743533

research-article2018
PED0010.1177/1757975917743533CommentaryX. Tan et al.

Commentary

Healthy China 2030, a breakthrough for improving health

Xiaodong Tan1, Yanan Zhang1 and Haiyan Shao1

Abstract: China has the largest population in the world, and its health levels have greatly affected the
healthy development of the population of the world. Healthy China 2030 is a breakthrough for
ensuring that the Chinese population have access to health, through advocating the whole society’s
participation in the concept of “Health for All, and All for Health.” The plan puts forward five
strategies such as popularizing healthy life, optimizing the health service, improving health protection,
building a healthy environment, and developing healthy industry, from the perspectives of health
effects of personal life and behavior, health care and security, production, and the living environment.
As a national guide for public health promotion, we briefly describe the main intentions of Healthy
China 2030, and give some commentaries from a health promotion perspective. (Global Health
Promotion, 2019; 26(4): 96–99)

Keywords: health promotion, healthy cities/healthy communities, global health/globalization

Why has Healthy China 2030 been
proposed?
China has the largest population in the world,
with a population of over 1.37 billion and increasing
health-related issues that affect the healthy
development of the population in the world. The
Chinese government has made remarkable
achievements in improving its people’s physical
fitness and reducing diseases, especially the first
revolution for promoting the whole society to
participate in a mass patriotic health campaign that
focused on disease prevention and control shortly
after the founding of new China. According to World
Bank data, China’s per capita life expectancy
increased to 66.86 years from 35 during 1950–1980,
and China completed the first health revolution
within 30 years (1). At the Alma-Ata conference in
1978, the World Health Organization recommended
the Chinese health development pattern to the world
as a model of primary health care.
However, China still faces various challenges
brought by industrialization, urbanization, an aging
population, the environment, and changes in
lifestyles in spite of its booming economy and an
improvement in its people’s well-being. This is a
critical period in China’s reform of its health system
since the end of the last century. In light of the
difficult and/or high cost to access medical services,
as well as an increase in the prevalence of chronic
disease, there are many health-related issues waiting
to be resolved. It is urgent to take effective measures
to deal with these changes. In the meantime, other
countries, such as the United States, Japan, and
Canada have provided successful experiences in
formulating and implementing long-term health
strategies based on national health system research
(2–6). Thus, China has embarked on a long-term
health strategy of its own – Healthy China 2030.
What is Healthy China 2030?
Healthy China 2030, released by the Communist
Party of China Central Committee and the State
Council on 25 October 2016, aims to enhance its
people’s health through promoting healthy lifestyles,
optimizing health services, improving health security,
building a healthy environment, and developing
health industries. The plan covers areas such as
public health services, environment management, the

