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EMBARGO: 02:00H (UK time) Monday October 20, 2008 THE LANCET SERIES ON HEALTH SYSTEM REFORM IN : PRESS RELEASE AND LAUNCH EVENT

In the Great Hall of the People in Beijing on October 20, 2008, an unprecedented scientific pressoffi[email protected] collaboration on China and global health is being launched by the The Lancet, Peking University Please mention The Lancet as the source of this Health Sciences Centre, and the China Medical Board. This Lancet Series on Health System material Issued by Tony Kirby, Reform in China consists of 19 commissioned research papers (7 papers and 12 comments) Press Officer, The Lancet that bring together the most recent scientific evidence on China’s major health challenges, its health strategies, and China’s health future. The Series was produced by a team of 63 scientists, with Chinese scientists constituting two-thirds of the authors, collaborating with an international team from 10 different countries. This Series aims to initiate long- term collaboration between The Lancet and China, together with the China Medical Board and WHO, including critically important partners, such as scientists both inside and outside China. The purpose of this collaboration is to introduce China’s health system, achievements, and predicaments to the world and to foster scientific and institutional alliances that can strengthen the health of the Chinese people.

The launch event features keynote speeches by Professor , Vice Chair of the People’s Congress; Health Minister ; Vice Health Minister Huang Jiefu; and former Vice Health Minister Wang Longde—all of whom are also contributing authors of scientific papers in the Series. Other speakers are Professor Ke Yang, Executive Vice-President of Peking University; Dr. Lincoln Chen, President of the China Medical Board; Dr. Richard Horton; Editor of The Lancet; Dr. Harvey Fineberg, President of the US National Academy of Sciences’ Institute of ; and Dr. Hans Troedsson, WHO Representative in China.

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Please note: • The press event to launch The Lancet Series will be held and the Chongqing Hall of the People’s Great Hall at 11:00am (Beijing time) , Monday October 20, 2008. Those who wish to attend must contact [email protected] to get an invitation and parking permit. Otherwise, they will not be able to get in.

For more information, please contact Tony Kirby , Press Officer, The Lancet. T) +44 (0) 20 7424 4949 [email protected]

EMBARGO: 02:00H (UK time) Monday October 20, 2008 CHINA FACES DAUNTING CHALLEGES TO HEATLH EQUITY BUT IT HAS THE MEANS TO TURN THESE PROBLEMS AROUND

China’s economic boom of recent decades has also seen its reputation for health slipping and the health gap between the rich and the poor widening. Yet this economic boom means it is in a much better position than other nations to overcome health inequities, as it should be able to afford major health reforms. These are among the conclusions of authors of the first paper in The Lancet’s Health System Reform in China Series, authored by Dr Lincoln Chen, China Medical Board, Cambridge, MA, USA, and Professor Margaret Whitehead, University of Liverpool, UK, and colleagues.

China has a number of health related disparities. Eg, rural infant mortality rates are nearly five times higher in the poorest compared with the wealthiest communities—123 versus 26 deaths per livebirths, respectively. And while life expectancy in the rich city of has increased 5·2 years in the years 1981–2000 (from 72·9 to 78·1 years), in Gansu, one of the poorest provinces, the increase was just 1·4 years from 66·1 to 67·5 years.

The authors say China is facing daunting equity challenges: a vicious cycle of three reinforcing forces which aggravate each other. Firstly, market failures and insufficient government stewardship—such as doctors using their knowledge to prescribe inappropriate yet profitable procedures and drugs; inadequate government investment, and, tied to that, increased out- of-pocket healthcare costs that hit the poorest hardest; and failure of government health insurance schemes. Secondly, the massive inequity in distribution of social determinants of health. The wealthiest counties in China have public spending 48 times higher than the poorest. Safe drinking water is available to 96% of the population in large cities but to less than 30% in poor areas. And migrants from rural to city areas have grossly inadequate healthcare, with massive differences in maternal mortality in migrant women in large cities compared with women resident in them. Finally, the Chinese government needs to tackle public perceptions of fairness and trust. As the economy has boomed, so has public

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dissatisfaction with unfair distribution of wealth and health services, especially concerning increasing out-of-pocket expenses.

