First-ever comprehensive studies of child mortality, life expectancy, and causes of death at the subnational level in China suggest that localized health policies will be crucial to further improve population health and lower inequality

SEATTLE – China has made enormous strides in health over the course of the past three decades, including a significant drop in child mortality, a leap in life expectancy, and a sizeable shift in the pattern of causes of death. But these gains are not shared equally among China’s provinces, some of which have health records similar to many developing countries, while others resemble the United States or Western Europe.

The studies, published in The Lancet today, were conducted by researchers in China and the U.S. and led by the Chinese Center for Disease Control and Prevention, China’s National Office for Maternal and Child Health Surveillance, and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The study, “Under-5 mortality in 2851 Chinese counties, 1996-2012: a subnational assessment of achieving MDG 4 goals in China is the first-ever analysis of the mortality rate in children under 5 in China at the county level. The study reveals that declines in the child mortality rate have been much faster than expected, even after gains in GDP and improvements in education are taken into account. Between 1996 and 2013, the mortality rate for Chinese children under 5 decreased by 70%, easily outpacing the Millennium Development Goal target of reducing child mortality by two-thirds between 1990 and 2015.

Child mortality has fallen dramatically even among China’s minority groups, despite the fact that these groups are usually the hardest to reach. In Huangpu District in Shanghai, which had the lowest child mortality rate in 2012, there were only 3.3 deaths per 1,000 livebirths. This is similar to rates in Australia or Germany. In all, 2,506 Chinese counties are on track to achieve the Millennium Development Goal target by 2015. However, progress is remarkably different across China’s 2,851 counties.

The study also shows that not all of this progress is due to economic growth and increases in income and women’s education. In fact, 83% of China’s counties achieved lower child mortality than expected based on income per person and maternal education. This highlights the importance of policies that accelerate access to life-saving interventions such as vaccinations, breastfeeding, and antibiotics for pneumonia.

According to Professor Jun Zhu from the National Office for Maternal and Child Health Surveillance of China, one of the study’s lead authors, “China has made remarkable progress in driving down the rates of mortality in children under 5 over the past three decades, but further improvements can be made. We need to focus efforts on those areas where mortality rates for children under 5 remain unacceptably high, redoubling efforts and applying the lessons of the most successful regions.”   

Another study published at the same time, “Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013,” is the first attempt to analyze life expectancy and causes of death on the province level in China.

According to the study, Shanghai had the highest life expectancy in China in 2013, at 80.2 years for men and 85.2 years for women. These figures are comparable to countries such as Japan or France, which have the highest life expectancies in the world, and represent a gain of around six years on the highest life expectancies seen in China in 1990. However, large inequalities between provinces remain.  

Moreover, the study reveals striking differences in the leading causes of death in different provinces. On a national level, China witnessed a marked shift in causes of death away from infectious diseases to non-communicable diseases between 1990 and 2013, with the noteworthy exception of HIV. Cerebrovascular disease (the main cause of stroke) is China’s leading cause of death for both men and women, with ischemic heart disease and chronic obstructive pulmonary disease (COPD) as the number two and three causes.   

The province-level picture of Chinese health is much more complex. Instead of one national pattern, the study illuminated five distinct, geographically defined patterns. Wealthy provinces such as Shanghai and Beijing have low mortality rates on par with the United States or South Korea. Poor, rural provinces are still battling infectious diseases, and have high rates of cerebrovascular diseases and other ailments. The three remaining patterns can be differentiated on the basis of mortality levels for four major cancers (lung, liver, stomach, and esophageal), COPD, and the ratio of cerebrovascular disease to ischemic heart diseases.

According to one of the study’s lead authors, Professor Maigeng Zhou, from the Chinese Center for Disease Control and Prevention’s National Center for Chronic and Noncommunicable Disease Control and Prevention, “Despite great progress, China still faces significant health challenges. As our Government works to reform the healthcare system, we need to closely examine regional trends and tackle the most prevalent and life-threatening diseases, injuries, and risk factors in specific areas. Localized health policies – informed by comprehensive, up-to-data data – will be the key to China’s continued health success.”

Professor Christopher Murray, Director of IHME and a co-author of both studies, says “China is a remarkable example of how targeted health policies and promotion of life-saving interventions can improve health. But against the backdrop of these achievements, regional differences are significant.  These studies have shown a bright light on China’s health transition and the important work that remains to be done.”

Download the studies at:

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.

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