Commentary
Viewpoint: Prevention is missing: Is China’s health reform reform for health? Le Yang, Xiaoli Zhang, Tengfei Tan, and Jingmin Cheng* School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi, 030001, China. E-mail: [email protected] *Corresponding author.
Abstract
Ancient China emphasized disease prevention. As a Chinese saying goes, ‘it is more important to prevent the disease than to cure it’. Traditional Chinese medicine posits that diseases can be understood, thus, prevented. In today’s China, the state of people’s health seems worse than in the past. Thus the Chinese government undertook the creation of a new health system. Alas, we believe the results are not very satisfactory. The government seems to have overlooked rational allocation between resources for treatment and prevention. Public investment has been gradually limited to the domain of treatment. We respond to this trend, highlighting the importance of prevention and call for government and policymakers to adjust health policy and work out a solution suitable for improving the health of China’s people. Journal of Public Health Policy (2015) 36, 73–80. doi:10.1057/jphp.2014.39; published online 2 October 2014 Keywords: health care; prevention; chronic disease; health policy; China
Introduction Since ancient times, the Chinese people have recognized adverse effects of stress on health. To regulate stress and emotional distress, traditional medicine practitioners in China have advised exercise, temperance in eating and drinking, a regular schedule, and mind-calming activities.1 Some chronic diseases can be eliminated or their effects reduced through learning to control emotional distress. Such prevention practices were also a means of dealing with diseases once diagnosed. Chinese understood disease causation to fall into two major categories, external and internal. External causes included extremes of weather and the influence of pathogens, while internal causes were attributed to the
© 2015 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy Vol. 36, 1, 73–80 www.palgrave-journals.com/jphp/
Yang et al
emotions – both amenable to prevention.1 In recent years, prevention has been increasingly neglected. Schistosomiasis, a parasitic disease, has an economic impact throughout the world second only to malaria. Snails that live in fresh water carry the schistosome, a parasitic worm. When people plant or harvest rice or raise fish in ponds, they are exposed to this terrible disease that can cause kidney and liver damage and bladder cancer. China undertook big campaigns to kill the snails that lived in ponds in the countryside. China largely eradicated schistosomiasis from 1949 to 1978. Following this success, workforce reductions ensued. In Jinjang County, the number of health workers decreased from 3900 in 1960 to 300 5 years later.2 Then came economic reforms of 1978 and dismantling of the rural communes and the collective health-care system in the countryside, followed by a resurgence in the incidence of schistosomiasis.2 Recently in China, the state of people’s health seemed to have worsened. Thus, the Chinese government undertook creation of a new health system from 2009. Alas, we believe the results are not very satisfactory. The government seems to have overlooked a rational allocation of resources between treatment and prevention. Investment has been gradually limited to the domain of treatment. We respond, highlighting the importance of prevention and look to China’s government to recognize this, adjust health policy, and work out a solution suitable for our country.
