View source for Health in China

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{{About|Health in [[Mainland China]]|Hong Kong|Health in Hong Kong|Macau|Health in Macau|Taiwan|Health in Taiwan|Medicine in Contemporary China|Medicine in China|Traditional Chinese Medicine|Traditional Chinese medicine}}
{{Use dmy dates|date=September 2019}}
{{Lead rewrite|date=December 2020}}
[[File:Jiuzhou Hospital, Panzhou, Guizhou, China.jpg|thumb|Jiuzhou Hospital in Guizhou, China]]'''Health in the People's Republic of China''' is a complex and multifaceted issue that encompasses a wide range of factors, including public health policy, healthcare infrastructure, environmental factors, lifestyle choices, and socioeconomic conditions.<ref name=":14">{{Cite news |title=China Health Statistics Yearbook 2020 |work=National Health Commission of the People's Republic of China}}</ref><ref name=":0" /> Although the [[People's Republic of China]] has made significant progress in improving public health and life expectancy, many challenges remain, including air pollution, food safety concerns, a growing burden of non-communicable diseases such as diabetes and cardiovascular disease, and an aging population. In order to improve the situation, the [[Government of China|central government]] has adopted a series of health policies and initiatives, such as the Healthy China 2030 program, investment in the development of primary health-care facilities and the implementation of public health campaigns.<ref name=":17">{{Cite book |title=Healthy China 2030: A Vision for Healthier Populations}}</ref><ref name=":15" /><ref name=":18">{{Cite news |title=Healthcare System In China: How It Works}}</ref>

Health care services in China are primarily provided by state-owned hospitals. Health insurance is primarily operated by local government.

The Human Rights Measurement Initiative finds that China is fulfilling 98.4% of what it should be fulfilling for the right to health based on its level of income.<ref name=":19" /><ref name="China - Rights Tracker2" /> When looking at the right to health with respect to children, China achieves 98.6% of what is expected based on its current income.<ref name="China - Rights Tracker2" /> In regards to the right to health amongst the adult population, the country achieves 97% of what is expected based on the nation's level of income. When considering the right to reproductive health, the nation is fulfilling 99.6% of what the nation is expected to achieve based on the resources (income) it has available. Overall, China falls into the "good" category when evaluating the right to health.<ref name="China - Rights Tracker2" />

== Current health care institutions ==
Healthcare services, in China are primarily provided by state-owned hospitals.<ref name=":0222">{{Cite book |last=Lin |first=Shuanglin |title=China's Public Finance: Reforms, Challenges, and Options |publisher=[[Cambridge University Press]] |year=2022 |isbn=978-1-009-09902-8 |edition= |location=New York, NY |pages=}}</ref>{{Rp|page=267}} State-owned hospitals provide services for approximately 90% of patients in China.<ref name=":0222" />{{Rp|pages=267-268}} Health insurance is primarily operated by local governments.<ref name=":0222" />{{Rp|page=267}} State-owned hospitals are larger than private hospitals and have better physicians and medical equipment.<ref name=":0222" />{{Rp|page=267}} The government regulates the price of services and wages for state-owned hospital personnel.<ref name=":0222" />{{Rp|page=268}}

==Post-1949 history==
{{further|Medicine in China|China#Health}}

=== 1949 - 1976 ===
An emphasis on [[public health]] and preventive treatment characterized health policy from the beginning of the 1950s. At that time the [[Communist Party of China|party]] began to mobilize the population to engage in mass "patriotic health campaigns" aimed at improving the low level of environmental [[sanitation]] and hygiene and attacking certain diseases. These public health measures contributed to a major decrease in mortality.<ref name=":16">{{Cite book |last=Harrell |first=Stevan |title=An Ecological History of Modern China |publisher=[[University of Washington Press]] |year=2023 |isbn=978-0-295-75171-9 |location=Seattle}}</ref>{{Rp|page=81}}

In 1956, China began a public health campaign to eliminate [[schistosoma]]-carrying [[snail]]s.<ref>{{Cite journal |last1=Kawai Fan |last2=Honkei Lai |date=2008 |title=Mao Zedong's Fight Against Schistosomiasis |url=http://muse.jhu.edu/content/crossref/journals/perspectives_in_biology_and_medicine/v051/51.2.fan.html |journal=Perspectives in Biology and Medicine |language=en |volume=51 |issue=2 |pages=176–187 |doi=10.1353/pbm.0.0013 |pmid=18453723 |s2cid=44475390 |issn=1529-8795|url-access=subscription }}</ref> Beginning in 1958, the "[[Great sparrow campaign|four pests]]" campaign sought to eliminate [[rat]]s, [[Old World sparrow|sparrow]]s, [[fly|flies]], and [[mosquito]]es. Particular efforts were devoted in the health campaigns to improving [[water quality]] through such measures as deep-[[water well|well]] construction and human-[[Sewage treatment|waste treatment]]. Only in the larger cities had human waste been centrally disposed of. In the countryside, where "[[night soil]]" has always been collected and applied to the fields as fertilizer, it was a major source of disease. Since the 1950s, rudimentary treatments such as storage in pits, [[compost]]ing, and mixture with chemicals have been implemented. As a result of preventive efforts, such epidemic diseases as [[cholera]], [[bubonic plague]], [[typhoid fever]], and [[Group A streptococcal infection|scarlet fever]] have almost been eradicated. The mass mobilization approach proved particularly successful in the fight against [[syphilis]], which was reportedly eliminated by the 1960s. The incidence of other infectious and parasitic diseases was reduced and controlled.

Political turmoil and famine following the failure of the [[Great Leap Forward]] led to the starvation of 20 million people in China. Beginning in 1961 the recovery had more moderate policies inaugurated by President [[Liu Shaoqi]] ended starvation and improved nutrition. The coming of the [[Cultural Revolution]] weakened epidemic control, causing a rebound in epidemic diseases and malnutrition in some areas.

Before the [[Cultural Revolution]] (1966-1976), the Ministry of Health focused on the delivery of health care in urban hospitals.<ref name=":05">{{Cite book |last=Lampton |first=David M. |title=Living U.S.-China Relations: From Cold War to Cold War |date=2024 |publisher=[[Rowman & Littlefield]] |isbn=978-1-5381-8725-8 |location=Lanham, MD |pages= |author-link=David M. Lampton}}</ref>{{Rp|page=304}} Mao criticized Minister of Health [[Qian Xinzhong]] for promoting this health care model, arguing that an urban hospital-focused health care model failed to treat peasants and focused on cure rather than preventative medicine.<ref name=":05" />{{Rp|page=304}} Mao also criticized the Ministry itself as the Ministry "of urban overlords".<ref name=":05" />{{Rp|page=105}}

With the Cultural Revolution, Mao Zedong introduced a new approach to public health, especially in rural areas.<ref name=":0">{{Cite journal|last1=Zhang|first1=Daqing|last2=Unschuld|first2=Paul U|date=November 2008|title=China's barefoot doctor: past, present, and future|journal=The Lancet|volume=372|issue=9653|pages=1865–1867|doi=10.1016/s0140-6736(08)61355-0|pmid=18930539|s2cid=44522656|issn=0140-6736}}</ref> In his June 26 Directive, Mao prioritized healthcare and medicine for rural people throughout the country.<ref name=":22">{{Cite book |last1=Xu |first1=Youwei |title=Everyday Lives in China's Cold War Military Industrial Complex: Voices from the Shanghai Small Third Front, 1964-1988 |last2=Wang |first2=Y. Yvon |publisher=[[Palgrave MacMillan]] |year=2022 |isbn=978-3-030-99687-1}}</ref>{{Rp|page=362}} As a result, clinics and hospitals sent their staff on medical tours of rural areas.<ref name=":22" />{{Rp|page=362}}

Rural cooperative medical systems provided subsidized health care to rural residents.<ref name=":0" /> One aspect of this system was [[barefoot doctor]]s, who received some training and then delivered primary care medicine to those who needed it.<ref name=":0" /> Barefoot doctors were a good contribution to primary health systems in China during the Cultural Revolution. It encompasses all principles stated in primary health care. Community participation is possible because the team is composed of village health workers in the area.  There is equity because it was more available and combined western and traditional medicines. Intersectoral coordination is achieved by preventive measures rather than curative. Lastly it is comprehensive using rural practices rather than urban ones.<ref>Cueto, Marcos, 2004.  The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care" ''Am J Public Health'' 94 (11) 1864-1874</ref>

=== 1976 - 2003 ===
[[File:Chinese barefoot doctor performing acupuncture.jpg|thumb|A Chinese [[barefoot doctor]] uses her needles to treat a production brigade worker]]
By the late 1970s, China's national health system covered almost the entire urban population and 85% of the rural population.<ref name=":13">{{Cite book |last=Lin |first=Chun |title=The transformation of Chinese socialism |date=2006 |publisher=[[Duke University Press]] |isbn=978-0-8223-3785-0 |location=Durham [N.C.] |page=80 |oclc=63178961}}</ref> The [[World Bank]] described this success as "an unrivaled achievement among low-income countries."<ref name=":13" />

