Tutorial for Outline of the Healthy China 2030 Plan [1st ed.] 9789813296022, 9789813296039

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Tutorial for Outline of the Healthy China 2030 Plan Bin Li Editor

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Tutorial for Outline of the Healthy China 2030 Plan

Bin Li Editor

Tutorial for Outline of the Healthy China 2030 Plan National Health Commission of the People’s Republic of China

Editor Bin Li Vice chairman, the National Committee of Chinese People’s Political Consultative Conference Beijing China Translator-in-chief Ying Chen Department of English China Medical University Shenyang China

ISBN 978-981-32-9602-2    ISBN 978-981-32-9603-9 (eBook) https://doi.org/10.1007/978-981-32-9603-9 © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 Jointly published with People’s Medical Publishing House, PR of China The print edition is not for sale in China. Customers from China please order the print book from: People's Medical Publishing House, PR of China. This work is subject to copyright. All rights are reserved by the Publishers, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publishers, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publishers nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publishers remain neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Foreword

Health is a must for human development and a basis for socio-economic development. Health and longevity are an important token of national wealth and prosperity, representing the common wishes of people of all ethnic groups in the country. The Communist Party of China (CPC) and the government have always attached great importance to the health of the population. Since the establishment of New China, especially with the reform and opening up, the health sector has seen successful reforms and development, with a better urban and rural environment, intensified health promotion campaigns, an improved medical care system, and continuously enhanced health and wellbeing among the population. In 2015, the average life expectancy reached 76.34 years; infant mortality, under-5 mortality and the maternal mortality rate were reduced to 8.1‰, 10.7‰, and 20.1 per 100,000, respectively. With main health indicators outperforming the averages seen in upper middle-income countries, the Chinese health system has laid a solid foundation for building an all-round moderately prosperous society. Meanwhile, industrialization, urbanization, aging population, a changing disease spectrum, ecosystem and lifestyles complicate the situation and pose new challenges to maintaining and promoting health. There are prominent conflicts between health needs and health supply, and health development and socioeconomic development are still lacking coordination. Long-term strategic solutions for key and profound issues are needed. A healthy China is fundamental for the country to achieve an all-round moderately prosperous society and the modernization of socialist society. “Healthy China 2030” is a national strategy for improving the health of the population and coordinating health and socioeconomic development, and a major means for the country to participate in global health governance and meet targets set in the 2030 Agenda for Sustainable Development. The next 15 years will be a key period for improving the population’s health. Economic growth at medium to high speed provides a solid foundation for health improvement. Upgrading of consumption may mean more opportunities for the development of the healthcare market. With more mature and fixed institutional arrangements and great momentum in science and technology innovation, sustainable development of the healthcare system will be guaranteed.

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Foreword

To build a healthy China and raise the health status of the people, we have developed the outline of a plan based on the decisions made at the Fifth Plenary Session of the 18th CPC Central Committee. This outline of the plan will be a blueprint and action plan for facilitating the development of Healthy China. The entire society will take responsibility and make commitments to achieving the goal, and contribute to the rejuvenation of the nation and advancement of human civilization. The Committee of the Book

Tutorial for Outline of the Healthy China 2030 Plan

By National Health Commission of the People’s Republic of China Editor-in-Chief: Bin Li Translator-in-chief: Ying Chen Translators: Yongxiang Shan, Yang Qu, Guimin Wang, Ruisi Wang, Chenglian Ji, Youli Wang, Yinghong Zhao, Xuemei Zhao Editorial Board Editor-in-Chief: Bin Li Association Editor-in-Chief: Xiaowei Ma

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General Remarks: Implementing the Outline of the Healthy China 2030 Plan to Build a Healthy China with Full Efforts

On October 25, 2016, the Communist Party of China (CPC) Central Committee and the State Council issued the Outline of the Healthy China 2030 Plan (hereinafter referred to as the Outline). It sets the roadmap for building a healthy China over the next 15 years. The CPC Central Committee and the State Council attach great importance to the health of Chinese population. The Chinese President Xi Jinping points out the fact that health is a must for full development of human beings and a basis for socio-economic development. Additionally, health is an important token of national wealth and prosperity as well as the common pursuit of the people. The Leading Group of the State Council for Healthcare Reform organized the drawing­up of the Outline based on the decisions made by the CPC Central Committee and the State Council. The Outline is a medium- and long-term strategic plan for health developed at the national level for the first time since the establishment of the People’s Republic of China. Developing and implementing the Outline are a major measure to implement the guiding principles of the Fifth Plenary Session of the 18th CPC Central Committee and to ensure the health of the population, which is of great significance to building a moderately prosperous society in an all-round way and speeding up the socialist modernization. Meanwhile, it is also an important measure for China to actively engage in global health governance and fulfill its commitment to the 2030 Agenda for Sustainable Development.

The Outline Embodies a Broad Consensus and Brings Together the Wisdom of All Parties The Fifth Plenary Session of the 18th CPC Central Committee made a strategic decision of “building a healthy China.” Under the leadership of the Leading Group of the State Council for Healthcare Reform, the drafting group and expert group were set up, which was led by the then National Health and Family Planning Commission, the National Development and Reform Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security and the General Administration of Sport of China and participated by more than 20 ministries and commissions, including the Ministry of Environmental Protection, China Food and Drug Administration, etc. With the open-door drawing-up of the plan and coordination of all parties involved, departments concerned, think tanks and experts were ix

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organized to conduct over 20 thematic studies, parallel studies and international comparative studies. Also, the central committees of democratic parties concerned were invited to participate in these studies. Drawing on the experience of medium and long-term plans in other areas and international health, we gathered feedbacks from local governments, enterprises, public institutions, and social groups, and solicited more than 200 comments and suggestions from the public. In the meantime, the Leading Group of the State Council for Healthcare held several thematic meetings and expert discussions to listen to various opinions and discuss the draft document. On May 26, 2016, the plenary session of the Leading Group of the State Council for Healthcare conducted a review. At the National Health Conference held on August 19–20, the Group asked for feedbacks from all delegates, 374 of which were taken one by one in the review. On August 26, the Plenary Session of the Politburo of the CPC Central Committee reviewed and approved the Outline. In summary, drawing up the Outline was a process of collecting experience, studying problems, deepening understanding, and improving healthcare work. In addition, it was not only a process of promoting democracy, brainstorming ideas, making scientific decisions, and reaching consensus, but also a process of the participation of the whole population, gathering wisdom, reflecting public opinions, and uniting the people. All of these processes fully embodied the unity of the will of the whole society.

The Outline Embodies the Concept of Big Health and Highlights a Wide Range of Health Effects The National Health Conference put forward the principles of health for the new situation as follows: focusing on primary healthcare, taking reform and innovation as the impetus, putting prevention first, giving equal importance to the development of traditional Chinese medicine and Western medicine, incorporating health into all policies, and promoting health by all, health for all. Its fundamental point is to uphold the people-centered principle and to adhere to serving the people’s health, which is the basic requirement that must be consistently adhered to in China’s health development. To build a healthy China, we need to adhere to the guidelines of health set by the National Health Conference under the new circumstances, firmly establishing and implementing the concept of innovation, coordination, greenism, opening up and sharing, focusing on promoting the health of the people, incorporating health into all policies, accelerating the transformation of the development modes of the healthcare sector, and maintaining and ensuring the people’s health at all stages of life.

The Outline Is Problem Oriented and Targets the Goals and It Also Highlights Its Strategic, Systematic, Guiding and Operable Nature The first is to highlight the concept of Big Health. Currently the core health indicators of Chinese residents are, as a whole, better than the average of middle- and

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high-income countries. But with industrialization, urbanization, population ageing, and the changes in ecological environment and life styles, protecting people’s health is faced with a series of new challenges. According to a study by WHO, the impact of human behaviors and environmental factors on health is becoming increasingly prominent. As a result, it is not only hard to solve the people’s health problems but it is also unsustainable, using “disease treatment as the center.” Therefore the Outline has identified the “concept of Big Health” “with the promotion of health as the center.” It also proposes integrating this concept into the whole process of public policy formulation and implementation to coordinate the response to a wide range of health effects and to maintain the people’s health at all stages of life. The second is to combine a long-term perspective with the present focus. Centering around the national strategy of building a moderately prosperous society and achieving the “two centenary goals,” the Outline gives full consideration to the convergence with the goals of all stages of economic and social development, as well as with the requirements of the 2030 Agenda for Sustainable Development. Meanwhile, in view of the current major problems and system and mechanism innovation, the Outline coordinates the policy measures in the areas of health and family planning, physical fitness, environmental protection, food and drugs, public security, and health education. As a result, a joint effort to promote health will take shape on the path of health development with Chinese characteristics. The third is that the goals of the outline are clear and operational. Focusing on overall health, health determinants, healthcare delivery and health protection, health industry, and institutional system in promoting health, the Outline sets a number of major quantitative indicators to make the target tasks specific, and the work process operable, measurable, and assessable. Setting forth the goal of “three steps” for healthy China by 2020, 2030, and 2050, the Outline clearly defines the specific development goals for 2020 and 2030 and the main development indicators for 2030. Moreover, it looks forward to the long-term goal of “building a healthy country compatible with socialist modernization” by 2050.

The Outline Requires That, to Build a Healthy China, We Should Adhere to the Principles of Health as a Top Priority, Reform for Innovation, Scientific Development, and Equity and Fairness The first is to take health as a top priority. Health should be at the top of the development agenda. Based on national conditions, promoting health should be a part of the public policymaking process. Healthy lifestyles, the ecosystem, and socioeconomic development models should be put in place to pursue the coordination of health and economic and social development. The second is reform for innovation. With the market playing its due role, government-­led reforms in key fields will free people’s minds, break vested interests, and eliminate institutional barriers. Sci-tech innovation and informationization should have a steering and supportive role in forming a system that contributes to improving people’s health, with Chinese characteristics.

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The third is scientific development. We need to identify patterns for health development, and adhere to “putting prevention first, combining prevention with control, and supporting both traditional Chinese and Western medicine.” The healthcare delivery system should become integrated, moving from an extensive development mode based on scale to an intensive one focusing on quality and efficiency, thereby improving healthcare delivery. The fourth is equity and fairness. Rural and primary health will be prioritized. We will aim to achieve equity of public health services, ensuring the nonprofit nature of basic healthcare services to reduce urban-rural, regional and subgroup health inequalities. Universal coverage and social equity in healthcare services will be realized.

The Outline Defines That “Contributing and Sharing to Build a Healthy Nation” Is the Strategic Theme for Building a Healthy China Taking “contributing and sharing” as the basic way to build a healthy China is the very concrete reflection of implementing “sharing is the essential requirement of socialism with Chinese characteristics” and “development for the people, by the people, and of the people.” Adhering to the combination of government leadership with the mobilization of the society and individuals, we should work hard from both the supply and demand sides to coordinate the three levels of society, industry, and individuals. And a situation where the government will take the lead, the society will take an active part and individuals will shoulder health responsibilities should be achieved. We will continue to improve institutional arrangements to form a strong joint force for maintaining and promoting health, and promote the participation of all, efforts of all, and health for all. Efforts should be made to improve health literacy for all, promote a healthy lifestyle and reduce the incidence of diseases. We will also promote the structural reform of the supply side of healthcare delivery, optimize the allocation of elements and supply of services, and promote the transformation and upgrading of health industry. Cross-sector cooperation will be strengthened to control effectively the risk factors of ecological and social environment affecting health, as well as to form a pluralistic pattern of social governance. With early diagnosis, early treatment, and early recovery strengthened, “health for all” will be achieved in “contributing and sharing” to enhance the people’s sense of gain. We will take “health for all” as the fundamental purpose of building a healthy China. Focusing on the lifelong needs of all people to ensure universal benefits and cover lifelong health needs, we will resolve the issues of providing “equitable and accessible” healthcare services and “comprehensive and continuous” healthcare services, respectively. We will also work hard on the health concerning priority groups such as women and children, the elderly, people with disabilities, and low-­ income population, so that the entire population can have access to quality and affordable healthcare services they need, such as prevention, treatment,

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rehabilitation, health promotion, etc. Furthermore, we will intensify effective interventions on major health problems and major influencing factors at different stages of life to provide “cradle-to-grave” healthcare services and health protection, and to comprehensively safeguard the people’s health.

The Outline Proposes Major Measures by 2030 to Improve Comprehensively the People’s Health Consisting of 29 chapters in eight parts with over 19,000 words, the full text of the Outline falls into three sections: Foreword and Overall Strategy, Strategic Tasks, and Supportive and Guarantee Mechanisms, and Organization and Implementation. The Outline first expounds on the significance of safeguarding the people’s health and promoting the development of a healthy China. It also summarizes the achievements of China’s reform and development in the field of health, analyzes the opportunities and challenges over the next 15 years, and makes clear the basic position of the Outline. In addition, the Outline establishes the overall strategy for building a healthy China for the next 15 years. Adhering to the people-centered thinking, we should firmly establish and implement the development concept of innovation, coordination, greenism, opening up and sharing. We should also adhere to the correct principle on health, and take the improvement of the people’s health as the core. What’s more, the Outline highlights three key points: The first is putting disease prevention first, promoting a healthy lifestyle, reducing the incidence of diseases, promoting the resources to primary healthcare, and achieving affordable and sustainable development. The second is adjusting and optimizing the health service system; strengthening early diagnosis, early treatment, and early recovery; promoting the development of health industry on the basis of strengthening community services; and meeting the people’s health needs better. The third is taking “contributing and sharing to build a healthy nation” as the strategic theme, adhering to the government leadership, mobilizing the whole society to take part, promoting social contributing and sharing with everyone’s self-discipline, and achieving universal health. The Outline makes clear the different stages of step-by-step development goals. The main goals for 2030 are as follows: The people’s health will continue to improve, the main health risk factors will be effectively controlled, universal health literacy will be greatly improved, healthcare service capacity will be enormously enhanced, health industry will be significantly expanded, and the health promotion system will be well developed. Centering on these goals, the Outline sets 13 key indicators. After a large number of international comparative studies and analysis forecast, the Outline points out that the main health indicators for 2020 will rank top among the middle- and high-income countries. By 2030, the average life expectancy will reach 79.0 years, with infant mortality dropping to 5.0‰, the death rate of children under age 5 dropping to 6.0‰, and maternal mortality rate reduced to 12/10 million. And therefore, the main health indicators reach the level of those in high-income countries.

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The Outline adheres to the people’s health as the center, standing at the height of Big Health, and focusing on health determinants (including genetic, psychological, and other biological factors; natural and social environmental factors; healthcare service factors; and life and behavior factors). In the order from the interior to the exterior and from the human to the environment, and targeting at lifestyles and behavior, healthcare services and protection, production and living environment, and other health determinants, the Outline sets five strategic tasks: The first is to popularize healthy living. Efforts will be made at the starting point of health promotion to emphasize individual responsibility and develop health culture. By strengthening health education and improving health literacy of all people, we should extensively carry out the nationwide fitness campaign to shape self-­ discipline and healthy behaviors. The people will be guided to shape a lifestyle with a balanced diet, moderate exercise, smoking cessation and limit of alcohol consumption, and psychological balance. The second is to optimize healthcare services. Focusing on women, children, the elderly, the impoverished people, and people with disabilities, we will take measures to prevent and treat diseases. And we will establish an integrated healthcare service system to strengthen public health services with universal coverage. In addition, we will make greater efforts to prevent and control chronic diseases as well as major infectious diseases, implement the health project for poverty alleviation, innovate the mode of healthcare services delivery, give full play to the unique advantages of traditional Chinese medicine in preventive treatment for diseases, and provide better healthcare services for the people. The third is to improve health protection. We will improve the universal healthcare system, and deepen the reforms of public hospitals and distribution systems of pharmaceuticals and medical devices. What’s more, we will improve the national drug policy and lower the artificially high price to effectively alleviate the burden of seeking medical care, and to improve the patients’ experience who are visiting doctors. Efforts will be made to strengthen the integration and connection of various healthcare insurance systems, improve the service system of healthcare insurance management, and promote the reform of healthcare insurance payment system. Efforts will also be made to actively develop commercial healthcare insurance so as to ensure long-term sustainability of the health protection system. The fourth is to build a healthy environment. Targeting at the environmental problems affecting health, we will carry out prevention and control of air, water, and soil pollution, and implement the comprehensive emissions standards for industrial pollution sources. And we will establish and improve a monitoring and assessment system for the environment and health, strengthen the regulation over food and drug safety, and reinforce safety in production and prevention and control of occupational diseases. We will also promote the safety of road traffic, deepen the patriotic health campaign to build healthy cities and healthy villages and towns, and improve emergency response capability to minimize the impact of external factors on health. The fifth is to develop the healthcare industry. Distinguishing basic medical services from nonbasic ones, we will optimize the pluralistic structure of medical care services to promote nonpublic medical institutions toward high-level and

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large-­scale development. Furthermore, we will strengthen the supply-side structural reform and support the development of new healthcare delivery forms, such as healthcare tourism and health management services. And finally, we will actively develop the fitness and leisure industry and improve the development of the pharmaceutical industry to continuously meet the people’s growing diversified demands for health. In order to ensure the realization of these goals, the Outline puts forward policies and measures to ensure the implementation of the strategic tasks in terms of the reforms in institutional arrangements, human resources, innovations in medical science and technology, informationalization service, legislative work, and international exchanges. The Outline requests that we integrate health into all policies, deepen the reform in the medical and healthcare system in an all-round way, improve the financing mechanism for health, strengthen talent training and technological innovation, and build the support for the information service system. Emphasizing the importance of strengthening organizational leadership, the Outline requires that all local Party committees, governments, and departments put the building of a healthy China on top of the agenda, and improve the assessment mechanism and accountability system. We must create a good social atmosphere and conduct monitoring to ensure the implementation of the Outline. In the meantime, under the guidance of the Outline, we will work on the preparation of the healthcare reform plan and the medical and health service development plan for the “13th 5-Year Plan” period to implement the tasks set forth in the Outline.

Studying the Outline Seriously to Grasp the Great Significance Building a healthy China is a major decision made by the CPC Central Committee in light of the national strategy and the overall situation. It is of great practical significance and far-reaching historical significance to building a moderately prosperous society in an all-round way by 2020, achieving the “two centenary goals,” and realizing the Chinese Dream of the great rejuvenation of the Chinese nation. Firstly it is a necessary requirement to implement the guiding principles of the Fifth Plenary Session of the 18th CPC Central Committee and to realize the goal of building a moderately prosperous society in an all-round way. Chinese President Xi Jinping points out that there will be no overall well-off society without universal health. It is an important part of the “two centenary goals” to promote the development of a healthy China to ensure that all people will have access to a higher level of healthcare services. Since the CPC Central Committee attaches great importance to safeguarding the people’s health, the Fifth Plenary Session of the 18th CPC Central Committee clearly puts forward the proposal to promote the development of a healthy China. Starting from the overall promotion of all-round economic, political, cultural, social, and ecological progress, and the Four-Pronged Comprehensive Strategy, the CPC Central Committee has made institutional arrangements for the development of health service, better maintenance, and improvement of the people’s health in the coming years. Implementing the Outline to promote the

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development of a healthy China and to better meet the people’s growing diversified health needs will surely lay a solid foundation for building a moderately prosperous society in an all-round way, achieving the “two centenary goals” and realizing the Chinese Dream of the great rejuvenation of the Chinese nation. Secondly, it is an important measure for complying with the new situation and new requirement, and safeguarding the people’s health better. And safeguarding the people’s health is the aim of the CPC in governing for the people and serving the people wholeheartedly. Since the establishment of the People’s Republic of China, especially with the reform and opening up, the health sector has seen successful reforms and development, with a better urban and rural environment, intensified health promotion campaigns, an improved medical care system, and continuously enhanced health and wellbeing among the population. At the same time, we must be aware that China still faces the complex situation of multiple disease threats and interweaving of a variety of health determinants due to industrialization, urbanization, ageing population, and changing disease spectrums, ecosystem, and lifestyles. Also China is faced with health and wellness issues of both developed countries and developing countries. Currently, there are prominent gaps between China’s health service supply and growing demand for health, and health development and socioeconomic development are still lacking coordination. Therefore, it is urgently necessary to put the people’s health as a strategic priority and propose a holistic solution to achieve the coordinated development and positive interaction between health and economic society. Thirdly, it is the objective need to implement the UN 2030 Agenda for Sustainable Development and comply with the international development trend. The people’s health is the foundation for a civilized and progressive society, while having a healthy people means having stronger overall national strength and capacity for sustainable development. In today’s world, the relationship between health and the development of political, economic, cultural, and social fields is getting closer and closer, and its impact on international relations and foreign policy is on the rise. What’s more, new changes based on health promotion are being prepared. Compared to the UN Millennium Development Goals, the UN 2030 Agenda for Sustainable Development has higher goals and standards with more emphasis on the determinants of health. In promoting the development of a healthy China, we will provide an overall solution to health issues from the perspectives of Big Health, and the overall economic and social development, so as to better respond to the UN 2030 Agenda for Sustainable Development and display a good international image.

 dvancing the Implementation of the Outline to Strive to Build A a Healthy China It is a solemn commitment of the CPC to the people to implement the Outline in order to advance the development of a healthy China. Firstly, we should earnestly strengthen the CPC’s leadership. The promotion of the development of a healthy China is a holistic, transdisciplinary, cross-sectoral and systematic project. It is by no means limited to the work of one department or the work in

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one locality. Governments and departments at all levels should be urged to put the development of a healthy China on the important schedule, strengthen the responsibilities they should bear, and form a work pattern of concerted efforts, to spare no effort to promote the development of a healthy China. In combination with the implementation of the guiding principles of the National Health Conference, we should formulate a disaggregated task plan and clarify the responsibilities of various departments. Secondly, we should conscientiously organize the implementation of the Outline. Since health issues cover a wide range, all parties concerned should strengthen coordination to promptly study and formulate supporting policies that are feasible and operable, with the protection of the people’s health as an important goal of economic and social policies. We will organize the implementation of the Outline in stages and steps, focusing on the strategic targets, main tasks, and major policies measures set by the Outline. To overcome any major issues in the implementation, local authorities should be encouraged to first try it out, summarize their experience, and scale it up as appropriate across the country. We must earnestly intensify the reform to promote the in-depth development of healthcare reform and to provide a powerful impetus for the building of a healthy China. We must also fully mobilize the enthusiasm of medical workers and give play to their dominant role. It is necessary to establish a normalized inspection and assessment mechanism to reinforce incentives and accountability, and to ensure that all policy measures are implemented and bear fruits. In the meantime, under the guidance of the Outline, we will formulate and implement the healthcare reform plan and the medical and health service plan for the “13th 5-Year Plan” period and implement various task requirements set forth in the Outline. Thirdly, we should strengthen publicity and guidance. We will attach importance to and ensure effective press publicity and public opinion guidance so as to maximize consensus, enhance confidence, guide social expectations rationally, and actively create a good atmosphere for the entire society to jointly make proposals and work for the development of a healthy China. The implementation of the Outline will surely further unite the consensus of the whole society on the development of a healthy China, boost the confidence in building a healthy China, create a good atmosphere for the reform and development in the field of health, and comprehensively improve the health of the Chinese people. Uniting more closely around the CPC Central Committee with President Xi Jinping as the core, let us emancipate our minds and seek truth from facts, keep pace with the times and implement reform and innovation, make concerted efforts and work hard, so as to speed up the reform and development of health services, and build a healthy China. And let us make new contributions to the achievement of the “two centenary goals,” and the realization of the Chinese Dream of the great rejuvenation of the Chinese nation.   

Bin Li National Committee of the Chinese People’s Political Consultative Conference Beijing, China

Contents

1 “Healthy China 2030”: Promoting Health and Longevity of the Whole Nation ����������������������������������������������������������������������������������   1 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 2 The Internal and External Environment for Building a Healthy China��������������������������������������������������������������������������������������������  11 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 3 Urbanization and Building a Healthy China������������������������������������������  25 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

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4 The Main Targets for Building a Healthy China������������������������������������  39 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 5 Healthy Living for All��������������������������������������������������������������������������������  53 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 6 Improving Physical Fitness for All ����������������������������������������������������������  65 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 7 Promoting Universal Access to Public Health Services��������������������������  77 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

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8 Improving Management of Family Planning Services ��������������������������  89 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 9 Delivery of High-Quality and Efficient Medical Care���������������������������� 103 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 10 Letting Traditional Chinese Medicine Play Its Unique Role ���������������� 113 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 11 Improving Health Security������������������������������������������������������������������������ 123 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

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12 Improving the Drug Supply Security System������������������������������������������ 131 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 13 Deepening Patriotic Public Health Campaigns�������������������������������������� 141 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 14 Strengthening Management of Environmental Problems Affecting Health ���������������������������������������������������������������������������������������� 149 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 15 Ensuring Food and Drug Safety �������������������������������������������������������������� 159 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

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16 Developing the Health Industries ������������������������������������������������������������ 169 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 17 The Overall Deepening of Medical and Health System Reform������������ 181 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 18 Strengthening the Construction of Health Human Resources�������������� 191 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 19 Promoting Science and Technology Innovation in Healthcare�������������� 203 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

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20 Developing Informationized Health Information Services�������������������� 211 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 21 Intensifying International Exchanges and Cooperation������������������������ 225 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu 22 Strengthening Organization and Implementation���������������������������������� 235 Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu Appendix A: Outline of the Healthy China 2030 Plan������������������������������������ 243 Appendix B: Glossary of Outline of the Healthy China 2030 Plan �������������� 271 Postscripts ���������������������������������������������������������������������������������������������������������� 281

Committee

Huili  Cao  The National Health Commission (Temporary Employee), Beijing, China Tao  Dai  Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China Hongpeng  Fu  Health Development Research Center of the National Health Commission, Beijing, China Wei Fu  Health Development Research Center of the National Health Commission, Beijing, China Fu Gao  Chinese Center for Disease Control and Prevention, Beijing, China Zhenwei Guo  The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China Xiaoning  Hao  Health Development Research Center of the National Health Commission, Beijing, China Chuanqi  He  China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Yan  Hou  The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China Angang  Hu  Institute for Contemporary China Studies of Tsinghua University, Beijing, China Yujun  Jin  Department of Planning and Information, The National Health Commission, Beijing, China Bin  Li  The National Committee of Chinese People’s Political Consultative Conference, Beijing, China Tie Li  China Center for Urban Development, Beijing, China Guoyong  Liu  Department of Mass Sports, General Administration of Sports of China, Beijing, China Hongyan Liu  China Population and Development Research Center, Beijing, China xxv

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Committee

Hongzhi  Liu  Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China Minquan  Liu  Center for Human and Economic Development Studies, Peking University, Beijing, China Yunan  Liu  Department of National Economy of the National Development and Reform Commission, Beijing, China Xiaowei  Ma  The National Health Commission of People’s Republic of China, Beijing, China Qingyue Meng  School of Public Health, Peking University, Beijing, China Yanqing  Miao  Health Development Research Center of the National Health Commission, Beijing, China Qichao Song  Department of Social Security of the Ministry of Finance, Beijing, China Gangqiang Su  Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China Quan  Wan  Health Development Research Center of the National Health Commission, Beijing, China Guodong Wang  National Healthcare Security Administration, Beijing, China Weifu  Wang  Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Xiufeng  Wang  Health Development Research Center of the National Health Commission, Beijing, China Yunping  Wang  Health Development Research Center of the National Health Commission, Beijing, China Yuxun Wang  The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China Zhongfan  Wang  The National Health Commission (Temporary Employee), Beijing, China Jigang Wei  Development Research Center of the State Council, Beijing, China Haidong  Wu  Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Ming  Xue  Center for Health Statistics and Information, The National Health Commission, Beijing, China Baofeng Yang  Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China

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Hongwei  Yang  Health Development Research Center, The National Health Commission, Beijing, China Fang Yu  The National Health Commission (Temporary Employee), Beijing, China Yonghui  Yu  The National Health Commission (Temporary Employee), Beijing, China Boli Zhang  China Academy of Chinese Medical Sciences, Beijing, China Guangpeng Zhang  Health Development Research Center of the National Health Commission, Beijing, China Huanbo  Zhang  The National Health Commission (Temporary Employee), Beijing, China Yuhui  Zhang  Health Development Research Center of the National Health Commission, Beijing, China Kun  Zhao  Health Development Research Center of the National Health Commission, Beijing, China Maigeng  Zhou  National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China Ning  Zhuang  Department of Healthcare Reform of the National Health Commission, Beijing, China

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“Healthy China 2030”: Promoting Health and Longevity of the Whole Nation Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_1

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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Health and longevity are not only the core objective of human development, but also the common wishes of people of all ethnic groups in our country. Healthy China is the China where the people can enjoy health and longevity and also the China where the people’s health and health service capacity have reached the world advanced level. From the following three dimensions—healthy life, quality of health and health capacity, Healthy China will provide the behavioral guidance and policy basis for individuals, families, health-related institutions, government departments and other entities to jointly construct a healthy China where people can enjoy health and longevity and where the economy and the society can carry each other.

1.1

Healthy China Is a Strategic Choice

Health is a state of complete physical, mental, moral and social well-being, not merely the absence of diseases and infirmity. As a basic human right, health is also the most valuable fortune of humans. One of the important purposes of “Healthy China 2030” is to promote health and longevity of the people and realize the health concepts of “healthy life with fewer diseases, early treatment and recovery, universal healthcare coverage and quality, fair and sustainable health service” (Table 1.1). Table 1.1  Development priorities of “Healthy China 2030”

Item Participants

Health concepts Strategic targets

Agenda for healthy living movement Individuals and families Public health facilities

Health and well-being promotion project Medical institution patients

Disease prevention

Early recovery

Controlling health risks Healthy life with fewer diseases

Improving health and well-being Early treatment and early recovery Promoting the health and well-being of the patients Enhancing healthcare delivery

Basic tasks

Improving health literacy of the people Controlling and lowering health risks

Major measures

The “cradle to grave” programming for healthy living Behavioral guidance for healthy living

Reforming of the medical and nursing processes Standardization of community hospitals

Healthcare service capacity promotion project Governmental health departments Health institutions Universal coverage and sustainability Increasing health capacity High quality, fair access and sustainability Elevating the capacity of healthcare service and protection Promoting equity in healthcare service and so on A national health system with labor division and collaboration Indicator system of Healthy China

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1.1.1 Basic Principles Note: The contents in this book are compiled on the basis of the findings from the previous projects of the Outline of the Healthy China 2030 Plan. Upholding the concepts of innovative, coordinated, green, open and shared development, centering on enhancing the health and well-being of the people, taking health risk control, health quality promotion and health care capacity elevation as the starting point, China will construct a national health system with the participation of all the people, the whole-course coverage, the labor division and collaboration and the mutual promotion between healthy living and healthcare services so as to meet the increasing needs of the people for health (Table 1.2). 1. Health as a top priority. Without health, there will not be a healthy China. As the physical basis for work and life, health shall be prioritized in work and life. We shall incorporate the concepts of health into daily life and all the policies. And we shall establish the health influence evaluation system and accelerate the formation of the socio-economic development model that will facilitate the promotion of health and the formation of healthy life style. 2. Quality as a priority. Quality will be put at the first place in healthcare service. We shall establish the comprehensive quality management system of healthy living and healthcare service and promote the quality of healthy living, healthcare service, health products and healthy environment. Thus, the people can enjoy better heath and have better health experience. 3. Equity as a priority. We will put people first and provide universal healthcare service. The basic public healthcare service will be provided for all. And we’ll strive to reduce urban-rural and regional health inequalities and continuously improve the health equity. We’ll ensure the non-profit nature of basic medical care and health services and encourage the proper development of non-basic healthcare services to meet the diversified health needs of people due to the improvement of living standards. 4. “Contribute and share”. According to the requirement of “health by all and health for all”, we will mobilize the whole society to actively participate in the construction and nurture the health culture and healthy living habits. We will promote the mutual trust and confidence between the supply-side and demand-side of healthcare services and strive to realize the cooperation and the win-win situation between them. Table 1.2  Principles and concepts of “Healthy China 2030” Item Objective Basic principles Basic concepts

Main contents Promoting health and longevity of the people “Health as a priority, quality as a priority, equity as a priority, contribute and share” Healthy China for everyone; healthy living by each family Universal coverage of health service; gradually enhanced health security Health improvement with prevention being put first; a health system with labor division and collaboration

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1.1.2 Strategic Targets 1.1.2.1 General Target We will make effort to improve the health literacy and extend the years of health life; enhance healthcare service quality; elevate the capacity and efficiency of health maintenance and health management; and set up an effective, sustainable, labor-­ dividing yet collaborated national healthcare system and a new healthcare service and health protection mechanism that covers the whole “cradle to grave” life course so as to make the people more satisfied with the healthy living. The labor-dividing yet collaborated national healthcare system will be an integrated healthcare system with the participation by all the citizens, the whole-course coverage and the clear specification of responsibilities and rights. In this system, health and longevity of the whole nation will be taken as the main purpose and the information technology taken as the prop. In addition, the labor-division will be clearly defined and the duties will be assigned to specific individuals. What’s more, the healthy living and healthcare service will be mutually promoted and the economy and society can carry each other. The system will mainly function to provide “cradleto-grave” healthcare service and healthcare protection for all the people (Fig. 1.1). 1.1.2.2 Strategic Targets of 2020 The modernization of the healthcare service will be basically realized, the labor-­ dividing yet collaborated national healthcare system will be basically established, the basic public healthcare and basic health services will be available for all the

Health Management

Health Living Health Security

Health Industry

Health Environment

Health Service

Health Products

Fig. 1.1  The structural diagram of the labor-dividing and cooperative national health system (Diamond Model)

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people, the health concepts of “healthy life with fewer diseases, early treatment and recovery, universal healthcare coverage and quality, fair and sustainable health service” will be partially realized.

1.1.2.3 Strategic Targets of 2030 The modernization of healthcare quality will be basically realized, the labor-­dividing and cooperative national health system will be established, all the people can enjoy high-quality healthy living, healthcare service and health protection, and the concepts of “healthy life with fewer diseases, early treatment and recovery, universal healthcare coverage and quality, fair and sustainable health service” will be fully realized. The regional imbalance of development exists in our country. And it is a major objective to promote and realize the equity in basic healthcare service. At the same time, in the relative well-developed areas, the development goals can be set a bit higher. While in the areas with relatively low development level, the development goals can be set a little lower. In different areas, we shall adjust measures to local conditions and formulate and carry out regional health development strategies that fit for the local situation.

1.1.3 Basic Tasks 1. Controlling dangerous factors to health. Living with fewer diseases or no diseases is the basic wish of the people, however, there are many factors that will influence the physical and mental health of the people and the health risks are prevalent. We must make efforts in many aspects to comprehensively control and reduce the risk factors and improve people’s health. And the basic tasks will include: implementing the healthy living action agenda, formulating the whole-­ course plan for healthy living, issuing the behavioral guidance on healthy living, improving the health habits, optimizing the public health service, lowering the health risks in society and environment and realizing the concept of “healthy life with fewer diseases”. 2. Enhancing health and well-being. Such matters as birth, death, illness and old age are all the basic parts of life. What we can do is to make the patients have quick and good recovery once they are ill and enhance the health and well-being of them. At the same time, we will make efforts to promote the health and well-­ being of all the people. The basic tasks include: carrying out projects to promote health and well-being, advancing the “patient-centered” process reengineering of the medical and nursing services and the standardization of community hospitals, providing timely and high-quality medical and nursing services for the people and realizing the health concepts of “early treatment and early recovery of diseases”. 3. Elevating health capacity. Health capacity refers to the capacity that can meet the health demands of the people. As the health needs of the people change with the times, the development of health capacity shall be developed moderately ahead of the time. The basic tasks of this will include: implementing the health capacity promotion project, setting up the labor-dividing yet cooperative national health-

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care system, establishing the Chinese health indicator system, putting emphasis on the enhancement of capacity in healthcare service, health protection and health management. At the same time, we will improve health environment, develop health industry and realize the health concept of “universal coverage of healthcare service and quality, fair and sustainable health service”.

1.2

Agenda of Healthy Living Action

We shall stick to the principle of “centering on the people’s health” and mobilize the whole society to get all the people to participate in the action. In addition, we will make the whole-course planning, cover all the areas, have clear labor division, assign the task to the specific person and construct a society where people can enjoy health and longevity (Table 1.3). Table 1.3  Framework for the Agenda of healthy living action

Item Key areas

Infancy (0–3 years old) Pregnancy healthcare Safe delivery Health of newborns Health of infants Nutrition of infants Accidental injury

Action plan

Major projects Core objectives

Learning period (3–18 years old) Health literacy Nutrition and overweight Moderate exercise Psychological health Eyesight and oral health Sex and puberty

Working period (18–60 years old) Health literacy Balanced diet

Postretirement period (over 60 years old) Health literacy Balanced diet

Moderate exercise

Moderate exercise

Psychological and mental health Sufficient sleep

Psychological and metal health Moderate sleep

Drug, tobacco and Drug, tobacco and alcohol alcohol Healthy habits Sex and Healthcare and reproductive health nursing Accidental Non-­communicable Non-­communicable diseases and injury diseases and geriatric diseases occupational diseases Accidental injury Accidental injury Healthy aging plan Healthy growth Away-from Health and safety plan for children sub-health plan for plan for infants and the working mothers population Action plan for promoting people’s health literacy, exercise promotion plan for all the people, plan for prevention and control of major diseases and infectious diseases Plan for doubling the public healthcare service capacity, plan for improving health environment The whole-course plan for healthy living, behavioral guidance for healthy living Letting the people have fewer or no diseases, increasing the proportion of people with a long life Lowering the incidence of avoidable diseases, improve health and life quality, lowing the social cost for healthcare service

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Involving the whole-life course and all the people, the overall healthy life planning will formulate systemic plans and carry out dynamic monitoring and comprehensive assessment on the health concepts, health habits, health environment, healthcare service and basic health conditions of the people. It will also provide health consultation, health guidance, health service and health management to promote and improve the people’s health. The planning can be revised every 5 years. Based on the overall healthy life planning and the Health Literacy of Chinese Citizens, the healthy life behavioral guidance will focus on the health concepts and habit in the key areas of healthy life to work out detailed operation procedures and provide “the specification of healthy life”. The guidance can be revised every 5 years.

1.3

Health and Well-Being Promotion Project

The health and well-being promotion project is a project that will enhance the health and well-being of the patients as well as a project that will promote the health and well-being of all the people. We shall uphold the principle of “centering on the patients”, improve the accessibility and timeliness of health service from the aspects of the medical and nursing system and the medical and nursing process, elevate the medical and nursing service quality from the aspects of the medical and nursing process and the clinical paths, promote the recovery and elevation of the well-being of the patients, and thus, enhance the health and well-being of all the people (Table 1.4).

Table 1.4  Framework of the health and well-being promotion project

Item Key areas

Major projects Action plans

Core objectives

Exiting the Diagnosis and medical and treatment Rehabilitation nursing system Rehabilitation Management Standardized and transfer mechanism of authentication of doctor-patient medical and nursing disputes, service quality, patients’ clinical paths and satisfaction diagnosis and treatment routines, the third-party supervision Reforming of the medical and nursing procedures and the standardization of the community hospitals Plan of clinical paths, plan of diagnosis and treatment routines and plan of overall nursing service Plan of doubling the income of doctors and nurses and plan of the supervisory system of medical and nursing quality Making quality medical and nursing services available to every patient, letting every doctor enjoy a decent life, ensuring early treatment and early recovery of diseases Promoting the accessibility and timeliness of medical and nursing services, elevating the level and quality of medical and nursing service, enhancing the health and well-being of patients Entering the medical and nursing system Labor-division and cooperation of the medical and nursing institutions, informationized service platform, emergency medical and nursing network

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The process reengineering of medical and nursing services will be simultaneously carried out in the medical and nursing system and hospitals. In the medical and nursing system, the labor-dividing and cooperative medical and nursing service system will be set up, the cooperative system among the medical and nursing facilities will be improved and the patients will be guided to rationally seek medical service and undergo referral. In the hospitals, all the links in the medical and nursing procedure, “entrance, diagnosis, treatment, recovery and exit”, will be systemically reformed, dynamically monitored and comprehensively assessed. In addition, responsibilities in the medical and nursing services will be specified, the medical and nursing cost will be controlled, the time patients spend in waiting and staying will be reduced and the medical and nursing service quality and the patients’ satisfaction will be comprehensively enhanced.

1.4

Health Capacity Enhancement Project

Upholding the principles of “putting people first, equity as a priority, being demand-­ oriented and appropriately advanced development”, we will make efforts to elevate the health capacity from the following three dimensions: healthcare service, health security and health management, set up and improve the labor-dividing yet collaborated national health system and realized the health concepts of quality, fair and sustainable healthcare services for all the people (Table 1.5). (Qu Yang)

Table 1.5  Framework for the health capacity enhancement project Item Key areas

Major projects

Core objectives

Health protection Health management Healthcare service capacity capacity capacity Health management system Health insurance Healthcare service system Health supervision system Human resources for health Health law enforcement Health and medical sector Improvement of health system Scientific innovation in environment Health industry health sector International health Information technology cooperation application in health sector Labor-dividing yet collaborated national healthcare system, plan for nurturing health human resources for a strong nation, plan for innovation of health technology, plan for information technology application in health sector, plan for improvement of health environment, healthy China indicator system, national health law Quality, fair and sustainable healthcare service for all “Cradle-to-grave” healthcare services and health security for all

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The Internal and External Environment for Building a Healthy China Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_2

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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 Trend in China’s Socioeconomic Development A for 2016–2030

2.1.1 Economic Growth As China’s economy goes into the new normal, hard constraints such as resources, environment and climate variation will slow it down. However, the great potential for economic development and the inertia for economic growth will still keep China’s economy growing at a medium-to-high speed. It is predicted that China’s GDP will maintain a growth rate of 6.5–7% in 2016–2020 and a medium-high rate of growth in 2020–2030 (see Fig. 2.1). In addition to the rapid development of industrialization, urbanization, informatization, internationalization and infrastructure modernization, higher domestic investment rate, human capital growth rate, non-agricultural employment growth rate and total factor productivity (TFP) improvement are all favorable factors to maintain high growth in China’s economic future.

2.1.2 Economic Structure Around the year 2023, China will usher in a transition of economic structure from the medium- to low-end to medium- to high-end and so the industrial structure will undergo an essential change. Over the next 15 years, primary industry will maintain long-term and steady growth at a low speed with the proportion of employed dropped to 12.5%. And the proportion of secondary industry in the national economy will gradually drop. The proportion of tertiary industry, represented by service industry, will rise to more than 60%, which will solve the employment problem for more people (Fig. 2.2). Meanwhile, emerging industry will gradually replace traditional industries while advanced world level will be attained in high-tech areas.

GDP Forecast (trillion dollars)

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Fig. 2.1  A chart for China’s 2016–2030 GDP forecast

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Fig. 2.3  A trend in the consumption levels of rural and urban residents for 2005–2030

2.1.3 Household Consumption With the consumption level of residents in our country continuously rising, the final consumption rate will be expected to rise to 55–60% by 2030, and the household consumption rate, to 45–50%. In the meantime, the consumption structure will be optimized and upgraded, the proportion of survival consumption will decline while the proportion of service consumption will keep rising, and the diversified consumer index will increase year by year. In terms of the growth rate of both urban and rural residents’ consumption in recent years, the per capita consumption of urban and rural residents will reach 75,242 yuan and 33,366 yuan, respectively, by 2030 (Fig.  2.3). From the perspective of Engel coefficient, the Engel coefficient of urban residents is expected to drop to 20% or so, and the Engel’s coefficient of rural residents, below 25%, both of which will reach the level of affluence.

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2.1.4 Demographic Structure At present, China is facing an increasingly serious problem of population aging. At the end of 2015, China’s population aged 60 and over accounted for 10.3% of the total. According to the experts’ speculation, the number of elderly people over 65 in China will account for 12.3% of the total population by 2020, and will reach 16.9% by 2030. At the same time, China will experience the transition from its demographic dividend period to the dividend period of human capital, due to the stability of the employed population, the improvement of the working population’ education and the rising proportion of non-agricultural employment.

2.1.5 Social Security At this stage, the investment in social security is far from reaching the perfect phase. For the next 15 years, both the central and local governments will increase investment in social security while improving the management of social security funds. By 2030, China will establish a basically sound social security system, basically eliminating the dual economic structure in urban and rural areas and establishing a unified basic pension service system that will benefit all citizens, in terms of social security.

2.1.6 Urbanization The influx of rural population into cities will drive large-scale urbanization. In the next 15 years, the urban population will increase by approximately 13 million annually on average, while the urban population will account for nearly two-thirds of the total by 2030 (Fig. 2.4). The acceleration of urbanization is conducive to the accumulation of social capital and will be an important driving force for China’s economic growth in the future.

population (100 million)

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Fig. 2.4  A prediction of trend in China’s urban population (2010–2030)

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Fig. 2.5  A comparison of the middle-class consumption structure in 2014 with that in 2030

2.1.7 The Size of the Middle Class Since the twenty-first century, China has seen a significant growth in the size of the middle class. Between 2016 and 2030, there are expected to be 326 million new middle-class people, with second- and third-tier cities and inland cities as the main sources of growth. In the meantime, as the number of middle-class consumers will quadruple by 2030, the rise of the middle class will boost the growth and upgrade of consumption, and middle- and high-end consumption such as education, service industry and real estate will be in great demand (Fig. 2.5).

2.1.8 Informatization By 2030, China’s modern information level will be close to that of the U.S. In the coming decades, there will be the following characteristics for the development of China’s informatization: The first is that we will develop the mobile Internet, cloud computing, Internet of Things and other emerging information services. The second is that enterprises will become the main body of information technology and research and development investment. The third is that the innovation platform for network-based collaboration, which is smart, highly efficient and green, will be developed.

2.1.9 More Diversified Market Entity By 2030, China will develop a common development model with a variety of economic components, each with its own contribution to economic indicators. In the future, it is imperative to achieve “two-legged walk” in private-owned and

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state-­owned enterprises. And the important measure is to achieve “actively developing a mixed-ownership economy.” By 2030, the marketization of China’s national economy will reach the level of a more developed market economy of the country, with the market environment being fairer and more efficient.

2.2

 n Analysis of Demands for Health Services A in China by 2030

Taking the maintenance and promotion of the people’s physical and mental health as the target, healthcare industry covers medical services, health management and promotion, and health insurance, which involve the supporting industries, such as medical products, medical equipment, healthcare products, health food products, fitness products, etc. Health services demands in China have stepped into a period of fast development.

2.2.1 E  conomic Development Will Bring About a Rise in Universal Health Needs As GDP per capita has been continuously rising over the past 30 years of reform and opening-up, GDP per capita is expected to exceed $12,000 by 2030, which will trigger an upsurge universal health needs (Table 2.1). The proportion of health investment to GDP is an important indicator to measure the health needs of a country’s population. In developed countries, the total expenditures on health account for more than 10% of GDP, while they account for only 5.9% now in China. In conclusion, there will be great potential in the market for universal health needs in the future. Table 2.1  Major areas of universal health demands Major areas of universal health demands

By population with needs

By providers of needs

By specific needs

Maternal, infantile and children’s health demands; adolescent health demands; middle-aged and elderly people’s health demands; the disabled people’s health demands; occupational safety and health demands, etc. Community-based health plan demands; demands for the construction of public health facilities; demands for the safety of medical products; demands for universal health care insurance; technical service demands for health dissemination and health information, etc. Service demands for mental health and mental disorders; sleep health demands; health demands for blood diseases and blood safety; health service demands for immunization and infectious diseases; health demands for environmental sanitation; food safety demands; drug safety demands; healthcare demands; universal physical exercise, etc.

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2.2.2 T  he Aging of the Population Will Lead to a Demand for a New Type of Old-Age Care The deepening of the aging population has spawned China’s huge market demand for old-age care (Table  2.2). Currently, China’s old-age care market is valued at roughly four trillion yuan, and it is expected to exceed 25 trillion yuan by 2030, with an average annual growth of 10% or so as required by pension.

2.2.3 T  he Scientific Development Will Give Rise to a Demand for Smart Health Services The rapid scientific development has made the demand for smart health services the mainstream of the future health service demands in China (Table  2.3). The Table 2.2  The present market demand for old-age care Main types of demands for old-age care

Demand for old-age care institutions Demand for old-age care services Demand for old-age care supplies Financial demand

Real estate demand

Nursing home; hospice; geriatric rehabilitation center; community healthcare center for the elderly; activity center for the elderly, etc. Daily nursing; housekeeping; psychological counseling; tourism; catering; training course for interest, etc. Healthcare equipment; elderly mobility scooter; cell phone for the elderly; hearing aid; domestic robot; drugs and health products for the elderly, etc. Investment and wealth management products from old-age savings; mortgage financial products of real estate for the elderly; securitization of life insurance products; long-term care insurance products; financing products of the elderly, etc. Apartment for old-age care; community for old-age care, etc.

Table 2.3  The demand for smart health services The demand for smart health services

Informationized health services

Smart health equipment

O2O health service network

Electronic health record (EHR); electronic medical record (EMR); statistical information system by cloud computing; platform for inter-institution medical information integration Smart living facilities using the Internet of Things, including smart toilet and smart mattress; wearable smart health devices such as health bracelets; portable blood pressure monitor, blood glucose meter and other mobile medical devices Online appointment for medical treatment; video probing; telemedicine consulting services; virtual medical team visit; online APP for health; electronic library for medicine, etc.

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development of smart health services in China is still in its infancy, but with its promotion across the country, there will be great potential for future growth.

2.2.4 T  he Broad Middle Class Will Bring a Demand for Mid-to-­ High-End Health Services China’s middle class will quadruple and become a mainstream social group by 2030, providing a huge demand market for mid- to high-end health services. With health services, combined with recuperation and tourism, the demand for characteristic mid- to high-end health services such as VIP nursing and maternity hotels for private reservation will be popular in the future. By 2030, China’s mid- to high-end health services will account for at least 10% of the total demand, exceeding 100 billion yuan.

2.2.5 A  Large Increase in Chronic Diseases Will Bring a Demand for Health Services of Chronic Diseases With nearly 300 million patients with chronic diseases in China, the rapidly aging population will increase the burden of chronic diseases in our country. Therefore, there is now an extremely urgent demand for health services of chronic diseases in China (Table 2.4).

2.2.6 U  rbanization Will Bring a Demand for Community Health Services As China’s urbanization is constantly improving, 200 million people will go into the urban areas in the next 15 years, bringing a broad demand market for community health services (Table 2.5). Table 2.4  Health services for chronic diseases Health services for chronic diseases

Chronic disease management services provided by health institutions Health services for chronic diseases provided by the community

Health services for chronic diseases provided by healthcare institutions

Health and disease risk assessment based on family genetics; established personal health records; working-out of personal health plan; counseling and intervention of personal health management, etc. Lectures on the healthy lifestyle of residents; knowledge on the prevention and treatment of chronic diseases; free medical examination for chronic diseases with a high incidence; executive supervision of personal health plans; launch of various universal health campaigns regularly Peer review of chronic disease treatment; assessment of drug use for chronic diseases; management and assessment of medication compliance and efficacy of patients with chronic diseases

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Table 2.5  Community health services for residents of various ages Community health services

Health demands of minors and special populations Health demands of adults

Health demands of the elderly people

Health and epidemic prevention for minors; community-­ based healthcare services for patients with chronic diseases; prenatal exam and postnatal care for pregnant women, etc. Community health education; exchange platform for universal fitness; regular physical examinations for community residents; creation of residents’ electronic health records; counseling services for residents’ mental health; working-out and supervision of personal fitness plan, etc. In-home services for the elderly; family “sickbeds;” community rehabilitation center; nursing care of the elderly; psychological care of the elderly; recreational and sports activities for the elderly in the community, etc.

2.2.7 There Will Be More Diversified Health Service Providers At present, China’s private health services are gradually gaining social recognition. By 2030, private institutions that provide “specialized services,” such as facial plastic surgery, gynecology, and dental care, to consumers at specific levels, will meet the increasingly diversified needs of consumers.

2.2.8 R  educing Social Inequality Will Bring a Demand for Equitable Access to Health Services With social fairness in China constantly improved, by 2030, the Gini coefficient will fall below the warning level, and the narrowing of the social gap will trigger a demand for equitable access to health services. In the future, China will meet the constantly growing demand for equitable access to health services through the support for health services in less developed areas and health relief programs for vulnerable groups.

2.2.9 T  he Improvement of the Quality of the Working Population Will Lead to a Demand for Occupational Health Services With the improvement of the quality of the labor force, employees will make higher demands on occupational health services. In 2030, there will be specialized and diversified demand for occupational health in our country. Not only will there be a need for mental health services such as pre-service psychological tests, but also physical health needs for prevention education of occupational diseases, occupational health checkup, and occupational disease treatment. At the same time, employees will be required to have access to a higher level of health insurance policies.

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 uggestions on China’s Health Service S Utilization for 2030

2.3.1 Promoting Comprehensive Health Development In the first place, we will establish a public policy system, an economic development model and a legal system, centering on maintaining and promoting universal health, and achieve the coordinated development of universal health and economic society. In the next place, we will improve the basic healthcare system and the public security system. In particular, we should establish a mechanism for effective prevention and control of major diseases, and improve the coverage and quality of medical and health facilities’ services. In the third place, through the necessary publicity of education to enhance the health and safety awareness of residents, we will provide healthcare industry services that cover all people, and develop a widely popular health culture project for all people.

2.3.2 Promoting the Development of Old-Age Care Firstly, we will speed up the training and reserve of talents for old-age care by accelerating the construction of professions related to old-age care. Secondly, by increasing the investment in the production and scientific research of old-age care products, we will promote the leap-forward development of China’s old-age service. Thirdly, the government should strongly encourage social capital and foreign capital to go into the domestic old-age care market.

2.3.3 Developing Smart Healthcare Industry In the first place, we will strengthen the construction of health information infrastructure and encourage social forces to participate in the development of smart healthcare industry. In the next place, we will actively develop advanced healthcare equipment and promote the combination of scientific research innovation and enterprise promotion. In the third place, we will introduce relevant laws and regulations to increase the protection and regulation of residents’ health records, health data and online health platforms. In the last place, we will accelerate the intelligentization of medical device products and focus on developing wearable and portable medical products.

2.3.4 Developing High-End Health Service Industry Firstly, we will introduce and develop high-end medical technology and equipment, and strengthen the education and training for healthcare workers, especially focusing on the training of highly skilled medical talents. Secondly, we will expand

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market access to further open up the high-end health service industry to social capital within the scope permitted by laws and regulations. Thirdly, we will develop high-­end medical complex to encourage the development and achievements transformation. Lastly, we will increase the regulation of the high-end health industry to improve the quality of employees in the high-end health industry.

2.3.5 Providing Health Services for Chronic Diseases In the first place, in terms of institutional and organizational setups, the major chronic diseases will be managed hierarchically. In the next place, the government should strengthen publicity and education of chronic disease prevention and healthcare to help our people develop good health habits. In the third place, the pharmaceutical industry should strengthen the research and development of drugs and healthcare products, while the government should establish a systemic quality regulation mechanism as early as possible to ensure high levels of basic health drugs.

2.3.6 Establishing a Mature Community Health Service System Firstly, we will strengthen primary healthcare and vigorously develop community health services that are less costly and most effective. Secondly, we will conduct physical examinations, psychological counseling and other activities to meet the diversified needs of residents for health services. Thirdly, we will pay attention to the introduction of outstanding talents into community health service organizations, and strengthen the use of intelligentization in community health services.

2.3.7 Safeguarding Substantially Health Equity In the first place, we will promote welfare equity of health services. Efforts will be made to distribute reasonably health resources in the east-central-west regions east and west to narrow the gap between urban and rural distribution of health resources. In the next place, in promoting community equity in health services, we will emphasize the training of general practitioners, gradually establish a system of family doctors, and implement the hierarchical medical system. In the last place, we will safeguard education equity of health services. Efforts will be made to eliminate asymmetry in medical information, and promote quality, popular and fair health education.

2.3.8 Improving Occupational Health Firstly, reducing occupational health risks by legislation, we will clearly require employers to ensure the specific responsibilities for safe production and

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occupational health. For high-risk industries that are likely to endanger employees’ health, employers are supposed to provide the relevant departments with a “security status report” similar to that of the United Kingdom. Thirdly, we will constantly draw lessons from accidents.

2.3.9 Establishing a Scientific Health Service System In the first place, we will strengthen the top-level design and return to public welfare characteristics. Furthermore, we will resolve the relationship between market allocation resources and government service responsibilities, and increase the government’s investment in health service industry. In the next place, we will establish a people-oriented, health-centered and green health service system. In the third place, with the health service system scaled up, we will reduce the medical care burden of residents through the market leverage of price and quality, and improve the efficiency and level of health services through graded diagnosis and treatment.

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Urbanization and Building a Healthy China Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_3

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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The Status Quo and Trend of Urbanization

3.1.1 The Status Quo of Urbanization Development Firstly, the rapid development of urbanization has led to an increasing population of agricultural transfer. In 1978–2015, the urbanization rate in China increased by around 1.03 percentage points annually on average. In 2015, the total number of rural migrant workers reached 277.47 million, an increase of 35.24 million over 2010 (Fig. 3.1). Secondly, some cities are experiencing a rapid growth of external population due to constant urban expansion, which has posed challenges to the capacity of urban governance. In 1978–2015, the number of cities in our country increased by 463 (Table  3.1). As a consequence, the population is obviously concentrated in large cities and even megacities (Table 3.2). And the rapid growth of external population in some cities poses a huge challenge to urban management, as is the case with Dongguan whose external population is three times that of the local population.

