Development of China's Public Health as an Essential Element of Human Rights

VI. Significant Improvement in the Health of Special Groups

The Chinese government attaches great importance to the protection of the right to health of special groups such as women, children, the elderly and the disabled. It constantly improves health programs, and provides diversified and targeted health services to meet the special needs of various groups in a non-discriminatory and equal manner.

The maternal and child healthcare service system has been continuously improved. A three-level network of maternal and child healthcare service has been put in place in urban and rural areas. In 2016, the Chinese government invested RMB2.9 billion to support the construction of 247 city- and county-level maternal and child healthcare institutions. By the end of 2016, there were 3,063 such institutions, 757 maternity hospitals, 117 children's hospitals, and 370,000 gynecologists, obstetricians and pediatricians, and assistants. Full-time and part-time maternal and child healthcare workers were available in 34,000 community health centers (stations), 37,000 town and township health centers and 640,000 village clinics.

Antenatal and perinatal care services have been upgraded. Since 2009, the Chinese government has been expanding year by year the coverage of cervical cancer and breast cancer screening programs in rural areas, and the number of beneficiaries has grown. Between 2009 and 2016, the government carried out free cervical cancer screening for more than 60 million rural women aged 35-64 in 1,299 project counties, and subsidized more than 74 million rural pregnant and lying-in women with a special investment of RMB22.6 billion. The rate of hospital deliveries for rural women increased from 92.3 percent in 2008 to 99.6 percent in 2016, and rates of maternal and infant mortality in rural areas decreased sharply. The government arranged subsidies for 11 programs, including free pre-pregnancy examinations for healthy childbirth, hospital deliveries for rural women, supplementary taking of folic acid by rural women to prevent neural tube defects, and prevention of mother-to-child transmission of HIV, syphilis and hepatitis B. The targets of the Program for the Development of Chinese Women (2011-2020) have been met one by one.

Children's health has improved remarkably. In 2013, the pure breastfeeding rate of babies aged 0-6 months increased to 58.5 percent nationwide. The breastfeeding rate keeps growing. In 2016, infant mortality was 7.5 per thousand and that of children under five was 10.2 per thousand, both meeting the targets set in the UN Sustainable Development Goals and the Program for the Development of Chinese Children (2011-2020) ahead of schedule. This shows that the gap between China and developed countries is rapidly narrowing. In 2016, for children under five, the underweight and growth retardation rates, and anemia prevalence decreased to 1.49 percent, 1.15 percent and 4.79 percent, respectively - all meeting the targets set in the Program for the Development of Chinese Children (2011-2020) ahead of schedule. By the end of 2016, 30 state-level demonstration bases for children' s early development had been set up. The government has implemented a program of nutrition improvement for children in poverty-stricken areas, providing one pack of nutritional dietary supplements containing protein, vitamins and minerals every day for every baby aged 6-24 months in impoverished areas. According to the fifth survey of Chinese children' s physical development in 2016, in the past 40 years the physical development of children under seven improved rapidly, even higher than the child growth standards published by the WHO.

Children's disease control has been consolidated. In 2016, the rate of mother-to-child transmission of HIV decreased to 5.7 percent, and the incidence of neonatal tetanus was less than 1 per thousand. Children' s vaccination rate under the national childhood vaccine program was more than 99 percent. The country remains polio-free, and has a low reported incidence of tuberculosis in children. In 2016, the screening rate of inherited metabolic diseases (phenylketonuria and congenital hypothyroidism) reached 96 percent, and the neonatal disease screening program for poor areas covered 354 counties (cities or districts) in 21 provinces (autonomous regions and centrally administered municipalities). The Chinese government has been carrying out major public healthcare service programs such as free pre-pregnancy examination for healthy childbirth, screening of neonatal diseases in poor areas, and pilot prevention and control of thalassemia.