The "barefoot doctor system" was based in the [[people's commune]]s.<ref>{{Cite journal|last1=Carrin|first1=Guy|last2=Ron|first2=Aviva|last3=Hui|first3=Yang|last4=Hong|first4=Wang|last5=Tuohong|first5=Zhang|last6=Licheng|first6=Zhang|last7=Shuo|first7=Zhang|last8=Yide|first8=Ye|last9=Jiaying|first9=Chen|last10=Qicheng|first10=Jiang|last11=Zhaoyang|first11=Zhang|date=April 1999|title=The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties|journal=Social Science & Medicine|volume=48|issue=7|pages=961–972|doi=10.1016/s0277-9536(98)00396-7|pmid=10192562 |issn=0277-9536}}</ref>  In the 1980s, with the disappearance of the people's communes and the rural cooperative medical system, the barefoot doctor system lost its base and funding.<ref name=":1">{{Cite journal|last1=Blumenthal|first1=David|last2=Hsiao|first2=William|date=2005-09-15|title=Privatization and Its Discontents — The Evolving Chinese Health Care System|journal=New England Journal of Medicine|volume=353|issue=11|pages=1165–1170|doi=10.1056/NEJMhpr051133|issn=0028-4793|pmid=16162889}}</ref> The Chinese government began to push for privatization of health care and, as a result, stopped providing necessary funding.<ref name=":3">{{Cite journal|last1=Yip|first1=Winnie|last2=Hsiao|first2=William C.|date=2008-03-01|title=The Chinese Health System At A Crossroads|journal=Health Affairs|volume=27|issue=2|pages=460–468|doi=10.1377/hlthaff.27.2.460|pmid=18332503|issn=0278-2715}}</ref> Instead, according to Blumenthal et al. (2005), individual towns were now responsible for ensuring that people were receiving adequate health care, which caused disparities between wealthier and poorer regions.<ref name=":1" /> Additionally, the decollectivization of agriculture resulted in a decreased desire on the part of the rural populations to support the collective welfare system, of which health care was a part. In 1984 surveys showed that only 40 to 45 percent of the rural population was covered by an organized cooperative medical system, as compared with 80 to 90 percent in 1979.

This shift entailed a number of important consequences for rural health care. The lack of financial resources for the cooperatives resulted in a decrease in the number of barefoot doctors, which meant that health education and primary and home care suffered and that in some villages sanitation and water supplies were checked less frequently. Also, the failure of the cooperative health care system limited the funds available for continuing education for barefoot doctors, thereby hindering their ability to provide adequate preventive and curative services. The costs of medical treatment increased, deterring some patients from obtaining necessary medical attention. If the patients could not pay for services received, then the financial responsibility fell on the hospitals and commune health centers, in some cases creating large debts.

Consequently, in the post-[[Mao Zedong|Mao]] era of modernization, the rural areas were forced to adapt to a changing health care environment. Many barefoot doctors went into private practice, operating on a fee-for-service basis and charging for medication. But soon farmers demanded better medical services as their incomes increased, bypassing the barefoot doctors and going straight to the commune health centers or county hospitals. A number of barefoot doctors left the medical profession after discovering that they could earn a better living from farming, and their services were not replaced. The leaders of brigades, through which local health care was administered, also found farming to be more lucrative than their salaried positions, and many of them left their jobs. Many of the cooperative medical programs collapsed. Farmers in some brigades established voluntary health-insurance programs but had difficulty organizing and administering them.

Their income for many basic medical services limited by regulations, Chinese grassroots health care providers has supported themselves by charging for giving injections and selling medicines. This has led to a serious problem of disease spread through health care as patients received too many injections and injections by unsterilized needles. Corruption and disregard for the rights of patients have become serious problems in the Chinese health care system.

The Chinese economist, Yang Fan, wrote in 2001 that lip service being given to the old socialist health care system and deliberately ignoring and failing to regulate the actual private health care system is a serious failing of the Chinese health care system. "The old argument that "health is a kind of welfare to save lives and assist the injured" is so far removed from reality that things are really more like its opposite. The welfare health system supported by public funds essentially exists in name only.  People have to pay for most medical services on their own.  Considering health to be still a "welfare activity" has for some time been a major obstacle to the development of proper physician - patient relationship and to the law applicable to that relationship."<ref>[http://www.usembassy-china.org.cn/sandt/healthcare-corruption.html "What Limits to Corruption in Health Care?"] {{Webarchive|url=https://web.archive.org/web/20070212071501/http://www.usembassy-china.org.cn/sandt/healthcare-corruption.html |date=12 February 2007 }} in April 2001 Viewpoint Voice of China translated on the U.S. Embassy Beijing website. Accessed 7 February 2007</ref>

Despite the decline of the public health care system during the first decade of the reform era, Chinese health improved sharply as a result of greatly improved nutrition, especially in rural areas, and the recovery of the epidemic control system, which had been neglected during the Cultural Revolution.

=== 2003 - present ===
From late 2002 to early 2003 the [[SARS]] (severe acute respiratory syndrome) outbreak began in [[China]] and spread across the world.<ref>{{Cite journal|last1=Zhong|first1=Nanshan|last2=Zeng|first2=Guangqiao|date=2006-08-17|title=What we have learnt from SARS epidemics in China|journal=BMJ|volume=333|issue=7564|pages=389–391|doi=10.1136/bmj.333.7564.389|pmid=16916828|pmc=1550436|issn=0959-8138}}</ref> In the early stages of disease spread, the Chinese government withheld information and may have contributed to the further spreading of the disease.<ref name=":15">{{Cite journal|last1=Qiu|first1=Wuqi|last2=Chu|first2=Cordia|last3=Mao|first3=Ayan|last4=Wu|first4=Jing|date=2018-06-28|title=The Impacts on Health, Society, and Economy of SARS and H7N9 Outbreaks in China: A Case Comparison Study|journal=Journal of Environmental and Public Health|volume=2018|article-number=2710185|doi=10.1155/2018/2710185|pmid=30050581|pmc=6046118|issn=1687-9805|doi-access=free}}</ref> In addition, [[Healthcare in China|China's health care]] system was still fairly decentralized, with a noticeable lack of oversight and little potential for rapid coordination.<ref name=":4">{{Cite journal|last1=Dong|first1=Zhe|last2=Phillips|first2=Michael R|date=2008-11-15|title=Evolution of China's health-care system|journal=The Lancet|language=en|volume=372|issue=9651|pages=1715–1716|doi=10.1016/S0140-6736(08)61351-3|pmid=18930524|s2cid=44564705|issn=0140-6736}}</ref><ref name=":1" /> Thus, the SARS epidemic highlighted the need for the Chinese government to begin restructuring its health care distribution.<ref name=":1" /> One big issue many have pointed out, including Blumenthal (2005) and Yip et al. (2008), is that much of China's population does not have access to affordable health insurance.<ref name=":3" /><ref name=":1" /> As a solution, the Chinese government planned to provide universal health insurance to all citizens by [[Healthcare reform in China|2020]].<ref name=":3" /><ref name=":1" /> To get closer to this goal, the Chinese government began a health insurance program known as the New Cooperative Health Scheme, which gave mainly rural Chinese residents limited insurance coverage for emergencies.<ref name=":3" /> Alongside the insurance measures, the Chinese government returned to the successful public health endeavors of the Cultural Revolution by instituting community health centers in urban neighborhoods with the goal of providing affordable options to hospital care.<ref name=":3" /> Dong (2008) also mentions that China has been working to reinstate the cooperative medical systems in rural areas by pushing for state-funded health centers to be established.<ref name=":4" /> That being said, some studies, such as Dib (2008) have shown that the quality of health care in rural areas still varies widely depending on wealth of the region.<ref>{{Cite journal|last1=Dib|first1=Hassan H.|last2=Pan|first2=Xilong|last3=Zhang|first3=Hong|date=2008-07-01|title=Evaluation of the new rural cooperative medical system in China: is it working or not?|journal=International Journal for Equity in Health|volume=7|issue=1|page=17|doi=10.1186/1475-9276-7-17|issn=1475-9276|pmc=2459170|pmid=18590574 |doi-access=free }}</ref> Despite debates surrounding the effectiveness of China's revamped health system, the [[COVID-19 pandemic|COVID-19 outbreak]] of 2019-2020 has shown that things have changed since the SARS outbreak of 2003.<ref name=":5">{{Cite journal|last=Nkengasong|first=John|author-link=John Nkengasong|date=2020-01-27|title=China's response to a novel coronavirus stands in stark contrast to the 2002 SARS outbreak response|journal=Nature Medicine|language=en|volume=26|issue=3|pages=310–311|doi=10.1038/s41591-020-0771-1|issn=1546-170X|pmc=7096019|pmid=31988464}}</ref> Specifically, the Chinese government notified their citizens and the rest of the world of the first cases of the outbreak much sooner than SARS in 2003. While it took around four to five months for a public statement on SARS after the first case, it only took about one month for the COVID-19.<ref name=":5" /> Because their response escalated more quickly, the food market thought to be at the center of the outbreak was also shut down sooner than the one that had been the source of the 2003 SARS outbreak.<ref name=":5" /> In addition to a more rapid response, the Chinese government quickly established committees and consortia made up of both Chinese and international experts to begin exploring methods to combat the outbreak.<ref name=":5" />