The Role of Prevention Disease prevention plays a very important role in health. Rather than treating a condition after it has progressed, preventive interventions focus on avoiding diseases and maintaining good health. Disease prevention includes measures not only to prevent the occurrence of disease, but also to control its progress and reduce its consequences. In China, raising the government’s awareness and attention to disease prevention and control – particularly for chronic diseases – should be the top priority for the health sector. For the past 35 years, China has experienced rapid change, notably in the economy. Economic development has improved living conditions. Growth, however, has usually been at the expense of the environment. China has seen increasing environmental problems – air, water, and soil pollution. These will undoubtedly threaten people’s health. Certain
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Commentary
diseases have become more common and new diseases emerge. Economic growth has increased the prevalence of the major risk factors for chronic disease.3 Chronic, largely non-communicable disease is, by far, the leading cause of mortality in the world, associated with 60 per cent of all deaths.4 This shift to chronic diseases, known as the epidemiological transition, has now arrived in China.5 In 2012, the number of confirmed cases of chronic disease in China reached 0.26 billion, accounting for an estimated 85 per cent of all deaths. Cancer is a leading cause of death and the chronic disease burden. The International Agency for Research on Cancer’s World Cancer Report 2014 shows that China has become a high cancer incidence country, especially for lung cancer. In 2008, lung cancer overtook liver cancer to be China’s number one cause of death among people with malignant tumors.6 While smoking has fallen in China, the prevalence of lung cancer has increased, most probably due to air pollution,7 mainly caused by the rapid economic development in China. In March 2009, they promulgated reforms described in ‘Opinions on Deepening Reform of the Medical and Health Care Systems’.8 The reforms were to provide the whole nation with basic medical and health services as a public good, that is, to ensure that everyone enjoys equal access to basic medical services and primary health care. At the same time, the reforms highlighted the role of public health, prevention, and control of diseases.9 But how important did the government believe them to be in actuality? A circular on the implementation of medical industry reforms as specified in the 12th Five-Year Plan (2011–2015) states that the government will focus on promoting equal access to medical care services for its citizens and significantly improving the quality and efficiency of medical services by 2015.10 This lack of attention to disease prevention and control seemingly violated one stated intention of the 2009 reform. It is difficult to make and carry out policies in a country with an immense population but limited resources. There is little doubt that the Chinese government and policymakers have made some efforts to help people and have made some progress. But not all results have been positive, and reform has had its negative effects. Medical reform has gradually become the focus in Chinese health reform. Policymakers seem to believe that the people’s health could be guaranteed if medical reform were successful. The public seems to agree
© 2015 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy Vol. 36, 1, 73–80
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and has high expectations for medical care. They look to hospitals and treatment, but even results for medical care are disappointing. Complaints and malpractice lawsuits have become more common.11 In hospitals and clinics across the country, doctors are abused, injured, and even murdered by patients or relatives of patients.12 The annual average number of assaults on doctors per hospital increased from 20.6 assaults/year in 2008 to 27.3 in 2012, according to a sample survey released by the Chinese Hospital Association on 15 August 2013. The survey was conducted among staff and patients at 316 hospitals nationwide from December 2012 to July 2013.13 Why have the doctor–patient relationships deteriorated? Despite the introduction of advanced medical techniques, some diseases remain incurable. The increasing complexity of modern medicine often exceeds the ability of doctors to deliver care successfully. In China, the number of doctors has not increased as rapidly as the number of patients, thus doctors are overworked. The heavy workload means they lack time and energy to communicate with their patients, to be more caring.14 In our view, the dramatically increasing violence against doctors reflects growing discontent with the current health system, even the part that policymakers have focused upon. Some people argue that low spending on health care harms doctor– patient relationships and confidence in China’s health care more generally. Because of the Chinese government’s efforts, by the end of 2012, 2566 of 2863 counties (cities, districts) had introduced the reformed medical care system in rural areas, achieving a participation rate of 98.1 per cent.15 From 2008 to 2012, the total number of hospitals in China increased from 19 712 to 23 170 (Figure 1).16 The government has slowly increased health spending from 4.8 per cent in 2002 year, reaching 5.36 per cent of GDP in 2012, thus exceeding 5 per cent of GDP, the lower limit advised by WHO (Figure 2).17 Despite spending on growth, current spending on health falls short of optimal. Government pays more attention to how to treat disease than how to prevent it and its causes. Because awareness of prevention is insufficient, those who might prevent disease only react; they do not act in advance to prevent it. As most of China’s resources are applied to strengthening medical services and facilities, prevention is weakened by neglect. From 2008 to 2012, the number of government facilities dedicated to control and prevention of disease and to improve the health of the people through environmental health, occupational safety and
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Commentary
Figure 1: The number of hospitals in China. Source: www.stats.gov.cn/tjsj/ndsj/2013/indexeh.htm, accessed 15 May 2014.
