UHC and SDG country profiles : China

China 1 UHC and SDG Country Profile 2018 China Ob je ct iv es Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Co un tr y s ta ti st ic s Population¹ 2016 1403.5 million GDP per capita (current US$)² 2016 8123.18 Income level² 2017 Upper middle income Income Gini coefficient³ 2013 42.1 0 (equality) – 100 (inequality) He al th sy st em Total health expenditure as % of GDP⁴ 2014 5.5% Total health expenditure per capita (current US$)⁴ 2014 419.73 General government health expenditure as % of total health expenditure⁴ 2014 55.8% Life expectancy at birth (in years)⁵ 2015 76.1 Key Messages Overall progress towards universal health coverage (UHC) • The 13th Five-Year Plan for Health Sector Development (2016–2020) and the 13th Five- Year Plan on Deepening the Medical System Reform set out China’s strategic direction and define tasks for implementation. The action plan for a Healthy China includes: disease prevention and treatment and basic public healthcare services; promote maternal and infant health; birth defect prevention and treatment; strengthening the provision of community-level medical services; impart and innovate traditional Chinese medicine; smarter healthcare; popular fitness, and food and medicine safety. • Based on 2007 survey data, 4.8% of the population incurred high out-of- pocket health payments, which suggests gaps in financial protection for health; the wealthiest quintiles are more affected by catastrophic expenditures. The majority of SDG 3 indicators are close to the target • Compared to other countries in the Region, China fared relatively well with SDG 3 indicators, particularly in reproductive, maternal, newborn and child health (RMNCH). • China has made major progress in malaria elimination, but an unfinished agenda for tuberculosis (TB) and other infectious diseases requires attention. • However, challenges remain in noncommunicable disease (NCD) prevention and control and in urban and environmental health, specifically with regard to male smoking, alcohol consumption per capita, and mortality attributed to household and ambient air pollution for which China has one of the highest rates in the Region. UHC Overall Progress UHC index6 – coverage of essential health services (SDG 3.8.1) 0–100 scale (Target: 100) 76 China 40 Region (lowest) ≥ 80 Region (highest) Financial risk protection:7 proportion of population with out-of- pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2) 4.8% China 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100% 5 tracer indicators > 80 4 tracer indicators 60–80 2 tracer indicators < 60 Reproductive, maternal, newborn and child health 2 2 0 Infectious diseases 1 1 1 Noncommunicable diseases 1 1 1 Service capacity and access 1 0 0 Note: Refer to page 2 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 11 indicators > 70% 0 indicators 40–70% 5 indicators < 40% Reproductive, maternal, newborn and child health 7 0 0 Infectious diseases 2 0 0 Noncommunicable diseases 1 0 2 Urban and environmental health 1 0 2 Health system resources and capacity 1 0 0 Note: Refer to page 3 • Compared to other countries in the Western Pacific Region, China has relatively high coverage of essential services. China2 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: What does financial protection measure? Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget. How does financial risk protection vary across population groups in China? Financial risk protection by place of residence and economic status 4.9% 4.6% 3.5% 4.4% 5.5% 5.1% 5.3% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% Rural Urban Poorest 20% (q1) Second poorest 20% (q2) Middle 20% (q3) Second richest 20% (q4) Richest 20% (q5) 2007 2007 How does China compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries AUS KHM CHN FJI JPN LAO MYS MNGPHL KOR VNM 0% 1% 2% 3% 4% 5% 6% 20 40 60 80 100 Fi na nc ia l ris k pr ot ec tio n (S D G 3 .8 .2 )* UHC index – coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household con- sumption or income, 2007. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. What tracer indicators are included in the UHC index6– coverage of essential health services? Tracer category Indicator value Indicator rescaled score, when applicable. Target: 100% Re pr od uc tiv e, m at er na l, ne w bo rn an d ch ild h ea lth 8 Family planning demand satisfied with modern methods (%), 2015 95 95 Antenatal care, 4+ visits (%), 2015 74c 74 Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015 99 99 Care-seeking behaviour for child pneumonia (%), 2015 79c 79 In fe ct io us d ise as es 9 Tuberculosis (TB) detection and treatment (%), 2015 82 82 HIV antiretroviral treatment (%), 2015 41c 41 Access to improved sanitation (%), 2015 75c 75 No nc om m un ica bl e di se as es 10 Prevalence of non-raised blood pressure (%), 2015 81 62 Mean fasting plasma glucose (mmol/L), 2008 5.5 82 Tobacco non-use (%), 2015 75 49 Se rv ice ca pa cit y a nd ac ce ss 11 Hospital beds per 10 000 population, 2012 42.0 Reference point: 18a Health worker density (per 10 000 population), 2011–2014 17.2b Reference point: 10.5a