==Health indicators==
[[File:Child mortality rate in China.png|thumb|250px|Development of child mortality rate in China since 1969]]
Some measures used to indicate health include [[Total fertility rate|Total Fertility Rate]], [[Infant mortality|Infant Mortality Rate]], [[Life expectancy|Life Expectancy]], [[Birth rate|Crude Birth]] and [[Mortality rate|Death Rate]]. As of 2017, China has a Total Fertility Rate of 1.6 children born per woman, an Infant Mortality rate of 10 deaths per 1000 live births, Crude Birth Rate of 13 births per 1000 people and a Death Rate of 7 deaths per 1000 people<ref>[https://www.prb.org/international/geography/china Data Center: International Indicators – Population Reference Bureau<!-- Bot generated title -->]</ref>'''<ref>[https://www.cia.gov/the-world-factbook/countries/china/ East Asia/Southeast Asia :: China — The World Factbook - Central Intelligence Agency<!-- Bot generated title -->]</ref>'''. Since 1949, China had a huge improvement in population's health. There are health related parameters:
{| class="wikitable"
|-
! !!  1950  !!  1960  !!  1970  !!  1980  !!  1990  !!  2000  !!  2011
|-
|  [[Life expectancy]]  ||  41.6  ||  31.6  ||  62.7  ||  66.1  ||  69.5  ||  72.1  ||  75.0
|-
|  [[Total Fertility Rate]]  ||  5.3  ||  4.3  ||  5.7  ||  2.3  ||  2.5  ||  1.5  ||  1.7
|-
|  [[Infant Mortality]] Rate  ||  195.0  ||  190.0  ||  79.0  ||  47.2  ||  42.2  ||  30.2  ||  12.9
|-
|  Under 5 Mortality Rate/[[Child mortality]]  ||  317.1  ||  309.0  ||  111  ||  61.3  ||  54.0  ||  36.9  ||  14.9
|-
|  [[Maternal Mortality Ratio]]  || || || ||  164.5  ||  88.0  ||  57.5  ||  26.5
|}
* data from www.gapminder.org.<ref>{{cite web|url=http://www.gapminder.org|title=Gapminder|work=gapminder.org}}</ref>

In general, all indices showed improvement except the drop around 1960 due to the failure of the Great Leap Forward, which led to the starvation of tens of millions of people. From 1950 to 2012, life expectancy nearly doubled (41.6-75.1). Total Fertility Rate changed from 5.3 to 1.7 which mainly caused by [[One-child policy]]. Infant Mortality rate and Under-5 mortality rate went down sharply. Though there is no data from 1963 to 1967, we can see the trend. The gap between IMR and U5MR became smaller and smaller, which indicates health in children has been promoted.
Maternal Mortality Ratio is not shown in the graph due to having insufficient data, but it did go down from 164.5(1980) to 26.5(2011).

As of at least 2023, China's life expectancy exceeds 78 years and is slightly higher than life expectancy in the United States.<ref name=":02">{{Cite book |last=Li |first=David Daokui |title=China's World View: Demystifying China to Prevent Global Conflict |date=2024 |publisher=[[W. W. Norton & Company]] |isbn=978-0-393-29239-8 |location=New York, NY |author-link=David Daokui Li}}</ref>{{Rp|page=163}}

=== One-child policy ===
[[File:China 1982 happy family with one child.jpg|thumb|A poster from 1982 showing a Chinese family with one child]]
Created in 1979, under Deng Xiaoping, the One-child policy incentivized families to have children later and to only have one child or risk penalization.<ref>[https://www.bbc.com/news/world-asia-china-34667551 Explainer: What was China's one-child policy? - BBC News<!-- Bot generated title -->]</ref> The [[One-child policy]] was a program created by the Chinese government as a reaction to the increasing population during the 1970s, that was thought to have negatively impacted China's economic growth. Implementation of the program included rewarding families who followed the program, fining families who resisted the policy, offering birth control/ contraceptives, and in some cases forced abortions.<ref name="Encyclopædia Britannica">{{Cite encyclopedia|url=https://www.britannica.com/topic/one-child-policy|title=one-child policy {{!}} Definition & Facts|encyclopedia=Encyclopedia Britannica|access-date=2018-04-12|language=en}}</ref> The policy was unevenly implemented throughout China and was easier established in urban areas rather than rural, because of ideals about family size and gender preferences. Prior to the One-child policy, the Chinese government had encouraged families to have more children in order to increase the future workforce, however, this promotion made the population of China in the 1970s increase at an alarming rate.<ref>{{Cite web|url=http://www.bbc.co.uk/schools/gcsebitesize/geography/population/managing_population_rev3.shtml|archive-url=https://web.archive.org/web/20120605003435/http://www.bbc.co.uk/schools/gcsebitesize/geography/population/managing_population_rev3.shtml|archive-date=5 June 2012|title=BBC - GCSE Bitesize: Case study: China|language=en-GB|access-date=2018-04-11}}</ref> Additionally, voluntary programs, involving family planning and contraceptive use, were proposed before the One-child policy was fully enforced.<ref name="Encyclopædia Britannica" />

'''Effects of the policy'''

In 2015, the one-child policy of Deng Xiaoping was replaced by a two-child policy, which increased the number of "allowed" children to two.<ref name=":6">{{Cite journal|last1=Zeng|first1=Yi|last2=Hesketh|first2=Therese|date=2016-10-15|title=The effects of China's universal two-child policy|journal=Lancet|volume=388|issue=10054|pages=1930–1938|doi=10.1016/S0140-6736(16)31405-2|issn=0140-6736|pmc=5944611|pmid=27751400}}</ref> With this, scholars began evaluating the effects of the one-child policy. The One-child policy was successful in halting China's increasing population and decreased both the birth rate and population, however, the harsh enforcement of the policy created long-term changes to some of China's health indicators. For instance, favoring males over female children lead to many forced abortions, [[infanticide]] and abandoned female children which led to an imbalance of men to women in China.<ref name=":10">[https://www.centreforpublicimpact.org/case-study/chinas-one-child-policy/ The one-child policy in China - Centre for Public Impact (CPI)<!-- Bot generated title -->]</ref> Additionally, birth rates and rate of natural increase decreased as a result of the One-child policy.<ref name="bbc.co.uk">{{Cite web|url=http://www.bbc.co.uk/schools/gcsebitesize/geography/population/managing_population_rev3.shtml|archive-url=https://web.archive.org/web/20120605003435/http://www.bbc.co.uk/schools/gcsebitesize/geography/population/managing_population_rev3.shtml|archive-date=5 June 2012|title=BBC - GCSE Bitesize: Case study: China|language=en-GB|access-date=2018-04-12}}</ref>  Other consequences of the One-child policy include difficulties accessing education and employment as a result of being an undocumented birth.<ref name="Encyclopædia Britannica" />

In terms of positive outcomes, as Zeng and Hesketh (2016) explain, the Chinese government cites the decreased [[Total fertility rate|fertility rate]] resulting from the one-child policy as a determining factor in China's rapidly increasing [[Gross domestic product|GDP]].<ref name=":6" /> However, Zeng and Hesketh (2016) as well as Zhang (2017) also mention that other scholars argue China's fertility rate would have decreased as the country became more and more developed, regardless of whether the one-child policy had been in place or not.<ref name=":6" /><ref name=":7">{{Cite journal|last=Zhang|first=Junsen|date=February 2017|title=The Evolution of China's One-child policy and Its Effects on Family Outcomes|journal=Journal of Economic Perspectives|language=en|volume=31|issue=1|pages=141–160|doi=10.1257/jep.31.1.141|issn=0895-3309|doi-access=free}}</ref> Zhang (2017) notes that one predicted positive outcome of having less children was that families would invest more money and other resources in the children they did have, leading to a healthier and more successful population.<ref name=":7" /> However, follow-up studies on this claim have examined child education outcomes and found that the effects of the one-child policy on [[education]] rates was "not statistically significant".<ref name=":7" />

=== Dependency ratio ===
China's [[dependency ratio]] is unfavorable because of the policy and its elderly population (65+) will outgrow the working aged people. The elderly population in China is highly reliant on the working aged people for support and the number of [[Dependant|dependents]] (children 0–14, adults 65+) are increasing compared to the number of working aged people. China's population is aging and the number of children born is less than the [[replacement rate]].<ref name="bbc.co.uk" />

