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

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 Environment and Conditions III. Public Health Service Improving Steadily IV. Great Improvement in the Quality 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 of Health Capability of

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.

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:

• Prioritizing health and fitness. 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.

• Focusing on prevention. 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.

• Nonprofit services. 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.

• Equality and benefit for all. 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.

• Universal participation and sharing of benefits. 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.

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.

Developing a healthy lifestyle. 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.

Giving full play to national physical fitness. 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.

Promoting national health education. 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

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