1. School of Public Health, Wuhan University, People’s Republic of China.

Correspondence to: Xiaodong Tan, School of Public Health, Wuhan University, No. 115, Donghu Road, Wuchang
District, Wuhan, 430072, People’s Republic of China. Email: 00300469@whu.edu.cn
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 X. Tan et al.
medical industry, and food and drug safety based on
the country’s new development concepts: innovation;
environmental concern; coordination; and open and
shared growth. To be specific, there are four core
principles in the plan. The first puts health as a
priority. The concept of health has the priority in
social development under certain circumstances.
Secondly, there is a focus on innovation. Reform in
key areas could be accelerated on the condition of
market regulation combined with government
leadership. The third principle is to foster scientific
development in disease prevention, control and
treatment, as well as development of traditional
Chinese medicine and Western medicine. In addition,
the service mode needs to change to reduce gaps in
people’s basic health services. Lastly, fairness and
justice require a focus on rural areas, promoting an
equal share of the basic medical and health services
in all populations.
There are 12 major indices for health in the plan:
five health level indices; one healthy life index; three
health service and health security indices; two
healthy environment indices; and one health
industry index (7).
Healthy China 2030 stipulates a number of
specific goals to be reached by 2030, such as:
increasing Chinese citizens’ life expectancy to 79
years; reducing the infant mortality rate from the
current 8.1 per 1,000 to 5 per 1,000 and the mortality
rate of children below five years old from 10.7 per
1,000 to 6 per 1,000; and reducing the mortality rate
of pregnant and postpartum women from 20.1 out
of 100,000 at present to 12 out of 100,000 by 2030.
In addition, there should be three registered doctors
and 4.7 registered nurses for every 1,000 permanent
residents, according to the outline. Tobacco control
is also a main goal. According to the outline, the
smoking rate of Chinese citizens above 15 years old
should be reduced to 20% by 2030.
The plan also aims to further ease people’s
financial burden when paying for health and medical
treatment. Currently 29.3% of the citizens’ overall
health expenditure is paid by individuals – the plan
intends to reduce the percentage to 25% by 2030.
Why is Healthy China 2030 of great
significance?
Healthy China 2030 is the first medium–long
term strategic planning in health at the national
97
level since the founding of new China. Compared
with the other documents released before, it has the
following significance:
Firstly, it represents an ideological change of
government from focusing mostly on economic
development to a health-centered coordinated
development of economy and ecology. People’s health
level is an important symbol of a country because
health is crucial to social wealth. China has always
paid attention to the people’s health, and now gives
full consideration to the whole lifecycle based on the
National Primary Public Health Service Equalization
Project. Health in all policies (HiAP) in China aims to
establish a comprehensive health impact assessment
evaluation system for systematically assessing the
economic and social development planning and
policies, and the impact of certain projects on health,
in order to appeal to all sectors to make decisions
based on the awareness of the universality and
complexity of social determinants of health. HiAP
will help China to develop its economy scientifically
and in an environmentally friendly way, which is the
key for China’s construction of a well-off society.
Secondly, it transforms the health services pattern
from disease treatment to health promotion and
health management. The plan added that future
efforts should focus on promoting healthy lifestyles,
optimizing health services, improving health
security, building a healthy environment and
developing health industries from the view of basic
determinants of health. In order to promote and
popularize healthy lifestyles, health education will
be strengthened and physical exercise will be widely
advocated among all citizens who will enjoy various
exercise services such as walking trails, exercise
centers, and stadiums that hold about 2.3 square
sports ground area per capita by 2030. Additionally,
the implementation of equalization of basic public
health services provides urban and rural residents
with guaranteed access to the most effective basic
health services. The public health service system will
be adjusted and improved, so that ordinary residents
will have their health problems diagnosed earlier
and so get earlier treatment. The plan also aims to
further ease people’s financial burden when paying
for health and medical treatment by reducing the
percentage of overall health expenditure paid by
individuals. Moreover, major policies to fight
environmental pollution and make environments
healthy, are crucial to disease prevention and health.
IUHPE – Global Health Promotion Vol. 26, No. 4 2019
98 Commentary
Thirdly, the government will play a leading role
and the whole public will be mobilized to participate.
The health of the whole society cannot leave out the
efforts of everyone, despite leadership coming from
the administrative department of health. ‘To construct
jointly and to enjoy together’ is the basic route of
Healthy China 2030. Every sector, including health-
relevant departments and social organizations, will
be united in the construction under the economic
and social development plans and some of the
leading policies or measures. As for individuals,
improving health literacy and leading healthy
lifestyles to prevent disease will benefit the whole
society. Lastly, a new health industry will be
encouraged. Multiple sources of information will
open a bigger market for the fitness and leisure
industry, rehabilitation and assistive products
industry, and other health-related industries. The
State Council has issued a plan to develop the fitness
and leisure industry, including daily fitness activities,
outdoor sports, sports tourism, and Internet Plus,