The authors say the Chinese Government is establishing one rural and two urban health insurance schemes, and has pledged stronger public financing; and add that public facilities must be deincentivised from profit-seeking to remain viable. They conclude: “Most important, China’s economic capacity is growing rapidly so that it should be able to afford major reforms.”

Professor Margaret Whitehead, University of Liverpool, UK. T) +44 (0) 151-794-5280 or [email protected] +44 (0) 7528 286169

EMBARGO: 02:00H (UK time) Monday October 20, 2008 CHINA’S EARLY DETECTION SYSTEM FOR INFECTIOUS COULD BE VITAL IN WARNING WORLD OF BIRD-FLU PANDEMIC

The Chinese early detection system for infectious could identify clusters of bird- flu in humans in real time, thus providing authorities and the rest of the world with early warning of the start of the pandemic. This is among the conclusions of the second paper in The Lancet Series on Health System Reform in China, written by Professor Longde Wang, Chinese Ministry of Health, and Professor Zunyou Wu, Chinese Centre for Disease Control and Prevention, Beijing, China, and colleagues.

Since the People’s Republic of China was established in 1949, the average life expectancy has increased from 35 years at birth to 72 years in 2000–2005. Infant mortality has decreased from 200 per 1000 livebirths to 23 per 1000 during the same period. The authors say: “These impressive gains were probably due to a substantial reduction in rates of infectious diseases.” The Chinese government has a reporting system for 27 infectious diseases, which has used web-based reporting since 2003, and covers all the main infectious diseases such as HIV, syphilis, meningitis, hepatitis and others. In 2006, tuberculosis, hepatitis B, dysentery, syphilis, and gonorrohea accounted for 86% of over 4·5 million reported cases of these 27 diseases; while tuberculosis, rabies, HIV/AIDS, hepatitis and Japanese encephalitis B accounted for 9439 of 10 726 (88%) of deaths from these 27 diseases.

Proven strategies such as improving water supply and sanitation, blood collection, fly, mite and rodent control have all aided in the Chinese government’s quest to reduce the impact of infectious disease. Specific example of success include a seven-fold increase in the tuberculosis budget between 2000–05, with detection rates for tuberculosis increasing to 80% and

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successful treatment for 92% of these cases, surpassing the 2005 WHO target. China was only one of four countries with a high tuberculosis burden to achieve this target.

The Chinese Government learnt a great deal from the severe acute respiratory syndrome (SARS) in 2003, and improved its reporting system for pneumonia of unknown cause. It replaced its lengthy system of ‘chain’ reporting through local centres for disease control to government to an instant, real-time web-based reporting system where every case of unidentified pneumonia has to be reported within 24 hours and, if necessary, contained. This surveillance system identified 21 cases of human bird-flu from 236 of unidentified pneumonia in 2005–06. The authors conclude: “Preparation for a pandemic will require a high degree of coordination between ministries and agencies in all countries, and the financial and technical support of the worldwide community. China can lead in developing systems for surveillance and response that can serve as a model for other developing countries.”

An accompanying Comment, by Dr Kong-Lai Zhang, Institute of Basic Medical Sciences, Beijing, and colleagues, focuses on China’s HIV/AIDS epidemic, which has gained momentum because of ‘the profound change in sexual attitudes and behaviour, and the rapid growth of the sex industry during the past two decades.” They conclude: “China also needs to mobilise and engage civil society in the fight against HIV/AIDS, and to encourage interdisciplinary approaches for HIV research, treatment, care, and prevention.”

A further Comment discusses the blight of schistosomiasis, a chronic and debilitating disease endemic in the tropics of China, and affecting mainly poor populations.

Professor Zunyou Wu, Chinese Centre for Disease Control and Prevention, Beijing, China. [email protected] T) Office: +86-10-63165758; mobile +86-13801251578

Comment Dr Kong-Lai Zhang, Institute of Basic Medical Sciences, Beijing. T) +86 13910-506-195 / [email protected] +86-10-65296973

EMBARGO: 02:00H (UK time) Monday October 20, 2008 A THIRD OF WORLD SMOKERS ARE CHINESE MEN: JUST ONE PART OF CHINA’S CHRONIC DISEASE BATTLE

Prevention must be at the heart of the China’s battle with chronic diseases if it is to stop the health and economic timebomb associated with these conditions. Dietary fat and salt intake, smoking, and lack of physical activity must all be targeted. These are the conclusions of authors of the third paper in The Lancet Series on Health System Reform in China, written

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by Professor Gonghuan Yang, Chinese Centre for Disease Control and Prevention, Beijing, China, and colleagues.

