than five per­cent­age points. China has mo­bi­lized over 800,000 med­i­cal work­ers to visit ill­ness-and-poverty-stricken fam­i­lies, and in­ves­ti­gate 93 ma­jor dis­eases with high oc­cur­rence, high treat­ment costs and se­vere im­pact on work and life, thereby keep­ing a record and set­ting up a data­base for poverty re­lief through health­care. The coun­try pro­vides cat­e­go­rized treat­ment to ru­ral poverty-stricken pop­u­la­tion suf­fer­ing from se­ri­ous ill­nesses and chronic dis­eases. By May 2017 China had given such treat­ment to over 2.6 mil­lion peo­ple. The coun­try has adopted pref­er­en­tial poli­cies fa­vor­ing the ru­ral poor with re­spect to re­im­burse­ment from se­ri­ous ill­ness in­surance. China im­ple­ments a pol­icy of treat­ment be­fore pay­ment and one-stop re­im­burse­ment for ru­ral poverty-stricken in­pa­tients at county-level hos­pi­tals. In ad­di­tion, China has des­ig­nated 889 Grade III (top-level) hos­pi­tals to as­sist 1,149 county-level hos­pi­tals in all pover­tys­tricken coun­ties across the coun­try.

VI. Sig­nif­i­cant Im­prove­ment in the Health of Spe­cial Groups

The Chi­nese gov­ern­ment at­taches great im­por­tance to the pro­tec­tion of the right to health of spe­cial groups such as women, chil­dren, the el­derly and the dis­abled. It con­stantly im­proves health pro­grams, and pro­vides di­ver­si­fied and tar­geted health ser­vices to meet the spe­cial needs of var­i­ous groups in a nondis­crim­i­na­tory and equal man­ner.

The ma­ter­nal and child health­care ser­vice sys­tem has been con­tin­u­ously im­proved. A three-level net­work of ma­ter­nal and child health­care ser­vice has been put in place in ur­ban and ru­ral ar­eas. In 2016, the Chi­nese gov­ern­ment in­vested RMB2.9 bil­lion to sup­port the con­struc­tion of 247 city- and county-level ma­ter­nal and child health­care in­sti­tu­tions. By the end of 2016, there were 3,063 such in­sti­tu­tions, 757 ma­ter­nity hos­pi­tals, 117 chil­dren’s hos­pi­tals, and 370,000 gy­ne­col­o­gists, ob­ste­tri­cians and pe­di­a­tri­cians, and as­sis­tants. Full-time and part-time ma­ter­nal and child health­care work­ers were avail­able in 34,000 com­mu­nity health cen­ters (sta­tions), 37,000 town and township health cen­ters and 640,000 vil­lage clin­ics. An­te­na­tal and peri­na­tal care ser­vices have been up­graded. Since 2009, the Chi­nese gov­ern­ment has been ex­pand­ing year by year the cov­er­age of cer­vi­cal can­cer and breast can­cer screen­ing pro­grams in ru­ral ar­eas, and the num­ber of ben­e­fi­cia­ries has grown. Be­tween 2009 and 2016, the gov­ern­ment car­ried out free cer­vi­cal can­cer screen­ing for more than 60 mil­lion ru­ral women aged 35-64 in 1,299 project coun­ties, and sub­si­dized more than 74 mil­lion ru­ral preg­nant and ly­ing-in women with a spe­cial in­vest­ment of RMB22.6 bil­lion. The rate of hos­pi­tal de­liv­er­ies for ru­ral women in­creased from 92.3 per­cent in 2008 to 99.6 per­cent in 2016, and rates of ma­ter­nal and in­fant mor­tal­ity in ru­ral ar­eas de­creased sharply. The gov­ern­ment ar­ranged sub­si­dies for 11 pro­grams, in­clud­ing free prepreg­nancy ex­am­i­na­tions for healthy child­birth, hos­pi­tal de­liv­er­ies for ru­ral women, sup­ple­men­tary tak­ing of folic acid by ru­ral women to pre­vent neu­ral tube de­fects, and preven­tion of mother-to-child trans­mis­sion of HIV, syphilis and hep­ati­tis B. The tar­gets of the Pro­gram for the De­vel­op­ment of Chi­nese Women (2011-2020) have been met one by one.

