Press Press Release EMBARGO: 02:00H (UK time) Monday October 20, 2008 THE LANCET SERIES ON HEALTH SYSTEM REFORM IN CHINA: 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 Han Qide, Vice Chair of the People’s Congress; Health Minister Chen Zhu; 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 Medicine; and Dr. Hans Troedsson, WHO Representative in China. pressoffi[email protected] Telephone: +44 (0)20 7424 4949/4249 Press 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 Shanghai 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 pressoffi[email protected] Telephone: +44 (0)20 7424 4949/4249 Press 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 DISEASES COULD BE VITAL IN WARNING WORLD OF BIRD-FLU PANDEMIC The Chinese early detection system for infectious disease 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 pressoffi[email protected] Telephone: +44 (0)20 7424 4949/4249 Press 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) epidemic 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 pressoffi[email protected] Telephone: +44 (0)20 7424 4949/4249 Press by Professor Gonghuan Yang, Chinese Centre for Disease Control and Prevention, Beijing, China, and colleagues.