Life expectancy in China increased rapidly from 1950–90, largely due to success in combating infectious diseases; but since 1990 has plateaued due to emergence of chronic disease. Deaths from cerebro-cardiovascular diseases, chronic obstructive pulmonary disease (COPD), and cancers have increased as a proportion of all deaths, from 47·1% in 1973 to 74·1% in 2005. Two major forces are behind this change—first, the aforementioned rapid increase in life expectancy has left China with an ageing population; and second, the even more powerful increase in several high-risk behaviours.

Rapid economic development has seen daily levels of fat in Chinese diets increase by 25% in urban people and nearly 100% in rural people between 1982 and 2002, increasing the risk for cardiovascular disease and cancer; meat consumption has also increased while dietary cereal levels have dropped over the same period. Some 177 million Chinese adults, and 18% of adult men, have high blood pressure (hypertension), with high daily salt intake (over 12 g in many people) thought to be a cause. And while overall daily calorie intake has remained largely static 1982–2002, the increase in overweight and obese Chinese people over this period leads to the conclusion that physical activity levels must have decreased. Finally, tobacco remains a scourge of Chinese health—one in three smokers in the world is a Chinese man, with 60% smoking prevalence in the male population. Smoking rates in women are much lower, at around 5%, due to social taboos around women smokers.

The costs surrounding the chronic disease burden are likely to be huge, and will include direct burdens such as hospital and medical costs and care-related travel; and also indirect costs such as lower productivity and premature deaths. The authors say that, as well as reducing out-of-pocket expenses and making sure care is delivered in the most financially effective way, “Prevention first is the best, most important, and most appropriate dictum and relevant strategy for China...The Ministry of Health must develop its skills and capabilities more broadly than the biomedical sciences. For example, hypertension and tobacco can be targeted health priorities. Reduction of salt intake should become a national campaign.”

The authors call for the WHO Framework Convention of Tobacco Control, which China has adopted, to be translated into policy. They conclude: “Just as China was able to control infectious diseases within a shorter time than other countries, it has the opportunity today to reduce the time over which chronic diseases take a high health and economic toll in the country...Prevention and control of chronic diseases is a large and complex task, but no more so than many of the challenges that have confronted China in its long history, and especially in the last 50 years.”

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In an accompanying Comment, Dr Shuiyuan Xiao, Central South University, Changsha, China and Dr Matthew Korman, Stanford University, California, USA, discuss smoking behaviours in China and note that only 3% of women in China smoke cigarettes daily compared with nearly 60% of men. They say “If present smoking trends continue, 100 million Chinese men will die [of smoking related causes] between 2000 and 2050, with many of their family members squandering life savings in desperate attempts at treatment.” They believe anthropological study holds practical value for the development of innovative interventions to reduce China’s smoking epidemic and attenuate other causes of ill-health and conclude: “Praise was fittingly showered on Beijing for running a smoke-free Olympics. It is time now for men and women of vision to embrace a smoke-free China.”

A further spotlight will be on China’s chronic disease challenges at the upcoming third Lancet Asia Medical Forum* which takes place from November 14 to 16, 2008, in Beijing. The forum will focus on stroke, the number one cause of death in China.

Professor Gonghuan Yang, Chinese Centre for Disease Control and Prevention, Beijing, China. [email protected] T) +86 10 6301 2327 / +86 13601033911

Comment Dr Shuiyuan Xiao, Central South University, Changsha, China. T) +86-13907494509 [email protected]

Note to Editors *For more information please visit http://www.thelancetforum.com/

EMBARGO: 02:00H (UK time) Monday October 20, 2008 ENFORCING DRIVING LAWS, RESTRICTING ACCESS TO PESTICIDES, AND TEACHING CHILDREN TO SWIM CAN ALL REDUCE CHINA’S INJURY-RELATED FATALITIES

The May 2008 earthquake in Wenchuan drew attention to the important but largely unrecognised problem of injury-related death and disease in China. Low-cost prevention measures that are most likely to produce large reductions in injury mortality are enforcement of laws for drinking and driving and for seat belt and helmet use, restriction of potent pesticides, and teaching children to swim. These are the conclusions of the fourth paper in The Lancet Series on Health System Reform in China, written by Professor Michael Phillips, Beijing Long Guan Hospital, China and Columbia University, New York, USA, and colleagues.