The healthcare service system for the elderly has improved. By the end of 2015, there were 453 rehabilitation hospitals, 168 nursing homes and 65 nursing stations around China, up by 69.0 percent, 242.9 percent and 16.1 percent, respectively from 2010. The number of health personnel working in the above three kinds of institutions was 36,441, 11,180 and 316, respectively, up by 96.5 percent, 286.7 percent and 69.9 percent from 2010. In 2015, the government offered 118 million medical examinations to senior citizens aged 65 or above, a health management rate of 82 percent. The mental health of the elderly has also attracted full attention. Governmental and social organizations publicize related knowledge and provide mental health counseling to the elderly, while working to enrich their cultural life.

The combined medical and elderly care services have been promoted. In 2016, 90 cities (districts) were selected as state-level pilot units to provide combined medical and elderly care services. Across China there were 5,814 institutions providing both services, with a total of 1.2138 million beds. Of these, 3,623 were nursing institutions for the elderly that have established medical facilities, 1,687 were medical institutions that have added care services for the aged, and 504 were institutions offering both services. In total, 2,224 were among designated medical insurance institutions. Special steps have been taken to improve services at these nursing institutions for the elderly; as a result, we have seen a sounder quality control system and better services at these institutions combining medical service and ordinary care service.

Disability prevention and rehabilitation services for persons with disabilities have improved. In 2016, the Chinese government published the National Action Plan on Disability Prevention (2016-2020), and in 2017, the Regulations on Disability Prevention and Rehabilitation, bringing the work onto the track of the rule of law. From 2012 to 2016, 15.26 million people with disabilities received basic rehabilitation services nationwide. By the end of 2016, there were 7,858 rehabilitation institutions for the disabled around China, with 223,000 employees; and 947 municipal districts and 2,015 counties (cities) provided community-based rehabilitation services, with 454,000 coordinators. August 25 is China's Disability Prevention Day, as set in 2017.

Rehabilitation sports for the disabled have been expanded to more areas. The Chinese government has been working to improve basic sports facilities for the disabled since the 13th Five-Year Plan period (2016-2020). It has implemented a region-based guidance policy by advancing from west to east, from north to south and from the underdeveloped to the more-developed areas. Under this policy framework, the government has funded six western provinces (autonomous regions and municipalities directly under the central government) in introducing rehabilitation sports into 8,000 households, from which a national campaign started, offering services to 88,884 households. It also subsidized 50 communities in installing fitness facilities as demonstration sites, and subsequently 1,842 new ones were set up nationwide. Now people with disabilities who regularly participate in sports and fitness activities make up 9.6 percent of the national total, a percentage higher than before.

Orphans with disabilities receive special care. Since 2015, the Chinese government has included sick and disabled children among urban and rural residents entitled to basic living allowances and people living in dire poverty and entitled to relief and support, and orphaned and disabled children who remain unsettled, in the Tomorrow Plan for Rehabilitation of Handicapped Orphans. In addition, it offers medical rehabilitation to these children with reference to treatment policies and practices of welfare institutions. Thanks to the Tomorrow Plan, tens of thousands of children have had operations and been integrated into society after recovery. At welfare institutions, all children with surgical indications who are new to these institutions are able to get surgery at the optimal opportunity for treatment. By the end of 2016, the country had invested RMB860 million in offering corrective operations and rehabilitation training to more than 90,000 orphans with disabilities.

VII. Active Participation in Global Health Governance and International Medical Assistance

China advocates, promotes and carries out international medical and health cooperation. It is firmly committed to realizing the Program of Action of the International Conference on Population and Development, and implementing the United Nations 2030 Agenda for Sustainable Development, especially sustainable development goals relating to health. China actively provides medical aid to other countries, and promptly conducts global emergency responses. It earnestly implements international health conventions and shoulders its international humanitarian responsibilities.

Taking part in the formulation of international medical and health rules. China was one of the first countries in the world to sign and approve the Constitution of the World Health Organization. It has joined the Single Convention on Narcotic Drugs and the Convention on Psychotropic Substances. China has participated in the making of a series of international treaties and declarations, including the Declaration of Alma-Ata, and supported the World Declaration on the Survival, Protection and Development of Children. At the 69th World Health Assembly held in 2016, China raised and promoted the adoption of a resolution to "promote innovation and access to quality, safe, efficacious and affordable medicines for children," getting positive responses from all sides.