==Medical issues in China==

===Smoking===
{{Main|Smoking in the People's Republic of China}}

Smoking is very prevalent in China. In fact, China has the largest smoking population in the world.<ref name=":11">{{Cite journal|last1=Parascandola|first1=Mark|last2=Xiao|first2=Lin|date=May 2019|title=Tobacco and the lung cancer epidemic in China|journal=Translational Lung Cancer Research|volume=8|issue=S1|pages=S21–S30|doi=10.21037/tlcr.2019.03.12|pmid=31211103|pmc=6546632|issn=2218-6751 |doi-access=free }}</ref> One of the most direct consequences of the popularity of smoking in China is lung cancer, and lung cancer is the single biggest contributor to the frequency of cancer in China.<ref name=":11" /> Parascandola and Xiao (2015) refer to the prevalence of lung cancer in China as an epidemic.<ref name=":11" /> Collecting data on the topic is complicated by the fact that lung cancer can also stem from China's air pollution.<ref name=":11" /> Regardless, smoking related illnesses killed 1.2 million in the People's Republic of China; however, the state tobacco monopoly, the [[China National Tobacco Corporation]], supplies 7 to 10% of government revenues, as of 2011, 600 billion yuan, about 100 billion US dollars.<ref name="ChinaSmoke">{{cite journal |title=The Political Mapping of China's Tobacco Industry and Anti-Smoking Campaign |journal=John L. Thornton China Center Monograph Series |date=October 2012 |issue=5 |url=http://www.brookings.edu/~/media/Research/Files/Papers/2012/10/25%20china%20tobacco%20li/25%20china%20tobacco%20li.pdf |access-date=11 November 2012 |author=Cheng Li |publisher=Brookings Institution |quote=...the tobacco industry is one of the largest sources of tax revenue for the Chinese government. Over the past decade, the tobacco industry has consistently contributed 7-10 percent of total annual central government revenues... |archive-url=https://web.archive.org/web/20130524174933/http://www.brookings.edu/~/media/Research/Files/Papers/2012/10/25%20china%20tobacco%20li/25%20china%20tobacco%20li.pdf |archive-date=24 May 2013 }}</ref> As a result, although movements for tobacco smoking cessation exist and have been gaining popularity, the financial benefit of the smoking industry stands in the way of more effective cessation programming.<ref name=":12">{{Cite web|title=China's cigarette smoking epidemic|url=https://signal.supchina.com/chinas-cigarette-smoking-epidemic/|last=Hao|first=Pei|date=2019-09-05|website=SupChina|language=en-US|access-date=2020-05-06|archive-date=18 May 2020|archive-url=https://web.archive.org/web/20200518142958/https://signal.supchina.com/chinas-cigarette-smoking-epidemic/}}</ref> In addition, the practice of smoking is intertwined with Chinese culture which further complicates the relationship between China and smoking. Smoking is central to socialization in many public spaces, although mainly men participate in the practice.<ref name=":12" /> With these complicating factors, it has been difficult to effectively reduce tobacco use and smoking. For example, a Chinese official in 2007 mentioned that if smoking were banned, it would result in social upheaval.<ref name=":12" /> After a decline from 2014 to 2016 as several major Chinese cities introduced tough indoor smoking bans, cigarette sales are still rising, reaching 2.44 trillion in 2023.<ref>{{cite web|author1=Li Xin|author2=Lin Liuhan|date=October 17, 2024|work=[[Sixth Tone]]|url=https://www.sixthtone.com/news/1016033|title=Cigarette Sales Are Rising in China, Defying Global Trend}}</ref>

===Betel chewing===
{{main|Betel chewing in China}}

Chewing betel nut, an addictive [[IARC group 1 Carcinogens|group 1 carcinogen]], is popular in China. According to research predictions, by 2030, the number of betel nut related [[oral cancer]] cases in China will exceed 1 million. The medical burden caused by betel nut related oral cancer in China will exceed 200 billion yuan.<ref>{{cite web|url=https://thepaper.cn/newsDetail_forward_20026400|title=【财智头条】槟榔"禁售潮"席卷而来, 千亿槟榔产业被多地下架|date=2022-09-23|language=zh-cn|work=[[The Paper (newspaper)|The Paper]]}}</ref>

=== Sex education, contraception, and women's health ===
{{main|Women's healthcare in the People's Republic of China}}

[[Sex education]] lags in China due to cultural conservatism.  From ancient China to the first half of the 20th century, formal sex education was not taught. Instead, a woman's parents were mostly responsible for her sex education after she is wed.<ref>[http://www.publish.csiro.au/?act=view_file&file_id=RD01082.pdf CSIRO PUBLISHING | Reproduction, Fertility and Development<!-- Bot generated title -->]</ref> Many Chinese people feel that sex education should be limited to biological science.{{Who|date=August 2025}} Combined with migration of young unmarried women to the cities{{Clarify|reason=What cities? Needs more information.|date=August 2025}}, lack of knowledge of [[contraception]] has resulted in increasing numbers of [[abortion]]s by young women.<ref>[https://www.nytimes.com/2007/05/13/world/asia/13abortion.html "Face of Abortion in China: A Young, Single Woman"] article by Jim Yardley in the [[New York Times]] 13 April 2007</ref>

The Basic Health Services Project piloted strategies to ensure equitable access to China's rural health system; health outcomes for women improved significantly, with substantial declines in maternal mortality due to increased coverage of maternal health services.<ref name="DFID Briefing January 2008">{{cite journal|last1=Huntingdon|first1=Dale|author2=Liu Yunguo, Liz Ollier, Gerry Bloom|title=Improving maternal health – lessons from the basic health services project in China|journal=DFID Briefing|date=January 2008|url=http://www.futurehealthsystems.org/storage/publications/briefings/ChinaMaternalHealthPolicyBrief.pdf|archive-url=https://web.archive.org/web/20130511013343/http://www.futurehealthsystems.org/storage/publications/briefings/ChinaMaternalHealthPolicyBrief.pdf|archive-date=11 May 2013}}</ref>

===SARS===
{{further|Progress of the SARS outbreak}}
[[File:2003 Probable cases of SARS - Worldwide.svg|thumb|Graphic showing the number of probable cases of SARS worldwide]]
Although not identified until later, China's first case of a new, highly contagious disease, [[severe acute respiratory syndrome]] (SARS), occurred in [[Guangdong]] in November 2002, and within three months the Ministry of Health reported 300 SARS cases and five deaths in the province.{{Citation needed|date=August 2025}} Dr. [[Jiang Yanyong]] exposed the level of danger the SARS outbreak posed to China.<ref name="China Status 2007">{{cite web | url=http://chinaview.wordpress.com/category/people/doctor/jiang-yanyong/ | title=China Hero Doctor Who Exposed SARS Cover-Up Barred U.S. Trip For Rights Award | work=New York Times| date=13 July 2007 | access-date=3 May 2013 |author=Kahn, Joseph}}</ref><ref name="award 2004">{{cite web | url=http://www.rmaf.org.ph/Awardees/Citation/CitationJiangYan.htm | title=The 2004 Ramon Magsaysay Awardee for Public Service | publisher=Ramon Magsaysay Foundation | date=31 August 2004 | access-date=3 May 2013 | archive-url=https://web.archive.org/web/20070614083317/http://www.rmaf.org.ph/Awardees/Citation/CitationJiangYan.htm | archive-date=14 June 2007 }}</ref> By May 2003, some 8,000 cases of SARS had been reported worldwide; about 66 percent of the cases and 349 deaths occurred in China alone.{{Citation needed|date=August 2025}} By early summer 2003, the [[SARS epidemic]] had ceased.{{Citation needed|date=August 2025}} A vaccine was developed and first-round testing on human volunteers completed in 2004.{{Citation needed|date=August 2025}}

The 2002 SARS in China demonstrated at once the decline of the PRC epidemic reporting system, the deadly consequences of secrecy on health matters and, on the positive side, the ability of the Chinese central government to command a massive mobilization of resources once its attention is focused on one particular issue. Despite the suppression of news regarding the outbreak during the early stages of the epidemic, the outbreak was soon contained and cases of SARS failed to emerge.<ref>[https://www.nytimes.com/2005/05/15/health/15sars.html "After Its Epidemic Arrival, SARS Vanishes"]. 15 May 2005. Jim Yardley. Accessed 17 April 2006.</ref> Obsessive secrecy seriously delayed the isolation of SARS by Chinese scientists.<ref>[http://yaleglobal.yale.edu/display.article?id=1745 "Chinese Scientists Say SARS Efforts Stymied by Organizational Obstacles] China Youth Daily interview with Chinese geneticist Yang Huanming and Chinese Academy of Sciences science policy researcher Chen Hao</ref> On 18 May 2004, the [[World Health Organization]] announced the PRC free of further cases of SARS.<ref>[https://web.archive.org/web/20040824014230/http://www.who.int/csr/don/2004_05_18a/en/index.html "China's latest SARS outbreak has been contained, but biosafety concerns remain"]. 18 May 2004. World Health Organization. Accessed 17 April 2006.</ref>