The urbanization rate (%)

60

49.95

51.27

52.57

53.73

34.17

34.5

35.29

35.7

2010

2011

2012

54.77

56.1

50 39.9 40 30 20 10 0

The urbanization rate (%)

2013 2014 2015 Year The urbanization rate of registered population

Fig. 3.1  The urbanization rate and urbanization rate of registered population in China in 2010–2015 Table 3.1  Changes in the number and size of cities in China since the reform and opening-up

Town types Cities Cities with a population of over ten million Cities with a population of 5–10 million Cities with a population of 2–4 million Cities with a population of 1–2 million Cities with a population of 0.5–1 million Cities with a population of 0.2–0.5 million Cities with a population of less than 0.2 million Designated towns

1978 193 0 2 8 19 35 80 46

2010 654 3 11 30 81 116 150 266

2173

20,401

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Table 3.2  Urban population absorbed by cities and towns of all sizes and its growth Town size With a population of over ten million With a population of 5–10 million With a population of 3–5 million With a population of 1–3 million With a population of 0.5–1 million With a population of less than 0.5 million Total

Fifth census (million) 4867.80 4127.45 3025.94 6606.91 7436.62 19857.70 45922.42

Sixth census (million) 7334.59 5951.83 4254.38 9290.08 9866.39 30323.18 67020.44

Growth rate 50.68 44.20 40.60 40.61 32.67 52.70 45.94

Legend Sub-regional urbanization rate in 2014 Sub-regional urbanization rate in 2010 Scale km 200 0 200 400 600 800 1000 km

Fig. 3.2  Sub-regional urbanization rate across the country in 2010 and 2014. Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps

Thirdly, regional gap tends to be narrowed as a result of rapid urbanization in the central and western regions. In 2010–2014, the urbanization rate in the eastern and northeastern regions increased by 3.8 and 3.2 percentage points, respectively, with an average annual increase of 0.95 and 0.8 percentage points, respectively. In the central and western regions, however, the counterpart increased by 6.2 and 5.9 percentage points, respectively, with an average annual increase of 1.55 and 1.48 percentage points, respectively (Fig. 3.2). Fourthly, the development coordination of large, medium-sized and small cities and small towns is being enhanced, and urban agglomeration is increasingly important. By the end of 2015, China’s 656 cities had generated 80% of the country’s aggregate economic volume. Many large towns are full of vitality in absorbing

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population and agglomerating economy. The three major urban agglomerations of the Beijing-Tianjin-Hebei Region, the Yangtze River Delta, and the Pearl River Delta have had 18% of the population in 2.8% of China’s land area, creating 36% of the gross domestic product (GDP).

3.1.2 The Trend of Urbanization and Its Impact on Health The first is the trend of urbanization in our country. The level of urbanization will continue to improve. If, in the future, China’s urbanization rate maintains an annual growth rate of 1 percentage point, permanent urban population will reach approximately 856 million and one billion by 2020 and 2030, respectively (Table 3.3). The spatial distribution of urban population is constantly changing. By 2025, the populations of cities with over ten million people will increase by around 37 million, whereas those of cities with 1–5 million will increase by 58 million or so (Fig. 3.3). The second is the impact of urbanization on economic society and population health. In 2015, China’s GDP per capita was 49,351 yuan (approximately 7786 U.S. Table 3.3  Forecast of urbanization rate in China in the future 2015 56.1 7.71

Years Urbanization rates (%) Urban population (100 million)

Over 10 million 100 90 Proportion (%)

80 70

2020 61 8.56

5-10 million

5-10 million

2030 70 10.04

0.5-1 million

less than 0.5 million

833

1849

1966

61.57%

48.6%

42.3%

60 50 40 30 20 10 0

363, 9.6% 128, 9.5% 244, 18% 109, 8% 39, 2.9% 1970

827, 21.9%

516, 11.1% 1129, 24.3%

300, 7.9%

402, 8.7%

453, 12%

630, 13.6%

2014 Year

2025

Fig. 3.3  Changes in the number and proportion of population in cities of different sizes worldwide (million)

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dollars). By 2030, China’s GDP per capita will exceed 12,000 U.S. dollars, close to the level of high-income countries. In the future, the Engel coefficient of urban-rural residents will continue to decrease, while the expenditures on health will increase substantially. With the increase of GDP per capita, the proportion of health services in the national economy will continue to increase. By 2020, China’s GDP per capita will reach approximately 10,000 U.S. dollars, and the value-added ratio of healthcare industry will be 7% or so of GDP. Health service industry is an important channel for increasing employment opportunities in the future. The new employment number required by China’s health service industry will reach around 20 million in the future, which is equivalent to the current employment number of the entire retail industry in China. The third is the huge demand for health services released by the promotion of the citizenization of agricultural transfer population. If the reform of household registration system can achieve the citizenization of rural migrant workers, their average annual consumption will increase by 2.1 trillion yuan, of which the average annual consumption of health services such as health care will reach 260 billion yuan or so.

3.2

Health Issues in Urbanization

3.2.1 The Health of External Population Is Seriously Neglected In 2014, the proportions of rural migrant workers’ participating in healthcare insurance, employment injury insurance and maternity insurance for urban employees were only 18.2%, 29.7%, and 7.1%, all lower than 30%, which is the main factor preventing rural migrant workers from having equal access to public health services and seeking medical attention for their illnesses.

3.2.2 T  here Are Noticeable Health Problems of “Left-Behind Women, Children and Elderly People” in Rural Areas The rural left-behind children are not only prone to mental health problems and even extreme behaviors, but also vulnerable to accidental injury and even illegal infringement, for lack of family affection and effective guardianship. There are more than 50 million left-behind women in rural areas nationwide, and they are in poor conditions physically and mentally due to years of high-density labor, heavy mental burden and lack of security. In China, there are 40 million rural left-behind elderly people, who are faced with problems such as insufficient supply, lack of daily care, serious psychological problems and monotonous life. And so it is difficult to effectively guaranteed old-age care and health care.

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3.2.3 M  ore Attention Is Paid to Quantity Than Quality in Infrastructure Construction There is a big gap between the quality of urban water supply pipelines and water supply facilities in China, and the percent of pass for urban tap water is only 50%. As a consequence, there is no tap water in any cities that is drinkable as it is. As urban sewerage system is seriously deficient in anti-disaster capacity, water-logging occurred in 234 cities across the country in 2013. What’s more, the capacity for urban sewage and garbage disposal is seriously inadequate.

3.2.4 There Is a Serious Problem of Urban Pollution Across the country, 90% of the urban waters and 65% of drinking water sources are contaminated to varying degrees. Air pollution continues to intensify, while haze is particularly severe in northern China.

3.2.5 P  ublic Facilities Associated with Health and Leisure Are in Seriously Short Supply The first is that the allocation of medical and health resources does not adapt to the rapid growth of population. The second is that there are not so many sports venues, and most cities lack sports facilities that are cheap and convenient for public use. The third is that a large number of greening and park landscape only possess viewing function, and so leisure and sports functions do not match. In addition, there are noticeable problems such as the excessive emissions caused by rural industrialization, rural straw burning, and much-used fertilizers and pesticides contributing to soil contamination, and health problems caused by food safety are also increasingly apparent.

3.3

I nternational Experience in Addressing Health Issues in Urbanization

3.3.1 F  ocusing on the Governance and Improvement of Urban Environment Air pollution: The first is to enact and strictly enforce relevant legislations. The second is to increase investment to improve environmental protection technology. The third is to introduce a market mechanism focusing on carbon emissions trading, and to adjust the behavior of various entities through pricing. At the same time, measures should be implemented in a comprehensive way, such as the emission reduction plan, the particulate matter reduction plan, the local air quality improvement plan, and the atmospheric protection plan.

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Water pollution: Most developed countries in Europe and the U.S. have established regional regulatory institutions for water prevention and control centering on water bodies for the comprehensive use of project management and ecological control measures. Many cities have introduced market mechanisms to achieve the industrialization of water pollution control, and implemented the system of “whoever discharges pollutants must pay fees.” Moreover, they have developed riverside tourism and entertainment industries, and raised funds through multiple channels. Slums: Since the 1980s, Mumbai in India has improved the living environment of slums through the prime minister’s empowerment plan, slum upgrading plan, slum reconstruction plan and slum restoration plan. In 2009, the Rajiv Housing Plan was launched in an effort to achieve a “slum-free” India by 2020. Traffic congestion: The first is to rationally plan urban transportation network, and improve traffic management using advanced means such as intelligent transportation. The second is to implement the principle of “whoever uses cars should pay fees” by means of marketization to impose charges on car users, and encourage people to travel by public transport.

3.3.2 Increasing Health Investment

10000

18

9000 8000

16

7000 6000 5000

12

14 10 8

4000 3000 2000 1000 China

Germany

France

U.S.

U.K.

Korea

Health expenditures / GDP (%)

2 Brazil

Per capita health expenditures ($)

4

Japan

0

6

3741 1454 2398 3311 9146 4334 4812

646

17.1 11.7 11.3

5.6

10.3

9.7

7.2

9.1

Fig. 3.4  National health expenditures at the later stage of urbanization

0

Percentage (%)

Per captia health expenditures ($)

With the development of urbanization, per capita healthcare expenditures in countries around the world have continued to rise, and healthcare expenditures as a percentage of GDP have been on the rise. And at the later stage of urbanization, per capita health expenditures have transitioned from steady growth to rapid growth (Figs.  3.4, 3.5 and 3.6). In the future, our country will need to further increase health investment to strengthen urban health infrastructures and public services.

3  Urbanization and Building a Healthy China 5000 Per capita health expenditures ($)

Fig. 3.5  A trend for the relationship between urbanization rate and per capita health expenditure in 20 countries

33

4000

3000

2000

1000

0 10

20

30

40 50 60 70 Urbanization rate (%)

80

90 100

120 100 80 60 40 20 0 Nurses and midwives (per 10,000 people) Coverage of urban public health facilities (%)

Japan

Brazil

Korea

U.K.

U.S.

France Germany

41

64

50

101

98

93

114

15

100

88

100

99.1

100

98.6

99.3

85.9

China

Fig. 3.6  The supply status of national health resources at the late stage of urbanization

3.3.3 Formulating Sound Public Health Policies In the period of urbanization acceleration, public health policies mainly focus on urban public health governance and public health facilities investment; at the later stage, they center on prevention and healthcare, and advocacy for lifestyle changes.

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3.3.4 Strengthening Urban Planning Guidance Urban planning is an important means to promote a healthy environment (Table 3.4). As early as the 1840s, the British government set up local boards of health to introduce the world’s first public health act and draw up modern urban planning based on public health standards. In the 1960s, the concept of urban planning gradually shifted from economic growth target to residents’ life quality target. In 2000, WHO proposed the “Healthy City Project”, and as a result the relationship between urban planning and public health became even closer. The American Urban Planning Association and American Public Health Association jointly initiated projects such as “Planning for Health.” It is suggested that there should be in-depth reflection on the influencing factors of urban health, starting from a multi-level analysis of urban functions, facility layout and detail design. Efforts should be made to carry out active intervention in urban environmental factors that have a direct or indirect impact on public health. What’s more, there should be planning for building compact cities, mixed use of land, open communities and space, guidance over walking activities, and reset layout of fast food restaurants to reduce the incidence of obesity.

3.3.5 I ncreasing the Supply of Convenient Sports and Fitness Facilities The first is that the construction of stadiums and gymnasiums as well as community sports centers is a basic measure for the development of sports public services in developed Western countries. The second is that school sports grounds and gymnasiums are more open to the public. The third is that the supporting standards for sports facilities are defined according to the population size. The fourth is that the construction and design of the sports center are integrated with the community and urban cultural landscape. The fifth is that small-sized sports facilities rely on the community, with diversity and flexibility.

3.4

 olicy Recommendations on the Development P of Health Services in the Course of Urbanization

3.4.1 A  dhering to the People-Oriented Principle, Improving the Quality of Urbanization and Implementing the Strategy for a Healthy China Basic health services and public health services will be promoted to cover all urban resident population. The prevention and control of diseases in areas with floating population such as urban villages will be strengthened. The system for the prevention and control of major diseases as well as the system for medical treatment and relief covering all rural migrant workers will be improved. Moreover the prevention and control of key occupational diseases will be strengthened.

*

* * **

** *

Building code

** * * *

Housing policy * **

*

** *

** *

Environmental development *

Note: *indicates a certain effect; **indicates greater effect

Determinants of health Lifestyle Housing Employment Accessibility Food Urban safety Air quality Water supply and water contamination Garbage and soil pollution **

Service facilities *

Table 3.4  The influencing factors of urban planning for promoting health Domain of urban planning

*

* *

* *

Open space **

** **

* **

Traffic **

* **

**

Energy supply and water supply and drainage

Land-use structure * * * ** * * *

**

* *

Urban renewal * * * *

3  Urbanization and Building a Healthy China 35

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The health services for “left-behind women, children and elderly people” in rural areas will be strengthened. Necessary services of basic healthcare and disease prevention and control will be provided for “left-behind women, children and elderly people” in rural areas. The reimbursement rate of hospitalization for children’s major diseases, women’s gynecological diseases, and chronic diseases in elderly people will be increased gradually.

3.4.2 A  ccelerating Public Health-Related Legislation to Integrate Health Concepts into Planning The study and formulation of public policies that are conducive to the development of healthy cities will be accelerated to improve related planning standards. Public health and health legislations will be strengthened to emphasize the concept of people-­oriented, green and low-carbon development. Health concept will be integrated into the “multiple plans in one area” plan. Comfortable and pleasant space environment will be designed from the people’s living habits, physical and mental needs. In urban planning and construction, micro-squares, parks and ecological space will be built in residents’ communities, and the size of health and leisure facilities will be defined. A healthy, civilized green lifestyle and consumption pattern will be advocated. The status of excessively intensive development and large area of hardening in the course of urban construction will be changed to create a livable green ecological environment. In addition, the integration of the concept of healthy development into urban development policies will be promoted, and a system of “comprehensive evaluation of urban health impacts” will be established. Public policies will be made according to local conditions. The western region should focus on increasing investments in clean drinking water, garbage removal and sewage services, food hygiene supervision, disease prevention and control, urban public health governance and public health facilities.

3.4.3 B  reaking the Pattern of the Allocation of Resources for Administrative Levels to Optimize the Allocation of Healthcare Resources Financial investment in public health will be increased. In addition to increasing the budgeted health expenditures, it is also necessary to increase the proportion of extra-budgetary health expenditures, especially those from the land transfer revenue. Under the premise of the guarantee of basic healthcare services in rural areas, the allocation of healthcare resources in urban areas will be moderately intensified on the basis of the size of urban and regional resident population. What’s more, the financial support in the areas of pairing-assistance, refresher training, technical exchanges and medical tour will be increased. A service supply mechanism will be built, in which the government provides basic medical services with social capital extensively involved. The role of the

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market mechanism will be brought into full play, and thus social capital will be encouraged to enter the field of health services according to the principle of “unlimited entry at the absence of threshold requirement.” And the development of nonprofit health service organizations will be speeded up.

3.4.4 P  romoting the Innovation in Urban Governance and Strengthening the Basic Unit of Health Services The role of community and social forces in the governance of healthy cities will be brought into play. The rapid integration of “new citizens” into the community life will be accelerated in combination with the urbanization of agricultural population shift. Various resources will be integrated to further develop the role of social groups in building healthy cities. The building of healthy environment in communities and administrative villages will be strengthened. The community and administrative villages will function as the units to provide the people with leisure facilities that are conducive to physical and mental health. The cooperation between community health service centers and the society will be actively promoted to build self-service health rooms and health centers for providing urban and rural residents with the services, such as basic health counseling, self-service health testing, and disease prevention and control. The health quality of urban and rural residents will be enhanced. Health education will be vigorously popularized to promote the nationwide physical fitness campaign. All sorts of chronic illnesses will be prevented, while mental health work will be strengthened to improve mental health quality.

3.4.5 R  elying on Smart Cities to Promote the Development of the Internet + Healthcare and Smart Healthcare The application of smart healthcare in smart homes will be strengthened. With the help of the Internet platform, the subsystems including health equipment at smart homes and the healthcare system of the community control center will be instantly and seamlessly connected. The connection between the smart medical and health function of smart communities and the telemedicine systems of major hospitals will be promoted. The wisdom and smartness of public health system will be achieved over the Internet. Furthermore, the construction of community-based self-service healthcare facility will be accelerated to provide high-quality basic healthcare services for “non-major diseases” in the community through smart means. The realization of “point-to-point” connectivity and system integration between smart homes, community-based wisdom centers, community-level healthcare institutions and hospitals will be speeded up. The community-level healthcare level, healthcare service efficiency and telemedicine capacity will be comprehensively improved. Taking the promotion of marketization as the starting point, we will carry out pilot projects in terms of smart homes and smart communities.

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3.4.6 I ncreasing the Support for Health Service Industry to Play the Role in Attracting the Employment of the Labor Force The institutional mechanisms that are conducive to the development of health service industry will be improved. The layout of health service planning and land use protection will be strengthened, while the inclusiveness for traditional health services will be enhanced. Policies such as small loans, financial discount, and skills training will be adopted to help support informal employees and persons in flexible employment in starting up business in health service industry. The development of diversified health services will be upheld. Health counseling and disease prevention will be vigorously carried out to promote the main focus shift from treatment to prevention. And the development of old-age care will be accelerated to encourage healthcare institutions to extend nursing care to residents’ households.

3.4.7 A  dapting to the Needs of People’s Health Services to Promote the Sound and Sustainable Urban Development A healthy lifestyle-oriented urban development mode will be established. From the perspective of residents’ long-term need for healthy living, the government will focus on the people’s livelihood. The investment in infrastructure and public health service facilities in residential areas mainly for rural migrant workers will be increased. In addition, the service and management for the construction quality, fire control safety and environmental hygiene of rented houses will be strengthened. A convenient and fast health service circle will be created. With the community as the basic unit, the space for public health activities will be vigorously developed to build a 15-min health service circle. There will be reasonable planning and construction of sports facilities sites and public activity space, which are convenient and practical, reasonable in layout, wide in coverage, highly inclusive, and highly utilized in openness. Public institutions will be encouraged to let the public have free access to their sports space. The level of comprehensive urban governance will be enhanced. The construction of municipal infrastructure will be strengthened to implement the reconstruction project of underground pipe network. Both the construction standards for urban drainage system and the standards for drinking water safety will be raised. And the urban life channel system will be improved. The urban and rural waste disposal will be coordinated to tackle the problem of garbage siege. The prevention and control of atmospheric pollution will be promoted in an all-round way.

4

The Main Targets for Building a Healthy China Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_4

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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As the core of the Plan, the target indicators for building a healthy China are a high degree of conciseness and summary of the development tasks and the fundamental basis for the implementation of all major tasks and major policies. With clear orientation and constraints, they are of great importance to strengthening the binding force of the Outline and ensuring the implementation of the Outline. The main targets and indicators of the Outline are supposed to closely focus on the national strategy of building a moderately prosperous society in an all-round way and achieving the “two centenary goals.” Moreover, they need to fully consider the convergence with the goals of various stages of economic and social development, and with the requirements of the UN 2030 Agenda for Sustainable Development. In this way the international comparability of indicators will be improved. The combination of taking a long-term perspective and focusing on the present must be adhered to, with consideration given to both guidance and maneuverability. It will be necessary to put an emphasis on the overall importance and representativeness of the main indicators, and to ensure that the indicators are clearly defined. With a stable source of data, the indicators will be measured, decomposed, and assessed, in order to make the annual data and provincial data accessible and to meet the requirements for the monitoring and evaluation of the Outline. Thus the binding force and maneuverability of the Outline will be guaranteed. Based on the above-mentioned facts, the Outline is linked with the country’s overall development targets and international commitments, and puts forward the targets of “three steps” for building a healthy China. The targets are listed as follows: By 2020, a universal primary healthcare system with Chinese characteristics will cover both urban and rural residents; enhance health literacy; deliver greatly improved health care; ensure universally accessible primary medical and healthcare services and sports facilities; develop a healthcare industry with sound structure and rich content; maintain health indicators ranked top in upper middle-income countries. By 2030, we will further improve institutional arrangements supporting implementation of the Healthy China strategy; develop a more coordinated healthcare sector; promote more healthy living styles; enhance healthcare service quality and health protection levels; revitalize the healthcare industry; achieve health equity; maintain health indicators equal high-income countries. By 2050, we will build a healthy China complemented with a modernized socialist country. In the meantime, the Outline sets forth the following sub-targets: By 2030, there will be continuously improved health of the people, key health risk factors under effective control, increased healthcare service delivery capacity, significantly expanded healthcare industry, and a well-developed health promotion system. In addition, the Outline further quantifies the above targets as 13 key indicators of health level, healthy living, healthcare services and health security, healthy environment and healthcare industry, which further strengthen the development orientation of all-round maintenance of health and concretize the target tasks, so as to enhance the people’s sense of gain.

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The People’s Health Will Continue to Improve

Health is a must for human development and a basis for socio-economic development. Health and longevity are an important token of national wealth and prosperity, representing the common wishes of people of all ethnic groups in the country. Since the establishment of New China, especially with the reform and opening up, the people’s health has been continuously enhanced. In 2015, China’s health level outperformed the averages seen in middle and high-income countries. With industrialization, urbanization, aging population, a changing disease spectrum, ecosystem and lifestyles, there will be a series of new challenges facing the maintenance of the people’s health. Therefore, the Outline clearly stipulates that the fundamental purpose of building a healthy China is to continuously improve the people’s health and achieve a higher level of health for all, with the improvement of the people’s health at the center. By 2030, physical fitness of the population will be significantly improved, with average life expectancy increasing to 79  years. Furthermore, the Outline sets four internationally recognized main indicators for measuring the health of residents, including the average life expectancy, infant mortality, under-­ five mortality and maternal mortality, as well as indicators for national standards of physical fitness. Through repeated measurement and calculation, compared with the predicted values of major health indicators of middle- and high-income countries in 2020 and high-income countries in 2030, China’s 2020 target values for the four main indicators of the average life expectancy, infant mortality, under-five mortality and maternal mortality mentioned by the Outline all outperform the top 1/4 of the middle- and high-income countries, whereas the 2030 target values are all at or close to the average level of high-income countries. Based on these statistics, it is proposed that “by 2020, the main health indicators will rank in the top of middle- and high-income countries,” and “by 2030, the main health indicators will enter the ranks of high-­ income countries.” 1. Life expectancy will be 79.0 years. Life expectancy refers to the average number of years that each person is expected to live at birth at a given level of death. It is also the main indicator for measuring the level of healthcare services and the level of socio-economic development in a country or region. In 2015 China’s life expectancy was 76.34 years. On the basis of the fourth, fifth, and sixth census data, China’s life expectancy by 2020 and 2030 will be approximately 77.3 years and 79.0 years respectively (the predictive value of the UN Population Division is 79.08 years), using exponential regression and life table. As a new measure of health developed by WHO, life expectancy indicates the average life expectancy without the effects of death and disability. As this indicator is still at an exploratory stage internationally, China currently is not eligible for a comprehensive measurement of life expectancy. In the future, we will actively carry out research and measurement and calculation, using the indicator as the target orientation. In promoting the building of a healthy China to greatly improve the people’s health, we must establish a “concept of comprehensive health” with the “promotion of

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health as the center.” In this way, we will maintain the people’s health in an all-­ round way and a full life-cycle, so as to further increase life expectancy on the basis of the current high level. 2. Infant mortality will drop to 5‰. Infant mortality indicates the ratio of live births to infant deaths of live births less than 1 year old, i.e., infant mortality = (the number of infant deaths in the area during the year/the number of live births in a certain area in a given year) × 1000‰. In 2015, the national infant mortality rate was 8.1‰. By comprehensively utilizing children’s cause-specific death rate approach and trend analysis approach to consider the declining trend of mortality rate for preventable diseases such as preterm birth, birth asphyxiation, pneumonia, and diarrhea, and in combination with the international development trend and the horizontal comparison, the Outline takes the reduction in the national infant mortality to 7.5‰ by 2020, and to 5.0‰ by 2030 as the planning objectives. The Outline also proposes implementing maternal and infant safety plan and providing basic healthcare services to pregnant and lying-in women free of charge throughout the entire childbirth process. And the implementation of policy measures, such as the safeguard project for maternity and child health and family planning services, as well as the improvement of the capacity of maternal and neonatal critical care, will effectively ensure the achievement of the goal of reducing infant mortality. 3. Under-five mortality will drop to 6‰. Under-five mortality refers to the ratio of live births to deaths of children under five during the year, i.e., under-five mortality = (the number of deaths of children under five in the area during the year/the number of live births in a certain area in a given year) × 1000‰. In 2015, the national under-five mortality rate was 10.7‰. By comprehensively utilizing children’s cause-specific death rate approach and trend analysis approach, and in combination with the international development trend and the horizontal comparison, the Outline estimates that by 2020 under-five mortality will drop to 9.5‰, and to 6.0‰ by 2030. In addition to a variety of measures for reducing infant mortality, the Outline makes requests such as implementing the healthy kids program, strengthening the construction of pediatrics, and continuing to carry out the nutrition improvement program for children in key areas, in order to ensure the achievement of the goal of reducing under-five mortality. 4. Maternal mortality will drop to 12/100,000. Maternal mortality indicates deaths per 100,000 pregnant and lying-in women during the year. Maternal death refers to death of any pregnancy or pregnancy-related cause within 42 days from pregnancy to childbirth, but not involving accidental deaths. By the internationally accepted method of calculation, the “total number of pregnant women” is replaced by “live births”. The formula is that maternal mortality = (the number of maternal deaths in the area in the year/the number of live births in a certain area in a given year) × 100,000/100,000. In 2015, the national maternal mortality was 20.1/100,000. According to the national “13th 5-Year Plan”, the Outline puts forward that the national maternal mortality rate will drop to 18/100,000 by 2020. By the internationally accepted method of calculation, based on China’s 1990–2015 maternal mortality decline, and by referring to the rules and charac-

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teristics of maternal mortality changes in developed countries, the Outline puts forward that maternal mortality rate will drop to 12/100,000 by 2030. With the adjustment of birth-control policy, to improve the health of women and children and to focus on solving the health problems of the key population such as women and children, it is imperative to further implement the subsidy system for hospital delivery to provide pregnant and lying-in women with basic healthcare services free of charge throughout the entire childbirth process. 5. Urban and rural residents will meet the National Physical Fitness Standards, with the proportion of eligible people reaching 92.2%. Also known as the “national fitness qualification rate,” the proportion of those urban and rural residents who have met the National Physical Fitness Standards, that is, the percentage of people nationwide who have met the National Physical Fitness Standards, is an important indicator reflecting the people’s physical fitness. According to the current National Physical Fitness Standards, the percentage of people who met the National Fitness Standards in 2014 was 89.6% based on the data released by the national physique monitoring. By using the curve-fitting method based on the monitoring data in 2000, 2005, 2010 and 2014 (with the qualification rate of 87.20%, 88.20%, 89.10% and 89.60%, respectively), the Outline puts forward that the qualification rate will be 90.6% by 2020 and 92.2% by 2030. To achieve the goal of the Outline that “the people’s physical quality has markedly improved,” we must carry out extensively the national physical fitness campaign to promote the deep integration of the national physical fitness with the national health.

4.2

Major Health Risk Factors Will Be Effectively Controlled

As revealed by the research of WHO, the level of health is mainly affected by four factors, including biological factors (genetic and psychological), accounting for around 15%; environmental factors (natural environment and social environment), around 17%; health service factors, around 8%; behavioral and lifestyle factors, around 60%. In accordance with the changing trends of major health issues in China and health development process in developed countries, the impact of lifestyle and behavioral factors and environmental factors on health has become increasingly prominent with the socio-economic development and the changes in disease spectrum. Therefore, in promoting the building of a healthy China, it is essential to promote the social and individual participation, co-ordinate comprehensive responses to a wide range of health influencing factors, and create a healthy lifestyle, an ecological environment, and a socio-economic development mode. To this end, the Outline proposes that by 2030 “the major health risk factors will be effectively controlled,” regarding “contribute and share” as the basic path for building a healthy China. The Outline also proposes that “health literacy for all will be greatly improved; a healthy lifestyle will be universally adopted; a healthy production and living environment will basically take shape; food and drug safety will be effectively guaranteed; and the hazards of some major diseases will be eliminated.”

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Considering comprehensively the availability and decomposability of indicators, the Outline sets four indicators for healthy living and healthy environment: the level of health literacy, the number of people who regularly participate in physical exercises, the ratio of days with fairly good air quality in cities at or above the prefecture level, and the ratio of surface water quality at or above that of case III waters. 1. Residents’ health literacy will go up to 30%. Residents’ health literacy refers to the proportion of people with basic health literacy among the population aged 15–69 in the total population, with the data sources being annual national health literacy surveillance. Health literacy refers to the ability of individuals to gain access to and understand basic health information and services, and to make correct decisions using these information and services so as to maintain and promote their own health. Based on Chinese Citizens’ Health Literacy—Basic Knowledge and Skills (2015 Edition), health literacy falls into three areas: basic health knowledge and philosophy, healthy lifestyle and behavior, and basic health skills. In 2015, Chinese residents’ health literacy was 10%. Based on the changing trends of national health literacy development in recent years, and comprehensively considering the future health promotion efforts and international experience, the Outline puts forward that the national residents’ health literacy will reach 20% by 2020 and 30% by 2030. To achieve this target, we must further strengthen health education, establish and improve a health promotion and education system, and establish a system for releasing core information on health knowledge and skills. In particular, we must integrate health education into the national education system, focusing on primary and secondary schools to popularize health science knowledge. 2. The number of people regularly participating in physical exercise will reach 530 million. Regular participation in physical exercises indicates participation in physical exercises three times a week or above, with moderate intensity for 30 min or more in each physical exercise. It is also a composite index that reflects participation in physical exercises. Confirmed by multiple studies, meeting the standards for regular participation in physical exercises is positively correlated with improving individual physical fitness and health level, which can accurately and effectively reflect, from one side, the development level of the universal physical fitness in a region. What’s more, it is one of the major indexes for the implementation of the comprehensive evaluation system established in the National Fitness Program (2016–2020). In accordance with the survey report on the national fitness activity, the number of people who regularly participated in physical exercises in 2014 was 364 million. On the basis of the National Fitness Program (2016–2020) and Several Opinions on Accelerating the Development of Sports Industry to Promote Sports Consumption issued by the State Council, the number of people who regularly participate in physical exercise will reach 435 million and 500 million by 2020 and 2025, respectively. By combining with the nationwide survey of mass sports, the Outline proposes that the number of people who regularly participate in physical exercises will reach 530 million by 2030. Making great efforts to improve the public service system for national fit-

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ness to extensively carry out the national fitness campaigns, China will promote life-oriented national fitness, and greatly increase the number of people who regularly participate in physical exercises. 3. The ratio of days with fairly good air quality in cities at or above the prefecture level will exceed 80% by 2020, and will continue to improve by 2030.The ratio of days with fairly good air quality in cities at or above the prefecture level refers to the proportion of days with fairly good air quality monitored in cities at or above the prefectural level to the total number of days monitored throughout the year. In the light of the 2015 Report on the State of the Environment in China by the Ministry of Environmental Protection, the average number of fine days (the ambient air pollution indexes meeting or exceeding the national second-level standards for air quality) in 338 cities above the prefecture level was 280 days, with a fine day ratio of 76.7%. In the future, China will vigorously implement not only the action plan for air pollution prevention and control, but also the emission plan for industrial pollution sources up to the standards. In addition, China will accelerate the elimination of the technologies, equipment and products causing high pollution and high environmental risk to fully implement the management of urban air quality standards. According to the Outline of the 13th 5-Year Plan for National Economic and Social Development, the ratio of days with fairly good air quality in cities at or above the prefecture level will exceed 80% by 2020, and air quality will continue to improve by 2030. 4. The ratio of surface water quality at or above that of case III waters will reach over 70%, and will continue to improve by 2030. The ratio of surface water quality at or above that of case III waters indicates the proportion of case III waters whose quality meets or is superior to that specified in the Environmental Quality Standards for Surface Water (GB 3838–2002) in the national control section (points) of surface water nationwide. In 2015, the ratio of China’s surface water quality at or above that of case III waters increased from 52.1% in 2010 to 66%. In the future, China will implement some measures such as the action plan for water pollution prevention and control, the control over the discharge of water pollutants, and the strict enforcement of environmental laws, so that existing case I to case III waters will remain stable, and some case IV waters will be upgraded to case III. And the target of “by 2020 the ratio of surface water at or above that of case III waters will reach over 70%” required by the Outline of the 13th 5-Year Plan for National Economic and Social Development will be achieved, and continue to improve.

4.3

 ealthcare Service Delivery Capacity Will H Be Significantly Enhanced

Centering on health and family planning services, healthcare service delivery is an important guarantee for effectively preventing and controlling major diseases and satisfying the people’s needs for seeking medical advice, and it is also an important demand of the people for pursuing a better life and achieving longevity. At present,

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the uncoordinated and unsustainable development in the field of healthcare service delivery and security in China has become a prominent issue. What’s worse, the situation of insufficient total resources and unreasonable layout has yet to be fundamentally changed, and quality medical resources are particularly scarce. Moreover there remain problems such as the lack of effective linkage between various systems of the medical and health service system, and it is difficult to effectively cope with the complex and ever-changing health impact factors and the challenges of high incidence of chronic diseases in the new era. To satisfy the people’s growing demand for health, to carry out the target task of the UN 2030 Agenda for Sustainable Development (SDGs) that by 2020 “the early death rate of non-communicable diseases will be reduced by 1/3,” and the initiative to achieve universal health coverage by WHO, and to ensure “that all people will be entitled to the required and quality healthcare services (including health promotion, prevention, treatment and rehabilitation, etc.), and that they will not be in financial trouble using these services, the Outline comprehensively promotes the supply-side structural reform of healthcare services in terms of the prevention and control of major diseases, provision of quality and efficient healthcare services, strengthening of healthcare service delivery in the key population, and the improvement of the medical security system and drug supply security system. Furthermore, the Outline focuses on optimizing the distribution of elements and service supply to correct and improve drawbacks in development, and to improve the equity, accessibility, service quality and efficiency of healthcare services. And accordingly the Outline sets three main indicators: premature mortality of major chronic diseases, the number of practicing (assistant) physicians per 1000 permanent residents, and the proportion of personal health expenditures to the total expenditures on health. 1. Premature mortality from major chronic diseases will decrease by 30%. The Report on Chinese Residents’ Chronic Diseases and Nutrition (2015) showed that the mortality rate of chronic diseases in Chinese residents was 533/100,000, accounting for 86.6% of the total deaths. And the disease burden caused by chronic diseases accounted for more than 70% of the total disease burdens, which was an important reason for illness-caused poverty and poverty-caused illness in the households. The growing trend of morbidity and mortality of chronic diseases in young people was both a serious threat to the health of Chiba’s workforce and a major factor affecting the increase in life expectancy. Therefore, the Outline regards the reduction in premature mortality from major chronic diseases as an important indicator. Premature mortality from major chronic diseases refers to the probability of deaths from cardiovascular and cerebrovascular diseases, cancer, chronic respiratory diseases and diabetes in people aged 30–70. And life-span table method is usually used for calculation. In 2013, China’s premature mortality from major chronic diseases was 19.1%. By calculating death probability via life-span table method, comprehensively considering China’s present status and development trend of chronic diseases prevention and control, and in combination with the requirements of the UN 2030 Agenda for Sustainable Development (SDGs), the Outline sets the target of reducing prema-

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ture mortality from major chronic diseases by 10% in 2020 and 30% by 2030. To ensure the achievement of the target, the Outline emphasizes that a comprehensive strategy for the prevention and control of chronic diseases will be implemented, and that the screening and early detection for chronic diseases will be strengthened. What’s more, the appropriate techniques for early diagnosis and treatment of eligible major chronic diseases such as cancer and stroke will be gradually incorporated into routine medical treatment to realize the health management of chronic diseases in the whole population and the whole life cycle. 2. There will be 3000 practicing (assistant) physicians per 1000 residents. The number of practicing (assistant) physicians per 1000 indicates the number of practicing physicians and practicing physician assistants per 1000 inhabitants in a designated area. As the main indicator used to measure the development of medical human resources in the region, it is also one of the major indicators for the indicator system of WHO’s World Health Statistics report and the Indicator System for National Health Statistics of our country. In 2015, the number of practicing (assistant) physicians per 1000 residents was 2.2, which was far below the 2013 average of the OECD countries (3.2 persons). On the basis of the increasing trend and training level of national physicians, there will be the targeted level of 2.5 physicians by 2020 and 3.0 by 2030. To achieve this target, we must strengthen the construction of human resources for health, speed up the establishment of training mechanisms for medical talents adapted to the characteristics of the industry, and strengthen the training for critically needed professionals in general practice and pediatrics, etc., to innovate the evaluation and incentive mechanism for talent employment. In particular, we will start with the promotion of remuneration, development space, practicing environment and social status to enhance medical workers’ professional sense of honor and foster an environment in which all parties in the society respect healthcare workers and attach importance to healthcare. 3. The proportion of personal health expenditures to the total expenditures on health will fall to around 25%. Personal health expenditures refer to the individual burden share of urban and rural residents in receiving various types of healthcare services. The proportion of personal health expenditures to the total expenditures on health refers to the proportion of the total expenditures on health that is borne by individuals, which is an evaluation index reflecting the burden of healthcare costs on urban and rural residents. In 2015, China’s personal health expenditures accounted for 29.3% of the total expenditures on health. Through the internationally used compositional model, the total health expenditures, government health expenditures, social health expenditures, and personal health expenditures can be predicted. The proportion of personal health expenditures to the total expenditures on health will drop to 27.8% by 2020 and 25% by 2030. Internationally, as the economy continues to develop, the proportion of personal health expenditures to the total expenditures on health will continue to decline, while the proportion of public funding will keep rising. When per capita GDP reaches 20,000 U.S. dollars, the proportions of personal health expenditures to the total expenditures on health in almost all the countries included in the analysis are between 10% and 30%. To achieve this target, we must further increase

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financial input, fully mobilize the enthusiasm of social organizations and enterprises, and improve the health financing mechanism.

4.4

Healthcare Industry Will Be Expanded Significantly

Health services refer to all kinds of service activities aimed at maintaining and promoting human mental and physical health, including healthcare services, health management and promotion services, health insurance and security services, and other health-related services. Covering a wider range of industries, healthcare industry expands the supporting industries such as pharmaceuticals, medical devices, health products, health foods and fitness products on the basis of health services. Healthcare industry is a key area that can effectively drive macroeconomic growth, and accelerate the economic transformation and upgrading as well as structural optimization. It is also an important breakthrough in the overall planning of steady growth, reform promotion, structural adjustment, improvement of people’s livelihood, prevention of various risk tasks, and fostering of endogenous dynamic of economic development. To continuously satisfy the people’s multi-level and diversified needs for health services, the Outline regards the guidance and support for the accelerated development of healthcare industry as an important task. In addition, the Outline proposes that by 2030, “a healthcare industry system with system integrity and structural optimization will be established. And a number of large enterprises with strong innovation capabilities and international competitiveness will be developed to become a pillar of our national economy.” What’s more, the “size of health services” will be taken as a major indicator. The total size of health services will increase to 16 trillion yuan. Based on Several Opinions of the State Council on Promoting the Development of Health Services, the total size of health services will reach roughly eight trillion yuan. In the next 15  years, China will move from middle-income and upper-income countries to high-income countries. Taking into account factors such as GDP growth rate, residents’ income growth rate, and reasonably controlling the growth of medical expenses, the Outline proposes that the total size of health services will reach 16 trillion yuan by 2030 by comparing various measurement plans. Health services to achieve development goals, we must actively promote the health and pension, travel, Internet, fitness, leisure food, especially to optimize multiple medical pattern, promoting the public medical institutions to develop in the direction of high level, scale, creating healthy new industries, new forms and new model, build a batch of well-known brand and the benign cycle of health services industry cluster, and actively developing fitness leisure sports industry, make with characteristic of area fitness leisure demonstration area, fitness leisure industry area. To achieve the development targets of health services, we must actively promote the integration of health with old-age care, tourism, the Internet, fitness and leisure, and foodstuff. In particular, we must optimize the pattern of diversified medical services to promote the development of non-public medical institutions to a high level and scale. We will also hasten new industries, new business forms and new models to create a number of well-known brands and a virtuous cycle of health services cluster. What’s more,

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we will actively develop fitness and leisure industry to create fitness and leisure demonstration areas and industrial belts of fitness and leisure with regional characteristics.

4.5

 he System for Promoting Health Will Be Further T Improved

Since the reform and opening-up, and with the rapid development of economy and the steady improvement of the country’s overall strength, China has gradually ­established a relatively complete system for promoting health and opened up a path of health and health development that is in line with China’s national conditions. At present, with the process of industrialization, urbanization, and aging population, and due to the constant changes in disease spectrum, ecological environment, and lifestyles, we are faced with complex situations in which multiple disease threats coexist and many kinds of health influencing factors are intertwined. In the face of the people’s growing, diversified and multi-level health needs, and to promote the building of a healthy China, we must speed up the establishment of an institutional system with Chinese characteristics and promoting health for all. What’s more, we must realize “the further improvement of the system for policies, laws and regulations that is conducive to health, and the basic modernization of health management system and governance capability.” The reform of the medical and health system is an important part of the system for health promotion. At present, the deepening of healthcare reform has entered the deep water zone where tough challenges must be met. Therefore we must speed up the implementation of the reform of the medical and health system determined by the Third Plenary Session of the 18th CPC Central Committee. We must also adhere to the goal of fair access and the benefit of the people, and correctly handle the relationship between the government and the market. And we must promote the separation of government affairs and management to maintain the public welfare of public health and promote medical treatment, healthcare insurance and medicine. Furthermore we will give full play to the role of local reform experience in demonstration, breakthrough and leading for overall reform, A breakthrough will be made in the construction of five basic medical and health systems, including the diagnosis and treatment system, modern hospital management system, universal healthcare insurance system, drug supply security system, and comprehensively regulatory system. From part to whole, a key breakthrough will be made to form an overall effect. We will speed up the establishment of a more mature basic medical and health care system to lay a solid foundation for advancing the building of a healthy China and a well-off society in an all-round way. The established health impact assessment system is an important system for integrating health into all policies and promoting the building of healthy cities. In compliance with the explicit requirements of General Secretary Xi Jinping at the National Health and Wellness Conference, China will establish a comprehensive system for health impact assessment to systematically assess various plans for

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socioeconomic development as well as the impact of policies and major projects on health. To this end, it is necessary to clarify as soon as possible the core issues, including the legal status, implementation subject, evaluation object and scope, evaluation procedure, and application and accountability of evaluation results. Meanwhile, we will accelerate the research and development of guidelines and tools of health impact assessment. In addition, it is necessary to improve the relevant investment mechanism of the government in health field, scientifically and reasonably define the responsibilities of the central government and local governments, and fulfill the responsibility of the government to ensure the needs for basic health services. Strengthening the legal construction of health, and the legislation and revision of laws and regulations in the key areas, we will reinforce the government’s regulatory responsibilities in healthcare, food, medicine, environment, sports, and other health areas, and enhance the supervision and law-enforcement system and capacity building in the field of health.

5

Healthy Living for All Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_5

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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Healthy living refers to the habitual behaviors beneficial to one’s health, which should include the following aspects: well-balanced diets, moderate exercises, tobacco and alcohol control and psychological balance. According to the study by the World Health Organization, living style and behaviors account for as much as 60% among the four factors influencing individuals’ health and life expectancy. Therefore, promoting healthy living for all is one of the key links to promote the health of the human being, a pilot and basic work for preventing and controlling various diseases, an important approach to improving health literacy of the citizens and the average social labor productivity, as well as an important means to helping building healthy China.

5.1

The Significance of Healthy Living for All

It is of great significance for improving people’s health and promoting the overall, coordinative and sustainable development of the economic society to promote healthy living for all, advocate establishing scientific concept of health and cultivate health culture.

5.1.1 P  romoting Healthy Living Is an Important Measure to Achieve Healthy China and Helps to Prevent Diseases at the Source Hyperlipidemia, hypertension, hyperglycemia, obesity etc. which are closed related to the unhealthy lifestyles such as smoking, alcohol drinking, lack of manual labor, unbalanced diets etc., have become the biggest threats to the health of the Chinese people. Faced with the increasing lifestyle-related diseases, every individual should start from themselves and abandon bad habits to practice the healthy lifestyles and benefit from them. Knowledge on health will be popularized and relevant standards on healthy living will be clarified by means of advocating by the government, comprehensive management and policy guiding so that the people will establish the awareness that they themselves are the first responsible persons of their own health and take action from an early age in all-round manners, which will help to prevent diseases at the source and effectively reduce the incidence of these diseases. Consequently, the people can step into a healthier and prosperous society.

5.1.2 P  romoting Healthy Living Will Both Save Expenditure on Health and Boost the Development of Relevant Industries The medical mode of focusing more on treating the advanced diseases, featuring high input, high cost, high technology and low output, is country to the concept of prevention first; therefore, such a mode, while improving people’s health, is liable to cause the overuse and waste of medical resources, increase the financial

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burden on the people and lack the sustainability. To resolve the main problems threatening the health of the rural and urban residents, prevention first should be intensified and huge rewards with small inputs will be achieved by promoting health living for all. Meanwhile, food industry and sport industry will be developed during the process of promoting healthy life for all, which will boost the transformation and upgrading of relevant industries and generate direct economic benefits.

5.1.3 P  romoting Healthy Living Will Contribute to Creating Harmonious Social Atmosphere and Improving People’s Health Literacy Health is the foundation of happiness, the sign of a nation’s civilization as well as the symbol of social harmony. Healthy living is an active, optimistic and positive behavior, which, while bringing benefits to the individuals, serves as a demonstration and contributes to building a harmonious social atmosphere. Meanwhile, the emergence of a behavior will arouse clustering effect, imitating effect and hereditary effect. Therefore, promoting healthy living not only benefits the health of the contemporary population, but also improves health literacy of the next generation. Hence, it is of great significance to improving the overall health literacy of the Chinese citizens.

5.2

 he Present Conditions and Achievements of Promoting T Healthy Living for All

5.2.1 H  ealth Education Pushed Forward Steadily and Health Literacy of the Citizens Improved Continuously The focus of health education in China has always conformed to the development characteristics of times. When New China was first founded, the focus was on the publicity of knowledge of epidemic prevention and endemic diseases. In 1970s and 1980s, the focus was on popularizing basic health knowledge. In late twentieth century, the focus was on the publicity of knowledge of preventing and treating chronic diseases and series of health promoting campaigns were launched, including the Healthy Lifestyle for All campaign and Health Literacy Promotion for Chinese Citizens campaign etc. The widespread and long-lasting health education has raised people’s awareness of health care and health literacy and has played an important role in changing outdated customs, preventing disease and improving health. In the past decade, in particular, great changes have taken place to people’s health habits and living styles, with health awareness enhanced, scientific health concept widely known, individuals’ health habits and healthy living styles well guided and people’s ways of living changed for the better.

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5.2.2 R  esidents’ Diet and Nutrition Generally Bettered and Children’s and Adolescents’ Growth and Development Steadily Improved The dietary quality of Chinese residents has improved remarkably. In 2012, each resident took in 2172 kilocalories of energy per day on average, 65 g of protein, 80 g of fat, and 301 g of carbohydrates, which means the supply of three main nutrients were adequate, and the intake of high-quality protein increased as well. As is revealed in 2015 Report on Chinese Nutrition and Chronic Diseases, in 2012, men of 18 years old and above were 167.1 cm tall and weighed 66.2 kg, and 155.8 cm and 57.3 kg for women. Both witnessed improvement over 2002. Those between 6 and 17 years old experienced significantly increased height and weight. Adult malnutrition was 6.0%, down 2.5% over 2002. Child and adolescent growth delay rate was 3.2%, down 3.1 percentage points, while malnutrition was 9.0%, down 4.4 percentage points. Anemia rate was 9.7% among residents of 6 years old and above, down 10.4 percentage points; the rate was 5.0% among those between six and 11 years old, down 7.1 percentage points; 17.2% among the pregnant, down 11.7 percentage points. Moderate and severe malnutrition rate among children under 5 years old was 2.34% in 2005, 1.55% in 2010 and dropped to 1.44% in 2012. Child and adolescent growth delay rate and marasmus rate, adults and children malnutrition rate and children and pregnant women anemia rate all dropped remarkably.

5.2.3 S  uccess Achieved in Intervening and Guiding Healthy Habits and Lifestyles We have actively implemented The World Health Organization Framework Convention on Tobacco Control and carried out effective measures on tobacco control. Smoking bans in public places have been enforced fully, and national legislation on smoke-free environments and law enforcement have been pushed forward to build smoke-free environment. Efforts have been made to build smoke-free health and family planning sector nationwide to give full play of the demonstrating role to the health and family planning sector. Publicity and education on tobacco control have been enhanced, the forms and contents of mass publicity on tobacco control have been innovated and people are more aware of the danger of tobacco. Services have been offered such as smoking cessation hotlines and smoking cessation clinics to improve intervention on smoking cessation. Monitoring on tobacco prevalence and relevant study have been intensified, which have provided scientific basis for tobacco control. According to the Fifth National Health Service Survey, 11.9% of smokers in the surveyed areas (13.6% in urban areas and 10.3% in rural areas) have ceased smoking, the cessation rate among residents surveyed in urban areas is higher than that in rural areas and the cessation rate has increased over those in the previous two surveys.

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While trying to keep AIDS under control and preventing and treating it, we have been adhering to the principles of highlighting the key work, guiding by the category, expanding the coverage and improving the quality, and, on the basis of Four-­Free and One-Care policy (Free AIDS drugs to rural residents and city-dwellers without insurance; Free voluntary counseling and testing; Free drugs to HIV-­infected pregnant women to prevent mother-to-child transmission, and HIV testing of newborn babies; Free schooling for AIDS orphans. Care and economic assistance to the households of people living with HIV/AIDS), we have further implemented the preventing and treating measures of Five Expanding and Six Strengthening. (Expanding the coverage of publicity and to create a good social atmosphere; Expanding the coverage of monitoring and checking to maximize the detection of HIV infected; Expanding the coverage of preventing mother-to-child transmission to effectively reduce neonatal infection; Expanding the coverage of comprehensive intervention to reduce the risk of HIV transmission; Expanding the coverage of antiviral treatment to improve treatment level and accessibility; Strengthening blood management to ensure clinical blood safety; Strengthening medical care to relieve the financial burden of HIV infected and patients; Strengthening care and assistance to improve the quality of life of people living with HIV and AIDS; Strengthening protection of rights and interests of the patients to promote social harmony; Strengthening the leadership of the organizations to fulfill their responsibilities; Strengthening the construction of the prevention and treatment team to improve their working enthusiasm). Health publicity and education on AIDS has been enhanced. At present, people’s knowledge rate of AIDS prevention and treatment has been on the rise, the knowledge rate among rural residents being over 75%, while that among urban residents being over 84%. Intervention measures have been taken for high-risk population and the coverage of intervention has been expanding with some results.

5.2.4 Public Fitness Campaigns Flourishing In the June of 1995, the Chinese government issued Outline of the National Fitness Campaign Plan, whose implementation was under the charge of the exNational Sport Commission, requiring increasing input in the public fitness campaigns to change the situation of strong competitive sports and weak mass sports. The 29th Summer Olympic Games were held in Beijing in 2008, which inspired people’s unprecedented enthusiasm for sports, and the modern civilized living concept of public fitness has been well accepted by the people. The State Council designated August 8 as the National Fitness Day and public fitness campaigns has flourished ever since. As is revealed by the data from the Fifth National Health Service Survey, the percentage of people aged 15 and above who engaged in physical exercises on regular basis rose from 14.6% in 2003 to 27.8% in 2013.

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Situations and Challenges

5.3.1 W  ork on Expanding the Coverage and Improving the Quality of Health Literacy Remains Arduous Although the health literacy of Chinese residents has been greatly improved, it is far from adequate. As is revealed in the survey, the health literacy is at a low level, with only 9.79% of Chinese people having basic health knowledge, skills and behaviors in 2014. A complete health education system which can meet people’s needs is to be developed.

5.3.2 Unhealthy Living Styles and Habits Still Prevail The first is the dual pressure of large smoking population and the fast-increasing smoking population. China is the largest tobacco producer and consumer in the world, with over 300 million smokers. A total of 28.1% of those above 15 years old are smokers. The smoking rate of male is on the increase, rising from 48.0% in 2008 to 52.9% in 2014. China has 300 million smokers. A total of 28.1% of those above 15 years old are smokers, 52.9% of whom are male. What’s worse, the percentage of nonsmoker exposing to passive smoking is as high as 72.4%. Furthermore, both male and female commence smoking at earlier ages. Tobacco smoking is one of the serious public health problems in China. The second is the nonnegligible problem of alcohol drinking. According to the analysis report of the Fifth Nation Health Service Survey, about 14.7% of those 15 years old and above consumed alcohol and as many as 28.0% of male consumed alcohol in 2013. As for the frequency of alcohol drinking, 9.5% of drinkers consumed alcohol over three times a week, and 5.2% of drinkers consumed alcohol one to two times a week. As for the quantity of alcohol drinking, according to the 2015 Report on Chinese Resident’s Chronic Disease and Nutrition, the harmful drinking rate among drinking was 9.3%, among whom 11.1% were male. Excessive drinking has not only endangered the health of the drinkers, but also brought about many personal, family and social problems. About 115 thousand people die from improper drinking every year and about one third of traffic accidents are related with drunk driving. The third is the increasingly prominent unbalanced diets. Unbalanced dietary habits and patterns are responsible for many chronic diseases. The dietary habits of the Chinese residents tend to be westernized, with too much intake of fat, and while the intake of high-quality protein increases, the consumption of beans and dairy remains low. Intake of vegetables and fruits decreases slightly, and deficiency of calcium, iron, vitamin A, vitamin D and other nutrients still prevails. In 2012, overweight rate among those 18  years old and above was 30.1%, up 7.3 percentage points over 2002; obesity rate among the same age group (including mild, moderate and severe obesity) was 11.9%, up 4.8 percentage points. Overweight rate among those between six and 17 years old was 9.6%, up 5.1 percentage points over 2002; obesity rate among the same age group was 6.4%, up 4.3 percentage points.

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The fourth is the unsafe sexual behaviors. Unsafe sex causes a large number of deaths every year, mainly through HIV infection. Meanwhile, premature and unprotected sexual behaviors also lead to unwanted pregnancies, sexually transmitted diseases and AIDS.

5.3.3 L  ack of Physical Exercises Is an Important Factor Affect People’s Health Lack of physical exercises affects people’s health directly or indirectly. One of the factors causing cardio-cerebrovascular diseases, diabetes and obesity is lack of physical exercises. As is pointed out in the 2002 WHO report, 10–16% of deaths from breast cancer, colon cancer, diabetes and 22% of deaths from coronary heart disease are related with lack of physical exercises. However, less than 10% of Chinese adult met the standards of effective physical exercises by WHO in 2014 and the majority of adults live a sedentary life.

5.4

Strategies to Further Promote Healthy Living for All

5.4.1 Comprehensively Intensifying National Health Education The first is to take multiple measures including rewards and punishments to improve the health literacy of the residents. Providing health education, popularizing health knowledge and improving health literacy of the individuals will play important roles in advocating healthy living and reduce the incidence of chronic diseases. We will take comprehensively improving health literacy of the residents as the basis to carry out the measures and push forward all the work by means of quantification and supervision. We will keep pushing forward and implementing healthy manner promotion campaign, enhance guidance on and intervention in healthy lifestyles for families and high risk individuals, and carry out special campaigns on healthy weight, healthy mouth and healthy bones etc. with the aim of basically covering all the counties (cities, districts) by the year 2030. We will develop and publicize techniques and products helpful to promote healthy living. Targeting the main factors and problems affecting people’s health, we will establish core information releasing system for health knowledge and techniques, and complete the monitoring system for health literacy and lifestyles that covers the whole country. We will carry out dynamic monitoring and modify and enrich the contents of health education constantly in accordance with the results of the monitoring. We will establish and complete health promotion and education system to improve the capacity of health education service and popularize health knowledge from children. We will enhance the construction of spiritual civilization, develop health culture and develop good living habits. Media at all levels will intensify the publicity of health science and knowledge and vigorously construct and normalize health columns on the radio and television to expand health education by means of new media.

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The second is to attach importance to health education for students and enhance health work in schools. Considering the characteristics of students acquiring knowledge quickly and school education being systematic and stable, we will integrate health education into the national education system with health education being important content of quality education at all stages of education. We will establish the promotion mechanism of health education in schools with the primary schools and secondary schools as the priorities. We will construct a health education mode combining the teaching of relevant disciplines with regular teaching activities, classroom teaching with extracurricular practice, and regular publicity education with concentrated publicity education. Meanwhile, we will train a group of eligible teachers for health education and integrate health education into the pre-service education and in-service training contents for PE teachers.