Chil­dren’s health has im­proved

re­mark­ably. In 2013, the pure breast-feed­ing rate of ba­bies aged 0-6 months in­creased to 58.5 per­cent na­tion­wide. The breast-feed­ing rate keeps grow­ing. In 2016, in­fant mor­tal­ity was 7.5 per thou­sand and that of chil­dren un­der five was 10.2 per thou­sand, both meet­ing the tar­gets set in the UN Sus­tain­able De­vel­op­ment Goals and the Pro­gram for the De­vel­op­ment of Chi­nese Chil­dren (2011-2020) ahead of sched­ule. This shows that the gap be­tween China and de­vel­oped coun­tries is rapidly nar­row­ing. In 2016, for chil­dren un­der five, the un­der­weight and growth re­tar­da­tion rates, and ane­mia preva­lence de­creased to 1.49 per­cent, 1.15 per­cent and 4.79 per­cent, re­spec­tively — all meet­ing the tar­gets set in the Pro­gram for the De­vel­op­ment of Chi­nese Chil­dren (2011-2020) ahead of sched­ule. By the end of 2016, 30 state-level demon­stra­tion bases for chil­dren’s early de­vel­op­ment had been set up. The gov­ern­ment has im­ple­mented a pro­gram of nutri­tion im­prove­ment for chil­dren in poverty-stricken ar­eas, pro­vid­ing one pack of nu­tri­tional di­etary sup­ple­ments con­tain­ing pro­tein, vi­ta­mins and min­er­als ev­ery day for ev­ery baby aged 6-24 months in im­pov­er­ished ar­eas. Ac­cord­ing to the fifth sur­vey of Chi­nese chil­dren’s phys­i­cal de­vel­op­ment in 2016, in the past 40 years the phys­i­cal de­vel­op­ment of chil­dren un­der seven im­proved rapidly, even higher than the child growth stan­dards pub­lished by the WHO. Chil­dren’s dis­ease con­trol has been con­sol­i­dated. In 2016, the rate of moth­erto-child trans­mis­sion of HIV de­creased to 5.7 per­cent, and the in­ci­dence of neona­tal tetanus was less than 1 per thou­sand. Chil­dren’s vac­ci­na­tion rate un­der the na­tional child­hood vac­cine pro­gram was more than 99 per­cent. The coun­try re­mains po­lio-free, and has a low re­ported in­ci­dence of tu­ber­cu­lo­sis in chil­dren. In 2016, the screen­ing rate of in­her­ited meta­bolic dis­eases (phenylke­tonuria and con­gen­i­tal hy­pothy­roidism) reached 96 per­cent, and the neona­tal dis­ease screen­ing pro­gram for poor ar­eas cov­ered 354 coun­ties (ci­ties or dis­tricts) in 21 prov­inces (au­ton­o­mous re­gions and cen­trally ad­min­is­tered mu­nic­i­pal­i­ties). The Chi­nese gov­ern­ment has been car­ry­ing out ma­jor pub­lic health­care ser­vice pro­grams such as free pre-preg­nancy ex­am­i­na­tion for healthy child­birth, screen­ing of neona­tal dis­eases in poor ar­eas, and pi­lot preven­tion and con­trol of tha­lassemia. The health­care ser­vice sys­tem for the el­derly has im­proved. By the end of 2015, there were 453 re­ha­bil­i­ta­tion hos­pi­tals, 168 nurs­ing homes and 65 nurs­ing sta­tions around China, up by 69.0 per­cent, 242.9 per­cent and 16.1 per­cent, re­spec­tively from 2010. The num­ber of health per­son­nel work­ing in the above three kinds of in­sti­tu­tions was 36,441, 11,180 and 316, re­spec­tively, up by 96.5 per­cent, 286.7 per­cent and 69.9 per­cent from 2010. In 2015, the gov­ern­ment of­fered 118 mil­lion med­i­cal ex­am­i­na­tions to se­nior cit­i­zens aged 65 or above, a health man­age­ment rate of 82 per­cent. The men­tal health of the el­derly has also at­tracted full at­ten­tion. Gov­ern­men­tal and so­cial or­ga­ni­za­tions pub­li­cize re­lated knowl­edge and pro­vide men­tal health coun­sel­ing to the el­derly, while work­ing to en­rich their cul­tural life. The com­bined med­i­cal and el­derly care ser­vices have been pro­moted. In 2016, 90 ci­ties (dis­tricts) were se­lected as state-level pi­lot units to pro­vide com­bined med­i­cal and el­derly care ser­vices. Across China there were 5,814 in­sti­tu­tions pro­vid­ing both ser­vices, with a to­tal of 1.2138 mil­lion beds. Of th­ese, 3,623 were nurs­ing in­sti­tu­tions for the el­derly that have es­tab­lished med­i­cal fa­cil­i­ties, 1,687 were med­i­cal in­sti­tu­tions that have added care ser­vices for the aged, and 504 were in­sti­tu­tions of­fer­ing both ser­vices. In to­tal, 2,224 were among des­ig­nated med­i­cal in­surance in­sti­tu­tions. Spe­cial steps have been taken to im­prove ser­vices at th­ese nurs­ing in­sti­tu­tions for the el­derly; as a re­sult, we have seen a sounder qual­ity con­trol sys­tem and bet­ter ser­vices at th­ese in­sti­tu­tions com­bin­ing med­i­cal ser­vice and or­di­nary care ser­vice.

