Health is the foundation of people’s happiness and social development; it is also the common aspiration of all Chinese people in their pursuit of a happy life. Since the Communist Party of China (CPC) convened its 18th National Congress in 2012, the CPC Central Committee with Xi Jinping at the core has made decisions and arrangements pertaining to developing a healthy China on the basis of the “Five-Pronged” overall plan and the “Four Comprehensives” strategy. In 2016, the CPC Central Committee and the State Council convened the National Health Conference – the first national meeting of its kind in the 21st century – at which General Secretary Xi delivered an important speech. Subsequently, the CPC Central Committee and the State Council promulgated the “Outline of the Healthy China 2030 Plan”, which lays out a fine blueprint for developing a healthy China. This is an important milestone in the development of China’s health care, and will have major short- and long-term implications for our efforts to raise the health of the Chinese nation as a whole and realize the “Two Centenary Goals.”
一、准确把握新形势，进一步增强推进健康中国建设的责任感和紧迫感
I. Accurately identifying new circumstances and further enhancing the sense of responsibility and urgency concerning the development of a healthy China
The CPC and government have long attached major importance to ensuring public health. After the founding of the PRC in 1949, they vigorously promoted health care with a heavy emphasis on improving it in rural areas. To address people’s difficulty in securing access to medical services, the CPC and government established China’s unique primary health care system which features a triple-tier network for the provision of medical services for both urban and rural areas, a cooperative medical care program for rural residents, and barefoot doctors. This system emphasizes taking advantage of the traditional Chinese medicine with regards to its quick diagnosis, convenient treatment, and low cost of its natural therapies and medicines. Meanwhile, with a view to “promoting physical culture and building up people’s physique,” extensive sporting and fitness activities for the general public were launched in an effort to promote public health. Under the firm leadership of the CPC Central Committee and the State Council, the Chinese nation is standing tall among the nations of the world as a strong and healthy nation. With great rapidity, China has improved its level of public health via the tireless efforts of its medical workers and the vigorous patriotic health campaigns the people have launched. Thus, it has cast aside its former label as the “sick man of East Asia”, and is now acclaimed as a paradigm for other developing countries by the World Health Organization (WHO).
Since the launch of reform and opening-up, China’s undertakings in health care have developed apace, and the monumental achievements made in this regard have captivated the world. In 2009, on the basis of an encapsulation of the experience of the SARS outbreak, China launched a new round of reform of the health care system, in which it clearly identified the basic principles of guaranteeing basic health care services, developing primary care, and establishing mechanisms, in order to realize the goal of providing basic medical services for everyone. Especially since the 18th CPC National Congress, in light of the new features at this critical point in furthering reform and meeting the new expectations of the people, the CPC Central Committee with Xi Jinping at the core has put forward a people-centered notion of development; thus, safeguarding public health has been adopted as a task fundamental to national governance. By adopting an overall perspective, making systematic plans, highlighting priorities, and establishing frameworks, the CPC Central Committee has implemented a series of major measures capable of yielding both short- and long-term benefits, driven forward with reform of the health care system using a gradual approach by making easy breakthroughs before moving onto the harder ones, and taken fast yet steady steps to continue reform, attaining a milestone achievement. Thus, China’s health care has progressed to new heights.
First, China has woven the world’s largest universal basic health care network. With a view to guaranteeing basic health care services, we have improved the medical insurance scheme for working urban residents, and expanded its coverage for new rural cooperatives and for non-working urban residents, developed a major disease insurance scheme and an emergency disease treatment scheme, and improved the medical assistance scheme, thus forming a closely linked, and multi-layered basic health care network that covers both urban and rural areas. Basic health care coverage has now stabilized at over 95% of the population, and the level of benefits has increased by a large margin. Government subsidies for basic health care have risen from 80 yuan per person per annum in 2009 to 450 yuan in 2017, and the proportion of reimbursement of hospital fees using medical insurance funds as prescribed by the relevant policies has steadily risen. This basic health care network provides strong institutional guarantees for universally affordable and accessible medical care.
Second, China has improved the health care service system that covers both urban and rural areas. With a view to developing primary care, we have stepped up efforts to develop a triple-tier network for the provision of basic medical services in rural areas and community health service centers in urban areas, fully implemented the national essential drugs system, deepened the comprehensive reform of grassroots medical and health institutions, prioritized the training of general practitioners, and made orderly progress with a classification mechanism for determining the kind of medical treatment required, so as to give more urban and rural residents access to family doctor services. We have launched comprehensive reform of county-level public hospitals, implemented pilot reforms for urban public hospitals, and explored the establishment of a new operational mechanism for health care institutions that will help to preserve their public welfare orientation, ensure that they are fully motivated, and guarantee their sustainability. We have actively encouraged non-government investment in health care, and the number of private hospitals now accounts for over 56% of the total. Thus, a health care service system with a diverse range of medical service providers is taking shape that will continue to satisfy the many-faceted and diverse health needs of the people.