setting up a goal to increase the output of the sector
to more than three trillion yuan ($442.5 billion) by
2025 (8). Additionally, by 2030, 16 trillion yuan will
be allocated to expand and construct the health
promotion industry, for example, by developing
cultural industries like the press and publishing,
radio and television, digital animation, as well as
specializing in sports fitness, keeping traditional
Chinese medicine in counseling, rehabilitation and
nursing services, providing people with a variety of
higher quality health services to meet an increasing
variety of health requirements (7).
Where could Healthy China 2030
improve from a health promotion
perspective?
Healthy China 2030 is not only an important
effort to improve people’s health, but also plays a
role in China’s engagement in global health
governance and implementation of the country’s
commitment to the United Nations 2030 Agenda for
Sustainable Development. Beyond these, there are
some points that need to be further discussed from
a health promotion perspective.
One of the key aspects of health promotion
embodied in the Ottawa Charter 1986 definition is
that it is a ‘process of enabling people to gain control
over their health’. This implies participation in
IUHPE – Global Health Promotion Vol. 26, No. 4 2019
decisions that affect their health. Leading a healthy
lifestyle needs to be facilitated by improved housing,
food and water, air quality, transportation, and
other social and environmental factors (9).
Additionally, other studies have shown that
developing personal skills (including the actions of
health education, health communications, and
training and skills development) is an ineffective
strategy if implemented in isolation from other
strategies. Personal skills development must be
combined with other strategies for effectiveness
(10). In the United States, a broad-based, public
engagement initiative, with thousands of citizens
helping to shape every step has always been the
principle of Healthy People 2020 (11). However, in
the Chinese context, it is very challenging to achieve
because of a host of factors. Although the language
of citizen participation is used, citizens can merely
get involved through developing their personal
health skills, doing physical activities and keeping a
heathy behavior in a certain range. For example,
fossil fuels are still the choice of many factories and
the vast Chinese rural areas, even though the
combustion of these fossil fuels can produce sulfur
dioxide and nitrogen dioxide pollution of the
environment. Chinese citizens protect themselves
from severe air pollution mostly by wearing masks
and staying inside, which are palliative strategies.
There have been other dilemmas associated with
economic development that affect quality of life.
There are many kinds of entertainment and
recreation for city dwellers nowadays, but in some
rural areas, especially northwestern China, the basic
survival problem is still not resolved, not to mention
leading a healthy life. From a health promotion
perspective, creating structural-level conditions to
support health and increasing access to goods,
products and services are needed to ensure the
effectiveness of personal skills, especially in rural
areas (10).
There are also contradictions set up by focusing
on healthy lifestyles – for example, many food,
tobacco, and alcohol industries will lose money
when people reduce consumption of these products.
China signed the Framework Convention on
Tobacco Control at the 56th World Health
Organization Assembly in 2003. The effects of
tobacco control actions are not admirable after
years of struggling. One of the professors from the
China University of Political Science and Law
 X. Tan et al.
believed that the biggest obstacles to tobacco control
stem mainly from tobacco companies and other
interest groups, which used the revenue generated
from taxation of tobacco products as an excuse to
continue pursuing profit and putting the tobacco
control work into an obscure position (12).
Therefore, having the focus restricted to healthy
lifestyles is an ineffective strategy to maintain health.
There are challenges of putting so much weight on
individual lifestyle change in Healthy China 2030.
Policies to restrict the sale of tobacco, alcohol, and
salty and highly sugared products would go further
to reduce related diseases than expecting individuals
to combat temptation on a daily basis. However,
Healthy China 2030 lacks clear policies or rules for
consumption of these products or restrictions on
these industries (7).
As for policies, the plan set plenty of goals or
actions from a medical view, including the medical
care system, technology, quality and level of medical
practice, food and medicine, medically-related
fitness, and so on. Improvements to the environment
are mainly focused on public safety, pollution from
air, water and soil, but in a guiding way. Although
HiAP is advocated in China, attention is rarely paid
to other social sectors except health sectors. Solid
policies and relevant laws concerning healthy food,
and reducing tobacco consumption, air pollution,
soil and water pollution are still waiting to be
carried out. What we have are regulations which are
weak in the current social context.
Other challenges still remain, for some of the
indicators lack accurate calculation. For example, a
life expectancy of 79 nationally is the goal by 2030,
but specialized guidance is missing for large and
medium-sized cities whose life expectancy is close to
or has already reached 80. Premature death caused
by major noncommunicable diseases is not
considered as an indicator for disease surveillance in
China, which is important for the evaluation of the
burden of noncommunicable diseases.
Therefore, to improve public health in the
construction of Healthy China 2030, integrated
health promotion strategies need to focus on the
following rules: 1) participation and engagement of
all people in decisions that affect their lives; 2)
political commitment, funding and infrastructure for
a broad range of social policy and health promotion
actions; and 3) all strategies require attention to the
socio-environmental context (10).
99
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
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