日志
中国的医疗卫生科研进展
热度 1 ||
Recent scientific health developments in China
6 e9 T% X, q; Q中国的医疗卫生科研进展
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7 M$ |: W+ [# v5 `The Lancet, Volume 375, Issue 9720, Pages 1055 - 1056, 27 March 2010 - r0 _' w0 p5 ^( N
Qide Han a, Lincoln Chen b, Tim G Evans c, William Summerskill d
3 J2 g4 e E0 B* ?1 ^2 a; P3 Z S) \* i# Y
The emphasis on China in today's themed issue of The Lancet builds on the previous series on health-care developments in China, published in October, 2008.1 This issue brings together two commissioned theme papers, one research article submitted in response to open solicitation, and five invited Comments. The aim is not only to recognise and promote high-quality scientific studies on health in China, but also to engage Chinese scientists in international scientific publications, and to accelerate the momentum sparked by the previous Series.# c- N6 H! w) j9 e$ H( \2 x
* D- s$ s5 ]# i! O L1 J$ T
The first Series emphasised four core aspects of China in global health. China is an often under-recognised but nevertheless major constituent of virtually every global health challenge. China historically has been a rich source of health innovations, and its scientific modernisation portends prospects for future contributions. As China accelerates participation in the global flow of goods, services, and people, it increasingly shares transnational health risks in an interdependent health world. Finally, China recognises its responsibilities in global health, and consequently has enhanced and expanded its international cooperation in health substantially with a particular focus on Africa.. r0 ^' t9 N2 d6 r
/ M2 ? a4 d/ \9 S5 G4 l
Today's issue on China is timely because the country has recently embarked on a major health reform to achieve universal coverage of primary health services by 2020.2 The reform has four components: medical insurance, public health, service delivery, and essential drugs. A key element is steady expansion of China's four subsystems of medical insurance to achieve universal health security. Priority is being given to prevention and equity through strengthening public health interventions in health surveillance, disease control, and maternal and child health. Improving the delivery of services requires better provision of community health care, expansion of primary health centres, improved training of health workers, and innovations in financing and management of major hospitals. Additionally, the list and prescribing policies for essential medicines are being updated to ensure widespread accessibility of safe, appropriate, and cost-effective drugs.
: k) C9 f m1 V( [! Q, [0 V M" n }9 @+ g3 \0 s: X
The reform is ambitious—a gigantic undertaking to improve health care for a fifth of humanity. As an indicator of its commitment, the Chinese Government has budgeted an extra US$125 billion over the next 3 years to support these reforms, an increase of public financing for health by about a third.2
! d7 k, M. }- D: D9 T3 \0 e( [7 T$ R I( F# _
The papers in this themed issue illustrate ongoing dynamics in health in China. One cluster of papers describes changing health threats. A growing health problem is environmental health, as reported by Junfeng Zhang and colleagues,3 for which China is experiencing simultaneously traditional threats (contaminated water and indoor-air pollution) as well as new environmental risks (intensive energy use and industrial pollution). Like all countries in the world, China's emissions of greenhouse gases will contribute to global climate change, affecting health in China and the world. China also continues to tackle the unfinished agenda of childhood mortality. As reported by Igor Rudan and co-workers,4 China has reduced under-5 mortality by three-quarters in the past two decades, achieving by 2006 Millennium Development Goal 4, even as the major causes of death have shifted from diarrhoea to pneumonia, birth asphyxia, and preterm births.( d( r* ^9 v' B) G
( u" M6 a7 L% H: L% bAnother cluster of papers reports on health-systems challenges, financing, and information. Probably no greater policy adjustment will determine the success of China's reform than the re-aligning of financial incentives to health providers. Several new incentive schemes for enhancing health-system quality, efficiency, and equity are being piloted, as described by Winnie Yip and colleagues.5 One more specific example of health-system practices challenged by the rapidly growing demand is the quantity, safety, and developments in China's blood-banking system, as detailed by Xuerong Yu and colleagues.6 Production of China's human resources depends on professional medical education. As described by Dong Xu and colleagues,7 higher education in China has several purposes: global academic excellence, training professionals to service diverse Chinese populations, and re-engineering the professions to grapple with the onslaught of non-communicable diseases. How China harmonises these diverse aims will determine not only the contributions of its next generation of professionals but also very probably the success and sustainability of its ambitious reforms towards universal health coverage.; X" E! X# B, N+ O
T4 w3 G, x8 v) R% u) E
For these and other studies, more and more Chinese health data are increasingly accessible, as illustrated by the wealth of data on child mortality from the internet in Chinese that was analysed by Rudan and colleagues.4 As reviewed by Yan Guo and colleagues,8 the recent round of health reforms will be monitored by key indicators, just as the reforms were stimulated in part by results from earlier health surveys. While it is too early to draw conclusions, China has rapidly expanded medical insurance so that the recent national household health-survey found a dramatic turnaround: 87% of urban and rural populations reached by 2008.9 In view of these developments, it seems likely that China will achieve universal insurance coverage well before 2020, albeit providing only limited benefits.
3 b5 j. Z( @4 ]6 T8 d1 j0 Q
3 O) c* E, x e* NThe Lancet's two China collections, in 2008 and 2010, illustrate the deepening engagement of Chinese academics in the global health sciences. The recent appointment of a Lancet Asia editor based in Beijing augers well for the journal's future publications on health in China. Just as China has much to learn from international science, China also has much to share for the mutual benefit of the entire global health community.
6 N3 `( e# K, b
' _% g* p, @) k* z8 b- z) v; {1 A! f$ Q% J1 I1 A
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60412-6/fulltext4 G6 l1 b$ p!