Figure 2: Total expenditure on health as a percentage of gross domestic product in China. Source: apps.who.int/gho/data/?theme=country&vid=6400, accessed 15 May 2014.
health, health promotion, prevention, and education activities (Chinese Center for Disease Control and Prevention) has decreased in China from 3534 to 3490 (Figure 3).16 A survey, conducted by the Chinese Ministry of Health, reveals that in Tianjin and Gansu, for example, investment in prevention represents only 1–2 per cent of total health expenditure.18 Health reform is surely necessary, and equity is a crucial principle within it. But as China implements health reform, the principle seems divorced from practice. China’s allocation of resources runs counter to Pareto improvement – a new allocation that makes at least one individual better-off without making any other individual worse off. Care, as it affects people’s well-being is of vital importance to China and its population of over 1.3 billion.19 But efforts to achieve health equity have gradually been limited to treatment in a narrow sense. Disease
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Figure 3: The number of center for disease control and prevention in China. Source: www.stats.gov.cn/tjsj/ndsj/2013/indexeh.htm, accessed 15 May 2014.
prevention needs a larger and more prominent role if the reformed health-care system is to improve the health of our population. Yet in China, prevention has not been stressed – recent neglect is even worse than earlier. It would be better to focus on prevention, a more cost-effective long-term strategy for the control of many diseases – cancer in particular.20 China’s policymakers should continue to adjust health policy to improve population health, with more attention to strengthening prevention, including population-based strategies for protection from harm (public health). The government should invest more on human and economic resources to improve overall system performance. We urge our government to go forward with the key health principle that prevention comes first, and should be integrated with treatment.
About the Authors Le Yang is a graduate student of the School of Public Health, Shanxi Medical University. Her research interests focus on the impacts of food safety management, health policy, health reform, and current situation of health care in China (E-mail: [email protected]). Xiaoli Zhang is a graduate student of the School of Public Health, Shanxi Medical University. Her research interests focus on the impacts of food safety management and current situation of health care in China.
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Tengfei Tan is a graduate student of the School of Public Health, Shanxi Medical University. His research interests focus on the impacts of food safety management, health policy, and current situation of health care in China. Jingmin Cheng, LLM, PhD, is an Associate Professor of Health Service in the School of Public Health, Shanxi Medical University. His research interests include public health policy, public health service, and food safety.
References 1. Dharmananda, S. (2002) Disease prevention and restoring harmony: Control the emotions. Internet Journal of Institute for Traditional Medicine, http://www.itmonline.org/arts/emotions. htm, accessed 15 May 2014. 2. Berry-Cabán, C.S. (2007) Return of the god of plague: Schistosomiasis in China. Journal of Rural and Tropical Public Health 6: 45–53, http://www.jcu.edu.au/jrtph/vol/v06caban.pdf, accessed 15 May 2014. 3. Longde, W., Kong, L., Wu, F., Bai, Y. and Burton, R. (2005) Preventing chronic diseases in China. Lancet 366(9499): 1821–1824. 4. World Health Organization (WHO). (2013) Chronic diseases and health promotion, http:// www.who.int/chp/en/, accessed 15 May 2014. 5. Liu, Y., Yang, G., Zeng, Y., Horton, R. and Chen, L. (2013) Policy dialogue on China’s changing burden of disease. Lancet 381(9882): 1961–1962. 6. She, J., Yang, P., Hong, Q. and Bai, C. (2013) Lung cancer in China: Challenges and interventions. Chest 143(4): 1117–1126. 7. Xu, P., Chen, Y. and Ye, X. (2014) Haze, air pollution, and health in China. Lancet 382(9910): 2067. 8. The State Council. (2009) Opinions on deepening reform of the medical and health care systems (in Chinese), http://www.sda.gov.cn/WS01/CL0611/41193.html, accessed 15 May 2014. 9. Hui, L. (2012) Healthcare reform improves equal access: White paper. Xinhua, 26 December, http://news.xinhuanet.com/english/china/2012-12/26/c_132064846.htm, accessed 15 May 2014. 10. Hong’e, M. (2012) China to boost medical service accessibility. Xinhua, 22 March, http://news. xinhuanet.com/english/china/2012-03/22/c_131483454.htm, accessed 15 May 2014. 11. Moore, P., Vargas, A., Núñez, S. and Macchiavello, S. (2011) A study of hospital complaints and the role of the doctor-patient communication. Revista médica de Chile 139(7): 880–885. 12. The Lancet. (2012) Ending violence against doctors in China. Lancet 379(9828): 1764. 13. China Daily. (2013) Violence against doctors on the rise: Survey, http://usa.chinadaily.com.cn/ china/2013-08/16/content_16897942.htm, accessed 15 May 2014. 14. Li, Q. and Xie, P. (2013) Outpatient workload in China. Lancet 381(9882): 1983–1984. 15. National Bureau of Statistics of China. (2013) Statistical communiqué of the People’s Republic of China on the 2012 national economic and social development, http://www.stats.gov.cn/ english/StatisticalCommuniqu/201302/t20130222_61456.html, accessed 15 May 2014. 16. National Bureau of Statistics of China. (2013) China statistical yearbook 2013, http://www .stats.gov.cn/tjsj/ndsj/2013/indexeh.htm, accessed 15 May 2014.