Carrying out in-depth cooperation with the WHO. In 2016, the China-WHO Country Cooperation Strategy (2016-2020) was signed in Beijing, defining cooperation in health policies, planning, technology and human resources. In 2017, the Memorandum of Understanding on the Belt and Road Health Cooperation Mechanism and the Implementation Plan on the Belt and Road Health Cooperation Mechanism were signed to promote cooperation in health emergency response, prevention and treatment of infectious diseases, and traditional medicine between countries along the Belt and Road.

Extending international medical and health exchanges and cooperation. China conducts health experience sharing and strategic dialogue with other countries. It organizes a number of international medical and health seminars. In December 2015, cooperation plans on public health were announced at the Johannesburg Summit of the Forum on China-Africa Cooperation, including participation in the construction of African Center for Disease Control and Prevention and other major initiatives. In October 2016, China built partnerships with counterpart hospitals in 15 Asian and African countries, including Ethiopia. In April 2017, China signed medical and health cooperation agreements with Malawi and other African countries. Since 2005, China has trained thousands of officials and technical personnel from developing countries, and encouraged its non-governmental organizations to develop education and training projects on adolescent reproductive health and AIDS prevention in Zimbabwe and Kenya, as well as the Greater Mekong Sub-region.

Making outstanding achievements in international medical and health assistance. Since 1963, China has sent teams totaling 25,000 medical workers to 69 developing countries. They have diagnosed and treated a total of 280 million cases. In September 2015, China announced at relevant United Nations summits that it would take major health assistance actions for developing countries in the five years to come, including the construction of 100 hospitals and clinics, and the implementation of 100 "maternal and child health projects." By June 2017, more than 1,300 medical team members and public health experts from China were working in 51 countries, and over 20,000 health management and technical personnel had been trained in China for the recipient countries. It had built more than 150 facilities, including general hospitals, specialized centers and drug warehouses. China had provided batches of medical supplies to those countries including ambulances, diagnosis and treatment equipment, and vaccine cold chains. In the same period it donated antimalarial drugs to Africa, saving 40 million lives. Since 2008, China has built 30 malaria prevention and treatment centers in Africa, and provided RMB190 million worth of artemisinin-based antimalarial drugs.

Effectively conducting global emergency response. China has met the requirements for implementing the International Health Regulations. It has been playing an active and leading role in international emergency rescue, and has participated in the fight against epidemics, including yellow fever and Zika virus disease in Angola and Guyana. After the outbreak of Ebola in West Africa in 2014, China provided assistance including cash and supplies to epidemic-stricken countries and international organizations on four consecutive occasions, with a total value of US$120 million. More than 1,200 Chinese medical personnel and public-health experts had been sent to epidemic-stricken areas and neighboring countries to complete nearly 9,000 sample tests, observe and treat over 900 cases and train 13,000 local people in medical care and community-based prevention and control. After an 8.1-magnitude earthquake hit Nepal in 2015, the Chinese government sent four medical and epidemic prevention teams with a total of 193 members to the disaster area to help relief efforts. A total of 2,600 cases were treated and more than 1,000 core members of health and epidemic prevention work were trained.

International recognition of TCM continuing to grow. Now, 183 countries and regions around the world have access to TCM. TCM has become an important part of China's cooperation with regions and health organizations in ASEAN, Europe and Africa. TCM acupuncture and moxibustion have been recognized as important parts of the intangible heritage of mankind by UNESCO, and the Chinese medical classics Huangdi Neijing (Inner Canon of the Yellow Emperor) and Bencao Gangmu (Compendium of Materia Medica) have been included in the UNESCO Memory of the World. According to statistics from the WHO, 103 member states have authorized the use of acupuncture and moxibustion, of which 29 have established laws and regulations promoting traditional medicines, and 18 include acupuncture and moxibustion in their medical insurance systems.

Conclusion

The CPC and the Chinese government earnestly respect and protect people's right to health, and consider safeguarding people's health as a basic task of governance. Significant actions have been taken, aiming to benefit people both in the present and the future. China has achieved great success in health affairs, making an important contribution to the sustainable development of mankind.

