Progress and challenges in NCD prevention and control in China

Non-communicable diseases (NCDs), such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, account for 91% of all deaths in China.1 China accounted for 17.9% of the world population in 2021, but 25.9% of global deaths from NCDs.12 The burden of most NCDs has continued to rise over the past two decades,345 driven mainly by population ageing6 and a failure to fully and effectively tackle major risk factors for NCDs, including use of tobacco and alcohol, physical inactivity, unhealthy diets, and air pollution. A new collection of articles in The BMJ (www.bmj.com/collections/chronic-diseases-in-china) attempts to shed light on the current state and challenges of NCD prevention and control in the context of China’s population ageing, as well as to discuss strategies and approaches to deal with these issues.

Over the past two decades, China has implemented several NCD prevention and control programmes, such as morbidity and mortality surveillance, public health intervention programmes,7 and screening for major chronic diseases, primarily through the national basic and major public health service programmes. Among several national health policies, laws, and regulations introduced to improve public health is the prominent Healthy China 2030 Outline, which introduced more proactive approaches to NCD prevention and control that align with the World Health Organization’s (WHO) global strategy. The global strategy explicitly acknowledges the primary role and responsibility of governments in responding to NCD challenges and the need for multisectoral engagement, emphasising health in all policies, addressing modifiable risk factors by creating health promoting environments, taking a life course approach to health, and making efforts to improve health equity.

Although China has made considerable progress in its national strategy for NCD prevention and control, challenges remain, as the collection lays out. First, there is insufficient emphasis on evidence in making policies, strategies, and practices for NCD prevention, diagnosis, treatment, and management. For example, because of insufficient studies and effectiveness trials in Chinese populations, good evidence for determining optimal thresholds for the diagnosis and treatment of hypertension, diabetes, and even cancer for the Chinese population is largely lacking.8 As a result, Chinese NCD policies often follow those of western countries, even though the cost effectiveness of interventions, available resources, and values of people differ hugely in China. This has resulted in poor compliance with NCD policies.8

Another challenge pertains to healthcare access and health equity. The implementation of national policies and programmes varies greatly by region, reflecting differences in the local economic development level, culture, healthcare system capacity, and priorities of local governments, including health and non-health sectors. As part of the collection, Lu and colleagues discuss how individual variations in socioeconomic position also result in inequalities in lifestyle factors, exposure to air pollutants, other disease risk factors, and the effectiveness of interventions on risk factor control and disease outcomes.9 Other articles argue that without a strong effort to address the social determinants of health, even effective policies and programmes, such as digital health solutions to disease prevention and management,1011 may exacerbate health inequities.