Injuries account for more than 10% of all deaths and more than 30% of all potentially productive years of life lost due to premature mortality in China. Traffic-related injuries (mainly among

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cyclists and pedestrians), suicide, drowning, and falls account for 79% of all injury deaths. Rural injury death rates are double those of urban rates and male rates are double those of female rates. Despite an 81% increase in traffic-related mortality from 1987 to 2006, overall injury mortality decreased by 17%, largely due to a surprising and unexplained 57% reduction in the suicide rate during this time. Possible reasons for the decreased suicide rate include improved financial prospects for the country’s poor and reduced access to lethal pesticides. Ingestion of pesticides is the most common method of suicide, but, due to rapid urbanization and massive rural to urban migration for work, both the rates and case-fatality of pesticide-related suicidal behaviour could have decreased. The probable reason for relatively high female suicide rates is that suicidal acts in which the individual has a low intent to die, which are more common in women, often result in death if the method employed is pesticide ingestion.

The close proximity of much of the Chinese population to its waterways, combined with a very small proportion of the population knowing how to swim, leads to many deaths by drowning. In children under 15 years, 54% of all injury deaths are due to drowning. Drowning rates are three times higher in rural than urban areas.

The authors conclude: “China has the financial resources, organizational infrastructure, and public support to rapidly apply lessons from high-income countries to achieve international best practice standards for injury prevention and control, and to become a model for other low-income and middle-income countries that have similar difficulties...Low-cost prevention measures that are most likely to produce large reductions in injury deaths include enforcement of laws for drinking and driving and for seatbelt and helmet use, restriction of access to the most potent pesticides, and teaching children to swim. China needs to improve monitoring of fatal and non-fatal injuries, promote intersectoral collaboration, build institutional capacities, and, most importantly, mobilise community support and political will for investment in prevention.”

Professor Michael Phillips, Beijing Long Guan Hospital, China and Columbia University, New York, USA. [email protected] T) +86 10-6271-2471

EMBARGO: 02:00H (UK time) Monday October 20, 2008 IMPROVED DISTRIBUTION OF DOCTORS AND NURSES AND ABSORPTION OF MEDICAL GRADUATES INTO THE HEALTH WORKFORCE ARE PRIORITIES FOR CHINA

Policies to address inequitable distribution of doctors and nurses and ensuring that medical graduates enter the health workforce are among the priorities China must tackle as it seeks to achieve its aim of a Healthy China by 2020. These are the conclusions of the fifth paper

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in The Lancet Series on Health System Reform in China, written by Professor Sudhir Anand, University of Oxford, UK, and colleagues.

Unlike most countries, China has more doctors than nurses. Latest data from 2005 show there were 1·9 million licensed doctors and 1·4 million licensed nurses. Most of China’s doctors (67·2%) and nurses (97·5%) have been educated only up to junior college or secondary school level, and doctor density in urban areas is more than twice that for rural areas; for nurses, this difference is three-fold. Analysis shows that increasing the density of health professionals by 1% leads to a decrease of 0·133% in the infant mortality rate. The authors say: “This maldistribution can only be corrected through national or provincial policies that create effective incentives for health professionals, especially physicians, to work and remain in stations.”

There is an apparent surplus of people trained as health workers but who are not employed as such. The authors estimated that almost 1 million graduates of medical and health-related education programmes were produced during 2000–05 who were not absorbed into the health workforce. Many of these may have gone to the pharmaceutical or biotechnology industries instead. The authors say: “This mismatch suggests a less than optimal allocation of educational investment in China; it also suggests the need for improved coordination between the Ministry of Health and the Ministry of Education.”

Finally, China faces the challenge of educational programme diversity and skill mix so as to best meet the needs of its population—eg, a doctor may not need eight years training to serve the basic health needs of a rural population, yet this could be necessary to become a specialised surgeon in a large city hospital. The authors say: “There is no clear-cut answer in the debate on setting uniform national standards for physician training and qualification.”

