Development of China's Public Health as an Essential Element of Human Rights

・ Prioritizing health and fitness. The government places people's health at the forefront of its development strategies, based on China's prevailing reality, incorporates the awareness of maintaining and improving people's health into the decision-making process of policies and the formulation and implementation of laws and regulations, and strives to achieve sound and coordinated development between healthy lifestyles, working conditions, the natural environment, and the economy and society.

・ Focusing on prevention. The focus on healthcare has been shifted from treating illnesses to enhancing people's health. Equal emphasis is put on disease prevention and treatment, and the well-being of both mind and body. Western medicine and TCM have been made complementary to each other. More efforts have been focused on the prevention and control of chronic, endemic and occupational diseases. In order to reduce the occurrences of illnesses, China's medical sector is striving to learn more about the patterns and development of health-related issues, emphasizing early diagnosis, treatment and recovery.

・ Nonprofit services. The basic medical and healthcare services will continue to be basically nonprofit, and made available to all citizens as a public product. Public hospitals are the pillar of the medical service system, and steps will be taken to ensure universal access to public-health services.

・ Equality and benefit for all. The state will continue to ensure full coverage of health and medical services. Focusing on rural areas and communities, the gaps in health conditions between urban and rural areas, between different localities and between different groups will be gradually narrowed, so that everyone has equal access to basic health services.

・ Universal participation and sharing of benefits. The government will continue to assume the leading role, while private organizations and individuals are encouraged to participate. The goal is to involve all citizens in the building and development of the medical care system, with the benefits jointly shared by all. The government will appropriately handle its relationship with the market, so that the former can play its due role in the basic medical and healthcare sector and that the market can provide more choices in the nonbasic medical care sector.

II. Continuous Improvement of Health Environment and Conditions

China is keen to promote a healthy lifestyle, national fitness and health education, protect food and drinking water safety, and improve the environment for production, people's life, ecology and society in order to better guarantee the Chinese people's right to health.

Developing a healthy lifestyle. In 2007, China launched the Healthy Lifestyle for All campaign, calling on the Chinese people to develop a healthy diet and engage in physical exercises, advocating healthy lifestyle ideas, creating a supporting environment for a healthy lifestyle, and enhancing the people's awareness and behavioral abilities to develop a healthy lifestyle. By the end of 2016, the campaign had covered 81.87 percent of counties (districts) across the country. China published the Chinese Dietary Guidelines (2016) that provides healthy dietary guidance to the Chinese people in general, and to children and the elderly in particular to help them develop a balanced diet and nutrition absorption; the government has intensified monitoring of the Chinese people's nutritional status and health conditions while keeping track of, and issue information about chronic diseases and the people's nutritional status; it urges the Chinese people to reduce their salt intake, and publicizes information on how to prevent and control high blood pressure; it has adopted measures to improve the nutritional status of key populations and instituted a nutritional improvement plan for compulsory education students in rural areas as well as nutritional improvement programs for children in poverty-stricken areas; the government is continuing to tighten control on the use of tobacco and implement the WHO Framework Convention on Tobacco Control. In 2014, Shenzhen began to activate the Regulations of the Shenzhen Special Economic Zone on Smoking Control; in 2015, Beijing implemented the Beijing Regulation on Smoking Control; in 2017, Shanghai enacted revised Regulations of Shanghai Municipality on Smoking Control in Public Places, banning indoor smoking in public areas. By the end of 2016, 18 cities had adopted regulations on a smoke-free environment, covering one tenth of the population.

Giving full play to national physical fitness. Physical fitness has become a national strategy, and the work regarding people's physical fitness has been included in economic and social development plans, fiscal budgets and annual work reports of governments at all levels. A development trajectory of nationwide physical fitness "led by the government, coordinated among relevant sectors and participated by all" has taken shape. Since the National Fitness Regulations were promulgated in 2009, 16 provinces and ten major cities have worked out local regulations on fitness for all, and all of the country's 31 provinces, autonomous regions and municipalities directly under the central government have worked out provincial-level fitness-for-all programs. Since 2009, August 8 has become National Fitness Day in China. From 2011 to 2014, 3,405 fitness centers, 9,447 community multipurpose sports playgrounds, 2,366 sports parks, 24,879 fitness squares and 878 outdoor camps were established nationwide, with 1.69 million outdoor fitness facilities installed. Physical fitness venues and facilities can be found in communities (administrative villages), sub-districts (towns and townships), counties (districts) and cities (prefectures).

By the end of 2015, up to 33.9 percent of the whole population engaged in physical exercises on a regular basis; the per capita sports venue area reached 1.57 square meters; the coverage rate of sports associations at county level and above was 72 percent; the number of various kinds of juvenile sports clubs was 7,147; every ten thousand people shared three fitness centers on average, and thus a popular national fitness network was basically formed.