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17. World Health Organization (WHO). (2014) WHO western pacific region: China statistics summary (2002 – present). http://apps.who.int/gho/data/?theme=country&vid=6400, accessed 15 May 2014. 18. Chinese Ministry of Health and Tsinghua University. (2012) The seventh China health communication conference (in Chinese), http://health.sohu.com/20121120/n358159370.shtml, accessed 15 May 2014. 19. The State Council Information Office of the People’s Republic of China. (2012) Medical and health services in China, http://news.xinhuanet.com/english/bilingual/2012-12/26/c_13206 4944.htm, accessed 15 May 2014. 20. World Health Organization (WHO). (2013) Cancer prevention. http://www.who.int/cancer/ prevention/en/, accessed 15 May 2014.
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Copyright of Journal of Public Health Policy is the property of Palgrave Macmillan Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Viewpoint: Prevention is missing: Is China’s health reform reform for health? Le Yang, Xiaoli Zhang, Tengfei Tan, and Jingmin Cheng* School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Yingze District, Taiyuan, Shanxi, 030001, China. E-mail: [email protected] *Corresponding author.
Abstract
Ancient China emphasized disease prevention. As a Chinese saying goes, ‘it is more important to prevent the disease than to cure it’. Traditional Chinese medicine posits that diseases can be understood, thus, prevented. In today’s China, the state of people’s health seems worse than in the past. Thus the Chinese government undertook the creation of a new health system. Alas, we believe the results are not very satisfactory. The government seems to have overlooked rational allocation between resources for treatment and prevention. Public investment has been gradually limited to the domain of treatment. We respond to this trend, highlighting the importance of prevention and call for government and policymakers to adjust health policy and work out a solution suitable for improving the health of China’s people. Journal of Public Health Policy (2015) 36, 73–80. doi:10.1057/jphp.2014.39; published online 2 October 2014 Keywords: health care; prevention; chronic disease; health policy; China
Introduction Since ancient times, the Chinese people have recognized adverse effects of stress on health. To regulate stress and emotional distress, traditional medicine practitioners in China have advised exercise, temperance in eating and drinking, a regular schedule, and mind-calming activities.1 Some chronic diseases can be eliminated or their effects reduced through learning to control emotional distress. Such prevention practices were also a means of dealing with diseases once diagnosed. Chinese understood disease causation to fall into two major categories, external and internal. External causes included extremes of weather and the influence of pathogens, while internal causes were attributed to the
© 2015 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy Vol. 36, 1, 73–80 www.palgrave-journals.com/jphp/
Yang et al
emotions – both amenable to prevention.1 In recent years, prevention has been increasingly neglected. Schistosomiasis, a parasitic disease, has an economic impact throughout the world second only to malaria. Snails that live in fresh water carry the schistosome, a parasitic worm. When people plant or harvest rice or raise fish in ponds, they are exposed to this terrible disease that can cause kidney and liver damage and bladder cancer. China undertook big campaigns to kill the snails that lived in ponds in the countryside. China largely eradicated schistosomiasis from 1949 to 1978. Following this success, workforce reductions ensued. In Jinjang County, the number of health workers decreased from 3900 in 1960 to 300 5 years later.2 Then came economic reforms of 1978 and dismantling of the rural communes and the collective health-care system in the countryside, followed by a resurgence in the incidence of schistosomiasis.2 Recently in China, the state of people’s health seemed to have worsened. Thus, the Chinese government undertook creation of a new health system from 2009. Alas, we believe the results are not very satisfactory. The government seems to have overlooked a rational allocation of resources between treatment and prevention. Investment has been gradually limited to the domain of treatment. We respond, highlighting the importance of prevention and look to China’s government to recognize this, adjust health policy, and work out a solution suitable for our country.