5.4.2 C  onducting Accurate Guidance Based on Health Risk Factors to Develop Self-Disciplined Healthy Behaviors The first is to promote the balance of diet. Diabetes, hypertension and cardio-­ cerebrovascular diseases are all directly related with the unbalanced food and nutrition of the residents, and the incidences of most chronic diseases can be reduced by intervention in lifestyles and early prevention. A national nutritional plan will be developed and implemented. Research and nutritional assessments of food (both at farm and table) will be carried out. Nutritional knowledge will be widely disseminated; dietary guidance of population sub-groups publicized; citizens coached to develop healthy dietary habits; and healthy culinary culture promoted. Nutrition monitoring will be established to monitor progress, with nutritional interventions in key areas and population groups, specifically focusing on micronutrient deficiency and excessive intake of high-calorie foods, such as fat, to improve problematic diets. Clinical nutritional interventions will be carried out. Meanwhile, guidance to schools, kindergartens, and nursing homes will be strengthened. Demonstration healthy canteens and restaurants will be nominated. By 2030, nutritional knowledge and literacy rates will be significantly improved, incidence of nutrition deficiency greatly reduced, average daily salt intake reduced by 20%, and increase in the overweight and obese population slowed down. Efforts will be made to carry out food safety campaigns, strengthen monitoring, tracing, pre-warning and controlling of food borne diseases, improve the monitoring system for food contaminants, strengthen the capability of identifying and evaluating food safety risks, establish the national authoritative platform for collecting, sorting and analyzing food safety information and communicating risk pre-warning, and strengthen the construction of food safety standards and the handling of sudden food safety emergencies. Food contamination will be kept under control, the incidences of food borne diseases will be reduced, the health of the consumers will be safeguarded and the development of economy will be promoted. The second is to vigorously fulfill our duties and tighten tobacco and alcohol control. The World Health Organization Framework Convention on Tobacco

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Control will be implemented fully and vigorously with effective measures. Tobacco control will be tightened with tobacco prices tightly controlled through pricing, taxation and other legal means. Advocacy and education on tobacco control will be launched, the forms and contents of mass communication on tobacco control will be innovated, the correct awareness of the public on the harm of tobacco will be improved and the social atmosphere will be formed of no smoking cigarettes, no offering cigarettes and no gifts of cigarettes. Smoke-free environments will be actively built, and supervision and law enforcement of smoking bans in public places will be enhanced. The smoking ban in public places will be fully enforced, and the indoor smoking ban will gradually cover all public venues. Officials will take the lead in implementing the smoking ban in public places, and the Party and government buildings will become smoke-free areas. Smoking cessation services will be strengthened. Services will be provided such as smoking cessation hotlines and smoking cessation clinics to improve intervention in smoking cessation. Monitoring and relevant study on tobacco prevalence will be enhanced to provide scientific basis for tobacco control. By 2030, the population of smokers aged 15 or above will be reduced to 20%. Education on alcohol control will be intensified to control excessive alcohol intake and reduce alcohol abuse. Monitoring of harmful alcohol use will be stepped up. The third is to attach importance to the mental health of the citizens and enhance the prevention and treatment of mental diseases. Great importance will be attached to the mental health of the public, basic researches on mental health will be vigorously conducted, advocacy on mental health knowledge and mental diseases will be launched, and mental health services such as psychotherapy and psychological counseling will be developed normatively. Mental health services will be further developed and orderly managed. Mental health advocacy will be strengthened to increase understanding of mental health. Common mental disorders, psychological or behavioral problems, such as depression and anxiety, will be targeted and intervened with, and more emphasis placed on early detection and intervention for mental disorders in priority groups. The national registry will be improved, as well as rescue and medical aid given to patients with severe mental illnesses. Community-­ based rehabilitation for patients with mental illnesses will be fully encouraged. Overall ability to implement interventions in emergency cases of psychological crisis will be enhanced. By 2030, competence in identifying and intervening in common mental disorders will be greatly enhanced. The fourth is to take both communicative and legal measures to reduce unsafe sexual behaviors and drug abuse. Comprehensive harnessing of social security will be strengthened. Education and intervention on sexual morality, sexual health and safe sex (focusing on teenagers, young women and migrants) will help high-risk groups reduce unplanned pregnancy and curb sexually transmitted diseases. Drug related harm will be actively addressed, with knowledge and treatment options improved. Nationwide drug-use services will be strengthened to provide drug addicts with access to early detection services and treatment. Drug maintenance therapy for detoxification will be linked with community-based drug rehabilitation as well as compulsory rehabilitation services. A comprehensive rehabilitation mode

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will be established, offering a variety of services including abstinence, psychological rehabilitation, employment support and return to the community, to minimize social harm caused by drugs.

5.4.3 I mplementing Work on Physical Fitness for All and Improve Physical Fitness for All The first is to build public service system for physical fitness which is well-planned and low-cost. Public facilities and infrastructure for physical fitness services will be uniformly planned and developed. More walking paths, bike lanes, public fitness centers, sports parks and community sports grounds will be built. Under the overall framework of the National Plan on New Urbanization, more sports facilities and infrastructure will be built, renovated and improved. In urban centers, development modes will be explored, in the light of the local conditions, which combine indoors fitness center and sport parks and can meet the new requirements and new changes of the particular population groups; existing fitness facilities will be renovated and maintained; a good job will be done in planning, examining and approving, building and guiding the operation of indoors sport centers while old cities are renovated, supportive planning, examining and approving, and guiding the operation of sport facilities and infrastructures while new cities are built, building, guiding the use of and maintaining country parks, urban cycling paths and suburban green paths, and planning, examining and approving, building and guiding the operation of outdoor special sport camps. Targets for the development of sport facilities and infrastructure will be formulated, i.e. by 2030, networks of public sports facilities at village, township and county levels will be established, with sports ground of no less than 2.3 m2 per capita. In urban areas, sports facilities will be within 15 min’ walking distance. More capital will be invested in sport facilities. Public sports facilities will be free or at less charge, and all public sports facilities and those of non-government institutions, which meet criteria for opening, should be made available for public use. Networks of public fitness clubs will be set up, and support and guidance provided to support the development of community-based sports organizations. The second is to proceed with the national fitness program to benefit more people and improve effectiveness. The effects and experience of previous plans will be summed up, a nationwide plan for public physical exercise continuously made, knowledge of physical exercises and body fitness publicized, and public fitness exercises made routine and the content of public fitness enriched. Mentoring of social sports activities will be organized to provide guidance in public fitness exercises. National criteria on physical exercise will be introduced. Common fitness and leisure exercises will be developed to enrich and improve public fitness. Exercises favored by communities will be adopted and developed. Sports events suitable for specific population groups or geographic areas will be encouraged, and traditional, cultural and historic sports exercises such as Tai Chi or Qigong will be supported and encouraged.

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The third is to strengthen the integration of sports exercises with medical care and non-medical health interventions. Guidelines on sports and fitness exercises will be researched on and formulated, with a database of prescriptions for different population groups, different contexts, and different physical statuses established to develop an innovative mode of disease management and healthcare services by combining sports exercise with medical care, the national fitness development pattern of Big Sports and Great Health will be constructed, and we will give full play to public fitness in improved health as well as the prevention and rehabilitation of chronic diseases. Platforms or centers for fitness technology innovations and supporting fitness services will be created. The informatization of sports and health will be enhanced, physical fitness assessments will be carried out; monitoring systems for fitness and health will be improved; big data on national physical fitness monitoring will be developed and applied; and risk assessment of sports exercises carried out. The fourth is to implement specific sports strategies targeting the characteristics of different population groups. Importance will be attached to the equalization of public sports service for the underprivileged people, tailored intervention plans made on fitness and health of priority groups, such as teenagers, women, elderly, occupational groups and the disabled. Plans on promoting sports among teenagers will be implemented to cultivate teenagers’ interests in sports. Teenagers will master at least one sports skill, and students will spend no less than 1 h doing sports exercises on campus every day. By 2030, 100% of sports facilities and devices at schools will meet national standards; young students will attend moderate-intensity physical exercises at least three times a week; and at least 25% of students will maintain excellent health status and physical fitness according to national standards. With enhanced mentoring, women, elderly and occupational groups will be mobilized to participate in public fitness exercises. Working interval fitness programs will be adopted; newly built working infrastructures will have proper space designated for fitness exercises. Rehabilitative sports and fitness exercises for the disabled will be widely promoted to effectively help the underprivileged people to adjust to the society better.

6

Improving Physical Fitness for All Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_6

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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Introduction

6.1.1 A  chievements of National Fitness for All During the 12th 5-Year Plan Period and the Present Situations During the 12th 5-Year Plan Period, the State Council issued National Fitness Program (2011–2015) and the local governments above county level also issued Implementation Program for National Fitness. With the implementation of these programs, the national fitness campaign was widely carried out and people’s physical fitness and health kept on improving, which were mainly revealed in the following aspects: The first is that the percentage of people participating in sports and exercises increased. By the end of 2014, 33.9% of people regularly participated in sports and exercises, rising by 5.7% over 2007. The percentage of urban residents 16 years and above (excluding school students) was 19.8%, up 6.7 percentage points over 2007, and that of rural residents was 9.5%, up 5.4 percentage points. The second is that the physical fitness of both rural and urban residents improved. According to the 2014 National Physique Monitoring Report, 89.6% of rural and urban residents in China met the standards of National Physique Determination Standards. The third is that the public service system for national fitness took initial shape which covered both rural and urban areas and was comparatively complete. The sports grounds and facilities increased drastically and the per capita sports ground area reached 1.57 square meters by the end of 2015. Socialized webs for national fitness organizations took initial shape. Various fitness activities were available. Teams of fitness mentors and service volunteers strengthened. Mentoring on scientific fitness benefited rural and urban residents. It can be concluded that the achievements of National Fitness Program (2011–2015) were remarkable, with the preliminary establishment of the public service system for national fitness which covered both rural and urban areas and was comparatively complete, the preliminary formation of the development pattern of national fitness industry which was led by the government, collaborated by different departments and participated by the whole society, and the achievements of national fitness contributed to improving the national health.

6.1.2 T  he Significance of Sports in the Planning of Healthy China The proposal of the Healthy China as a national strategy is in line with the people-­ centered Chinese dream that General Secretary Xi Jinping has proposed. The happiness of the people is the basic connotation and category of the Chinese Dream. The national fitness program is an important part of improving the overall quality of the Chinese nation and achieving the great rejuvenation of the Chinese nation. At present, China has stepped beyond the stage of basic food and clothing, and the

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people’s pursuit of health has become more prominent and urgent. The proposal to advance the new goal of building healthy China is a manifestation of the Party’s philosophy of putting people first and governing for the people. It is also promoting social fairness, realizing the fruits of development shared by the people, and laying a sound foundation for building an overall well-to-do society and a prosperous, strong, democratic, civilized and harmonious modern country. Therefore, as an important part of people’s healthy life, the National Fitness Program is beneficial for the people’s health need as guidance. The government provides public services to meet the people’s need for active participation in the physical fitness in the community, establishes the scientific fitness concept among the public, and helps them form a happy and healthy lifestyle, and share the achievements of economic and social development.

6.2

The Main Goals and Tasks

6.2.1 The Main Principles The first is that health always comes first. The ultimate goal of national fitness is to realize the people’s health. There are many issues that arise during the course of social development, such as chronic diseases of the elderly, sub-healthy middle-­ class, lack of movement of young people, and the issue of sports right equality. The starting point for solving these problems is the initial motivation for “health first”. The formulation of goals and tasks should take “health first” as the primary principle, and give top priority to improving the health of the entire people and improving the overall quality of the Chinese nation. The second is that science plays the leading role. International experience shows that if we want to fully promote national fitness, we must form a strong scientific decision on the premise of a scientific organizational structure, and ensure the implementation, supervision, evaluation, and assessment of decision-making by a corresponding scientific system. In the process of implementation, we must scientifically improve fitness awareness, effectively expand participation in sports, scientifically pursue the achievement of individual health goals, and complete the national will of healthy China. The third is that innovation of the system is crucial. Through the strengthening of the national fitness organization structure in which the government takes the lead, departments coordinates, social organizations and other social forces participate together to promote the smooth development of all work. In accordance with the principle of scientific overall planning and reasonable distribution, the government should do a good job of macro management, policy system formulation, resource allocation, work supervision and evaluation, and coordination of cross-­departmental linkages; the department must connect the national fitness work with existing policies, goals, and tasks. According to the division of responsibilities, work plans are formulated and work tasks are carried out; think tanks can provide democratic decision-­making and consulting services for important work involving national

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fitness, major projects, and play a role in top-level design and creative implementation; social organizations can play a role in guiding and organizing daily physical fitness activities and hosting sports events, and become the main body for undertaking public fitness services.

6.2.2 The Main Goals The goals include four levels: The first is the improvement of the consciousness of national fitness; the second is the improvement of sports participation and the realization of the equalization of participation rights; the third is the public fitness service system and the improvement of the efficiency of multi-elements co-governance; the fourth is the improvement of the physical and mental health of all the people. Through the implementation of the first three sub-targets, the ultimate goal is to improve people’s physical and mental health. Through the improvement of people’s awareness of health, we will increase participation in fitness and the equalization of participation rights and create a nationwide fitness environment. The ultimate goal is to integrate the national fitness work into the social and economic development process of the country, and people can share the achievements of social and economic development of the country’s reform and opening up.

6.2.3 Staged Goals The first stage, by 2020: –– The awareness of mass sports and fitness has generally increased, and the number of people participating in physical exercise has increased significantly. The number of people participating in physical exercise once or more per week has reached 700 million, and the number of people who regularly participate in physical exercise has reached 435 million. The physical quality of the people has been steadily increased. –– The educational, economic and social functions of national fitness have been brought into full play. The situation of mutual promotion with various social undertakings has basically taken shape. The total scale of sports consumption has reached 1.5 trillion RMB, and the national fitness program has become the source of power for promoting the development of the sports industry, stimulating domestic demand and the forming new economic growth point. –– The national public health service system becomes complete that supports national development goals and is compatible to the goal of building a moderately prosperous society in all respects. The pattern of development of the national fitness program led by the government and coordinates with other departments has becomes clearer.

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The second stage, by 2030: –– The “big health” awareness of sports and fitness among urban and rural residents has been deeply rooted in people’s hearts, the atmosphere of the national fitness community is strong, the public participation in sports is increasingly self-­ conscious, the quality of life brought about by sports and leisure lifestyles has significantly improved, and the scientific level of national fitness is greatly improved. The proportion of people participating in physical exercise has reached the level of developed countries, and the physical quality and health level of the masses has increased significantly. The physical condition of adolescents and children has entered a stage of benign development. The sub-health and cardiovascular and cerebrovascular chronic diseases caused by lack of exercise have been initially controlled by adults. The average life expectancy and healthy life of the elderly have been significantly extended. –– The education of national fitness, economic and social functions of the national fitness program have been brought into full play, and the situation of symbiosis with various social undertakings has taken shape. The consumption of fitness has grown rapidly, the total scale of sports industry and sports consumption has increased significantly, and national fitness has become a booster to lead the development of the sports industry, boost domestic demand and form new economic growth points. –– Establishing a national public health service system that is compatible with national development goals, people’s happiness, and the realization of the Chinese dream. Form an organic combination of the government, society, and market. National fitness is included in the new social and economic development pattern with government public services, social organizations, and complete market network.

6.2.4 The Main Tasks The first is to establish a national health system with “both offensive and defensive measures, addressing both temporary and permanent symptoms” (Table 6.1), which incorporates sports and health care to achieve universal health services and advanced sports industry. The second is to create a situation in which the people take the initiative in pursuing health, form new forms of health services, and achieve universal access to fitness services. The third is the implementation of national sports and health education strategy, the construction of sports/mental health compulsory education and higher education system. The fourth is to upgrade the monitoring of national physiques to national health monitoring and evaluation, establish a national strategic research think tank for fitness and health, and publish a national annual national fitness report.

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Table 6.1  Composition of the National Fitness Index System First-level indicators Fitness environment

Sports participation

Physical health

Second-level indicators Sports facilities Urban greenway Sports parks Sports center Community Sports Club Grassroots Sports NGO Folk Sports Association Sports Social Workers Social Sports Instructors Participation consciousness and values Participation form and content Participation level and function

Physical health Health risks

Subjective health

Third-level indicators Average area and growth rate Kilometers and growth rate Number and growth rates Number and growth rate Number and growth rate Number and growth rate Number and growth rate Total and bought positions Quantity and quality Proportion of consciousness combined with practice Organization degree, project type Proportion of sports population, the proportion and growth of endurance and endurance type, the level of participation of minor sports people, the participation of specific groups Physical fitness and athletic ability Subjective psychological assessment such as depression propensity; diagnosis of sub-health, chronic diseases, obesity, etc. Psychology, life satisfaction and happiness

The fifth is to highlight the leading role of sports in safeguarding the health of the entire nation, promote the deep integration of national fitness and national health, establish a universal health service system, establish a diversified nationwide fitness fund-raising system, establish a public fitness price formation mechanism, and strengthen sports fitness technology. Establish a sports prescription database and a sports and health non-medical program for the specific population. The sixth is laws and regulations and financial construction: The establishment of a universal fitness service fund, the establishment of a national fitness incentive system and new sports health insurance, and the formation of a long-term strategy.

6.3

Implementation Strategy

6.3.1 National Fitness Public Service Upgrade The first is to incorporate the new urbanization process. Under the overall framework of the new national urbanization development plan, the construction, transformation and upgrading of sports facilities will be strengthened.

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The second is the formation of sports facilities development goals as follows: –– Per capita sports area reaches 2.3 m2 or more; –– Achieve 15-min fitness coverage in urban communities; –– Basically build a network of public sports facilities at the county (city, district), street (township), and community (village) levels; –– The county (city, district) has a medium-sized and above national fitness center, a county-level public stadium, an indoor (outside) swimming pool (pool), and an outdoor fitness exercise site. The street (township) has a small fitness center and an outdoor gym. The community (administrative village) has a fitness place; –– There is a small national fitness center for every 30,000–50,000 people in the town, and a medium-sized fitness center for every 50,000–100,000 people; –– There is an outdoor fitness place for every 30,000–50,000 people in the town (it can be a sports fitness plaza, a sports park, a fitness trail). Nationally, expand capacity, build (renovate or extend) a group of national fitness facilities, build more than 1500 public stadiums at the county level, build more than 3000 medium-sized and above fitness centers, and formulate service standards for different types of national fitness and similar types of sports and fitness facilities, effectively do a good job in the standardization of the facility’s regional layout, basic functions, classification and configuration, and service management. The third is to increase investment in sports facilities. We will implement the systems and mechanisms for the investment in sports venues, increase financial capital investment, actively guide social capital to increase investment, establish coordination mechanisms for various departments, and strengthen supervision and inspection of the development of venue facilities.

6.3.2 Implement the Campaign for Health Promotion Research, formulate and implement the Sports Promotion Health Science and Technology Action Plan (2016–2030), which systematically supports the fitness technology of the entire nation, effectively exerts the leading and supportive role of science and technology in the development of sports, health, and innovation, and improves the scientific level of national fitness. Systematic measures will be adopted to coordinate all aspects of the work so that scientific fitness will become an important part of the national health protecting system. –– Build a sports prescription library with Chinese characteristics. –– Strengthen the construction of a national fitness science and technology collaborative innovation platform. –– Strengthen the construction of scientific fitness guidance service platform. –– Strengthen the construction of sports health informationalization. –– Promote the construction of the “Health and Medical Integration” disease management and health service mode.

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–– Non-medical health interventions. Under the guiding ideology of “priority on promotion over treatment,” non-medical health intervention projects will be gradually formed in stages, steps, and groups.

6.3.3 Promote National Fitness Awareness Strengthen the propaganda of scientific fitness concepts and form a new concept of “love life, love sports, love health” among the broad masses so that the masses can develop healthy and civilized lifestyles.

6.3.4 I mprove the National Fitness Organization System and Personnel Training System Strengthen the mentoring of social sports, increase the number, optimize the structure, improve the quality, and play a role. Accelerate the training of sports professionals and relevant professionals, and establish a professional certification system for sports and health mentors during the “13th 5-Year Plan” period. Continue to enhance cultivation and training, expand the talent team of sports health mentors, and improve the competence of sports health instructors. Further strengthen the function and role of sports associations at all levels to promote and serve the fitness of all citizens. Strengthen the construction of social organizations of sports, promote the construction of schools, communities, units, and grassroots sports organizations, and effectively manage young people, the elderly, adult employees, women, and other groups of people in an orderly manner to join various organizations to meet individual diversified sports needs At the same time, build a social network system for public fitness. To create a professional sports volunteer service team, make full use of the university sports teaching and social sports service demand, foster professional sports volunteer service teams, and the government can take the way to buy jobs and purchase services, and support more sports volunteers in professional areas.

6.3.5 Develop Key Groups and Key Projects for National Fitness The first is to build a special action plan for young people. By 2030, a pattern of youth sports work will be formed featuring “led by the government, coordinated by different departments, and participated by the whole society.” The physical fitness level of the majority of adolescents will be significantly enhanced, and skills in more than two sports events will generally be mastered; the number of young people participating in sports activities will continue to increase, and scientific fitness qualities will continue to improve; the quality of physical education classes and extracurricular sports activities will continue to increase, and brand activities and demonstration projects will continue to increase; The youth sports public service

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system will be further improved. The youth sports volunteer service system will be basically established; the sports facilities for youth will be basically covered; the level of juvenile sports information will be continuously improved; and the development monitoring and evaluation system will be basically established. The second is to create a special plan for the elderly. The system will carry out guidance for elderly sports activities and encourage the elderly, especially the emptynesters, to participate in elderly sports organizations, hold regular elderly sports activities, and regularly implement physical health interventions for the elderly. Elderly sports should work closely with family sports programs, and organize sports associations of all ages so that elderly people can integrate into the national fitness network. Strengthen the collection of information on the national fitness and health of the elderly, to engage in sports interventions, medical interventions and health interventions, and effectively solve the problems of integration of the elderly into the society, integration into families, and integration into national health plans. The third is the action strategies Tai Chi and Health Qigong projects. Based on the Tai Chi project and the Health Qigong project, by 2030, the Tai Chi public service system centered on the “Tai Chi Health Project” will be established, and a stable Tai Chi core backbone team will be trained to complete the counseling site covering all the communities and townships, with 100 million people practicing Tai Chi. We will increase the support of policies and funds to comprehensively promote the implementation of Tai Chi Health Project. The Health Qigong organization management network will be improved. The Health Qigong service centers will cover the entire country and urban areas. Health Qigong mass organizations will be widely developed, long-term investment protection mechanisms will be generally established, and a set of scientific management system and the operating mechanism full of vitality featuring Health Qigong will be formed with the government’s leadership, sound institutions, complete systems, clear responsibilities and rights, and strong support, complete functions and efficient operation. The fourth is to promote the development of key projects in the ice and snow sports. With the hosting of the Beijing Olympic Winter Games and Winter Paralympic Games in 2022, the foundation of the ice-snow sports masses will become more solid. Popularize the ice and snow sports program, carry out a variety of mass ice and snow activities, strengthen the publicity and promotion of ice and snow sports, and increase the awareness of the masses’ ice and snow sports consumption. Strengthen the training of youth’s snow and ice sports skills. Actively promote the “snow and ice sports” into the campus, the primary and secondary schools in the north will be included in the winter sports teaching content; the urban primary and secondary schools in the southern region should actively cooperate with the city’s ice and snow stadiums or snow sports clubs to develop ice sports courses. The “Millions of Young People on Ice and Snow” campaign and the “One Hundred Cities and One Thousand School” project will be carried out to promote the development of the ice and snow sports on campus. Support schools and social training institutions to cooperate in the development of ice-snow sports courses or sports skills training by means of government purchases services.

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We will vigorously develop the popular ice-snow fitness leisure project. Strengthen the professional guidance and training of snow and ice sports, and support the establishment of snow sports clubs or snow sports training schools by qualified companies and individuals. We will vigorously support the development of ice- and snow-based fitness and recreational projects that have mass foundations, and support the rapid development of potential ice-snow fitness leisure projects such as figure skating, ice hockey and Alpine skiing. Deeply explore traditional folk ice and snow projects such as ice skating, ice cars, ice smashing, ice sledge, and snow walking in the northeast, north, and northwest regions. Encourage local people to rely on local natural and humanistic resources to develop ice-snow fitness leisure projects that are suitable for different needs, in various forms, and good for health and full of fun. Activate the ice race competition market. Vigorously expand the ice and snow competition market, promote the diversity of the hosts of competitions, and promote the market-oriented operation of ice and snow events. Organize international high-­ level professional competitions of snow and ice sports, establish strong brand events such as figure skating, ice hockey, curling and snowboarding; promote professional club construction and professional league development for ice hockey and other projects; organize inter-city and inter-regional exchanges of ice and snow events; support and guide on the development of commercial performance of ice and snow sports, and create a “national public ice and snow season” to carry out ice and snow activities among the general public.

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Promoting Universal Access to Public Health Services Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_7

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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 trategy and Security Mechanism for Preventing S and Controlling Major Diseases

Major diseases refer to the illnesses that severely endanger public health and life safety of the people, severely affect the national economy and the development of society, and severely impair national security and our international image. Based on the characteristics of the present stage, five categories of 18 major diseases are selected as the representatives of major diseases, i.e. infectious diseases (AIDS, TB, hepatitis B, schistosomiasis, malaria, plague, cholera, echinococcosis, brucellosis), chronic diseases (hypertension, cerebral apoplexy, diabetes, lung cancer, liver cancer), mental diseases (severe psychonosema), occupational disease (pneumoconiosis) and endemic diseases (iodine deficiency disorders, Kaschin-Beck disease).

7.1.1 R  emarkable Achievements Have Been Made in Disease Prevention and Control in New China with a Wealth of Experience Accumulated Since the founding of New China, with the attention from the government and the joint efforts from all the departments, we have always been adhering to the concept of “All for the Health of the People” and persisted in the principle of “prevention first”, formed the working mechanism of disease prevention and control characterized by “the government taking the lead, departments taking respective responsibility, and the whole society taking part in”, established the disease prevention and control system with the disease prevention and control centers playing the main role and medical and health institutes taking part in, established the multi-channel fund raising mechanism with the central finance and local finance investing mostly and international projects supplementing, and established the medical security system supported by the basic medical insurance for working urban residents and urban residents, new rural cooperative medical care scheme and urban and rural medical assistance system. People’s health has improved remarkably. In 2014, the maternal mortality rate dropped to 21.7 per 100,000, the infant mortality rate was 8.9 per thousand and the mortality rate of children under the age of five fell to 11.7 per thousand, which all met the Millennium Development Goal of the United Nation ahead of schedule. In over 60 years, China’s disease prevention and control has achieved the targets which took the western countries 150 years.

7.1.2 T  he Characteristics of Epidemics Keep Changing in the New Era and We Are Faced with Great Challenges of Transformation During the process of economy going global and people’s working and living styles going modern, the prevalence of diseases also changes. Consequently, many of the preexistent prevention and treatment strategies are inadequate. The first is the problem of fragmentization of prevention and treatment strategy. The existent prevention

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and treatment mode for major diseases is “one strategy for one disease”, which means the strategy can only attend one disease and neglect others. The second is the poor implementation of prevention and treatment measures. The grassroots institutions can not accurately implement prevention and treatment measures. Thus the results may be far from satisfying. The third is the inadequate integration of resources. Various major disease prevention and treatment strategies and management modes are relatively closed. Hence, the integration and utilization of resources are inadequate. The fourth is the insufficient security ability. In recent years, the investment by the central government into the construction of major disease capability is insufficient, especially in the middle and western regions with weak local financial resources, where the lagging medical insurance management and commercial insurance fail to provide forceful security.

7.1.3 T  he Focus of New Strategies Is Comprehensive Prevention and Treatment, Signifying the Opportunity for Reform The prevention and control of tuberculosis is faced with a tough situation. The number of people infected with HIV and patients of tuberculosis in China ranks the second in the world, and the number of people infected with HBV (hepatitis B virus) accounts for one third of that globally. In recent years, some newly-found infectious diseases have endangered China severely such as the Middle East respiratory syndrome and Ebola virus. Chronic non-communicable disorders have brought about immeasurable damage and become the main cause of deaths for the Chinese residents, and deaths caused by them rose from 53% of the total in 1973 to 85% in 2010. Mental diseases have brought about serious impact on the individuals, families and the society. It is estimated that more than 100 million people in China suffer from common mental disorders. The issue of occupational health becomes increasingly prominent, and by the end of 2013, 830,000 cases of occupational diseases had been reported nationwide, including 750,000 cases of pneumoconiosis. The situation of disease prevention and control is still serious, and some of the endemic diseases that had been eliminated have recurred in recent years. As is revealed in the survey, except for IDD (iodine deficiency disorder), per capita medical expenses on the representative of major diseases exceeded 40% of the household income, among which the catastrophic medical spending of liver cancer patients was the most, with the average annual medical expensed accounting for 217% of the household income. The situation of major disease prevention and control is serious and the burden is heavy, indicating that the focus is on the prevention and treatment of major diseases. Innovating prevention and treatment strategies and security policies for diseases is an important foundation for promoting the transformation of health work development mode, an important means to deepen health reform, an urgent task to promote the equity of public health services and an important measure to address the issue of people’s health. And one ounce of prevention might be worth one pound of cure.

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7.1.4 S  uggestions on Major Disease Prevention and Control Strategies The first is to formulate programs on major disease prevention and treatment guided by Healthy China Strategy. We will set up major disease prevention and treatment modes with the Chinese characteristics in the new era, moving from the prevention and treatment of major diseases to health management, striving for the targets of people’s “free from diseases, fewer diseases, putting off diseases, free from major diseases”. We will formulate our national health strategy and the mid- and long-­ term program on the prevention and treatment of major diseases, taking into account the national health level, main diseases, death cause spectrum and major health risks etc., taking health management as the core, acting on the principles of the government taking the lead, the whole society participating, scientific and legitimate, guided by programs and supported by policies. The second is to complete the major disease prevention and treatment system centering on National Health Campaign. We will complete the system of national health management. Major disease prevention and treatment will be transformed to national health management, with health management as the platform, carrying out the strategy of early screening and heath evaluation, the strategy of tiered diagnosis and treatment, the strategy of community management of diseases, the strategy of risk factor intervention, the strategy of medical security, and the strategy of monitoring and effect evaluation, to get rid of the past dilemma of “one policy for one disease” that was carried out in the form of healthcare packages fund and reduce the fragmentization of policies. Major disease prevention and treatment system will be improved. The responsibilities of public health institutions and medical institutions will be rationally divided to improve major disease prevention and treatment system. The capability of staff, start a new round of construction for public health institutions will be enhanced and standardized training on public heath physicians will be carried out. The integration of clinical medicine and public health will be enhanced to give full play to the medical institutions in major disease prevention and treatment. Priority will be given to the construction of specialized departments of mental health in general hospitals at prefecture level and specialized institutions of mental health at county level, and we will especially enhance the construction of the specialized departments of tumor prevention and treatment in general hospitals at county-above level and the specialized hospitals of tumor prevention and treatment. The responsibilities and tasks of TCM medical institutions will be clarified in major disease prevention and treatment. Internet Plus will be given full play to in pushing forward major disease prevention and treatment. The sharing of health information resources will be further implemented, taking information integration as the opportunity and Internet Plus as the approach, to make information collection more intelligent and systematic. The monitoring information system of various diseases will be integrated, the capability of major disease monitoring and early warning and the construction of analysis and evaluation system enhanced, the popularization of residents’ health cards and the

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development of their functions accelerated, which may include the functions of disease management and health management such as seeking medical treatment, health records, medical records management, reimbursement of medical insurance and health risk factor intervention etc. The guiding role of the patriotic health campaign in the prevention and treatment of major diseases will be improved. We will proceed to give full play to the overall planning and coordinating role of patriotic health campaign in the prevention and control of major diseases so as to reduce and keep under control the incidence and spread of major diseases from the source. Ways to mobilize the people will be innovated to encourage and attract the non-governmental sectors to participate in the prevention and treatment of major diseases, explore effective ways to promote the health self-management team of residents and give full play to the positive role of mass organizations. The construction of national demonstration sites of comprehensive prevention and control of major diseases will be combined with the construction of health towns and the pilot demonstration of health cities, to apply the new concept of health into the planning and management of cities. The third is to carry out the responsibility for the prevention and treatment of major diseases by means scientific and law-based prevention and treatment. The law-based management system for the prevention and treatment will be established. The formulation of basic medical and health laws will be promoted soon. The present regulations on the prevention and treatment of single diseases will be integrated and regulations on the prevention and treatment of major diseases will be formulated. Law enforcement and supervision will be enhanced. The coordinating mechanism for the prevention and control of major diseases will be established. The following are suggestions for the government: health (management) committees will be established at all levels of government to plan the management of health and major disease prevention and control, with the government leaders in charge as the heads of the committees, and the responsibilities and tasks of all the departments will be clarified so that a leading pattern will be developed with the interconnection between different levels and advancement as a whole. The prevention and treatment of major diseases will be included into the evaluation of government at all levels and relevant entities and the achievement evaluation of the major leaders. The investment into and support for the prevention and treatment of major diseases will be increased. The finance at all levels will include the funds for major disease prevention and treatment in the annual budgets, which will be paid for by finances at different levels and the operational funds will increase in proportion with the revenue growth. All the personnel funds, agency operation funds and career development funds for centers of disease control at all levels will be included in the financial budgets at the same level and the funds will be released in full. The remuneration system for public health physicians will be established to make sure that the remuneration for disease control staff is no less than the average of medical staff at the same level. The scientific research on the prevention and control of major diseases will be enhanced. The research on and the development of vaccines and new drugs will be

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enhanced, especially the research on and the application of vaccines for AIDS, TB, tumors and other major diseases and the powerful new drugs. The development and promotion on appropriate technology will be enhanced. The integration and coordination of scientific power will be enhanced and a batch of key R&D programs will be implemented systematically and selectively.

7.2

 he Institutional Construction of National Essential T Public Healthcare Service Package

7.2.1 Present Development Periodical achievements have been made since the implementation of the national essential public healthcare service package in 2009. The first is the steady promotion of institutional construction of healthcare packages management and the formation of a relatively complete framework. An appropriate service package has been formed, a steady mechanism for fund security set up, an effective system for the healthcare packages management established, and a scientific mode for healthcare packages management developed. The second is the implementation of the principle of Prevention First, which was promoted by the national essential public healthcare service package, and the remarkable effects of the healthcare packages. Major health problems are detected early by implementing healthcare management for priority groups, i.e. children, pregnant and lying-in women and the elderly, and appropriate interventions or transferred treatment are adopted to implement the strategy of “early detection, early diagnosis and early treatment”; the control over infectious diseases and chronic diseases are improved and the morbidity of most infectious diseases that can be prevented by vaccination are kept at a low level by providing effective vaccination at the grassroots medical and health institutions; maternal and child health indicators are improved; residents’ health literacy are improved remarkably; and the gaps between the health of the urban and rural residents, and between the eastern and middle residents and the western residents are narrowed. The third is the fulfillment of the medical care reform tasks of ensuring basic medical services, improving such services at the grass-roots level and establishing the effective mechanisms. Our work includes enhancing the public health function of the grassroots medical and health institutions, reversing the situation of emphasizing on treating and neglecting prevention diseases and promoting the grassroots medical and heath institutions to retrieve their nonprofit nature; the situation of “practicing medicine in hospitals” and waiting for patients to visit at the grassroots medical and health institutions are changed and the service modes at the grassroots medical and health institutions are changed from “treating diseases” to “enhancing healthcare management”; a steady fund-raising mechanism is established at the grassroots medical and health institutions, primary service capabilities are gradually improved and foundation is laid for primary treatment at the community level and tiered healthcare delivery systems. The fourth is the emerging social economic effects of the healthcare packages. According to estimate, 17.9 billion

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yuan medical expenses is saved for patients of hypertension annually by means of hypertension healthcare management, much more than the 7.7 billion yuan investment into hypertension care and health management.

7.2.2 Present Problems Despite the great achievements of the national essential public health care service package, there still exit a lot of institutional problems. The first is that the management mechanism of the healthcare package funds needs to be improved. In some counties (cities, districts), the subsidy standards per capita for the national essential public health service package haven’t met the national standards of the year, and the funds are far behind schedule when reaching the grassroots medical and health institutions. The specified scope for the use of healthcare packages funds for the national essential public health service package cannot meet the needs of carrying out the healthcare packages. In some places, the funds are included in the gross payroll of the grassroots medical and health institutions to pay for the salaries of the staff, hence, the funds have been changed from supporting the healthcare packages to supporting the personnel. The second is that the quality of service needs to be improved and modes of service to be changed. There exist the segregation of basic medical service from essential public health service and the irregularities in the service procedures in a few places, and the service modes of general physician teams, grid management and family physician contracted services and the mechanism of tiered healthcare delivery and t mutual referral between hospitals have not been established. The third is the insufficient management and technical guidance for the healthcare packages. At present, the responsibility for the management of the healthcare packages is taken by different department offices; the absence of clearly defined responsibilities and labor division of professional guidance by the professional public health institutions on the national essential public health service package, together with the lack of special funds, leads to the poor enthusiasm and low participation; the responsibilities, power and benefits are not clearly defined between the towns and the villages, and the divisions of tasks and funds are not proportional; in most of the places, the evaluation on the national essential public health service package is not conducted by the third party, hence, the results of the evaluation are not highly credible. The fourth is the inadequate capability of health service at the grassroots level and lack of enthusiasm for work. The number of medical workers at the grassroots level is usually insufficient; the workload of the medical workers at the grassroots level is not in proportion with their income because of the capped performance salary policy in most places; the lagging informationization of national essential public health service hinders the improvement of working efficiency and management efficiency with the information system. The fifth is the inadequate publicity on the national essential public health service package. At present, there is no systematic and standard publicity by the national or local media, the residents’ awareness rate of the national essential public health service package is low and few

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would seek service voluntarily, and even some government officials don’t have adequate knowledge about the package. The sixth is the ever increasing indicator tasks and the unmatched input of funds and manpower. For years, many provinces, municipalities and counties would increase the task indicators respectively on the basis on the tasks assigned by the superior government without adding corresponding funds or manpower, leading to the prominent contradictions between the arduous tasks and high demands for quality by the national essential public health service package and the lack of manpower and insufficient funds at the grassroots medical and health institutions.

7.2.3 Situations and Challenges From the 13th 5-Year-Plan period to the year 2030, the development of the national essential public health service package will be faced with new situations and challenges. At the 18th National Congress of CPC, great targets were proposed to “build a moderately prosperous society in all respects” and “ensure universally accessible essential medical and healthcare services” by 2020, which means higher demands for promoting equity of essential public healthcare services; a changing disease spectrum and changes in the demands for healthcare services pose severe challenges for the service capabilities of healthcare management for the patients of chronic diseases at the grassroots level; with the rapid growth of ageing population in China as well as the implementation of universal two-child policy, the demands for essential public healthcare service keep increasing; besides, migrant workers and their family members migrating with them who have included in the urban demographic statistics haven’t obtained completely equal access to the national essential public healthcare service which is available to the urban residents.

7.2.4 Development Targets The funds for essential public healthcare service will be steadily raised to 100 yuan per capita, increasing by 12 yuan per year; improve the essential public healthcare service provided for the residents, consolidate the present service items, expand the coverage of service, enlarge the population served, extend the contents of service, improve the quality of service, and meanwhile appropriately add new items which are urgently needed by the residents with great influence and high cost effectiveness; develop scientific and effective fund management modes, motivate enthusiasm, improve the effectiveness of funds; ensure equitable access to essential public healthcare service to all residents regardless of regions, status, and income, primarily meet their demands for essential medical and public healthcare services, improve people’s health, promote social harmony, fairness and justice, and speed up social and economic development.

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7.2.5 Main Suggestions The first is to establish national essential public healthcare service system. It is suggested that Measures on the Management of National Essential Public Healthcare Service Packages or Regulations on the Management of National Essential Public Healthcare Service Packages be issued in the name of National People’s Congress or the State Council, to accelerate the integration of national essential public healthcare service packages into the legislation, prepare for the connection with the forthcoming essential medical and healthcare laws, stipulate that the government establish the essential public healthcare service system, firmly demand the government at all levels to provide free service to all residents, promote the equity of essential public healthcare service and improve people’ health. The second is to further improve relevant supporting policies for the healthcare packages. The supportive policies include: improving personnel policy for health staff at the grassroots level, establish the dynamic adjusting mechanism for the manning quotas, improving salary system for the medical and healthcare institutions at the grassroots level, do away with the caps of the performance salary, establish a salary system of more pay for more work and better pay for better work, which is in line with the characteristics of the medical and healthcare institutions at the grassroots level; further improve the fund management mechanism for the national essential public healthcare service package, ensure the local supporting fund appropriated in time and in full, strictly apply the newly-added funds into the project of village-doctor, avoid cashing or embezzling funds, change patterns of payment for the healthcare package funds, explore settling accounts by purchasing service, carefully calculate the costs of all the services and the contents of all the services; change the service modes at the grassroots medical and healthcare institutions, gradually establish the new healthcare management modes of putting people first, prevention first and the combination of prevention and treatment, comprehensively promote the new service modes of “general physician teams, contracted services, initiative services, appointment services, community participation” etc., provide initiative, accessible, comprehensive, continuous and coordinative services to the residents of the areas; forcefully establish the system of tiered diagnosis and treatment, explore the methods of diagnosis related groups (DRGs) and cross-level hospital cooperation, establish the tiered diagnosis and treatment mode featuring first diagnoses on grass-roots level and mutual referral between hospitals; improve the essential drug system, urge the second and third level hospitals to use essential drugs, and ensure the grassroots medical and health institutions’ effective access to drugs for chronic diseases and common diseases. The third is to improve the management system for the healthcare packages. The focus is to improve scientific decision-making mechanism, establish leading groups and expert committee for the healthcare packages, initiatively and openly solicit opinions from the local governments, professional public health institutions, grassroots medical institutions and urban and rural residents, give full play to the experts’ role of advising and consulting in the professional fields, establish open, effective and transparent decision-making mechanism; sort out management mechanism,

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clarity that the grassroots health sectors take the responsibility for the comprehensive coordination of the national essential public healthcare service packages, while all the relevant departments take the main responsibility for the routine work of the healthcare packages such as the operational guidance and management; include the national essential public healthcare service packages into the important duties and evaluation of the public healthcare service institutions at all levels and relevant medical and healthcare institutions; establish the coordinated management mechanism by multiple departments, clarify the division of duties among relevant departments and include them into the evaluation of the departments’ work targets. The fourth is to determine the contents and task indicators scientifically and rationally. The admission principles and exit mechanism for the extension of the service packages, newly-added and adjusted items and their contents should be clarified, the bank for the national essential public healthcare service packages should be established as well as the evaluation indicators for admission into the bank, priorities should be given to the items admitted into the bank, and dynamic adjustment should be made annually; the extended, newly-added and adjusted items as well as their contents should be submitted to the leading group for discussion after being demonstrated by the expert committee; all the localities should determine the task indicators for the essential public healthcare service packages in accordance with the actual situations in their respective regions, and raising indicators at every level must be prohibited; training and publicity on the national essential public healthcare service packages should be enhanced and relevant research and monitoring should be carried out centering on the packages. (Zhao Xuemei)

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Improving Management of Family Planning Services Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_8

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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The next 15 years is the important turning stage for China’s demographic development, the important stage of opportunity for improving family planning policies and promoting the long-term balanced demographic development, and the critical stage of reform for building Healthy China and laying solid foundations for realizing the Chinese dream of national rejuvenation. It is of great significance to consider the overall situation and aim far, research on the demographic development, grasp the objective laws, use the international experience, improve strategy and promote the balanced development.

8.1

 he Demographic Development Trend T in the Next 15 Years

The current demographic development of the world has taken up some new trends and characteristics. The first is the continuous increase of the total population. In 2015, the world population was 7.35 billion. It is projected to be 7.76 billion in 2020 and 8.5 billion in 2030 respectively. Asia is still the most populous continent and its population will keep increasing slowly, and the proportion of Asian population in the global population will decline slightly, from 60% in 2015 to 58% in 2030; Africa’s population will rise from 1.19 billion in 2015 to 1.68 billion in 2030, and the proportion of African population in the global population will rise from one sixth to one fifth; European population will reach a peak of 730 million in 2020, accounting for 9.5% of the global population, and then start to decline slowly to 730 million in 2030. The population in North America, South America and Oceania will increase slightly, but their proportions in the global population will decline slightly. The second is the larger ageing population. In 2015 the population ageing 60 and above was 900 million, equivalent to 12.3% of the total world population. It will be 1.05 billion in 2020 and 1.4 billion in 2030, equivalent to 13.5% and 16.5% of the total world population respectively. The ageing population in developed countries will rise from 23.9% in 2015 to 29.2% in 2030, while that of the developing countries will rise from 9.9% to 19.8%. The third is increasing urbanization of the population. World urbanization rate reached 50% for the first time in 2008, 54% in 2014, and it will reach 60% in 2030. In 2014, there were 28 megacities with over ten million people and there will be 41 in 2030. The rapid growth in urban population will bring about greater and greater influence on the economic and social development. The fourth is the on-going migration of population from under-developed regions to developed regions, but the migration will slow down. The net migration rate of the population in the developed regions will fall from a peak of 2.7 per thousand in 2005–2015 to 1.8 per thousand in 2015–2030. The fifth is the recovery of fertility rates in some low fertility countries or regions. The number of countries or regions with extremely low fertility of 1.3 and below decreased from 29 in 2003 to 10 in 2015. In the late 1990s, countries or regions with low fertility all formulated policies to encourage fertility with positive effects. The demographic development of China conforms to the general rules of that of the world and yet has its own characteristics, both facing the problems of ageing

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populations with few children and the decrease of labor in developed countries, and the problems of employment, poverty and resource and environment in the developing countries. At present and in the coming period of time, the problems of population size, quality, structure and distribution in China are complicated and complex, which will have profound influence on the economic and social development. The demographic development in China will take on the following trends: –– The inertia of population growth will weaken and the total population will decline slowly after reaching its peak. With the implementation of universal two-­child policy, the newly-born population will increase and highest birth will reach around 20 million annually during the 13th 5-Year-Plan period. After the 14th 5-Year-Plan period, the fertility rate will remain stable with a slight decline, and the natural growth rate of population will keep on declining as a result of the decrease of fertile women population and the rise of mortality caused by population ageing. The total population is expected to hit its peak of 1.45 billion around the year 2029 and then shrink slightly to 1.37–1.4 billion in 2050 (see Fig. 8.1, the data in Figs. 8.1–8.5 are estimates from the projections on the universal two-­child policy by National Health and Family Planning Commission). The proportion of Chinese population in the global population will drop from 19% in 2015 to 17% in 2030. According to the projections of the United Nations, the population in India will exceed that of China in early 2020s. For a long period of time, China’s population and the resource and environment carrying capacity will be in a tight balance. –– The health of the population keeps bettering and literacy further improves. In recent years, the population quality in China improves steadily and the human capital ranks middle or above among the developing countries. In 2015, the life

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expectancy in China reached 76.34 years, and maternal mortality rates and infant mortality rates dropped to 20.1 per 100,000 and 8.1 per 1000 respectively. By 2020, the main health indicators of the Chinese will outperform the averages seen in upper middle-income countries. The average education years for people aged 15 and older was over 9 years in 2010 and is expected to be 10–10.5 years in 2020. By the year 2030, the health and literacy rates will further improve and the gap between the urban and rural areas will gradually narrow.

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–– Working-age population tends to shrink and the ageing of labor force deepens. Working-age population between the ages of 15–59 hit the peak of 940 million in 2011. The 13th 5-Year-Plan period will witness a temporary and slight recovery with 917 million in 2020, a mere shrink by 4.43 million from 2016. In 2030, the working-age population will be 840 million, with an annual decrease of 7.61 million from 2021 to 2030 (Fig. 8.2). As regards of the age structures, the proportion of older labor force aged between 45 and 59 will keep on rising to 36%

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in 2030, 3.2% over that in 2015, much higher than that in developing countries (27.3%) and equivalent to that of developed countries in the same period of time. In a long period of time in the future, the working-age population in China will be ample but the structural conflict between labor force supply and demand will intensify. The elderly population keeps increasing but the proportion of children population fluctuates downward. The population of people aged 60 and older was 220 million in 2015, and is expected to be 250 million and 360 million in 2020 and 2030 respectively, and the proportion will rise from 15.8% to 17.5% and 25% (Fig. 8.3). The population of children aged 0–14 was 25 million in 2015, and will be 260 million in 2020 and 240 million in 2030; the proportions are 17.37%, 18.23% and 16.73% respectively (Fig.  8.4). The ageing of population will ­accelerate from 2020 to 2030, which will pose a great challenge to the economic and social development. The migration of rural population tends to slow down while urban population will keep rising. The rate of urbanization in 2015 was 56.1%, and is expected to be 60% in 2020 and 70% in 2030 respectively. In the next 15 years, the population migrating from rural areas to urban areas will accumulate to 160 million but the annual migrating population will decline. The urban population will keep rising to 570 million; while the rural population will continue to decrease to 480 million (Fig. 8.5). From the perspective of the special distribution, the population will mainly center round the urban agglomeration and urban circle, while further aggregating to the regions along the coasts, rivers, and railways, but the basic pattern of national population distribution along the demarcation line of Aihui-­ Tengchong will not change. The sex ratio at birth will gradually return to the normal and the family patterns will be diversified. The sex ratio at birth was 113.5 in 2015, meeting the planning target (115) set for the 12th 5-Year-Plan Period. With the development of economy and society, the increase of urbanization and the adjustment and improvement of birth policies, the sex ratio at birth will go on falling back. In 2015, the average household numbered fewer than three people. Nuclear families and extended families make up most of the families, while the proportion of one-­ person family, single-parent family and DINK family will gradually increase; family’s functions of taking care of the kids and the elderly will weaken ant their ability to counter risks will decrease. The proportion of ethnic minority population will increase and extreme poverty will be largely eliminated. The population of ethnic minorities was 114 million in 2010, accounting for 8.5% of the total, increasing by 0.48 percentage point over the year 2000. The number of ethnic minorities with over ten million people has increased from two in 2000 to five at present (Zhuang Nationality, Man Nationality, Hui Nationality, Uygur Nationality and Miao Nationality). The birth rates of the ethnic minorities are higher than the average of the whole country, therefore their proportion of population will be higher. In some ethnic areas, the population of the major ethnic minorities has increased rapidly, causing greater pressure on resources and environment. In 2015, the poverty stricken population

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in rural areas was 55.75 million, decreasing by 14.42 million over 2014. By 2020, the poverty stricken population in rural areas by the present standards will have been alleviated from poverty, and regional overall poverty will have been resolved. However, in the 136 boundary counties, there are still the prominent issues of backward economic and social development, drainage of young and median population and the complicated ethnic and religious problems etc. In general, in the next 15 years, especially from 2021 to 2030, the demographic development of China will experience dramatic changes in both the internal motivations and external conditions into a stage of rapid transformation. During this period of time, China’s basic national condition of a large population will not fundamentally change. The population pressure on economic and social development will not fundamentally change. The tensions between population and resources and environment will not fundamentally change. During this period, the total population of China will decline after reaching the peak, the structural conflicts will be more prominent, the influence of population ageing on the economic and social development will deepen and the poor population quality is still a bottleneck for improving the national competitiveness. During this period, the potential energy of China’s population is large, which will provide important support for expanding domestic demand; our labor force will be ample, and we are in its demographic dividend period with the dependency ratio lower than 50%, which is beneficial for the economic development. People have higher demands for health service and greater desires for happy life. Efforts will be made to start from our national conditions, seize the opportunities, always be problem-oriented, proactively adjust to the new normalcy of economic development, perfect demographic and relevant economic and social policies, promote the long-term and balanced development of population and give full play to population’s dynamic role in the economic and social development.

8.2

 trategic Thoughts for Countering Demographic S Development

Overall thoughts: In light of the Four-Pronged Comprehensive Strategy, we will further implement the development concept of being innovative, coordinative, green, open and shared, take into consideration the basic national conditions of China, balance the requirements of national development and the fundamental interests of the people, balance the coordinative and sustainable development between population and economy, society, resources and environment, stick to the basic national policy of family planning, implement the universal two-child policy, perfect related social and economic policies, maintain moderate fertility rates, and strive for the balanced demographic development with moderate size, high quality, optimum structure and rational distribution. By 2030, the overall fertility rate will remain at around 1.8, the sex ratio at birth between 103 and 107, the total population being around 1.45 billion.

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Policy orientation: –– Stick to the people-centered principle of development. Improving people’s well-­ being and promoting people’s all-round development must be the aim and outcome of demographic development strategy. The fundamental position of population must be strengthened and overall solutions must be found for the issues of population size, quality, structure and distribution. Priority must be given to invest into the overall development of human being, and push forward the transformation from population dividend to talent dividend and from a country with large population to a country with strong human capital power. –– Maintain moderate fertility rates. From the perspective of the developing rules of population itself and its coordinative development with economy and society, in a long period in the future, the fertility rates between 1.6 and 2.1 will be rational, while approximate 1.8 will be ideal, which will be beneficial for the slow decline of population size after it reaches the peak and beneficial for the gradual formation of balanced population structure. The opportunity of implementing the universal two-child policy must be seized to further improve the support policies and measures, moderately improve fertility, rationally adjust population size, enhance quality capital and the cumulative advantage of structure dividend and ensure the security of national population. –– Improve the health of the population. Efforts will made to build Healthy China, deepen the reform of medical and health system, integrate health into all the socio-economic policies, create healthy environment, guide the people to enhance self healthcare management, integrate prevention, treatment, rehabilitation and health promotion, provide the people with convenient, continual and optimum health service that covers the whole process of life and meet the target of universally accessible primary medical and healthcare services. –– Formulate policies beneficial for the more balanced demographics. Efforts will be made to deepen the reform of education, promote fairness of education and improve the quality of education. Equity of public services such as medical and health, education and social security etc. will be achieved, and policies for granting permanent urban residency to the rural migration population will be perfected. Actions will be taken to tackle population ageing, nursing care system encompassing multiple levels will be built and the securing system for the nursing care will be improved. Supporting policies for family development will be established and improved and birth decisions in line with policies will be encouraged. Main countermeasures: –– The basic national policy of family planning will be stuck to and people will be guided to make planned and responsible birth decision. China’s basic national condition of a large population will not fundamentally change, the task of addressing the problem of population structure will be arduous, and therefore, the basic national policy of family planning must be stuck to. Organization and leadership

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must be strengthened, with the principal leaders of the Party and the government taking overall responsibility in person and the accountability of family planning must be stuck to and improved. The implementation of population development targets will be integrated into the performance evaluation of the local Party and government leaders at all levels to ensure the awareness, responsibility, measures and investment. The universal two-child policy will be implemented by law, publicity, guidance and policy interpretation will be strengthened and the service system of birth registration will be carried out. Surveillance on newly-born population will be strengthened, basic information on population will be shared, and the prediction and pre-warning system for population will be completed to address the risks of population security in time. Strategies of demographic development will be perfected, the mid- and long-term planning targets of population will be formulated scientifically and the resources of primary public services such as health and family planning, education and social security will be allocated rationally. Study and prediction will be made accurately on the changes of fertility rates and the influence of economic and social development on reproductive behaviors so that prospective policies will be prepared. –– Reproduction services will be enhanced to create a reproduction-friendly social environment. The security system and mechanism for reproduction service will be improved to address people’s worry about reproduction, which will concern the effective implementation of the universal two-child policy and the harmony and happiness of the family. Maternal health services will be enhanced by increasing supply, optimizing structure and tapping potential, and the cultivation of obstetricians and pediatricians will be sped up and rescue, acute and emergency care competence for pregnant and lying-in women and newborns will be enhanced to ensure the safety of mothers and infants. The system of free primary reproduction services will be improved, full services for healthy births and rearing will be provided, including quality pre-pregnancy examinations for healthy childbirth, hospital deliveries, maternal and child healthcare, and free vaccination for children etc. as well as the assisted reproductive technology services needed by those infertile people. Birth defects will be controlled and prevented to improve the quality of the newborns. Policies on making informed choices will be fully implemented and safe, effective and suitable contraceptive services will be provided for people of reproductive age. The award of maternity leave for families practicing family planning policies will be improved, the maternity leave and the paternity leave will be moderately prolonged and the legitimate right to maternity leave will be secured. Both maternity insurance and basic medical insurance will be applied to ensure that the statutory maternity welfare will not be damaged. Development programs and industry standards for the child-­ care sector will be formulated that is suitable for the conditions of China, non-­ government organizations will be encouraged to run inclusive nurseries, community day-care centers etc. to meet the needs for diversified child care services. The voluntary services of childcare by neighborhoods will be supported, encouraged and promoted actively. Help will be offered to women to balance work and family, men will be encouraged to share with women the duty of child-

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care and other housework, and employers will be encouraged to provide flexible working schedules and the necessary convenience for pregnant employees. –– Proactive ageing strategy of Health First will be implemented to improve the supportive policies for healthy nursing care. Health is the most prominent issue during the process of population ageing, so we must lose no time in building a health security and service system which can meet the demands of population ageing. A health service system for the elderly will be established and completed with equal emphasis on prevention and healthcare, medical treatment and rescue, rehabilitation and nursery, as well as mental health care, the construction of geriatric departments in comprehensive hospitals, geriatric hospitals, rehabilitation hospitals, nursing homes and hospice care institutions will be enhanced, and more nursing beds for the aged will be set at the community health service centers. Medical and healthcare will be integrated with nursing care services, which will be led by the government and driven by the market, models of service will be innovated, collaboration between medical institutions and nursing care institutions will be enhanced, nursing care institutions will be supported to establish medical institutions, and non-government organizations will be encouraged to develop the industry of combining medical service and nursing care. Based on the communities and facing the families, the community service platform for the healthy ageing of the elderly will be established, the system of family doctors will be perfected, and contracted services will be pushed forward to provide the elderly with continual health management and medical services. Exploration will be made to establish long-term nursing care insurance, pilot will be carried out in eligible localities and long-term nursing care will be provided to the elderly with chronic diseases and disabled elderly people by unifying training, formulating standards and regulating services. The elderly people will be encouraged to participate in economic, political, cultural and social activities by various means to tap the human capital of the elderly. Palliative treatment and hospice service will be explored to protect the dignity and happiness of the human being to the maximum. –– A new type of people-centered urbanization will be vigorously pushed forward to promote orderly migration of the people. Pushing forward a new type of urbanization and guiding the orderly migration of people is a major step in promoting the rational distribution of population and economy and maintaining the rapid growth of the economy. The Belt and Road Initiative, the coordinated development of the Beijing-Tianjin-Hebei region, and the development of the Yangtze Economic Belt will be further implemented, population will be guided to aggregate from the restricted development zones and prohibited development zones to the optimized development zones and key development zones, while the development of border areas will be emphasized on to promote the coordinated development among regions. Policies conducive to population migration and social mobility will be formulated vigorously to form a social structure compatible with the economic structure. Institutional reform in key areas such as land, fiscal and taxation, and household registration will be pushed forward to speed up the establishment of a linking mechanism for financial transfer pay-

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ments and for granting permanent urban residency to people originally from rural areas. The demands of the migrant population and their families for primary public health services will be met and the security system of services covering all permanent residents will be established and completed. The overall planning of medical insurance system nationwide will be sped up as well as the connection and integration of service supply system so as to achieve equity of public health services. The education right of children living with the migrant population will be ensured so that vocational education will cover all the rural students who can’t further their study after freshly graduating from junior or senior high schools. The identity of young people among the migrating population will be strengthened and the left-behind people will be cared for to promote social integration. –– Medical programs for poverty reduction will be implemented to promote the coordinated development of population and resource & environment in poverty-­ stricken areas. The implementation of medical programs for poverty reduction is a key measure for targeted poverty reduction and poverty alleviation as well as a basic program for lifting the rural poor out of poverty by 2020. The standardized construction of medical and health service institutions in poverty-stricken areas will be enhanced to improve the quality of medical services. Medical care and assistance will be improved to reduce the medical burden for the rural poor. Different situations in different localities will be taken into consideration and corresponding measures will be taken to enhance the prevention and control of infectious diseases, endemic diseases and chronic diseases in poverty-stricken areas. The capacity of treating emergent and severe cases for pregnant and lying­in women and newborns will be enhanced in poverty-stricken areas to improve the maternal and child healthcare in those areas comprehensively. Coordinated efforts will be made to address the environmental and hygiene issues in poverty-­ stricken areas to effectively improve the quality of living environment there. The health consciousness and the health level of the poor will be improved and everyone in the poverty-stricken areas will be entitled to primary medical and healthcare services so that the problem of poverty caused by illness will be addressed effectively. Family planning will be enhanced in poverty-stricken areas, unified family planning policies will be implemented in ethnic areas, comprehensive governance will be enhanced, people will be guided to transform their fertility vision to make birth decisions in accordance with the policy, and efforts will be made to help the poor families to eradicate poverty so that the economic and social development in the poverty-stricken areas will be better and faster. –– Policies to support the development of families will be formulated to improve families’ capability of development. The development of family is an important support and lasting motive force for the development of the society. Hence, during the process of economic transition, social transformation and demographic transition, the development of family deserves more attention and support. Family development policies will be built for reproductive care, child rearing, youth development, elderly care, and disability care. Efforts will be made to establish socio-economic policies to support family reunion, establish and

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improve policies to promote the healthy development of the youth, strengthen the education and cultivation on the social behaviors of the youth and complete policies and measures for supporting families to raise minor children and care for the elderly. Efforts will be made to integrate service resources and management at the grassroots communities, support the development of service organizations at communities, and establish multi-functional service centers focusing on family services, child-rearing guidance, elderly care support and emergency rescue. Local governments will be encouraged, in accordance with their actual situations, to implement service projects to care for the families practicing family planning policies, empty nest families, migrant families and families with leftbehind children and the elderly parents. The awarding and supporting system and the special supporting system for families practicing family planning policy will be improved and the dynamic adjusting mechanism for supporting standards will be established. Poor families, the loss-of-only-child families and old solitary people will be protected as a result of more accurate social assistance. –– The construction of the governance system and governance capability of population and development will be strengthened and international exchange will be expanded. The comprehensive policy system and mechanism for population and development will be established and completed to coordinate efforts to address the major problems concerning population and development with the help of the part-time members of the National Family Planning Committee and the leading group system for family planning work at various local levels. The annual consultation system for the demographic development will be established to make comprehensive evaluation on the demographic changes and its influences and propose suggestions for major policies. Coordinative governance between the government and the society will be strengthened, and the Unions, Youth League, Women’s Federation, Family Planning Association and non-government organizations will all be mobilized to make joint efforts for the family planning work. Efforts will be made to improve the working network at the communities participated by multiple organizations, integrate resources from the government, enterprises and the society and combine government service management with social work. We will further play the role of a responsible big country, and actively participate in the dialogue and cooperation in the field of population and development and the formulation of rules, promote the international community to understand China’s population and family planning work and expand consensus. We will study the trend of world demographic development, communicate extensively and learn from international advanced ideas and experiences. We will expand south-south cooperation and promote north-south cooperation, cooperate with countries along the “One Belt and One Road” rout in the field of population and development, and establish and develop partnership between government departments and non-governmental organizations and the private sector, and developing countries and developed countries.