They conclude: “Although the production of doctors and nurses has greatly expanded in recent years, serious problems of distribution remain. As the government seeks to achieve its aim of a Healthy China by 2020, the goal of its health reform should be to promote equitable and universal access to basic health services. This will require that every Chinese family—living in poor or rich counties and rural or urban areas—has access to an appropriately trained and supported health worker.”

An accompanying Comment, by Dr Daqing Zhang, Peking University, and Dr Paul Unschuld, Charite Universitatsmedizin, Berlin, Germany, discusses China’s programme from 1968, which effectively reduced costs and provided timely treatment to rural people. They conclude: “The new cooperative medical system...which draws heavily on the experiments of the barefoot doctor programme, will take responsibility for the healthcare of peasants in rural China.”

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Professor Sudhir Anand, University of Oxford, UK T) +44 (0) 1865-281287 sudhir.anand@economics. ox.ac.uk

Dr Daqing Zhang, Peking University, China. T) +8610-82801568 [email protected]

EMBARGO: 02:00H (UK time) Monday October 20, 2008 OUT-OF-POCKET EXPENSES AND INSURANCE COVERAGE MUST BE ADDRESSED FOR CHINA TO ACHIEVE ITS HEALTH GOALS

High levels of out-of-pocket medical expenses, increasing costs and stalled progress in providing adequate health insurance for all have been set-backs for China’s health goals. But the government is determined to address the issues—it is already significantly increasing health spending and is committing to reaching 100% health insurance coverage by 2010. The issues are addressed in this sixth paper in The Lancet Series on Health System Reform in China, written by Dr David de Ferranti, The Brookings Institution, Washington, DC, USA, and colleagues.

As a proportion of total health expenditure, out-of-pocket payment costs rose from 20% in 1980 to 59% in 2000, before falling back to 49% in 2006. This is above the level found in countries to which China compares itself: South Korea (45%), Sweden (16%), Japan (15%), and (11%). The average cost of a single hospital admission is now equivalent to China’s annual income per head, and more than twice the average annual income of the lowest 20% of the population. And 35% of urban households and 43% of rural households have difficulty affording healthcare and often go without. The authors say: “The major changes that are required to reduce dependence on patient payments at the point of service, and replace them with prepaid coverage, are yet to gather steam. It is urgent to push forward on this front with high priority, and to recognise that getting to the end of this difficult transition is a long and sometimes difficult process, as other countries have learned.”

Improving health insurance coverage and quality goes hand-in-hand with lowering out-of- pocket payments. Government insurance schemes have expanded in recent years, yet many OECD countries provide more comprehensive coverage in terms of the services covered and the portion of the costs than China does; also a much larger proportion of the Chinese population have excessively high health-care expenses relative to their annual disposable income compared with OECD countries. The authors say these differences require further study.

China must also vigorously tackle rising costs and the distribution of funds. The authors say: “As long as providers in China continue to be paid on the current fee-for-service basis, escalating costs will undermine even the best-conceived reforms.” Current arrangements mean providers can prescribe drugs or procedures which are inappropriate to drive profits; the pressoffi[email protected] Telephone: +44 (0)20 7424 4949/4249 Press

authors look at the per-patient-episode system, used by several countries, with South Korea reducing costs by 14% and length of hospital stays by 6% using this system. How money is distributed needs urgent attention as the current system favours city-based hospitals (which receive over half of all health funding), and leaves village health and community health centres with disproportionately little. Countries such as Thailand, which have shifted more resources to clinics, are showing encouraging results. The authors says China can look to the examples set by Colombia, Thailand, and Mexico, who have all succeeded in substantial increases in coverage, despite difficulties.

The authors conclude: “The challenges are daunting, but China has enormous strengths it can bring to bear...Its ability to design, develop, and implement new policies and programmes, once its leadership puts full support behind a change in direction, is impressive, far surpassing that of many other nations.”

