Courtesy Reuters

Yanzhong Huang (“The Sick Man of Asia,” November/December 2011) paints a troubling picture of a China that has rapidly industrialized yet lags in modernizing its health-care system. 

Yet in his cogent history of China’s health policy, much of which centers on self-reliance, Huang puzzlingly omits China’s success in winning nearly $1 billion in recent years from the Global Fund to Fight AIDS, Tuberculosis and Malaria. That the country’s health officials have had to resort to tapping a fund ostensibly dedicated to helping the world’s poorest countries speaks to their inability to persuade the government to pay for public health with its national coªers. Only when the incongruity of a financial giant getting grants at the expense of impoverished African countries was illuminated did China choose to stop taking Global Fund awards.

Ultimate responsibility for transforming China’s health conditions lies squarely with the country’s national leaders, not just its health officials. Considering the benefits derived from investing in health, the pathway ahead for China should be evident: identify attainable public health goals and standards, bolster resources for health-care work on the frontlines, allow more nongovernmental organizations and private-sector groups to participate, and educate Chinese citizens about better habits, such as smoking cessation. In taking these steps, China would earn a long-term health dividend that would sustain its economy and bring its population to a standard worthy of international recognition and to a level commensurate with what it has accomplished in economic prowess. 

Distinguished Service Professor of Global Health, Heinz College, Carnegie Mellon University


Although Yanzhong Huang’s overall assessment of the health-care challenges facing China is accurate, the current situation is not as desperate as the reader is led to believe. 

Over the last four decades, China has experienced profound and rapid demographic, epidemiologic, and socioeconomic changes that would have tested the strength of any health-care system. But the country’s investments in maternal and child health and infectious disease control have sharply reduced maternal and child mortality and the prevalence and deadliness of infectious diseases. 

The infant mortality rate in China decreased from 38 deaths per 1,000 live births in 1990 to 16 per 1,000 in 2010, and over the same period, the mortality rate for children under five years of age dropped from 48 per 1,000 live births to just 18. The maternal mortality ratio has also fallen, from 110 per 100,000 live births in 1990 to 38 in 2008. 

Furthermore, the prevalence of tuberculosis cases in China in 2010 was estimated at 216 per 100,000, a reduction of 45 percent from the rate in 2000 -- thanks to the government’s tuberculosis control program. In 2008, China also became the first country in the world to eradicate the parasitic disease filariasis.

Huang makes only a quick and rather shallow reference to the health reforms that China launched in 2009. Beijing has clearly recognized the challenge that the increasing prevalence of noncommunicable diseases poses to the healthcare system, and at that time, it launched a comprehensive health-sector reform based on five pillars: expanding health insurance to achieve universal health coverage by 2020; developing a national drug system to improve quality of care, lower costs, and reduce abuse; improving primary-care delivery; promoting equity in the provision of essential public health services; and reforming public hospitals. The reform agenda was set after a thorough consultation process involving several governmental entities; civil-society organizations; academics; international partners, including the World Health Organization and the World Bank; and private consulting firms.

Although China is nowhere close to reaching its health-care objectives in the near future, it has already laid the groundwork for a more prominent state role in developing and sustaining universal health coverage and improving equity in health and health care by 2020, steps in the right direction that the author failed to fully acknowledge.

Professor of Medicine and Global Health, Duke University

Sector Manager; Health, Nutrition, and Population; Middle East and North Africa Region; World Bank