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China could provide global health model for non-communicable diseases

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Holly Korschun

China's global influence has grown along with its economic progress, and now it has a unique opportunity to be a global leader in preventing non-communicable diseases.

China's global influence has continued to grow along with its tremendous industrial and economic progress, as well as a significant increase in lifespan due to effective control of infectious diseases. As China's challenge shifts to an increase in non-communicable diseases, mirroring the health problems of other high-income nations, it has a unique opportunity to be a global leader in modeling prevention of non-communicable diseases, according to a new article in The Lancet.

"With its rapid progression in development and its recognized success in preventing and controlling infectious diseases over the past few decades, China now has the chance to serve as a health model for the world in confronting non-communicable diseases," says Jeff Koplan, vice president for global health at Emory University.

"By taking advantage of lessons learned in other high-income countries and by applying aggressive policies and actions, China can easily leapfrog the incremental gains against non-communicable diseases that have occurred in other industrialized countries and make much more rapid and life-saving progress. Chinese scientists and physicians also can increase worldwide knowledge and contribute to improving global disease and prevention efforts."

Koplan is co-author of the paper, along with Cheng Huang of the Milken Institute School of Public Health at George Washington University, and Hai Yu of Zhejiang University School of Medicine in Hangzhou, Zhejiang, China.

Although China's economic transition has led to increased longevity, say the authors, if China is to continue to make strides to improve the health of its people it must identify and acknowledge the adverse health outcomes of non-communicable diseases, including road injuries and mental illness, and address key risk factors for disease, including environmental pollution, tobacco use and obesity.

The authors recommend that China adopt the intervention strategies against non-communicable diseases suggested by the World Health Organization (WHO), which include interventions for tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol with approaches including taxation, regulations or legislation, and information. Reducing risk factors should help control cardiovascular disease, diabetes, cancer, injuries and domestic violence.

Specific recommendations include improving road design and enforcing the use of safety equipment in automobiles, bicycles and motorcycles; increasing the mental health professional workforce, expanding insurance coverage for mental health, and reducing the stigma of mental health care; and raising the price of alcoholic beverages through taxation.

Steps to address environmental pollution could include adjusting and closing high polluting enterprises, promoting clean energy and implementing taxation and subsidy policies that encourage reduction of air pollution, some of which are already underway.

Although China increasingly recognizes the importance of tobacco control and has been working with many international organizations in this effort, the pace of tobacco control is slow due to the lack of clear consequences or strict enforcement of regulations. The authors recommend taxation and regulations that are respected and enforced, including restrictions on advertising, marketing, packaging and purchasing; and education aimed at changing to a non-smoking culture.

China has experienced an alarming increase in overweight and obese individuals, particularly children, along with its rapid economic growth, despite national and provincial campaigns aimed at promoting physical activity and healthy eating. The authors suggest economic incentives including taxation and regulation of fat content and transfats in processed foods.

"China's ability to aggressively address these chronic disease risks will be boosted by its ability to set goals, allocate resources and personnel, and formulate policies and regulations, all of which were helpful in the progress it made in infectious disease control," notes Koplan. "The Chinese government also has the funds to make substantial commitments to health and social welfare and the authority to make and enforce regulations."

Weaknesses that could lead to delays, however, include gaps between policies and enforcement, difficulty achieving collaboration between agencies, and shortages and lack of training in the health care workforce. Other challenges include the huge and profitable tobacco industry, the effect of urbanization of physical activity and diet, and an aging population.

In order to be successful, note the authors, national policies must be mirrored by local policies and consistent and robust enforcement. The China CDC, as the country's leading public health agency, also must expand its focus from infectious diseases to include non-communicable diseases and injuries.

The authors conclude:

"China has shown its ability to set priorities, make ambitious goals, and meet or exceed them…If China makes its current and future major health risks a priority, takes advantage of lessons learned in other countries and in China itself, and uses its own scientific and creative resources to increase our knowledge for better disease control and prevention, it will provide a health model for the world."

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