Meeting the Challenge of Diabetes in China

Document Type : Editorial

Authors

1 Robert F. Wagner School of Public Service, New York University (NYU), New York City, NY, USA

2 IRIEC EA 740, Université Paul Valéry, Montpellier3, Montpellier, France

3 World Cities Project, Wagner School of Public Service, New York University (NYU), New York City, NY, USA

Abstract

China’s estimated 114 million people with diabetes pose a massive challenge for China’s health policy-makers who have significantly extended health insurance coverage over the past decade. What China is doing now, what it has achieved, and what remains to be done should be of interest to health policy-makers, worldwide. We identify the challenges posed by China’s two principal strategies to tackle diabetes: (1) A short-term pilot strategy of health promotion, detection and control of chronic diseases in 265 national demonstration areas (NDAs); and (2) A long-term strategy to extend health promotion and strengthen primary care capacity and health system integration throughout China. Finally, we consider how Chinese innovations in artificial intelligence (AI) and Big Data may contribute to improving diagnosis, controlling complications and increasing access to care. Health system integration in China will require overcoming the fragmentation of a system that still places excessive reliance on local government financing. Moreover, what remains to be done resembles deeper challenges faced by healthcare systems worldwide: the need to upgrade primary care and reduce inequalities in access to health services.

Keywords

Main Subjects


  1. International Diabetes Federation. IDF Diabetes Atlas. 8th ed. https://diabetesatlas.org/resources/2017-atlas.html.  Published 2017.
  2. National Commission of Health. Chinese National Statistical Yearbook of Health. China, Beijing: Peking Union Medical College Press; 2018.
  3. National Commission of Health and Family Planning. Chinese National Statistical Yearbook of Health and Family Planning. China, Beijing: Peking Union Medical College Press; 2017.
  4. Holmes D. Linong Ji: Fighting to turn the tide against diabetes in China. Lancet. 2014;383(9933):1961. doi:10.1016/S0140-6736(14)60942-9
  5. Pan X-R, Yang W-Y, Li G-W, Liu J. Prevalence of diabetes and its risk factors in China, 1994. Diabetes Care. 1997;20(11):1664-1669. doi:10.2337/diacare.20.11.1664
  6. Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948-959. doi:10.1001/jama.2013.168118
  7. Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA. 2017;317(24):2515-2523. doi:10.1001/jama.2017.7596
  8. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362(12):1090-1101. doi:10.1056/NEJMoa0908292
  9. Hu D, Sun L, Fu P, et al. Prevalence and risk factors for type 2 diabetes mellitus in the Chinese adult population: the InterASIA Study. Diabetes Res Clin :Pract. 2009;84(3):288-295. doi:10.1016/j.diabres.2009.02.021
  10. Popkin BM. Will China’s nutrition transition overwhelm its health care system and slow economic growth? Health Aff (Millwood). 2008;27(4):1064-1076. doi:10.1377/hlthaff.27.4.1064
  11. Hu C, Jia W. Diabetes in China: epidemiology and genetic risk factors and their clinical utility in personalized medication. Diabetes. 2018;67(1):3-11. doi:10.2337/dbi17-0013
  12. Li Y, He Y, Qi L, et al. Exposure to the Chinese famine in early life and the risk of hyperglycemia and type 2 diabetes in adulthood. Diabetes. 2010;59(10):2400-2406. doi:10.2337/db10-0385
  13. van Abeelen AF, Elias SG, Bossuyt PM, et al. Famine exposure in the young and the risk of type 2 diabetes in adulthood. Diabetes. 2012;61(9):2255-2260. doi:10.2337/db11-1559