Dis­abil­ity preven­tion and re­ha­bil­i­ta­tion ser­vices for per­sons with dis­abil­i­ties have im­proved. In 2016, the Chi­nese gov­ern­ment pub­lished the Na­tional Ac­tion Plan on Dis­abil­ity Preven­tion (2016-2020), and in 2017, the Reg­u­la­tions on Dis­abil­ity Preven­tion and Re­ha­bil­i­ta­tion, bring­ing the work onto the track of the rule of law. From 2012 to 2016, 15.26 mil­lion peo­ple with dis­abil­i­ties re­ceived ba­sic re­ha­bil­i­ta­tion ser­vices na­tion­wide. By the end of 2016, there were 7,858 re­ha­bil­i­ta­tion in­sti­tu­tions for the dis­abled around China, with 223,000 em­ploy­ees; and 947 mu­nic­i­pal dis­tricts and 2,015 coun­ties (ci­ties) pro­vided com­mu­nity-based re­ha­bil­i­ta­tion ser­vices, with 454,000 co­or­di­na­tors. Au­gust 25 is China’s Dis­abil­ity Preven­tion Day, as set in 2017. Re­ha­bil­i­ta­tion sports for the dis­abled have been ex­panded to more ar­eas. The Chi­nese gov­ern­ment has been work­ing to im­prove ba­sic sports fa­cil­i­ties for the dis­abled since the 13th Five-Year Plan pe­riod (2016-2020). It has im­ple­mented a re­gion­based guid­ance pol­icy by ad­vanc­ing from west to east, from north to south and from the un­der­de­vel­oped to the more-de­vel­oped ar­eas. Un­der this pol­icy frame­work, the gov­ern­ment has funded six western prov­inces (au­ton­o­mous re­gions and mu­nic­i­pal­i­ties di­rectly un­der the cen­tral gov­ern­ment) in in­tro­duc­ing re­ha­bil­i­ta­tion sports into 8,000 house­holds, from which a na­tional cam­paign started, of­fer­ing ser­vices to 88,884 house­holds. It also sub­si­dized 50 com­mu­ni­ties in in­stalling fit­ness fa­cil­i­ties as demon­stra­tion sites, and sub­se­quently 1,842 new ones were set up na­tion­wide. Now peo­ple with dis­abil­i­ties who reg­u­larly par­tic­i­pate

in per­cent sports of and the fit­ness na­tional ac­tiv­i­tiesto­tal, a make per­cent­ageup 9.6 higher Or­phansthan be­fore.with dis­abil­i­ties re­ceive spe­cial care.has in­clud­edSince 2015,sick and the dis­abled Chi­nese chil­dren­govern­ment among­ba­sic liv­ing ur­ban al­lowance­sand ru­ral and res­i­dents peo­ple en­ti­tledliv­ing into dire povertyand or­phanedand en­ti­tledand dis­abledto re­lief and chil­dren­sup­port, who re­main un­set­tled, in the To­mor­row Plan for Re­ha­bil­i­ta­tion of Hand­i­capped Or­phans. In ad­di­tion, it of­fers med­i­cal re­ha­bil­i­ta­tion to th­ese chil­dren with ref­er­ence to treat­ment poli­cies and prac­tices of wel­fare in­sti­tu­tions. Thanks to the To­mor­row Plan, tens of thou­sands of chil­dren have had op­er­a­tions and been in­te­grated into so­ci­ety after re­cov­ery. At wel­fare in­sti­tu­tions, all chil­dren with sur­gi­cal in­di­ca­tions who are new to th­ese in­sti­tu­tions are able to get surgery at the op­ti­mal op­por­tu­nity for treat­ment. By the end of 2016, the coun­try had in­vested RMB860 mil­lion in of­fer­ing cor­rec­tive op­er­a­tions and re­ha­bil­i­ta­tion train­ing to more than 90,000 or­phans with dis­abil­i­ties.