===COVID-19 pandemic===
{{further|COVID-19 pandemic in China}}
{{Update section|date=May 2025}}
A [[coronavirus disease 2019]] (COVID-19) [[COVID-19 pandemic|pandemic]], caused by the [[SARS-CoV-2]] virus, started in December 2019.<ref>{{cite news|url=https://www.voanews.com/a/science-health_coronavirus-outbreak_who-coronavirus-epidemic-not-yet-pandemic/6184766.html|title=WHO: Coronavirus Epidemic Is Not Yet Pandemic|first=Lisa|last=Schlein|date=24 February 2020|access-date=26 February 2020|archive-url=https://archive.today/20200227063047/https://www.voanews.com/science-health/coronavirus-outbreak/who-coronavirus-epidemic-not-yet-pandemic|archive-date=27 February 2020|url-status=live|work=[[Voice of America|VoA News]]}}</ref> It was first identified in [[Wuhan]], the capital of [[Hubei]], China.<ref name="auto12">{{Cite journal|date=20 February 2020|title=The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) - China, 2020|archive-url=https://web.archive.org/web/20200222141550/http://www.ne.jp/asahi/kishimoto/clinic/cash/COVID-19.pdf |journal=China CDC Weekly|volume=2|pages=1–10|url=http://www.ne.jp/asahi/kishimoto/clinic/cash/COVID-19.pdf |archive-date=22 February 2020|via=Chinese Center for Disease Control and Prevention |url-status=live}}</ref><ref name=":2">{{Cite journal|author1=Novel Coronavirus Pneumonia Emergency Response Epidemiology Team|date=17 February 2020|title=[The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) in China]|journal=Zhonghua Liu Xing Bing Xue Za Zhi = Zhonghua Liuxingbingxue Zazhi|volume=41|issue=2|pages=145–151|doi=10.3760/cma.j.issn.0254-6450.2020.02.003|pmid=32064853|s2cid=211133882|language=zh}}</ref> Its severity has surpassed of the 2003 [[Severe acute respiratory syndrome|SARS]] [[Timeline of the SARS outbreak|outbreak]].<ref>{{cite news|url=https://www.nytimes.com/2020/02/09/world/asia/coronavirus-china.html|title=Deaths in China Surpass Toll From SARS|date=9 February 2020|work=[[The New York Times]]|url-status=live|archive-url=https://web.archive.org/web/20200209052034/https://www.nytimes.com/2020/02/09/world/asia/coronavirus-china.html|archive-date=9 February 2020|access-date=21 February 2020}}</ref>  On 30 January, the outbreak was declared to be a [[Public Health Emergency of International Concern]] (PHEIC) by the World Health Organization (WHO).<ref name="The Hill 20200130">{{cite web|url=https://thehill.com/changing-america/respect/diversity-inclusion/480749-the-coronavirus-is-causing-an-outbreak-in-anti|title=The coronavirus is causing an outbreak in America—of anti-Asian racism|last=Somvichian-Clausen|first=Austa|date=30 January 2020|website=[[The Hill (newspaper)|The Hill]]|url-status=live|archive-url=https://web.archive.org/web/20200201181522/https://thehill.com/changing-america/respect/diversity-inclusion/480749-the-coronavirus-is-causing-an-outbreak-in-anti|archive-date=1 February 2020|access-date=4 February 2020}}</ref> Wider concerns about consequences of the outbreak include political and economic instability. Political fallout has included the firing of several local leaders of the Chinese Communist Party for their poor response to the outbreak.<ref>{{Cite news|url=https://www.theguardian.com/world/2020/feb/11/china-fires-two-senior-hubei-officials-over-coronavirus-outbreak|title=China fires two senior Hubei officials over coronavirus outbreak|website=[[The Guardian]]|access-date=18 February 2020|first=Lily |last=Kuo|date= 11 February 2020 }}</ref> Outbreak-related incidents of [[Xenophobia and racism related to the COVID-19 pandemic|xenophobia and racism against people of Chinese and East Asian descent]] have been reported in several countries.<ref>{{cite web|url=https://www.sbs.com.au/news/this-is-racism-chinese-australians-say-they-ve-faced-increased-hostility-since-the-coronavirus-outbreak-began|title='This is racism': Chinese-Australians say they've faced increased hostility since the coronavirus outbreak began|work=Special Broadcasting Service|first=Evan|last=Young|date=31 January 2020}}</ref><ref>{{Cite news|last=Iqbal|first=Nosheen|url=https://www.theguardian.com/world/2020/feb/01/coronavirus-weaponised-way-to-be-openly-racist|title=Coronavirus fears fuel racism and hostility, say British-Chinese|date=1 February 2020|work=The Observer|access-date=4 February 2020|url-status=live|archive-url=https://web.archive.org/web/20200203232009/https://www.theguardian.com/world/2020/feb/01/coronavirus-weaponised-way-to-be-openly-racist|archive-date=3 February 2020|issn=0029-7712}}</ref><ref>{{cite web|url=https://globalnews.ca/news/6495961/coronavirus-anti-china-sentiment/|title=Coronavirus fears trigger anti-China sentiment across the globe|website=Global News|url-status=live|archive-url=https://web.archive.org/web/20200203150150/https://globalnews.ca/news/6495961/coronavirus-anti-china-sentiment/|archive-date=3 February 2020|access-date=4 February 2020}}</ref><ref>{{cite news|url=https://www.cnn.com/2020/01/31/asia/wuhan-coronavirus-racism-fear-intl-hnk/index.html|title=As the coronavirus spreads, fear is fueling racism and xenophobia|last=Yeung|first=Jessie|publisher=[[CNN]]|url-status=live|archive-url=https://web.archive.org/web/20200203194428/https://www.cnn.com/2020/01/31/asia/wuhan-coronavirus-racism-fear-intl-hnk/index.html|archive-date=3 February 2020|access-date=4 February 2020}}</ref> [[Misinformation related to the COVID-19 pandemic|The spread of misinformation and disinformation about the virus]], primarily online, has been described as an "[[infodemic]]" by the WHO.<ref>{{Cite news|url=https://www.npr.org/sections/goatsandsoda/2020/02/21/805287609/theres-a-flood-of-fake-news-about-coronavirus-and-a-plan-to-stop-it|title=Fake Facts Are Flying About Coronavirus. Now There's A Plan To Debunk Them|newspaper=NPR.org|publisher=NPR|access-date=23 February 2020}}</ref>

===Hepatitis B===
{{main|Hepatitis B in China}}

Work with the CDC has created goals of decelerating the spread of [[Hepatitis B]] through immunization efforts.<ref>{{Cite web|url=https://www.cdc.gov/globalhealth/countries/china/default.htm|title=CDC Global Health - China|date=24 August 2017|website=www.cdc.gov|language=en-us|access-date=2018-03-29}}</ref> However, Hepatitis B is still widespread in China and has been determined by Wang et al. (2019) to have "higher intermediate prevalence (5-7.99%)".<ref>{{Cite journal|last1=Wang|first1=Huai|last2=Men|first2=Peixuan|last3=Xiao|first3=Yufeng|last4=Gao|first4=Pei|last5=Lv|first5=Min|last6=Yuan|first6=Qianli|last7=Chen|first7=Weixin|last8=Bai|first8=Shuang|last9=Wu|first9=Jiang|date=2019-09-18|title=Hepatitis B infection in the general population of China: a systematic review and meta-analysis|journal=BMC Infectious Diseases|volume=19|issue=1|page=811|doi=10.1186/s12879-019-4428-y|issn=1471-2334|pmc=6751646|pmid=31533643 |doi-access=free }}</ref> In fact, no country has a higher prevalence of Hepatitis B than China and one third of the world's Hepatitis B-afflicted individuals are thought to reside in China.<ref name=":9">{{Cite journal|last1=Chen|first1=Shanquan|last2=Li|first2=Jun|last3=Wang|first3=Dan|last4=Fung|first4=Hong|last5=Wong|first5=Lai-yi|last6=Zhao|first6=Lu|date=2018-04-21|title=The hepatitis B epidemic in China should receive more attention|journal=The Lancet|language=en|volume=391|issue=10130|page=1572|doi=10.1016/S0140-6736(18)30499-9|issn=0140-6736|pmid=29695339|s2cid=13856592|doi-access=free}}</ref> Hepatitis B in China was even described as an "epidemic" in Chen et al. (2018).<ref name=":9" /> Some socioeconomic factors that contribute to the continued prevalence of Hepatitis B in China are first the high medical cost related to treatment.<ref name=":9" /> Second, the stigma that surrounds the disease causes the importance of Hepatitis B testing to go undiscussed in that people who disclose their Hepatitis B positive status may be discriminated against.<ref>{{Cite journal|last1=Kan|first1=Quancheng|last2=Wen|first2=Jianguo|last3=Xue|first3=Rui|date=2015-07-18|title=Discrimination against people with hepatitis B in China|journal=The Lancet|language=en|volume=386|issue=9990|pages=245–246|doi=10.1016/S0140-6736(15)61276-4|issn=0140-6736|pmid=26194522|s2cid=5597937|doi-access=free}}</ref> These combine to cause a situation where many people in China do not even realize that they are infected with the disease and thus unknowingly may succumb to the disease or pass it on to others.<ref name=":9" />

===HIV and AIDS===

{{main|HIV/AIDS in the People's Republic of China}}

The [[AIDS]] disaster of [[Henan]] in the mid-1990s is estimated to be the largest man-made health catastrophe, affecting five-hundred thousand to one million persons. It was also in [[Hebei]], [[Anhui]], [[Shanxi]], [[Shaanxi]], Hubei and [[Guizhou]].<ref>Pekka Mykkänen, Kiina rynnistää huipulle, Gummerus/Nemo 2004, pages 314-318</ref> [[HIV]] was transmitted via blood sale. Blood plasma mixture from several persons was returned so that same person could give blood up to 11 times a day.<ref>Johan Björksten, I mittens rike, Det historiska och moderna Kina, Bilda förlag 2006, pages 190-191{{in lang|sv}}</ref> The disaster was only recognized in 2000 and found out abroad in 2001. Pensioner [[Gao Yaojie]] sold her house to deliver data leaflets of HIV to people, while officials tried to prevent her. Some local officials and politicians were involved in the blood sale. In 2003 only 2.6% of Chinese knew that a condom could protect from AIDS.<ref>Pekka Mykkänen, Isonenä kurkistaa Kiinaan, Nemo 2006, pages. 145-147 {{in lang|fi}}</ref>

