Shu Chen1, Lei Guo1, Zhan Wang1, Wenhui Mao2, Yanfeng Ge3, Xiaohua Ying4, Jing Fang5, Qian Long1, Qin Liu6, Hao Xiang7, Chenkai Wu1, Chaowei Fu4, Di Dong1, Jiahui Zhang3, Ju Sun8, Lichun Tian9, Limin Wang10, Maigeng Zhou10, Mei Zhang10, Mengcen Qian4, Wei Liu9, Weixi Jiang1, Wenmeng Feng3, Xinying Zeng10, Xiyu Ding1, Xun Lei6, Rachel Tolhurst11, Ling Xu12, Haidong Wang13, Faye Ziegeweid13, Scott Glenn13, John S Ji14, Mary Story2, Gavin Yamey2, Shenglan Tang2. 1. Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China. 2. Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America. 3. Research Department of Social Development, Development Research Center, State Council of People's Republic China, Beijing, China. 4. School of Public Health, Fudan University, Shanghai, China. 5. Institute for Health Sciences, Kunming Medical University, Kunming, Yunnan, China. 6. School of Public Health and Management, Chongqing Medical University, Chongqing, China. 7. School of Health Sciences, Wuhan University, Wuhan, Hubei, China. 8. School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China. 9. School of Public Health, Kunming Medical University, Kunming, Yunnan, China. 10. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. 11. Faculty of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. 12. Center of Health Human Resource Development, National Health Commission, Beijing, China. 13. Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America. 14. Environment Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
Abstract
BACKGROUND: The Sustainable Development Goals (SDGs), adopted by all United Nations (UN) member states in 2015, established a set of bold and ambitious health-related targets to achieve by 2030. Understanding China's progress toward these targets is critical to improving population health for its 1.4 billion people. METHODS AND FINDINGS: We used estimates from the Global Burden of Disease (GBD) Study 2016, national surveys and surveillance data from China, and qualitative data. Twenty-eight of the 37 indicators included in the GBD Study 2016 were analyzed. We developed an attainment index of health-related SDGs, a scale of 0-100 based on the values of indicators. The projection model is adjusted based on the one developed by the GBD Study 2016 SDG collaborators. We found that China has achieved several health-related SDG targets, including decreasing neonatal and under-5 mortality rates and the maternal mortality ratios and reducing wasting and stunting for children. However, China may only achieve 12 out of the 28 health-related SDG targets by 2030. The number of target indicators achieved varies among provinces and municipalities. In 2016, among the seven measured health domains, China performed best in child nutrition and maternal and child health and reproductive health, with the attainment index scores of 93.0 and 91.8, respectively, followed by noncommunicable diseases (NCDs) (69.4), road injuries (63.6), infectious diseases (63.0), environmental health (62.9), and universal health coverage (UHC) (54.4). There are daunting challenges to achieve the targets for child overweight, infectious diseases, NCD risk factors, and environmental exposure factors. China will also have a formidable challenge in achieving UHC, particularly in ensuring access to essential healthcare for all and providing adequate financial protection. The attainment index of child nutrition is projected to drop to 80.5 by 2025 because of worsening child overweight. The index of NCD risk factors is projected to drop to 38.8 by 2025. Regional disparities are substantial, with eastern provinces generally performing better than central and western provinces. Sex disparities are clear, with men at higher risk of excess mortality than women. The primary limitations of this study are the limited data availability and quality for several indicators and the adoption of "business-as-usual" projection methods. CONCLUSION: The study found that China has made good progress in improving population health, but challenges lie ahead. China has substantially improved the health of children and women and will continue to make good progress, although geographic disparities remain a great challenge. Meanwhile, China faced challenges in NCDs, mental health, and some infectious diseases. Poor control of health risk factors and worsening environmental threats have posed difficulties in further health improvement. Meanwhile, an inefficient health system is a barrier to tackling these challenges among such a rapidly aging population. The eastern provinces are predicted to perform better than the central and western provinces, and women are predicted to be more likely than men to achieve these targets by 2030. In order to make good progress, China must take a series of concerted actions, including more investments in public goods and services for health and redressing the intracountry inequities.
BACKGROUND: The Sustainable Development Goals (SDGs), adopted by all United Nations (UN) member states in 2015, established a set of bold and ambitious health-related targets to achieve by 2030. Understanding China's progress toward these targets is critical to improving population health for its 1.4 billion people. METHODS AND FINDINGS: We used estimates from the Global Burden of Disease (GBD) Study 2016, national surveys and surveillance data from China, and qualitative data. Twenty-eight of the 37 indicators included in the GBD Study 2016 were analyzed. We developed an attainment index of health-related SDGs, a scale of 0-100 based on the values of indicators. The projection model is adjusted based on the one developed by the GBD Study 2016 SDG collaborators. We found that China has achieved several health-related SDG targets, including decreasing neonatal and under-5 mortality rates and the maternal mortality ratios and reducing wasting and stunting for children. However, China may only achieve 12 out of the 28 health-related SDG targets by 2030. The number of target indicators achieved varies among provinces and municipalities. In 2016, among the seven measured health domains, China performed best in child nutrition and maternal and child health and reproductive health, with the attainment index scores of 93.0 and 91.8, respectively, followed by noncommunicable diseases (NCDs) (69.4), road injuries (63.6), infectious diseases (63.0), environmental health (62.9), and universal health coverage (UHC) (54.4). There are daunting challenges to achieve the targets for child overweight, infectious diseases, NCD risk factors, and environmental exposure factors. China will also have a formidable challenge in achieving UHC, particularly in ensuring access to essential healthcare for all and providing adequate financial protection. The attainment index of child nutrition is projected to drop to 80.5 by 2025 because of worsening child overweight. The index of NCD risk factors is projected to drop to 38.8 by 2025. Regional disparities are substantial, with eastern provinces generally performing better than central and western provinces. Sex disparities are clear, with men at higher risk of excess mortality than women. The primary limitations of this study are the limited data availability and quality for several indicators and the adoption of "business-as-usual" projection methods. CONCLUSION: The study found that China has made good progress in improving population health, but challenges lie ahead. China has substantially improved the health of children and women and will continue to make good progress, although geographic disparities remain a great challenge. Meanwhile, China faced challenges in NCDs, mental health, and some infectious diseases. Poor control of health risk factors and worsening environmental threats have posed difficulties in further health improvement. Meanwhile, an inefficient health system is a barrier to tackling these challenges among such a rapidly aging population. The eastern provinces are predicted to perform better than the central and western provinces, and women are predicted to be more likely than men to achieve these targets by 2030. In order to make good progress, China must take a series of concerted actions, including more investments in public goods and services for health and redressing the intracountry inequities.
Authors: Shi Liang; Chong Sun; Chanfang Liu; Lili Jiang; Yingjia Xie; Shaohong Yan; Zhenyu Jiang; Qingwen Qi; An Zhang Journal: Int J Environ Res Public Health Date: 2021-05-12 Impact factor: 3.390