VII. Ac­tive Par­tic­i­pa­tion in Global Health Gov­er­nance and In­ter­na­tional Med­i­cal As­sis­tance

China ad­vo­cates, pro­motes and car­ries out in­ter­na­tional med­i­cal and health co­op­er­a­tion. It is firmly com­mit­ted to re­al­iz­ing the Pro­gram of Ac­tion of the In­ter­na­tional Con­fer­ence on Pop­u­la­tion and De­vel­op­ment, and im­ple­ment­ing the United Na­tions 2030 Agenda for Sus­tain­able De­vel­op­ment, es­pe­cially sus­tain­able de­vel­op­ment goals re­lat­ing to health. China ac­tively pro­vides med­i­cal aid to other coun­tries, and promptly con­ducts global emer­gency re­sponses. It earnestly im­ple­ments in­ter­na­tional health con­ven­tions and shoul­ders its in­ter­na­tional hu­man­i­tar­ian re­spon­si­bil­i­ties. Tak­ing part in the for­mu­la­tion of in­ter­na­tional med­i­cal and health rules.

China was one of the first coun­tries in the world to sign and ap­prove the Con­sti­tu­tion of the World Health Or­ga­ni­za­tion. It has joined the Sin­gle Con­ven­tion on Nar­cotic Drugs and the Con­ven­tion on Psy­chotropic Sub­stances. China has par­tic­i­pated in the mak­ing of a se­ries of in­ter­na­tional treaties and dec­la­ra­tions, in­clud­ing the Dec­la­ra­tion of Alma-Ata, and sup­ported the World Dec­la­ra­tion on the Sur­vival, Pro­tec­tion and De­vel­op­ment of Chil­dren. At the 69th World Health Assem­bly held in 2016, China raised and pro­moted the adop­tion of a res­o­lu­tion to “pro­mote in­no­va­tion and ac­cess to qual­ity, safe, ef­fi­ca­cious and af­ford­able medicines for chil­dren,” get­ting pos­i­tive re­sponses from all sides. Car­ry­ing out in-depth co­op­er­a­tion with the WHO. In 2016, the China-WHO Coun­try Co­op­er­a­tion Strat­egy (2016-2020) was signed in Bei­jing, defin­ing co­op­er­a­tion in health poli­cies, plan­ning, tech­nol­ogy and hu­man re­sources. In 2017, the Me­moran­dum of Un­der­stand­ing on the Belt and Road Health Co­op­er­a­tion Mech­a­nism and the Im­ple­men­ta­tion Plan on the Belt and Road Health Co­op­er­a­tion Mech­a­nism were signed to pro­mote co­op­er­a­tion in health emer­gency response, preven­tion and treat­ment of in­fec­tious dis­eases, and tra­di­tional medicine be­tween coun­tries along the Belt and Road. Ex­tend­ing in­ter­na­tional med­i­cal and health ex­changes and co­op­er­a­tion. China con­ducts health ex­pe­ri­ence shar­ing and strate­gic di­a­logue with other coun­tries. It or­ga­nizes a num­ber of in­ter­na­tional med­i­cal and health sem­i­nars. In De­cem­ber 2015, co­op­er­a­tion plans on pub­lic health were an­nounced at the Jo­han­nes­burg Sum­mit of the Fo­rum on China-Africa Co­op­er­a­tion, in­clud­ing par­tic­i­pa­tion in the con­struc­tion of African Cen­ter for Dis­ease Con­trol and Preven­tion and other ma­jor ini­tia­tives. In Oc­to­ber 2016, China built part­ner­ships with coun­ter­part hos­pi­tals in 15 Asian and African coun­tries, in­clud­ing Ethiopia. In April 2017, China signed med­i­cal and health co­op­er­a­tion agree­ments with Malawi and other African coun­tries. Since 2005, China has trained thou­sands of of­fi­cials and tech­ni­cal per­son­nel from de­vel­op­ing coun­tries, and en­cour­aged its non­govern­men­tal or­ga­ni­za­tions to de­velop ed­u­ca­tion and train­ing projects on ado­les­cent re­pro­duc­tive health and AIDS preven­tion in Zim­babwe and Kenya, as well as the Greater Mekong Sub­re­gion.