Promoting national health education. Publicity media, such as newspapers, television, radio, the internet and other forms of new media are utilized for public health publicity, education and consultation to help people develop a self-tailored and self-disciplined healthy lifestyle. China celebrates National Environment and Health Publicity Week every year; it has promulgated the Environment and Health Literacy of the Chinese Citizens (Trial) and a code of conduct for Chinese citizens with the slogan "Breathe the same air and get it done together" to improve air quality and intensify publicity and education through basic public health services and health education, health literacy promotion campaigns, the "Healthy Chinese" and "TCM in China" initiatives, and major theme-day public health publicity. Health awareness in both urban and rural areas rose to 10.25 percent in 2015 from 6.48 percent in 2008.

Vigorously pursuing environmental improvement. Joint pollution prevention and control between different regions has been enhanced; air quality monitoring facilities at county and district levels in the Beijing-Tianjin-Hebei region, the Yangtze River Delta and the Pearl River Delta function as a network; a network monitoring particle matter (PM) and photochemical pollutants in the Beijing-Tianjin-Hebei region and neighboring areas is in full operation. From 2011 to 2015, the nationwide chemical oxygen demand, emissions of ammonia nitrogen, sulfur dioxide, and nitrogen oxide decreased by 12.9 percent, 13 percent, 18 percent and 18.6 percent, respectively. In 2016, the PM 2.5 average concentration dropped by 6.0 percent year on year and the number of days with excellent and good air quality increased by 2.1 percentage points year on year in 338 cities at the prefectural level and above. In 2013, China enacted the Air Pollution Prevention and Control Action Plan; from 2014 to 2016, about 16 million heavily-polluting vehicles and old vehicles that couldn't meet the environmental protection standards were eliminated; all coal-fired generators have realized desulfurization and denitrification; ultralow emissions have been encouraged, and by March 2017 coal-fired generators of about 500 million kw had been improved to achieve ultralow emissions; the Action Plan for the Prevention and Control of Soil Pollution has been enacted, and a comprehensive survey of soil pollution has been launched; the Rules on Environmental Management of the Soil of Contaminated Sites (Trial) have been promulgated. A fund for soil pollution prevention and control has been set up, and from 2016 to 2017, RMB15 billion was earmarked by the government for this purpose. A national soil environment network has been primarily established, with 22,000 basic monitoring spots and about 15,000 risk-monitoring stations; the Action Plan for the Prevention and Control of Water Pollution has been promoted and completely implemented; the comprehensive management of the environment surrounding the river valleys has been enhanced; the environmental protection of the Yangtze River Economic Belt has been pursued, and the investigation of black and odorous water bodies in urban areas has been carried out; in 2016, according to the state-controlled monitoring bodies of surface water, the proportion of such spots of Grades I-III reached 67.8 percent, while that of inferior water bodies of Grade V dropped to 8.6 percent.

Progress in comprehensive management of environmental hygiene in urban and rural areas. The China Healthy Cities and Towns Initiative is being pursued to largely improve living conditions in urban and rural areas. According to a survey in 2012, since the initiative was introduced, the proportion of standardized fairs and markets had risen to 60.6 percent from 35.2 percent, and the percent of residents who are satisfied with urban amenities and the environment increased from 30 percent to 98 percent, with 98 percent of them satisfied with the effect of the initiative. By the end of 2015, the sewage treatment rate in urban areas had increased to 92 percent while the pollution-free treatment rate of household garbage in urban built-up areas had reached 94.1 percent. Comprehensive environmental improvement had been carried out in 78,000 villages, benefiting over 140 million people in rural areas; waste treatment and resource utilization facilities had been installed in 61,000 large-scale livestock and poultry farms. By the end of 2016, the treatment rate of household garbage in rural areas was around 60 percent, and the proportion of administrative villages with sewage treatment had reached 22 percent. In 2016, 80.4 percent of rural households use toilets while the rate was 71.7 percent in 2012; in some provinces in the more developed eastern areas the figure was 90 percent or higher.

Drinking water safety issues in rural areas basically solved. From 2006 to 2010, the investment in safe drinking water projects in rural areas reached RMB105.3 billion, providing safe drinking water to 212 million rural residents in 190,000 administrative villages. From 2011 to 2015, RMB121.5 billion from the central government and over RMB60 billion from local governments were appropriated for safe drinking water projects in rural areas. By the end of 2016, the safe drinking water monitoring covered over 85 percent of rural villages, and up to 82 percent of rural residents enjoy centralized water supply. The state has allocated funds to areas with particular difficulties, and raised the subsidy standards, such as by appropriating RMB495 million to provide safe drinking water to over 1,400 monasteries, 32,300 monks and nuns and 60,000 other residents with temporary needs in the Tibet autonomous region.

