Read our COVID-19 research and news.

Health indicators for Shanghai are comparable to those of advanced industrialized countries, but China's rural areas are lagging.

Health indicators for Shanghai are comparable to those of advanced industrialized countries, but China's rural areas are lagging.

Agnieszka Bojczuk

China making dramatic public health gains

BEIJING—China’s robust economic growth in recent decades has ushered in monumental health improvements—but wide regional disparities remain, a pair of studies published in The Lancet this week shows.

Researchers from the Chinese Center for Disease Control and Prevention, China’s National Office for Maternal and Child Health Surveillance, and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, used provincial and county-level data to produce a detailed picture of health throughout the country. Wealthy urban centers such as Shanghai enjoy a health status comparable to that of developed Western European nations, but the situation in the rest of the country is complex and potentially challenging for public health improvement efforts.

One key finding is that mortality rates for children under 5 dropped 78% nationwide between 1990 and 2013. Children in richer urban areas fared far better than those in the poorer countryside. In 2012, Shanghai’s wealthy Huangpu district had the lowest rate, 3.3 deaths among children under 5 per 1000 live births. By contrast, that same year the rate across the Tibetan plateau ranged as high as 104.4.

“The progress is well beyond what you would expect on the basis of simply education and income,” says Christopher Murray, an IHME public health specialist and co-author. “This is a country that has a very strong commitment to maternal and child health,” he adds. As part of a “concerted public health strategy,” China has invested heavily in hospitals and clinics as well as in widespread vaccination programs and breastfeeding awareness campaigns.

Despite that commitment, “Health inequalities are also large and data from several analyses suggest that they are growing,” the researchers write, suggesting that imbalances in health and access to care across China reflect growing income inequality. Top-level health care facilities and providers are concentrated in China’s cities. The authors recommend localizing health policies to address varying regional challenges.

Differences in health also feature in the second paper that focuses on overall mortality. Shanghai again fared best on overall life expectancy; in 2013 its women lived an average of 85.2 years compared with an average of 72.4 years for their counterparts in Tibet. The researchers note that a marked decline in deaths resulting from communicable diseases (with the exception of HIV/AIDS) had helped to narrow the gap between the best and worst provinces from 21.4 years in 1990 to 12.8 years in 2013.

Notably, China’s alarmingly high female rural suicide rates also fell dramatically during that period, dropping by between 36% and 81% depending on the area. Murray says theories for the decline include greater opportunities for rural women as they leave for work in cities and reduced access to the toxic pesticides that were a favorite suicide method.

Today, cerebrovascular disease, the main cause of stroke, is the leading cause of death in 27 provinces; ischemic heart disease kills the most in five provinces. In Hong Kong lung cancer is the leading killer. Along with development, road accidents have become a top 10 cause of death. Murray notes that although there are clear geographic patterns to some of the major causes of death, there are unusual variances that might be due to environmental contamination or heavy smoking.

In Beijing this week for meetings with Chinese government officials and researchers about the findings, Murray says he sees an apparent willingness to address inequities.

“I’ve been impressed by how much [authorities have] embraced the quantification of these disparities,” he said. He is hopeful this will lead to the localized policies recommended by the authors.