Mak­ing out­stand­ing achieve­ments in in­ter­na­tional med­i­cal and health as­sis­tance. Since 1963, China has sent teams to­tal­ing 25,000 med­i­cal work­ers to 69 de­vel­op­ing coun­tries. They have di­ag­nosed and treated a to­tal of 280 mil­lion cases. In Septem­ber 2015, China an­nounced at rel­e­vant United Na­tions sum­mits that it would take ma­jor health as­sis­tance ac­tions for de­vel­op­ing coun­tries in the five years to come, in­clud­ing the con­struc­tion of 100 hos­pi­tals and clin­ics, and the im­ple­men­ta­tion of 100 “ma­ter­nal and child health projects.” By June 2017, more than 1,300 med­i­cal team mem­bers and pub­lic health ex­perts from China were work­ing in 51 coun­tries, and over 20,000 health man­age­ment and tech­ni­cal per­son­nel had been trained in China for the re­cip­i­ent coun­tries. It had built more than 150 fa­cil­i­ties, in­clud­ing gen­eral hos­pi­tals, spe­cial­ized cen­ters and drug ware­houses. China had pro­vided batches of med­i­cal sup­plies to those coun­tries in­clud­ing am­bu­lances, di­ag­no­sis and treat­ment equip­ment, and vac­cine cold chains. In the same pe­riod it do­nated an­ti­malar­ial drugs to Africa, sav­ing 40 mil­lion lives. Since 2008, China has built 30 malaria preven­tion and treat­ment cen­ters in Africa, and pro­vided RMB190 mil­lion worth of artemisinin-based an­ti­malar­ial drugs. Ef­fec­tively con­duct­ing global emer­gency response. China has met the

re­quire­ments for im­ple­ment­ing the In­ter­na­tional Health Reg­u­la­tions. It has been play­ing an ac­tive and lead­ing role in in­ter­na­tional emer­gency res­cue, and has par­tic­i­pated in the fight against epi­demics, in­clud­ing yel­low fever and Zika virus dis­ease in An­gola and Guyana. After the out­break of Ebola in West Africa in 2014, China pro­vided as­sis­tance in­clud­ing cash and sup­plies to epi­demic-stricken coun­tries and in­ter­na­tional or­ga­ni­za­tions on four con­sec­u­tive oc­ca­sions, with a to­tal value of $120 mil­lion. More than 1,200 Chi­nese med­i­cal per­son­nel and pub­lic-health ex­perts had been sent to epi­demic-stricken ar­eas and neigh­bor­ing coun­tries to com­plete nearly 9,000 sam­ple tests, ob­serve and treat over 900 cases and train 13,000 lo­cal peo­ple in med­i­cal care and com­mu­nity-based preven­tion and con­trol. After an 8.1-mag­ni­tude earth­quake hit Nepal in 2015, the Chi­nese gov­ern­ment sent four med­i­cal and epi­demic preven­tion teams with a to­tal of 193 mem­bers to the dis­as­ter area to help re­lief ef­forts. A to­tal of 2,600 cases were treated and more than 1,000 core mem­bers of health and epi­demic preven­tion work were trained. In­ter­na­tional recog­ni­tion of TCM con­tin­u­ing to grow. Now, 183 coun­tries and re­gions around the world have ac­cess to TCM. TCM has be­come an im­por­tant part of China’s co­op­er­a­tion with re­gions and health or­ga­ni­za­tions in ASEAN, Europe and Africa. TCM acupunc­ture and mox­i­bus­tion have been rec­og­nized as im­por­tant parts of the in­tan­gi­ble her­itage of mankind by UNESCO, and the Chi­nese med­i­cal clas­sics

Huangdi Nei­jing (In­ner Canon of the Yel­low Em­peror) and Ben­cao Gangmu (Com­pendium of Ma­te­ria Med­ica) have been in­cluded in the UNESCO Mem­ory of the World. Ac­cord­ing to sta­tis­tics from the WHO, 103 mem­ber states have au­tho­rized the use of acupunc­ture and mox­i­bus­tion, of which 29 have es­tab­lished laws and reg­u­la­tions pro­mot­ing tra­di­tional medicines, and 18 in­clude acupunc­ture and mox­i­bus­tion in their med­i­cal in­surance sys­tems.