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Delivery of High-Quality and Efficient Medical Care Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_9

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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 oundation for the Development of Medical and Health F Service Systems

9.1.1 Steady Increase in Medical Resources With rapidly increased number of medical institutions and ward beds as well as expanded scale of medical institutions, great achievements have been made in the medical and health service systems during the 12th 5-Year Plan period. While strengthening the construction of the medical insurance system, government has also continuously enhanced the construction of the public medical care delivery systems by various means, both providing support to medical care delivery systems and satisfying people’s needs, which created a favorable funding environment for the development of the health system. The increased medical professionals were 960,000 during the period between 2007 and 2010, with an average annual growth of 240,000, and 1673,600 during the period between 2010 and 2015, with an average annual growth of 334,700. Public funding also soared to a greater height during the same period. Government payment as a share of total health increased by 129 billion yuan from 2004 to 2007, 315 billion yuan from 2007 to 2010 and 674.28 billion yuan from 2010 to 2015. The increased percentage was from 22.3% in 2007, to 28.7% in 2010 and 30.4% in 2015.

9.1.2 Improvement in Equity of Medical Resource Allocation The number of medical professionals, practicing or assistant physicians and ward beds per 1000 in all provinces, autonomous regions, and municipalities grew year by year. There was fluctuation of regional disparity in the 11th 5-Year Plan period, while with improvement in equity of medical resource allocation in the 12th 5-Year Plan period, both relative and absolute regional disparity tended to reduce.

9.1.3 Growth in Efficiency of the Health System Compared with other countries, efficiency of our country’s health system has been relatively high. World ranking for the comparison of health investment (total health expenditure per capita) and healthcare outcome (life expectancy, infant mortality) of our country and foreign countries could roughly show relative efficiency of the health system. Since 1995, the ranking of our country’s total health expenditure (from high to low) had been consistently lower than life expectancy (from high to low) and infant mortality (from low to high), which showed that the efficiency of our country’s health system was relatively high. But after 2007, there was a downward trend in the ranking for the total health expenditure per capita and life expectancy and relative efficiency was declining compared with other countries.

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9.1.4 Initial Success in Reforms The central government invested 70 billion yuan in support of the construction of 2400 county-level hospitals and 40,000 primary medical and health institutions. With a focus on general practitioners, the construction of primary medical and health taskforces was initiated and from 2011 to 2013, order-based and targeted cultivation was offered freely to 16,000 medical students who would work in rural areas after graduation. Systems such as the national essential drug system, the new operating mechanisms at primary medical and health institutions and the systems of equity of public health services were further consolidated and optimized and public health service competence and enthusiasm of primary medical and health institutions improved. Local governments actively explored the construction of multi-­ tiered medical care delivery systems.

9.2

Development of Medical and Health Service Systems

Situation and challenges.

9.2.1 E  conomic and Social Development Proposes Higher Demands for Health and Healthcare Services Building an all-round moderately prosperous society has laid a solid economic and social foundation for realization of a healthy nation. The first step to become a healthy nation is to promote the improvement of people’s overall health, while people’s health can be improved only if economy and society develop sustainably, steadily and healthily. Building an all-round moderately prosperous society requires the improvement in equity of people’s health and the sharing of health development achievements.

9.2.2 T  he New Normal of Economic Development Is Beneficial for Promoting the Development of Healthcare Services and the Transformation of Health Development Modes The adjustment of economic structure and the shift of the motive force for economic growth call for the development of healthcare-oriented services. Healthcare service is a typical modern service and strategic newly-emerging industry. The new normal of economic development requires transformation of health development modes and more attention to improvement in medical and health service quality and efficiency. To adapt to the new normal and develop medical and health services, economy and society coordinately, we will not only rely on high input of the country and society, but also improve efficiency of medical services by attaching importance to structure adjustment of the medical and health systems and services. Scale expansion will no longer be the way for medical and health development, but an intensive

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development, based on the advance of medical technology to improve total-factor productivity, health promotion and service quality.

9.2.3 U  rbanization, Aging Population and Information Technological Revolution Raise Requirements for the Medical and Health Service Delivery Systems In the process of the new-type urbanization, there exist policy and system barriers as to how to improve fairness of medical and health resource allocation and ensure migrants’ equal access to medical and healthcare services. Aging population poses new challenges to the provision of medical insurance funds and the care for the aged, which requires establishment of integrated medical and health service systems. Industry reform triggered by information technology is bound to promote medical resource pooling and sharing and renovation of medical service delivery modes.

9.2.4 I mbalance of Supply and Demand of Medical and Health Services and Rising Medical Cost Call for New Type Medical and Health Service Delivery Systems While there are tremendous changes in demands for medical and healthcare services, there are no corresponding changes in medical care delivery systems, including overall service scale, structure and modes. Due to cultivation period and many other factors, the number of high-quality medical professionals does not grow with the demands, so there is severe shortage. In remote rural areas, demands for medical care services cannot be satisfied for lack of health resources and appropriate techniques, which aggravates the economic burden of patients and society. With growing demands for medical services, medical care is mainly provided in high-level medical institutions.

9.2.5 S  ervice Delivery Capacity of Primary Medical and Health Systems Needs to Be Improved Development of medical workers, ward beds and other resources slow down in primary medical and health institutions. Since high-quality medical resources further centralize in high-level institutions, the top-heavy problem in medical and health service systems becomes further serious. Medical professionals in large hospitals grow more rapidly than in primary medical and health institutions and both the outpatient and inpatient rates and the percentage of medical workers in primary medical and health institutions keep declining. As health care taskforces, the most vulnerable part of primary medical and health institutions, fail to be reinforced, demands for medical and health services can’t be satisfied.

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9.2.6 M  edical and Health Service Systems Need in-Depth Adjustment and Integration Integration of medical and health service systems is a significant strategy for perfecting the systems. Current major problems include the inadequate service capacity of primary medical and health institutions in rural areas and urban communities, the unclear orientation of functions in high-level medical service institutions and the lack of integration of medical and health services. By integration of medical and health service systems, the goals of improving service efficiency and quality and controlling service cost will be realized.

9.3

 verall Requirements for Optimizing Medical O and Health Service Systems

We will build a fair and efficient medical and health service system to support the construction of a healthy China, with health as the guide, innovation of service organizations and delivery of medical and health services as the orientation, primary medical and health institutions as the basic service delivery institutions and integration and collaboration of the medical and health service systems as the working method.

9.3.1 Basic Principles The first is, with the focus on health care, to serve the overall situation. We will attach more attention to the fundamental demand of health promotion and by developing the health system and optimizing resource allocation, improve the capacity for solution to major health problems so as to serve the construction of a healthy China. The second is, with equity of medical and health services as the priority, to prioritize the highlights. We will give priority to guarantee of the accessibility to the basic medical and health services and the promotion of equity and fairness. In accordance with the principle of healthcare outcome and cost effectiveness, health resources will be allocated to solve the social concerns and improve the overall performance of the health system. The third is to match supply and demand so as to achieve coordinated development. We will well guarantee and guide the need for medical and health services and also reform medical service supply, developing medical and health institutions with appropriate scale and adjusting distribution of service delivery institutions to satisfy people’s basic demands for medical and health services. The fourth is, under government’s leadership, to make full use of joint forces. Government’s responsibilities for fundraising, supervisory administration and delivery of medical and health services will be fulfilled and the role of market mechanism in medical resource allocation and medical and health service delivery will be brought into play. We will innovate systems and mechanisms for non-governmental

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sectors to run hospital so as to meet people’s need for diversified and multi-level medical and health services. The fifth is to collaborate and integrate all-level and various medical and health institutions. We will encourage and guide medical and health institutions to cooperate and integrate with each other, make overall plans for prevention, medical care and rehabilitation and let medical and health service systems play integral functions in health promotion and delivery of the basic medical and health services. We will also establish and perfect multi-tiered medical care systems, and by establishing the mechanisms for initial medical care in primary medical and health institutions, two-­ way referrals, separation of acute and chronic care and vertical coordination, promote the multi-tiered medical care system to develop and become mature.

9.3.2 Targets To realize the overall target for the construction of a healthy China, we will establish a fair and efficient medical and health service system in which medical and health institutions with an appropriate scale and complete functions cooperate and integrate with each other. By 2020, we will basically construct a medical and health service delivery system that adapts to our country’s basic medical and health system and by 2030, construct a fair and efficient medical and health service delivery system that is suitable to our country’s economic and social development and people’s health needs. 1. Allocation of ward beds. By 2020, ward beds per 1000 permanent residents will reach 6, 4.8 being in hospitals and 1.2 being in primary medical and health institutions. For the 4.8 hospital beds per 1000 permanent residents, 3.3 will be in public hospitals and no less than 1.5 in non-governmental hospitals. 2. Allocation of medical professionals. By 2020, practicing or assistant physicians per 1000 permanent residents will reach 2.5 and registered nurses per 1000 permanent residents will reach 3.14, while by 2030, the number of practicing or assistant physicians and registered nurses per 1000 permanent residents will reach 3.0 and 4.7 respectively. With comprehensive and coordinated development of medical professionals in various specialties, people’s demands for health services will be better satisfied and distribution of medical and health taskforces in rural and urban areas will be more rational. 3. Scale of ward beds in public hospitals. It will be appropriate for county-level public general hospitals to have about 500 ward beds. Hospitals in counties with more than 500,000 populations will be equipped with more ward beds according to local situation and in theory, there will be no more than 1000 ward beds in hospitals of the counties with more than one million populations. While it will be appropriate for city-level general hospitals to have 800 ward beds and hospitals in the cities with more than five million populations can increase the number of beds to no more than 1200 in theory. In provincial general hospitals or above, there will be approximately 1000 ward beds, but no more than 1500 ward beds in principle.

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4. Allocation of information resources. We will vigorously take advantage of mobile internet, internet of things, cloud computing, wearable devices and other latest techniques to promote beneficial health information services and intelligent medical care, boost the use of big data in health, transform service modes, improve service capacity and management and realize information sharing and business collaboration in regards to all-level medical care, medical security and public health services. 5. Collaboration and integration of medical and health service systems. With health promotion as the goal and by various means of collaboration and integration of information, resources, functions and institutions, we will strengthen collaboration on prevention and clinical care and with clear targets and defined roles and functions, various medical and health institutions with different ownership at different levels will establish and perfect collaboration and coordination so as to heighten service capacity of medical and health service systems.

9.4

Key Tasks and Policies

9.4.1 P  erfecting Functions of Medical and Health Service Systems We will further clarify the leading role of public medical and health institutions in the basic medical and health service delivery, with non-profit medical and health institutions and organizations as the main force, encourage and standardize private non-profit medical and health institutions. The primary function of public medical and health institutions is to protect people’s health and safety, deliver primary medical and health services, prevent and control the public health emergencies and the prevalence of infectious diseases, launch and promote national health campaigns and promote the construction of health professionals and the development of medical science and technology. We will eliminate barriers between medical and health institutions with different ownership at different levels in the reform of medical and health service systems and on the basis of clarifying functions and responsibilities, establish a people-oriented all-round medical and health service network with defined functions, successive services and resource sharing.

9.4.2 I ntensifying the Construction of Primary Medical and Health Service Systems We will further perfect compensation policies for primary medical and health institutions, with more funding, establish sustainable financing mechanisms, improve the financial condition and the survival and development ability. Policies for the development of community health institutions will be explored in accordance with different regional conditions and in such regions with medical and health

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institutions with different ownership, government subsidy policies will be optimized to ensure the delivery of primary medical and health services. Construction of the primary health system will be integrated with the overall plans and other reforms; medical care and public health services of primary medical and health institutions will develop coordinately to avoid unequal emphasis on medical care and prevention. It will be a long-term and profound issue for primary medical and health institutions as to how to improve the basic medical and health service quality by the construction of medical taskforces, the training of standardized services and the perfection of incentive mechanisms.

9.4.3 Improving Equity of Health Resource Allocation Firstly, government’s input and distribution of health resources will benefit the people, vulnerable groups in particular, help them get access to health services and make them experience government’s support to the health system. Secondly, the health system supported by the government will deliver the basic medical and health services which benefit all the people. Thirdly, a friendly health system will be built to make people feel love and care in health care. Construction of medical and health service systems in poverty-stricken regions and remote areas will be strengthened to meet the primary and other public medical and health institutions’ needs for facilities and funds and ensure the capacity for delivery of the basic medical and health services.

9.4.4 Integrating Health Service Delivery Systems Integration and collaboration of the health service systems accord with the demands of the bio-psycho-social medical mode and the trend of medical integration, and also meets the requirement for solution to the key health issues mainly caused by chronic diseases. By horizontal and vertical integration, we will set up a service system which takes health as the orientation, primary medical and health service delivery systems as the foundation and provide integrated medical and health services. People-centered principle will be adhered to in the integration of the health service system and by integration and collaboration, it will be more convenient for people to get access to medical and healthcare services; medical expenditure will be regulated and service quality will be improved. When integrating vertically, we will focus on the link and mutual support of various medical and health institutions at different levels; while integrating horizontally, we will focus on the coordinated medical care of various medical and health service institutions of different ownership for solution to the key health issues and special groups’ health problems. System construction is the core principle that we will stick to and the key to effective integration and collaboration is the construction of systems and mechanisms, including the mechanisms for resource sharing, information sharing, financing, the incentives for institutions and staff and the systems for management of performance and quality.

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9.4.5 M  otivating Momentum and Vitality for Pluralistic Development of Medical and Health Service Systems Non-profit medical and health institutions run by non-government organizations will be encouraged and standardized for they act as a critical complement to public medical and health institutions. They will be encouraged to provide basic medical and health services and government will offer support by purchase of services, social medical insurance and some other ways. Profit-making medical and health institutions will be a vital ingredient of medical and health service systems for they can satisfy people’s diversified and all-level needs for medical and health care and complement nonprofit medical and health institutions in the delivery of non-basic medical care. Government will create a sound market environment for the development of profit-making medical and health institutions by law construction and policy guidance. New types of medical and health services will be encouraged and the capacity and level of the basic medical and health service delivery will be improved. We will make good use of the ideology and technology of “Internet+”, innovate service structure, channels, modes, techniques, process and standards, make it convenient for community residents to get access to medical and health services, promote cooperation and integration of various medical and health institutions with different ownership at different levels and guide high-quality health resources to provide primary medical and health services.

9.4.6 S  trengthening Planning for Medical and Health Service Systems and the Authority of the Plans Planning for medical and health service systems is an important means for government to implement macro-control. As an important work in the agenda, strengthening leadership over the planning will be incorporated into government’s working and assessment objectives and accountability will be established to effectively promote the implementation of the plans for medical and health service systems.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_10

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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Traditional Chinese medicine is a treasure of Chinese ancient science and also a valuable fortune in the construction of a healthy China. TCM-based unique outlook on life, health, disease and prevention has been applied to the whole lifecycle and has also played a vital role in every part of the construction of a healthy China. As our country’s unique health resource, traditional Chinese medicine can meet the needs for public health and primary medical care, improve health equity and realize the great goal that everyone will get access to the basic medical and health services. It is significant to fully incorporate traditional Chinese medicine into the construction of a healthy China for realization of the “two centenary goals” and the great rejuvenation of the Chinese nation.

10.1 Current Situation The first is to fully play the role of traditional Chinese medicine in our national economic development. Traditional Chinese medicine has its unique health resources, enormous economic resources, original scientific resources, excellent cultural resources and profound ecological resources and with its growing value, TCM development has become an essential part of the strategy for the development of our country. Transformation of resource advantages into industry advantages makes traditional Chinese medicine become a powerful force in the development of health industries and the promotion of industrial transformation and upgrading as well as a new source of economic growth in the new normal. The second is to play the prominent role of traditional Chinese medicine in building a healthy China. Satisfying people’s needs for TCM services is the starting point and also an ultimate objective. In the 12th 5-Year Plan period, efforts were made to promote the comprehensive and coordinated development of TCM medical care, health care, research, education, industry and culture and extensive and profound social impacts were generated. TCM health management services were incorporated into the national essential public health service package and by the end of 2014, coverage of TCM health management services for the elderly aged 65 or above and children from 0 to 36  months reached 38.6% and 48.7% respectively throughout the country. The third is to play the indispensable role of traditional Chinese medicine in the medical and health services with Chinese characteristics. TCM professionals take an active part in the reform and unique advantages have been brought into full play so that people’s access to essential medical and health services has greatly improved. By the end of 2014, access to TCM departments in all the localities reached 1.541 billion person-times, accounting for 1/5 of the whole. Traditional Chinese medicine provides larger service share with less total amount of resources, benefits more people and plays a unique role in the exploration of the medical reform with a “Chinese-style” approach. The fourth is to play the vital role of traditional Chinese medicine in science and technology innovation. The vast sea of TCM books and more than 100,000 prescriptions on the foundation of abundant clinical experience have been our country’s

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scientific and technologic resources with the original superiority. Professor Tu Youyou from China Academy of Medical Sciences discovered artemisinin, for which she won 2005 Nobel Prize in Physiology and Medicine, and she is the first winner of Nobel Prize of our country, which shows tremendous contributions of traditional Chinese medicine to the human health. The fifth is to play the unique role of traditional Chinese medicine in our country’s foreign services. TCM unique effectiveness and services are commonly accepted by the WHO, foreign governments and people and traditional Chinese medicine serves as a special bond that connects and integrates the civilization of China and foreign countries. Together with finance, energy and other industries, traditional Chinese medicine was firstly incorporated into the Belt and Road Initiative. TCM trade service is a significant part of the strategic and economic dialogue with major countries and with various services and service modes, traditional Chinese medicine serves our country’s public and economic diplomacy.

10.1.1 Major Problems The principal contradiction in traditional Chinese medicine is that TCM development can’t satisfy people’s growing needs for multiple-level and diversified TCM services. The first problem is inadequate TCM resources. TCM service scope begins to shrink, especially in primary medical and health institutions. The second problem is lack of high-level TCM professionals, inheritance and innovation. The third problem is imbalanced and uncoordinated development of TCM medical care, health care and health maintenance services. The fourth problem is that new types of TCM health services are at the initial stage and the vitality and the potential need to be further motivated. The fifth problem is lack of importance attached to TCM services. The sixth problem is severe challenges in the preservation and development of TCM resources for some wild TCM resources are draining and exhausting. The seventh problem is that the step of traditional Chinese medicine to the world is confronted with restraints and barriers and global competitiveness needs further improvement. Main causes for the above mentioned issues include that policies and mechanisms for supporting TCM development are not perfect, nor are they well implemented, that TCM management system and capacity can’t meet the requirements for TCM modernized development and that there is a need for improvement in the competence and conditions beneficial for playing the role of TCM unique superiorities.

10.2 Strategic Targets 10.2.1 Overall Targets By 2020, universal access to TCM services will be ensured. TCM-based medical care, research, education, industry and culture will further develop and TCM standardization, informatization, industrialization and modernization will be

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continuously perfected. Availability and accessibility of TCM-based healthcare services will be dramatically improved so will the capacity for medical care and disease prevention and the academic level. Systems for personnel training will be built initially. Traditional Chinese medicine will become a mainstay of the national economy and there will be more exchange and cooperation with foreign countries. Systems of legislation, standard, supervision and policy that match the laws of TCM development will be basically completed and TCM management systems will be more perfected; the goal will be realized initially that traditional Chinese medicine will develop with inheritance and innovation, overall coordination, ecological green, openness and inclusiveness and people’s universal access to TCM services and traditional Chinese medicine will do new contributions to building a healthy China and an all-round moderately prosperous society. By 2030, modernization of TCM management systems and capacity will be significantly improved and with cover-all TCM service scope and improved service competence, the leading role in preventive health care, the collaborative role in the treatment of major diseases and the key role in rehabilitation will be brought into full play. TCM science and technology will be remarkably improved. A taskforce composed of about a hundred of country-level masters, tens of thousands of well-­ known experts, millions of physicians and tens of millions of medical personnel will be basically set up. People’s health literacy will be greatly improved. Great achievements will be gained in TCM industry intelligence and more contributions will be made to economic and social development. China’s leading position in development of traditional medicine in the world will be more consolidated and the goal of developing traditional Chinese medicine with inheritance and innovation, overall coordination, ecological green, openness and inclusiveness and people’s universal access to TCM services will be realized, which will lay a solid foundation for building a healthy China.

10.2.2 Main Indicators by 2020 Allocation of the resources of traditional Chinese medicine: ward beds per 1000 residents will reach 0.55 in public TCM hospitals and TCM practicing or assistant physicians per 1000 permanent residents will reach 0.4 in medical and health institutions. All of the community health service institutions, township health centers and 70% of village clinics will be able to deliver TCM service. Development of Chinese medicinal materials: monitoring and technological information service networks of the resources of Chinese medicinal materials will cover above 80% of the county-level producing areas; standards for 100 kinds of Chinese medicinal materials will be greatly raised and the gross industrial value of Chinese medicinal materials will account for above 30% of the whole pharmaceutical industry. Popularization of TCM knowledge: above 85% of Chinese will acquire knowledge on TCM-based health maintenance and people’s literacy for TCM-based health maintenance will reach 12%.

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10.3 Strategic Tasks 10.3.1 Promoting TCM Cultural Inheritance and Development and Encouraging Healthy Habits in Individuals TCM cultural quintessence will be carried forward and the core value system will be constructed. Efforts will be made to advocate TCM masters’ excellent skills and absolute sincerity, construct fine medical ethics, strengthen the protection of TCM cultural relics and the inheritance of intangible cultural heritage, set up national TCM museums and realize the goal of creative transformation and innovative development of TCM knowledge on health maintenance. National programs on TCM promotion will be promoted to advocate the knowledge on health maintenance and improve people’s health awareness and literacy for TCM-based health maintenance.

10.3.2 Implementing Health Management with TCM Characteristics and Promoting Equity of Universal Access to Public Health Services By combining TCM advantages with health management and taking chronic disease management as the focus and TCM-based preventive health care as the core ideology, we will explore TCM-based health maintenance models that integrate health culture, health management and health insurance. TCM characteristic health management services will be provided in accordance with commercial health insurance products and the share of TCM health management will be larger in the national essential public health service package.

10.3.3 Promoting Inheritance and Development of Traditional Chinese Medicine and Perfecting HighQuality and Effective Integrated Medical and Health Service Systems TCM unique advantages in preventive health care will be further played and health care and rehabilitation services with TCM characteristics will be encouraged. Efforts will be made to optimize TCM medical and healthcare services, innovate service modes and improve primary service capacity. Research achievements in TCM appropriate technologies and TCM superior effects in dealing with specific conditions will be promoted. Traditional Chinese medicine will be better combined with Western medicine to enhance the treatment of major, complex and critical conditions as well as acute diseases. Ethnic medicines will also be encouraged.

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10.3.4 Developing TCM Healthcare Services Energetically and Promoting the Development of Healthcare Industry More support will be rendered to non-profit private TCM institutions. New types of TCM healthcare services will be explored and TCM medical resources will be promoted to reach nursing homes, communities and residents’ homes. TCM health tourism will be promoted and a number of leading brands will be built. Efforts will be made to implement surveys on TCM resources, strengthen the protection of TCM resources and promote the green development of TCM plantation. Support will be given to research, manufacture and application of TCM-related health products. TCM service trade will be promoted and building of world-known Chinese brands and multinational companies covering the whole production chain will be accelerated.

10.4 Supporting Measures 10.4.1 Perfecting Legal Systems of Traditional Chinese Medicine Efforts will be made to promote the implementation of TCM law, formulate supporting policies and departmental regulations, promote the revision and perfection of the and legislations concerning administrative examination and approval, construct legal systems that conforms to TCM development and instruct localities to enhance TCM legal work.

10.4.2 Giving More Policy Support to the Development of Traditional Chinese Medicine Government’s policies on financial support to the development of traditional Chinese medicine will be carried out. The quantity of Chinese patent drugs in the National Essential Medicine List will further increase and the quality will also be increasingly improved. Governments at all levels will incorporate TCM development into the overall planning for land use and for urban and rural development and increase land supply for TCM medical care, health maintenance and health care for the elderly.

10.4.3 Optimizing Management Systems of Traditional Chinese Medicine Modernization of TCM management capacity and competence will be boosted and management models will be innovated. National, provincial, municipal and county-­ level TCM management systems will be established and perfected and all-level

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governments will establish coordinated mechanisms for TCM development to enhance overall planning and coordination in TCM work.

10.4.4 Establishing and Perfecting Standard Systems of Traditional Chinese Medicine Projects on TCM standardization will be launched and TCM quality standard systems will be perfected. Research and formulation of standards for TCM preventive health care, medicated diet and health products will be conducted systematically. Conversion of domestic standards into international standards will be accelerated. Construction of TCM supervision systems will be strengthened and information data platforms will be set up. Administration of TCM certification will be pushed forward and social sectors will play a more significant role in the supervision.

10.4.5 Bring Supportive Role into Full Play Training for TCM taskforces will be strengthened. The training system for TCM personnel will be established and perfected, integrating college education, post-­ graduate education, continuous education and master-apprentice education. Priority will be given to the cultivation of leading talents in TCM key disciplines, specialties and clinical scientific research and the cultivation of the TCM general practitioners, the personnel at primary medical and health institutions, the professionals in ethnic medicine and the talents for integrating Western medicine and traditional Chinese medicine will be intensified. Manning quotas for TCM professionals will be set up. Reform in TCM education will be deepened to make TCM universities and disciplines famous in the world. The system for electing and commending country-level TCM master as well as the system for assessment on TCM personnel will be perfected. Guarantee and long-term incentive mechanisms will be established to attract and stabilize TCM personnel at primary medical and health institutions. Science and technology innovation will be promoted. TCM collaborative innovation systems and mechanisms will be established to perfect distribution of scientific research, consisting of multiple disciplines and departments, supported by TCM scientific research bases (platforms), with state and provincial research institutes as the core and colleges and universities, medical institutions and enterprises as the main force. TCM scientific research will be strengthened and research will be deepened on the TCM basic theory, the syndrome differentiation treatment, the specificity of acupuncture-point effect, the theory of property of Chinese medicinal materials, the prescription compatibility and the effective substances and mechanisms of Chinese medicinal materials. Joint research on treatment and prevention of major and complex diseases as well as major infectious diseases will be enhanced and exploration on TCM-based instrument and

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equipment of diagnosis and treatment will be promoted. Exploration will also be conducted on the modes of developing new drugs suitable for Chinese medicinal materials and innovation on major drugs will be boosted. Research and development of new drugs based on classic and effective prescriptions of medical institutions will be encouraged. Assessment systems and standards for TCM scientific research conforming to TCM characteristics will be established and optimized and incentive policies beneficial for TCM innovation will be worked out and perfected. TCM informatization will be pushed forward. The application of TCM big data in cloud service plans for a healthy China will be promoted. Construction of TCM information infrastructure will be strengthened and the information system for TCM hospitals will be more perfect. Mechanisms for online verification of the true effectiveness of prescriptions will be established and people’s health information will be shared comprehensively. The national network system for direct reporting TCM comprehensive statistics will be established.

Improving Health Security

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_11

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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11.1 Situation and Challenges The first is the challenge brought about by continuous decline in economic growth. Correspondently social security revenue and financial support to social security will also shift from rapid rise to stable and limited growth. With increasing rise in the need for social security and rapid increase in medical cost, pressure on social security funds is increasingly tremendous which will challenge social security continuously. The second is the challenge intensified by increased aging population. Aging population and low birth rate will impose impact on both revenue and expenditure of the old-age insurance and the medical insurance, leading to lack of medical insurance funds and weakened security capacity on the one hand, rapid rise in the need for medical care and dramatic increase in the expenditure of medical insurance funds on the other hand, which will pose increasingly serious risks for the sustainable development of the medical security system. The third is the challenge caused by increasingly accelerated pace of urbanization. Urbanization will not only give rise to rapid increase in demands for social security, which imposes pressure on social security funds, but also demands unity of urban and rural social security. Urbanization, together with its growing mobility of the population, poses a new challenge for the management service of social security. The fourth is the challenge posed by the multiple methods of medical service delivery and the application of network information technology. Multiple medical service delivery methods and tremendous impact of Internet+ will greatly change the service delivery modes and organizational structure, which will have fundamental influence on the operation of medical institutions and medical service practice and present huge challenges for medical security management.

11.2 Development Objectives With a focus on the goal of building a healthy China, we will adhere to the policy in the construction of the social security system with Chinese characteristics that universal coverage, basic and multi-level security and sustainable development will be guaranteed and there will be complete legal systems, system frame, institutional mechanisms, supportive projects, adequate security capacity, safety-enhanced security funds and efficient and convenient management services in the system. Detailed objectives include the following:

11.2.1 Objectives of Legal System Construction A legal system for the social security system will be constructed, consisting of the Social Insurance Law, the provisions concerning the basic old-age insurance, the basic medical insurance, the unemployment insurance, the work-related injury insurance and the maternity insurance and the supportive laws and departmental regulations.

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11.2.2 Objectives of System Construction Multi-level social security systems will be formed. The basic old-age insurance system will be set up composed of the basic old-age insurance for both rural and non-working urban residents and the old-age insurance for working people. Efforts will be made to establish the basic urban and rural medical insurance system with full coverage and unified treatment, the “three-in-one” unemployment insurance system that prevents unemployment, ensures unemployment treatment and promotes employment and the “three-in-one” work-related injury insurance system concerning prevention, rehabilitation and compensation of work-related injuries. Supplementary insurance schemes such as enterprise annuity, occupational annuity and supplementary medical insurance schemes will have a sound development, so will the commercial insurance system.

11.2.3 Objectives of the Coverage All rural and urban citizens will be under the coverage of the social insurance system with their full required payment and government’s tailored financial support to the low-income groups.

11.2.4 Objectives of the Construction of the Mechanisms for Financing and Benefits Dynamic financing mechanisms will be constructed in line with the economic development, the applicants’ affordability, the security level and the demand for fund expenditure and the mechanisms will be established to determine and adjust security levels in accordance with financing capacity and security demand. The social security system will basically eliminate all life risks. Responsibilities of the state, units and individuals will be divided rationally and harmonious inter-­ generation relationship will be constructed to promote coordinated economic and social development.

11.2.5 Objectives of the Construction of the Capacity for Management Services Efforts will be made to establish unified management systems for social insurance schemes, accelerate the construction of public service systems and build a full-­coverage public service network for the social security. Management taskforces and fund guarantee systems will be suitable for target groups and service functions and management services will be standardized, informationized and specialized.

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11.2.6 Objectives of the Fund Supervision and Management Efforts will be made to implement medium-term plans for social insurance funds, intensify the budget and management of social insurance funds and the allocation of state-owned property, make overall planning for social insurance funds, invest the funds in business and construct a fund supervisory management system that has complete systems, advanced means, social participation and universal coverage.

11.3 G  oals and Methods for the Development of Medical Security Two steps will be taken to achieve the goals for medical security by 2030.

11.3.1 Targets Met by 2020 Targets that will be met in the system construction by 2020 are as follows. The first is to integrate urban and rural basic health insurance schemes and achieve the required “6-unified”: unified coverage, unified financing policy, unified security, unified drug reimbursement list, unified designated management and unified fund management in both urban and rural areas. The second is to implement the major disease insurance scheme for rural and non-working urban residents throughout the country. Multiple and sustainable financing mechanisms and reimbursement policies will be perfected and the major disease insurance scheme for rural and non-­ working urban residents, together with medical assistance will provide tailored help for the needy. The third is to optimize financing mechanisms and gradually change the urban and rural residents’ financing mode from the fixed amount of payment to a certain proportion of their income, so that their payment to the medical insurance system will rise with the growth in economy and income and fit in with the increasing medical cost and medical insurance expenditure that are growing with economic development. The fourth is to reform individual accounts of the basic medical insurance for urban employees to cover outpatient care, define insurance coverage reasonably in accordance with the basic principle of control of the economic risk, establish a stable fund source, gradually alleviate the economic risk of outpatient expenditure, particularly high outpatient expenditure, strengthen the management of chronic diseases in communities, establish and optimize tiered medical services and promote rational use of medical service resources. The fifth is to optimize stable and sustainable financing and benefit adjustment mechanisms for the basic medical insurance to ensure the match of financing capacity and economic development, the match of benefits and financing capacity and the rational adjustment of financing and benefits in different areas. The sixth is to perfect multi-tiered medical security systems, standardize urban and rural medical assistance systems and employee

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complementary medical insurance schemes, promote actively the development of commercial insurance schemes, clearly define the boundary of the following systems: the basic medical insurance system functions as a fundamental security, the urban and rural medical assistance systems play a supplementary role and various complementary medical insurance schemes satisfy people’s demand for high-level medical services, and establish policies for collaboration of different systems and schemes so as to integrate multi-tiered insurance systems and schemes orderly and enable them to play a more collaborative role. Targets that will be met in management by 2020 are as follows. The first is to actively promote reform in payment for medical insurance schemes, establish the systems of negotiation between medical insurance organizations and medical institutions as well as the mechanisms for multiple payment methods and standards under global budget management and make exploration on application of DRGs (diagnosis related groups) payment. The second is to make the basic medical insurance funds more sustainable, fully implement the Plan for the Registration of Universal Participation in Social Insurance, strictly conduct budget management of medical insurance schemes and establish scientific and rational fund balance mechanisms for different regions. The third is to improve service capacity of medical insurance organizations. Intelligent monitoring of the medical insurance system will be comprehensively implemented and supervision on designated medical services will be expanded to individual medical professionals. Efforts will be made to construct medical insurance taskforces, increase fund input, enhance cross-­departmental cooperation, crack down on fraud in medical services and organize comprehensive management and special inspection. The fourth is to encourage commercial insurance companies to engage in the management of the basic medical insurance, explore multiple service management and make them collaborate and coordinate with clear targets and defined roles and functions. Medical service systems will be further reformed and optimized in order to ensure the establishment of medical security systems that satisfy the demands of Chinese people. Main objectives include the following. The first is to energetically promote nongovernmental sectors to provide primary medical services and gradually construct a primary medical service system with multiple stakeholders, fair competition and high quality. General practitioner system will be established and the “gate-keeping” role will be brought into play. The second is to separate management and operation of government-owned hospitals to ensure the autonomous right in operation, establish public hospitals’ corporate governance structure and control the scale and the number of public hospitals rationally. The third is to actively promote the move of social capital to medical service market and create a sound environment for private hospitals to compete with public hospitals fairly and orderly. The fourth is to gradually build a multitiered medical service system which is based on improved primary medical service capacity and guided by market and promote people to get access to medical services orderly.

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11.3.2 Goals Achieved by 2030 Goals that will be achieved in system construction are as follows. Stable benefits of the basic medical insurance will be ensured and tailored security will be promoted. Insurance for major and catastrophic illness will be further perfected and incidence of the risk from catastrophic payment for medical care will be reduced effectively. Mechanisms for scientific control of individual medical expenses and policies for tailored insurance of low-income groups will be established. Primary public health services will be incorporated into the basic medical insurance and a unified national medical insurance system will be built initially. Goals that will be achieved in management are as follows. Standardized and socialized management of medical insurance organizations will be further promoted and more management autonomy will be offered so that the role of representing the insured will be better played. Multiple managements will be gradually improved; systems for purchase and supervision of management services will be established and perfected and exploration on the establishment of effective and convenient systems of management services will be conducted. Budget management on medical insurance schemes will be comprehensively implemented and the mechanism that matches budget management of the micro health expenses and the medical insurance system will be launched as well as multiple payment methods under global budget management, DRGs payment for all inpatients and capitation for outpatient services. Systems for assessment of medical care quality based on DRGs and clinical pathways will be established and perfected and performance-related payment will be encouraged. Meanwhile reform will also be implemented in medical service systems, which aims to build the multi-tired, convenient, accessible, high-quality and effective primary medical service delivery systems to basically meet people’s needs. General practitioners’ primary care system will be established to fully play the role of “gate keeping” and the medical service delivery structure will be formed, in which services of primary general practitioners, special clinics and high-level hospitals are both independent, competitive and cooperative and integrated medical service are provided.

Improving the Drug Supply Security System

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_12

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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Making improving the drug supply security system as an important task, the Outline of the Healthy China 2030 Plan requires to deepen the reform of the drug and device circulation system and to improve the national drug policies. The construction of drug supply security system is one of the key tasks of the new round of healthcare reform and, together with the medical service system, the medical security system and the public health service system, it serves the goal of providing basic medical and health services for everyone. The national essential drug system was initially established during the “11th 5-Year” period, which has laid the foundation for the formation of a drug supply security system. During the “12th 5-Year” period, positive progress has been made in consolidating and improving the essential drug system and promoting reform in the field of drug production and circulation.

12.1 A  dvances in the Construction of the Drug Supply Security System During the New Round of Healthcare Reform 12.1.1 The Drug Policy Framework with Chinese Characteristics Has Been Initially Formed 1. The essential drug system has been gradually perfected from its initial establishment. In 2009, the national essential drug system was launched. In 2011, the national essential drug system was initially established and entered the stage of standardization and perfection. In March of 2013, a new edition of the National Essential Drugs List was issued. It optimized the categories of basic drugs, appropriately increased the types of the drugs for chronic diseases and children diseases and standardized the forms, dosages and specifications of basic drugs. In 2014, the Opinions on Further Strengthening the Management of Drug Use in Primary Medical and Health Institutions was issued. The connotation of the basic drug system has constantly been enriched and the policies and experience have gradually been popularized. Based on the experience of zero-profit policy on essential drugs, all public hospitals abolished the drug markups. Based on the National Essential Drugs List, some regions have formulated the essential drugs list of public hospitals at the county level, commonly-used low price drugs list of public hospitals or the essential drugs list of provincial medical institutions, which constitutes an effective supplement to the national essential drug system. The full compensation for geriatric medication was studied and piloted in Zhejiang province and other places. 2. The reform of drug manufacturing and distribution system has been advanced. The government ranked the biomedicine industry as the pillar industry, made great efforts to develop the health service industry and provided opportunities for the research and development, manufacturing and distribution of all kinds of medical products. Breakthroughs were also made in the pricing policy of drugs. After completing the third round of drug price reduction and the reform of the

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administrative measures on the pricing of low price drugs, the National Development and Reform Commission, since June 1st, 2015, had abolished the limit on the highest retail price of almost all the drugs and made exploration to establish the market-regulated drug pricing mechanism that is mainly operated by means of the centralized drug procurement for public hospitals and the supervision on medical cost, pricing behaviors and payment standards for drugs covered by medical insurance. The policies on drug procurement and supply were improved. On the basis of the policy for basic drug procurement at the community-level, the classified drug procurements like invitation for bids, negotiation, on-line price negotiation and designated production were adopted for public hospitals. The construction of the information network for the comprehensive management of drug supply security was initiated, the criteria for the construction of provincial centralized drug procurement platform were unified and the standardized coding of drug purchase was advanced. The preparation for the formulation of the policy on medical insurance payment standards was under way.

12.1.2 Drug Supply Capacity Has Increased Obviously 1. The price has fallen, and the promotion of fairness has been achieved. Through centralized procurement at the provincial level, the nationwide price of basic drugs has generally fallen by more than 30%, effectively improving the accessibility of essential medicines. All provinces and municipalities have carried out the procurement of drugs in public hospitals adopting the experience of purchasing essential medicines and achieved great results in controlling the price level of non-essential drugs. From 2011 to 2015, the drug cost in the outpatient department of the second level hospital increased by 20.8%, while the cost of hospitalized medicine decreased by 1.11%. The increase was lower than the level of 32.26% and 29.67% in the first stage of medical reform. The proportion of drug consumption continued to decline, of which the proportion of drug cost in hospitalization dropped by 5.8%, which was faster than that in the first stage of medical reform. Considering the price level in the same period, as well as the development of the medical security system, the fairness and accessibility of both essential and non-essential drugs have been improved. The increase in drug costs has declined. In 2015, the national drug cost was 1.475 trillion yuan, and the per capita drug cost was 1073 yuan. The proportion of drug cost to total health expenditure dropped from 40% in the early 12th 5-Year to 36.35%. The circulation structure tends to be optimized. The proportion of drug cost in retail drugstores is 33.3%, which is 4.3% higher than that in 2011. The proportion of outpatient drug expenses is 30.2%, which is 6.5% lower than that in 2011. Pharmacies of social sectors play a more and more important role in meeting the needs of patients. 2. The upgrading of the industry was accelerated, and the supply capacity was improved. The industry proceeds from imitation to innovation. In 2015, the State Food and Drug Administration approved the application of 351 for drug registration, including 268 of new chemical drugs, and the proportion of new drugs kept increasing. The driving force of enterprise innovation has been enhanced to

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improve the quantity of drug supply from the source. The pharmaceutical industry continues to develop rapidly. The gross domestic product of the pharmaceutical industry continued to grow at a rate of more than 10% per year. In 2015, the main business income of industrial enterprises reached 2.7 trillion yuan, a 9% increase year-on-year, and 76.24% higher than that in 2011. The fixed assets investment in the pharmaceutical industry continued to maintain a rapid growth, reaching 581.2 billion in 2015, which is 8.2% higher than the national industrial average. According to “the top 100 Chinese pharmaceutical industry in 2014 and its industrial structure analysis”, the sales of the top hundred pharmaceutical enterprises in 2014 accounted for 46.3% of the total sales of pharmaceutical enterprises, which was close to the target value of 2015, set in the medical reform plan, by 50%. 3. The drug circulation system was gradually adjusted, and the reorganization was accelerated. The investment and merger activities of listed companies become gradually active. With the implementation of the “two-vote system” in centralized procurement of public hospitals, circulation enterprises have begun a new round of optimization. The timely rate of drug delivery has been increased year by year. The retail drugstore system continues to grow. The total number of stores in the country kept increasing, and 2015 increased by 2.6 million over 2011. Drug chain enterprises have been developing rapidly. 4. The construction of the team was accelerated, and the pharmaceutical service was enhanced. Medical institutions promote the rational use of antibiotics, actively carry out prescription reviews and improve the level of rational drug use. Private sector pharmacies actively explore the function of health service, give full play to the professional and technical ability of pharmacists, and provide pharmaceutical services to patients. With the requirements for practitioners in the field of circulation, the registration and enrollment of licensed pharmacist qualifying examinations increased significantly.

12.2 T  he Current Situation and Challenges of Drug Supply Security 12.2.1 The Price and Quality Remain Hot Issues in Society The price of drug is highly sensitive. At present, the price of patent medicine, original research product and exclusive Chinese medicine is still high, and the price of anti-cancer products, paid attention by society, is high for a long time. After the abolition of the maximum retail price restriction, the price of some drugs increased exceedingly and quickly, which leads to patients’ dissatisfaction and public concerns. Because of the remote area, the price issue, the GMP reform, the enterprise marketing strategy, the purchase management and so on, some drugs failed to be supplied in time or even in shortage from the source of production. Although the work of food and drug supervision system increased during the period of “12th 5-Year”, drug related cases, as well as quality problem of drug product occurred frequently after successive years of “severe measures”. After several

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pharmaceutical companies were investigated by the judiciary, the problem of commercial bribery in circulation sector continued to emerge, causing strong public repercussions.

12.2.2 The Rapid Growth of Overall Health Demand Brings More Demand for Medicine The aging of population and the enhancement of protection bring about a rapid increase in total demand. The aging of the population, the promotion of the new medical reform and the improvement of the medical security will further accelerate the release of the needs on residents’ health. The total of medical demand will continue to increase, which makes it urgent to further improve the drug supply security system. On the other hand, with the progress of science and technology, new drug research and development have been breaking through in the field of difficult and severe disease, cancer for instance. However, the price is generally beyond the capacity of our residents and government. It is expected that in the period of “13th 5-Year”, the incidence of cancer in our country will continue to rise and bring economic pressure to the individual and the society under the circumstances that the environmental health risk is difficult to be effectively controlled in the short term.

12.2.3 The Progress of Partial Supporting Reform Is Slow The reform of public hospitals needs further breakthroughs. Public hospitals are the most important buyers in the pharmaceutical market, whose functional positioning and compensation mechanism are the key elements in drug price formation and cost control. To break the mechanism of “compensate doctors with drug profits” is a prerequisite for rationalizing the circulation chain of drugs and improving the market structure in the pharmaceutical field. At present, the reform of public hospitals is at a critical stage, and the reform mode is under exploration. The effectiveness of reform will have a profound impact on the construction of drug policy system. In 2015, the State Development and Reform Commission formulated the proposal to promote the reform of the drug price and proposed the establishment of a market— oriented mechanism for the formation of drug prices to promote the reasonable price of the drug market. But the implementation of new policy will take some time, especially the payment standard of medical insurance as one of the new price management policies. It is also unclear how the payment standard of medical insurance should be linked with the centralized drug procurement policy.

12.2.4 New Challenges Keep Emerging While the drug market is gradually standardized, medical devices have become one of the issues. In 2015, a total of 20,000 new medical devices were registered, and there were 14,151 medical device manufacturers in the country. Compared with the year

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2012, 7895 pieces of equipment were approved annually. The new business models, such as the marketing of natural persons in the field of drug circulation, are constantly emerging, and new phenomena such as pharmaceutical companies owning hospitals, different forms of pharmacy trusteeship, and hospital hosting drugstores have been emerging, testing tightness of drug policies and basic drug systems.

12.3 T  he Construction Task of the Drug Supply Guarantee System 12.3.1 Promoting the Construction of National Drug Policy Based on the basic drug system, we should adhere to the “health first” concept, promote the construction of the national drug policy framework and coordination mechanism, clarify the power and responsibility of the administrative departments, form the basic framework for the top design of the national drug policy, solve the problems that administrative system is poor and each department’s act on its own, also, issue of multisectoral coordination and policy cohesion in the pharmaceutical sector.

12.3.2 Speeding Up the Construction of Medical Price Formation Mechanism In accordance with the principle of combining government regulation with market regulation, we should improve the mechanism of drug price formation and eradicate the mechanism of drug supplement. Combined with the progress of reform on medical insurance payment system, the centralized procurement policy should be linked up in a timely manner to promote policy coordination and enhance policy effectiveness. We should adhere to the principle of fairness and accessibility and control drug prices and expenses. We should strengthen supervision over inadequate market competition and high value medical consumables, establish a system of price information monitoring and information disclosure, and curb the overcharging problem. We must strictly control the price level of new antitumor drugs and other proprietary medicines and maintain the price of essential drugs in a level where supply is guaranteed. We should promote the coordinated development of medical, medical and medical insurance reform, the coordinated development of drug policy, medical service policy and medical insurance policy, and to provide support for the development of the drug supply security system.

12.3.3 Consolidating and Improving the Basic Drug System 1. We need to further improve the basic drug security function. We should shift from controlling merely price to the price and cost both. We should play a role and expand the connotation from the perspective of ensuring the supply of drugs

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and fairness. For one thing, it is to expand the range of drug varieties and population covered by free public health drugs. For another thing, we should improve the government’s input level of basic drugs, and in combination of improvement of medical insurance system, set clear policy differences on basic drugs and non-­ basic drugs. We should also test various specific policies and supporting management measures such as the direct supply of basic drugs, the “0 yuan starting price” of basic drugs, the basic drug insurance, which help patients use drugs without self-expense, maximizing the fairness and accessibility of basic drugs. We also need to strengthen the protection of drug usage from children, elderly and other special groups. 2. We must strengthen construction of a standardized essential drug system. According to the requirements of the national basic drug system covering urban and rural areas in 2020, the basic drug catalogue selection, production supply, centralized procurement, allocation and use, quality supervision, medical insurance payment, and supporting government input and public hospital reform should be reviewed and evaluated to improve the standardized operation of basic drug system. We will encourage local governments to explore in advance, carrying out policies on the catalogue, production, identification, price, distribution, allocation and utilization of essential medicines. 3. We should establish funding mechanism of the basic drugs. Financing is the prerequisite for the implementation of all policies. The establishment of financing mechanism will provide a clear and stable source of funds for the implementation of the basic drug system and therefore the basic drug system is able to design policy in a systematic way and improve itself, which helps the establishment of accountability and evaluation on how the regulation works. 4. Promoting the transformation of the production and circulation system The implementation of the “two votes system” for centralized procurement of public drugs in public hospitals will lead to specification of drug production and circulation order, decrease of disorder competition and reduction of circulation costs. Pharmaceutical equipment circulation enterprises should be encouraged to extend their service to the upstream and downstream. We should regulate the medical electronic commerce, enrich the circulation channels and development models of drugs, and therefore form a standardized and intensive modern drug circulation system. We should strengthen guaranteed supply and early warning of drugs of shortage. We should speed up the construction of drug circulation network covering urban and rural areas in towns, villages and remote areas, so as to ensure timely supply of drugs. We should deepen the reform of public hospitals, give full play to the main role of drug procurement in public hospitals, and improve the policy of centralized drug purchase. We should expand the number of pharmacists, develop pharmaceutical care, improve the professional and technical level of pharmacists, and encourage pharmacists to carry out diversified professional pharmaceutical service. 5. Exploring the unique advantages of traditional Chinese Medicine We should improve the system of traditional Chinese medicine and health care covering urban and rural areas. Great efforts should be made to develop

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non-drug therapies for Chinese medicine and play a unique role in the prevention and treatment of common diseases, frequently occurring diseases and chronic diseases. We should develop the rehabilitation service of traditional Chinese medicine and carry out the health project of preventive treatment in traditional Chinese medicine. We should encourage traditional Chinese medicine to inherit innovation. By 2030, the leading role of Chinese medicine in the prevention of disease, the coordinating role in the treatment of major diseases, and the core role in disease rehabilitation will be brought into full play.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_13

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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Deepening patriotic public health campaigns is a great creation and successful practice by applying the mass line to the preventive sanitation work. It is also an important part of socialism with Chinese characteristics. The “Outline of the Healthy China 2030 Plan” regulates that patriotic public health campaigns should be deepen, urban and rural environment and sanitary conditions should be comprehensively improved, healthy cities, towns and villages should be built. “Building healthy cities, towns and villages” is an important project for Healthy China. The land supply for public health infrastructure should be secured, and health-related infrastructure, planning and standards should be improved. We will blend health in the urban and rural planning, construction and management process, to improve the coordinated development of the urban development and residents’ health. By 2030, a group of healthy cities, towns and villages will be built for nationwide demonstration.

13.1 T  he Achievements and Challenges of the Comprehensive Improvement of Urban and Rural Environment and Sanitary Conditions With the promotion of the national urbanization process, the comprehensive improvement of urban and rural environment and sanitary conditions becomes more and more important. In May 2010, the National Patriotic Health Campaign Committee (NPHCC), issued The National Action Plan of the Urban and Rural Environment and Sanitation (2010–2012) (NPHCC, [2010] No. 1), which set the general goal as to further improve the health awareness, health quality and life quality of urban and rural residents. We should comprehensively improve the environment and sanitary conditions, and publicize the concept of healthy environment. To realize the general goal, we will work hard to solve the problem of the urban and rural filthy environment; vigorously strengthen the infrastructure construction of environmental health in both urban and rural areas, especially in the rural areas; gradually establish and improve the management mechanism of environmental health; promote the urban and rural integration process. In February 2015, NPHCC issued The National Action Plan of the Urban and Rural Environment and Sanitation (2015–2020) (NPHCC, [2015] No. 1). In the same year, the National Patriotic Health Campaign Office, The National Task Division Plan of the Urban and Rural Environment and Sanitation (NPHCO, [2015] No. 2), requested each member unit to undertake the implementation of each task, according to the division of responsibilities.

13.1.1 Achievements During the “12th 5-year Plan” period, China’s rural areas have carried out with the construction of the beautiful villages, rural water safety system, rural toilet reform, vector biological control system, hygienic towns and villages building, etc. the urban and rural environment and sanitary conditions have been comprehensively improved, by solving the huddle and misplacing problems. The patriotic hygiene

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work has been promoted as a whole. The rural population proportion of central water supply in the rural areas increased from 58% to 82%. The problem of rural drinking water safety has been basically solved. The work of rural toilet reform has been vigorously promoted. The popularizing rate of rural sanitary toilets increased from 67.4% to 78.4%. In 24 provinces, such as Shanghai, Beijing, Shandong and Hainan, the non-hazardous rate of domestic refuse in towns has exceeded or reached the national target of 35%. In Shandong province, there are 108 non-hazardous waste disposal sites, with 88,000  tons of daily garbage disposal and 98% non-­ hazardous disposal rate, ranking among the best in the country. In accordance with the long-effective mechanism, “harmlessness, resource and reduction”, Sichuan province carried out the special operation of rural domestic waste disposal, and explored some new modes of rural domestic waste disposal with regional characteristics and typical significance. The new models include: the “Luojiang model”: “locate in households, classify in groups, collect in villages, transfer in towns, disposal in counties”; the “Longhu model”: “local condition, waste separation, village self-government, market operation”; “Dazhou model”: “town-driving-country, area radiation, local condition”; “Aba model”: “to implement three changes, and to reduce the garbage damage”, and so on. They have introduced their experience in the National Rural Domestic Refuse Disposal Television Conference, held by the Ministry of Housing and Urban-rural Development and other ten national departments. Sichuan became the first province which passed the acceptance of Rural Refuse special administration.

13.1.2 Problems and Challenges The first is that the rural environmental sanitation infrastructure is weak. It has a lot of historical debts, which is incompatible with socio-economic development and people’s need for a happy life. In particular, the construction of rural environmental sanitation infrastructure is lagging behind, in some less-developed provinces or the less-developed areas of some developed provinces. In these towns and villages, the non-hazardous disposal capacity of domestic refuse and sewage is low; the penetration rate of rural sanitary toilets is low, far from the national requirements; the drinking water safety for residents is not guaranteed, while the rural population proportion of central water supply in rural areas is low, and the qualified rate of water quality is not high. Some of the hard targets have not met the requirements of phased targets. The second is the imbalance of the development of urban and rural environment and sanitation. Affected by various factors, such as the degree of emphasis at all levels and the socio-economic development, the progress of clean and tidy action in various regions is uneven, and the gap between regions is obvious. Overall, it is better in cities than in countryside. Due to the unbalanced economic development between the urban and rural areas, its advance speed and quality are relatively better in the areas with better economic conditions than they are in the areas with poor economic conditions. Especially, in some rural areas, the overall advance of clean and tidy action is restricted, caused by their government financial problems and relatively

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small investment, joint with geographic condition restriction and peasant household dispersal. In some provinces, villages are better than towns in the clean and tidy action, so towns gradually become the difficult points of environmental hygiene.