Dr David de Ferranti, The Brookings Institution, Washington, DC, USA. T) +1 202-468-1301 [email protected] / ddeferranti@resultsfordev elopment.org

EMBARGO: 02:00H (UK time) Monday October 20, 2008 CHINA HAS IMPROVED MATERNAL AND NEWBORN HEALTH BUT AFFORDABILITY OF HEALTH MUST BE ADDRESSED AS IT MOVES FORWARD

China has done well in provision of maternal and health services, but poorly in non- communicable diseases and smoking cessation. China’s health drive must also address the high numbers of families who are financially devastated by seeking healthcare. These are among the conclusions of authors of the final paper in The Lancet Series on Health System Reform in China, written by Dr Yuanli Liu, Harvard School of Public Health, Boston, MA, USA, and colleagues.

In this comprehensive study to measure China’s health system performance, the authors used two major indicators: coverage of health services (i.e. the extent to which people in need of certain services actually get them), and affordability of health services (i.e. incidence rate of household catastrophic medical spending and forgone medical care due to inability to pay). The study’s major findings include: Coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas; however effective coverage of high blood pressure (hypertension) treatment was only 12% for patients living in urban areas and 7% in rural areas in 2004. And while 45% and 50% of men living in urban and rural areas were regular smokers in 2003, only 5–6% of them tried to quit. With respect to the effect of healthcare on family budgets, 14% or urban and 16% of rural households incurred ‘catastrophic’ medical expenditure in 2003; while a further 15% of urban residents and 22% of rural residents had affordability difficulties when accessing .

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Although health insurance coverage improved both in urban areas and rurally between 1993 and 2003, The authors say: “On the basis of the proportion of residents reported having forgone medical care or early hospital discharge due to cost concerns in 2003, we can extrapolate that about 438 million Chinese people had affordability difficulties in 2003... Affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China’s current health-system reform efforts need to be assessed for their direct effect on performance indicators, for which substantial data gaps exist.”

They conclude: “We have shown the urgent need for China to construct a more comprehensive nationally and regionally representative dataset (whether a cohort or repeated cross-sections to be able to monitor and assess health-policy changes properly.”

Dr Yuanli Liu, Harvard School of Public Health, Boston, MA, USA. T) +1 617-432-4623 (Boston, USA); [email protected] +86 135-2259-2907 (China)

EMBARGO: 02:00H (UK time) Monday October 20, 2008 THE FUTURE OF TRADITIONAL CHINESE MEDICINE: AN EFFICACY DRIVEN APPROACH?

The future of traditional Chinese medicine (TCM) could see research move to an efficacy- driven approach. But many poor people (both Chinese and from other nations), rely on for basic health care, and an absence of reliable evidence of efficacy for these treatments is likely to aggravate the entrenched inequity in access to effective care for poor people. The issues are discussed in a Comment which forms part of The Lancet Series on Health System Reform in China, written by Dr Jin-Ling Tang, Chinese , China, and colleagues.

While randomised trials have shown efficacy for some TCM therapies, the efficacy of most evaluated TCM therapies remains uncertain, often due to low methodological quality of trials. These trials are published in Chinese, are inaccessible to Western doctors, and often not included in systematic reviews. The authors say TCM trials could be improved by adopting the bias-reduction points in the CONSORT guidelines, and, meanwhile, patients, intervention, comparator and outcome must be carefully chosen to ensure the clinical value of the results. Regarding the comparator, the authors note: “It is important to compare TCM with a placebo or an intervention of proven efficacy.” They add: “A real challenge is how to interpret and

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generalise the findings from trials of TCM delivered in the traditional way, in which the same patients are treated differently over time.”

The authors say that international collaborations and dialogues between practitioners of TCM or western medicine are important to further improve the quality and significance of TCM trials. They also note that TCM has some adverse effects, with the main reason for this being ‘contamination and inappropriate use rather than inherent risks with the herbs themselves.’ An example given is the use of raw or unprocessed Radix aconite lateralis, which is toxic to the heart and can cause severe irregular heartbeat. The authors say: “In a sceptical environment, it would be a mistake to dismiss effective therapies on the basis of adverse effects rather benefit-harm ratios.”

They conclude: “Particularly in developing countries, over 80% of the populations depend on herbal medicine for basic health care. An absence of efficacy for these treatments is likely to aggravate the entrenched inequity in access to effective care for poor people.”