Enhancing occupational health management. In 2011, China revised the Law of the People's Republic of China on Prevention and Control of Occupational Diseases. Campaigns were launched to control and reduce the hazards associated with fine dust and toxic stuff during production processes in particular sectors, such as quartz sand processing, asbestos mining and asbestos-product manufacturing, gold mining, cement manufacturing, stone-material processing, ceramics and refractory-material production. Corporations are urged to increase investment to improve production processes and protection measures for employees. Operational environment and conditions at workplaces have been primarily improved. By the end of 2016, the government, in accordance with the law, had punished the corporations that refused or failed to improve their occupational health management, demanding 1,524 corporations to suspend production for rectification, shutting down 1,576 corporations in response to public demand, and eliminating 426 illegal enterprises. The government has intensified supervision and inspection on occupational health management of employers. From 2013 to 2016, the number of corporations nationwide that had been brought under government supervision and inspection increased from 229,000 to 395,000, up by 72.5 percent.

Tougher control of food safety. In 2015, China revised the Food Safety Law. In 2016, regulatory agencies at all levels conducted inspections of the food production process of 521,000 food producers, 15,000 food additive producers, and 72,000 food processing workshops. As for the selling of food products, regulatory agencies at all levels conducted inspections of 12.093 million businesses, and 8.869 million catering services. In 2016, competent authorities conducted random inspections on 257,000 food samples, of which 96.8 percent met the required standards, and properly settled several food safety incidents, including one involving the sale of counterfeit infant formulas.

III. Public Health Service Capability Improving Steadily

The Chinese government gives priority to prevention while combining prevention with treatment, and makes great efforts to ensure the people's equal access to public health services. It devotes great efforts to preventing and controlling epidemic, chronic and endemic diseases, strengthening the quick response capacity on public health emergencies, and developing an increasingly equal and universal basic public health service system.

The coverage of basic public health services has been further expanded. The government has extended free vaccinations from children only to adults. By the end of 2015 the vaccination rate of every town or township was at least 90 percent and the incidence of and mortality from diseases that can be prevented by programmed vaccines had fallen to the lowest level ever. From 2010 to 2017, the state subsidy for basic public health services has increased from RMB15 to RMB50 per person, and the services have also expanded from 41 in nine categories to 47 in 12 categories. The 12 categories span a person's life circle, including citizens' health archives, health education, vaccination, children's health management, pregnancy and maternity health management, elderly people's health management, health management of chronically ill patients, management of patients with severe mental disorders, health management of tuberculosis patients, TCM health management, reporting and handling of epidemic diseases and public health emergencies, and assisting management and supervision on health and family planning. By the end of 2016, the government had set up digital health archives for 76.9 percent of Chinese citizens, covering 90.23 million hypertension patients and 27.81 million diabetes sufferers. At the same time, 91.6 percent of pregnant and lying-in women and 91.1 percent of children under the age of three were brought under systematic management.

The scope of beneficiaries of the basic public health services has expanded steadily. By 2012, China had eliminated tetanus among all newborn babies. In 2014 through injection of hepatitis B vaccine to newborn babies, the prevalence of hepatitis B surface antigen in children under five years of age decreased from 9.67 percent in 1992 to 0.32 percent in 2014, achieving the WHO's goal of reducing that figure to below 1 percent three years ahead of schedule. An increasing number of the floating population now have better access to basic public health services. Epidemic diseases have been effectively prevented and controlled among them, and more than 90 percent of their children have received vaccinations. Aiming at serious diseases, major risk factors affecting health and key groups, the state has formulated and implemented major public health service projects that cover nearly 200 million people, such as hepatitis B vaccination for people under 15 years of age who missed the vaccination earlier, nutrition improvement for children in impoverished areas, facilitating rural pregnant women's delivery in hospital, screening for cervical and breast cancers among women in rural areas, and construction of hygienic toilet in rural areas. In 2009 the government launched the Regaining Eyesight Program for a Million Impoverished Cataract Patients, and had subsidized surgery for more than 1.75 million cataract patients by the end of 2013.

The ability to control epidemic diseases has continuously improved. The Chinese government has established the world's largest online direct reporting system for notifiable epidemic diseases and public health emergencies. Reported incidence of epidemic diseases has dropped by 19.4 percent. The early detection and early warning capacities have been further improved. The epidemic disease reporting system covers 71,000 medical institutions, with 160,000 users and nine million annual individual reports. In 2016, the reported incidence and death rate of epidemic diseases in categories A and B was controlled below 215.7/100,000 and 1.31/100,000, respectively. The state has set up a laboratory network comprised of disease control and prevention institutions at national, provincial, city and county levels. The influenza, poliomyelitis, measles and meningitis B labs of the Chinese Center for Disease Control and Prevention have become WHO reference labs. On the whole, the epidemics are under control and there has been no widespread epidemic in China. The spread of HIV remains at a low level, and its rapid growth in certain areas has been checked. The efforts to prevent and treat tuberculosis have achieved good results, with a cure rate of over 90 percent. In 2016, the reported incidence of tuberculosis had decreased by 12.6 percent compared to 2011, and the mortality rate from tuberculosis had dropped to 2.3 per 100,000 patients, reaching the level of developed countries. In the same year, there were 3,189 malaria cases reported nationwide, with only three domestically infected. This was much lower than the 4,262 cases in 2010. The disease has now been eradicated in over 80 percent counties that once had a widespread malaria problem. The prevention and treatment of major parasitic diseases have achieved solid results. By the end of 2016, the transmission of schistosomiasis was brought under control in all the 453 counties where it once had been widespread.