13.2 T  he Transformation of Hygienic Cities into Healthy Cities Since the founding of New China, the Chinese government constantly insists on the concept of Gig Sanitation and Big Health, combined with China’s national conditions, to intensively promote the patriotic sanitation campaign. Starting from solving the social determinants that affect health, the government strengthened the social comprehensive governance and achieved higher health performance with the limited resources. Started from the 1980s, in order to change the urban environment of dirty, chaotic, and poor appearance, China launched the hygienic cities construction, which was run by the National Patriotic Health Campaign Office. So far, China has named 259 national hygienic cities, about 36% of the total number of the cities in our country. With the continuous development of the national hygienic cities construction, a large number of cities’ appearance has changed significantly. The infrastructure construction has been significantly improved, such as environmental health quality, sewage treatment system, household medical and refuse disposal system, and excreta disposal system. The environmental health indicators of the hygienic cities are higher than those of non-hygienic cities. The continuous improvement of the infrastructure construction has brought about the improvement of urban residents’ health literacy and the changing of bad hygiene. The healthy lifestyles are popularized, such as quit smoking-limited wine, moderate exercises, rational diet. The awareness rate of health knowledge and the formation rate of healthy behaviors are significantly increased. However, with the acceleration of the urbanization progress, the cities in our country face a series of new problems: ageing populations, the high frequency of chronic disease and mental disease, the growing health demands of urban residents, and so on. The new problems require improving the level of the hygienic cities construction. Therefore, drawing lessons from the healthy cities strategy action put forward by the World Health Organization, in 2007, china carried out the pilot exploration in ten Cities (districts), such as Hangzhou and Suzhou. It represented the beginning of the transformation of hygienic cities into healthy cities. In 2014, Chinese government presents clearly: we would explore and carry out the healthy cities building, strive to build an upgraded version of health cities and towns, and promote the coordinated development of urban construction and human health. In July 2016, NPHCC issued Guidance on the Construction of Healthy Cities, Towns and Villages, which represented the health cities construction has been formally staged. The Guidance further clarified that healthy cities were the upgraded version of hygienic cities, with the major missions of solving the outstanding problems affecting the public health, and promoting the economic and social sustainable development. From the establishment of hygienic cities to the construction of healthy cities, the transformation shows that the Central Committee with Comrade Xi Jinping attaches great importance to the coordinated development of urban construction and

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human health. The Outline changes the word “health” from a one-dimensional vocabulary into a Multi-dimensional vocabulary. Not only should we focus on the biological and personal factors that affect health, but also the social environmental determinants of health problems, which can play a role in disease prevention and health maintenance, such as natural environment, poverty, education and natural ecosystems. This is also one of the development tendencies of the international health system. With the promotion of the new-type urbanization, the development of healthy cities is encouraged and supported. The goals of healthy city constructions are: to sound, guarantee and promote the healthy public policies; to perfect the health supporting environment; to optimize the medical and health services; to strengthen the involvement of communities, villages, towns and units; to form a healthy social culture; to build a harmonious social relations; to improve the public health literacy and health level; to realize the coordinated development of urban construction and human health. The construction of health cities should be focused on five aspects: the creation of a healthy environment, the establishment of a healthy society, the optimization of health services, the cultivation of healthy population and the development of healthy culture. It has been nearly 10  years since China began to explore the construction of healthy cities in 2007. China built the pilots of healthy cities by intervening from multiple levels in a variety of forms, according to the health determinants, and integrates the work of multiple departments. The working mechanism was gradually established and improved, and the phased objectives were obtained. Firstly, the health environment was improved obviously. In Zhangjiagang, a pilot of health cities, the ratio of fairly good air quality increased from 94.8% in 2007 to 99.2% in 2012, and the ratio of centralized disposal of domestic sewage increased from 85% in 2007 to 98% in 2012. The water supply coverage, the pass rate of the domestic drinking water quality, the coverage rate of rural sanitary latrine, and domestic refuse non-hazardous disposal reached 100%. Secondly, healthy social indicators were balanced developed. The city of Hangzhou took healthy society, healthy economy and healthy culture as the important content of the construction of healthy cities. The enrolment ratio of the children attending the kindergartens in 3  years before entering school was 98.6%, the enrolment ratio of the junior high school graduates entering various senior high schools was 99.59%, and the high quality pre-school education and high quality high school education coverage reached 72.6% and 82.65% respectively. In 2012, Hangzhou secured a total of 11,935 low-­ rent housing families accumulatively. The scope of affordable housing was extended to low-and middle-income families which had the per capita disposable income bellowing 80% in the previous year. A total of 74,876 public offering housing resources and a total of 12,921 public rental housing were launched accumulatively. The totality of dilapidated house transforming reached 176,000 m2, which benefited 35,000 households. Thirdly, health services were further optimized and healthy population was gradually formed. In the city of Dalian, health literacy and health services were carried out simultaneously and the population health indicators were improved significantly. The infant mortality rate was 4.92 1‰ in 2007 and 3.31 1‰ in 2013. The maternal mortality rate dropped from 11.77 per 100,000 in 2007 to 5.2

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per 100,000 in 2013, lowering more than 50%. The life expectancy was 79.86 years in 2007, 80.66 years in 2013, and a slight increasing in stability.

13.3 T  he Key Work to Strengthen Patriotic Sanitation Campaign 13.3.1 Comprehensively Improving Urban and Rural Environment and Sanitary Conditions The Outline proposed that by 2030, more rural areas will have beautiful homes suitable for growing old with improved sanitary conditions in residential environments, and rural residents and nature will be developed in a harmonious manner. The first is to focus on the contribution of the urban and rural domestic refuse and sewage treatment facilities. Opinions of the State Council on Strengthening the Urban Infrastructure Construction should be thoroughly implemented. With the reasonable division of labor between the government and the market, the investment and financing mechanism should be established actively. By ensuring the government’s input and attracting various social capitals through various forms, the government and the market will jointly promote the construction of environmental sanitation infrastructure. The second is to increase the investment in the construction of garbage collection equipment and transit facilities in villages and towns. The construction of garbage collection and disposal facilities in villages and towns should be standardized in a step-by-step and focused manner, to further improve the construction of garbage collection systems in villages and towns. The village cleaning system should be established to promote the local classification and reduction of local waste and the recycling of resources. The model of “classify in households, collect in villages, transfer in towns, and disposal in counties” should be implemented in the villages with convenient transportation and closer transport distance. The third is to carry the out rural sewage disposal and the prevention and control pollution of the livestock and poultry farms. The focus point is the sewage disposal in the rural livestock and poultry farms. We will promote the comprehensive control and utilization of the livestock and poultry pollution; strengthen the hazard-free collection and disposal of the dying livestock and poultry; promote the improvement of the connective remediation of rural environment. The administrative proportion of rural sewage disposal will be increased constantly. The fourth is to ensure drinking water safety for urban and rural residents. The 12th 5-Year Plan for Drinking Water Safety in the Rural Areas should be fully implemented, to further increase the population proportion of rural centralized water supply and the guarantee rate of water supply. We will strengthen the monitoring and capacity building for drinking water, and establish and improve the long-­ term mechanism for maintaining water supply facilities. The fifth is to continue to popularize the rural sanitary toilets. The implementation of the rural toilet modernization should be sped up, adhering to the principles

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of local conditions, centralization, and the whole village promotion. We will encourage the construction of four-format eco-toilets and biogas digesters, and strengthen the non-hazardous disposal and resource utilization of feces. The long-term management mechanism of sanitary toilets should be established as laying equal stress on construction, management and utilization. The sixth is to promote the further development of the urban and rural environment and sanitation, and enhancing the urban and rural environmental health standardization and fine management level. Focusing on the construction of hygienic cities and towns, we will further improve the working mechanism and innovate the working methods.

13.3.2 Promoting the Key Work of Healthy Cities Construction The key field of healthy cities construction contains five aspects: health environment, health society, health service, health culture and health population. In order to promote healthy cities construction, the following aspects should be emphasized on: The first is to promote the integration of relevant policies. Each city will be encouraged and urged to develop the public policies conducive to health. China has announced the first 38 healthy city pilots, and officially began the construction of healthy cities. In the next step, each pilot should take healthy cities construction as the government’s preferential task and strategic subject, to fully embody the political will of healthy cities construction. The second is to highlight the plan making. Guided by the problems, we will carry out the assessment on the health influence factor and residents’ health conditions, to identify the major health issues and major health concerns. The development plan of healthy cities should be developed to identify the targeted interventions and the phased goals. The third is to establish the organizational guarantee mechanism. Multi-sectorial coordination teams should be set up to deepen the communication and collaboration among multiple departments. The duties and roles of healthy cities construction institutions should be defined, which mainly include: (1) to organize baseline surveys to clarify the problems of healthy cities; (2) to establish and improve the working mechanism which is built and shared by all the people, and to build a platform for communicating at home and abroad; (3) to design projects according to health demands; (4) to design and implement the health cities assessment. The fourth is to build a health management service system. We will speed up the information construction, to realize the interconnectivity of medical services, public health services, health management services, medical care and other information. We will strengthen the fusion of prevention and control, to realize the health management of the whole population, the all-direction and the whole life cycle.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_14

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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14.1 The Situation of Ecological Environment Protection 14.1.1 Positive Progress in Ecological and Environmental Protection The CPC central committee and the State Council have attached great importance to environmental protection by putting it in the main position and making it the main force of ecological civilization construction and the core content of building a beautiful China, realizing a sustainable development, introducing an overall plan for the reform of the ecological civilization system, implementing the action plan for the prevention and control of air, water and soil pollution, and vigorously strengthening environment and health work. In 2015, the average annual concentration of fine particulate matter (PM2.5) in 338 prefecture-level and above cities was 50 μg/ m3; the proportion of the 1940 state-controlled sections of class I–III surface water increased to 66%; the proportion of worse V fell to 9.7%; the quality of the main streams in major rivers was obviously improved. The capacities of national desulfurization and denitrification units, accounting for the total installed capacity of coal power, increased to 99% and 92% respectively, which completed the ultra-low emission transformation of 160 million kilowatts of coal-fired power units. The comprehensive environment improvement in 72,000 villages has been implemented, directly benefiting more than 120 million rural people. A number of major ecological conservation and rehabilitation projects have been carried out steadily, including natural forest protection, returning farmland into forest and grass, and grazing land into grassland, shelter forest system construction, protection and restoration of lakes and wetlands, desertification control, water and soil conservation, desertification management, wildlife protection and nature reserve construction. Pollutant emissions of the five heavy metals of lead, mercury, cadmium, chromium and arsenic have fallen 27.7% since 2007, and the number of sudden environment incidents involving heavy metals has been greatly reduced. In order to solve the environmental problems that harm people’s health, the Environment Protection Law and the series of environmental management documents clearly put forward the requirements for strengthening environment and health management, which provide legal and policy basis for the establishment and the improvement of environment and health management systems, organization and the implementation of environment and health surveys, monitoring and risk assessment.

14.1.2 Pressure of Ecological Environment Protection At present, the level of ecological civilization construction in China still lags behind economic and social development. Resource constraints, serious environment pollution, ecological degradation, and increasingly prominent contradiction between development and the population resource environment have become a major bottleneck restricting the sustainable development of economy and society. The total emission of the main pollutants is large and the intensity is high. The spatial structure of resource consumption and environment pollution have changed, and the

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transfer of industries to the central and western regions has accelerated significantly. The problems of air, water and soil pollution are outstanding, and the improvement of environment quality is faced with unprecedented difficulties and complexity. China is a major producer and consumer of chemicals with the number of toxic and harmful pollutants increasing, and the regional, structural and environmental risks are becoming increasingly prominent. The number of enterprises with environmental risks is large and they are close to water and cities so hazardous chemical accidents have caused frequent environmental pollution incidents. The causes of sudden environment events are complicated, the polluted materials are diverse, the regional sensitivity is high and the scope of the influence expands. There is still a huge gap between China’s ecological environment protection and the overall goal of beautiful China and ecological civilization construction. In 2015, fine particulate matter and inhalable particulate matter in 338 prefecture-level and above cities exceeded the annual average of 42.9% and 24.3% respectively. The proportion of inferior water body of Class V and the black smelly water quantity was much higher than those of the organizations from the major countries for economic cooperation and development in the same historical periods. The plot ratio of farmland soil in the whole country was up to 19.4%. Most of the 600,000 administrative villages had no environmental infrastructure so the emissions of major pollutants remained high. The national problems of a complete set of pipe network supporting sewage treatment and sludge treatment were serious. The overall trend of the declining biodiversity had not been effectively curbed; some ecosystem functions had deteriorated; and some species had become more endangered. The foundation of environment and health work was generally weak, the legal and policy systems had not yet been formed and there was a lack of cohesion and integration with environmental management policies and measures. The coming period is the time when China’s improvement range of environmental quality and public expectation gap are the biggest; the resource and environment bottleneck constraints and development contradictions are the most acute and difficult; the important window opportunities come, in which China will rationalize the management system of ecological environment, transform the mode of economic development, and comprehensively promote the ecological environment protection and ecological civilization construction. The construction of beautiful China and healthy China are faced with great opportunities and great challenges.

14.2 G  uiding Ideology, General Idea and Goal of Environment Treatment Under the Background of Healthy China Construction 14.2.1 Guiding Ideology We should comprehensively implement the spirit of the Party’s 18th national congress and the third, fourth, fifth and sixth plenary sessions of the 18th CPC central committee guided by Deng Xiaoping Theory, the Important Thought of Three

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Represents, and the Scientific Outlook on Development, carry out the important speech spirit of General Secretary Xi Jinping centering the “Five in One Overall Layout” and the “Four-Pronged Comprehensive Strategy”, firmly establish the development concept of innovation, coordination, green, openness and sharing by taking the improvement in environmental quality as the core, implement the strictest environmental protection system, fight against the three major battles of air, water and soil pollution, strengthen coordination between pollution prevention and control, and ecological protection, closely control environmental risks, continuously improve the environmental management system at scientific, legal, refined and information level, accelerate the modernization of the ecological environment treatment system and treatment capacity, ensure a clear improvement in the quality of the ecological environment by 2030, strive to build a beautiful China with “blue sky, green land and clean water”, and effectively control the environmental factors affecting health.

14.2.2 General Idea We should put prevention first, strengthen macro-policy control over the environment, establish an environmental prevention system, promote the integration of environmental function zones and the main function zones, strengthen the space control, total control and environmental access requirements for strategic and planning environmental assessment, optimize the space development layout and promote the improvement of environmental quality in the regions (river basins), promote industrial transformation and upgrading, combine the key development and control industry resource energy consumption with the total amount of pollutant emission, combine the optimization development with the promotion of the industry production efficiency admittance standard, promote green production and green consumption, develop ecological and environmental protection into new development advantages, and form a space layout of saving resources and protecting the environment, industrial structure, mode of production and way of life. Taking the improvement in environmental quality as the core, we should promote joint prevention and control, and the joint treatment of the basin of the Yangtze River, construct three major pollution prevention and control action plans for air, water and soil, coordinate control of major pollutants in the air, water and soil, and improve the pertinence and effectiveness of treatment measures according to regional, watershed and type differences. We should implement environmental quality target assessment and the strictest environmental protection system, and effectively address the outstanding environmental problems affecting the health of the general public. We should, making the discharge of pollution sources as the bottom line, the backbone of the project as the grip, and the construction of an environmental management system based on health risk assessment and ecological risk assessment as the aim, reform and improve the total volume control system, promote pollution control and reduction of pollutants of the industry, and strengthen the overall treatment in urban and rural areas. Under strict control increment at the same time, we

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should strive to slash pollution inventory, improve the performance of environmental pollution prevention and control, build a poisonous and harmful pollutant environmental benchmark system, and promote the fundamental shift in environmental treatment concept. We should compile and implement plans for the prevention and treatment of nuclear safety and radioactive pollution, heavy metals, and toxic and hazardous chemicals, improve our basic capabilities for risk prevention and control, clarify the base, carry out emergency and cumulative environment risk assessment, bring the environmental risks into normal management, build systematically the whole process of strict prevention in advance, strict management in the process, post-­disposal and multi-level risk prevention system, and effectively manage and control the environmental risks in key areas such as nuclear and radiation, heavy metals, hazardous wastes, and toxic and harmful chemicals, and keep the bottom line of environmental safety. We should implement the concept of “community life of mountain, water, forest, farmland and lake”, adhere to the priority of protection and natural recovery, implement the strategy of the main functional areas, demarcate and strictly observe the red line of ecological protection. Taking national ecological security pattern of ecological protection and construction as a whole, we should implement the unified planning, unified protection, monitoring and evaluation and information release, improve ecosystem stability and service function, and promote harmony between man and nature.

14.2.3 Overall Goal By 2020, the ecological environment quality will be overall improved; the total emission of major pollutants will have been greatly reduced; the environmental quality of the atmosphere, the key river basins and the water environment in the offshore areas will have been improved; the number of air quality days in the city and above will be increased to over 80%; the ratio of surface water quality at or better than class III will increase to more than 70%; the level of safe drinking water will continue to be improved; the overall soil environment quality remain stable; environment risks will be effectively controlled; the loss of biodiversity will be largely controlled; the stability of national ecosystem will be significantly enhanced; the level of ecological civilization construction will be compatible with the building of a moderately prosperous society in all respects. By 2030, the quality of ecological environment will continue to be improved, the total emission of major pollutants will have been steadily declining, the quality of atmospheric environment, key river basins and coastal waters will have been significantly improved, the level of safe drinking water improved continuously, the overall soil environment quality improved, environmental risks will be under steady control, the loss of biodiversity will be fundamentally controlled, the stability of the ecosystem will continue to increase, and the level of ecological civilization construction will be improved significantly.

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14.3 M  ajor Measures for Managing Environment Problems Affecting Health 14.3.1 Strengthening Macro-Control, and Constantly Optimizing and Promoting Green Development We will improve the macro-control mechanism for the environment, further promote the implementation of the strategies and planning for round environmental assessments, promote the “integration of the rules”, and give full play to the guiding role of the environmental standard system. The space management and control of ecological environment should be strengthened, the plan of the main functional areas be fully implemented, the red line of ecological protection demarcated and strictly observed, environmental function zones implemented, and the green and coordinated development in the regions promoted. The co-control energy resource consumption should be undertaken, by establishing a monitoring and warning mechanisms for the carrying capacity of resources and environment, controlling the total coal consumption, promoting water conservation and pollution reduction, and strictly constraining the construction land taking up green space. Lowcarbon development of the green circle should be promoted, the green transformation of traditional industries, green design and green transformation be implemented, circular economy, the energy conservation and environment protection industries developed, and the development of low-carbon industries vigorously promoted. The formation of green consumption consciousness should be promoted by strengthening ecological civilization propaganda education, increasing the effective supply of green products and promoting green consumption in the whole society.

14.3.2 Deepening Quality Management and Carrying Out an Action Plan for the Prevention and Treatment of Air, Water and Soil Pollution We will deepen the joint prevention and control of regional air pollution and establish a normal region cooperation mechanism. We will also improve the regional joint warning mechanism for severe and above polluted weather. The management of urban air quality standards should be fully implemented and the air quality of urban environment in China improved. We will also promote safety standards for drinking water sources, strengthen the management and protection of groundwater and promote the comprehensive prevention and control of groundwater overexploitation and pollution. We will launch national soil environment quality network construction, establish a soil environment quality survey and evaluation system for construction land, and carry out soil pollution treatment and repair. Arable land will be focused on and the classified management of agricultural land be implemented.

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14.3.3 Carrying Out Special Governance and Comprehensively Promoting Standardized Emission and Pollution Reduction The industrial pollutant discharge permit management will be comprehensively implemented by promoting self-monitoring and disclosure of information by enterprises, setting up sewage account and realizing the sewage discharge accredited by the permit. The elimination of technologies, equipment and products that are highly pollutant and environmentally risky will be accelerated. Special treatment for industrial agglomeration areas will be also carried out by focusing on steel, cement, petrochemical and other industries, and industry standardized emission transformation be promoted. Emissions of key pollutants will be further reduced, the total volume control system be reformed and improved, the construction of pollution-reduction projects for key pollutants in major industries be promoted, the emission of volatile organic compounds in key industries of key areas vigorously be controlled, and the regional total control of total phosphorus and total nitrogen be implemented. The construction and operation of environment infrastructure will be strengthened, and the improvement of the urban sewage treatment system will be accelerated so as to achieve full coverage of urban garbage disposal and the stable operation of disposal facilities and speed up the use of infrastructure for clean energy. The comprehensive rural environment treatment will be accelerated, the rural environment be comprehensively improved continuously, pollution prevention and control of livestock and poultry breeding vigorously promoted to fight hard against the pollution of agricultural flour sources and the control of straw and agricultural source ammonia pollution strengthened. The motor vehicle pollution control will be strengthened with strict implementation of motor vehicle emission standards and active promotion of the upgrading of fuel quality.

14.3.4 Implementing the Whole Process Management and Control and Effectively Preventing and Reducing the Sudden Environment Risk In the light of heavy metals, hazardous chemicals, hazardous wastes, nuclear and radiation, and other key industries, it is necessary to establish a management system of enterprise environment risk hidden trouble detection and risk source registration, and implement file management of the hidden environment risks. We will strengthen risk assessment and source prevention and control, establish environmental risk assessment system, ecological isolation belt and safety distance system, and gradually resettle the projects with serious ecological and environmental conflicts. We will improve the emergency management system for sudden environment emergencies, develop the big data platform of regional watershed risk and emergency, build multidirectional monitoring and warning system, implement strictly the early warning and the plan management of environment risk, strengthen the capacity building

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for emergency response to emergencies, and improve the risk prevention and response ability of emergent environment events.

14.3.5 Implementing Corporate Responsibility and Strengthening Environment Supervision and Law Enforcement We will make efforts to build a management system of “self-discipline of the enterprise, unified leadership of the government, supervision in accordance with the law by the department and extensive supervision by the society”, and establish a long-­ term mechanism to ensure that the pollution sources of industrial pollution are constantly reaching the standard, with clear tasks, clear responsibilities, clear operation standards, strong supervision, and transparent information. The environment monitoring and enforcement system of industrial pollution sources will be innovated and optimized to explore the management of excessive amount of cumulative scorecard management for enterprises, carry out the management of “red yellow card”, and regularly publish the enterprise score points and the list of enterprises which are punished by environment protection of “red and yellow card”, according to the accumulative scores. The environment violations will be cracked down on continuously and the malicious illegal acts such as emitting and discharging secretly, improper use of pollution prevention and treatment facilities, and falsifying or tampering with environmental monitoring data in accordance with the law, be severely punished.

14.3.6 Setting Up a New Concept to Develop Environmental Health Risk Prevention and Control Ability We will gradually establish a sound environment and health monitoring, investigation and risk assessment system to carry out the research on key areas, river basins, industry environment and health, make the overall plan and highly integrate all departmental monitoring systems, and establish an integrated monitoring network and risk assessment system covering pollution source monitoring, environment quality monitoring, population exposure monitoring and health effect monitoring. We will implement environmental health risk management to define high-risk areas for environment health, evaluate the impact of environment pollution on human health, and explore the establishment of a health risk assessment system for key projects in high-risk areas.

14.3.7 Strengthening Protection and Repair and Effectively Safeguarding the Health and Safety of the Ecosystem We will maintain national ecological security pattern, systematically carry out national ecological protection and construction, build a national ecological security

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barrier of “two screens and three belts”, and construct national ecological corridor and biodiversity conservation network to manage and protect key ecological areas, deepen the protection and management of key ecological zones, demarcate and strictly observe the red line of ecological protection, and strengthen priority protection and supervision of biodiversity conservation in priority areas. We will strengthen the construction and management of natural reserves, promote ecological compensation to restore ecological degraded areas, strengthen the ecological environment protection and restoration of resource development, promote comprehensive treatment of soil erosion, and improve the prevention and treatment of desertification. We will protect biodiversity, conduct biodiversity surveys and assessments, improve the biological diversity observation system, implement the protection of endangered wildlife, improve the protection of biodiversity migration, strengthen the protection of biological genetic resources, and guard against the risks of biosecurity so as to strengthen the protection, planning management of biodiversity in the course of urbanization, and publicity for biodiversity and expand public participation.

14.3.8 Accelerating Institutional Innovation and Vigorously Promoting the Modernization of Management System and Capabilities Environmental legal system should be improved, the relevant laws and regulations on environment protection be revised and improved, and the relevant legislation be promoted. Strict environmental law enforcement supervision should be carried out to improve market mechanism, establish a system of resources and environment property rights, bring a guiding role of tax policy into play, accelerate the reform of the price of resources and the environment, the cultivation of market players and market subject cultivation, and develop the green finance. Government accountability must be ensured to improve the authority of office and expenditure responsibilities of central and local governments, reconstruct the ecological environment management system, carry out environmental protection supervision tour, compile natural resource balance sheet, promote the leading cadre departure audit of natural resources assets, carry out the evaluation and assessment of ecological civilization construction goals, and establish an ecological environment damage responsibility system of lifelong inquiry. The basic system of environment management should be reformed to make the system of pollutant discharge permit system the core system of the fixed source environment management, and implement the corporate responsibility so that the implementation of the system of compensation for environment damage can be accelerated. Social supervision and public participation should be strengthened to implement the information disclosure and comprehensively promote the openness of environment information. Environmental public interest litigation and supervision of public opinion should be bettered to improve governance capacity, carry out the construction of ecological environment monitoring network and strengthen the capacity of environment supervision and management.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_15

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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“Food safety is a big issue, and drug safety is a matter of life.” The security of food and drug (including five types of products: food, medicine, health food, medical equipment, cosmetics and so on, hereinafter referred to as “Four Products and One Machinery”) is one of the most concerned about by the people, the most direct, and the most realistic problems of the interests, which acts as the important foundation to ensure and improve people’s livelihood and innovate social governance, and is the important test for the Party’s ruling ability and national governance ability to comprehensively promote the rule of law, maintain social harmony and stability, and build a moderately prosperous society in all respects. Since China’s reform and opening-up, remarkable achievements have been obtained in our modernization construction, and the rapid economic and social development. The rapid development in food and drug industry, which has become the important pillar industry of our national economy, has better guaranteed the people’s basic needs for diet and medication, and has made outstanding contributions to the people’s life from insufficient food and clothing to the overall well-off society. Since entering the new century, people have a higher expectation for a better life, and the demands for diet and medication are undergoing profound changes from quantity to quality by quickly turning “no starvation and drug accessibility” into “food safety and nutrition, medicine safety and effectiveness”, thus, the guarantee of food and drug safety has entered a new era.

15.1 C  urrent Situation and Requirements of Food and Drug Safety The CPC central committee and the State Council have always attached great importance to food and drug safety. Under the joint efforts of all places and the departments concerned, the food and drug supervision and management system in China are further improved, and the food and drug safety situation in general has maintained a steady and positive trend. At present, China’s reform is in a critical period and deep water zone, and social stability enters the risk period. With the rapid development of economy and society, the construction of public security system is relatively weak. The regulatory system of food and drug safety lags behind industrial development and regulatory needs. And due to the lack of social integrity and moral anomie, the upgraded level of social needs, social anxiety, consumer risk cognitive bias and other factors of interactive influences, there is still a big gap in China’s food and drug safety level and regulatory capacity, compared with the CPC central committee requirements and the people’s expectations. Some unsafe factors still exist in the whole process of the food and drug supply chain for a long time, and some deep-seated problems affecting the safety of food and drug administration have not yet been solved. The specialized food and drug safety supervision lacks the specialized mechanism, ability and the team to guarantee so that the highlighted stage characteristics of the high risk and the contradictions are very obvious. From the perspective of industry, China’s food and drug industry has a relatively weak foundation, which is characterized by a low degree of standardization,

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scale and intensification. And there are great difficulties in supervision and management of various small, scattered, disorderly supervision objects. At the same time, the self-discipline mechanism of industry integrity is not perfect, and the problems of “ignorance, unkindness and inability” of the production operators are outstanding. Some enterprises and practitioners have little self-discipline, low moral quality, lack of awareness of quality and safety, lack of legal awareness, lack of integrity, evasion of supervision, and even cynical, and commit crimes intentionally. From the point of view of regulation, the regulatory capacity can’t meet the actual needs, and there is still a great distance from the requirements of the modernization of national governance capability. The first is that a unified regulatory system has not yet been established. In some places, the reform of the food and drug regulatory system has been slow, even shaken and repeated. The administrative supervision teams at all levels, the supervision of law enforcement teams and technical support teams are not complete enough to adapt to the characteristics of the strong professional supervision of food and drug safety. Therefore, a unified and authoritative regulatory system is urgently needed. The second is that the most rigorous process of supervision has not yet been formed. Relevant laws and regulations are in urgent need of revision and improvement, and the supporting regulations and the relevant standards are still incomplete. The standard of regulation is not effective to the standard of production and operation. Punishment for illegal acts is not strong enough so it is difficult for the regulatory mechanism to adapt to the new situation. All these have to be reformed and improved. Regulatory approaches need to be redirected to inspection and on-site inspections so as to strengthen feasibly the prevention and the guard of strategic pass beforehand, the standardized management in the whole process, and the post inspection system disposal. The third is that the supervision and safeguard ability to adapt to practical needs has not yet been formed. After institutional reform, the food and drug regulatory system is under great regulatory pressure. Food and drug regulatory agencies at all levels, especially those at community-level, are underfunded, and with the small number of personnel, the professional quality is low. The technical support ability of inspection and test, examination and verification, technical evaluation, monitoring and evaluation, and risk warning communication is weak. Infrastructure, equipment, and information-­based supervision are backward, and the material and human support for food and drug safety problems is still weak. The fourth is that the pattern of diversified regulation has not yet been formed. At present, the relationship between government, market and society is not completely rationalized. Food and drug regulation continues to be dominated by government regulation of “walking on one leg”. Industrial selfdiscipline has not yet been fully developed, the corporate responsibility has not been fully implemented, and social supervision has not been fully activated. And social governance has not yet been achieved in food and drug safety. The “13th 5-year Plan” period will be a key stage for China’s food and drug safety supervision to climb over the hill. We must continue to work harder and improve our security capacity and can’t relax a bit.

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15.2 Overall Thinking and Development Goals We will carry out the spirits of series of important speeches of General Secretary Xi Jinping, in accordance with the unified perfect authoritative and efficient food and drug safety supervision system, and the general requirements of the food and drug safety, build a more rigorous regulation standard system, establish the whole process of stricter supervision system, perfect the supervision mechanism of more effective, tougher regulatory enforcement and more forceful supervision of security mechanism, strengthen supervision law enforcement team and technology support system construction, improve supervision by law, in accordance with the scientific and regulatory ability and level, make full use of market mechanism, give play to the role of social work, promote the supervisory ability of the food and drug safety management system and specialization, modernization, effectively prevent and control food and drug safety risks, promote the sustained and sound development of the food and drug industry, and ensure the safety of people’s food and drug use. By the end of the “13th 5-year Plan”, a unified and authoritative comprehensive management system for food and drug safety will have been established. The traditional extensive and fragmented government supervision will be turned into scientific and precise, unified and efficient social governance. The capacity of food and drug safety management has been significantly improved, and the food and drug safety situation has been steadily improved. By 2030, the supervision pattern of food from source to consumption will have been improved to form a whole variety of drugs and the whole process of the supervision chain so that we can strictly adhere to each line of defense and significantly improve people’s satisfaction with food and drug safety.

15.3 Main Tasks 15.3.1 Establishing a Unified and Authoritative Regulatory System The comprehensive coordinating role of the food safety commission and its offices, and the overall planning and assessment will be strengthened, and the construction of institutional mechanisms will be promoted. The food and drug regulatory agencies at national, provincial, municipal and county levels will be set up as a government component of this level. The capacity building of community-level supervision will be highlighted, the local regulatory agencies of food and drug in townships or regions set up, and the responsibilities of the administrative supervision and administration of food and drug in the region uniformly fulfilled. We will improve the food and drug administration, reasonably establish professional food and drug law enforcement agencies in provinces, cities and counties, and carry out the law enforcement duties of the administrative region in a unified manner. The staffing of the food and drug regulatory agencies will be further improved to enhance regulatory effectiveness. The implementation of territorial management responsibilities

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will be promoted, regulatory accountability and investigation system established and perfected, “top leader” responsibility system of local food and drug safety implemented, and food and drug safety integrated into the annual comprehensive target assessment of local government and the comprehensive assessment of leading cadres of the local governments.

15.3.2 Accelerating the Construction of a More Rigorous System of Laws and Regulations Food Safety Law of the People’s Republic of China and its implementation regulations should be revised and issued as soon as possible, Drug Administration Law of the People’s Republic of China and Cosmetics Hygiene Supervision Regulations be revised, and Regulations on the Supervision and Administration of Medical Devices be fully implemented. A series of departmental rules, normative documents and other supporting systems with the “two laws” and “two regulations” as the core are to be revised. The formulation of a system of supporting laws and regulations for the online sale of food and drug products should be accelerated. The cleaning and integration of food safety standards will be completed. The Pharmacopoeia of the People’s Republic of China and its uncollected varieties, standards issued by bureaus and ministries be comprehensively combed, and the elimination mechanism of drug standards be established and improved. The revision of the relevant standards around food and drug regulatory requirements should be accelerated. Rolling implementation of national drug and medical device standards should be made to improve the action plan. The national basic drugs, the categories of medical insurance catalogs, and the high risk varieties such as injections, biological products, eye preparation, and inhalation preparations, etc. should be focused on, and a batch of standards for drugs and medical devices should be revised to expand standard coverage, improve standards of scientization and applicability, and promote the standardized internationalization process. The technical regulations for the review and guiding principles of drug and medical device technology should be revised. The requirements for the inspection technique of in-use medical devices should be formulated. The classification and naming system for medical devices should be established and improved and the technical basis for supervision and management should be improved.

15.3.3 Reforming and Improving the Regulatory Mechanism for Food and Drug We will transform the functions of the government, deepen the reform of the administrative examination and approval system, and gradually eliminate and delegate some administrative examination and approval items. The guidance and management of local technical review bodies will be strengthened and the ability of

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local review and approval will be improved. We will reform the acceptance mode, refine the acceptance inspection standards, ensure the allocation of resources for review and approval, set up the review and approval process scientifically and rationally, and gradually resolve the backlog of review and approval. A reasonable charging mechanism for review and evaluation should be established to bring the market regulation of charging into play, reform and improve the personnel management system and strengthen the guarantee of examination and approval. The principle of risk management must be adhered to, and a system of classified and graded supervision to strengthen supervision over high-risk subjects must be established. Source supervision should be strengthened, and the monitoring and evaluation of food safety risks, adverse drug reactions, drug abuse, adverse events of medical devices and the adverse reactions of cosmetics should be carried out systematically, and the monitoring and early warning level and risk control ability should be improved. A strict system of re-evaluation of pharmaceutical medical devices should be established and implemented, and the quality consistency evaluation of generic drugs should be accelerated. The establishment of a comprehensive evaluation system for food and drug safety after the listing should be explored. The on-site inspection system which is the core of quality management system should be established and improved so as to perfect the ability to detect problems on site. The supervision and sampling inspection should be increased continuously, the coverage of food and drug sampling inspection be expanded, and the effectiveness of sampling inspection be improved. The coordination and cooperation between departments and regions should be strengthened and problem products should be disposed systematically.

15.3.4 Stricter Regulatory Enforcement Market access for edible agricultural products and the supervision over the whole process of food production, processing, circulation and catering services should be strengthened. The management systems of drugs, GLP, GCP, GMP and GSP of medical devices and GMP of cosmetics should be strictly implemented so as to strictly supervise the development, production, operation and use of drugs, medical devices and cosmetics, and establish the traceability system to ensure supply chain security. The supervision over the online sales of food and drug products and other new forms of business should be strengthened. Efforts to improve the safety of food and drugs in rural areas and other weak links should be made to promote equal access to basic public services in urban and rural areas. We will refine the regulatory measures, formulate law enforcement regulations, step up inspections, improve the enforcement of supervision and gradually achieve full coverage of the production operators, product varieties and production and management sectors. We should grasp the strong and prominent problems in the food and drug safety field, continue to carry out a special rectification and crack down on illegal food and drug offenses.

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15.3.5 Establishing a Scientific and Authoritative Technical Support System The followings should be strengthened: food and drug testing system, check and verification system, technical evaluation system, monitoring and evaluation system, early risk warning and communication system, the complaint reporting system, the informatization construction and intellectual support system and other technical support system and capacity building.

15.3.6 Improving the Mechanism for Ensuring Regulatory Safeguard of Food and Drug A safeguard mechanism to meet the actual needs of food and drug administration should be established to ensure that all levels of regulatory bodies have sufficient manpower, material resources and financial resources for the performance of their supervisory duties. The plan for the development of food and drug regulatory talents should be implemented. With the help of the national development of professional education policy, it is reasonable to set up the disciplines and specialties, expand the enrollment scale and cultivate the reserve talents. Professional education training base and system construction should be strengthened and a sound training mechanism for inspection personnel echelon should be established to generally train and improve the comprehensive quality and ability of the supervisors. A long-term mechanism for ensuring financial support should be established. The relevant construction standards should be implemented to strengthen the protection of facilities and equipment.

15.3.7 Bringing Market Mechanisms into Full Play The consciousness of the main responsibility of food and drug enterprises should be further improved to strictly implement the various management systems, actively carry out process control, strengthen supply chain management and safeguard measures, and strengthen the quality and safety management of the whole process of production and operation. Credit record construction should be strengthened by improving the credit records of the food and drug industry and the credit records of practitioners, promoting the sharing of credit information in different places and departments and the link of credit conditions to the market, and implementing the credit reporting system so as to form a market to force inversely the enterprises to obey the law. The industry associations, academic associations and chamber of commerce should be promoted to establish and improve business self-discipline specification, self-discipline convention and professional ethics, standardize the behavior of members and fulfill the responsibility of the main body. Through the government buying services from social forces, the role of professional market service organizations in food and drug testing and compliance inspection should be

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promoted. The supply of licensed pharmacists should be strengthened and the development of licensed pharmacists be promoted. We will improve the policies of the food and drug industry, guide enterprises to merge and reorganize, promote the concentration of resources in advantageous enterprises, and improve the quality and safety of food and drug products and the standardization, scale and intensification of the industry. We will explore the establishment of the enterprise compulsory liability insurance system, the harm relief system for drug adverse events and a risk-­ sharing mechanism for social relief by studying and improving economic policies such as drug pricing, bidding procurement, medical insurance reimbursement and other economic policies, and improve the incentive mechanism for improving drug quality and ensuring drug safety.

15.3.8 Actively Playing the Role of Social Supervision The incentive mechanism for public participation in supervision will be improved by opening up channels for complaint reporting, strengthening the protection of whistleblowers, and encouraging the public and industry insiders to report food and drug violations. Mass teams of food and drug administration officials, coordinators and information workers will be developed to expand social supervision and control measures. The news media should be supported to carry out supervision of public opinion and deter illegal and criminal acts. National food safety publicity week and national key campaign of drug safety month will be held to give full play to their roles as the food and drug safety experts and volunteers in widely popularizing knowledge of food and drug safety, and guiding the public in scientific and rational consumption. Food and drug safety will be integrated into the popularization of the legal system, common knowledge, vocational skills and students’ classroom education to improve the safety literacy and basic knowledge awareness of food and drug safety. Activities such as the establishment of food safety cities and the operation of good faith and consumption, etc. should be carried out. We will play a leading role in building a diversified governance structures for food and drug safety that is closely coordinated by the government, the market and society.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_16

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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16.1 O  verall Judgment of China’s Economic and Social Development Trend in 2030 From now to 2030, China’s economic level, service consumption, population development, scientific and technological progress will undergo profound changes, which will present the following main features:

16.1.1 China’s Per Capita GDP Will Be Close to the Level of High-­ Income Countries in 2020, and It Is Expected to Continue to Grow Rapidly in 2030 In the medium and long term, China is still in a period of strategic opportunities that can go a long way and the long-term economic fundamentals have not changed. However, with the changes of the external environment, supply and demand structure, factor advantage, constraint condition and potential risk, the connotation and conditions of strategic opportunity period are also changing. Economic development has entered a new normal state, and economic growth rate is shifting, structural adjustment, and kinetic energy conversion are intertwined. Economic growth is shifting from high growth to medium-high growth, to a more advanced stage, more complex division of labor and a more rational structure. In 2015, China’s per capita GDP was $7924. Considering the factors such as the RMB exchange rate, price reduction and the change of the World Bank’s standard of high-income countries ($12,736 in 2014), the per capita GDP in 2020 is expected to reach about US $10,000. The first half of the “14th 5-year Plan” is expected to cross the threshold of high-income countries. After that, the economy will continue to grow at a high speed through 2030, and the income of the urban and rural residents will continue to grow in line with GDP.

16.1.2 The Upgrade of Residents’ Consumption Structure Will Be Accelerated In 2020, the added value of China’s service sector is expected to increase to 56% of GDP, and it is expected to increase to 60% and 65% in 2030, which means the growth into a mature service economy. China is in the stage of rapid upgrading of consumer structure. The consumption structure of the residents rises along the Maslow demand curve, and the model of the consumption pattern is basically over. Traditional bulk consumption, such as living and transportation, enters the plateau. The proportion of service consumption continues to rise, and there is a huge amount of consumption and investment in the services of education, health, culture, sports, tourism, care for the aged and childcare. Currently, the total effective supply amount and supply structure of our country’s service area cannot adapt to this change, and particularly, the refined and high-quality living services are not available. The added value of health, culture, sports, tourism and other industries is far less than that of

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developed countries and some developing countries so the overseas spillovers of the residents’ demand for high-quality services is increasing. In the next 15  years, China will vigorously promote the market-oriented supply of productive services and living services, and it is predicted that the added value of China’s service industry will increase to 56% by 2020 and 60% to 65% of GDP by 2030.

16.1.3 The Trend of Population Aging Will Be Continuously Deepened By 2020, the proportion of people aged 60 and above will continue to rise steadily, and will enter a period of rapid development after 2020. Before the middle of the twenty-first century, our country will face an unprecedented demographic transition characterized by an aging population, and the aging level and growth rate will be significantly higher than the world level. With the rapid development of aging, the trend of aging population and fewer children is becoming more and more obvious. Multiple phenomena, such as empty nest, can be superimposed. The dual burden of family education and child care is increased and various aging problems are presented in the short term. These will bring serious challenges to economic and social development. We can judge that in the next 15  years, the under-5 mortality will reduce the contribution to life expectancy while there will be the improvements in the health of the elderly and the early mortality reduction. However, the middle-age group with chronic diseases will increase that contribution. In 2020 and 2030, China’s total population will rise to 1.42 billion and 1.45 billion respectively, and the life expectancy will increase to 77.3 and 79 years old respectively.

16.1.4 Urbanization Will Be Continuously Developed The proportion of urban population in 2020 and 2030 is expected to increase to 60% and 70% respectively, and China will grow into a stable urban society. In 2015, the urbanization rate of permanent residents in China was 56.1%, equivalent to the global average but lower than 83% of the US, 74% of Germany, 92% of Japan, 74% of Russia, 85% of Brazil and 63% of South Africa. According to the common characteristics of urbanization in various countries proposed by US geographer Northam, China is in the accelerated development stage of the s-shaped curve of urbanization (the urbanization rate is between 30% and 70%). In the next 15 years, our country will accelerate the new urbanization process with the urbanization as the core, the urban agglomeration as the main form and the comprehensive bearing capacity of the city as the support.

16.1.5 The Innovation Power Will Be Continuously Strengthened China is expected to become one of the 20 or so innovative countries in the world by 2020 and the innovation power is expected to continue to rise by 2030. A new

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round of global scientific and technological revolution and industrial revolution is surging and information technology, biotechnology, new energy technology and new material technology are widely permeated. A mass technological revolution in almost all areas with green, intelligent and ubiquitous features is driving profound changes in the global economy and human life. In the next 15 years, China, with science and technology innovation as the core supported by talent development, will further promote innovation-driven development strategy and the integration of scientific and technological innovation with mass entrepreneurship and innovation, create more innovation-driven priorities of the first-mover development, and continue to increase the contribution rate of the total factor productivity and technological progress. According to the forecast, with the unremitting efforts to strengthen the innovation drive, the investment intensity of research and development spending in China is expected to increase to 2.5% by 2020. The number of patents per 10,000 people can be increased to 12, and the contribution rate of scientific and technological progress can be increased to 60%, which will make China recognized as an innovative country in the world. Then the international ranking is expected to continue to rise as the innovation continues to be strengthened in 2030.

16.2 T  he Main Impact of Medium and Long-Term Development on Health Service Demand According to Several Opinions of the State Council on Promoting the Development of Health Services (No. 40 [2013]) issued by the Office of the State Council, health services are the sum of services to maintain and promote the physical and mental health of the residents, including medical services, health management and promotion, health insurance and the related services, involving drugs, medical devices, health products, health food, fitness products and other supporting industries. In the next 15 years, the total demand for health services will be increased rapidly and the demand structure will be upgraded gradually considering all the comprehensive factors.

16.2.1 Continuous Improvement and Enrichment in People’s Health Wishes with Economic Growth and Income Increase Economic growth will lead to faster growth in health spending, according to the health demand theory of scholars like Grossman. The Nobel Prize winner in economics, Vogel, has come up with an empirical analysis that for every doubling of household income, health spending will grow by 1.6 times. In the next 15 years, China will move from middle-income country to a high-income one, which will inevitably lead to a rapid increase in the diversity of health needs. Taking health care for the main body of health needs as an example and according to China Health and Family Planning Statistics Yearbook over the years, the annual growth rate of national health expenditure is close to 16%, which is significantly higher than the GDP growth rate during the “12th 5-year Plan” period. In 2015, the total cost of

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health was only 5.96% of GDP, while in 2013, most of the OECD countries were between 9% and 11%, so China’s total health expenditure is likely to increase significantly in the future.

16.2.2 Profound Changes in the Pattern of Health Needs by Industrialization, Urbanization, the Aging of the Population and the Changes in Disease Spectrum Along with industrialization and urbanization, people’s production and living habits, surrounding environment and disease spectrum have changed significantly and health effects tend to be complex. According to China Health and Family Planning Statistics Yearbook over the years, the prevalence rate of major chronic diseases in China has increased by 3–5% a year, and the average age of the ill has been reduced, which has become an important driver for the enhancement of medical service strength and the increase of medical costs in recent years. Because of the sub-health spread among the population and the increased disease awareness, preventive health, physical examination, health consultation, physical fitness, and health tourism are more popular and the public demand for health management and services is growing. Increased environment pollution and public health incidents, and increased pressure on major disease prevention and control will produce more health and safety protection needs. According to the research and measurement, it is estimated that by 2030, the proportion of China’s population aged 60 and over will be about 25%. From the historical experience, the increase of the proportion of the elderly population will further increase the demand for medical services, nursing services and health care services for the aged.

16.2.3 More Health Needs Created and Released by Advances in Science and Technology Health technology is changing rapidly. The breakthrough of life science has brought about the transformation of medical model and biological technology is increasingly showing clinical value and economic value. Research forecasts suggest that biotech drugs will account for about 30% of the global drug market by 2020. The crossed fusion of multi-disciplinary frontier technology and technology integration are creating new diagnosis and treatment methods. Medical devices and equipment have been developed in the direction of digitalization, networking, intelligence, household portability, and new technologies such as surgical robots making the diagnosis and treatment methods less invasive and accurate. Internet medical and health data comprehensively improve the perception, fusion and processing power of health information, promote the sharing and joint application of regional, institutional and personal medical information, and accelerate the development of collaborative medical and integrated services. These advances will fundamentally change the landscape of health and make it possible for more health needs.

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According to Several Opinions of the State Council on Promoting the Development of Health Services, the total size of health services in 2020 is about eight trillion yuan. China will move to high-income country from middle-income one. Considering comprehensively the factors such as GDP growth, household income growth and reasonable control of medical expenses, we have made a mid-­ term and long-term model prediction for the development of health services. With the comparison of various measurement schemes, the total size of health services in 2030 will be 16 trillion yuan.

16.3 M  ajor Challenges to the Development and Utilization of Health Services 16.3.1 The Incompatibility of the Development of Health Services with the Requirements of the Future High-Income Countries From the international experience and with the improvement of national economic and social development, the contribution of developing health services to economic structure transformation and innovation-driven development is increasing. The health industry has become one of the biggest industries in the United States, providing 14.3 million jobs in 2010 and it is expected to add 5.6 million jobs by 2020. According to our forecast, in 2020 and 2030, the added values of health industry in our country, even taking into account of the differences in the statistical calibre, are still significantly lower than the 10% level in high-income countries such as Canada, Germany and Japan, and even less than 17% in the US.

16.3.2 The More Prominent Structural Problems of Supply and Demand of Health Services At present, the health service industry structure, product quality, development model and basic system need to be reformed and promoted. Health services rely too heavily on the medical services provided by the public sector while the private sector participation is inadequate. In 2015, non-public medical institutions accounted for only about 22% of the total outpatient visits and their levels were uneven. The high level was not much and their roles were far from being fully utilized. The total quantity of health service personnel was insufficient. The configuration was unbalanced and the structure was unreasonable. Health management and the related services were not enough. The market development of health examination, health consultation, psychological consultation, health care, physical fitness, health tourism and others was not sufficient. The long-term care system had not been established, and there were shortages of health care for the aged and rehabilitation service. The overall development of health insurance lagged behind, and commercial health insurance was too weak to support the multi-level health services.

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According to the insurance regulatory commission, the average annual premium incomes of commercial health insurance in the United States and Germany are equivalent to RMB 16,800 and 3071 yuan respectively. In 2014, the per capita premium income of China’s commercial health insurance was 116 yuan, far lower than that of the average high-income countries.

16.3.3 Lack of Health Service Innovation Ability and Competitiveness The extension of health service is broad, but there is not the core innovation capability as the support. Therefore, it is difficult to develop the extension service. Presently, the core competitiveness of the industry closely related to health service is still weak in China. Taking the pharmaceutical industry as an example and according to statistics, the research and development investment of the top 50 pharmaceutical companies in the world in 2013 accounted for an average of 18% of the operating income, and the average research and development investment of pharmaceutical enterprises in China was only about 1%. Large and medium-sized medical equipment, medium and high-end medical devices and high-value medical consumables rely heavily on imports, and the overall technical level of medical equipment and devices developed and manufactured by independent research and development is not high. The intellectual property protection system is not perfect, and the enthusiasm of enterprise research and development investment is restricted. New health services such as Internet medical care are still in the market test phase, and consumption and business models are still immature.

16.3.4 The Need to Improve the Opening-Up of Health Service and the Ability of Industry Governance According to the requirements of promoting the negative list management system, China’s further opening-up of the service industry is the general trend. At present, the social capital still faces many obstacles in the health service industry, the “spring door” or “glass door” has not been completely broken. In the face of the development trend of new forms of health service and new emerging technologies, the existing standards, industry self-discipline and legal supervision are not compatible any longer. For example, it remains to be explored how to guide the healthy and orderly development of doctors’ online practice, online electronic prescriptions, online sales of the prescription drugs and online medical insurance settlement under the background of the rise of internet healthcare, and, another example, how to give full play to the use value of big data, and effectively protect the personal health privacy and data security in the big data era of health. In the face of the new situation, the traditional concept of medical institutions may need to be redefined and the regulatory mechanism needs to be reformed.

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16.4 P  olicies and Recommendations to Promote the Development and Utilization of Health Services 16.4.1 Strengthening Strategic Planning Guidance Health service industry development is a matter of national modernization level in 2030, which will adapt to the overall trend and requirements of the long-term economic and social development. The prospective and strategic planning should be made full use of, and the requirements and problems as the guidance be adhered to. From system innovation to the improvement in the policies, it is necessary to fully connect with the development of health service industry and other policies and provide clear policy guidance and stable market expectations for the various subjects participating in health services.

16.4.2 Promoting Supply-Side Structure Reform in the Health Service Sector Innovation, coordination, green, openness and sharing should be integrated into the development of health services, and the decisive role of the market in resource allocation be adhered to so as to deepen the reform, which leads the innovation and development of the big health service industry. The initiative of the government and the market should be brought into full play to focus on the aggregate supply increase. In combination with the comprehensive deepening of medical reform, the establishment of a clear, well-structured, distinct, dynamic and diversified supply system for health services should be promoted. The allocation of resources, the supply structure and the quality of supply should be improved in response to new trends such as consumption upgrading and the acceleration of new urbanization.

16.4.3 Implementation of the High-Standard Opening-Up Strategy of Health Service To comply with the new requirements of service sectors in China, we will actively integrate and participate in global health service development pattern and division of labor, effectively connect the international resources and domestic market for the development of health services, and accelerate the construction of a new system for the opening-up of health services so as to provide new impetus to the high level of the opening-up. The opening of health services in an orderly manner will be expanded and the promotion of the negative list of foreign investment in free trade zones to a wider range be accelerated, and a management system for pre-­ establishment of national treatment and negative list established. Social capital and foreign capital access will be gradually relaxed, the establishment of health service institutions and the allocation and approval of large medical equipment will be

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reduced, and the fair competition environment for all kinds of market players will be formed. We will study and formulate policies and suggestions on the opening of the medical service market with high-quality and high-end, and take the lead in breaking through the opening of non-essential medical services.

16.4.4 Promoting the Modernization of the Governance and Supervision of the Health Service Industry We will work hard to strengthen the governance system and capacity building in the area of health services, and promote the coordination and linkage of simplified administration and decentralization with decentralization, management and service in the field of health services. Laws and regulations on health services will be improved, a service standard system will be set up and standard implementation will be enforced. The supervision mechanism for health services will be improved, the local management of the whole industry will be implemented, and the middle and after-the-fact supervision will be strengthened and innovated while relaxing the restrictions on access. The convenient and efficient opportunities brought about by Internet will be seized, the construction of “Internet + government services” in the field of health service will be actively promoted, and the policies and regulations on Internet medical development will be introduced as soon as possible.

16.4.5 Accelerating the Establishment of a Fundamental System of Big Health We will coordinate the basic and non-essential health services and clarify government and market boundaries to improve the system of equalization of basic medical and health services, accelerate the signing of contract services provided by general practitioners at community-level and build a hierarchical medical diagnosis and treatment system based on the hub of general practitioners. The administrative level of public hospitals will be abolished, the establishment and management of public hospitals be reformed, an incentive and restraint mechanism consistent with the public goals be established, and the modernization of the corporate governance structure of public hospitals be realized. The basic projects of Internet medical development will be actively promoted, such as big data development of medical health, electronic health records and electronic medical record application, to realize the standardization and unified management of health information.

16.4.6 Vigorously Supporting Health Service Innovation and New Economic Development The whole industry chain, full life cycle and all-round innovation of the health service should be promoted to attach the importance to the forward and back-end

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extension of industrial chain, and form a continuous service process of health management and promotion, disease prevention, medical treatment and rehabilitation nursing. To meet the new health needs, we will vigorously develop TCM health care, physical examination, health consultation, health care for the aged, health tourism, and physical fitness. We will also promote the “Internet + health services”, the in-depth integration of information technologies and health services such as cloud computing, big data, Internet of things and mobile Internet. The creation and making of major new drugs will be promoted and the clinical application of the research results of stem cells, biochips, genomics, proteomics, and surgical robots and tissue regenerative biomedical materials will be accelerated. The standardized commercial health insurance services will be encouraged, the health insurance tax policies will be improved, and the establishment of new organizational forms such as health management organizations by commercial insurance companies will be promoted. The development of industrial agglomeration will be supported and a healthy service brand with international influence and competitiveness will be built.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_17

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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17.1 P  rogress and Effectiveness in Deepening Medical and Health System Reform Deepening the reform of medical and health system, greatly focused on by the Party Central Committee and the State Council, is an important part of comprehensively deepening reform and a major livelihood project of hearts and minds to safeguard the health and well-being of the people. After launching a new round of medical and health reform in 2009, and especially since the 18th national congress of the communist Party of China, deepening the medical reform has been put to a more important position in the overall cause of the Party and the state by means of the overall planning, comprehensive promotion, continuous improvement of the top-level design. A relatively perfect institutional framework has been established and the significant progress and mark results in deepening reform made.

17.1.1 Basic Establishment of a Universal System of Medical Insurance The multi-level medical security system with basic medical guarantee as the main body is gradually perfected, and the support capability and management level gradually increased. The number of urban residents covered by medical insurance and the rural residents participating in new rural cooperative medical care has exceeded 1.3 billion and the coverage is stable at over 95%. The subsidy by financial administration for basic medical insurance of urban and rural residents increased from 80 yuan per person in 2008 to 420 yuan in 2016. The insurance for serious diseases of urban and rural residents was fully implemented, the establishment of disease emergency rescue system promoted and the medical assistance system constantly improved. The reform of the payment system should be vigorously promoted, and the implementation of national network of basic medical insurance and the settlement of medical care in different places should be accelerated. The accelerated development of commercial health insurance should also be supported. In a relatively short period of time, China has made the largest network of basic medical insurance in the world, providing institutional guarantee for all patients seeking medical treatment.

