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    • Dr. Zuo-Feng Zhang in the lab with his students.
      Dr. Zuo-Feng Zhang with his students.

Improving China’s Health, From Near & Far

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Zuo-Feng Zhang got his start providing preventive care to China’s rural poor as a barefoot doctor. As an epidemiologist at the FSPH, he continues to influence the health of his native country.

As a barefoot doctor in the countryside of China, Zhang watered white fungus which was used in Chinese medicine to nourish bodies, heal dry coughs and clear heat in the lungs.When Dr. Zuo-Feng Zhang was 15, he was one of more than 16 million students sent to the Chinese countryside to accept “re-education.” The year was 1969, and China was in the midst of Mao Zedong’s Cultural Revolution. Zhang was soon chosen by farmers to become a “barefoot doctor,” bringing basic preventive medicine to the rural poor under Rural Cooperative Medical System program.

More than four decades later Zhang is an epidemiologist at the UCLA Fielding School of Public Health and his native China operates under a far different political structure. The barefoot doctor and Rural Cooperative Medical System were eliminated by 1980, along with most of the other Maoist reforms. “The thinking was that as a product of the Cultural Revolution, it couldn’t be good,” says Zhang. “But it was a very effective system. For only a small amount of money, farmers could get basic treatment and preventive measures for common problems such as headache, cold and diarrhea. Once the system was abolished, a lot of people couldn’t afford to pay for medical services.” 

Zhang’s life today appears far removed from his days as a barefoot doctor. Rather than treating Chinese peasants for everyday ailments, he’s using the latest molecular approaches in his UCLA laboratory to identify tumor markers, genetic mutations and inherited susceptibilities. But if the techniques are more sophisticated and the target populations much larger, Zhang remains focused on prevention – and on the health concerns in his country of origin.
 
While at UCLA,Zhang has continued to devote a portion of his time to conducting research in China on the major risk and protective factors for four of that country’s leading cancers – lung, stomach, esophageal and liver – and targeting preventable risks that could be influenced through policies, including smoking, alcohol consumption, diet, indoor air pollution and water pollution.
 

Zhang served as a WHO consultant on the Non-Communicable Diseases (NCDs) Prevention and Control in China and conducted a WHO training workshop on NCD prevention and control in Suzhou, China in 2004.In 2004, he went to China to serve as a consultant charged with making policy recommendations to the World Health Organization (WHO) and Chinese government on non-communicable disease prevention and control. Zhang spent four weeks as a WHO consultant on non-communicable disease (NCD) prevention and control in China. “NCDs account for 60 percent of deaths worldwide but more than 80 percent of deaths in China, and thus should be a high priority of public health policy,” Zhang says. “But at the time there was no plan.”

During his stay, Zhang organized a four-day WHO training course; visited national, provincial and local Chinese Center for Disease Control and Prevention offices and reviewed reports from various sources on NCD prevention and control efforts in China. His final report, issued to both the WHO and the Chinese government, made the case for an integrated national NCD prevention and control effort. “NCDs kill many more people than all other diseases combined, and should be considered the highest priority for prevention,” Zhang argued, adding: “The majority of NCD deaths are preventable through effective behavior intervention measures such as tobacco cessation, reduced alcohol consumption, improved diet and physical activity levels, and weight and blood pressure control.”

Among the recommendations of Zhang’s report:

  • The national government should play a proactive role, with a stable budget for NCD research, prevention and control.
  • The State Council or Ministry of Health should publish an annual report on risk factors for major NCDs.
  • The Ministry of Health should consult with national and international experts in establishing a national plan for NCD prevention and control, integrated with medical system reform.
  • Existing demonstration projects to monitor and evaluate interventions aimed at reducing the NCD burden should be continued and expanded. 

One of the major emphases of Zhang’s report was tobacco prevention and control. China is home to 350 million smokers; an estimated 1.2 million Chinese die each year from smoking, and many more become disabled. The issue is politically sensitive in China, which owns the tobacco industry and derives a considerable amount of revenue from tobacco sales. Zhang recommended a first-of-its-kind 0.5 yuan per pack tax, with the money going to NCD prevention and control research; along with publication of an annual report on smoking and health, similar to the U.S. Surgeon General’s report.

Although Zhang’s report was only one of many contributing factors, change on the issue of tobacco control was swift for a country that had long shied away from acknowledging the problem. In October 2005, less than a year after Zhang’s report, China ratified the landmark WHO Framework Convention on Tobacco Control. China started the International Tobacco Control Policy Evaluation Project the following April, and in May 2007 the Ministry of Health released the first annual report on tobacco prevention and control, as Zhang had recommended. In 2011, the Ministry of Health launched a ban on smoking in indoor public spaces. China is home to 350 million smokers; an estimated 1.2 million Chinese die each year from smoking, and many more become disabled.

When the Chinese Ministry of Healthand 14 other ministries and state administrations issued the China National Plan for NCD Prevention and Treatment (2012-2015) in May 2012, many of the plan’s key features followed Zhang’s 2005 report, including its strong emphasis on integrating prevention with treatment and emphasizing primary health care. “This is a plan that indicates a critical national policy change,” Zhang says. “I was very pleased to see that the report referred to some of my recommendations.”

Zhang has another reason to be pleased: The medical system reform into which the NCD prevention and control program is being integrated includes the New Rural Cooperative Medical System (NRCMS), established in 2005 to make health care more affordable to the rural poor. Zhang hopes that the new focus on NCD prevention and control within the Chinese medical system will help to ensure continued funding for the NRCMS, which draws heavily on lessons from the barefoot doctor era that launched Zhang’s career.