  14. Fuentes S, Fosse-Edorh S, Regnault N, Goldberg M, Cosson E. Prevalence of Prediabetes and Undiagnosed Diabetes among Adults Aged 18 to 70 Years in France—The CONSTANCES Cohort. Diabetes 2018; 67(suppl 1). doi:10.2337/db18-1657-P
  15. National Center for Chronic Disease Prevention and Health Promotion. National Diabetes Statistics Report, 2017. Estimates of Diabetes and Its Burden in the United States. https://www.cdc.gov/diabetes/data/statistics/statistics-report.html.  Published 2017.
  16. Diabetes UK. Facts and Statistics. https://diabetes-resources-production.s3-eu-west-1.amazonaws.com/diabetes-storage/migration/pdf/Diabetes-key-stats-guidelines-April2014.pdf.  Published 2014.
  17. Sainsbury E, Shi Y, Falck J, Colagiuri S. Burden of Diabetes in Australia: Its Time for More Action Report. http://bit.do/faM3Q.  Published 2018.
  18. World Health Organization. World Health Day 2016: Diabetes. http://www.searo.who.int/india/mediacentre/events/2016/en/.   Published 2016.
  19. National Bureau of Statistics. The growth of per capita income and consumption in 2016. http://www.stats.gov.cn/tjsj/sjjd/201701/t20170120_1456174.html.  Published 2017.
  20. Zhou M, Astell-Burt T, Bi Y, et al. Geographical variation in diabetes prevalence and detection in China: multilevel spatial analysis of 98,058 adults. Diabetes Care. 2015;38(1):72-81. doi:10.2337/dc14-1100
  21. People’s Daily. The number of migrant workers is declining. http://society.people.com.cn/n1/2017/1115/c1008-29646364.html.  Published 2017.
  22. Bi Y, Wang L, Xu Y, et al. Diabetes-related metabolic risk factors in internal migrant workers in China: a national surveillance study. Lancet Diabetes Endocrinol. 2016;4(2):125-135. doi:10.1016/S2213-8587(15)00366-6
  23. Su X. Migrant workers’ utilization of health services: Shanghai as an example. School of Social Development and Public Policy, Fudan University; 2012.
  24. Bragg F, Holmes MV, Iona A, et al. Association between diabetes and cause-specific mortality in rural and urban areas of China. JAMA. 2017;317(3):280-289.
  25. Chan M. China’s burgeoning epidemic of diabetes-associated mortality. JAMA. 2017;317(3):264-266.
  26. CCP Central Committee and State Council. Healthy China 2030 Plan. http://www.gov.cn/zhengce/2016-10/25/content_5124174.htm.  Published 2016.
  27. State Council. The National Long-term Plan to Control and Prevent Chronic Diseases, 2017-2025. http://www.gov.cn/zhengce/content/2017-02/14/content_5167886.htm.  Published 2017.
  28. National Commission of Health and Family Planning. Achievements of National Demonstration Areas. http://www.gov.cn/xinwen/2016-11/20/content_5135074.htm.  Published 2016.
  29. Li J, Li J, Zhang J, et al. Study on the overall implementation status of the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Zhonghua Liu Xing Bing Xue Za Zhi. 2018;39 (4):417-421. doi:10.3760/cma.j.issn.0254-6450.2018.04.006
  30. Jin R, Li J, Zhang J, et al. Management programs on diabetes among Chinese adults in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Zhonghua Liu Xing Bing Xue Za Zhi. 2018;39(4):407-411. doi:10.3760/cma.j.issn.0254-6450.2018.04.004
  31. State Council. Health expenditure responsbilities of central and provincial governments. http://www.gov.cn/zhengce/content/2018-08/13/content_5313489.htm.  Published 2018.
  32. State Council. Promoting hierarchical medical system. http://www.gov.cn/zhengce/content/2015-09/11/content_10158.htm.   Published 2015.