17.1.2 Deepening Comprehensively the Reform of Public Hospitals The reform of county-level public hospitals has been fully implemented. The number of pilot cities for national contact has been expanded to 200, and the number of pilot programs for comprehensive reform at provincial level has been expanded to 11. The reform area is closely related to the three key links of breaking down supplementing doctor by medicine, innovating institutional mechanism and mobilizing medical staff. We will implement government’s leadership responsibility, guarantee responsibility, management responsibility and supervision responsibility, explore

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the establishment of modern hospital management system, promote the transformation of hospital management mode and operation mode, and focus on the establishment of a new mechanism for maintaining public welfare, mobilizing enthusiasm and ensuring sustainable operation of public hospitals. Meanwhile, we will actively promote the development of health services and hospital operation by society.

17.1.3 Promoting the Construction of Hierarchical Diagnosis and Treatment System in an Orderly Manner The establishment of a hierarchical medical system with “consultation at community-­ level, two-way referral, divided treatment for urgent and chronic diseases, and up and down linkage” must be accelerated. The capacity of community-level medical and health care services will be improved, the standardization of county-level hospitals and community-level medical and health institutions will be supported, and the training of community-level health personnel focusing on general practitioners will be strengthened. The mechanism for cooperation of labor division among medical and health institutions should be improved and the formation of a community of shared interests, community of responsibility and development should be promoted. A variety of family doctor contract service pilot and the pilot work of hierarchical diagnosis and treatment with high blood pressure and diabetes will be carried out and the comprehensive prevention and treatment service mode of hierarchical TB diagnosis and treatment will be explored.

17.1.4 Improving Gradually the Drug Supply System The management system of basic drug selection, production, circulation, use, pricing, reimbursement, monitoring and evaluation will be improved continuously, the connection between the national basic drug system and public health, medical services and medical guarantee system will be strengthened, and the centralized procurement of drugs and high-value medical supplies in public hospitals will be improved. The price negotiation strategy for some patent medicines and exclusive drug production should be improved by establishing a new order for drug production and circulation. The reform of drug prices should be vigorously promoted, and most of the actual transaction prices of drugs are mainly formed by market competition.

17.1.5 Implementing Vigorously the Public Health Service Projects The government subsidy standards for basic public health services have been continuously improved. The subsidy for basic public health services per person increased from 15 yuan in 2009 to 45 yuan in 2016 and the project category reached 12 major categories, basically covering the whole life of the residents. The coverage of major public health services has been expanded.

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17.1.6 Improving Constantly the Comprehensive Supervision System In deepening medical reform, we should focus on the rule of law to establish the medical and health supervision system with governments as the main body and all the society participating. The local and industry-wide supervision of medical and health services should be strengthened, focusing on strengthening medical and health service behaviors and quality supervision so as to improve continuously the medical and health service standards and quality control evaluation system with strengthened mid and post supervision. The results of the medical reform have been widely shared among people, and the health of people has been improved continuously. The overall health level is better than the average of middle and high income countries. The average life expectancy increased from 74.83 years in 2010 to 76.34 years in 2015. Maternal mortality declined from 34.2 per 100,000 in 2008 to 20.1 per 100,000 in 2015. The infant mortality rate decreased from 14.9‰ in 2008 to 8.1‰ in 2015. And the goals of the “12th 5-year Plan” of medical reform planning and the UN millennium development goals have been achieved in advance. The proportion of personal health expenditure in total health expenditure continued to decline, from 40.4% in 2008 to less than 30% in 2015, and higher health performance was achieved at a lower cost. With the deepening of medical reform, which involves more reform of the institutional mechanism and the adjustment of the interests of departments and parties, the difficulty in the reform is further intensified. The first is that the system of leadership and organizational implementation needs to be strengthened, but the effective linkage mechanism between governments at all levels and the relevant departments to promote reform has not yet formed. Therefore, it is difficult to form the overall resultant force of reform. The second is that the reform policy measures are not comprehensive enough, and the progress of the “three linkage reforms” is uneven. Some links fail to connect effectively, which affects the actual effect of the reform. The third is that the institutional reform needs further breakthroughs, especially the system establishment of modern hospital management, medical service price adjustment, the reform of medical insurance payment system, medicine circulation field, personnel salary system reform, the reform of talent incentive mechanism at community-­level, the weak sense of gain for the masses and the weak sense of identity for the medical staff.

17.2 R  elevant Health Systems and the System Construction Experience in Some Typical Nations 17.2.1 Financing System Britain, Germany, Singapore and other countries have established the financing system on the basis of the tax and social insurance of financing mechanisms to achieve universal health security system and it is generally adopted to pay according to the disease type, capital, service unit, total prepayment, and health performance, etc.

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17.2.2 Service Delivery Mechanism The first is that in the countries with national health service system, most of the services are provided by the government-sponsored medical and health institutions, and the primary consultation system at community-level is strictly carried out. The service of countries with social medical insurance is mainly provided by government-­sponsored medical and health institutions, and supplemented by private for-profit or non-profit medical institutions. Patients select the general practitioner of public or private medical and health institutions for the first consultation and referral. The service in the state of commercial medical insurance is mainly provided by private or non-profit medical institutions and there is no strict primary diagnosis system, while the family doctors are only “gatekeepers” in certain insurance programs. The second is that public hospitals in these countries mainly adopt service projects and wage system, and the average income of medical staff in public hospitals is higher and mainly comes from salary. Doctors are in the upper income bracket. The third is that, on the premise that the basic medical and health service needs are satisfied, medical insurance control is increasing so that the prescription behavior of doctors is basically standardized, and the space of drug circulation expense is constantly compressed. Drugs are not a major make-up source of revenue for doctors or medical institutions, but the goods procurement through public bidding by some national government procurement laws, or public procurement laws require the public medical institutions to do so.

17.2.3 Management System Britain, Germany, the United States, Singapore and other countries have experienced a process of government decentralization and the gradual improvement of the autonomy in public hospitals but the government still has to fulfill a lot of responsibilities for the management of public hospitals (including restricting public hospital behavior, and exercising administrative and supervisory power in public hospitals through legislation) by means of adopting motivation and reward, increasing the strength of regulatory scrutiny, publicly disclosing performance information of medical institutions, temporarily or permanently restricting and regulating organization’s activities, fines, direct intervention with organizational supervision, performance monitoring, inspection, investigation and others. At the same time, except in Hong Kong, the governance model of public hospitals in the above countries adopted board system, but the level and composition are different.

17.3 C  onstructing and Improving the Strategy and Suggestion of Our Country’s Health Related System 17.3.1 Financing System The government insists on the principle of health first and ensures that the government dominates the provision of basic medical services by establishing a system

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for ensuring that all people enjoy equal access to and guaranteeing adequate levels of health care, improving the multi-level medical security system supplemented by basic medical insurance as the main body and other forms of supplementary insurance and commercial health insurance, and reducing catastrophic health spending. The first is to establish a healthy financing system shared by the government, society and individuals. Firstly, based on the demand of basic medical and health services, the financial input mechanism should be linked to the performance of medical service. Secondly, taking social medical insurance as the main body, the compensation level should be gradually raised so as to reduce the personal expenditure burden of basic medical and health. Thirdly, the needs of non-essential medical and health services mainly through commercial health insurance and personal expenditure should be met. The second is that a fair, sustainable and dynamic financing mechanism for basic health care should be established. Firstly, the sustainable financing mechanism for basic medical insurance shared reasonably by government, society and individuals should be established and perfected to narrow the gaps between financing and compensation of different basic types of medical insurances and develop an appropriate insurance system with unified coverage for all. Secondly, a sustainable financing mechanism for the basic medical insurance should be established. The new rural cooperative health insurance and urban residents’ medical insurance (medical insurance for urban and rural residents) shall be paid according to a certain proportion of income by the individual quota, and government’s subsidies should be replaced by subsidies from the fiscal revenue according to a certain proportion. Thirdly, a dynamic adjustment of the basic health insurance financing mechanism should be established to make an overall planning for financial input, service mode transformation, service demand growth and other comprehensive factors, and the dynamic adjustment mechanism of basic medical insurance financing and compensation based on guaranteeing the basic, promoting the fairness and securing the bottom line should be established. The fourth, the compound payment should be practiced mainly according to the disease type, and then according to the capitation, service unit, total prepayment, health performance and so on.

17.3.2 Service Delivery System A collaborative and integrated medical and health service system with the community-­level health care institutions as the core is established based on the health needs in order to form a hierarchical diagnosis and treatment pattern, strengthen the support and guarantee capacity of personnel, drugs, supervision and other mechanisms and provide more continuous, fair, effective, high quality and better service to meet the health needs of residents. The first is to build a collaborative and integrated medical and health service system with medical and health institutions at community-level as the core. Firstly, to define the functional orientation and benefit distribution mechanism of medical

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and health institutions of different classes and different levels, build a collaborative and integrated medical and health service system and form a service mode of continuity covering the whole life cycle. Secondly, to formulate a scientific and institutionalized plan for medical and health services under the government leadership and optimize the allocation of resources to encourage social forces to develop in areas and specialties that are relatively weak in the allocation of medical resources. The second is to establish and improve a system of training and management of multi-level health personnel based on demand. Firstly, the standardized training system of clinical medicine talents of college education, education after graduation, and the continuous education of organic link should be established. Secondly, the employment mechanism of institutions of public business based on employment system and post management system should be established and perfected, and the input mechanism for health talents with government as the main body, and unit and society as the supplementation be improved to form a job performance wage system based on service quality, quantity and satisfaction degree, and establish a talent evaluation mechanism that is in line with the characteristics of the industry, scientization and socialization. Thirdly, the multi-point practice policy of physicians and a mechanism for the flow of health talents should be implemented. The third is to further improve the basic drug system and ensure that the basic drugs are safe, effective, fair and accessible. Firstly, the nature of essential drugs and their catalogues need to be further clarified at the institutional level; appropriate adjustment and expansion of chronic diseases, common diseases related with drug types, and the reimbursement directory covered in medical insurance should be done well; and a drug delivery mechanism that is compatible with two-way referral should be established. Secondly, the platform for basic drugs and non-essential drugs in the bidding and procurement should be integrated to strengthen the mutual communication between provincial drug bidding information and national bidding price information. Thirdly, the relationship between the enterprise’s active research and development, and the basic drug demand should be correctly handled in order to establish a unified scientific drug quality and price evaluation system and improve the market-based mechanism for drug pricing. Fourthly, the drug inspection and testing system, and safety monitoring and early warning level should be improved so as to speed up the legislative pace of licensed pharmacists, clarify the responsibilities of licensed pharmacists, and strengthen the quality supervision of the whole process. The fourth is to establish a comprehensive and standardized system of population health informatization that is of standardization, safety and stability, system integration, information sharing, efficiency and practicality, and real-time supervision. Firstly, the top-level design should be strengthened and the standardization and safety of the information system of population health be improved. Secondly, the development and application of information system functions should be strengthened so as to promote connectivity, efficiency and practicality. Thirdly, the mechanism for supervising the informatization of population health and realizing the real-time supervision of the information system should be improved. Fourthly, the construction of security mechanisms such as capital, manpower and policies should be intensified.

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17.3.3 Management System Taking health as the starting point, we will implement comprehensive management, coordinate the functions of departments and establish an administrative system to promote national health by fully mobilizing the initiative of all parties to achieve “health governance, universal joint construction and universal sharing”, establishing a hospital management system characterized by clear property rights, clear rights and responsibilities, separate political affairs and scientific management, exploring the effective form of the relationship between government and public hospitals, establishing the power operation mechanism for the decision-making, implementation and supervision of checks and balances, implementing the status of independent legal persons and autonomous management rights of public hospitals, and promoting the development of public hospitals. The first, in the context of the establishment of a comprehensive and integrated basic medical and health system, and a unified and coordinated administrative system, the unified “big health” administrative system will be established to meet the requirements of the health system, and realize the concept of transformation from the macroscopic implementation of “management” to “governance” around the basic medical and health system requirements. The second is to integrate health into all policies. The transformation of economic growth and social development models by friendly environment and health promotion should be carried out so as to focus on the health of key people, establish corresponding decision-making procedures and policy system, promote cooperation in various fields in forming a social security network, and bring individual and social organizations in promoting health into play. The third is to establish an open, transparent, fair, scientific and rational regulation system of the whole industry participated by government, industry organizations, and the social public. Firstly, the construction of legalization should be paid attention to and the relevant laws, regulations, rules and standards for health supervision be improved so as to make the implementation of the comprehensive information disclosed, and the health supervision of the law open and transparent. Secondly, the functions of the government should be transformed, and the boundary of the government’s regulatory functions should be clarified to encourage the participation of diverse bodies such as industry organizations and professional social groups, and realize the supervision of the whole industry. Thirdly, a long-term supervision mechanism should be established, the regulatory content and ways be determined scientifically to make full use of information technology to strengthen the supervision of the rationality of security, quality, efficiency and satisfaction, and link the evaluation results with the financing and payment. Fourthly, the training and rational allocation of health supervision personnel should be improved and the corresponding incentive and restraint mechanisms be established. The fourth is to establish a modern hospital management system, accelerate the transformation of government functions, transform public hospitals from direct management to industry management, and establish effective checks and balances. Firstly, an independent legal person status should be given in the public

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hospitals and the full authority should be given to the President. Through the formulation of laws, single policy documents, entrusted agency contracts and other forms, the relevant powers of public hospitals (such as personnel management, internal allocation, organizational structure, etc.) and the attribution are stipulated in detail. Secondly, the system for selecting and appointing the President of public hospitals should be improved, the system of responsibility for the goal of tenure should be implemented, and the supervision mechanism of various parties, such as the trade association, the National People’s Congress and the CPPCC should be improved. Thirdly, all kinds of decision-making bodies, and the mechanisms for decision-­making and coordination should be clearly stipulated. Fourthly, administrative level in public hospitals should be gradually phased out so as to implement independent recruitment, full employment, post management, and establish a quantitative performance appraisal system, the corresponding reward and punishment mechanism, and a post-performance wage system reflecting the value of labor. Fifthly, the full cost accounting should be implemented, the quality monitoring and evaluation system be improved, and the clinical pathway and single disease quality management be implemented. Sixthly, the clinical pathway and electronic medical records are organically combined to carry out the informatization management of single disease.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_18

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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18.1 F  ully Understanding the Significance of Health Human Resources to the Construction of Healthy China Health is the foundation of the all-round development of human beings and of the great significance to safeguarding national security, social stability and unity, and the economic development. Human resources are the first resource of China’s economic and social development. Health human resource is the health guardian of the people and an important support for building a moderately prosperous society in all respects, a healthy China and realizing the basic medical and health services for all. Health human resource status determines the level, ability and effectiveness of health service, and is the first resource for the undertaking of hygiene and health. Building a health human resource team of sufficient number, high quality, structure of optimization, and reasonable distribution is the foundation of our country’s continuous development of hygiene and health undertaking, and an important task to protect the health of the people. Strengthening the construction of health human resources is the overall requirement to implement the strategy of reinvigorating China through human resource development. In particular, with the deepening of the reform of medical and health system, the decisive position and role of the health talents are fully recognized, and the need to strengthen the construction of the health personnel team is becoming more and more urgent. The first is that with the development of economy and the changes of residents’ lifestyle, as well as the development of aging and urbanization, the demand for health services such as chronic diseases, public health, rehabilitation, elderly care and maternal and child health care is increasing. The second is that with the establishment of the hierarchical system of medical diagnosis and treatment, and the rapid development of information technology, the medical and health service mode and service level are deeply affected. The third is that with the globalization of health and the implementation of “One Belt and One Road” development strategy, higher requirements are put forward for international cooperation in the field of hygiene and health. All these changes have put forward the new requirements for health human resources. The talent problem is inevitable in further development of hygiene and health industry, for health talent is the health service provider and the powerful promoter of healthy China strategy. Therefore, it is necessary to further improve policies, strengthen human resources construction, arouse enthusiasm, and continuously meet the growing needs for health services of the people.

18.2 H  ealth Human Resource Status Quo and Problems of Our Country 18.2.1 The Status Quo 1. The total number of talents has increased rapidly. During the “12th 5-year Plan” period, the construction of hygiene and health personnel in China has achieved remarkable results, and the number of talented personnel has increased rapidly. The first is that the number of registered nurses is growing fastest, from 2.048 million in

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2010 to 3.241 million in 2015. The number of registered nurses per thousand population reached 2.36. The second is that the number of practicing (assistant) physicians increased from 2.413 million to 3339 million, with 2.21 per thousand practicing (assistant) physicians. The third is that the number of professional public health workers per thousand people increased from 0.54 to 0.64, especially in maternal and child health centers (stations), and mental health institutions. The fourth is that the number of general practitioners increased rapidly, reaching 1.38 people per 10,000 population. The fifth is that the number of high-level professionals has increased year by year, and the total number of medical and health research personnel has increased from 69,900 per year to 82,800 per year. The sixth is that the construction of specialized talents in pediatric, psychiatric, clinical nursing and rehabilitation is strengthened. The seventh is that the number of non-public medical and health personnel has rapidly developed, with the total number of personnel increasing from 1.397 million in 2010 to 2.047 million in 2015. 2. The mechanism of talent system is constantly improved. The policies of health personnel incentive guarantee, flow configuration and evaluation use have been innovated and improved to a certain extent. The first one is that the health personnel training system which is in line with the characteristics of the industry is basically established. The medical and educational cooperation should be utilized to deepen the reform of medical personnel training, promote the joint construction of higher medical colleges and universities, and further standardize education and schooling system for medical major. A national unified system of standardization training for resident physicians is established, and institutional arrangements have been made and implemented for recruitment, training mode, training base, training content and assessment certification. Medical education project declaration, credit granting, base certification and quality monitoring are orderly developed. The second is that the evaluation mechanism of health talents with practice as the key is constantly improved. To highlight the evaluation of clinical practice abilities, the introduction of clinical data, such as medical records, and diagnosis and treatment records of difficult diseases, the evaluation of the professional technical level of clinical medical staff, has been widely implemented in senior professional titles. The community-level professional title evaluation criteria and the evaluation system, based on the job responsibilities and the actual work, are gradually improved. The third is that the new characteristics adapting to service needs emerge in the flow configuration of health personnel. In addition to various oriented assistance programs, talent integration, medical association, flexible introduction, management in county and internship in town, special post, multi-point practice, the talent flow allocation mechanism is continuously explored and the role of market mechanism in the allocation of health human resources is gradually revealed. The fourth is that the pilot health personnel incentive guarantee mechanism that conforms to the industry characteristics starts. Through continuous research and exploration, an allocation incentive mechanism that is closely related to job responsibilities, work performance and actual contribution has been established, which has reached a consensus that the value of medical workers’ technical services should be properly reflected.

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18.2.2 The Main Problems 18.2.2.1 Talent Structure and Its Imbalanced Distribution The first is that the development of talent team construction at community-level has been slow and the gap between urban and rural talents has widened. During the “12th 5-year Plan” period, the average annual growth rate of community-level medical and health personnel is much slower than that of China’s total health personnel. The proportion of the total number of health personnel at community-level has been decreasing year by year, and the gap between the urban and rural distribution of health technicians per thousand people is widening. The second is that the progress in the construction of public health teams has been slow, with the absolute number of disease prevention and control and health monitoring teams decreasing particularly year by year. From 2010 to 2015, the number of people in disease prevention and control agencies dropped from 195,000 to 191,000, and the number of public health practitioners (assistants) decreased from 127,000 to 110,000. With the globalization of public health problems and the requirements of the diplomatic situation in China’s health field, the construction of international talents in the field of public health is lagging behind the development of the demand. The third is that due to many factors, such as the lack of job attractiveness and limited career development, qualified general practitioners are in short supply. At present, the total number of qualified doctors is 189,000, only 6% of the total number of clinicians, and there is a large gap compared with the construction requirements of the hierarchical diagnosis and treatment system. In addition, there is still a shortage of professionals such as pediatrics and the special talents in psychiatric departments so it is hard to meet the needs of medical services. 18.2.2.2 T  he Quality of Talent Training Still Cannot Meet the Demand The first is that the quality of education in colleges and universities is uneven, and the enrollment scale is too large in some local universities so the quality of the graduates is low. The proportion of practicing assistant physicians in clinical practice is 18%, which is too large while only 51.5% of the practitioners get bachelor’s degree or above and most of them have not received strict and standardized residency training. Specialist training is only explored in a very small scope and a strict and normative system has not yet been formed. Most rural doctors have not received a formal medical education before they go to work. The results show that the world’s first-class medical science and technology talents are scarce, the original innovation ability is not strong, and the research achievement conversion rate is not high. The second is that the resource distribution of talent cultivation is unbalanced, and the western region is relatively deficient in medical education resources. There are an average of 1.28 undergraduate colleges and universities for every ten million people nationwide, 1.38 in the eastern region, 1.32 in the middle, and 1.07 in the west, and the supply of medical graduates in some provinces is insufficient.

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The third is that the high-level talent is scarce, and there are fewer interdisciplinary talents. And the innovation ability of new theory and technology in medical field is insufficient. Among the high-level talents in the field of health, the number of academicians of the two Chambers, experts on special government allowances and academic leaders is far from satisfying the needs for the high-level medical innovation talents in the development of medical and health service, and the development of strategic emerging industries.

18.2.2.3 The Lack of Vitality in Talent Management System The first is that due to the lack of incentive, the pay of medical staff does not reflect professional value. The current salary level and the compensation structure do not match with the industry characteristics. As the basic salary of indemnificatory income, the proportion is low, and the standard of protected age is too low so is the epidemic prevention allowance. Professional technical posts of general practitioners, community nurses, pediatrics, psychiatric and public health professionals are not attractive. Therefore, there are still severe challenges in cultivating the top innovative talents with international competitiveness. The second is that due to the lack of autonomy, health institutions, especially community-level organizations, are unable to recruit. It is not conducive to the improvement of the service ability and level of the health organizations in the aspects of post setting, quota allocation, recruitment examination content, professional indicators and public recruitment. The third is that due to the lack of flexibility, institutional barriers restricting the smooth flow of talent; staffing, identity, unit, department, ownership and other institutional barriers still exist; The problem of innovative staffing management has not been solved; Identity management has not yet been changed to post management; The employment system of most units is of mere formality in the form. The flexible mechanism of employment that allows talents coming in and leaving is not yet formed. The fourth is that the lack of coordination cannot meet the needs of the integrated medical and health services. There is a lack of effective coordination between different functions, such as medical treatment, prevention, health care and rehabilitation, as well as hospitals, public health and health at community-level. There is a large gap between the fragmentation of medical and health services and the residents’ demands for the integrated health service mode, the comprehensive, continuous and integrated health service.

18.3 S  trengthening the Thought and Measure of Healthy Human Resource Construction 18.3.1 Overall Goals and Train of Thought We will promote quality improvement and structural optimization of health talents, establish and improve the personnel system mechanism which is in line with the characteristics of the industry, and create a good environment for talent

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development so that the sustainable development of the talent guarantee mechanism is more robust, the quality of talents greatly improved, structure bettered, and the talent distribution in urban and rural areas tends to be reasonable, which meets the need that everyone has the access to basic medical and health services, and the need for driven innovation. Job vision of talents should be broadened and adapted to health service needs. The construction of healthy China, healthy city, healthy community, healthy family, healthy school, healthy enterprise, etc. needs a lot of service personnel in health education, health promotion, and health management. In a broad sense, health talents not only refer to all kinds of professional technical personnel of health system, but also all kinds of health related production and service workers. We will make the overall development and do well in the registration, training and service of professional and technical personnel related to health service. Talent first should be adhered to and the first resource concept be strengthened. In the implementation of the healthy China strategy, we should put the construction of talent team in the priority development position, give full play to the basic role of talents, and pay attention to the investment guarantee and institutional innovation of the talent construction. Problem orientation should be adhered to and the coordinated talent development at all levels be ensured. We will pay more attention to personnel team building at community-level, public health, urgent need and health service, and the adjustment of personnel structure and policy innovation, and stimulate the enthusiasm and the creativity of the talented persons. We should pay more attention to improve service quality, talent cultivation, attraction, use and stick to it. We should pay more attention to the coordinated interaction between different institutions of upper and lower levels, different majors and functions, and form an orderly division of labor and cooperation.

18.3.2 Main Tasks and Initiatives According to the Outline requirements, the following aspects of work should be focused on:

18.3.2.1 T  he Training and Construction of the Health Workforce Will Be Vigorously Strengthened The first is to focus on the general practitioners and strengthen the construction of community-level talent team. By standardized training for resident physicians, assistant general practitioner training, general practitioner transfer training, free training for the targeted medical students of rural order and other channels, the training of general practitioners can be increased to the main gradual transition of the standardized training for general professional resident physicians. The training of medical, pharmaceutical, nursing and technical personnel in medical and health posts in urban and rural areas will be strengthened, and the quality and work level of on-the-job personnel will be comprehensively improved.

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The second is to strengthen the team construction of public health professionals. According to the factors of service population, workload, service scope and economic and social environment, public health personnel should be scientifically and rationally determined so that all levels and all kinds of public health personnel can meet the service needs. The establishment of a mechanism for the cultivation of the compound talents of public health and clinical medicine should be explored and the ability of laboratory testing and on-site disposal be improved. The cultivation and use of communitylevel public health personnel should be promoted and a coordination mechanism between public health physicians and general practitioners should be established. The third is to strengthen the construction of professionals of the shortage specialties, health services and other talents. The team construction of obstetrics, pediatric and psychiatric doctors, and the training of midwives should be strengthened. The construction of health service related personnel and multi-sectoral cooperation should be strengthened, the training for the relevant health personnel, such as aged care, rehabilitation therapists, nutritionists, psychologists, the nursery teachers, massage therapists, health management masters, sports protective masters, fitness instructors, social sports instructors and other health service personnel should be strengthened. Inheritance and innovation will be focused on, and the talent cultivation of traditional Chinese medicine through various channels be strengthened. To take the enhancement of medical innovation ability, and the medical and health care technology as the core, the platform construction of medical science and technology, and clinical database will be strengthened, and a batch of leaders with leading international standards be introduced. The specialization and professionalization of health management personnel and the level of industry management should be improved. The team construction of social sports instructors should be strengthened with 2.3 social sports instructors per 1000 population by 2030.

18.3.2.2 E  stablishing and Improving the Personnel Training System Adapting to the Characteristics of the Industry The first is to adhere to the coordination of medicine and education, deepen the comprehensive reform of education in medical colleges and universities, and establish a balance mechanism between the training of clinical medical personnel and the demand of talents in health industry. In order to increase the supply of graduates directed by demands, the macro-control of medical colleges and universities, the setting up of medical colleges and universities, regional layout, professional structure and enrollment scale should be strengthened. The education level of professional degree of medical science should be improved, undergraduate education scale of clinical medical major be stabilized, the basic capacity building of health professional education be improved, nursing education in colleges and universities be enhanced and standardized, and the professional setting and personnel training of midwife be strengthened. The quality of medical students’ training should be comprehensively improved and the differences between regions and colleges and universities be significantly reduced. The second is to establish and implement medical education system after graduation. The supporting policies for standardized training of resident physicians will

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be improved, and a comprehensive policy system for both national and local training bases be built. The subsidy mechanism will be improved and the responsibilities of local financial and training bases be put in place. The training bases and the team construction should be strengthened, and the quality of training be improved. Standardized training for specialist physicians will be carried out, and supporting policies such as financial support, degree linking, assessment and certification be improved. A group of specialists with high quality and ability should be cultivated to meet the needs of the clinical diagnosis and treatment of difficult and critical diseases, scientific research and teaching. The third is to consolidate and improve the continuing medical education for the whole staff, with the demand as the orientation. Information technology should be made full use of, the continuing education implementation methods be optimized, national open university of health and treatment construction supported, and the establishment and development of the remote medical education training platform of China mooc alliance of health and treatment supported so as to innovate education mode and management methods, promote new theories, new knowledge, new technologies, new methods, and improve the pertinence, effectiveness and convenience of education.

18.3.2.3 E  stablishing and Perfecting a Compensation Incentive Mechanism Adapting to the Characteristics of the Industry The first, it is necessary to take full account of the long training period, high occupational risk, big technical difficulty and heavy responsibility of the medical industry, and mobilize the enthusiasm, initiative and creativity of the medical staff from the promotion of salary, development space, practice environment, social status and so on. The second, the medical staff compensation system which is in line with the characteristics of the industry should be established, reflecting the value of medical personnel’s technical labor service. It is allowed that medical and health institutions break through the wage control level of the existing institutions of public business, the cost of medical service income is deducted, and the funds are mainly used for staff reward after the funds are extracted so that the proportion of personnel expenditure in business expenditure will gradually be increased, and the vitality of the medical staff be stimulated. The public medical institutions engaging in more labor, high-level medical personnel gathering, and the onerous tasks of public welfare, and the family doctor contract service besides working hours will be tilted during the performance of the approved total payroll. Medical personnel can be paid by part-­time and remunerations within the scope of national laws and regulations, and policies. The third, the performance pay system for community-level medical and health institutions will be improved, leaning toward frontline staff, especially the general practitioners by extracting a certain proportion in the balance of income and expenditure approved by the community-level medical and health institutions. In addition to the total performance salary as employee benefits and incentive fund, the overdose labor compensation mechanism should be explored

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to honor the outstanding medical staff who have been rooted in communities for a long time, and enhance the sense of honor and belonging of the medical staff at community-level. The fourth is to improve the incentive mechanism of professional public health personnel. Personnel and operation funds shall be fully arranged by the government budget according to staffing, standard of funds, completion of tasks and assessment to encourage the prevention and control of the integrated public health institutions obtaining reasonable income by providing preventive care and basic medical services. Health protection, health care measures and appropriate allowances for infectious disease prevention and control personnel should be implemented.

18.3.2.4 D  eepening the Reform of the Professional Title System and Improving the Talent Evaluation Mechanism The first is to establish and improve the evaluation mechanism conforming to the characteristics of health talents. We will stick to virtue and integrity and evaluate talents according to their ability, performance and contribution by overcoming the tendency of only educational background, professional title, and thesis, improving the evaluation mode of health personnel, giving full play to the role of the government, the market, professional organizations, employers and other multi-evaluation subjects, and accelerating the establishment of a scientific, socialized and market-­ oriented talent evaluation system. The second, the methods for promotion of professional titles and the proportion of senior positions in medical and health institutions, especially community-level medical and health institutions should be improved, and the space for professional development of medical personnel be expanded. The scientific level of the evaluation should be improved, the main role of the employer in the title evaluation be highlighted, and the authority of title evaluation reasonably defined and delegated. We will explore ways to direct the employment of high-level talents and urgently needed talents. Docking international mode, we will further optimize and improve personnel evaluation standards in nursing, midwifery, medical auxiliary services and medical and health technology, and open the channel for non-public medical and health institutions to participate in professional title appraisal. The third, according to the functional orientation and working characteristics of medical and health institutions, the evaluation criteria will be set up. For health professionals at community-level and remote areas, the hard requirement will not be made for the paper and scientific research, and the foreign language for professional title will not serve as the ability request. The evaluation criteria of general practitioners should be further improved, and their professionalism, pertinence and scientificity be continuously improved. 18.3.2.5 I nnovating and Improving the Mechanisms for Talent Flow and Uses The first is to perfect the position setting, and execute the employment of all staff. In accordance with the requirements of the medical and health institutions playing the role of public welfare and performing the functions of the organizations,

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dynamic verification of staffing will be prepared. The management mode of staffing system in public hospitals should be innovated and the management methods of staffing system be improved. The autonomy of legal persons in public hospitals, and the reduced direct management of hospital staffing system, office setting, job appointment and income distribution should be implemented so that hospitals can take an exploratory approach to open recruitment of high-level talents, professionals in shortage and persons with a senior technical position or doctorate degree, who are in urgent need of introduction. The public recruitment methods for community-­ level medical and health institutions should be improved by easing the conditions, lowering entry barrier, and strengthening the policy leaning toward the difficult and remote areas. The second is to break the restriction of household registration, geography, identity, education and personnel relations and promote the rational talent flow. Talent configuration mechanism should be innovated through the promotion of urban and rural linkage, management in county and internship in town, rural integration, flexible introduction and other modes. Registration system of physician practice should be reformed, and regional registration be practiced. Free physician practice, the sign up service between individual physicians and medical institutions or the forming of a doctor group should be promoted and standardized to let the hospital doctors spend their spare time and the retired doctors practice in community-level health care institutions or open studios. We should facilitate the flow of talents between urban and rural areas, between regions, and different medical and health institutions of different ownership, and support the medical operation by society. The third is to build a platform for international exchanges and cooperation and foster a number of international and high-level health professionals. Therefore, we will promote global health diplomacy in China by means of strengthening the team construction of foreign affairs and the international staff reserve team, implementing the plan for the introduction of high-level talents from overseas, introducing a group of internationally influential scientists, entrepreneurial leaders and innovative teams, building a base for innovation and entrepreneurship by the overseas high-­ level talents, and increasing support for high-level overseas talents.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_19

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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Our society is in the process of modernization. With economic development, social progress and rapid improvement of people’s living standards, industrialization, urbanization, informatization and internationalization are gradually increasing. Aging problems are getting worse. Health and well-being in the national economic and social development are great challenges and opportunities. After nearly 30 years of rapid development, China has made remarkable achievements in healthcare. However, it still cannot meet the growing health needs of the people and faces many difficulties and challenges. The main problems lie in the following aspects: The first is to accelerate the transformation of the health mode. The second is the deterioration of the ecological environment has become an important factor that threatens the health of our people. The third is that there is fragmentation of preventive care strategies and preventable risk factors are not effectively controlled. The fourth is that there is inadequate provision of health services and the development of healthcare lags behind economic development and cannot meet national needs. In 2015, the Chinese Academy of Engineering launched the “Research on the Mid—and Long-term Development Strategy for China’s Engineering Science and Technology 2035”, studied and put forward the engineering and technical issues in medicine that need to be resolved in China’s new economic and social development stage and form. Among them, the technical directions of the top ten important comprehensive indexes to have been achieved before and to be achieved by 2030 are as follows: research on the discovery of new drugs in pharmaceutical engineering and the key technology in pharmaceutical engineering; the research and development of new-generation antibody engineering drugs; the protection of traditional Chinese medicine resources and advanced pharmaceutical and efficacy evaluation techniques in the field of traditional Chinese medicine; new technology and applications of cell and tissue repair, and organ regeneration in regenerative medicine; community-­oriented big health data and intelligent health management system in integrated medicine and medical information technology; precise diagnosis and efficacy evaluation techniques based on molecular detection and molecular imaging in biological and molecular medicine; infertility treatment system optimization in reproductive medicine; food safety prevention and control identification system and safety control technology in preventive medicine; new diagnosis and treatment technology based on sound, light, electricity in biophysical and medical engineering and chronic disease prevention and control engineering and key treatment technology in disease prevention and treatment. Based on this, the major areas of key technological innovation and achievement transformation in 2030 and their impact on health needs and supply are described below.

19.1 I nnovation of New Drugs and Breakthroughs in Key Technology of Pharmaceutical Engineering With China’s rapid economic and social development, there has been the continued rapid growth of the pharmaceutical industry. China has become the largest emerging pharmaceutical market in the world. In the next 10 years, the total output value of China’s pharmaceutical industry will grow at a CAGR (Compound Annual Growth

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Rate) of 22% and is expected to become the second largest pharmaceutical market in the world by 2020. Technological innovation and variety innovation of drug development are the eternal theme and the motive power of the development of the pharmaceutical industry. The breakthroughs and transformation of major technologies represented by biosynthesis, targeted drug delivery, precise drug therapy, reprogramming of small molecule-based regulation of somatic cell, broad-spectrum anti-multidrug-resistant bacteria, broad-spectrum antiviral drugs, pharmaceutics of genetically modified animals, drug research based on system biology, new-­generation antibody engineering pharmaceutics, etc. can effectively solve the common key technical problems of new drug research and pharmaceutical engineering, including the efficient acquisition of complex structural compounds, the industrialization transformation of drug research and development, the drug orientation and the precise treatment by drugs, which can truly overcome the bottleneck factors restricting the discovery of new drugs in China. While enhancing the innovation capability of the pharmaceutical industry in China, they will greatly enrich innovative varieties with market competitiveness, enhance the overall level of the pharmaceutical industry both in terms of capability and market, and promote the sustainable development of the industry so as to significantly improve the supply capacity of health security.

19.2 B  reakthroughs in Key Technology of Traditional Chinese Medicine The first is that the protection of traditional Chinese medicine resources will be strengthened. The project of resource conservation of wild Chinese herbal medicines will be implemented. Endangered wild medicinal plant and animal protection zones will be established. A base for cultivation of wild Chinese medicinal materials, and cultivation and breeding bases for rare and endangered Chinese medicinal herbs will be built. A national-level medicinal plant and animal seed resources base will be established; Quality assurance project of Chinese herbal medicines will be implemented. Quality management and quality traceability system will be established in the entire process of Chinese herbal medicine production and distribution. The second is that standardized cultivation and breeding of Chinese herbal medicines will be improved. The system of origin mark of Chinese herbal medicines will be established and perfected. The green development of Chinese herbal medicine planting and breeding industry will be promoted and the scale and standardization will be improved. The promotion of traditional Chinese medicine industry in under-­ developed areas will be implemented and local economic development will be promoted. The third is that Chinese medicine industry will achieve transformation and upgrading. Chinese medicine industry will achieve digitalization, networking, intelligence and standardization. The manufacturing level of Chinese medicine equipment will be significantly improved. A group of internationally competitive famous medicines will be nurtured. Large Chinese medicine enterprise groups and industrial clusters will be gradually formed. The green industry system of a rich variety of emerging traditional Chinese medicine will be built.

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19.3 B  reakthroughs in Key Technology of Regenerative Medicine With the rapid development of regenerative medicine for the purposes of rehabilitating and rebuilding tissues and organs, research on regenerative medicine will gradually move from the laboratory to the clinic and become industrialized, which is getting closer and closer to our daily life. As the first largest populous country in the world, China has an extremely high incidence of tissue or organ damage or dysfunction every year, which not only poses a serious threat to people’s health, but also requires hundreds of billions yuan in annual medical expenses. Every year, 1.5 million people in China need to be transplanted for terminal organ failure. Only about 10,000 people can have organ transplants. The ratio of organ demand to the number of deliveries is 150:1, whereas the global average according to WHO statistics is 20–30:1. It is 5:1 in the United States and 3:1 in the United Kingdom. The number of organ transplants in China is far below the world average. There is a major national demand for the repair and regeneration of cells and tissues, bringing new hope to hundreds of millions of patients. Innovative theories and key technologies (products) will be established to fundamentally improve the level of treatment for tissue repair and regeneration in China, and the new treatment technology will change the medical treatment of alleviating the suffering of patients and simply prolonging the life, be able to replace and repair defective tissues or dysfunctional organs and greatly meet the patients’ needs for better quality of life.

19.4 Breakthroughs in Key Technology of Precision Medicine The application of gene editing tools for the treatment of various genetic diseases caused by gene mutation or deletion has become a key research area of medicine in the twenty-first century. With the emergence and maturation of a number of innovative technologies, gene therapy will usher in a period of rapid development in 2030. The single-gene genetic disorders with clear pathogenicity are expected to become the first to achieve the healing effect through gene therapy. In addition, the establishment of China’s big data platform of cancer and the development of gene panels for the precise diagnosis and treatment of cancer patients in China can provide a good platform for the research and development of China’s targeted therapeutic drugs for the patients and vigorously promote individualized treatment of cancer, and will become major innovative technology with important clinical transformation value in 2030 and drive the development of related medical industries.

19.5 B  reakthroughs in Key Technology of Reproductive Medicine At present, China has become the country where the number of test-tube babies born each year is the highest. The incidence of infertility will continue to show a significant upward trend due to lifestyle, diet structure and environmental pollution,

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etc. The current difference is that the incidence of birth defects, mutations, etc. is also significantly increasing. Therefore, reproductive medicine will face new challenges such as an increase in the number of diseases, an increase in the number of disease types, the diversification of the causes of morbidity, etc. After the key technical breakthroughs and achievements transformation in the field of reproductive medicine, the first is to reduce the incidence of infertility in China, improve the reproductive health level of Chinese population and achieve true human family planning; the second is to effectively reduce the incidence of birth defects and effectively prevent the incidence of progeny inheritance of mitochondrial diseases; the third is to promote the application of precision medicine in the field of female cancer prevention and treatment.

19.6 B  reakthroughs in Cognitive and Behavioral Science and Technology The first is that the molecular genetic mechanisms of mental illness are well established, the demand for definitive etiological diagnosis and targeted therapies for the patient population and potentially susceptible and high-risk populations will be greatly increased. The supplier’s investment will subsequently focus on diagnostic and therapeutic technology development. The breakthrough of molecular imaging technology, the application of neurosurgery technology and drug development and the development of nerve repair technology will greatly improve the level of diagnosis of mental diseases and guarantee the treatment of refractory mental disorders, and will further improve the screening, treatment and management level of mental disorders in China, and effectively reduce the risk of mental illness. The second is that as the aging problems get worse in China, dementia and incapacity of the elderly will become serious social problems that the government and the public must face and solve. The application of new technologies for prevention and control will greatly solve the problems of dementia and incapacity arising from aging and lift the social burden. The third is that advances in neuroscience will play a significant role in promoting the development of artificial intelligence, especially advanced artificial intelligence.

19.7 T  echnological Breakthroughs in the Prevention and Control of Chronic Diseases In the prevention and control of chronic diseases, the main task is to establish artificial health environment and health network support system. The first is that, in accordance with the Notice of the State Council on Issuing the Air Pollution Prevention and Control Action Plan (No. 37 [2013] of the State Council), a series of effective technologies for air pollution prevention and control will be developed. Enterprises such as steel, building materials, non-ferrous metals, petroleum and chemical industries will take strict measures such as cleaner production process and

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supporting facilities such as dust removal, desulfurization and denitrification to control emissions of air pollutants or technological transformation and greatly muffle the impact of air pollution on human health. At the same time, it will guarantee the long-term development of the environmental protection industry. The second is that technology transformation of food safety control can minimize the food contamination caused by various harmful factors and minimize the impact of various hazards on consumer health, and in particular, reduce the risk of rise in chronic diseases. The third is that precision nutrition intervention technology will have a positive impact on the development of agriculture, food processing industry and healthcare products industry, form a nutrition demand-oriented agricultural production and food processing mode, build a supply chain system of healthy food, and finally achieve precise prediction of nutrition-related diseases, and prevent or reduce the incidence of chronic diseases through reasonable nutrition. The fourth is that a breakthrough in the management of chronic disease prevention and control technology will inevitably establish an effective chronic disease prevention and control mechanism to improve the control of chronic diseases, significantly muffle the impact of chronic diseases on the health of residents, and further improve the life expectancy per capita.

19.8 T  echnological Breakthroughs in the Control and Prevention of Infectious Diseases The first is that the technology transformation of infectious disease prevention and treatment will greatly improve the diagnosis and treatment of infectious diseases, reduce the incidence and mortality of major infectious diseases, and improve emergency monitoring and early warning of emerging infectious diseases. The second is that broad-spectrum vaccine will be expected to be first used for the prevention of major infectious diseases and influenza. According to the statistics of Centers for Disease Control and Prevention of the United States, the ratio of the costs for the treatment of some diseases to vaccination costs is 27 to 1. Vaccination will save a lot of treatment costs. There will be more room for growth in the domestic vaccine market. With the implementation of the preferential approval system for innovative drugs, the vaccine industry will be more vigorous in innovation. It will not only be able to respond effectively to the prevention and treatment of common infectious diseases and emerging and sudden infectious diseases, but also respond actively to the rapid growth of chronic disease prevention and control needs.

19.9 K  ey Technological Breakthroughs in the Innovation of Advanced Medical Equipment Medical equipment is the most important basic equipment in the medical service system and public health system construction. With the continuous improvement of China’s technological innovation capability, the technological level of independent

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research and development in medical equipment industry will be improved. Industrial restructuring and upgrading will be promoted. New economic growth points will be fostered. It will be also the key engine that will give birth to a new round of healthy economic development. It is highly strategic, leading and growth-­ oriented. In the next 15 years, “digital, networked, intelligent” will be the development characteristics of medical equipment. Early diagnosis, accurate diagnosis, minimally invasive treatment and precise treatment of diseases will be gradually realized. Personalized treatment programs are formed based on advanced molecular diagnosis, early warning and treatment strategies. The level of diagnosis and treatment will be remarkably enhanced. People’s health will be significantly improved. Among them, the development of mobile medical and wearable devices will fundamentally improve the efficiency and quality of medical information transmission and treatment, and diagnosis and treatment will be further carried out outside the hospital to fundamentally improve the medical treatment mode and promote the formation of an efficient and healthy management mode.

19.10 B  reakthroughs and Improvement in the Theoretical System of Medical Big Data and Integrated Medicine Breakthroughs in medical big data will eventually lead to the cross-regional settlement of medical insurance, break the barriers of information between medical treatment, prevention, community health, etc. and lead a medical revolution from disease prevention, diagnosis and treatment to health management. The health revolution will play an important technical support role in building a healthy China. Meanwhile, the application of information technology in the field of health will drive the development of related industries. The popularization and application of integrated medical theory will surely bring tremendous influence and change for China’s medical system and even medical education.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_20

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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With the construction of health information service system in the past 10 years or so and the rapid development of information technology and the Internet, the development trend of cross-border integration has been highlighted. Many new industry types have emerged such as smart manufacturing, online consumption and mobile healthcare. These new industry types are profoundly influencing and changing the organization of large-scale social production and people’s lifestyles. In the next 15 years, the cross-border integration of information technology and the Internet will continue, but what will be the trend? What changes in people’s health needs will take place when this trend is superimposed on the steady increase in urban and rural income levels, moderate population growth, aggravating population aging problems and other factors? What impact will these changes have on the health service supply and the development of the whole health industry? To sort out these issues will be of great significance to advancing the construction of “healthy China” and to the coordinated development of China’s economy and society and the attainment of the goal of “200 Years.”

20.1 D  evelopment Trend of Cross-Border Integration of Information Technology and the Internet According to the current development and application of information technology and the Internet, information technology and the Internet will have all been integrated and developed across borders by 2030,. “Smart +” “Virtual Technology” “Mobile Wearable Devices” “Quick Data” “Additives Manufacturing” and “Overall Plans” will become the main theme of future development.

20.1.1 “Smart +” Will Become the Motive Engine of Industrial Upgrading and Transformation “Smart +” will be an in-depth extension of “Internet +” and the next stop. Smarter machines, smarter networks and more intelligent interactive platforms will create smarter models of economic development and social ecosystems. “Smart +” will accelerate the integration of the physical world with the digital world. The trend of interconnection and interoperability will have an important impact on business models and industrial economy in many aspects. The combination of smart + industry will make hardware, networking and interaction more intelligent, and become the motive engine of industrial upgrading and transformation. Internet, Internet of Things, Cloud Computing, Big Data and other technologies will be rapidly developed. Upgrading manufacturing industry will be accelerated. Manufacturers, service providers and Internet users will interact with each other through network platforms. The factories of intelligent interconnection will become the main form of manufacturing in the future. Manufacturers and users (consumers) will achieve zero-distance connection.

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20.1.2 “Virtual Technology” Will Bring Convenience to the Real World Large-scale manufacturing. How to carry out large-scale technical training will be a tricky problem in the field of large-scale, intelligent and highly complicated manufacturing industry. The VR + AR approach will address the challenge by using digital virtual reality to replicate an ongoing manufacturing process that is dynamically presented in three dimensions and combined with the worker’s actual training course of AR so as to reduce costs and improve the efficiency. Online retail. The first is that the physical channels will gradually disappear. With the help of VR  +  AR, the product provider will provide the user mainly online with a dynamic three-dimensional model of a specific product, thus rendering the physical store insignificant. The second is that the rise of virtual goods. With the large-scale application of VR + AR, people’s definition of commodities will blur the boundaries between the real and the virtual. For some products, having real physical goods may not be the first choice for consumers. The virtual three-dimensional model will be better able to attract the attention of consumers. Healthcare. Virtual reality and augmented reality will also have the same dramatic impact on the health industry, leading to major changes in health services. Taking general surgery as an example, the future scene will be like this if the VR + AR technique is added: First, a 3D model of the patient will be drawn with details that are specific to the various tissues, organs, etc. that affect the operation; next, Technology, doctors will begin their initial consultation on this model based on AR; Finally, the operation will be conducted and other things will be done to achieve success.

20.1.3 “Fast Data” Value Will Continue to Be Developed and Utilized In the future, more and more enterprises will choose to construct real-time computing framework for big data in order to obtain real-time insights into the data. The concept of “fast data” will emerge as the times require. Fast data will be a near real-­time data flow around the supply chain that gives parties (raw material suppliers, manufacturers, etc.) greater awareness of the needs and changes that come from end-users of the product, and will facilitate enterprise growth in four ways: Enterprise customer experience will be improved; Business operations will be optimized, Business resources will be optimized; Business services will be expanded. For the health industry, on the one hand, “fast data” will be very much in line with the real-time monitoring of the health industry and provide people with real-­ time health and medical monitoring and services. On the other hand, with the support of “fast data” technology, the healthcare industry will be able to integrate and optimize existing resources and improve operational efficiency.

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20.1.4 “Addictive Manufacturing” Will Promote the Development of Personalization and Customization With the integrated development of information technology, the Internet and manufacturing, the emerging rapid prototyping technology of 3D printing (also known as “additive manufacturing”) came into being. At present, 3D printing equipment has been applied to varying degrees in aerospace, automotive, consumer electronics, medical and other fields. Its functions range from the earliest display and teaching expansion to the manufacture of industrial molds and even the direct manufacture of spare parts. It is estimated that 3D printing technology will mature by 2030 and is expected to replace some traditional large-scale manufacturing enterprises. A large number of localized micro-factories with modern production capacity will emerge. Studies have shown that 5% of consumer products will be produced by using 3D printing. Meanwhile, as they become cheaper, more powerful and easier to use, 3D printers will also have access to ordinary consumers’ lives, allowing people to print at home to cater to their needs. In the health industry, 3D printing technology will be more widely used due to its advantages of personalization, small batch and high precision. In particular, the continuous development of 3D printing and biotechnology is expected to create organs and tissues of the true size of human beings, provide strong support for organ and tissue transplantation and alleviate the shortage of real organs and tissues in the human body.

20.1.5 “Intelligent Hardware” Will Provide a Full Range of Instant Services Intelligent hardware is a product of information technology and the integration of “Internet +” with manufacturing. With the development of smart technology and the full interpenetration of big data and Internet technologies, smart hardware devices will provide a full range of instant services for human life. To be sure, the future development of intelligent hardware will be presented in a blossoming pattern led by leading enterprises and many innovative science and technology enterprises. Mobile medical and intelligent home will become two important areas for the development of intelligent hardware applications. It is estimated that by 2030, the intelligent hardware in the field of healthcare will be greatly developed and the market has great potential. Advances in sensing technologies, artificial intelligence algorithms and other technologies will make wearable mobile smart devices a powerful defense against human chronic diseases.

20.1.6 “Overall Plans” Will Change the Traditional Industries’ Operating Mode “Overall plans” will be a major change in the field of modern business services after the highly integrated cross-border development of information technology and the

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Internet. It will be based on consumer demand and provide customers with “one-­ stop” service. As far as the health industry is concerned, with the integrated cross-border development of information technology and the Internet, the traditional health industry will be redefined to form the concept of “big health industry” (that is, the sum of activities such as maintaining health, restoring health, promoting healthy product production and service delivery and information dissemination). Under the concept of “big health industry”, service providers will provide users with “Big Health” overall plans specific to each user’s own living environment, personalization, customization, and lifelong healthcare and medical services instead of a single product, service, or treatment.

20.2 I mpact of the Integrated Cross-Border Development of Information Technology and the Internet on Health Needs and Supply Modes 20.2.1 Impact on Health Needs The first is that consumer health awareness will be enhanced. The development of information technology will make consumers tend to diversify their access to health information. On the one hand, the cross-border integration of information technology and the Internet will give rise to an explosive development of new media. Consumers will have more channels to access information. It will also be more convenient. On the other hand, there will be more and more channels for public health agencies and medical personnel to spread health knowledge. Medical institutions, medical personnel, etc. will successively set up accounts in the name of the unit or individual to answer questions related to diseases and regimens and provide medical and health solutions for some common diseases. New technology tools and communication platforms will enhance consumers’ health awareness. The development and popularization of new media forms and applications represented by the Internet, mobile terminals, cloud computing, etc. will make the access to health information more timely, anywhere and as you wish. Consumers will begin to pay attention to healthy and environment-friendly food, clothes, houses, other goods and transportation. Health awareness will be significantly improved. The second is that consumers will turn from passive treatment to active prevention. They will take the initiative to prevent diseases through new media. Diversified new media channels will allow consumers to actively search for and focus on disease information they need. Myopia, cervical spondylosis, sub-health and other diseases will be prevented in advance. There will be an increasing demand for preventive healthcare. Health management will be enhanced and physical fitness improved through smart devices. With the development and large-scale application of IoT technology and smart devices, there will be the trend for “sun movement” and “sun health” among

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consumers. Subtly, consumers will consciously or unconsciously get more physical training, strengthen their health management and enhance their physical fitness. Disease prediction through personal databases will be strengthened. With big data technology, consumers will be able to monitor trends based on signs (such as heart rate, pulse rate, respiratory rate, body temperature, blood pressure, blood glucose, hormones, BMI, etc.). According to the changing trend, some common diseases such as hypertension and heart disease will be given timely warning and prompt treatment. The third is that consumers’ online demand will increase. Online medical treatment will replace traditional hospital treatment. At the consumer level, online medical treatment will greatly alleviate the problem of information asymmetry, avoid the time-consuming queuing, improve the efficiency of medical treatment and the availability of high-quality medical resources. At the practitioner level, increased online demand will increase the chances for doctors to practice more and help to increase their current income and arouse their interest in diagnosis and treatment. At the medical institution level, the increase of online demand will directly affect the operation and benefit of the hospital. Medicine will be bought online but not in the traditional pharmacies. For consumers, thanks to the convenient and quick online purchases of medicine, they can quickly find out drug information, make price comparison, consult drug information and see if they support medicare reimbursement, so online purchases of medicine will be the preferred drug purchase channels for consumers in the future. For traditional pharmacies, the development of cross-border integration of information technology and Internet will accelerate the decline of pharmacy business and force traditional pharmacies to choose to cooperate with third-party providers or open up online businesses. The fourth is that the overseas demand for Chinese medicine will have great potential. International medical treatment will be convenient thanks to online medical treatment. At present, the new model of medical services such as telemedicine, mobile medicine and smart medical services will start to build a medical information sharing service system integrating medical imaging records, laboratory test reports and other health records. This system will make it possible for foreign consumers to obtain the online services of Chinese medicine practitioners without leaving home, stimulate the interest of foreign consumers in Chinese medicine and significantly increase the amount of Chinese medicine clinics available. TCM reliability will be guaranteed. At present, there are many objections to Chinese medicine in the international arena due to the fact that TCM treatment data is insufficient, subjective and unreliable. In the future, relying on big data technology for patient cases, prescriptions, past medical conditions and other data processing, statistics and analyses, doctors will find the regularity of diagnoses and prescriptions adopted by Chinese medicine experts to improve data support and diagnostic reliability for traditional Chinese medicine treatment. There will be improved controllability of the quality of Chinese herbal medicine. The recognition of the quality of Chinese herbal medicines is not high at home and abroad at present. It is generally believed that there is the abuse of Chinese herbal

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medicines pesticides, chemical fertilizers, and excessive levels of heavy metals. In the future, based on the Internet of things, the Internet, cloud computing, big data and other information technology to establish a quality traceability system of Chinese herbal medicines, planting, processing, circulation of the whole process will be traceable. By tracing, consumers will be able to freely find the dates of planting Chinese herbal medicines, planting conditions, planting units, harvest dates and other information to improve the credibility of the quality of Chinese herbal medicines and increase sales.

20.2.2 Impact on Supply Modes The first is that medical service system will be rebuilt through cross-border integration. Cross-border integration will promote reasonable allocation of medical resources. On the one hand, the flow of medical services will be optimized. The professional division of service system will be achieved. Efficiency of resource utilization will be improved. By 2030, the new medical service system relying on big data technology will realize the integration of hospitals, doctors, clinics, financial security and the vast majority of patients. On the other hand, cross-border integration will shift the traditional “hospital-and-doctor-centered” medical service model to a “patient-centered” model of healthcare delivery. Cross-border integration will assist hierarchical medical system. Cross-border integration will be conducive to optimizing the layout of medical resources, improving the utilization efficiency of high-quality medical resources, and accelerating the implementation of the hierarchical medical system. Firstly, the Internet technology will help achieve primary care. In the future, treatment of a lot of patients with common diseases and stable frequently-occurring diseases, long-term health management, and disease follow-up care will be completed in the primary healthcare institutions. Secondly, regional medical resources sharing will be achieved. On the one hand, the resources of hospitals at Grade 2 and above will be open to primary healthcare institutions; on the other hand, third parties can establish information platforms. Third-party independent inspection agencies can be established. All these resources can be opened to the primary medical and health institutions through the Internet to achieve regional resources sharing. Thirdly, information sharing will be achieved. Through the establishment of the data platform, an orderly two-way referral, separation of treatment of acute diseases from treatment of chronic diseases, and effective linkage up and down will be achieved. Fourthly, doctors will use Internet technology to improve the level of primary medical services. The second is that cross-border integration will help create pharmaceutical industry 3.0. Cross-border integration will help develop innovative drug research and development tools. Information technology research and development platforms such as Laboratory Information Management System (LIMS) will be established through the development of computer-aided drug design, simulation screening, drug evaluation, structural analysis, comparative research, quality control and optimization of pharmaceutical technology.

