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 of Health Environment and Conditions

III. Public Health Service Capability Improving Steadily

IV. Great Improvement in the Quality of 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

Major Indicators for the Healthy China Program

Preface

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 (CPC) 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 well-being and all-round 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 (WHO) 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.

I. Ensuring People's Right to Health Based on China's Conditions

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 multi-channel 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 (SARS) 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 law-based development, in an effort to form a basic medical and healthcare system and promote the all-round, 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 Five-Year 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 communique 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 decision-making 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 non-basic medical care sector.

Graphics shows main health indicators in selected years written in the "Development of China's Public Health as an Essential Element of Human Rights" white paper, issued by the State Council Information Office. (Xinhua/Ma Yan)

II. Continuous Improvement of Health Environment and Conditions

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 "Breathe the same air and get it done together" to improve air quality and intensify publicity and education through basic public health services and health education, health literacy promotion campaigns, the "Healthy Chinese" and "TCM in China" initiatives, and major theme-day public health publicity. Health awareness in both urban and rural areas rose to 10.25 percent in 2015 from 6.48 percent in 2008.

Vigorously pursuing environmental improvement. Joint pollution prevention and control between different regions has been enhanced; air quality monitoring facilities at county and district levels in the Beijing-Tianjin-Hebei region, the Yangtze River Delta and the Pearl River Delta function as a network; a network monitoring particle matter (PM) and photochemical pollutants in the Beijing-Tianjin-Hebei region and neighboring areas is in full operation. From 2011 to 2015, the nationwide chemical oxygen demand, emissions of ammonia nitrogen, sulfur dioxide, and nitrogen oxide decreased by 12.9 percent, 13 percent, 18 percent and 18.6 percent, respectively. In 2016, the PM 2.5 average concentration dropped by 6.0 percent year on year and the number of days with excellent and good air quality increased by 2.1 percentage points year on year in 338 cities at the prefectural level and above. In 2013, China enacted the Air Pollution Prevention and Control Action Plan; from 2014 to 2016, about 16 million heavily-polluting vehicles and old vehicles that couldn't meet the environmental protection standards were eliminated; all coal-fired generators have realized desulfurization and denitrification; ultra-low emissions have been encouraged, and by March 2017 coal-fired generators of about 500 million kw had been improved to achieve ultra-low emissions; the Action Plan for the Prevention and Control of Soil Pollution has been enacted, and a comprehensive survey of soil pollution has been launched; the Rules on Environmental Management of the Soil of Contaminated Sites (Trial) have been promulgated. A fund for soil pollution prevention and control has been set up, and from 2016 to 2017, RMB15 billion was earmarked by the government for this purpose. A national soil environment network has been primarily established, with 22,000 basic monitoring spots and about 15,000 risk-monitoring stations; the Action Plan for the Prevention and Control of Water Pollution has been promoted and completely implemented; the comprehensive management of the environment surrounding the river valleys has been enhanced; the environmental protection of the Yangtze River Economic Belt has been pursued, and the investigation of black and odorous water bodies in urban areas has been carried out; in 2016, according to the state-controlled monitoring bodies of surface water, the proportion of such spots of Grades I-III reached 67.8 percent, while that of inferior water bodies of Grade V dropped to 8.6 percent.

Progress in comprehensive management of environmental hygiene in urban and rural areas. The China Healthy Cities and Towns Initiative is being pursued to largely improve living conditions in urban and rural areas. According to a survey in 2012, since the initiative was introduced, the proportion of standardized fairs and markets had risen to 60.6 percent from 35.2 percent, and the percent of residents who are satisfied with urban amenities and the environment increased from 30 percent to 98 percent, with 98 percent of them satisfied with the effect of the initiative. By the end of 2015, the sewage treatment rate in urban areas had increased to 92 percent while the pollution-free treatment rate of household garbage in urban built-up areas had reached 94.1 percent. Comprehensive environmental improvement had been carried out in 78,000 villages, benefiting over 140 million people in rural areas; waste treatment and resource utilization facilities had been installed in 61,000 large-scale livestock and poultry farms. By the end of 2016, the treatment rate of household garbage in rural areas was around 60 percent, and the proportion of administrative villages with sewage treatment had reached 22 percent. In 2016, 80.4 percent of rural households use toilets while the rate was 71.7 percent in 2012; in some provinces in the more developed eastern areas the figure was 90 percent or higher.

Drinking water safety issues in rural areas basically solved. From 2006 to 2010, the investment in safe drinking water projects in rural areas reached RMB105.3 billion, providing safe drinking water to 212 million rural residents in 190,000 administrative villages. From 2011 to 2015, RMB121.5 billion from the central government and over RMB60 billion from local governments were appropriated for safe drinking water projects in rural areas. By the end of 2016, the safe drinking water monitoring covered over 85 percent of rural villages, and up to 82 percent of rural residents enjoy centralized water supply. The state has allocated funds to areas with particular difficulties, and raised the subsidy standards, such as by appropriating RMB495 million to provide safe drinking water to over 1,400 monasteries, 32,300 monks and nuns and 60,000 other residents with temporary needs in the Tibet Autonomous Region.

Enhancing occupational health management. In 2011, China revised the Law of the People's Republic of China on Prevention and Control of Occupational Diseases. Campaigns were launched to control and reduce the hazards associated with fine dust and toxic stuff during production processes in particular sectors, such as quartz sand processing, asbestos mining and asbestos-product manufacturing, gold mining, cement manufacturing, stone-material processing, ceramics and refractory-material production. Corporations are urged to increase investment to improve production processes and protection measures for employees. Operational environment and conditions at workplaces have been primarily improved. By the end of 2016, the government, in accordance with the law, had punished the corporations that refused or failed to improve their occupational health management, demanding 1,524 corporations to suspend production for rectification, shutting down 1,576 corporations in response to public demand, and eliminating 426 illegal enterprises. The government has intensified supervision and inspection on occupational health management of employers. From 2013 to 2016, the number of corporations nationwide that had been brought under government supervision and inspection increased from 229,000 to 395,000, up by 72.5 percent.

Tougher control of food safety. In 2015, China revised the Food Safety Law. In 2016, regulatory agencies at all levels conducted inspections of the food production process of 521,000 food producers, 15,000 food additive producers, and 72,000 food processing workshops. As for the selling of food products, regulatory agencies at all levels conducted inspections of 12.093 million businesses, and 8.869 million catering services. In 2016, competent authorities conducted random inspections on 257,000 food samples, of which 96.8 percent met the required standards, and properly settled several food safety incidents, including one involving the sale of counterfeit infant formulas.