6 e9 T% X, q; Q中国的医疗卫生科研进展
) P+ @8 V0 r3 c/ q0 l
6 d7 k/ j+ w, R) p, z4 N
7 M$ |: W+ [# v5 `The Lancet, Volume 375, Issue 9720, Pages 1055 - 1056, 27 March 2010 - r0 _' w0 p5 ^( N
Qide Han a, Lincoln Chen b, Tim G Evans c, William Summerskill d
3 J2 g4 e E0 B* ?1 ^2 a; P3 Z S) \* i# Y
The emphasis on China in today's themed issue of The Lancet builds on the previous series on health-care developments in China, published in October, 2008.1 This issue brings together two commissioned theme papers, one research article submitted in response to open solicitation, and five invited Comments. The aim is not only to recognise and promote high-quality scientific studies on health in China, but also to engage Chinese scientists in international scientific publications, and to accelerate the momentum sparked by the previous Series.# c- N6 H! w) j9 e$ H( \2 x
* D- s$ s5 ]# i! O L1 J$ T
The first Series emphasised four core aspects of China in global health. China is an often under-recognised but nevertheless major constituent of virtually every global health challenge. China historically has been a rich source of health innovations, and its scientific modernisation portends prospects for future contributions. As China accelerates participation in the global flow of goods, services, and people, it increasingly shares transnational health risks in an interdependent health world. Finally, China recognises its responsibilities in global health, and consequently has enhanced and expanded its international cooperation in health substantially with a particular focus on Africa.. r0 ^' t9 N2 d6 r
/ M2 ? a4 d/ \9 S5 G4 l
Today's issue on China is timely because the country has recently embarked on a major health reform to achieve universal coverage of primary health services by 2020.2 The reform has four components: medical insurance, public health, service delivery, and essential drugs. A key element is steady expansion of China's four subsystems of medical insurance to achieve universal health security. Priority is being given to prevention and equity through strengthening public health interventions in health surveillance, disease control, and maternal and child health. Improving the delivery of services requires better provision of community health care, expansion of primary health centres, improved training of health workers, and innovations in financing and management of major hospitals. Additionally, the list and prescribing policies for essential medicines are being updated to ensure widespread accessibility of safe, appropriate, and cost-effective drugs.
: k) C9 f m1 V( [! Q, [0 V M" n }9 @+ g3 \0 s: X
The reform is ambitious—a gigantic undertaking to improve health care for a fifth of humanity. As an indicator of its commitment, the Chinese Government has budgeted an extra US$125 billion over the next 3 years to support these reforms, an increase of public financing for health by about a third.2
! d7 k, M. }- D: D9 T3 \0 e( [7 T$ R I( F# _
The papers in this themed issue illustrate ongoing dynamics in health in China. One cluster of papers describes changing health threats. A growing health problem is environmental health, as reported by Junfeng Zhang and colleagues,3 for which China is experiencing simultaneously traditional threats (contaminated water and indoor-air pollution) as well as new environmental risks (intensive energy use and industrial pollution). Like all countries in the world, China's emissions of greenhouse gases will contribute to global climate change, affecting health in China and the world. China also continues to tackle the unfinished agenda of childhood mortality. As reported by Igor Rudan and co-workers,4 China has reduced under-5 mortality by three-quarters in the past two decades, achieving by 2006 Millennium Development Goal 4, even as the major causes of death have shifted from diarrhoea to pneumonia, birth asphyxia, and preterm births.( d( r* ^9 v' B) G
( u" M6 a7 L% H: L% bAnother cluster of papers reports on health-systems challenges, financing, and information. Probably no greater policy adjustment will determine the success of China's reform than the re-aligning of financial incentives to health providers. Several new incentive schemes for enhancing health-system quality, efficiency, and equity are being piloted, as described by Winnie Yip and colleagues.5 One more specific example of health-system practices challenged by the rapidly growing demand is the quantity, safety, and developments in China's blood-banking system, as detailed by Xuerong Yu and colleagues.6 Production of China's human resources depends on professional medical education. As described by Dong Xu and colleagues,7 higher education in China has several purposes: global academic excellence, training professionals to service diverse Chinese populations, and re-engineering the professions to grapple with the onslaught of non-communicable diseases. How China harmonises these diverse aims will determine not only the contributions of its next generation of professionals but also very probably the success and sustainability of its ambitious reforms towards universal health coverage.; X" E! X# B, N+ O
T4 w3 G, x8 v) R% u) E
For these and other studies, more and more Chinese health data are increasingly accessible, as illustrated by the wealth of data on child mortality from the internet in Chinese that was analysed by Rudan and colleagues.4 As reviewed by Yan Guo and colleagues,8 the recent round of health reforms will be monitored by key indicators, just as the reforms were stimulated in part by results from earlier health surveys. While it is too early to draw conclusions, China has rapidly expanded medical insurance so that the recent national household health-survey found a dramatic turnaround: 87% of urban and rural populations reached by 2008.9 In view of these developments, it seems likely that China will achieve universal insurance coverage well before 2020, albeit providing only limited benefits.
3 b5 j. Z( @4 ]6 T8 d1 j0 Q
3 O) c* E, x e* NThe Lancet's two China collections, in 2008 and 2010, illustrate the deepening engagement of Chinese academics in the global health sciences. The recent appointment of a Lancet Asia editor based in Beijing augers well for the journal's future publications on health in China. Just as China has much to learn from international science, China also has much to share for the mutual benefit of the entire global health community.
6 N3 `( e# K, b
' _% g* p, @) k* z8 b- z) v; {1 A! f$ Q% J1 I1 A
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60412-6/fulltext4 G6 l1 b$ p!