Third, we have erected enduring and tight security and prevention barriers for safeguarding public health. With a firm focus on prevention, we have strengthened our ability to respond to public health emergencies, developed the world’s largest monitoring network for epidemic diseases and public health emergencies, and organized a disease prevention and control emergency response team who is capable in both calm and calamitous times, of a swift response, and of successfully carrying out their work; these efforts have enabled us to effectively respond to major epidemic outbreaks. These efforts proved especially effective in 2015, when we stood the test of the outbreak of Ebola hemorrhagic fever and realized a double victory – domestically by taking strict precautions and thus achieving zero outbreaks, and in Africa by giving a successful response so that none of our aid workers contracted infections. China’s overall strength in public health and capabilities in the prevention and control of diseases have taken a great step forward, and its capacity for public health emergency response is now among the best in the world.
Fourth, we have improved the health and wellbeing of the people. We strive to give people a greater sense of gain with regard to health; as such, in improving health care our ultimate goal is to bring tangible benefits to the public. We have lightened the burden of people in obtaining medical services and reduced individual payment of the expenditure to below 30% of the total, the lowest level in 20 years. We have made clear improvements in equal access to public health services, provided 12 free national basic public health services to urban and rural residents, and increased per capita government expenditure on health care from 15 yuan in 2009 to 50 yuan in 2017, benefiting tens of millions of households. We have implemented a new two-child policy and its supporting measures to ensure that every family can afford to raise two healthy children. From 2009 to 2015, China’s average life expectancy rose from 74.8 years to 76.3, the maternal mortality rate fell from 0.319‰ to 0.201‰, and the infant mortality rate decreased from 13.8‰ to 8.1‰. Major public health indicators in China are better than those of the average medium- to high-income country, signaling that China has achieved the United Nations Millennium Development Goal ahead of schedule. These achievements were made in only eight years with a per capita cost of less than US$500, demonstrating the superiority of China’s basic health care system.
In sum, the five years since the 18th CPC National Congress have witnessed great investment in and rapid growth of China’s health care, which brings many benefits to the people and enjoys domestic and international recognition at unprecedented levels. This period has been another golden age for the development of health care in the country. Particularly, the CPC Central Committee and the State Council have made remarkably effective theoretical, systemic, and practical innovations, formulated a series of new, landmark policies and measures, formed an initial institutional framework that ensures universal basic medical services, and created policy systems for health care that are commensurate with China’s level of social and economic development, thus laying a solid foundation for a healthy China. International organizations such as the World Bank and the WHO believe that, with unprecedented speed, China realized universal coverage of basic health care in just half the time it took some developed countries, captivating the world with its achievements. Experience has proven that the basic direction, general approach, and major measures that China takes in reforming and developing its health care are valid and its achievements are remarkable, and that they guarantee and improve public wellbeing and promote economic development and social equity. China has gradually made inroads towards a Chinese approach to health care reform, which is a difficult issue of global proportions. This rapid investment in and development of health care are an important constituent of the major achievements of China’s reform and opening-up and socialist modernization. These achievements did not easily come by, and as such they are of extra value.
As the old saying goes, “There will be both good and bad times on the long journey of life.” We must always keep in mind that, as China is a large developing country with a population of over 1.3 billion, developing a healthy China remains a long and arduous task with many difficulties and challenges yet to be overcome. Particularly, the CPC Central Committee and the State Council have put forward new and more demanding requirements regarding the reform and development of health care; the people have new and higher expectations for public health services; and the health care sector is undergoing profound changes without precedent. To arise to these challenges, we must understand the bigger picture and fully understand the new conditions facing our efforts to develop a healthy China.