Authorities blocked protests over ineffective drug treatments, cancelled meetings on HIV groups, and detained or put under house arrest prominent activists including the 2005 Reebok Human Rights Award winner [[Li Dan (activist)|Li Dan]], eighty-year-old AIDS activist Dr. Gao Yaojie, and the husband-and-wife HIV activist team of [[Hu Jia (activist)]] and Zeng Jinyan.<ref>[http://china.hrw.org/press/news_release/china_stop_hiv_not_people_living_with_hiv China: Stop HIV Not People Living With HIV] China Should Fulfill Promises Made to Global Fund, Respect Rights, [[Human Rights Watch]] November 2007</ref>

China, similar to other nations with migrant and socially mobile populations, has experienced increased incidences of [[human immunodeficiency virus]]/[[acquired immune deficiency syndrome]] (HIV/AIDS). By the mid-1980s, some Chinese physicians recognized HIV and AIDS as a serious health threat but considered it to be a "foreign problem". As of mid-1987 only two Chinese citizens had died from AIDS and monitoring of foreigners had begun. Following a 1987 regional World Health Organization meeting, the Chinese government announced it would join the global fight against AIDS, which would involve quarantine inspection of people entering China from abroad, medical supervision of people vulnerable to AIDS, and establishment of AIDS laboratories in coastal cities. Within China, the rapid increase in venereal disease, prostitution and drug addiction, internal migration since the 1980s and poorly supervised plasma collection practices, especially by the Henan provincial authorities, created conditions for a serious outbreak of HIV in the early 1990s.<ref>[https://web.archive.org/web/20021214033216/http://www.usembassy-china.org.cn/english/sandt/hivartic.html July 2001 compendium, U.S. Embassy Beijing website Recent Chinese Reports on HIV/AIDS and Sexually Transmitted Diseases]. Accessed 23 May 2010 via Internet Archive of U.S. Embassy Beijing website.</ref><ref>{{cite web|url=http://www.usembassy-china.org.cn/sandt/henan-hiv.htm|archive-url=https://web.archive.org/web/20021018224210/http://www.usembassy-china.org.cn/sandt/henan-hiv.htm|title=Revealing the Blood Wound of the Spread of AIDS in Henan Province|archive-date=18 October 2002|work=usembassy-china.org.cn}}</ref><ref>[https://web.archive.org/web/20020415101724/http://www.usembassy-china.org.cn/sandt/ChinaHealthNews-criticism.html China Health News And the Henan Province Health Scandal Cover-up] translation of a report by the PRC NGO Aizhi</ref>

As of 2005 about 1 million Chinese have been infected with HIV, leading to about 150,000 AIDS deaths. Projections are for about 10 million cases by 2010 if nothing is done. Effective preventive measures have become a priority at the highest levels of the government, but progress is slow. A promising pilot program exists in [[Gejiu]] partially funded by international donors.

===Tuberculosis===
{{main|Tuberculosis in China}}

[[File:Mycobacterium tuberculosis.jpg|100px|right|thumb|Scanning electron micrograph of ''[[Mycobacterium tuberculosis]]'']]
[[Tuberculosis]] is a major public health problem in China, which has the world's second largest [[tuberculosis epidemic]] (after [[India]]). Progress in tuberculosis control was slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and [[multidrug-resistant]] tuberculosis was a major problem. These signs of inadequate tuberculosis control can be linked to a malfunctioning health system. Prevalent [[Smoking in the People's Republic of China|smoking]] aggravates its spread.

===Leprosy===
{{main|Leprosy in China}}

Leprosy, also known as Hansen's disease, was officially eliminated at the national level in China by 1982, meaning prevalence is lower than 1 in 100,000. There are 3,510 active cases today. Though leprosy has been brought under control in general, the situation in some areas is worsening, according to China's [[Ministry of Health (China)|Ministry of Health]].<ref>{{cite journal |vauthors=Chen XS, Li WZ, Jiang C, Ye GY |title=Leprosy in China: epidemiological trends between 1949 and 1998 |journal=Bull. World Health Organ. |volume=79 |issue=4 |pages=306–12 |year=2001 |pmid=11357209 |pmc=2566398 |url=http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862001000400007&lng=en&nrm=iso&tlng=en |hdl=10665/268303 }}</ref>

===Malaria===

[[File:Population denominator for case incidence and mortality rate, and estimated malaria cases and deaths in China, 2000–2019.png|thumb|Population denominator for case incidence and mortality rate, and estimated malaria cases and deaths in China, 2000–2019]]

Plasmodium vivax malaria is the most common malaria in China, followed by P. falciparum malaria, while Plasmodium vivax malaria and Plasmodium ovale malaria are less common. P. falciparum malaria occurs mainly in the southwest and Hainan, while P. vivax malaria occurs in the northeast, north and northwest of China.<ref>{{cite journal |vauthors=Zhang, Q, Lai, S, Zheng, C |title=The epidemiology of Plasmodium vivax and Plasmodium falciparum malaria in China, 2004–2012: from intensified control to elimination.  |journal=Malar J |volume=13 |article-number=419 |year=2014 |doi=10.1186/1475-2875-13-419 |pmid=25363492 |pmc=4232696 |doi-access=free }}</ref><ref>{{cite journal |vauthors=Lu G, Zhou S, Horstick O, Wang X, Liu Y, Müller O |title=Malaria outbreaks in China (1990-2013): a systematic review. |journal=Malar. J. |volume=13 |article-number=269 |year=2014 |doi=10.1186/1475-2875-13-269 |pmid=25012078 |pmc=4105761 |doi-access=free }}</ref>

[[File:Malaria incidence in China from 1949 to 2020.jpg|thumb|Malaria incidence in China from 1949 to 2020]]

Since the 1950s, Chinese health authorities have worked to detect and prevent the spread of malaria by providing prophylactic anti-malarial drugs to people at risk of malaria and treating patients, and in 1967 the Chinese government launched the research "Project 523". This work resulted in the antimalarial artemisinin-based combination therapies.<ref>{{cite journal |vauthors=Hsu E |title=Reflections on the 'discovery' of the antimalarial qinghao |journal=British Journal of Clinical Pharmacology |volume=61 |pages=666–670 |year=2006 |issue=6 |doi=10.1111/j.1365-2125.2006.02673.x |pmid=16722826 |pmc=1885105 }}</ref> One of the team members, Tu Youyou, was awarded the 2015 Nobel Prize in Physiology or Medicine for her work.{{citation needed|date=September 2023}}<ref>{{cite web |title=The Nobel Prize in Physiology or Medicine 2015 |url=https://www.nobelprize.org/prizes/medicine/2015/tu/facts/ |website=NobelPrize.org}}</ref>

In the 1980s, began to experiment on a large scale with the use of drugs to prevent malaria. By 1988, the use of nets greatly reduced the incidence of malaria. By the end of 1990, the number of malaria cases in China had fallen to 117,000, and deaths had been reduced by 95 per cent. China was free of malaria cases for four consecutive years starting in 2017. The World Health Organization (WHO) confirmed that malaria had been eliminated in China in 2021.<ref>{{cite web |title=从3000万例到零: 中国被世卫组织认证为无疟疾国家 |url=https://www.who.int/zh/news/item/30-06-2021-from-30-million-cases-to-zero-china-is-certified-malaria-free-by-who |website=www.who.int |language=zh}}</ref><ref>{{cite journal |last1=Feng |first1=Xinyu |last2=Zhang |first2=Li |last3=Tu |first3=Hong |last4=Xia |first4=Zhigui |title=Malaria Elimination in China and Sustainability Concerns in the Post-elimination Stage |journal=China CDC Weekly |date=4 November 2022 |volume=4 |issue=44 |pages=990–994 |doi=10.46234/ccdcw2022.201 |pmid=36483989 |pmc=9709298 |language=en |issn=2096-7071}}</ref>

===Mental health===
{{main|Mental health in China}}

100 million Chinese people have mental illnesses that are varying degrees of intensity.<ref name="economist">{{cite news|title=And now the 50-minute hour: Mental health in China|page=35|newspaper=  [[The Economist]]|date=18 August 2007|url=http://www.economist.com/world/asia/displaystory.cfm?story_id=9657086|access-date=18 July 2007}}</ref> Currently, dilemmas such as human rights versus political control, community integration versus community control, diversity versus centrally, huge demand but inadequate services seem to challenge the further development of the mental health service in the PRC. China has 17,000 certified psychologists, which is ten percent of that of other developed countries per capita.<ref name="economist" />

===Nutrition===
{{See also|Food safety in the People's Republic of China}}
In the 2000–2002 period, China had one of the highest per capita caloric intakes in Asia, second only to South Korea and higher than countries such as Japan, Malaysia, and Indonesia. In 2003, daily per capita caloric intake was 2,940 (vegetable products 78%, animal products 22%); 125% of [[Food and Agriculture Organization|FAO]] recommended minimum requirement.