The effects of China's practice in preventing and controlling chronic diseases have remarkably improved. China has set up a monitoring network for chronic diseases and risk factors. As a basic public health service, the health management of the aged and hypertension or diabetes patients is provided free to the public. The state runs many services, like screening for cerebral apoplexy and cardiovascular disease, comprehensive oral disease intervention, and early diagnosis and treatment of cancer. By the end of 2016, the service of screening for and intervention of cerebral apoplexy had been provided to more than 6.1 million people, 820,000 of whom were found to be at high risk, and 952,000 follow-up interventions were conducted. Early screening and comprehensive intervention of cardiovascular disease had been provided to 3.389 million people, 776,000 of whom were found to be at high risk, and 524,000 follow-up interventions were conducted. Comprehensive oral disease intervention had provided free oral examination to 100 million children. A total of 5.168 million children received free dental sealants treatment and 2.229 million children received free local fluoride varnish treatment. The early diagnosis and treatment of cancer service had been provided to 2.14 million high-risk people. Some 55,000 cancer patients were diagnosed through this service, and the overall early diagnosis rate reached 80 percent or above.

The spread of endemic diseases is under effective control. By the end of 2015, 90.8 percent of counties whose water sources contained excess iodine had reached the benchmark that 90 percent of salt consumed was iodine-free, and 94.2 percent of the nation's counties had eradicated iodine deficiency, ranking among the top of all 128 countries and regions officially using iodized salt. Kaschin-Beck disease has been eradicated in 95.4 percent of villages where it was once widespread, and Keshan disease has been put under control in 94.2 percent of the counties where it was once prevalent. In the counties that suffered from endemic fluorosis caused by coal burning, 98.4 percent of coal stoves have been transformed, and in the areas suffering from drinking water-caused endemic fluorosis, 93.6 percent of the rural population now have access to de-fluoridated drinking water. Areas suffering from arsenic poisoning through coal burning have had their stoves transformed, and all people in water-related arsenic poisoning areas now have access to safe drinking water.

Mental health services have been improved constantly. The state issued the Mental Health Law of the People's Republic of China, putting the related work within the legal framework. At the end of 2015, China had 2,936 mental health institutions with 433,000 beds－increases of 77.9 percent and 89.9 percent, respectively compared with 2010. There were 27,700 practicing (assistant) psychiatrists nationwide, an increase of 20.2 percent over the 23,100 at the end of 2012. Severe mental disorders have been included as serious diseases under the new type of rural cooperative medical care and basic medical insurance for nonworking urban residents. The central government has provided subsidies to local hospitals to help with the management of and treatment for severe mental disorders. Special aid and treatment policies have been drawn up in some local areas. The patients' expenditures have been greatly reduced. The government has enhanced the management of patients with severe mental disorders, including case reporting and registration, assistance and treatment. Between 2012 and 2016, the number of registered patients with severe mental illnesses increased from 3.08 million to 5.4 million nationwide. From 59.1 percent to 88.7 percent, more and more patients were put under management. The state has enhanced the intervention in common mental disorders or psychological problems, like depression and anxiety. It has intensified the efforts to promptly detect and treat psychological problems among key groups, built up the psychological intervention capacity in emergency events, and promoted the community rehabilitation services for mental disorders.

The ability to quickly respond to public health emergencies has been strengthened in a comprehensive way. The legal system for emergency response has taken initial shape, and the response mechanism has been optimized. Thirty-six national teams and nearly 20,000 local teams, with over 200,000 members for four categories of emergencies, have been set up in different regions. In 2014, China's core public health emergency response capacity achieved 91.5 percent of the requirements of the International Health Regulations, better than the world's average of 70 percent. In recent years the state has accelerated the construction of a public health emergency response system, which not only effectively handled such epidemic emergencies as human infections of the avian influenza A (H7N9) virus, Ebola hemorrhagic fever, Middle East respiratory syndrome and Zika fever, but also promptly carried out emergency medical rescue and post-disaster epidemic prevention in such disasters and accidents as the 2008 Wenchuan earthquake and the 2015 Tianjin Port explosions.