Developing a healthy China is a major decision towards realizing our national development strategy. We are marching ahead to realize the “Two Centenary Goals,” achieve socialist modernization and the Chinese dream of national rejuvenation. The dream of a healthy China is an important constituent of the Chinese dream; in particular, developing a basic health care system with universal coverage and raising average life expectancy by one year are two important indicators for the goal of achieving moderate prosperity throughout society by 2020. In realizing these goals, we are faced with complex situations with many intertwined and overlapping factors, including continued acceleration of industrialization, urbanization, and population aging, and constant changes in the spectrum of disease, the environment, and ways of life. The number of citizens aged 60 years and over has now reached 230 million, and is projected to reach 370 million by 2030 and 487 million by 2050. Alongside issues regarding the provision of support for the elderly, population aging also brings with it health issues regarding medical treatment, care, and the emotional wellbeing of the elderly. In China, there are over 250 million patients suffering from high blood pressure, and over 97 million from diabetes. Chronic non-communicable ailments such as cardiovascular and cerebrovascular diseases and cancer account for 85% of the death toll, and have now become the number one killer. In addition, we still face a grim situation regarding damage and pollution to the environment, safety of food and drugs, safety of drinking water, hidden occupational dangers, and the frequent occurrence of industrial accidents in coal mining and transportation, which all pose threats to public health. In order to more actively prevent these potential threats, we need to take strong and decisive measures.
Developing a healthy China is a pressing task that the CPC undertakes in order to meet the people’s new expectations regarding their health. On one hand, in the wake of increasing economic and social development and growing personal incomes, people lay more emphasis on quality of life as well as health and safety because ideas about health are disseminated and people’s awareness of their health improves; that is to say, rather than simply having adequate and effective medical services, they hope to avoid or reduce the risk of contracting illnesses, and enjoy medical services that are more agreeable and better catered to their particular needs. In this regard, the people are placing higher expectations on the government when it comes to ensuring their health and providing basic health services, and they are making increasingly multi-layered and diversified demands for health services. In 2016, medical institutions provided 8 billion sessions of treatment nationwide, which is an increase of 63% compared to 4.9 billion in 2009. On the other hand, some people do not fully understand the limitations, complexities, and risks of medicine, and have a weak awareness of health management and overly high expectations for medical services. From time to time and for a variety of reasons, medical disputes occur, and these disputes adversely affect health care development, social harmony and stability in China. Issues with health care not only affect people’s livelihood, they also have major social and political implications.
Developing a healthy China is an inherent requirement for furthering health care reform and coordinated development of health care. China’s health care faces a complex situation whereby old and new problems overlap, development issues and reform tasks intertwine, and emphasis needs to be placed equally on both consolidating extant achievements in reform and expanding and furthering reform into new areas. There are still many shortcomings in developing health care, which include the low quality of services supplied, insufficient resources, unequal distribution of resources, disequilibrium in personnel structures, insufficient capability in providing services at the grassroots, and lagging development in old revolutionary base areas, ethnic minority areas, border areas, and impoverished areas. As we move into the “deep end” of health care reform, a decisive phase in which still more deep-seated issues will arise, the troubles we face will be much harder to resolve. Profit-driven mechanisms still exist in public hospitals, and thus the phenomena of excessive prescriptions and medical examinations remain. Funding standards for medical insurance for urban and rural residents are relatively low, and medical insurance needs urgent improvement regarding its roles in controlling cost and encouraging certain types of practices and discouraging others. Due to poor control of drug circulation, artificially high drug prices are a prominent issue. We need to maintain a problem-oriented approach, confront challenges head-on, not be afraid to assume responsibility, and fully devote ourselves to overcoming these difficulties.
Developing a healthy China is essential for us to adapt to changes in global health governance and better fulfill our international responsibilities. The global health system is at an important stage of development and reform. The UN’s 2030 Agenda for Sustainable Development raised health to an even more prominent position. All countries worldwide are actively promoting health care reform, with many of these formulating health plans to better coordinate the level of public health with economic development. Moreover, as the pace of globalization quickens, transnational threats to public security such as outbreaks of epidemic diseases, bioterrorism, and antibiotic resistance become increasingly serious. The outbreak in some countries of new infectious diseases such as Ebola hemorrhagic fever and Middle East respiratory syndrome has resulted in major public health issues that must be addressed via the joint efforts of all countries. Furthermore, developmental imbalances and inequality in global health are still evident. As health is a common undertaking of humanity and common responsibility of the international community, we need to actively drive reforms of global health governance and spur the founding of a new order in international health that is fairer and more equitable.
In sum, the reform and development of health care in China has entered a crucial stage in which we must overcome many difficulties; yet it also presents us with a great opportunity for writing a new chapter in this regard. With the strong leadership of the CPC Central Committee with Xi Jinping at the core, the superiority of the socialist system, the continued increase in overall national strength, and the solid foundation already laid down in prior reforms and developments of health care over the years, as long as we unite as one, forge ahead, seize opportunities, and dismantle barriers, we will surely actualize our blueprint for developing a healthy China.
