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Improving the World’s Largest Health System—Scholars Convene at YSPH to Plan for Future

May 16, 2018

Some 200 researchers and health leaders gathered at Yale University for the second biennial conference of the China Health Policy and Management Society (CHPAMS), focusing on the Healthy China 2030 national blueprint for the health of the 1.3 billion Chinese.

The three-day conference (May 11-13) drew public health professionals from throughout China and the United States and featured 140 talks by leading health care experts. The event was co-sponsored by the Yale School of Public Health.

China will soon be the largest economy in the world and in the aftermath of its one-child policy, it has a growing population of both elderly and the young. That dependency ratio adds complexity to the health environment, Dean Sten Vermund of the Yale School of Public Health said in his opening remarks. Vermund first travelled to China in the early 1980s and was impressed by the Barefoot Doctors Program—community health workers who increased Chinese life expectancy from age 40 to 60 years by focusing on primary care and disease prevention

Today, China’s life expectancy matches that of the United States, but with high rates of smoking, pollution, a trend toward western diets and a shift from bicycles to automobiles, the country faces rising rates of cancer, obesity and diabetes.

“The United States-China relationship is the most important in the world,” Vermund told the large gathering. “It is inspiring to see you tackling these issues. Helping China achieve good health care is immensely important.”

Harlan Krumholz, the Harold H. Hines, Jr. Professor of Medicine at the Yale School of Medicine, who also has a long history of collaboration with researchers in China, said that the two countries are more strongly aligned in health than in many other spheres and demonstrated the power of collaboration. “The miracle of China is a breathtaking thing to witness in person,” he said. With more than a billion people, it is the ideal place for clinical trial research. “The country should not be an importer of medical knowledge; it should be an exporter.”

Lincoln Chen, president of the China Medical Board, founded by the Rockefeller Foundation, said that China is emerging as a force in global health as a way to support its economic globalization and international health security. In particular, China is becoming more involved in Africa, where it recently deployed 1,200 health workers and treatment units to fight the Ebola outbreak.

T. Paul Schultz, the Malcolm K. Brachman Professor Emeritus in Economics at Yale University, spoke on the challenges both high- and low-income countries face in achieving health equity, even with national health systems in place.

Paul Cleary, the Anna M.R. Lauder Professor of Public Health and former dean of the Yale School of Public Health, addressed the role of patients’ voices in providing quality health care. China has the highest rates of violence between patients and physicians. Lack of trust in health care providers leads many patients to skip their medications or to not follow up with their appointments and treatment, contributing to poorer health outcomes. Cleary, who has led the development of the Consumer Assessment of Healthcare Providers and Systems since the mid 1990s, said that the public domain surveys are continually updated and refined. They are available in many languages and provide an important tool in developing patient-centered care.

Jody Sindelar, a professor of health policy at the Yale School of Public Health, said that behavior is a bigger issue in health now than contagion. The most worrisome health behavior in China is smoking, and the number of deaths caused by smoking is expected to triple by 2050. While the first step in addressing the issue is prevention, there is also a need to develop and test interventions. Sindelar is proposing an intervention that encourages men to stop smoking while their wives are pregnant by enrolling couples in smoking cessation programs tied to prenatal care. Pregnancy is a window of opportunity, and younger men are more willing to change, said Sindelar. “With only one child, there is heightened concern for the health of that child.”

Michael Grossman, founder of health economics and Director of Health Economics Program at the U.S. National Bureau of Economic Research (NBER) summarized health economics research at the Bureau and its implications for China. Based on studies in the U.S., Grossman advised Chinese policymakers that policies to regulate e-cigs and reduce use may increase smoking and increase weight gain by successful quitters and that crackdowns on use of marijuana may exacerbate the opioid epidemic.

Gonghuan Yang, former vice director of the China CDC discussed challenges of population health measurement and assessment in China. “Over 100 countries do not have systems for civil registration and vital statistics. Without these data, these countries and areas are still working in the dark,” Yang called for strategies to improve the quantity and quality of bottom-up data and to ensure the robustness and transparency of estimates.

Three special panels were also the highlights of the conference. A lunch panel celebrated a century of modern western medical education in China pioneered by China Medical Board and Yale-China Association. The two organizations focussed on learning from history while China is moves forward with health care quality and innovations.

In a roundtable “Mining Gold” from Big Data in Healthcare,” Shuangge Steven Ma, a professor of biostatistics at the Yale School of Public Health, and Hongyu Zhao, department chair and Ira V. Hiscock Professor of Biostatistics at the Yale School of Public Health, were joined by Gongwei Zhou, vice director of the National Center for Statistics and Information at China National Health Commission, and Dr. Guangjun Yu, director of Shanghai Renmin Hospital, to discuss the opportunities and challenges presented by the big data collected by hospitals, pharmaceutical and insurance companies, universities and government agencies.

Yawei Zhang, an associate professor at Yale School of Public Health, was joined by Michelle Bell, Mary E. Pinchot Professor of Forestry and Environmental Studies at Yale, to lead a roundtable discussion on Environment, Climate Change and Health in China, a session co-organized by YSPH’s Climate Change and Health Initiative.

Formed by a group of Chinese scholars in schools of public health in the United States in 2008, CHPAMS is committed to promoting knowledge transfer across systems, leveraging talent and promoting health and health equity in China.

The conference was also sponsored by the China Medical Board, the Yale Macmillan Center, the Yale-China Association, The Chinese Economists Society and the Global Labor Organization.

Xi Chen, assistant professor of health policy at the Yale School of Public Health, hosted the conference and is president-elect of CHPAMS. “Pressing public health issues in China and the U.S. were grouped together in all events to facilitate in-depth discussions in comparative perspectives. The discussions revolved around three major transitions vital to Healthy China 2030, including targeting health service provision from patients to healthy citizens, managing population health from “cradle to grave,” and stressing roles of all related sectors. The meetings highlighted Yale’s century long engagement in China’s public health advances and the path forward,” Chen said of the conference.

Submitted by Denise Meyer on May 16, 2018