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Integration of cross-border development will improve the automation and the level of information of the production process. The new generation of information technology and its cross-border development with the Internet can effectively improve the automation, digitization and networking of pharmaceutical equipment and enhance the function of information upload and control and the interconnection of Netcom. The wide application of information technology such as industrial internet, internet of things, big data and cloud computing can effectively and more widely acquire and mine the data and information of the production process and provide support for the automatic optimization and decision-making of the production process. Big data will boost quality management. The cross-border integrated development of a new generation of information technology and the Internet will provide a strong technical support for enhancing the level of quality management. Based on the integration of the two, production quality information real-time monitoring system will be established to achieve automatic collection, management and traceability of quality data. The intelligent control system based on “Process Analysis Technology” (PAT), which will be developed and applied based on the integrated development of both, can realize early warning of mass deviation and maximal limit, regulation and reduction of the operation of employees, promote the strict implementation of GMP, and effectively ensure the stable product quality. The third is that health management will help personalized medicine. Personal health databases will be the basis for personalized medicine. By 2030, smart wearable devices will achieve 24 h a day of continuous monitoring of blood glucose, blood pressure, blood oxygen and other monitoring data collection and have them sent to the cloud for storage and analyses. The data will form a personal health database. Doctors who log on can analyze real-time data of the personal health records and help individuals with health management. Once there are data perturbations or possible variations, the database will alert and the doctor can then conduct comprehensive, professional and timely analysis and treatment guidance through video for individuals. If medication is needed, the message will be immediately transmitted to the nearest pharmacy, from which the drug will be delivered to an individual. If there is a more serious abnormality, smart wearable devices will automatically be connected to the nearest hospital to help individuals arrange ambulances, during which multiple medical history, ECG, blood pressure and many more will be sent simultaneously to the doctor’s library of cases. Chronic diseases will receive personal monitoring. The advantage of big data technology is that it will realize life-cycle management of individual health and access to relevant information anytime, anywhere, and ensure the integrity, connection and privacy of personal health information. Relying on big data technology and cloud platforms, users can always update their own dynamics of health and diseases. Some patients with chronic diseases can fully realize the monitoring, evaluation, management and intervention of diseases. Personal health databases will drive the realization of “precision medicine.” In the future, big data technology will make the description of personal health status changed from being subjective to being accurate, smooth and continuous. When the

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patient is getting medical treatment, it will be the data rather than the patient that tell the doctors about the medical conditions of the patients. The efficiency of the doctor’s diagnosis and treatment will be improved. Precise medical treatment will be achieved. The fourth is that cross-border integration will create a new mode of health security. Internet insurance will increase consumer health security. New internet insurance based on internet and big data technology is called the mainstream service in the medical insurance field. This insurance service will provide commercial insurance plans for patients in the form of health fund + health insurance. Meanwhile, the advantages of internet insurance lie in the rewards of real-time data funds, which will enable patients to effectively manage their health. Smart pension platform will provide a full range of medical and nursing services for the elderly. Relying on wearable smart devices and cloud computing technologies, future smart pension platform will cover several major modules such as medical care, nursing care, housekeeping services, community and online shopping malls, provide for the elderly family doctors, chronic disease management, escort/nursing care, emergency alarm, network hospitals and other services. The specific operation mode will be as follows: the elderly can upload the real-time data recorded to the cloud by wearing the wearable intelligent monitoring equipment, and the family doctor and their children can view the data information on the cloud platform at any time so as to monitor the health status of the elderly and provide timely treatment.

20.3 Policy Recommendations 20.3.1 Establishing a Mechanism of Synergy and Promotion The guiding role of the government will be given full play to. The mechanism of synergy and promote will be established and improved. Efforts will be made to fully utilize the existing resources. The first is that the communication and coordination between the NDRC, the National Health and Family Planning Commission, the Ministry of Industry and Information Technology, the Ministry of Commerce, the State Food and Drug Administration, the State Administration of Traditional Chinese Medicine and other departments will be strengthened and the mechanism of synergy and promotion will be established and improved. Work force will be coordinated and jointly plans will be made to promote the development of the health industry, especially the development of Internet medical top design. The second is to give full play to the role of commercial operators and various venture capital funds such as telecom operators, banks, IT companies and insurance companies to establish an interest distribution mechanism to promote the full utilization of existing resources and improve the efficiency of resource utilization. The third is that the role of medical intermediary organizations will be given full play in areas such as medical and health services, informatization and the Internet to speed up the construction of Internet pharmaceutical intermediary organizations, guide the development of industry self-discipline and create the environment of fair play.

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20.3.2 More Support for Policies Relevant resources will be coordinated. The formulation of relevant industrial policies will be accelerated. More support will be given to policies of medical and health services based on information technology and the Internet. The first is that the formulation of health industry policies and fiscal and tax policies based on information technology and the Internet will be accelerated to provide the basis for industry investment and industrial development and stimulate investment vitality. The second is to explore and set up a guidance fund for health industry policies based on information technology and the Internet. More support will be given to investment in R & D and production of special equipment, upgrading of equipment and information systems in medical institutions, construction of Internet hospitals, software development, personnel training, construction of cold chain logistics and distribution system, and infrastructure construction in health base, road traffic and communications, etc., and other aspects. Efforts will be made to strive to solve the hardware and software factors constraining industrial development. The third is that the financing channels will be broadened. Financing costs will be reduced. The development of health industry venture capital funds and equity investment funds will be encouraged based on information technology and the Internet. Eligible internet medical companies will be supported to go public for listing and financing at home and abroad and issue various debt financing instruments.

20.3.3 Accelerating the Construction of Multi-Level Information Sharing Platform The advantages of Internet connectivity will be fully used. The construction of multi-level information platform will be accelerated. Information sharing will be realized. The first is that the construction of national and provincial platforms will be accelerated. The national platform will focus on data extraction and aggregation of national information resource bases, and establish data warehouses and data marts to provide multi-angle and multi-dimensional data analysis functions. The provincial platform will focus on storage of medical and health management information in the area and share of the information resources in the area will be realized. The second is that relying on the key medical institutions or grassroots healthcare industry management departments, grassroots medical information platform will be built to focus on storing case information such as health records and electronic medical records. The traditional management of medical institutions will be changed. Hospital costs will be reduced. Work efficiency will be improved.

20.3.4 Establishing and Improving the Standardization of Information Systems The construction of Internet medical information standard system will be strengthened to lay the foundation for information interconnection. The first is that the standardization of hospital information construction will be achieved. The national

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standardization of medical information on the Internet will be accelerated. Unified hospital information construction standard systems in China will be built. Medical information big data platform will be built to achieve Internet interoperability, sharing and utilization of cross-agency, cross-regional, cross-sector medical information resources. The second is to accelerate the application and development of standardized production and standardized software of medical information equipment. The application of equipment and software will be standardized. The third is that the formulation of the access standard system for the Internet medical industry will be accelerated. The filing and management of Internet medical access will be strengthened. Industry access will be standardized to prevent low-level redundant construction and illegal operation. The fourth is that the construction of the internet medical social credit management system will be strengthened. The construction of internet medical institutions and business integrity systems will be accelerated, and the mechanism of reward for honesty and credit and the mechanism of punishment for dishonesty and incredibility will be established.

20.3.5 Strengthening the Cultivation of Medical Talents The construction of a complex talent pool will be accelerated to adapt to the trend of cross-border integration of information technology and the Internet and the development of the health industry and lay a solid foundation for the development of the health industry. The first is that based on the relevant national science and technology talent plan, the introduction of high-level talents integrating information technology, Internet technology and medical health knowledge will be accelerated to focus on areas such as strategic design, applied research and health industry development and management. The second is to accelerate the training of advanced information technology (safety) talents, Internet technical talents and medical and health professionals urgently needed for the development of the health industry so as to enhance the pertinence and practicability of talent training on the basis of the relevant institutions of higher learning and research institutes and the actual needs. The third is to guide and support the relevant medical colleges or vocational and technical colleges, set up health industry specialties, establish training and training base and carry out front-line staff training of the health industry.

20.3.6 Accelerating the Application of Cloud Computing, Internet of Things and Other Technologies Aiming at key areas or directions, the application of cloud computing and Internet of Things technologies in the health industry will be accelerated. The service efficiency of the health industry will be accelerated. The first is that with the cloud computing platform as a support, through the innovative model of software services (SaaS), electronic health records, registration and other online services will be

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provided for medical institutions and individuals to reduce duplication of investment in medical institutions and provide patients with convenient services. The second is to actively promote the application of Radio Frequency Identification (RFID) in traceability management in areas such as healthcare, public health, medicine and equipment traceability, speed up the implementation of “All-in-one ordinary card for individual ID information, social insurance, medical insurance, medical service and financial service” to effectively improve the efficiency and service quality. The third is that Internet of Things technology will be used to achieve the electronic monitoring of medical waste, rapid tracking and positioning of drug problems, reduction of regulatory costs and improvement of regulatory efficiency.

20.3.7 Effectively Guaranteeing Security of the Information and Data The construction of the medical and health information security system will be strengthened. The medical and health information security will be effectively protected. The first is that security awareness of hospital information and data will be strengthened in hospital information collection, processing, analysis and utilization. Hospital information quality management capabilities will be improved. The monitoring system will be established and improved. New monitoring model will be explored. The second is to improve the network data security monitoring and evaluation, supervision and management, standard certification system, strengthen the safety monitoring and assessment and accountability management of information system facilities and new areas, and promote the research, formulation and implementation of safety standards. The medical network data safety regulatory system and standard system will be initially established to enhance the medical and health Internet security capabilities. The third is that data security risks will be highlighted arising from the integration and development of the Internet and various fields such as medical care, health management, insurance and finance. The network data protection system will be improved. The research, development and application of information and data security protection technologies will be promoted. The construction of a safety management system will be strengthened. The main responsible parties will be defined. Information and data security accountability system will be established.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_21

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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The “Outline for Strengthening International Exchanges and Cooperation” has made in-depth expositions on strengthening international exchanges and cooperation and actively participating in global health governance. It has clearly defined the key areas and mechanisms for promoting international exchanges and cooperation in the future and indicated that China will play a more active and constructive role in global health governance, and earnestly fulfill its international commitments and actively assume the responsibility of a big country. This is of great significance to creating a good international environment for building a healthy China, building a community of shared interests, a community of shared responsibilities and a community of shared destiny for human health, and promoting the global achievement of the 2030 health-related sustainable development goals.

21.1 P  ositive Progress in International Exchange and Cooperation in Health Fields International exchanges and cooperation in the area of health are an important part of China’s foreign human and cultural exchanges and an important link that promotes understanding between peoples.

21.1.1 Bilateral Cooperation Will Be Active and the Mechanism of Multilateral Cooperation Will Develop Rapidly Bilateral cooperation has always been the foundation of international exchanges and cooperation in the field of health in China. At present, China has signed 118 health and family planning cooperation agreements with 81 national and regional organizations. Health cooperation has also been incorporated into the mechanism of high-level human and cultural exchanges between the governments of China and the United States, China and Russia, China and Britain, China and France, China and Israel, China and Indonesia, etc. Multilateral cooperation will be an important complement. In recent years, as the threats to health and the spread of globalized risks have intensified, the mechanism of multilateral health cooperation has been rapidly developed, driven by the shared interests of health safety and healthy development in various countries. At present, more than 40 long-term and stable health cooperation and exchange mechanisms have been set up at various levels such as vice premiers, ministers and senior officials, including China-ASEAN, APEC, the SCO, China-Africa Cooperation Forum, the BRICS Summit, China—Central and Eastern Europe Cooperation, China-Arab Health Cooperation Mechanism, etc. In the field of cooperation, more attention will be paid gradually to such fields as human resources training, disaster emergency rescue, hospital management cooperation, traditional medicine, public health system and medical service system, population and development cooperation, etc. in addition to communicable disease control and prevention, public health emergencies and health policy exchange in the past. Since the “One Belt One Road” initiative was put forward 3 years ago, China has actively promoted health cooperation with countries along the line from concept to unity of

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peoples, from the top-level design to the implementation of projects, and from consolidating existing achievements to actively innovating. China will initially form “Healthy Silk Road” cooperation from parts to the whole.

21.1.2 Positive Achievements in Foreign Health Aid Over 50 years of sending medical aid teams to foreign countries, China has sent 24,000 medical aid team members to Africa, Asia, Central America, South America, Pacific Island Countries and European countries to provide medical services for over 270 million African patients. The medical aid teams not only undertook the main medical treatment tasks of the hospitals where they were stationed, but also taught the local medical personnel high, precise and advanced medical technologies such as cardiac surgery and neurosurgery, tumor removal, replantation of severed limbs, minimally invasive medical techniques medical treatment, etc. in different forms such as clinical teaching, cooperative surgery, holding seminars and training courses, etc., making up for the gaps in local clinical medicine technology; At the same time, the methods of traditional Chinese medicine such as acupuncture and massage were also brought to these countries, local health talents were trained and a medical team was formed as if they hadn’t left the aided countries. In addition, China’s medical assistance activities such as “light line”, “smile line” and “love line” to conduct cataract surgery, cleft lip and palate repair and cardiovascular surgery in Asian-African and Latin American countries. The Chinese medical aid teams were welcome and praised widely by the local people and governments. To help developing countries improve healthcare infrastructure, the Chinese government has successively constructed 38 medical facilities projects since 2013 for African countries and provided nearly 50 batches of medical equipment and pharmaceutical materials to enhance the hardware development of their healthcare system level. Chinese enterprises and non-governmental organizations also actively helped solve the problems of seeking medical treatment for local people in such ways as aid to the building and operation of hospitals, investment in pharmaceutical factories and localization of drug production. To train health talents in developing countries, China has sponsored dozens of foreign aid human resources training courses in health field each year since 2003, and invited hundreds of health administrative officials and medical and health technical personnel from developing countries to come to China for training, including health policy and management, prevention and treatment of infectious diseases, reproductive health and maternal and child healthcare, clinical medical technology, traditional medicine, nursing technology, hospital operation management and equipment maintenance, etc. In addition, a government medical fellowship program has been set up to support those who have come to China for medical education degree and further education in China. In order to help West Africa to cope with the Ebola haemorrhagic fever epidemic, China provided a total of four rounds of aid worth more than 750 million yuan for and sent more than 1200 medical and nursing staff to 13 countries in the epidemic area and the surrounding areas. A fixed biology safety laboratory was built for Sierra Leone. More than 30 batches of experts in public health, clinical care and laboratory

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testing were sent to 11 countries such as Guinea, Sierra Leone and Liberia to train 12,000 healthcare and public health workers in remote areas and help epidemic areas strengthen capacity of public health. A high-level consultant was sent for the first time to the United Nations. Major breakthroughs in trilateral cooperation with the United States, France and Britain were achieved in Africa. The image of China as an international humanitarian and responsible big country was projected.

21.1.3 Continuously Enhanced Initiative and Ability to Participate in Global Health Governance China has continuously deepened its participation in global health and population development and has participated in the UN system organizations such as the World Health Organization, UNAIDS, UNFPA, UNICEF and UN Women, and APEC, the Group of Twenty, the SCO and other issues related to global and regional health governance. The participating departments have also expanded from the health and family planning departments to the diplomatic, commercial, environmental, women’s, and disabled federations, etc. The concerns of participating countries are increasingly turning to major issues such as global health and population development, and setting of new rules and agenda. At the 67th World Health Assembly in 2014, the resolution on essential medicines and traditional medicine led by the Chinese government was passed. In the same year, China advanced the “Healthy Asia-Pacific 2020” initiative at the APEC High-level Meeting on Health and Economics. The initiative was included in the outcome documents of the informal summit of leaders of the year. In recent years, China has increased its contributions to the World Health Organization, which is currently the fifth contributor to pay membership fees. In 2015, a total of US $ seven million was also donated to the newly established emergency response fund of the World Health Organization and the United Nations trust fund for Ebola Trust Fund. China also provided voluntary contributions to the global fund to fight against AIDS, tuberculosis, malaria and the GAVI Alliance in support of global efforts to reduce the incidence of tuberculosis, prevent and treat HIV infection, eliminate malaria and promote global planned immunization programs. In addition, more and more health officials and technical experts from China hold high-level posts in international organizations and play an active role in safeguarding and expanding the health interests and voice of China and other developing countries.

21.2 Situation of International Exchanges and Cooperation 21.2.1 Globalization Exacerbates Global Health Risks and Threats and Requires Closer International Cooperation Since the 1980s, the tide of globalization has not only profoundly affected the world’s political, economic, social and cultural, environmental and other fields, but also has had an important impact on global health. Continuously growing global trade, population immigration and international exchange activities have spawned a

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surge of health risks across borders, such as new and recurrent infectious diseases, antibiotic -resistant issues, global spread of diseases linked to harmful product consumption and unhealthy lifestyles, combined with various regional conflicts and terrorism, environmental degradation, differences between rich and poor, gender discrimination, climate change, natural disasters, population aging and other factors. All these constitute a comprehensive and complex threat to human health, which makes maintaining global public health and safety and promoting fair global health and sustainable development become shared national interests of all countries. Bilateral and multilateral international exchanges and cooperation need further strengthening to achieve these goals.

21.2.2 The Adjustment of the Global Health Governance System and Health Aid Pattern Has Provided Space for China to Play a Greater Role At present, profound changes have taken place in the global political and economic patterns and global balance of power. In the field of health, the global health governance system and the health aid pattern are undergoing major adjustments. Emerging market countries represented by China are playing a more and more important role and making more and more investment in global health governance and health aid. It contributes to projecting China’s image as a responsible big country and global healthy and sustainable development. It provides a good opportunity and space for creating a new situation in China’s health diplomacy. On the one hand, with the improvement of China’s overall national strength and the increase in the international community’s expectations, China will have a more solid economic foundation and extensive partnership to support more active and committed health development assistance and cooperation activities. On the other hand, in September, 2015, the United Nations development summit adopted the 2030 agenda for sustainable development. The majority of low- and middle-income countries still need assistance from international development partners to make up for their capital, technology, people and ability, and enhance their internal development momentum. The path of health and healthy development with Chinese characteristics has gained global attention over more than 60 years. By strengthening international exchanges and cooperation, China can learn from the beneficial knowledge, technologies and experiences of other countries, continuously provide other developing countries with the aid it can within its capacity and make its contribution of the knowledge, technology and experience from China.

21.2.3 China’s Strategic Predetermination, Systemization and Capability Needs to Be Improved in Participating in Global Health China will play a more active and constructive role in global health development assistance, and global health governance in response to the complicated global health challenges. There are still many challenges that China faces in terms of

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strategic predetermination, systematic and coordinated actions, and enhanced capabilities of participating parties: The first is that there is a lack of a strategic, forward-looking and systematic global health strategy to guide bilateral and multilateral exchanges and cooperation in health development assistance and participation in global health governance. This has made it difficult to make overall plans for and coordinate the efforts of various domestic departments, take the initiative to plan and develop health diplomacy, or maximize the promotion of the realization of national strategic interests. The second is that there is a lack of close integration of “foreign affairs” and “internal affairs.” In particular, sectors apart from the health sector lack a health perspective and consideration in the global governance of their own fields, which has led to difficulty in effectively reflecting and implement those documents in domestic health reform and development policies. The documents include health-­ related agendas, signed conventions and ordinances, bilateral and multilateral cooperation agreements, etc. which have been consulted globally and reached a consensus. At the same time, the development and reform of domestic health needs to include issues in the global health governance platform for consultation and promotion. The issues such as agendas and formulation or adjustment of rules can hardly be solved one by one by integrating different parties. The third is that policies and models for health development assistance management need to be adjusted and innovated in time according to the changes in the economic and social foundation in China, the needs of recipient countries and the development of mission and tasks of foreign aid in health. Coordination among different types of health aid projects needs to be reinforced. Treatment and humane care of health aid workers needs to be improved. The Fourth is that there are not enough high-quality and compound talents for international exchange and cooperation in health, especially those capable of holding senior positions and working as senior consultants in international organizations and participating in global and regional health governance, and those playing an expert role in China’s health aid projects for foreign countries and providing technical support for recipient countries. Compound talents need to have not only professional knowledge and skills in medical and health services, but also a wealth of comprehensive knowledge systems and global perspectives, good diplomatic and negotiation skills, good command of foreign languages and good adaptability to cross-cultural work.

21.3 M  ajor Tasks and Initiatives in the Future to Strengthen International Exchanges and Cooperation In the coming 15 years, we must comply with the trend of China’s deep integration with global health, conduct international exchanges and cooperation with constructive and facilitator’s stances and responsibilities, actively participate in and guide global health governance, promote mutual benefits and achieve a healthy China dream, global health and shared development.

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21.3.1 Implementing China’s Global Health Strategy Global health strategies will be implemented, aiming at effectively protecting the health and well-being of the Chinese people and contributing to global health and actively shaping the global health governance system including: health security will be included in the national security system through closer coordination between health and foreign policies; more active participation in global health governance will be realized; health assistance to foreign countries will be innovated; a global contingent of health talents will be built; cooperation with non-government organizations will be strengthened to ensure stable global health funding and other means, focus on promoting the prevention and control of communicable diseases and neglected tropical diseases, the prevention and monitoring of and response to public health emergencies, the establishment of a more robust health system, response to the challenge of non-communicable diseases and environmental health threats, promotion of the health in the whole life, safeguard and promotion of the public health interests in international trade, and strengthened action in such key areas as food safety. The strategy will be the guide for China in the future to carry out international exchanges and cooperation in the field of health and the action guide to take part in global health governance.

21.3.2 Promoting Health Exchanges and Cooperation Between China and the Countries Along the “Belt and Road” With the theme of strengthening all-round exchange and cooperation with foreign countries, we should comprehensively upgrade the health standards of China and other countries along the line and adhere to the core values of peace and cooperation, opening up and tolerance, mutual learning and mutual benefit, and win-win solutions, and the principles of discussion, jointly building, and win-win solutions. The neighboring countries will be taken as the key point. The bilateral and multilateral cooperation mechanisms will be taken as the basis. The cooperation mode will be innovated. Pragmatic cooperation will be promoted. The development of health undertakings of China and the countries along the line will be promoted. A “healthy Silk Road” will be created. Key cooperation areas include: building a cooperation mechanism that will integrate inter-governmental policy cooperation, inter-agency technology exchange and health industry cooperation; strengthening the mechanism of cross-border joint prevention and control of infectious diseases with neighboring countries and technical exchanges of prevention and control technology. Coordination of rapid response to the prevention and control of infectious diseases and emergency response to public health emergencies will be improved; Cooperation in training of health professionals will be strengthened; Various forms of health assistance will be provided; Targeted medical, educational, scientific research and industrial cooperation will be carried out in traditional Chinese medicine in accordance with the characteristics of traditional medicine in various countries; Medical tourism, healthcare and cross-border telemedicine services will be encouraged in suitable areas.

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21.3.3 Intensifying “South-South Cooperation” and Innovating the Mode of Cooperation South-South cooperation in health needs to be guided by the strategic plan for national health of China and other developing countries, and the UN’s goal of achieving sustainable development of its health. Based on the mechanism of bilateral cooperation, bilateral and multilateral cooperation will be continuously deepened. To actively implement General Secretary Xi Jinping’s announcement during the UN General Assembly Summit on Sustainable Development and the Central African public health cooperation plan announced at the Forum on China― Africa Cooperation (FOCAC) Johannesburg Summit, China will provide construction projects of 100 hospitals and clinics and 100 maternal and child health projects, increase training and scholarships for those from developing countries to China, and train professional and technical personnel. Cooperation models will be innovated. The self-development capacity of health systems in developing countries will be enhanced. The development of healthcare infrastructure in developing countries will be supported through new construction, maintenance and equipment provision, etc. Foreign aid medical teams will be continuously dispatched to developing countries and shift from providing medical services to giving more play to the functions of medicine, teaching, research and prevention. The integration of medical assistance and public health assistance will be strengthened. Strengthening medical assistance including maternal and child health will be stressed. The development of disease prevention and control systems in African countries will be supported. Laboratory capacity and diagnosis systems will be strengthened. Health information system will be improved. The counter-part cooperation between large-scale domestic top-tier hospitals and developing hospitals in developing countries will be supported. They will be helped with the establishment of key clinical departments. Technical cooperation and technology transfer will be strengthened to help developing countries increase access to health services and quality medicines, vaccines, diagnostic reagents and health-related products. Continue to promote international cooperation in population health. In promoting South-South cooperation in health, it is necessary to strengthen policy coordination among government departments and communication among various links such as project establishment, implementation and assessment. We must make good use of the resources and experience of the international community to carry out the tripartite cooperation featuring complementarities.

21.3.4 Actively Participating in Global Health Governance and Promotion of Health Diplomacy The mechanism of high-level national strategic dialogue will be used to include health in the grand-power diplomatic agenda and to lead the regional and global healthy development agenda. Selected as “flagship” sectors, areas that have the comparative advantage of developing health and health services and can share

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knowledge and experience with the international community such as universal health coverage, maternal and child health, public health system construction and primary healthcare services will be brought into the agenda and outcome documents of bilateral high-level dialogues between major diplomats and leaders such as the bilateral high-level human and cultural exchanges between China and the United States, China and Britain, China and France, China and Germany, China and Canada, China and Russia, and China and Indonesia. China’s initiatives and proposals will be actively put forward under the mechanism of multilateral cooperation between China and The Association of South-East Asian Nations (ASEAN), China and Africa, China and Central and Eastern Europe, and BRIC Cooperation. In particular, taking advantage of China’s assumption of the rotating presidency of the multilateral cooperation mechanism, the agenda and results consensus of the health ministers’ forum will be included in the agenda and outcome documents of the summit. The role of health diplomacy will be used in gathering the people. At the same time, there will be active participation in global health governance, including participation in the reform of WHO and other health governance, and the reform of the international health development assistance system. In accordance with the common interests of China and the vast majority of developing countries, they participated in the research, negotiation and formulation of relevant international standards, norms, guidelines, access and exit mechanisms, etc. to enhance China’s international influence and institutional discourse in the field of sound development.

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Bin Li, Xiaowei Ma, Yonghui Yu, Guodong Wang, Ning Zhuang, Hongyan Liu, Haidong Wu, Huanbo Zhang, Fang Yu, Yan Hou, Ming Xue, Quan Wan, Zhongfan Wang, Minquan Liu, Gangqiang Su, Chuanqi He, Yuhui Zhang, Qingyue Meng, Fu Gao, Jigang Wei, Yunping Wang, Weifu Wang, Yunan Liu, Tie Li, Qichao Song, Yanqing Miao, Kun Zhao, Zhenwei Guo, Yuxun Wang, Hongpeng Fu, Guoyong Liu, Baofeng Yang, Guangpeng Zhang, Yujun Jin, Xiaoning Hao, Huili Cao, Xiufeng Wang, Tao Dai, Hongzhi Liu, Hongwei Yang, Boli Zhang, Maigeng Zhou, Angang Hu, and Wei Fu

B. Li The National Committee of Chinese People’s Political Consultative Conference, Beijing, China X. Ma The National Health Commission of People’s Republic of China, Beijing, China Y. Yu · H. Zhang · F. Yu · Z. Wang · H. Cao The National Health Commission (Temporary Employee), Beijing, China G. Wang National Healthcare Security Administration, Beijing, China N. Zhuang Department of Healthcare Reform of the National Health Commission, Beijing, China H. Liu China Population and Development Research Center, Beijing, China H. Wu Department of Consumer Goods, Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, China Y. Hou · Z. Guo · Y. Wang The Former Department of Planning and Information of the National Health and Family Planning Commission, Beijing, China M. Xue Center for Health Statistics and Information, The National Health Commission, Beijing, China © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9_22

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Q. Wan · Y. Zhang · Y. Wang · Y. Miao · K. Zhao · H. Fu · G. Zhang · X. Hao · X. Wang · W. Fu Health Development Research Center of the National Health Commission, Beijing, China M. Liu Center for Human and Economic Development Studies, Peking University, Beijing, China G. Su Department of Planning and Finance, National Administration of Traditional Chinese Medicine, Beijing, China C. He China Center for Modernization Research, Chinese Academy of Sciences, Beijing, China Q. Meng School of Public Health, Peking University, Beijing, China F. Gao Chinese Center for Disease Control and Prevention, Beijing, China J. Wei Development Research Center of the State Council, Beijing, China W. Wang Bureau of Disease Prevention and Control, The National Health Commission, Beijing, China Y. Liu Department of National Economy of the National Development and Reform Commission, Beijing, China T. Li China Center for Urban Development, Beijing, China Q. Song Department of Social Security of the Ministry of Finance, Beijing, China G. Liu Department of Mass Sports, General Administration of Sports of China, Beijing, China B. Yang Chinese Academy of Engineering (Academician under the Category of Pharmacy and Medicine), Beijing, China Y. Jin (*) Department of Planning and Information, The National Health Commission, Beijing, China e-mail: [email protected] T. Dai Pharmaceutical Technology Development and Research Center of the National Health Commission, Beijing, China H. Liu Department of Technical Standards, Ministry of Ecology and Environment of the People’s Republic of China, Beijing, China H. Yang Health Development Research Center, The National Health Commission, Beijing, China B. Zhang China Academy of Chinese Medical Sciences, Beijing, China M. Zhou National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China A. Hu Institute for Contemporary China Studies of Tsinghua University, Beijing, China

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Strengthening organization and implementation to build a healthy China, is a major strategic task to cover modernization construction of our country. Strengthening organization and implementation is the key to ensuring the effective implementation of the goals and tasks of the Healthy China construction, and the key to transforming the blueprint into the effective improvement of people health. For the goal of on building moderately prosperous society by 2020, it has great significance to realize the Two Centenary Goals and the Chinese dream of the great rejuvenation of China. The Outline proposed that organization and leadership should be strengthened, and the evaluation system of health impact assessment should be established, to create a good social atmosphere and carry out the conduct monitoring work.

22.1 Strengthening Organization and Leadership The construction of a health China is a cross-departmental and cross-sector systematic project with wholeness and integrality. General Secretary Xi Jinping pointed out: to build a healthy China, as a “people’s will project”, is our party’s solemn commitment to the people. Party committees and governments at all levels should include it into the important agenda, strengthen responsibility and promote implementation. In order to implement the Outline and strengthen organization and leadership, we must adhere to the core role of the party’s leadership in grasping the overall situation and coordinating all parties. Under the leadership of the party committees (party groups) of all levels, we should improve the advance and coordination mechanism of Healthy China construction, improve the leadership system and working mechanism, and strengthen the overall coordination of the major events, to provide a strong guarantee for the realization of the Outline. We must place the promotion of Healthy China construction into the important agenda of governments and departments at all levels, and include Healthy China construction in economic and social development plan. We must clarify and strengthen the leadership and responsibilities, and balance promote the overall work of Healthy China construction. We must improve the assessment and accountability system. We will include the main health indicators into the assessment indexes of the party committees and governments at all levels, and include medicine and health care system reform into the comprehensively deepened reform, with the principle as same deployment, same requirement and same assessment, to deployment an effective incentive mechanism. We must maximize the cohesion of all social consensus and force, and pay attention to the important role of the Labor Union, the League, t Women’s Federation, Disabled Persons’ Federation and other organizations. We will actively promote the target tasks for protecting and guarantying the health of employees, adolescents, women, children, the elderly and the disabled. We should give full play to the role of the democratic parties, the federation of industry and commerce and the non-­party personages, and mobilize all forces to promote the implementation of the Outline.

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22.2 E  stablishing the Evaluation System of Health Impact Assessment With the rapid development of economic society and the changes of disease spectrum, the influence of social, natural environment, living and behavioral characteristics and other factors on health is becoming more and more prominent. To effectively counter the increasing completed challenges of health influence factors, not just by relying on the health system alone, the idea of Big Health must be established to integrate health into all policies. The evaluation system of health impact assessment refers to a series of institutional arrangements which can make investigation, analysis, prediction and assessment of the possible impacts of the policies, programs and projects on population health. Based on the results, the suggestions and countermeasures for preventing or mitigating adverse health effects are proposed and kept tracking on. It is the whole process of incorporating the health considerations into the policy formulation and implementation. It is also an important system for integrating health into all policies. The General Secretary Xi Jinping clearly demanded, on the Hygiene and Health Assembly, that we should completely establish the evaluation system of health impact assessment to assess the impact of economic and social development plans and policies and major projects on health. The establishment of the evaluation system of health impact assessment is a major task of structural reform confirming by the Outline. The recent establishment of the evaluation system of health impact assessment may begin from the following aspect. The first is improving the existing assessment system of environmental impact. We will strengthen collaboration with the environmental protection departments; put body health at the top of ten categories on the assessment elements of environmental impact; clearly define the health impact as the primary content and mandatory requirement of the environmental impact assessment for planning and constructing projects. At the same time, joint monitoring, information sharing and technical cooperating will jointly organize and launch the researches on the impact of environmental quality on public health. The second is carrying out pilot programs of health impact evaluation in the construction of Healthy China. In combination with healthy cities construction, some cities will be selected to carry out independent health impact evaluation, led by governments and guided by health departments. The scope and procedure of health impact assessment and evaluation should be clear, to, accumulate experience for establishing national evaluation system of health impact assessment. The third is strengthening the research and development of the guidelines and tools of health impact evaluation. We will strengthen the construction of the basic database and evaluation index system; encourage and support the relevant institutions, like Chinese Center for Disease Control and Prevention, to conduct scientific researches on the methods and technical specification of health impact evaluation. At the same time, the public have the right to know health information, which should be empowered and satisfied, consequently to improve the effectiveness of public participation and health impact evaluation. The fourth is starting the legislation of health impact evaluation, to clarify the core issues: the legal status of the evaluation system of health impact

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assessment, the adscription of functions and implement subjects, objects and scope of evaluation, starting conditions and evaluation procedures, public and social participation mechanisms, information opening system, application mechanism of the evaluation results, the accountability and compensation mechanism on health damage, etc. In this way, the legal support can be provided for establishing an independent evaluation system of health impact assessment.

22.3 Creating Favorable Social Conditions The implementation cycle of the Outline is 15 years. It is crucial to create a good social atmosphere for promoting Healthy China construction. In accordance with the requirements of the Outline, it is necessary to strengthen the formulation, implementation, monitoring and evaluation of the Outline. The following aspect should be publicized in a innovating and enriching way: the major strategic thoughts and policies of the Party and country on safeguarding and promoting of people health; the great significances, overall strategies, task objects and major initiatives of promoting the Health China construction. The new achievements and new progress should be published timely, with a comprehensive and objective analysis of difficulties and problems. We should guide the public opinion and strengthen the common awareness in the whole society of Healthy China construction. At the same time, we should increase the international spread of the Outline, with accurately interpret the experience and achievements of Healthy China construction, to win the understanding and recognition in the international community. We should pay special attention to the correct orientation, and strengthen the positive publicity, utilizing the right messages to inspire, guide and unite people. The lively stories and typical cases emerged Healthy China construction should be published timely, in order to fully arouse the enthusiasm, proactivity and creativity of all sectors of the community, and inspire the people of all nationalities to participate in planning and implementing Healthy China construction. Consequently, the good social atmosphere of caring, supporting and participating of Healthy China construction will be formed. We should intensify consensus supervision, and safeguard the interests of people, to promote the construction of Healthy China.

22.4 Conducting Implementation Monitoring 22.4.1 Promoting the Implementation of the Outline with the 5-Year Plan and Other Policy Documents In the next 15 years, the Outline will be the grand blueprint and program of action for the promotion of Healthy China construction. In order to ensure effective implementation of the Outline, we must adhere to the combination of strategy and operability, to achieve the combination of emptiness and reality. The Outline is put

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forward to implement policy documents, like 5-years plan, to refine the various policies and measures, and to clarify the major projects, key projects and major policy in different phases. Guided by the Outline, the relevant departments under the State Council should organize and prepare a bunch of 13th 5-Year Plan subject plans, such as, health care reform, hygiene and health, etc. We will refine and implement the target tasks in specific areas of the Outline, and clarify the major projects, major programs and major policies for promoting Healthy China construction in all areas of the 13th 5-year plan, as the important supports of the Outline. In the future, we will compile relevant specialized plans of 14th and 13th 5-Year Plans step by step. The local plans should refine and implement the target tasks of the Outline, according to the practical conditions, and do a good job of linking the main objectives and key tasks with the national Outline.

22.4.2 Improving the Supervision and Assessment Mechanisms The Outline proposed that regular and standardized supervision and assessment mechanisms should be identified to strengthen incentives and accountability. We will intensify supervision and oversight, and set up a specific inspection mechanism, focusing on the primary targets, significant policies and important missions of the Outline. We should consciously accept the supervision of the National People’s Congress and the Chinese People’s Political Consultative Conference, and encourage deputies to the NPC and the members of CPPCC to track and oversee the implementation of the Outline. We will improve the mechanism for social supervision and timely release the implementation of the Outline, to keep the public supervision channels open. We will give full play to the democratic supervision on the implementation of the Outline, by the democratic parties, the association of industry and commerce and the non-party personages. We will attach great importance to the role of civil force, such as industrial associations and chambers, the trade promotion agencies and think tanks. We will establish an effective mechanism to monitor the implementation of the Outline through new media such as the Internet. We will strengthen the performance appraisal, annual appraisal, mid-stage assessment, summative evaluation and thematic evaluation. The main health indicators will be included in the assessment systems of party committees and governments at all levels, and the assessment results will be linked to the performance of the examined.

22.4.3 Establishing and Improving the Monitoring and Evaluation Mechanisms To establish and improve the monitoring and evaluation mechanisms has the significant meaning, for promoting the smooth implementation of the Outline and ensuring the realization of the main objectives and strategic tasks. Several View Points of the State Council of the People’s Republic of China on Strengthening the Planning

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Compilation of National Economic and Social Development clearly demanded that the planning evaluation system should be implemented. Planning Compilation departments should timely organize the evaluation on the implementation of the Outline, in order to find the problems in time. By analyzing the causes of the problems carefully, and they should put forward the targeted countermeasures and suggestions. The medium-term assessment of the Outline was established as a formal institutional arrangement, during the 11th 5-Year Plan period in China. The second term in Law on the Supervision of Standing Committees of People’s Congresses at Various Levels, released in 2006, specified: The People’s Government shall submit the medium-term assessment report on the implementation of the Outline to the standing committee of the National People’s Congress at the corresponding level for deliberation. The Outline demands: monitoring and evaluation mechanisms will be established and improved, detailed task distribution among main departments or agencies and monitoring and evaluation strategies developed, and annual evaluation of progress and outcomes of implementation conducted. Necessary adjustments will be made to the objectives and tasks in an appropriate and timely manner. Therefore, it is necessary to set up the task division plan and define the subjects of responsibility. On this basis, the departments of each region shall formulate the main objectives and the implementation plan relating to the local department and local region; determine the subject of responsibility, implementation schedule and roadmap; ensure that the objectives of the Outline are implemented. It is necessary to develop a monitoring and evaluation plan for the Outline, and establish an annual monitoring and evaluation mechanism. The major indexes and significant tasks of the Outline will be separately included into annual highlights of different regions and governmental departments. We will perfect the mid-stage assessment and summative assessment mechanism, and carry out special assessment duly. We will take full advantages of all kinds of information and data resource, to enhance dynamic monitoring analysis, in order to increase the timeliness, comprehensiveness and correctness. We will sound the mechanism for dynamic adjustment and revision. To the target tasks, implementing emphasis, policy measures and safeguard mechanisms, we will make the necessary adjustment, basing on the monitoring analysis and assessment results of the Outline. To innovatively promote the pilot demonstration tasks proposed by the Outline, local governments at all levels should give full play to their initiative. Initiatives and innovations by the basic level will be respected. We will encourage local governments to promote the implementation of the Outline adjusting to local conditions. Good local practices and effective experiences will be summarized in timely fashion, and actively scaled up during implementation. (Wang Ruisi)

 ppendix A: Outline of the Healthy A China 2030 Plan

Part I: Overall Strategy Chapter 1: Principles To build a healthy China, we need to hold high the great banner of socialism with Chinese characteristics. We need to implement the guiding principles of the 18th National Congress of the CPC and the third, fourth and fifth plenary sessions of the 18th CPC Central Committee. We must follow the guidance of Marxism-Leninism, Mao Zedong Thought, Deng Xiaoping Theory, the Theory of Three Represents, and the Scientific Outlook on Development. The guiding principles from General Secretary Xi Jinping’s major policy addresses must be put into practice. Work must be carried out in accordance with the plan for promoting all-round economic, political, cultural, social and ecological progress, and the Four-Pronged Comprehensive Strategy. Decisions made by the CPC Central Committee and the State Council must be carried out. The people-centered and new vision of development must be followed, and the right health policies must be stuck to. With people’s health at the center, we need to reform and innovate institutional arrangements, and make healthy living, healthcare services, health security, healthy environment, and the healthcare market as our five priorities. We should incorporate health into all policies, and transform the development modes of the healthcare sector, and ensure people’s health at all stages of life by improving their health and health equity. Ultimately, this will lay a solid health foundation for the great rejuvenation of the Chinese nation and realization of the “two centenary goals”. The following principles need to be adhered to: Health as a top priority. Health should be at the top of the development agenda. Based on national conditions, health promotion should be a part of the public policymaking process. Healthy lifestyles, the ecosystem, and socio-economic development models should be put into place to pursue the coordination of health and economic and social development. © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9

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Reform for innovation. With the market playing its due role, government-led reforms in key fields will free people’s minds and thoughts, break vested interests and eliminate institutional barriers. Sci-tech innovation and informatization should have a steering and supportive role in forming an institution that contributes to improving people’s health, with Chinese characteristics. Scientific development. We need to identify rules for health development, and adhere to “prevention first, combining prevention with control, and supporting both traditional Chinese and Western medicine.” Healthcare delivery systems should become integrated, moving from an extensive development mode based on scale to an intensive one focusing on quality and efficiency. Efforts should be made in the complementary development of both traditional Chinese medicine (TCM) and Western medicine, as well as overall enhancement of healthcare delivery. Equity and fairness. Rural and primary health will be prioritized. We will aim to achieve equity of public health services, ensuring that access and the non-profit nature of basic medical care and health services to reduce urban-rural, regional and sub-group health inequalities. Universal coverage and social equity in health care services will be realized.

 hapter 2: Strategic Themes C To “contribute and share to build a healthy nation” is the theme for the Healthy China strategy. Centered around population health, with momentum in terms of reform and innovation, the strategy takes the principle: “health in all, health by all, health for all”. It will prioritize primary health care, focus on prevention, give equal stress to the development of Chinese and Western medicine, incorporate health care into all policies, and encourage people to contribute and share. Targeting risk factors of health related to lifestyles, working and living environments, and healthcare services, the strategy will be led by the government and actively implemented by society. All interventions and programs will be participated in and contributed to by all, and results shared by all. Prevention measures will be emphasized alongside healthy lifestyles to prevent diseases and ensure early diagnosis, treatment and rehabilitative care, and to improve the population’s health. “Contribute and share” is the basic method to build a healthy China. Supplyside and demand-side reforms integrating individual, institutional and social factors will provide momentum to maintain and protect people’s health. There will be an emphasis on encouraging social participation. Cross-sector cooperation will be strengthened, and military and civilian healthcare delivery integrated. Motivating the initiative and creativity of social forces, we will protect the environment, ensure food and drug safety, prevent and reduce harm, control health risks and environmental hazards, and form a social co-regulation system encompassing multiple levels and multiple stakeholders. To drive supply-side reforms, sectors such as health, family planning and sports will deepen institutional reform in optimizing health resource allocation and service delivery, developing underdeveloped areas, upgrading the healthcare industry, and meeting increasing healthcare needs. Individuals will be held accountable for their own health. Health literacy will be improved. Self-­ motivated and self-disciplined living

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habits need to be explored by citizens based on their own needs, so as to control factors affecting health, and create a social environment nurturing, pursuing and supporting good health. The fundamental goal of building Healthy China is to maintain a healthy population. Focusing on the lifelong needs of all people, we need to provide equitable, accessible, comprehensive and continuous care to achieve better health. To ensure universal benefits, we need to innovate institutional arrangements, expand coverage, improve healthcare quality, ensure access to quality and affordable preventive, curative, rehabilitative health care, while focusing on priority groups such as women, children, the elderly, the disabled and low-income groups. To cover lifelong health needs, we need to deal with key health issues, identify priorities, and step up interventions, to provide “cradle-to-grave” care and protection.

 hapter 3: Strategic Targets C By 2020, a universal primary healthcare system with Chinese characteristics will cover both urban and rural citizens; enhance health literacy; deliver greatly improved health care; ensure universally accessible primary medical and healthcare services and sports facilities; develop a healthcare industry with sound structure and rich content; maintain health indicators ranked top in upper middle-income countries. By 2030, we will further improve institutional arrangements supporting implementation of the Healthy China strategy; develop a more coordinated healthcare sector; promote more healthy living styles; enhance healthcare service quality and health protection levels; revitalize the healthcare industry; achieve health equity; maintain health indicators equal high-income countries. By 2050, we will build a healthy China complemented with a modernized socialist country. The following targets will be met by 2030: • Continuously improved health of the people. Physical fitness of the population will be significantly improved, with average life expectancy increased to 79 years. • Key health risk factors under effective control. Health literacy of the population will be greatly increased and healthy lifestyles widely advocated. Living and working environment favoring health improvement will be formed, with effective food and drug safety. A batch of major diseases will be eliminated. • Increased healthcare service delivery capacity. Effective and integrated medical and healthcare service delivery systems will be built. Public sports and fitness services covering all citizens will be developed. Health security systems will be improved. World-leading health sci-tech innovation capacity will be fostered. Healthcare service quality will be enhanced. • Significantly expanded healthcare industry. A healthcare industry with complete and optimal structure will be established. Large businesses with a track record of strong innovation and a global competitive edge will become a mainstay of the national economy. • A well-developed health promotion system. Policy and legislation will be strengthened and modernized. A health governance system will be built up.

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Main indicators for the healthy China strategy Domain Health status

Healthy living

Health service and protection

Healthy environment

Healthcare industry

Indicators Life expectancy (year) Infant mortality (‰) Under-five mortality (‰) Maternal mortality (1/100,000) People meeting the fitness standards defined in the National Physical Fitness Standards (%) Health literacy (%) Frequent physical exercises (100 million) Premature death rate from major chronic diseases (%) Practicing or assistant physicians per 1000 Out-of-pocket payment as a share of total health expenditures (%) Percentage of days with good air quality in cities at prefecture or above level (%) Percentage of surface waters at or above level III Total size of healthcare industry (trillion Yuan)

2015 76.34 8.1 10.7 20.1 89.6 (2014)

2020 77.3 7.5 9.5 18.0 90.6

2030 79.0 5.0 6.0 12.0 92.2

10 3.6 (2014) 19.1 (2013) 2.2

20 4.35

30 5.3

10% lower than 2015 2.5

30% lower than 2015 3.0

29.3

Around 28

Around 25

76.7

>80

Continuous improvement

66

>70

–

>8

Continuous improvement 16

Part II: Healthy Living for All Chapter 4: Strengthening Health Education Section 1: Improving Health Literacy An emphasis will be placed on healthy living among urban and rural residents by providing health mentoring and interventions to households and high-risk groups, and by launching programs on weight control, as well as dental and bone health. By 2030, all county-level areas nationwide will be covered by such programs. Appropriate techniques and products for healthy living will be developed and promoted. Effective publicity for core information and health knowledge will be developed. The monitoring of health literacy and healthy living will cover all the country. Health education will be increased and strengthened, and health knowledge will be made available for all, with special focus on children and teenagers. Stressing spiritual awareness, health culture will be nurtured, obsolete habits and customs discarded, and good living habits cultivated. Media institutions at different levels will advocate good health knowledge; health-related broadcasting or TV programs will be actively developed and standardized, and health education expanded via new media.

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Section 2: Promoting School Health Education Health education will be part of the national curriculum and relevant classes made available for students at all levels as essentials for quality education. Making primary and middle school education a priority, school-based health education will be explored. Subject-based education will be combined with theme-based in-class and outdoor education. This will be advocated at regular and centralized levels. Health education faculties need to be trained, and health education will be conducted in the whole process of vocational training of sports teachers.

Chapter 5: Encouraging Healthy Habits in Individuals Section 1: Developing Well-Balanced Diet A national nutritional plan will be developed and implemented. Research and nutritional assessments of food (both at farm and table) will be carried out. Nutritional knowledge will be widely disseminated; dietary guidance of population sub-groups publicized; citizens coached to develop healthy dietary habits; and healthy culinary culture promoted. Nutrition monitoring will be established to monitor progress, with nutritional interventions in key areas and population groups, specifically focusing on micronutrient deficiency and excessive intake of high-calorie foods, such as fat, to improve problematic diets. Clinical nutritional interventions will be carried out. Meanwhile, guidance to schools, kindergartens, and nursing homes will be strengthened. Demonstration health canteens and restaurants will be nominated. By 2030, nutritional knowledge and literacy rates will be significantly improved, incidence of nutrition deficiency greatly reduced, average daily salt intake reduced by 20%, and increase in the overweight and obese population slowed down. Section 2: Tightening Tobacco and Alcohol Control The World Health Organization Framework Convention on Tobacco Control will be implemented fully, with tobacco prices tightly controlled through pricing, taxation and other legal means. Advocacy and education on tobacco control will be launched, smoke-free environments actively built, and supervision and law enforcement of smoking bans in public places enhanced. The smoking ban in public places will be fully enforced, and the indoor smoking ban will gradually cover all public venues. Officials will take the lead in implementing the smoking ban in public places, and Party and government buildings will become smoke-free areas. Smoking cessation services will be strengthened. By 2030, the population of smokers aged 15 or above will be reduced to 20%. Education on alcohol control will be intensified to control excessive alcohol intake and reduce alcohol abuse. Monitoring of harmful alcohol use will be stepped up. Section 3: Protecting Mental Health Mental health services will be further developed and orderly managed. Mental health advocacy will be strengthened to increase understanding of mental health. Common mental disorders, psychological or behavioral problems, such as depression and anxiety, will be targeted and intervened with, and more emphasis placed on

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early detection and intervention for mental disorders in priority groups. The national registry will be improved, and rescue and medical aid given to patients with severe mental illnesses. Community-based rehabilitation for patients with mental illnesses will be fully encouraged. Overall ability to implement interventions in emergency cases of psychological crisis will be enhanced. By 2030, competence in identifying and intervening in common mental disorders will be greatly enhanced. Section 4: Reducing Unsafe Sexual Behaviors and Drug Abuse Comprehensive harnessing of social security will be strengthened. Education and intervention on sexual morality, sexual health and safe sex (focusing on teenagers, young women and migrants) will help high-risk groups reduce unplanned pregnancy and curb sexually transmitted diseases. Drug related harm will be actively addressed, with knowledge and treatment options improved. Nationwide drug-use services will be strengthened to provide drug addicts with access to early detection services and treatment. Drug maintenance therapy for detoxification will be linked with community-based drug rehabilitation as well as compulsory rehabilitation services. A comprehensive rehabilitation mode will be established, offering a variety of services including abstinence, psychological rehabilitation, employment support and return to the community, to minimize social harm caused by drugs.

Chapter 6: Improving Physical Fitness for All Section 1: Improving Physical Fitness Services Public facilities and infrastructure for physical fitness services will be uniformly planned and developed. More walking paths, bike lanes, public fitness centers, sports parks and community sports grounds will be built. By 2030, networks of public sports facilities at village, township and county levels will be established, with sports ground of no less than 2.3 m2 per capita. In urban areas, sports facilities will be within 15 min’ walking distance. Public sports facilities will be free or at less charge, and all public sports facilities and those of non-government institutions, which meet criteria for opening, should be made available for public use. Networks of public fitness clubs will be set up, and support and guidance provided to support the development of community-based sports organizations. Section 2: Launching a Nationwide Fitness Campaign A nationwide plan for public physical exercise will be continuously made, knowledge of physical exercises and body fitness publicized, and public fitness exercises made routine. Mentoring of social sports activities will be organized to provide guidance in public fitness exercises. National criteria on physical exercise will be introduced. Common fitness and leisure exercises will be developed to enrich and improve public fitness. Exercises favored by communities will be adopted and developed. Sports events suitable for specific population groups or geographic areas will be encouraged, and traditional, cultural and historic sports exercises such as Tai Chi or Qigong will be supported and encouraged.

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Section 3: Integrating Sports Exercises with Medical Care and Strengthening Non-medical Health Interventions Guidelines on sports and fitness exercises will be published, with a database of prescriptions for different population groups, different contexts, and different physical statuses established to develop an innovative mode of disease management and healthcare services by combining sports exercise with medical care. In this way, public fitness exercises can play an active role in improved health as well as the prevention and rehabilitation of chronic diseases. Platforms or centers for fitness technology innovations and supporting fitness services will be created. Physical fitness assessments will be carried out; monitoring systems for fitness and health will be improved; big data on national physical fitness monitoring will be developed and applied; and risk assessment of sports exercises carried out. Section 4: Promoting Physical Exercise Among Priority Groups Tailored intervention plans will be made on fitness and health of priority groups, such as teenagers, women, elderly, occupational groups and the disabled. Plans on promoting sports among teenagers will be implemented to cultivate teenagers’ interests in sports. Teenagers will master at least one sports skill, and students will spend no less than 1 h doing sports exercises on campus every day. By 2030, 100% of sports facilities and devices at schools will meet national standards; young students will attend moderate-intensity physical exercises at least three times a week; and at least 25% of students will maintain excellent health status and physical fitness according to national standards. With enhanced mentoring, women, elderly and occupational groups will be mobilized to participate in public fitness exercises. Working interval fitness programs will be adopted; newly built working infrastructures will have proper space designated for fitness exercises. Rehabilitative sports and fitness exercises for the disabled will be widely promoted.

Part III: Optimizing Healthcare Services Chapter 7: Promoting Universal Access to Public Health Services Section 1: Preventing and Controlling Major Illnesses A comprehensive strategy for prevention and control of chronic diseases will be implemented. National demonstration sites for such diseases will be further developed. Early screening and diagnosis for chronic diseases will be strengthened. For areas with high cancer prevalence, early diagnosis and treatment programs for major cancers will be launched. Opportunistic screening for cancers, stroke and coronary heart disease will be encouraged. Management and intervention programs for hypertension and diabetes will cover all target demographics. Appropriate technologies for early diagnosis and treatment for major chronic diseases such as cancer and strokes will be included in diagnosis and treatment routines. Control and

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prevention of common illnesses among students, such as short-sightedness and obesity, will be intensified. By 2030, chronic disease care and management will cover lifelong needs of all people. The overall 5-year survival rate of cancer patients will increase by 15%. Dental health will be improved, with the prevalence of cavities among the under 12-years kept within 25%. Control and prevention of major infectious diseases will be strengthened. Early warning systems for infectious diseases will be improved. The Expanded Program on Immunization will be continuously implemented. Inoculation rate of vaccines included in the national immunization program for eligible children will be maintained at a relatively high level. Compensation and insurance systems will be developed for vaccination anomalies. HIV/AIDs detection, antiviral therapy and follow-up management will be further improved. Nucleic acid testing will be performed fully on blood for clinical use and efforts will be made to prevent motherto-­ child transmission of HIV.  HIV prevalence will be kept at a low level. A comprehensive service model for tuberculosis prevention and control will be established. Screening and monitoring of multi-drug resistant tuberculosis will be enhanced. Diagnosis and treatment of tuberculosis will be standardized. Prevalence of tuberculosis will continue to decrease. Epidemics caused by influenza, foot-and-­ mouth disease, dengue fever and measles will be effectively dealt with. A control and prevention strategy of schistosomiasis will be continuously adopted with a focus on control of the source of infection. All counties suffering from epidemics will meet standards for eliminating schistosomiasis. Achievements made in eliminating malaria will be consolidated. All counties suffering from epidemics will control prevalence of major parasitic diseases such as hydatidosis. Major endemic diseases will be contained or eliminated, so that such diseases can no longer pose major threats to people’s health. Control and prevention of sudden outbreaks of acute infectious diseases will be stepped up. Active measures will be introduced for controlling imported acute infectious diseases. Control and prevention of fulminating infectious diseases such as plague will be strengthened. Infection source of major animal-borne diseases will be tightly controlled. Section 2: Improving Management of Family Planning Services Policymaking processes and systems on population and development will be improved, and policies beneficial for more balanced demographics formulated. Management of family planning services will be reformed to deliver household-­ based services and build family development policies for reproductive care, child raising, youth development, elderly care, and disability care. The public should be guided to make planned and responsible birth decisions. There will be more well-­ developed policies concerning technological services for family planning and more investment in techniques supporting second births. Policies on making informed choices will be fully implemented with contraceptive and reproductive health knowledge widely publicized. Allowance, support and special aid programs for families practicing family planning policies will be improved, and dynamic adjustment of the allowances made. Targeted management will be upheld and improved. Long-term systems will be developed to advocate and publicize family planning

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policy, and to better manage, regulate, serve and promote related work. A monitoring system for newborns will be developed. Continuous efforts will be made to bring the gender ratio at birth under control. By 2030, a natural balance of gender ratio at birth will be achieved. Section 3: Equity of Primary Public Healthcare Services An essential public healthcare service package and major public health service package will be implemented and improved continuously. Studies on the economic burden of diseases will be conducted to make appropriate adjustments to the funding of healthcare packages. Efforts will be made to enrich and expand healthcare services, improve service quality, provide equal access to primary public healthcare services for urban and rural residents, and ensure migrants equal access to both primary public healthcare and family planning services.