Con­clu­sion

The CPC and the Chi­nese gov­ern­ment earnestly re­spect and pro­tect peo­ple’s right to health, and con­sider safe­guard­ing peo­ple’s health as a ba­sic task of gov­er­nance. Sig­nif­i­cant ac­tions have been taken, aim­ing to ben­e­fit peo­ple both in the present and the fu­ture. China has achieved great suc­cess in health af­fairs, mak­ing an im­por­tant con­tri­bu­tion to the sus­tain­able de­vel­op­ment of mankind.

“Be­tween heaven and earth, man ex­pe­ri­ences both dan­gers and sta­bil­ity dur­ing the course of his life­time.” We are keenly aware that safe­guard­ing peo­ple’s health is a sys­tem­atic project. It takes a long pe­riod of sus­tained ef­forts. At present, with the sit­u­a­tion of the coun­try’s in­dus­tri­al­iza­tion, ur­ban­iza­tion and ag­ing pop­u­la­tion, as well as the chang­ing dis­ease spec­trum, eco­log­i­cal en­vi­ron­ment and life­style, the Chi­nese peo­ple are still fac­ing a com­plex sit­u­a­tion in which mul­ti­ple dis­ease threats co­ex­ist and a va­ri­ety of health fac­tors are in­ter­twined; mean­while, with the im­prove­ment of liv­ing stan­dards and en­hance­ment of the con­cept of health of the peo­ple, pub­lic de­mand for health prod­ucts and health ser­vices con­tin­ues to grow, show­ing mul­ti­level, di­ver­si­fied and in­di­vid­u­al­ized char­ac­ter­is­tics. Con­se­quently, China is faced with health prob­lems com­mon to both de­vel­oped and de­vel­op­ing coun­tries.

In or­der to bet­ter safe­guard peo­ple’s right to health, we are speed­ing up the build­ing of a heathy China. A se­ries of plans and out­lines have been made and im­ple­mented, in­clud­ing the “Healthy China 2030” Plan­ning Out­line, the Na­tional Fit­ness Pro­gram (2016-2020), the 13th Five-Year Plan for Med­i­cal and Health Ser­vice De­vel­op­ment, and the Plan for Deep­en­ing Re­form of the Med­i­cal and Health­care Sys­tem Dur­ing the 13th Five-Year Plan Pe­riod (2016-2020). The Chi­nese gov­ern­ment has put for­ward a “three-step” goal: a sound ba­sic med­i­cal and health­care sys­tem with Chi­nese char­ac­ter­is­tics will be es­tab­lished cov­er­ing both ur­ban and ru­ral res­i­dents, with the main health indi­ca­tors rank­ing in the fore­front of the high- and mid­dle-in­come coun­tries by 2020; the health-pro­mo­tion sys­tem will be im­proved, with the main health indi­ca­tors in the ranks of the high-in­come coun­tries by 2030; and a healthy China con­form­ing to the re­quire­ments of a mod­ern so­cial­ist coun­try will be built by 2050. Gov­ern­ments at all lev­els will con­tinue their work to­ward com­pre­hen­sively safe­guard­ing peo­ple’s health for the full life cy­cle, and pro­mot­ing the over­all de­vel­op­ment of med­i­cal and health ser­vices, with a high sense of re­spon­si­bil­ity and ur­gency.

Health is an eternal pur­suit of mankind, and health pro­mo­tion is the com­mon re­spon­si­bil­ity of the world com­mu­nity. The United Na­tions 2030 Agenda for Sus­tain­able De­vel­op­ment has set healthy lives as a ma­jor sus­tain­able de­vel­op­ment goal, and the de­vel­op­ment of the global health sys­tem is at a cru­cial stage. China will, as al­ways, en­er­get­i­cally par­tic­i­pate in health-re­lated in­ter­na­tional ac­tiv­i­ties, take an ac­tive part in global health gov­er­nance, and im­ple­ment sus­tain­able de­vel­op­ment goals in the pub­lic health sec­tor. In its ef­forts to build the Belt and Road, China will en­hance med­i­cal and health co­op­er­a­tion with coun­tries along the route, and em­pha­size learn­ing from and draw­ing on the ex­pe­ri­ences of other coun­tries. In the great process of “jointly build­ing a com­mu­nity with a shared fu­ture for mankind,” China is keen to join hands with peo­ple around the world in mak­ing un­remit­ting ef­forts to build a bet­ter and health­ier world.

ZHAO YINGQUAN / XINHUA

A doc­tor mea­sures blood pres­sure for lo­cal res­i­dents at a vil­lage in Wuzhis­han, Hainan prov­ince, in Au­gust.

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