The Role of Prevention Disease prevention plays a very important role in health. Rather than treating a condition after it has progressed, preventive interventions focus on avoiding diseases and maintaining good health. Disease prevention includes measures not only to prevent the occurrence of disease, but also to control its progress and reduce its consequences. In China, raising the government’s awareness and attention to disease prevention and control – particularly for chronic diseases – should be the top priority for the health sector. For the past 35 years, China has experienced rapid change, notably in the economy. Economic development has improved living conditions. Growth, however, has usually been at the expense of the environment. China has seen increasing environmental problems – air, water, and soil pollution. These will undoubtedly threaten people’s health. Certain
74
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Commentary
diseases have become more common and new diseases emerge. Economic growth has increased the prevalence of the major risk factors for chronic disease.3 Chronic, largely non-communicable disease is, by far, the leading cause of mortality in the world, associated with 60 per cent of all deaths.4 This shift to chronic diseases, known as the epidemiological transition, has now arrived in China.5 In 2012, the number of confirmed cases of chronic disease in China reached 0.26 billion, accounting for an estimated 85 per cent of all deaths. Cancer is a leading cause of death and the chronic disease burden. The International Agency for Research on Cancer’s World Cancer Report 2014 shows that China has become a high cancer incidence country, especially for lung cancer. In 2008, lung cancer overtook liver cancer to be China’s number one cause of death among people with malignant tumors.6 While smoking has fallen in China, the prevalence of lung cancer has increased, most probably due to air pollution,7 mainly caused by the rapid economic development in China. In March 2009, they promulgated reforms described in ‘Opinions on Deepening Reform of the Medical and Health Care Systems’.8 The reforms were to provide the whole nation with basic medical and health services as a public good, that is, to ensure that everyone enjoys equal access to basic medical services and primary health care. At the same time, the reforms highlighted the role of public health, prevention, and control of diseases.9 But how important did the government believe them to be in actuality? A circular on the implementation of medical industry reforms as specified in the 12th Five-Year Plan (2011–2015) states that the government will focus on promoting equal access to medical care services for its citizens and significantly improving the quality and efficiency of medical services by 2015.10 This lack of attention to disease prevention and control seemingly violated one stated intention of the 2009 reform. It is difficult to make and carry out policies in a country with an immense population but limited resources. There is little doubt that the Chinese government and policymakers have made some efforts to help people and have made some progress. But not all results have been positive, and reform has had its negative effects. Medical reform has gradually become the focus in Chinese health reform. Policymakers seem to believe that the people’s health could be guaranteed if medical reform were successful. The public seems to agree
© 2015 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy Vol. 36, 1, 73–80
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Yang et al
and has high expectations for medical care. They look to hospitals and treatment, but even results for medical care are disappointing. Complaints and malpractice lawsuits have become more common.11 In hospitals and clinics across the country, doctors are abused, injured, and even murdered by patients or relatives of patients.12 The annual average number of assaults on doctors per hospital increased from 20.6 assaults/year in 2008 to 27.3 in 2012, according to a sample survey released by the Chinese Hospital Association on 15 August 2013. The survey was conducted among staff and patients at 316 hospitals nationwide from December 2012 to July 2013.13 Why have the doctor–patient relationships deteriorated? Despite the introduction of advanced medical techniques, some diseases remain incurable. The increasing complexity of modern medicine often exceeds the ability of doctors to deliver care successfully. In China, the number of doctors has not increased as rapidly as the number of patients, thus doctors are overworked. The heavy workload means they lack time and energy to communicate with their patients, to be more caring.14 In our view, the dramatically increasing