Dr Jin-Ling Tang, Chinese University of Hong Kong, China. T) +852-2252 8779 / +852 2252 8744 [email protected]

EMBARGO: 02:00H (UK time) Monday October 20, 2008 NEW RULES FOR ORGAN TRANSPLANTATION IN CHINA WILL MEET INTERNATIONAL STANDARDS

More than 90% of transplanted organs in China are obtained from executed prisoners, and the previously under-regulated growth of transplantation in China provided an atmosphere for other organ donors to get financial compensation. But the Chinese Government’s Regulations on Human Organ Transplantation have banned financial reward by attaching stiff penalties to it, and introduced other safeguards. These regulations have been praised by WHO. The issues surrounding organ transplantation in China are discussed in a Comment in The Lancet Series on Health System Reform in China, written by Jiefu Huang, Vice-Minister of Health, China, and colleagues.

The new regulations have seen large decreases in transplants from dead donors and a more- than-doubling of transplants from living donors in 2007. The overall drop in transplantation in the last three years is a combination of these two factors. The authors say: “An organisational structure for transplantation must be established to oversee, implement, audit, and set up balance of authority between the central and provincial governments. A registry of recipients that uses robust methods of data-collection should be started. Donation, use of organs, and selection of patients are currently hospital based, without centralised standards, and

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a transparent system for organ procurement, equitable organ allocation, and selection of patients is needed.”

China is planning regulations for the new phase of transplantation, which will largely conform to international standards, and incorporate cultural nuances, eg, the laws for brain death will incorporate language that respect the family’s wishes, especially when they are based on religious belief that the whole body be buried. The authors conclude: “Despite a sharp decrease, capital punishment still exists in China. The long-term goal for social development is to abolish the death penalty but, until then, regulations need to protect prisoners’ rights and desires and separate transplant programmes from the prison system.”

Jiefu Huang, Vice-Minister of Health, China T) +86-10-68792005 [email protected]

EMBARGO: 02:00H (UK time) Monday October 20, 2008 PROFILES OF HEALTH MINISTER FOR CHINA CHEN ZHU AND VICE CHAIR OF PEOPLE’S CONGRESS HAN QIDE

To mark the publication of The Lancet Series on Health System Reform in China, The Lancet is publishing early Online Perspectives profiles of two key figures involved in the Series: Minister of Health for China Chen Zhu, and Vice Chair of the People’s congress Professor Han Qide.

See full profiles, links to which are included in the e-mail with this press release.

EMBARGO: 02:00H (UK time) Monday October 20, 2008 A REPORT TO HELP CATALYSE FUTURE HEALTH PROGRESS IN CHINA

The Lancet Series on Health System Reform in China opens with a Comment jointly written by Lancet Editor Dr Richard Horton, Professor Han Qide of the National People’s Congress, China, Tim Evans of WHO, and Dr Lincoln Chen from the China Medical Board, Cambridge, MA, USA. The Comment draws together all the themes in the Series, and concludes: “This report aims to initiate long-term collaboration between The Lancet and China, together with the China Medical Board and WHO, including critically important partners, such as scientists outside China who have strong interests in working with Chinese colleagues. The purpose of this collaboration is to introduce China’s health system, achievements, and predicaments to the world and to foster scientific and institutional alliances that can strengthen the health— and ameliorate the adverse social and environmental determinants of health—of the Chinese

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people. We are at the beginning of this relationship. Our report, we hope, has the potential to catalyse progress towards enhanced human health and wellbeing in China.”

A second Comment, by Chinese Minister of Health Zhu Chen, examines China’s investment in biomedical science and technology, and also discusses the importance of clinical trials to test efficacy of traditional Chinese . He concludes: “China’s translational research capacity will be improved by combining its clinical resources and research strength, while creating an environment that considers ethical, legal, and societal input. While encouraging indigenous innovation, China needs to further extend international collaboration through personal exchanges and joint projects. We believe that all these factors will contribute to the improvement of public health in the 21st century.”

Dr Lincoln Chen, China Medical Board, Cambridge, MA, USA [email protected]

Zhu Chen, Minister of Health, Ministry of Health, Beijing, China, and Rui Jin Hospital, Shanghai, China. [email protected] / [email protected] T) +86-10-68792005

Lancet Press Office. T) +44 (0) 20 7424 4949 pressoffi[email protected]

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