===Malnutrition among rural children===
{{See also|Zhejiang Xinhua Compassion Education Foundation}}
China has been developing rapidly for the past 30 years. Though it has uplifted a huge number of people out of poverty, many social issues still remain unsolved. One of them is malnutrition among rural children in China. The problem has diminished but still remains a pertinent national issue.  In a survey done in 1998, the stunting rate among children in China was 22 percent and was as high as 46 percent in poor provinces.<ref>Park, A. and Wang, S., 2001. "China's Poverty Statistics." China Economic Review
12:384–98</ref><ref>Park, A. and Zhang, L., 2000. "Mother's Education and Child Health in China's Poor Areas." Mimeo, University of Michigan Department of Economics</ref> This shows the huge disparity between urban and rural areas. In 2002, Svedberg found that stunting rate in rural areas of China was 15 percent, reflecting that a substantial number of children still suffer from malnutrition.<ref>Svedberg, P. (2006) "Declining child malnutrition: a reassessment", International
Journal of Epidemiology, Vol. 35, No. 5, pp. 1336-46</ref> Another study by Chen shows that malnutrition has dropped from 1990 to 1995 but regional differences are still huge, particularly in rural areas.<ref>Chen, C. 2000. "Fat Intake and Nutritional Status of Children in China." American Journal of Clinical Nutrition 72(Supplement):1368S–72S</ref>

In a recent report by The Rural Education Action Project on children in rural China, many were found to be suffering from basic health problems. 34% have iron deficiency anaemia and 40 percent are infected with intestinal worms.<ref>The Rural Education Action Project - REAP, http://reap.stanford.edu/ - a group of researchers from the Freeman Spogli Institute and the Chinese Academy of Sciences, 2008 – retrieved from www.ccap.org.cn/uploadfile/2011/0111/20110111054129822.doc on 11 February 2011</ref> Many of these children do not have proper or sufficient nutrition. Often, this causes them not being able to fully reap the benefits of education, which can be a ticket out of poverty.

One possible reason for poor nutrition in rural areas is that agricultural produce can fetch a decent price, and thus is often sold rather than kept for personal consumption. Rural families would not consume eggs that their hen lay but will sell it in the market for about 20 yuan per kilogram.<ref name="ChinaDaily">{{cite news |title=West China county improves rural children health with free eggs |url=http://www.chinadaily.com.cn/china/2008-12/07/content_7279010.htm |access-date=11 February 2011 |work=China Daily |date=7 December 2008}}</ref> The money will then be spent on books or food like instant noodles which lack nutrition value compared to an egg. A girl named Wang Jing in China has a bowl of pork only once every five to six weeks, compared to urban children who have a vast array of food chains to choose from.

A survey conducted by China's Ministry of Health showed the kind of food consumed by rural households. 30 percent consume meat less than once a month. 23 percent consume rice or egg less than once a month.

In a 2008 Report on Chinese Children Nutrition and Health Conditions, West China still has 7.6 million poor children who were shorter and weigh lesser than urban children. These rural children were also shorter by 4 centimetres and 0.6 kilograms lighter than World Health Organization standards.<ref name="ChinaDaily" /> It can be concluded that children in West China still lack quality nutrition.

====Epidemiological studies====
The most comprehensive epidemiological study of nutrition ever conducted was the [[China-Oxford-Cornell Study on Dietary, Lifestyle and Disease Mortality Characteristics in 65 Rural Chinese Counties]], known as the "China Project", which began in 1983.<ref>Brody, Jane E. [https://www.nytimes.com/1990/05/08/science/huge-study-of-diet-indicts-fat-and-meat.html?scp=8&sq=%22T.%20Colin%20Campbell%22&st=cse "Huge Study Of Diet Indicts Fat And Meat"], ''The New York Times'', 8 May 1990.</ref> Its findings are discussed in ''[[The China Study]]'' by T. Colin Campbell.

=== Environment and health ===
[[File:Factory in China at Yangtze River.JPG|thumb|A factory in China along the Yangtze River, illustrating one of the factors contributing to China's air pollution]]
China's rapid development has led to [[environmental issues in China|numerous environmental problems]] which all have a direct impact on health. According to Kan (2009) the environmental issues include "[[Air pollution|outdoor and indoor air pollution]], water shortages and pollution, [[desertification]], and [[soil pollution]]".<ref name=":32">{{Cite journal|last=Kan|first=Haidong|date=December 2009|title=Environment and Health in China: Challenges and Opportunities|journal=Environmental Health Perspectives|volume=117|issue=12|pages=A530-1|doi=10.1289/ehp.0901615|pmid=20049177|pmc=2799473|issn=0091-6765}}</ref> Of these, Kan (2009) states that the most detrimental one is the outdoor air pollution for which China has become known.<ref name=":32" /> In Liu et al.'s research (2018) on this issue specifically, the major health effects are listed as "including adverse cardiovascular, respiratory, pulmonary, and other health-related outcomes".<ref name=":8">{{Cite journal|last=Liu|first=Wenling|date=2018|title=Health Effects of Air Pollution in China|journal=International Journal of Environmental Research and Public Health|volume=1471|issue=7|page=1471|doi=10.3390/ijerph15071471|pmid=30002305|pmc=6068713|doi-access=free}}</ref> The air pollution is not limited to industrial cities. In fact, due to the fact that rural Chinese people still use fuels such as [[coal]] for cooking, the World Health Organization attributes more premature deaths to that sort of air pollution than to [[Pollution in China|China's ambient air pollution]].<ref name=":32" /> In addition, many factories are located in the countryside, which exacerbates rural air pollution.<ref name=":32" /> Despite China's notoriously poor air quality, Matus et al. (2011) have found that the severity of China's air pollution has been declining over the years.<ref>{{Cite journal|last=Matus|first=Kira|date=2012|title=Health damages from air pollution in China|url=https://globalchange.mit.edu/sites/default/files/MITJPSPGC_Reprint_12-3.pdf|journal=Global Environmental Change|volume=22|issue=1 |pages=55–66|doi=10.1016/j.gloenvcha.2011.08.006|bibcode=2012GEC....22...55M |hdl=1721.1/61774}}</ref>

Finally, as described by Kan (2018) and Wu, et al. (1999) another major contributor to adverse health effects related to environmental issues is water pollution.<ref name=":42">{{Cite journal|last=Wu|first=C|date=1999|title=Water pollution and human health in China|journal=Environmental Health Perspectives|volume=107|issue=4|pages=251–256|pmc=1566519|pmid=10090702|doi=10.1289/ehp.99107251|bibcode=1999EnvHP.107..251W}}</ref><ref name=":32" /> In rural areas, this is once again due to factories located nearby. In urban areas on the other hand, China's water sanitation systems have not yet caught up with the needs of the population.<ref name=":42" /> As a result, the water is often contaminated with human waste and is not considered potable.<ref name=":42" /> Ingestion of contaminated water has caused diseases such as cholera.<ref name=":32" />

==== Climate change ====
{{excerpt|Climate change in China|Health impacts}}

===Infection from animals===

The first known human contraction of Avian Influenza (bird flu), after contact with live poultry in February 2018, was diagnosed to a woman living in the Jiangsu Province of China.<ref>{{Cite web|url=https://www.who.int/csr/don/22-february-2018-ah7n4-china/en/|archive-url=https://web.archive.org/web/20180222165210/http://www.who.int/csr/don/22-february-2018-ah7n4-china/en/|archive-date=22 February 2018|title=Human infection with avian influenza A(H7N4) virus – China|website=World Health Organization|language=en-GB|access-date=2018-03-29}}</ref>

Pig-human transmission of the ''Streptococcus suis'' bacteria was reported in 2005, which led to 38 deaths in and around [[Sichuan]] province, an unusually high number. Although the bacteria exists in other pig rearing countries, the pig-human transmission has only been reported in China.<ref>[http://www.aphis.usda.gov/vs/ceah/cei/taf/emergingdiseasenotice_files/strep_suis_china.htm "''Streptococcus suis'' Outbreak, Swine and Human, China"] {{Webarchive|url=https://web.archive.org/web/20100327033408/http://www.aphis.usda.gov/vs/ceah/cei/taf/emergingdiseasenotice_files/strep_suis_china.htm |date=27 March 2010 }} August 2005. Veterinary Service. Accessed 17 April 2006.</ref>

==Hygiene and sanitation==

{{Further|Water supply and sanitation in the People's Republic of China}}
Many of China's water sources, including underground sources and rivers, have been heavily polluted because of industry and economic growth. Increased exposure to polluted water and air has created "[[Cancer cluster|cancer villages]]" and further health and environmental problems.<ref name="Global Water Forum">{{Cite news|url=http://www.globalwaterforum.org/2017/04/03/chinas-war-on-water-pollution-must-tackle-causes-of-deep-groundwater-pollution/|title=China's "war on water pollution" must tackle causes of deep groundwater pollution|date=3 April 2017|work=Global Water Forum|access-date=2018-04-12}}</ref> A majority of groundwater and shallow wells surveyed in China showed signs of heavy pollution, by measuring [[nitrate]] levels which indicate water contamination<ref name="Global Water Forum" />
[[File:Tianjin sanitation tricycle IMG 5367.JPG|thumb|Workers in Tianjin biking on sanitation tricycles]]
By 2002, 92 percent of the urban population and 8 percent of the rural population had access to an improved water supply, and 69 percent of the urban population and 32 percent of the rural population had access to improved sanitation facilities.{{citation needed|date=January 2019}}