violence against doctors reflects growing discontent with the current health system, even the part that policymakers have focused upon. Some people argue that low spending on health care harms doctor– patient relationships and confidence in China’s health care more generally. Because of the Chinese government’s efforts, by the end of 2012, 2566 of 2863 counties (cities, districts) had introduced the reformed medical care system in rural areas, achieving a participation rate of 98.1 per cent.15 From 2008 to 2012, the total number of hospitals in China increased from 19 712 to 23 170 (Figure 1).16 The government has slowly increased health spending from 4.8 per cent in 2002 year, reaching 5.36 per cent of GDP in 2012, thus exceeding 5 per cent of GDP, the lower limit advised by WHO (Figure 2).17 Despite spending on growth, current spending on health falls short of optimal. Government pays more attention to how to treat disease than how to prevent it and its causes. Because awareness of prevention is insufficient, those who might prevent disease only react; they do not act in advance to prevent it. As most of China’s resources are applied to strengthening medical services and facilities, prevention is weakened by neglect. From 2008 to 2012, the number of government facilities dedicated to control and prevention of disease and to improve the health of the people through environmental health, occupational safety and
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Commentary
Figure 1: The number of hospitals in China. Source: www.stats.gov.cn/tjsj/ndsj/2013/indexeh.htm, accessed 15 May 2014.
Figure 2: Total expenditure on health as a percentage of gross domestic product in China. Source: apps.who.int/gho/data/?theme=country&vid=6400, accessed 15 May 2014.
health, health promotion, prevention, and education activities (Chinese Center for Disease Control and Prevention) has decreased in China from 3534 to 3490 (Figure 3).16 A survey, conducted by the Chinese Ministry of Health, reveals that in Tianjin and Gansu, for example, investment in prevention represents only 1–2 per cent of total health expenditure.18 Health reform is surely necessary, and equity is a crucial principle within it. But as China implements health reform, the principle seems divorced from practice. China’s allocation of resources runs counter to Pareto improvement – a new allocation that makes at least one individual better-off without making any other individual worse off. Care, as it affects people’s well-being is of vital importance to China and its population of over 1.3 billion.19 But efforts to achieve health equity have gradually been limited to treatment in a narrow sense. Disease
© 2015 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy Vol. 36, 1, 73–80
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Figure 3: The number of center for disease control and prevention in China. Source: www.stats.gov.cn/tjsj/ndsj/2013/indexeh.htm, accessed 15 May 2014.
prevention needs a larger and more prominent role if the reformed health-care system is to improve the health of our population. Yet in China, prevention has not been stressed – recent neglect is even worse than earlier. It would be better to focus on prevention, a more cost-effective long-term strategy for the control of many diseases – cancer in particular.20 China’s policymakers should continue to adjust health policy to improve population health, with more attention to strengthening prevention, including population-based strategies for protection from harm (public health). The government should invest more on human and economic resources to improve overall system performance. We urge our government to go forward with the key health principle that prevention comes first, and should be integrated with treatment.
About the Authors Le Yang is a graduate student of the School of Public Health, Shanxi Medical University. Her research interests focus on the impacts of food safety management, health policy, health reform, and current situation of health care in China (E-mail: [email protected]). Xiaoli Zhang is a graduate student of the School of Public Health, Shanxi Medical University. Her research interests focus on the impacts of food safety management and current situation of health care in China.
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Tengfei Tan is a graduate student of the School of Public Health, Shanxi Medical University. His research interests focus on the impacts of food safety management, health policy, and current situation of health care in China. Jingmin Cheng, LLM, PhD, is an Associate Professor of Health Service in the School of Public Health, Shanxi Medical University. His research interests include public health policy, public health service, and food safety.
