Special collection lays out progresses and challenges in chronic disease prevention and control in China

Today, The BMJ is launching a special collection of articles on tackling non-communicable diseases (NCDs) in China, such as cardiovascular and chronic respiratory diseases, cancer, and diabetes, which account for 91% of all deaths in China.

The articles, written by leading international experts, attempt to shed light on the current state and challenges of chronic disease prevention and control in the context of China’s ageing population, as well as to discuss strategies and approaches to deal with these issues.

In 2021, China accounted for 17.9% of the world population, but 25.9% of global deaths from NCDs, explain Jun Lv and Zuo-Feng Zhang in an editorial to launch the collection.

The burden of most NCDs has continued to rise over the past two decades, they add, driven mainly by population ageing and a failure to fully and effectively tackle major risk factors for NCDs, including use of tobacco and alcohol, physical inactivity, unhealthy diets, and air pollution.

Although China has made considerable progress in its national strategy for NCD prevention and control, challenges remain, as the collection lays out.

For example, because of insufficient studies and effectiveness trials in Chinese populations, good evidence for determining optimal thresholds for the diagnosis and treatment of hypertension, diabetes, and even cancer for the Chinese population is largely lacking. This has resulted in poor compliance with NCD policies.

Another challenge pertains to healthcare access and health equity. For example, one article discusses how individual variations in socioeconomic position result in inequalities in lifestyle factors, exposure to air pollutants, other disease risk factors, and the effectiveness of interventions on risk factor control and disease outcomes.

Other articles argue that without a strong effort to address the social determinants of health, even effective policies and programmes, such as digital health solutions to disease prevention and management, may exacerbate health inequities.

Strong leadership from the central and local government is also critical for successful implementation of policies and programmes that can truly improve health, say Lv and Zhang.

For example, national air quality improvement plans issued by the Chinese government since 2013 led to a significant reduction in PM2.5 concentrations between 2014 and 2022, whereas gaps remain in the implementation of tobacco control measures that need national or non-health sector’s leadership, such as national smoke-free law, health warnings on tobacco packaging, and tobacco tax increases.

In summary, Lv and Zhang say: “The BMJ collection contributes to a growing understanding of NCD prevention and control, not least by showing that successful national prevention and control will depend on strong leadership from the central and local governments, on the integration and collaboration of both health and non-health sectors, and on policies made based on evidence relevant to the Chinese population.”

“It will also require a shift from health in all policies to a health for all policies approach—that is, moving from focusing on wins for the health sector to emphasising co-benefits for all sectors,” they conclude.

18/10/2024