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Comparing the United States’ and China’s shifting health challenges

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Date: 
Wednesday, November 7, 2018
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The American Journal of Public Health (AJPH) published an article by Dr. Jonathan Fielding, distinguished professor of health policy and management at the UCLA Fielding School of Public Health, in which he addresses the question of how China can prioritize programmatic resources and policy interventions to make the greatest impact on the health of its inhabitants.


The United States and China both face the question of how to prioritize programmatic resources and policy interventions to make the greatest impact on the health of their populations. I discuss strengths and limitations of the expert panel survey used by Wu et al. in “The 20 Most Important and Most Preventable Health Problems of China: Opinions From Chinese Experts Using a Modified Delphi Process,” in this issue of AJPH. I juxtapose this method with several US approaches to priority setting at the federal, state, and county levels and suggest steps for moving from research to action.

Setting national priorities to improve health and prevent disease is vital. Ideally, priorities should be driven by scientific processes, but in reality, they tend to be driven by perception, political realities, feasibility, and timing. Those of us in public health feel it is imperative to put science and data first so that there can be broad agreement and a common understanding that underlies the discussion of priorities.

Difficulty in setting health priorities is magnified when there are rapid changes in economic, social, and political conditions. Such is the case in China. That nation’s explosive economic growth over the past 40 years brought many advantages to its people, including increased longevity and progress in controlling some occupational and communicable diseases.

China faces shifting health challenges, with noncommunicable diseases now accounting for the vast majority of all deaths, many attributable to environmental degradation, global warming, changes in health-affecting behaviors, and aging of the population. In addition, emerging diseases threaten the public’s health, and even infectious disease notifications for common infectious diseases have increased despite substantial investments in disease control and prevention.

Like many other countries, including the United States, China faces the question of how to prioritize programmatic resources and policy interventions to make the greatest impact on the health of its 1.3 billion inhabitants. “Prevention first” has been selected as the national priority. However, an operational plan specifying which diseases to prevent and which to control, as well as target objectives and what interventions are needed to effect the desired improvements, has yet to be published.