International Health Regulations compliance (%), 2015 99 99 a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 1.5 physicians per 1000 pop (2011); 1.7 psychiatrists per 100 000 pop (2014); 21.6 surgeons per 100 000 pop (2012) c No estimate; regional or imputed value used as placeholder Quadrant Interpretation North-west Limited coverage of essential health services, and relatively high risk of financial hardship South-west Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services North-east Relatively high coverage of essential health services, and relatively high risk of financial hardship South-east Relatively high coverage of essential health services, and relatively low risk of financial hardship > 80% Average of 27 Western Pacific Region countries 60–80% Average of 27 Western Pacific Region countries < 60% Average of 27 Western Pacific Region countries Reproductive, maternal, newborn and child health 86 Infectious diseases 63 Noncommunicable diseases 63 Service capacity and access 100 China 3 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, China has a value of 96%, meaning it has performed at 96% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% Proximity from the target 40–70% Proximity from the target < 40% Proximity from the target How far is China from the SDG targets? SDG Indicator value Indicator rescaled score to 0–100% Target: 100% Reproductive, maternal, newborn and child health Maternal mortality ratio (per 100 000 live births)¹² 2015 3.1.1 27.0 100%d Proportion of births attended by skilled health personnel (%)¹³ 2014 3.1.2 100.0% 100%e Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 9.9 100%d Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 5.1 100%d Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 99.0% 98%e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 3.7.1 Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2011 3.7.2 6.2 96%e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016 3.b.1 99.0% 97%e Infectious diseases New HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷ 3.3.1 TB incidence (per 100 000 population)¹⁴ 2016 3.3.2 64.0 90%e Malaria incidence (per 1000 population at risk)¹⁴ 2015 3.3.3 0.0 100%e Noncommunicable diseases Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015 3.4.1 18.1% Regional Average: 17.1 Suicide mortality rate (per 100 000 population)¹⁴ 2015 3.4.2 10 Regional Average: 10.8 Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016 3.5.2 7.8 39%e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015 3.a.1 1.8% 99%e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015 3.a.1 47.6% 35%e Urban and environmental health Road traffic mortality rate (per 100 000 population)²¹ 2013 3.6.1 18.8 Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012 3.9.1 161.1 0%e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012 3.9.2 0.4 98%e Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015 3.9.3 1.6 29%e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014 3.b.2 0.06 Skilled health professionals density (per 10 000 population)²⁵ 2011 3.c.1 31.5 Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016 3.d.1 99.0 98% e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in China being left behind?²⁶ Poorest 20% Richest 20% Diff Rural Urban Diff SDG 3.1.2 Proportion of births attended by skilled health personnel (%) 100% 100% 0% SDG 3.2.1 Under-5 mortality rate (per 1000 live births) 12 5 58% SDG 3.2.2 Neonatal mortality rate (per 1000 live births) 6 3 49% SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10–50%) Major inequalities (> 50%) Source: 2017 China Health and Family Planning Statistical Yearbook China4 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017. 2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017). 3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26 September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/). 6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report. pdf?ua=1). 7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in China was the China Household Income Project Series (CHIP), University of Michigan from 2007. 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/ monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016. 14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml). 16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/ development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/). 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main. GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/ bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017). 21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/, accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/ bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis. 24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016. 25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/ hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For China, the tool used the China Health and Family Planning Statistical Yearbook conducted in 2017. Technical notes and sources WPR/2018/DHS/004 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.