Enhancing global health engagement in 21st century China

Since the opening up and reforms that began 40 years ago, China’s economy and society have developed rapidly. It is estimated that between 1978 and 2017, China’s Gross Domestic Product (GDP) increased on an average of 9.5% annually, and per-capita GDP growth was about 22.8-fold.1 During the same period, more than 700 million Chinese people were lifted out of poverty.2 Consequently, China has become a much healthier nation. The average life expectancy in China rose from 65.2 years in 1978 to 76 years in 2017.3 China did remarkably well in meeting the Millennium Development Goals of reducing infant mortality and improving maternal health.4 For example, under-five mortality dropped from 54·1 death per 1000 live births in 1990 to 12·5 per 1000 live births in 2015. Similarly, the maternal mortality ratio declined from 111·0 deaths per 100 000 live births to 21·8 per 100 000 live births during the same time.4 5 China has also established the most extensive universal health insurance network in the world, covering more than 95% of the population since 2011.6–8 Less than 50% of the Chinese population had any health insurance in 2005. About 97% of the rural population (approximately 45% of the Chinese population) have access to health insurance under the Rural Cooperative Medical Scheme.6 Similarly, since 2008, the vaccination rate reached more than 90% coverage rate under the National Immunization Program.9 10 As part of China’s ongoing effort for global engagement, a new China International Development Cooperation Agency (CIDCA) was launched in 201811; a platform for China to better participate in global health governance, as its status changed from being a recipient country to a donor country.11 12 In this editorial, we highlight China’s contribution to global health in the last four decades and …