References 1. Dharmananda, S. (2002) Disease prevention and restoring harmony: Control the emotions. Internet Journal of Institute for Traditional Medicine, http://www.itmonline.org/arts/emotions. htm, accessed 15 May 2014. 2. Berry-Cabán, C.S. (2007) Return of the god of plague: Schistosomiasis in China. Journal of Rural and Tropical Public Health 6: 45–53, http://www.jcu.edu.au/jrtph/vol/v06caban.pdf, accessed 15 May 2014. 3. Longde, W., Kong, L., Wu, F., Bai, Y. and Burton, R. (2005) Preventing chronic diseases in China. Lancet 366(9499): 1821–1824. 4. World Health Organization (WHO). (2013) Chronic diseases and health promotion, http:// www.who.int/chp/en/, accessed 15 May 2014. 5. Liu, Y., Yang, G., Zeng, Y., Horton, R. and Chen, L. (2013) Policy dialogue on China’s changing burden of disease. Lancet 381(9882): 1961–1962. 6. She, J., Yang, P., Hong, Q. and Bai, C. (2013) Lung cancer in China: Challenges and interventions. Chest 143(4): 1117–1126. 7. Xu, P., Chen, Y. and Ye, X. (2014) Haze, air pollution, and health in China. Lancet 382(9910): 2067. 8. The State Council. (2009) Opinions on deepening reform of the medical and health care systems (in Chinese), http://www.sda.gov.cn/WS01/CL0611/41193.html, accessed 15 May 2014. 9. Hui, L. (2012) Healthcare reform improves equal access: White paper. Xinhua, 26 December, http://news.xinhuanet.com/english/china/2012-12/26/c_132064846.htm, accessed 15 May 2014. 10. Hong’e, M. (2012) China to boost medical service accessibility. Xinhua, 22 March, http://news. xinhuanet.com/english/china/2012-03/22/c_131483454.htm, accessed 15 May 2014. 11. Moore, P., Vargas, A., Núñez, S. and Macchiavello, S. (2011) A study of hospital complaints and the role of the doctor-patient communication. Revista médica de Chile 139(7): 880–885. 12. The Lancet. (2012) Ending violence against doctors in China. Lancet 379(9828): 1764. 13. China Daily. (2013) Violence against doctors on the rise: Survey, http://usa.chinadaily.com.cn/ china/2013-08/16/content_16897942.htm, accessed 15 May 2014. 14. Li, Q. and Xie, P. (2013) Outpatient workload in China. Lancet 381(9882): 1983–1984. 15. National Bureau of Statistics of China. (2013) Statistical communiqué of the People’s Republic of China on the 2012 national economic and social development, http://www.stats.gov.cn/ english/StatisticalCommuniqu/201302/t20130222_61456.html, accessed 15 May 2014. 16. National Bureau of Statistics of China. (2013) China statistical yearbook 2013, http://www .stats.gov.cn/tjsj/ndsj/2013/indexeh.htm, accessed 15 May 2014.
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17. World Health Organization (WHO). (2014) WHO western pacific region: China statistics summary (2002 – present). http://apps.who.int/gho/data/?theme=country&vid=6400, accessed 15 May 2014. 18. Chinese Ministry of Health and Tsinghua University. (2012) The seventh China health communication conference (in Chinese), http://health.sohu.com/20121120/n358159370.shtml, accessed 15 May 2014. 19. The State Council Information Office of the People’s Republic of China. (2012) Medical and health services in China, http://news.xinhuanet.com/english/bilingual/2012-12/26/c_13206 4944.htm, accessed 15 May 2014. 20. World Health Organization (WHO). (2013) Cancer prevention. http://www.who.int/cancer/ prevention/en/, accessed 15 May 2014.
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© 2015 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy Vol. 36, 1, 73–80
Copyright of Journal of Public Health Policy is the property of Palgrave Macmillan Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