Although China has made great efforts of making sanitary facilities and safe water more accessible, there are water and sanitation disparities all over China. As of 2012, sanitary facilities were available to 69% of the Chinese people and 71% of water in China is piped, yet it is still difficult preserving drinking water that is affordable and efficient at a communal level. Additionally, water in both urban and rural areas of China are still vulnerable to disease, pollution, and contamination, with rural areas at higher risk of sewage contamination.<ref>{{Cite web|url=http://www.wpro.who.int/china/mediacentre/factsheets/watsan/en/|archive-url=https://web.archive.org/web/20160510122045/http://www.wpro.who.int/china/mediacentre/factsheets/watsan/en/|archive-date=10 May 2016|title=Home}}</ref>

The lack of sanitation in multiple areas of China has affected many student for decades. An absence of modern-day toilets and hand washing areas have directly affected students nationwide. The lack of reliable drinking water and sanitation areas, along with many others health issues, has directly led to 1/3 of young students in China having intestinal parasites.<ref name="unicef.cn">{{Cite web|url=http://www.unicef.cn/en/water-and-sanitation/sanitation-and-hygiene/|title=Sanitation and Hygiene - UNICEF China Protecting children's rights|website=www.unicef.cn|access-date=25 March 2017}}</ref>

The [[Patriotic Health Campaign]], first started in the 1950s, are campaigns aimed to improve sanitation and [[hygiene]] in China. UNICEF also plans to incorporate government programs and policies in order to improve normal health standards in China. The programs and policies are used to teach students about basic hygiene and form campaigns encouraging people to wash their hands with soap instead of water only.<ref name="unicef.cn" />

== Measure ==
[[File:Life-expectancy, 1930 to 2023, CHN.svg|thumb|Historical development of life expectancy]]China has made significant progress in improving public health over the past few decades, with life expectancy increasing from 67.8 years in 1981 to 76.7 years in 2019. The Chinese government has implemented a range of health policies and initiatives, including the Healthy China 2030 program, which aims to improve public health outcomes by addressing major health challenges such as chronic diseases, infectious diseases, and environmental health hazards.<ref name=":142">{{Cite news |title=China Health Statistics Yearbook 2020 |work=National Health Commission of the People's Republic of China}}</ref><ref name=":52">{{Cite journal |last=Nkengasong |first=John |author-link=John Nkengasong |date=2020-01-27 |title=China's response to a novel coronavirus stands in stark contrast to the 2002 SARS outbreak response |journal=Nature Medicine |language=en |volume=26 |issue=3 |pages=310–311 |doi=10.1038/s41591-020-0771-1 |issn=1546-170X |pmc=7096019 |pmid=31988464}}</ref><ref name=":172">{{Cite book |title=Healthy China 2030: A Vision for Healthier Populations}}</ref>

The healthcare system in China is a mix of public and private providers, with the government responsible for providing basic healthcare services to the population. However, there are significant disparities in access to healthcare between urban and rural areas, as well as between different socioeconomic groups.

In recent years, China has made efforts to improve its healthcare infrastructure, including investing in the development of primary healthcare facilities and expanding health insurance coverage. Additionally, the government has implemented a number of public health campaigns, such as anti-smoking and anti-obesity initiatives.<ref name=":152">{{Cite journal |last1=Qiu |first1=Wuqi |last2=Chu |first2=Cordia |last3=Mao |first3=Ayan |last4=Wu |first4=Jing |date=2018-06-28 |title=The Impacts on Health, Society, and Economy of SARS and H7N9 Outbreaks in China: A Case Comparison Study |journal=Journal of Environmental and Public Health |volume=2018 |article-number=2710185 |doi=10.1155/2018/2710185 |issn=1687-9805 |pmc=6046118 |pmid=30050581 |doi-access=free}}</ref><ref name=":182">{{Cite news |title=Healthcare System In China: How It Works}}</ref>

Despite these efforts, there is still much work to be done to improve health outcomes in China. Ongoing efforts are needed to address the root causes of health disparities and to promote healthy lifestyles and behaviors among the population.

The Human Rights Measurement Initiative<ref name=":19">{{cite web |title=Human Rights Measurement Initiative |url=https://humanrightsmeasurement.org/ |access-date=1 May 2023 |website=humanrightsmeasurement.org}}</ref> finds that China is fulfilling 98.4% of what it should be fulfilling for the right to health based on its level of income.<ref name="China - Rights Tracker2">{{cite web |title=China - Rights Tracker |url=https://rightstracker.org/en/country/CHN?as=core&tab=report-esr |access-date=1 May 2023 |website=rightstracker.org |archive-date=1 May 2023 |archive-url=https://web.archive.org/web/20230501185827/https://rightstracker.org/en/country/CHN?as=core&tab=report-esr }}</ref> When looking at the right to health with respect to children, China achieves 98.6% of what is expected based on its current income.<ref name="China - Rights Tracker2" /> In regards to the right to health amongst the adult population, the country achieves 97% of what is expected based on the nation's level of income. When considering the right to reproductive health, the nation is fulfilling 99.6% of what the nation is expected to achieve based on the resources (income) it has available. Overall, China falls into the "good" category when evaluating the right to health.<ref name="China - Rights Tracker2" />

==WHO in China==
The World Health Organization (WHO) [[Constitution]] came into force on 7 April 1948, and China has been a Member since the beginning.

The WHO China office has increased its scope of activities significantly in recent years, especially following the major [[SARS|SARS outbreak of 2003]]. The role of WHO China is to provide support for the government's health programs, working closely with the [[Ministry of Health of the People's Republic of China|Ministry of Health]] and other partners within the government, as well as with [[UN agencies]] and other organizations.

China's government with WHO assistance and support has strengthened public health in the nation. The current [[Five-Year Plans of the People's Republic of China|Five Year Plan]] incorporates public health in a significant way. The government has acknowledged that even as millions upon millions of citizens are prospering amid the country's [[economic boom]], millions of others are lagging behind, with healthcare many cannot afford. The challenge for China is to strengthen its health care system across the spectrum, to reduce the disparities and create a more equitable situation regarding access to health care services for the population at large.

At the same time, in an ever-interconnected world, China has embraced its responsibility to global public health, including the strengthening of surveillance systems aimed at swiftly identifying and tackling the threat of infectious diseases such as SARS and [[avian influenza]]. Another major challenge is the epidemic of [[HIV/AIDS]], a key priority for China.

The staff of the WHO Office in China are working with their national counterparts in the following areas:
* [[healthcare system|Healthcare systems development]]
* [[Immunization]]
* [[Tuberculosis control]]
* [[HIV/AIDS|HIV/AIDS control]]
* [[Maternal health]] and [[child health]]
* [[Injury prevention]]
* [[Avian influenza|Avian influenza control]]
* [[Food safety]]
* [[Tobacco control]]
* [[Non-communicable disease|Non-communicable diseases control]]
* [[Environmental health|Environment]] and [[health]]
* [[Communicable diseases]] [[disease surveillance|surveillance]] and [[emergency response|response]]

In addition, WHO technical experts in specialty areas can be made available on a short-term basis, when requested by the Chinese government. China is an active, contributing member of WHO, and has made valuable contributions to global and regional health policy. Technical experts from China have contributed to WHO through their membership on various WHO technical expert advisory committees and groups.

==See also==
* [[Healthcare in China]]

==References==
{{reflist|30em}}

==External links==
* [http://www.chc.org.cn/ China Health Care Association]
* [https://web.archive.org/web/20190713211003/http://www.cpma.org.cn/ Chinese Preventive Medicine Association]
* [https://www.who.int/countries/chn/en/ China Profile] by World Health Organization ([http://www.wpro.who.int/china WHO Office in China])
* [http://www.moh.gov.cn/ Chinese Ministry of Health] {{Webarchive|url=https://web.archive.org/web/20171112045852/http://www.moh.gov.cn/ |date=12 November 2017 }}
* [http://www.chinamedicalboard.org/ China Medical Board] {{Webarchive|url=https://web.archive.org/web/20150404064529/http://www.chinamedicalboard.org/ |date=4 April 2015 }}
* [https://www.chinaeducationaltours.com/guide/culture-chinese-health-care-system-hospitals.htm Hospitals in China]

===Resources===
* [https://web.archive.org/web/20051204104225/http://heapro.oxfordjournals.org/cgi/content/full/15/3/269 "Critical health literacy: a case study from China in schistosomiasis control"]
* [http://www.china.org.cn/e-white/children/c-3.htm Children's Healthcare in China]
* [http://wwwn.cdc.gov/travel/destinationChina.aspx Health Information for Travelers to China] {{Webarchive|url=https://web.archive.org/web/20090503151550/http://wwwn.cdc.gov/TRAVEL/destinationChina.aspx |date=3 May 2009 }} U.S. Centers for Disease Control and Prevention (CDC).
* [https://web.archive.org/web/20081012044311/http://www.brookings.edu/events/2007/0806_china.aspx China's Healthcare System: Improving Quality of Insurance, Service, and Personnel] ''Reforming China's Healthcare System'' Roundtable series held by the [[Brookings-Tsinghua Center]] at [[Tsinghua University]]
* [https://archive.today/20130223135406/http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.publhealth.25.101802.123116 The Current State of Public Health in China] ''Annual Review of Public Health''  Vol. 25: 327-339 (Volume publication date April 2004)
* [http://siteresources.worldbank.org/INTEAPREGTOPHEANUT/Resources/publichealth,09-13-04.pdf A Critical Review of Public Health in China] August 2004 paper

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[[Category:Health in China| ]]
[[Category:Death in China]]