China in transition: health, wealth, and globalisation.

Although most nations have benefitted from globalisation after World War 2, people from different parts of the planet might hold quite different views on this evolution, with some anticipating a probable clash of civilisations, and others envisioning a trend towards a more convergent world. To achieve a more convergent world, what are some common global values our human communities could offer? What might be the role of public health? And what part can China play during its health reform and transitions?

In his 2015 book, Nobel laureate and economist Angus Deaton documented how the world has evolved with unprecedented improvement in human wellbeing over the past two centuries. Notably, although income between the poor and the rich has been increasingly diverging, population health has not appeared to suffer from this problem. Instead, many health measures show an encouraging trend. For example, in 1950 longevity differed between the highest and lowest performing countries by 43 years but this gap had reduced substantially to 31 years by 2018. Given its large population, China has played a leading role in the world's health metric dynamics. During the 70 years following World War 2, life expectancy in China more than doubled, from 35 years in 1949 to 77 years in 2018.

Although more competitive, the flattening world might nevertheless become more harmonised if people can share more common values. In this regard, public health is an appealing arena that could serve as the glue that binds people together. Such a point is well illustrated by recent China–US relations, where geopolitical divisions between the two countries have been troubling many bilateral dialogues, such as those on economic and maritime issues, but both countries green-lighted the Track II Dialogues on Health. American and Chinese participants found substantial consensus in addressing common barriers to global health promotion. Similarly, the 2001 WHO report on macroeconomics and health forcefully argued that globalisation could enable an epidemic in one part of the world to spread rapidly to another, such as the outbreaks of severe acute respiratory syndrome or H5N1 influenza. Therefore, improving global health should be a public mission for mankind.

With health reform, China finds itself in a unique position to both benefit from and contribute to the global commons. In 2009, when China launched its national health reform initiative, the central goal was to transform the health-care system towards one that would ensure the population had essential health services. From an institutional standpoint, perhaps the most substantial progress is in health financing, with the accomplishment of near universal health coverage, which offers an employment-based policy to urban employees and a residence-based policy to all residents otherwise. Future reforms will seek more appropriate pooling capacity for the residence-based insurance, payment reforms, and health technology assessment. In service delivery, many changes have been made in areas including pricing, essential drug policy, hospital management, and vertical integration of service provision. However, greater challenges remain, especially in redirecting patient flows from tertiary facilities to primary care. Another major task is containment of rising health-care costs, a common issue worldwide. On one hand, increasing health spending is good in that people find investing in health more worthwhile. On the other hand, the growing political and public pressure on cost containment requires greater scrutiny and economic assessment of medicine for better value.

As the most substantial initiative within the larger health reform programme, the Healthy China 2030 agenda was issued in 2016, calling for more comprehensive approaches to serving population health rather than patient health only. Healthy China 2030 aims to meet the United Nations 2030 sustainable development goals and promote inclusive development. To respond to this initiative, a series of instrumental actions are needed: full population health management, full life-cycle health management, and full engagement in all health-related policies.

Looking forward, China will play an increasingly important part in the world community. It should be of common interest to pursue Healthy China 2030 with multilateral support as part of global efforts toward a healthier, wealthier, and wiser human population.