  33. Li B. Director of National Committee of Health and Family Planning, Li Bin: Four Models of Medical Partnerships. http://www.sohu.com/a/128570598_452205.  Published 2017.
  34. Li X, Lu J, Hu S, et al. The primary health-care system in China. Lancet. 2017;390(10112):2584-2594.  doi:10.1016/S0140-6736(17)33109-4
  35. OECD. Health care resources, OECD Health Statistics (database). Primary care and nurse workforce. doi:10.1787/data-00541-en. Published 2016.
  36. Zhu J, Li W, Chen L. Doctors in China: improving quality through modernisation of residency education. Lancet. 2016;388(10054):1922-1929. doi:10.1016/S0140-6736(16)00582-1
  37. People’s Daily. Further reform is required to make reimbursement more convenient for migrant workers. http://opinion.people.com.cn/n1/2018/0302/c1003-29842690.htm.  Published 2017.
  38. Beijing Municipal Government. Beijing Statistical Yearbook 2018. http://tjj.beijing.gov.cn/nj/main/2018-tjnj/zk/indexch.htm.  Published 2018.
  39. Shanghai Municipal Government. Shanghai Statistical Yearbook 2018. http://www.stats-sh.gov.cn/tjnj/nj18.htm?d1=2018tjnj/C0201.htm.  Published 2018.
  40. Beijing CCP Committee and Municipal Government. Healthy Beijing 2030. http://www.beijing.gov.cn/zfxxgk/110088/zzqgh33/2017-09/14/content_5a0a51794dc347028b7069657d407c7c.shtml.  Published 2007.
  41. Shanghai CCP Committee Municipal Government. Healthy Shanghai 2030. http://wap.sh.gov.cn/nw2/nw2314/nw2319/nw12344/u26aw55477.html.  Published 2018.
  42. Dankwa-Mullan I, Rivo M, Sepulveda M, Park Y, Snowdon J, Rhee K. Transforming diabetes care through artificial intelligence: the future is here. Popul Health Manag. 2019;22(3):229-242. doi:10.1089/pop.2018.0129
  43. Wee S-L, Mozur P. Amazon wants to disrupt health care in America. In China, tech giants already have. New York Times 31 January, 2018. https://www.nytimes.com/2018/01/31/technology/amazon-china-health-care-ai.html.  
  44. This how artificial intelligence is transforming diabetes care management. CB Insight. October 3, 2018. https://www.cbinsights.com/research/artificial-intelligence-diabetes-diagnosis-treatment/.   
  45. Fagherazzi G, Ravaud P. Digital diabetes: Perspectives for diabetes prevention, management and research. Diabetes Metab. 2019;45(4):322-329. doi:10.1016/j.diabet.2018.08.012
  46. Ni D. Ali Health developed the first diabetes AI physician. 2018; http://company.cnstock.com/company/scp_gsxw/201805/4220563.htm.  
  47. Fabre G. China’s digital transformation. Why is artificial intelligence a priority for chinese R&D? https://halshs.archives-ouvertes.fr/halshs-01818508v2/document.  Published 2018.
  48. Xinhua News. Ali wholly-owned acquired E’leme with 9.5 billion US dollars. http://www.xinhuanet.com/tech/2018-04/03/c_1122629159.htm.  Published 2018.
  49. Tencent. WeChat Data Report, 2018. https://support.weixin.qq.com/cgi-bin/mmsupport-bin/getopendays.  Published 2018.
  50. China Daily. QQ Big Data: How many steps an average Chinese walks per day? http://tech.chinadaily.com.cn/a/201901/08/WS5c3409caa3100a343d6f28d0.html.  Published 2019.
  51. State Council. China’s plan to promote the development of Big Data. http://www.gov.cn/zhengce/content/2015-09/05/content_10137.htm.  Published 2015.
  52. State Council. Li Keqiang: Health Big Data should focus on urgent demands of the people. http://www.gov.cn/guowuyuan/2016-06/08/content_5080599.htm.  Published 2016.
Volume 9, Issue 2
February 2020
Pages 47-52
  • Receive Date: 30 June 2019
  • Revise Date: 18 September 2019
  • Accept Date: 18 September 2019
  • First Publish Date: 01 February 2020