"Between heaven and earth, man experiences both dangers and stability during the course of his lifetime." We are keenly aware that safeguarding people's health is a systematic project. It takes a long period of sustained efforts. At present, with the situation of the country's industrialization, urbanization and aging population, as well as the changing disease spectrum, ecological environment and lifestyle, the Chinese people are still facing a complex situation in which multiple disease threats coexist and a variety of health factors are intertwined; meanwhile, with the improvement of living standards and enhancement of the concept of health of the people, public demand for health products and health services continues to grow, showing multi-level, diversified and individualized characteristics. Consequently, China is faced with health problems common to both developed and developing countries.

In order to better safeguard people's right to health, we are speeding up the building of a heathy China. A series of plans and outlines have been made and implemented, including the "Healthy China 2030" Planning Outline, the National Fitness Program (2016-2020), the 13th Five-Year Plan for Medical and Health Service Development, and the Plan for Deepening Reform of the Medical and Healthcare System During the 13th Five-Year Plan Period (2016-2020). The Chinese government has put forward a "three-step" goal: a sound basic medical and healthcare system with Chinese characteristics will be established covering both urban and rural residents, with the main health indicators ranking in the forefront of the high- and middle-income countries by 2020; the health-promotion system will be improved, with the main health indicators in the ranks of the high-income countries by 2030; and a healthy China conforming to the requirements of a modern socialist country will be built by 2050. Governments at all levels will continue their work toward comprehensively safeguarding people's health for the full life cycle, and promoting the overall development of medical and health services, with a high sense of responsibility and urgency.

Health is an eternal pursuit of mankind, and health promotion is the common responsibility of the world community. The United Nations 2030 Agenda for Sustainable Development has set healthy lives as a major sustainable development goal, and the development of the global health system is at a crucial stage. China will, as always, energetically participate in health-related international activities, take an active part in global health governance, and implement sustainable development goals in the public health sector. In its efforts to build the Belt and Road, China will enhance medical and health cooperation with countries along the route, and emphasize learning from and drawing on the experiences of other countries. In the great process of "jointly building a community with a shared future for mankind," China is keen to join hands with people around the world in making unremitting efforts to build a better and healthier world.

Major Indicators for the Healthy China Program

Sphere: health status Indicator: life expectancy

2015: 76.34 2020: 77.3 2030: 79.0

Sphere: health status Indicator: infant mortality rate (per thousand)

2015: 8.1 2020: 7.5 2030: 5.0

Sphere: health status Indicator: under five mortality rate (per thousand)

2015: 10.7 2020: 9.5 2030: 6.0

Sphere: health status Indicator: maternal death rate (1/100,000)

2015: 20.1 2020: 18.0 2030: 12.0

Sphere: health status Indicator: the proportion of residents who reach or exceed the National Physical Fitness Evaluation Standards (%)

2015: 89.6 (2014) 2020: 90.6 2030: 92.2

Sphere: healthy lifestyle Indicator: proficient health literacy rate (%)

2015: 10 2020: 20 2030: 30

Sphere: healthy lifestyle Indicator: number of people who frequently attend fitness exercises (million)

2015: 360 (2014) 2020: 435 2030: 530

Sphere: health services and guarantees Indicator: premature death rate from serious chronic disease (%)

2015: 19.1 (2013) 2020: lower by 10 percent comparing with 2015 2030: lower by 30 percent comparing with 2015

Sphere: health services and guarantees Indicator: number of practicing (assistant) physicians per 1,000 permanent residents

2015: 2.2 2020: 2.5 2030: 3.0

Sphere: health services and guarantees Indicator: proportion of personal expenditure in China's total expenditure on health (%)

2015: 29.3 2020: around 28 2030: around 25

Sphere: healthy environment Indicator: proportion of days per year meeting good or excellent air quality index standard in cities at prefectural level and above (%)

2015: 76.7 2020: >80 2030: keep improving

Sphere: healthy environment Indicator: proportion of water bodies of Grade III and better quality in all surface water bodies (%)

2015: 66 2020: >70 2030: keep improving

Sphere: health industry Indicator: monetary value of health service industry (RMB trillion)

2015: - 2020: >8 2030: 16