Chapter 8: Delivery of High Quality and Efficient Medical Care Section 1: Improving Medical Care Delivery Systems Integrated medical care delivery systems with complete structures, clear and complementary functions, close coordination, and high performance will be put into place. Primary medical care resources at county and city levels will be planned and distributed based on population and distance to care facilities to ensure universal access to primary medical care services. At provincial regions or above, resources will be allocated on a regional basis, and regional resource pooling and sharing will be encouraged. Balanced allocation of quality medical and health resources will be achieved, with equal access to high quality acute, emergency and specialist care. Based on current health facilities, a group of national centers of clinical excellence with global influence will be developed. A group of regional medical centers and clinical specialties networks will be established to enhance regional medical delivery capacity and competence, and to promote coordinated medical development in areas such as the Beijing-Tianjin-Hebei region and the Yangtze River economic zone. Post-acute medical care facilities, such as rehabilitation, elderly care, long-­ term care, chronic disease management and hospice palliative care facilities will also be developed. Medical programs for poverty reduction will be implemented, with more medical infrastructure projects needing to be launched in central and western poverty-stricken regions, to increase medical service capacity and protect the poor’s health. By 2030, all communities will be within 15 min distance of primary medical care facilities, and registered nurses per 1000 permanent residents will reach 4.7. Section 2: Innovating Medical Care Supply Modes A “3-in-1” control and prevention mechanism for major diseases will be established. It will incorporate professional public health facilities, general and specialty hospitals, and primary medical care facilities, which will share information and coordinate control, prevention and day-to-day management of chronic diseases to achieve integration in prevention and clinical care. Various medical care facilities

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with different ownership at different levels will collaborate and coordinate with clear targets and defined roles and functions. Care networks, operational mechanisms and incentives will be constantly explored. Primary medical care providers will acquire gate-keeping function for residents. Contract-based care provision by family doctors will be further implemented and improved. Mature mechanisms of coordinated care will be explored, including the gate-keeping functions of primary care providers, two-way referrals, vertical coordination, and the separation of acute and chronic care. Integrated curative, rehabilitative and long-term care will be soundly developed. Bigger public hospitals at Grade 3 will be encouraged to reduce outpatient encounters and focus on acute and emergency care, as well as complex and specialist care. Medical complex or hospital groups will be encouraged to explore coordination between care facilities and to improve system-wide performance. The integration of military and civil medical care delivery will be accelerated; military hospitals need to play a bigger role in serving the people. Section 3: Improving Medical Care Quality and Competence A world-class quality management and control system for medical care will be developed with Chinese characteristics. A three-tier quality control network covering most specialties will be established at city, provincial and national levels, with a batch of international standards and norms. Information platforms will be set up for quality control and management, with precise and real-time management and control, covering all aspects of all hospitals to improve medical care quality and safety. Efforts will be made to increase homogeneity of hospital care quality, and reduce readmission rates, and antibiotics used to catch up with advanced world levels. Clinical pathway management will be implemented to reduce clinical variations, optimize care process and improve patients’ experiences. Programs on rational drug use, clinical blood safety and mutual recognition of test results will be further implemented. Medical ethics needs to be encouraged to build good doctor-patient relationships. Crimes, especially violence against doctors, will be cracked down on, with legal backup, to protect the personal safety of medical professionals.

Chapter 9: Letting Traditional Chinese Medicine Play Its Unique Role Section 1: Improving the Capacity of Traditional Chinese Medicine Projects bolstering TCM with clinical advantages will be launched to enhance research on the superior effects of TCM in treating specific conditions. TCM will be better combined with Western medicine to enhance treatment of major, complex and critical conditions as well as acute diseases. Non-medicine therapies will be developed to play a role in preventing and treating common and chronic illnesses. Rehabilitation with TCM will be encouraged. Primary medical care with TCM will be developed to cover both urban and rural communities. General care departments providing TCM will be set up in all township and community health centers. Appropriate technologies will be promoted, and all primary health facilities will be able to deliver TCM. Ethnic medicines will also be encouraged. By 2030, TCM will play a key role in preventing illnesses, treating major illnesses and in rehabilitation.

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Section 2: Developing Preventive and Health Maintenance Services Based on Traditional Chinese Medicine Projects on TCM-based preventive care will be implemented to explore the strength of TCM in health management. TCM-based health maintenance models will be explored, incorporating health culture, health management and health insurance. Social enterprises will be encouraged to open TCM-based healthcare centers providing standard services to develop healthcare service quickly. The service scope of TCM hospitals will be expanded to offer TCM-based preventive interventions, such as health counseling, assessment, recuperation, and follow-up care. TCM hospitals and doctors are encouraged to provide expertise support, such as health consultancy and recuperation care, for such TCM-based healthcare centers. National programs on TCM promotion will be launched to advocate TCM knowledge and easy-to-­ understand healthcare techniques and methods. Efforts will be made to protect and carry on the intangible cultural heritage of TCM, as well as to innovate and develop TCM-based health care. Section 3: Promoting Preservation and Innovation of Traditional Chinese Medicine Projects promoting TCM need to be launched to draw special attention to the studies of classic TCM books and reuse of historical theories, trends, approaches and methods. Academic thinking and clinical experiences of well-known and senior TCM experts will be carried forward to extract indigenous clinical techniques and prescriptions, and to preserve and promote TCM. Intellectual property will be established to protect TCM. A list of protected TCM patents will be set up. TCM prescriptions will be studied with the assistance of modern technologies. TCM technologies and new therapeutics for major, complex acute and chronic diseases will be strengthened. TCM theories and clinical practices will be further developed. The TCM market will be expanded, and world-known Chinese brands and multinational companies covering the whole production chain will be created to introduce TCM to the world. Major TCM resources and biodiversity will be preserved. Surveys and dynamic monitoring of TCM resources will be implemented. Plantation bases for large quantities, genuine, or endangered TCM seedlings will be built. Monitoring data of TCM markets will be provided in real time. TCM plantation will be encouraged to pursue green policies.

Chapter 10: Improving Healthcare Services for Priority Groups Section 1: Improving Maternal and Child Health Plans to ensure mother and baby safety will be implemented, and healthy births and rearing encouraged. Public subsidies will be made available for hospital deliveries, and free primary care services will be provided for pregnant women for all their pregnancy. Birth defects will be controlled and prevented, and a prevention and control system will be built to cover pre-pregnancy, pregnancy, and post-natal care for both the urban and rural population. A healthy childhood plan will be initiated to support early childhood development, develop pediatrics, strengthen prevention

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of major children’s diseases, expand disease detection services for neonates, and continue to support nutrition projects in priority areas. More women will be screened for common gynecological diseases to ensure early diagnosis and treatment. Projects for protecting maternal and child health, and family planning services will be launched to enhance rescue, acute and emergency care competence. Section 2: Promoting Healthy Aging The development of medical and health care systems for the elderly will expand to communities and households. Coordination between medical facilities and nursing homes will be sought, and nursing facilities will support medical services. Coordinated development of TCM and elderly care will be encouraged, to provide integrated care for the elderly, covering hospital care, rehabilitative care, home care and palliative care. Chronic disease management will link with home care, community care and nursing care. The private sector is also encouraged to open facilities providing both medical and nursing care. Common geriatric illnesses or major chronic diseases will be closely supervised alongside intervention where necessary to develop a holistic health management system for the elderly. Mental health care will be encouraged, and effective interventions for diseases such as dementia will be introduced. Long-term home-based care for the elderly will be developed. Policies for subsidizing the elderly at an advanced age or for disabled elderly with financial difficulties will be fully established. Long-term nursing care insurance programs with multiple-layer designs will be established. More policies will be introduced to make essential drugs more readily accessible for the elderly. Section 3: Maintaining Health of the Disabled Regulations on prevention of disability and the rehabilitation for disabled people will be issued. Medical financial aid for low-income disabled people will also be increased, and eligible medical rehabilitation services for the disabled will be covered by basic medical insurance schemes. A medical assistance system will be established for disabled children. Local governments will be encouraged to subsidize equipment to assist the disabled. Rehabilitation for the disabled will be included in the basic public service package. Tailored rehabilitation will be given to those who need it, and poor or severely disabled people will be provided with primary rehabilitation services. Barrier-free facilities will be developed in medical institutions, and medical services for the disabled will be improved. Rehabilitation systems will be further developed. More rehabilitation and nursing home facilities for the disabled will be built. Two-way referrals will be made possible between medical facilities and rehabilitation centers. Primary medical care providers will give priority to contract-based services for disabled people, providing them with primary medical care and public health management. A national action plan for the prevention of disabilities will be introduced, and public awareness of disability prevention will be raised. Disability prevention measures targeting the life cycle of all the population will be carried out to effectively control incidences and the development of disabilities. Diseases or risk factors that may cause disabilities will be better controlled. National pilot programs on disability control and prevention will be introduced. Prevention and treatment for the deaf and blind will be continued.

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Part IV: Improving Health Security Chapter 11: Strengthening the Medical Insurance System Section 1: Developing Universal Health Coverage Multi-level health insurance systems will be developed and improved, and be dominated by basic health insurance, and supplemented by commercial and other forms of insurance. Urban and rural basic health insurance schemes and management systems will be integrated. Sustainable financing and benefit adjustment mechanisms of basic health insurance schemes will be improved to achieve medium to long-term actuarial balance. The premium collection mechanism will be improved to keep organizational and personal contributions at appropriate levels, and rationally determine the share from public funds and private contributions. Individual accounts of the basic medical insurance for urban employees will be reformed to cover outpatient care. Insurance policies for major and catastrophic illness will be further reformed, and the link between basic health insurance schemes, insurance for major illnesses for urban and rural residents, commercial health insurance and medical financial assistance strengthened. A mature form of universal health coverage will be developed by 2030. Section 2: Improving Health Insurance Management Budget management of health insurance schemes will be strictly implemented. Payment reforms will be launched on the active promotion of case payment and capitation, and on the exploration of diagnosis related groups (DRGs) as well as pay for performance methods, to launch multiple payment methods under global budget management. Negotiation and risk sharing arrangements between health insurance organizations and medical organizations need to be improved. Policies on medical billing and making-claims at localities other than home counties, cities or provinces will be quickly implemented. On site billing and claims by retired inpatients in their non-home province, and direct billing claims for inpatients meeting referral requirements will be made possible. Intelligent monitoring of health insurance schemes will be implemented, and supervision of designated health services will be expanded to individual medical professionals. Commercial insurance companies will be encouraged to engage in management of basic health insurance schemes. Basic standards and specifications for basic health insurance schemes will be developed and applied. Management of universal health coverage will be well developed and achieve high performance by 2030. Section 3: Promoting Commercial Health Insurance Favorable policies including taxation will be introduced to encourage enterprises and individuals to join commercial health insurance and other supplementary insurance schemes. More health insurance products will be provided, and insurance policies related to health management services developed. Cooperation between commercial insurance companies and health facilities, as well as examination

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centers and nursing facilities, will be facilitated. New forms of health organizations such as health maintenance organizations will be developed. By 2030, a modern commercial health insurance industry will be developed, with an increased share of commercial claims in total health expenditure.

Chapter 12: Improving the Drug Supply Security System Section 1: Deepening Reforms on Drug and Medical Device Circulation Systems Upstream and downstream drug and medical device services in the supply chain will be expanded to develop a modern system. Medical e-commerce will be standardized, with drug circulation channels and development models enriched. Modern logistic techniques will be promoted. Modern TCM distribution networks and tracing systems will be improved. Health facilities will play a pivotal role in drug procurement, with joint procurement encouraged. The national drug price negotiation system will be improved, and a tracing system for pricing set up. Availability guarantees and warning of drugs shortages will be developed, and drug reserve and emergency supply chains established. Urban and rural modern drug circulation networks will be built to improve drug security at community level and remote areas. Section 2: Meliorating National Drug Policy The national essential drug system will be consolidated and developed to ensure special groups’ access to essential drugs. Drug policy on free treatment will be improved, and free drug supply for prevention and treatment of special diseases such as HIV will be increased. Children’s drug supply will be guaranteed. Drug supply for rare diseases will be ensured. A comprehensive clinical evaluation system will be built with a focus on essential drugs. Drug pricing systems will be improved under regulation of the central government and with support of the market. Linkage of pricing, health insurance, and purchasing policies will be strengthened. Category-based management of drugs will be adhered to. Price regulation for expensive medical consumables and drugs with insufficient market competition will be strengthened, and a public drug price monitoring and information disclosure system will be set up. Standards for drug payments by health insurance schemes will be formulated.

Part V: Building a Healthy Environment Chapter 13: Deepening Patriotic Public Health Campaigns Section 1: Comprehensively Improving Urban and Rural Environment and Sanitary Conditions Urban and rural environment and sanitation will continued to be enhanced, with better infrastructure and long-term mechanisms to solve environmental and sanitary

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problems. Residential environment will be managed well in rural areas with improved garbage disposal and proper domestic sewage treatment. Clean energy will be promoted. By 2030, more rural areas will have beautiful homes suitable for growing old with improved sanitary conditions in residential environments. Rural residents and nature will be developed in a harmonious manner. Projects to ensure the safety of drinking water in rural areas will be implemented, and efforts made to expand urban water supply to rural areas. Centralized water supply in rural areas will be increased, as will access to tap water, better water quality, and adequate water supply. A comprehensive rural water safety system will be built from source to tap. The building of safe public toilets will be accelerated to ensure they can be accessed by all rural residents by 2030. Prevention and control strategy for diseases, with a focus on environmental management will be implemented. By 2030, the share of national sanitary cities will reach 50%, and provinces (autonomous regions, municipalities) with favorable conditions will have 100% coverage. Section 2: Building Healthy Cities, Towns and Villages “Building healthy cities, towns and villages” is an important project for healthy China. Land supply for public health infrastructure will be secured, and health-­ related infrastructure, planning and standards improved. Health will be included in urban and rural planning, construction and management process, and urban development and residents’ health will be improved in a coordinated manner. Based on local health needs, plans for healthy cities, towns and villages will be developed and implemented. Healthy communities, healthy enterprises and healthy households will be launched to increase social participation. Also, the building of healthy schools will be emphasized, with the enhancement of student health risk factor monitoring and evaluation, alongside school food-safety management, infectious disease control and other related policies. By 2030, a group of healthy cities, towns and villages will be built for nationwide demonstration.

 hapter 14: Strengthening Management of Environmental Problems C Affecting Health Section 1: Strengthening Prevention and Management of Air, Water and Land Pollution Joint control and prevention, and co-governance of water sources will be strengthened, with a focus on improving the environment. Targets for environmental quality control and strict environmental protection regulations will be implemented to solve outstanding environmental issues that affect people’s health. Environmental impact assessment of the development of new industrial parks, districts and cities will be reinforced, with strict control of approval of construction projects and intensive use of preventive measures. Regional measures on air pollution control and prevention will be promoted with regular regional cooperation. A joint warning mechanism will be enhanced to handle heavily polluted air and other conditions. Goals for city air quality will be fully monitored, and city air quality improved significantly. Water source safety management will be developed. Groundwater management and

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protection will be strengthened, and management and pollution control in excessively pumped areas of ground water will be enhanced. A national land quality monitoring network will be built, with a soil quality assessment system for construction land established, and soil pollution control and repair implemented. With the focus on arable land, categorical management of farmland will be implemented. Full measures for pollution control and prevention will be taken to effectively protect ecosystems and genetic diversity. Noise control and prevention will be strengthened. Section 2: Implementing Comprehensive Plan on Discharge Control of Industrial Pollution Sources A licensing policy for industrial pollution sources will be fully implemented. Self-­ monitoring and information disclosure of enterprises will be promoted, with disposal accounts established to ensure licensed discharge. Highly pollutant and risky techniques, products and devices will be eliminated quickly. Special pollution control projects for industrial agglomeration areas will be carried out. Renovation projects for discharge control of industries will be accelerated, with a focus on steel, cement and petrochemical industries. Section 3: Building Comprehensive Environment and Health Monitoring, Survey and Risk Assessment System A comprehensive environment and health management system will be gradually established, with health surveys conducted in key areas, fields and industries. A comprehensive monitoring network and risk assessment system will be established to cover pollution sources, environmental quality, and health outcomes. Environment and health risk management will be implemented. Areas of high health risk will be identified, the health impact of environmental pollution on the population studied, and policy on health impact evaluation for major projects in high risk areas will be developed. Environmental health risk communication mechanisms will be set up. A unified platform for publicizing environmental information will be established, and mandatory information disclosure fully launched. Air quality of counties and higher levels will be monitored, and information publicized.

Chapter 15: Ensuring Food and Drug Safety Section 1: Strengthening Food Safety Regulation Food safety standards will be improved to comply with international standards. Food safety risk monitoring and assessment will be strengthened. Nationwide reporting on food safety-risk monitoring and food-borne diseases will be fully established by 2030. Standardized and hygienic agricultural production will be encouraged. Risk assessment of the quality and safety of agricultural products will be carried out, comprehensive management of pesticide residue and heavy metal pollution conducted, and actions taken on animal antibiotics control. Supervision and regulation of the geographical origin of food will be stepped up, and market access control of agriculture products established. An edible agricultural product

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tracing mechanism will be developed, as will uniform and authoritative food safety regulation armed with a professional inspection taskforce. Regular testing capacity will be improved, and coverage of sample-based checking will be expanded. Regulation of online food businesses will be reinforced. Management of the entrance of imported food will be strengthened, and inspection of safety testing for food with foreign origin conducted. Construction projects of designated ports for imported food will be orderly launched. Local governments will be encouraged to develop demonstration zones on safety and quality control of foods and agricultural products for export. And a food safety credit system will be developed, and policy on food safety information disclosure implemented. A whole-process regulation system will be established, covering activities from production to consumption. Every procedure from farm to table will be closely controlled to provide safe and quality food for consumers. Section 2: Strengthening Drug Safety Regulation Policies on drug (medical device) assessment and regulation will be further reformed, a clinical-effectiveness oriented regulatory system established, and drug (medical device) regulatory standards upgraded. The assessment and approval process for innovative and urgently-demanded clinical drugs (and medical devices) will be accelerated, and bioavailability and bioequivalence study of generics encouraged. The national drug standard system will be improved, medical device standards raised, and global standards of TCM developed. Drug regulation will be enhanced, and regulatory chains on the whole process and all products formed. Medical devices and cosmetics will be closely regulated.

Chapter 16: Improving Public Safety Systems Section 1: Improving Production Safety and Occupational Health Production safety will be enhanced, and double defense of risk level control and hidden hazard screening established to effectively reduce the frequency and harm of major accidents. Industries will strengthen their ability to regulate and supervise themselves, while enterprises will take the main responsibility; source control of occupational diseases will be strengthened. Production safety supervision and management of mines, dangerous chemicals and other key industries will be enhanced. A census on occupational diseases will be carried out, and tailored health interventions developed. Occupational safety and health standard systems will be further improved, and network on monitoring, reporting and managing of major occupational diseases and risk factors established to control high incidence of pneumoconiosis and occupational poisoning. Tiered and targeted regulation will be established, with special attention given to enterprises with high risk of occupational disease hazards. Earmarked actions on occupational disease hazards of key industries will be launched. Policies on occupational disease reporting will be strengthened, and employers encouraged to promote occupational health education to control and prevent workrelated injuries and occupational diseases. National per capita radiation dose control will be implemented, with radiation harm in radiotherapy controlled and prevented.

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Section 2: Enhancing Road Traffic Safety Design, planning and construction of road traffic safety facilities will be supported. Highway safety and life protection projects will be launched to control hidden traffic dangers on highways. Road transport safety management will be strictly implemented together with the enhancement of self-discipline in enterprises. Transportation enterprises will be held accountable for safe production. Supervision of safe operations and support of safe production will be enhanced. Regulation for road traffic safety will be further strengthened, standards for vehicle safety techniques raised, and comprehensive quality of automobile drivers, passengers and pedestrians improved. By 2030, deaths caused by road traffic accidents per 10,000 vehicles will decrease by 30%. Section 3: Preventing and Reducing Injuries A comprehensive monitoring system for injuries will be established, and technical guidelines and standards for the interventions of major injuries established. Prevention and intervention of children and elderly injuries will be strengthened; cases of traffic injury, drowning of children and accidental falls among the elderly reduced; and safety standards for children’s toys and supplies raised. Suicide and accidental poisoning will be prevented and related cases reduced. Mandatory reporting on consumer goods quality and safety accidents will be enforced, and a product injury monitoring system established. Extra efforts will be taken to strengthen quality and safety supervision in key areas to reduce injuries from consumer goods. Section 4: Improving Emergency Management Capacity Safety awareness education will be conducted among all people. A mechanism for the responsibility in construction and maintenance for urban and rural public firefighting facilities will be clarified and improved, and coverage of urban and rural firefighting facilities reach will 100% by 2030. Disaster prevention capacity and emergency response will be improved. Health emergency response systems will be improved, and capacity of early prevention, timely detection, quick response and effective action enhanced. Emergency medical rescue systems with land, sea and air tactics covering all health facilities including military ones will be established to improve emergency medical rescue capability. By 2030, a more comprehensive emergency medical rescue network will be established, with improved response and rescue capacity equal to that of developed countries. Emergency medical rescue systems and their performance will be further improved. By 2030, road traffic injuries and deaths will be reduced to the levels of moderately developed countries. Section 5: Improving Public Health System at Ports Control and prevention system of infectious diseases at ports will be established, with intelligent monitoring and early warning of global epidemics and accurate quarantine measures, in addition to a prevention and control system handling hazardous nuclear, biological and chemical factors in modern ports. Border public health emergency response systems will be established, based on source control and domestic-foreign joint control and prevention mechanisms. Monitoring and control

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mechanism of major infectious diseases and port pathogens will be implemented to actively prevent, control and respond to foreign public health emergencies. Core capabilities will be continually consolidated to create world-class healthy airports and ports. An international travel and health information network will be improved to provide timely and effective international travel health guidance; to build a world-­ class international travel health service system; and to protect the health and safety of cross-border travelers. Control and prevention capability of plant and animal epidemics will be improved. Risk assessment and access control of quarantine inspection on inbound animals and plants will be implemented. Efforts should be made for detention, detection and identification, elimination, monitoring and control of imported diseases, epidemics and hazardous life. An accountability system will be enhanced to investigate individual or institutional buyers and carriers of plants and animals to prevent and control international plant and animal-borne epidemics and cross-­ border transmission. Biological safety inspection mechanisms in gateways will be enhanced to effectively prevent the loss of species and invasion of foreign species.

Part VI: Developing Healthcare Industry Chapter 17: Optimizing Pluralistic Structure of Medical Care Services Policies will be further optimized to support the development of non-profit private health services, and treatment for profit private hospitals and public hospitals will be equal. Physicians are encouraged to use their free time to practice in primary health institutions or to open clinics, as are retired physicians. The establishment of private clinics will not be bound by regional health planning. Unreasonable restrictions and invisible barriers for private health services will be eliminated. Scope for health services with foreign investment will be expanded gradually. Public procurement of services will be increased. The insurance sectors will be supported in investing in and opening health services and non-public hospitals will be encouraged to develop to a higher level and achieve economies of scale. Development of professional hospital management groups will be encouraged. Government regulation, industry self-­ discipline and social supervision will be enhanced to support the development of non-public health services.

 hapter 18: Developing New Types of Health Services C Nursing care, tourism, the Internet, fitness and leisure, and food sectors will be integrated with the health sector to develop new health industries, businesses and care models. Development of Internet-based health services, physical checkups and consultations will be promoted to foster a personalized health management service industry. Wearable devices, intelligent electronic products and mobile health will be explored and developed. Maternal and childcare services will be standardized. Health culture and sports rehabilitation industry will be cultivated. The healthcare

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tourism industry will be standardized, and medical tourism destinations with global competitiveness developed. TCM health tourism will be promoted. Efforts will be made to nurture the positive development of leading brands of healthcare businesses and to support the development of micro, small and medium-sized enterprises. Development of professional medical centers including medical laboratories, health imaging centers, pathological diagnosis and blood dialysis centers will be guided and supported. Development of third party healthcare evaluation, health management services, as well as health market research and consultation services will be supported. The private sector is encouraged to provide food and drug testing services. Science and technology intermediary systems will be developed, and professional and market-oriented transformation of medical knowledge greatly promoted.

 hapter 19: Promoting Fitness, Leisure and Sports Industry C The market environment will be improved and pluralistic ownership supported. The private sector will be encouraged to construct and operate fitness and leisure facilities. Reforms in sports associations and separation of management rights from sport organization ownership will be launched. Sports resources will be made available to the public, with innovative fitness leisure sports popularized. Policy and mechanisms in favor of public procurement of sports services will be developed, to create a comprehensive fitness and leisure service system. The development of various forms of fitness clubs will be encouraged, amateur sports enriched, and consumption-­ based sports including ice and snow, mountain, water, automobile, aviation, extreme, equestrian, and other fashionable leisure sports developed. Fitness and leisure industry demonstration zones and industrial belts with regional characteristics will be created. Chapter 20: Promoting Development of Medical Industry Section 1: Strengthening Medical Technology Innovation A system of innovation will be developed to promote innovation and transformation, with coordination between government, industry, universities, research institutions and users. Innovation capacity of patent drugs, new TCM, new type of formulations, and advanced medical equipment will be built. Development of generics for expired patent drugs of major diseases will be promoted. Biological medicine, new types of chemical drugs, quality TCM, medical devices with high performance, new packaging materials and drug manufacturing devices will be developed. Major drugs will be industrialized, medical devices transformed and upgraded quickly, and international competitiveness of medical diagnostics and supplies with independent intellectual property rights will be developed. Business of rehabilitation assistive devices will be developed speedily, and independent innovation capability increased. Quality standard systems and quality control technology will be improved by launching projects on green and intelligent transformation and upgrading. By 2030, quality standards of drug and medical equipment will fully meet international standards.

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Section 2: Enhancing Development of Healthcare Industry Development of professional medical industrial parks, and formation of business alliances or consortiums will be supported to build innovation-driven, green and low-carbon, intelligent, efficient and advanced manufacturing systems; increase industrial concentration; and enhance the supply capacity of high-end products. Trade in healthcare services will be strongly promoted to help pharmaceutical enterprises go abroad to intensify international collaboration, and to improve their international competitiveness. By 2030, global market share of new drugs and medical devices with independent intellectual property rights will be substantially increased, and the localized production of high-end medical devices greatly promoted. The medical industry will develop at a medium-to-high speed and march toward medium and high-end markets, so that China will become a country with a strong pharmaceutical industry. The pharmaceutical distribution industry will be transformed and upgraded to reduce intermediate links in distribution, improve market concentration, and form a batch of large multinational pharmaceutical distribution enterprises.

Part VII: Improving Supportive and Guarantee Mechanisms Chapter 21: Deepening Reforms in Institutional Arrangements Section 1: Putting Health in All Policies Cross-ministerial and industrial communication and cooperation will be strengthened to form a joint health promotion force. Evaluation system for conducting health impact assessment will be established to systemically assess the health impact of economic and social development plans and policies, as well as major projects. Associated supervision mechanisms will be developed. Channels of public participation will be opened, and social supervision strengthened. Section 2: Deepening Healthcare System Reforms The establishment of a more mature primary healthcare system will be facilitated, effectively maintaining the welfare of government-sponsored healthcare services; containing unreasonable growth of medical cost; and continuing to improve people’s access to essential healthcare services. Administration will be kept away from health institutions, while management and operation of government-owned hospitals will be separated to ensure proper relationships between publicly-owned health institutions and the government, and to establish modern management systems in public hospitals. Health administration powers between central and local governments and governments at all levels will be clearly distributed to set up a territory-­ based and sector-wide health management structure. Military hospitals will be covered by urban public hospital reform initiatives and national reform programs for developing tiered healthcare delivery systems. A sector-wide supervision system will be built covering all aspects of health and family planning.

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Section 3: Improving Health Financing Mechanisms Public input in health will be increased and relevant mechanisms improved. Budgetary structures of public finance will be adjusted and optimized. Total public health spending increased, the share of financing responsibilities between the central and local governments clarified, and public financing for primary healthcare services ensured. Economically underdeveloped areas will be favored in the transfer payment plans of the central government, and effectiveness of funding use improved. Result-based health financing will be established and monitoring and evaluation of health input performance launched. Social organizations and enterprises will be fully mobilized to form a diversified health financing pattern. Financial institutions will innovate products and services and improve supportive measures. The development of charity, including social and personal donations as well as mutual assistance, will be encouraged. Section 4: Speeding up Transformation of Government Functions Decentralization and reduction of administrative interference, power delegation and regulation, and optimization of public services will be further promoted. Approval policy of drugs and health institutions will be reformed, and opening of health facilities orderly supervised. Health authorities and agencies will abide by the law, and disclose public affairs and information. Regulatory innovation in health care, family planning, sports, food and drug and other health-related fields will be accelerated, with the establishment of pre and post regulatory systems. The “randomized sampling of subjects and inspectors by industrial and commercial agencies and market regulation and publicity of inspection results” will be fully implemented. Comprehensive supervision and inspection systems will be established, and self-­ discipline and credit systems will be developed. Development of industry associations will be encouraged so that social forces will play a role in supervision. Fair competition will be promoted and health-related industries developed. Public service processes will be simplified, administrative services optimized, and productivity of public services improved.

Chapter 22: Developing Human Resources for Health Care Section 1: Strengthening Health Personnel Training Health and education policies will be better coordinated, and the supply and demand balance of medical personnel training achieved. Medical education systems will be reformed to speed up the construction of the health education system integrating college education, post-graduate education and continuous education, reflecting features in the health sector. Quality assurance systems in medical education will be improved, with the establishment of health professionals licensing systems equivalent to internationally-recognized health education programs. With a focus on general practitioners, primary healthcare taskforces will be built. Training programs of resident and specialist doctors will be improved, and programs for high-level professionals with training in both public health and clinical medicine. Continuous medical education will be strengthened for all medical professionals. More supports

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will be given to primary healthcare staff and those working in remote areas. Education and training of those specialties in great shortage, such as general medicine, pediatrics, obstetrics, psychiatry, pathology, nursing, midwifery, rehabilitation, and mental health, will be strengthened. Capacity building for interdisciplinary talents including pharmacists and TCM care providers, health emergency staff, and health information specialists will be increased. Training of high-level international academic leaders will be strengthened, and leading experts with global recognition will be cultivated. Professionalism and specialization in health management staff will be enhanced. The range of medical specialties in health education will be adjusted and optimized to meet human resource demands of the healthcare industry. More healthcare talents including nurses, physiotherapists and psychiatrists will be trained. Health education cloud platforms will be established based on national open universities of health and medical care and supported by the Chinese open online courses on health and medical care to provide lifelong training support for health staff. A taskforce of social sports mentors will be built, and a target of 2.3 instructors per 1000 achieved by 2030. Section 2: Incentives for Innovative Talents Health facilities will be given more autonomy in personnel management, and a contract-­based employment system implemented, so that flexible employment measures encouraging inward and outward flow of staff can be applied. Policies on the remuneration of primary healthcare staff will be firmly implemented. Medical personnel employment, mobility and practice models will be reformed, with efforts to actively explore self-employed practice, and practice based on contract with health institutions or medical groups organized by physicians. Medical personnel and remuneration-systems characteristic of the health sector will be established. Assessment of nurses, midwives, medical auxiliary staff, health technicians and other professionals will be further improved based on common international practices. Assessment of talented staff will be reformed, with less attention on academic publications, foreign languages and scientific professional titles. Assessment of talented general practitioners will be reformed to meet specialty requirements.

 hapter 23: Promoting Science and Technology Innovation C in Health Care Section 1: Building National Medical Innovation Systems National clinical research centers and collaborative innovation networks will be developed with significant efforts, and more laboratories, engineering centers and other research bases built. TCM clinical research bases and institutions will be developed from existing facilities, and capacity increased. Distribution and layout of health research and scientific research bases will be optimized. Resource integration and data interchange will be enhanced, with comprehensive integration of national resource platforms, including biomedical big data, biological samples, and laboratory animal resources, etc. Clinical data demonstration centers will be established for cardio-cerebrovascular diseases, cancer, and geriatric diseases, etc. The

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national project on health and medical for the Chinese Academy of Medical Sciences will be implemented. Construction of biomedical and health industrial bases will be accelerated, high-tech healthcare enterprises fostered, and several medical research and health innovation centers established. Integration among healthcare delivery, health research and development, and the health industry will be enhanced. Effective cooperation among health facilities, research institutes, universities and enterprises will be encouraged. A platform for transformation and promotion of medical research and development results will be developed to facilitate transformation and promotion of innovations. Better incentives for medical innovation and application-­ oriented assessment measures will be designed. Scientific research bases, bio-safety, technology assessment, medical research standard, ethics and scientific integrity, and intellectual property rights will all be improved. Integration of science and health policies will be strengthened; civilian and military health research coordinated; central and provincial cooperation also strengthened. Capacity for fundamental frontier research, key common research, public welfare research and strategic high-tech research will be increased. Section 2: Promoting Medical Science and Technology Progress Major scientific and technological projects and programs in areas including brain science, brain-like intelligence technology, and health protection, etc. will be initiated. Ear-marked major national science and technology projects will be promoted, as will ear-marked R&D programs and other major science plans. Advanced medical technologies such as Omics technology, stem cell technology and regenerative medicine, new vaccines, and biotherapy will be developed. Breakthroughs in key technologies, such as control and prevention of chronic diseases, precision medicine, and e-Health will be promoted. New drug R&D, domestic production of medical equipment, and modernization of TCM will be carefully planned. Science and technology will play a major supportive role in prevention and treatment of major diseases and development of the healthcare industry. By 2030, the impact of scientific and technological papers and the total number of triadic patents will reach top international rankings. Scientific and technological innovation will contribute more to the growth of the pharmaceutical industry, and innovation transformation will increase.

Chapter 24: Developing Digital Health Information Services Section 1: Improving Population Health Information Service Common, authoritative and well-connected information platforms on the population’s health will be established. “Internet + healthcare” services will be standardized and promoted, and Internet-based healthcare services innovated. National health information services will be continuously developed in a bid to cover the whole life cycle of prevention, treatment, rehabilitation and self-health management. Cloud service plans for Healthy China will be implemented, a comprehensive telemedicine system established, and digital health services with better accessibility developed. Standards and security for public health information will be established.

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Soldiers’ electronic health records will be shared continuously before and after military service. By 2030, a standard health information platform for the population’s health connecting county, city, provincial and national levels will be established. Standard digital health records will be available for all, and health cards with complete functions also available for all. Telemedicine will cover all health facilities at township, county, city and provincial levels. All population health information will be managed and used in a standard format. Information needs of personalized and precision medicine will be met. Section 2: Promoting Use of Big Data in Health Use of big data in health will be promoted. Open sharing, deep mining and wide application of big data in health will be promoted based on regional population health information platforms. Barriers to data sharing will be eliminated. Coordination and unification of cross-departmental and cross-sector data sharing will be established in a bid to realize data extraction, sharing and integration of public health, family planning, health services, health protection, drug supply and comprehensive management. A national health data resources directory system will be established and improved. Health data utilization will be used in supporting health governance, clinical and scientific research, public health, education and training. New business models of big data use in health will be developed. Regulations and standards of big data in health will be established. Capacity of national and regional population health information technology will be improved. Policies and regulations on data classification, domain classification and application will be developed. Credited information systems will be built. Network system, content, data and technology security will be strengthened to ensure health data security and patient privacy protection. Internet-based health services supervision will be enhanced.

 hapter 25: Strengthening Health Legislation C Basic health law and TCM law will be developed and issued, and the Drug Administration Law amended. Legislation and revision will be enhanced in key areas. Departmental and local health regulations will be improved, and all health-­ related standards and guidelines developed. Government’s regulatory responsibilities in health, food, medicine, environment, sports and other health-related areas will be strengthened. Supervision and management systems combining government regulation, industry self-regulation and social supervision will be established. Supervision on health law enforcement systems and relevant capacity building will be enhanced.  hapter 26: Intensifying International Exchanges and Cooperation C China’s global health strategy will be implemented, and all-round international cooperation in population health promoted. Based on bilateral partnership, the mode of cooperation will be innovated and cultural exchanges strengthened, to promote China’s Belt and Road Initiative in international health cooperation. “South-­ South cooperation” will be intensified, and China-Africa cooperation in public

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health implemented. Health professional teams will be dispatched to developing countries, medical assistance in areas such as maternal and child health emphasized, and major support given to development of disease control and prevention systems. International exchanges and cooperation in TCM will be encouraged. By establishing high-level strategic dialogues between countries, China will encourage putting health on the diplomatic agenda of major countries. China will actively participate in global health governance, play a key role in research, negotiation and establishment of standards, regulations, guidelines, and gain international influence and a strong voice in building institutional health.

Part VIII: Strengthening Organization and Implementation Chapter 27: Strengthening Organization and Leadership Implementation and coordination mechanisms for Healthy China will be established to promote the overall strategic agenda. Deliberations on key programs, important policies, large-scale infrastructure development plans, major issues and arrangements will be initiated. Strategic planning will be emphasized to provide guidance to ministries, agencies and local governments. Local governments, ministries and agencies will put Healthy China on top of the policy agenda, and improve leadership and working mechanisms. Healthy China will be incorporated into local economic and social development plans, and key health indicators used for merit assessment of all Party committees and government departments. Assessment and accountability will be improved to ensure actual implementation of relevant tasks and missions. Trade unions, communist youth leagues, women’s federations, federations of the disabled, and representatives of other social organizations, non-communist parties and persons without party affiliation will be supported to play their roles. Social consensus will be reached and joint taskforces formed as much as possible.

 hapter 28: Creating Favorable Social Conditions C Major strategic thinking of the Party and the government’s policies on maintaining and improving population health will be strongly advocated. The significance of building Healthy China, its overall strategy, objectives and tasks and major initiatives, will be publicized. Positive publicity, public opinion supervision, scientific guidance and reports on typical cases will be encouraged to help create social awareness of building Healthy China, and create favorable conditions to support its implementation.  hapter 29: Conducting Implementation Monitoring C The 5-Year Plan for Health and Family Planning and other policy documents will be formulated and implemented. Details of policies and measures stated in the outline of the plan will be constructed, and major infrastructure development programs, key projects and policies in all stages defined. Regular and standardized supervision and

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assessment mechanisms will be identified to strengthen incentives and accountability. Monitoring and evaluation mechanisms will be established and improved, detailed task distribution among main departments or agencies and monitoring and evaluation strategies developed, and annual evaluation of progress and outcomes of implementation conducted. Necessary adjustments will be made to the objectives and tasks in an appropriate and timely manner. Initiatives and innovations by the people will be respected. Good local practices and effective experiences will be summarized in timely fashion, and actively scaled up during implementation. Supervised by Planning and Information Department of the national health and Family Planning Commission. Manuscript by China Population Communication Center.

Appendix B: Glossary of Outline of the Healthy China 2030 Plan

Average Healthy Life Expectancy  It is a new indicator of health measurement developed by World Health Organization, referring to the average health life expectancy after deducting the mortality and morbidity data. It is still in the searching period at the international level, and our country currently does not have the sufficient conditions of completely calculating the average healthy life expectancy. It can be seemed as a striving direction, but the research of calculation should be carried out positively. Healthcare Industry  It refers to a variety of services: medical and health services, health management and promotion services, health insurance and security services, and other services related to health. The scope of health industry is much wider. Based on the healthcare industry, it expends to the supporting industry, such as medicine, medical equipment, health products, health food and fitness products. Putting health in all policies: It emphasizes on combining several of different forces to improve the health level of the entire population, by putting a high premium on social determinants of health, and putting the idea of health protection and promotion in all of the development and implementation of public polices in each department. In June 2013, the Eighth Global Conference on Health Promotion passed The Framework for Action on Putting Health in all Policies, and clarified the specific requirements. Universal Health Coverage (UHC)  Proposed by the World Health Organization in 2005, it is about ensuring that people have access to the quality health care they need (health promotion, prevention, treatment, rehabilitation, etc.), without suffering financial hardship. UHC emphasizes on three important dimensions of health services: the fairness and availability, the service quality, and the economic risk protection. Health Equity  Health equity is an important aspect of social equity. The World Health Organization and Swedish International Development Cooperation Agency released a written proposal in 1996: The Equity of Health and Health Service. It © Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9

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stresses that “equity” is not equal to “equality”. Health equity means the distribution of life chance should be guided by need, instead of equal distribution, much less social status or income difference. Health equity demands: making efforts to remove the inevitable unfairness existing among people in the aspects of health condition, health services, health financing, etc.; reducing the undue health disparities; striving to achieve the basic living standards of every member of society. Among the demands, the equity of health condition refers to that different social groups should have the same health conditions, or the health gap should be minimized as possible; the equity of health services refers to the allocation of health resources in a just and equal way, in order to ensure that different social groups have the same opportunity to benefit from it; the equity of health financing refers to that different social groups should share equitable economic burden among the process of health financing, including horizontal equity and vertical equity. Horizontal equity means that the ones have the same affordability should bear the same cost, while vertical equity means that the ones have different affordability should bear different cost (the ones of higher affordability should pay more, while the ones of lower affordability shall bear less cost). The core issue of the equity of health financing lies in how to avoid poor for disease or back to be poor for disease. Healthy Nations Healthy nations are the nations whose core health indicators (such as life expectancy, infant mortality rate, under 5 mortality rate, maternal mortality rate, etc.) have achieved or exceeded the mean level of the other nations at the same stage of economic and social development, having achieved a coordinated development between the national health and the economic society. In addition, there are other aspects which are significant to evaluate health nations: the national health literacy, the behavior pattern of living, natural and social environments, the quality of medical and health services, accessibility and equity, etc. Whole Life Cycle  It refers to “cradle-to-grave”, which can be divided into different life stages. Different life stages contains different health issues and influence factors. Therefore, the priority areas and the intervention measures should be confirmed specifically. Meanwhile, different life stages closely connect to each other. Only the health care work of each period accomplished well, can realize everyone’s lifelong health be realized. The mid-and-long term health planning of other countries stress to cover lifelong health needs by identifying priorities according to different stage, and stepping up interventions. Integrated Medical and Healthcare Service Delivery Systems  It aims at effectively improving the accessibility, quality, efficiency and patient satisfaction of medical treatment and public health. It changes the condition that individual organizations provide the service in one aspect, integrates different services and different levels of organization, to realize upper and lower linkage and horizontal bridging. It can provide continuous services of prevention, treatment, rehabilitation and health promotion, in order to satisfy the residents’ demands of health diversification and continuity. At present, it has become a global trend to build integrated medical and healthcare service delivery systems.

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Determinants of Health  The World Health Organization has defined determinants of health as the combination of all the factors influencing population health, which include social economic environment, natural environment, personal features and individual behaviors. Among the influential factors, social economic environment includes income, social status, education, medical services, etc.; natural environment includes water, air, working place, human settlement, traffic, etc.; personal features include genetic factors, gender, etc.; individual behaviors include diet, sporting, smoking, drinking, psychological coping, etc. According to the research of the World Health Organization, there are four major determinants: biological factors (heredity and psychology, 15%), environmental factors (natural environment and social environment, 17%), health service factors (8%) and behavior and lifestyle factors (60%). Healthy Living  It refers to the healthful behavior style of habituation, which is advocated by the World Health Organization, including rational diet, proper sporting, quit smoking-limited wine, psychological equilibrium, etc. A healthy lifestyle not only helps resist to disease, but also contribute to the prevention and treatment of the following chronic diseases: cardiovascular and cerebrovascular diseases, malignant tumor, respiratory disease, diabetes Mellitus, etc. National Nutritional Plan To improve the national nutritional conditions, the National Health and Family Planning Commission led the development and implement of National Nutritional Plan. Directing at low-income people, the elders, pregnant women, nursing mothers, infants, students, patients, and other key groups, the nutritional surveillance should be enhanced with nutritional interventions, to improve nourishment and lower the risks of nutrition-related diseases. Harmful Alcohol Use  According to Global Strategy to Reduce the Harmful Use of Alcohol released by the World Health Organization in 2010, harmful alcohol use refers to the drinking behaviors with negative effects on the drinkers, the people around them, and entire society, as well as the drinking behaviors which can raise the risk of unhealthy consequences. In Guidelines on International Alcohol Consumption and Hazard Monitoring, the World Health Organization has defined “harmful alcohol use” as: a man intakes 61  g pure alcohol average per day, or a woman 41 g pure alcohol average per day. Social Sports Mentors  There are two kinds of positions of social sports mentors: public welfare position and professional position. Public welfare social sports mentors refer to the volunteers who provide skill training, fitness activities organizing, scientific fitness knowledge spreading and other volunteering work of the national fitness program, without paying. The nation practices a skill-grading system for social sports mentors in public position. From low to high, they are the third grade, the second grade, the first grade and national. Professional social sports mentors refer to the professionals working in the business sport fitness centers, engaging in sports fitness guidance. Professional social sports mentor, as an official employment included in national professional classification code with professional certification, includes the instructors of several specific sporting events, such as, fitness, swimming, aerobics,

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skiing, tennis, mountain climbing. They are important human resource to satisfy the personalized and specialized needs of public fitness. Public Fitness Adaption  The sports building activities should penetrate into daily life, while fitness should become the fifth basic necessities of life, among clothing, food, shelter and means of travel, to form a healthy lifestyle. Aiming at improving people’s physical fitness, and perfecting people’s mental, moral and physical health, public fitness adaption can meet people’s needs of health, entertainment, leisure, fitness, rehabilitation, etc. Sports Exercises with Medical Care and Non-medical Health Interventions Sports exercises with medical care means the combination of the functions of both sports exercises and medical care. The former has the function of the constitutions strengthen, while the latter has the functions of disease prevention, treatment and rehabilitation. On the grounds of testing and evaluation on the health risk factors among general population, high risk individuals and patients, non-medical health interventions refer to the comprehensive interventions to the health risk factors among individuals or groups by non-medical methods, such as proper exercise. National Demonstration Sites of Chronic Diseases It refers to the towns and counties which are established under the guidance of the National Health and Family Planning Commission, locating in the provinces (districts or cities) across the country. The demonstration sites can match the comprehensive strategy for preventing and controlling of the chronic diseases, according to the development characteristics in different regions. Their functions are: to implement the strategic position of governmental responsibility; to perform the whole function of health care service system; to provide the management services of chronic disease prevention in the whole life cycle of the entire population. Via the construction of the national demonstration sites of chronic diseases, the total prevention and management level of regional chronic diseases can be promoted, while the premature mortality caused by major chronic diseases can be reduced. Policymaking Processes and Systems on Population and Development The Central Party and the State Council have always paid high attention to the population and family planning program. They clearly demanded to bring it into the overall plan of economic and social development. We should insist on the policymaking processes on population and development, and full play the central role of the party’s political leadership. In the process of significant policymaking, the factors of population, such as, population size, structure, distribution and quality, should be considered carefully. The comprehensive assessment for population, resources and the environment should be taken with perceptiveness and globality. We should study and develop the comprehensive evaluation system of balanced population development, and bring the family planning into the overall plan of the economic and social development. We should comprehensively apply the measures of economy, administration, education, technology, law, society and so on, to give full play of the active role of each department, perfect related system and mechanism, comprehensively address the issue of population and promote the balance population growth in the

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long term. Since 1991, the Central Party and the State Council have issued four “Decisions” which clearly demanded that the leaders of the Party and governments shall personally supervise the work and assume overall responsibilities. Opportunistic Screening  It refers to the screening carried out among the high risk individuals in the hospital and other patients. Clinical Pathway Management  Clinical pathway is a set of standardized treatment modes and procedures. It is an aggregative model of clinical treatment, and a method on improve medical organizations and disease management, under the guidance of the confirmation medical evidence. Clinical pathway management, as a management method, means that medical organizations make diagnoses and treatment of the patients by the clinical pathway of different diseases, in order to regulate the medical behavior, reduce the variation and cost, and improve the quality. Healthy Aging  It refers to constantly maintain and develop the various functions which are needed in the healthy living of aged people. It contains: to raise the physical health of aged people, to improve the life environment and social support, to increase the medicine and auxiliary equipment, to help the unhealthy aged people participate in social activities, etc. In 1990, the World Health Organization proposed a goal that “healthy aging” should be realized to deal with the aging population problems. Integrated Care  It refers to a service mode which combines medical and health services with pension services. Medical and health services include: health education, prevention and healthcare, diseases diagnosis and treatment, rehabilitation nursing and hospice palliative care; pension services include: daily life care, mental services, cultural activity services, etc. The service mode of integrated care combines medical treatment, rehabilitation, nursing and pension services into one. Thereby, the needs of health care of the elderly can be meet effectively. Diagnosis Related Groups (DRGs)  The diseases are divided into several groups, according to diagnosis, age, sex, etc. The classification criterions of the groups are entity, state, severity and complication of the disease. The medical expense standard of each group is calculated by the clinical pathway combined with the confirmation medical evidence. And the medical expense is paid in advance to the service providers. Performance-Related Payment  The amount of payment is combined with medical service quality and efficiency. A measurable performance objective is set at first, by which the result is evaluated. The expenses or materials will be transferred, according to the evaluation. General payment, together with other modes of payment, is put in practice, in order to improve the quality and efficiency of service. Output should be the payment basis of performance-related payment. Healthy Cities, Towns and Villages Healthy cities, as the upgrade versions of hygienic cities, can meet the health needs of residents and realize the harmonious development of the city construction and the residents’ health, by optimizing urban

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planning, construction and management, improving the natural environment, social environment and health services, and advocating the healthy lifestyles widely. On the basis of hygienic towns and villages, healthy towns and villages realize the harmonious development of the producing and the living conditions of the residents, with residents’ health, by perfecting the infrastructure, improving the health living environment, establishing a sound health care service system, promoting the civilized hygienic quality of residents. Agricultural Non-point Source Pollution  It refers to the agricultural eco-environment pollution caused by the following actions: the misusing of the chemical inputs, such as, chemical fertilizers and pesticides, plastic film, fodder, and veterinary drug; the improper handling of the agricultural waste materials, such as, crop straws, livestock waste, rural domestic sewage, and domestic garbage. The Plan on Discharge Control of Industrial Pollution Sources  The environmental impact assessment and the “3 Simultaneous” system must be strictly implemented. For the new pollutant sources, the up-to-standard release should be ensured; for the existing pollutant sources, the comprehensive measures should be taken to ensure the up-to-standard release, such as, clean production transforming, deep pollution abatement, limiting production and limiting emission, cessation or close the business, etc. Environment and Health Monitoring, Survey and Risk Assessment System Article 39 of Environmental Protection Law released in 2015 stipulated explicitly: “The state builds comprehensive environment and health monitoring, survey and risk assessment system; encourages and organizes the research on the impact of environmental quality on public health; takes measures to prevent and control diseases related to environmental pollution.” World-Class Healthy Airports and Ports  To gain the title, “world-class healthy airports” or “world-class healthy ports”, awarded by the General Administration of Quality Supervision, the national open ports must accept the field assessment by the experts from the World Health Organization, and also meet the requirements of core public health capacities of ports in International Health Regulations (2005): prevention and control of infectious diseases, public health emergency preparedness, environment hygiene, drinking water and food safety, solid and liquid waste disposal, public place hygiene, aircraft (camera drone) health supervision, surveillance and control of vectors, lab configuration and monitor, etc. At present, ten airports and nine ports of our country have successfully created the world-class healthy airports and ports. Biological Safety in Gateways  It refers to adopting comprehensive measures to protect national biological security, by preventing the entry-exit personnel, vehicles, containers, goods, luggage, and parcels carrying the dangerous materials, such as infectious disease pathogens, vectors, bio-terror, foreign flora and fauna, and foreign microorganism. They can hazard the public health, ecological security, social stability in our country.

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Evaluation System for Conducting Health Impact Assessment  According to the World Health Organization Health Impact Assessment (Gothenburg Consensus Paper) in 1999, health impact assessment (HIA) is a series of procedures, methods and tools for comprehensively assessing the possible influences of the policies, programs and projects in different departments on population health. The valuation system for conducting health impact assessment, as the institutionalization of HIA, refers to the investigation, analysis, prediction and assessment of the possible influence of the policies, programs, and projects on population health. Thereby the countermeasures and suggestions are made and submitted following the procedures. It is one of the significant actions to implement the putting health in all policies. National Open Universities of Health and Medical Care  It depends on the professional resources and talents superiority of healthcare industry, and insists on integrating of resources, opening and sharing, to build a win-win platform. With the online learning platform construction as the technical support, and the Massive Open Online Courses construction as the content-base, it aims at promoting the extensive use of online courses, and impelling the credit-recognize system of opening courses. For the teachers and students in medical school, professionals and the broad masses of the people, it provides a cross-unit, cross-cutting, cross-space, digitized, integrated, opening online learning platform, covering medical education, academic communication, and science popularization of health. It forms a new pattern of health care education in the Internet Plus model. Chinese Open Online Courses on Health and Medical Care  The advantages of online education and off-line education in school are combined together, mainly by some units, such as, the medical and health organizations related to medical education, research institutes, industrial societies, publishing units and information technology firms. On the basis of the large-scale Internet medical distance online education, the medical education can be realized as multiscreen interconnection with the methods of mechanism innovation, theory research, curriculum co-construction, policy suggestion, exchange and cooperation, consultant and service, quality supervision, propagandizing and popularizing, Evaluation and excellence recommendation, etc. Geriatric Nurses  Geriatric nurses are the care workers who provide life care and nursing to the aged people. Their work mainly includes: taking care for aged people’s cleanness, sleep, diet and excretion; taking charge for aged people’s safety protection and preventing the accidental injuries; keeping nursing record and doing technical nursing, such as, drug administration, observation, disinfection, cryotherapy and thermotherapy; taking hospice care for critical aged people. The former Ministry of Labor and Social Security issued On Issuing the third list of National Occupation Standard in 2002, including geriatric nurses into the third list of the National Occupation Standard. According to Ministry of Civil Affairs, National Mid-Term and Long-Term Development Plan on Personnel Training in Civil Administration (2010–2020), there are 30,000 geriatric nurses in our country, and the number will reach to 6,000,000 by the year of 2020.

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Rehabilitation Therapists  They take charge of the rehabilitation evaluation, formulate the rehabilitation recipes, and undertake the treatment of the patients’ functional recovery. Up to now, there is no professional certification, but only relative qualification attestation examination. Psychological Consultants The psychological consultants are professionals with the professional knowledge of psychology and related disciplines. Following the psychological principles, they can assist the help seekers in psychological problems through psychological counseling. Their work mainly includes: to diagnostic the psychological problems, to develop the counseling plans, to carry out psychological counseling and mental behavior modification for individuals and groups, to evaluate the effectiveness of psychological counseling. Former Ministry of Labor and Social Security issued On Printing and Issuing National Occupation Standard of Anticorrosion Workers in 2001, including the psychological consultants into National Occupation Standard, and revised the occupation standard in 2005. National Clinical Research Centers  According to 12th 5-Year Plan of Medical Science and Technology Development, the construction of national clinical research centers was launched by the former Ministry of Health, joint with the former Health Department of General Logistics, in 2012. The establishment of national clinical research centers can strengthen the medical science construction and technology innovation system, optimize the organizational pattern of medical science and technology development, accelerate the technological breakthrough of the major diseases prevention and control, and facilitate the popularization and promotion of medical technology. The construction of national clinical research centers should distributed by the field of disease. We will choose the third-level first-class hospitals as support units, which can take the leading ship of clinical performance and research ability in the field of related disease. We will choose the second-level and third-level hospitals and primarylevel medical and health care institutions to build the cooperative research network in different disease areas. The primary missions are: to study and propose the national research assignments and the solutions of different disease areas; to set up the professional public service platform of clinical research; to cultivate the talents of clinical research; to set up the cooperative research network; to organize the polycentric research of the standardized clinical diagnosis and treatment in a large-scale; to study the evaluation of the new technique and new products, and the translational medicine of the combination of fundamental research with clinical research; to set norms of the diagnosis and treatment; to carry out the technical training of the first-level health workers. Located in guiding, integrating, driving and popularizing, national clinical research centers play the following roles: the fundamental factor of integrating the clinical research resource and creative force; the major research power of the optimizing organization and implementation of clinical study of related diseases, as well as the development of translational medicine; an important promotion platform of the popularization of medical science and technology.

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Omics Technology  In molecular biology, omics technology covers genomics, proteomics, metabonomics, lipidomics, immunomics, glycomics, and etc. For example, Genomics is a forum for describing the development of genome-scale technologies and their application to all areas of biological investigation. Proteomics is the large-scale study of proteins, particularly their structures and functions. The Impact of Scientific and Technological Papers  It concludes the academy impact and social impact of scientific and technological papers. The academy impact reflects the researchers’ academic status in their researching field, and the academic value of their research achievement; social impact is reflected in the understanding by the public out of the group of academic peer and experts. The impact of scientific and technological papers is evaluated by citation analysis, peer review and journal impact factor and etc. The Contribution Rate for Pharmaceutical Industry Increase of Scientific and Technological Innovation It refers to the contribution portion of scientific and technological innovation to the income of pharmaceutical industry, excluding capital and labor. It is reflected in the relative relationship among investment, labor and science and technology, during the income growth of pharmaceutical industry. The Transform Rate of Scientific and Technological Innovation To raise the productivity level, the scientific and technological achievements with practical value should be put into subsequent activities, such as, experimental test, exploitation, application, popularizing, until be developed into new product, new craft, new material, new clinical diagnosis program and new industry. The transform rate of scientific and technological innovation refers to the ratio of the ones which are put into subsequent activities to the total quantity of scientific and technological achievements. (Wang Ruisi)

Postscripts

In accordance with the deployment of the Party Central Committee and the State Council and under the leadership of the medical reform leadership group of the State Council, the research and compilation of the “Outline of the Healthy China 2030 Plan” program was launched in January 2016. Attaches great importance to the mission, the Party committee of the National Health and Family Planning Commission make it as priority mission of the whole year. With the effort of the whole committee and cooperation with the relevant departments, this glorious and arduous task has been successfully completed. In October 25th, the outline was issued by the Central Committee of the Communist Party of China and the State Council. The outline is the fruition of collective wisdom. During the process of compiling, the democratic parties, the Central Committee, the Department, the think tank and the experts have been invited to carry out several thematic studies, parallel studies and international comparative studies, and public collection of opinions has been made to the society. Most of the contents of this book are compiled based on the research results mentioned above and are fully integrated with the outline. To facilitate readers to make more comprehensive and profound understanding, some experts were organized to compile some contents which included illustrations and term interpretations. Here, sincere thanks are expressed to them! Due to the time limits, there are inevitably some shortcomings in this book. Readers are welcome to criticize and correct this book.

© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2020 B. Li (ed.), Tutorial for Outline of the Healthy China 2030 Plan, https://doi.org/10.1007/978-981-32-9603-9

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