thumb|Jiuzhou Hospital in Guizhou, ChinaHealth in the People's Republic of China is a complex and multifaceted issue that encompasses a wide range of factors, including public health policy, healthcare infrastructure, environmental factors, lifestyle choices, and socioeconomic conditions.
Health care services in China are primarily provided by state-owned hospitals. Health insurance is primarily operated by local government.
The Human Rights Measurement Initiative finds that China is fulfilling 98.4% of what it should be fulfilling for the right to health based on its level of income. State-owned hospitals provide services for approximately 90% of patients in China.
In 1956, China began a public health campaign to eliminate schistosoma-carrying snails. Beginning in 1958, the "four pests" campaign sought to eliminate rats, sparrows, flies, and mosquitoes. Particular efforts were devoted in the health campaigns to improving water quality through such measures as deep-well construction and human-waste treatment. Only in the larger cities had human waste been centrally disposed of. In the countryside, where "night soil" has always been collected and applied to the fields as fertilizer, it was a major source of disease. Since the 1950s, rudimentary treatments such as storage in pits, composting, and mixture with chemicals have been implemented. As a result of preventive efforts, such epidemic diseases as cholera, bubonic plague, typhoid fever, and scarlet fever have almost been eradicated. The mass mobilization approach proved particularly successful in the fight against syphilis, which was reportedly eliminated by the 1960s. The incidence of other infectious and parasitic diseases was reduced and controlled.
Political turmoil and famine following the failure of the Great Leap Forward led to the starvation of 20 million people in China. Beginning in 1961 the recovery had more moderate policies inaugurated by President Liu Shaoqi ended starvation and improved nutrition. The coming of the Cultural Revolution weakened epidemic control, causing a rebound in epidemic diseases and malnutrition in some areas.
Before the Cultural Revolution (1966-1976), the Ministry of Health focused on the delivery of health care in urban hospitals. Mao criticized Minister of Health Qian Xinzhong for promoting this health care model, arguing that an urban hospital-focused health care model failed to treat peasants and focused on cure rather than preventative medicine. In his June 26 Directive, Mao prioritized healthcare and medicine for rural people throughout the country. As a result, clinics and hospitals sent their staff on medical tours of rural areas.
1976 - 2003
thumb|A Chinese [[barefoot doctor uses her needles to treat a production brigade worker]]
By the late 1970s, China's national health system covered almost the entire urban population and 85% of the rural population. The World Bank described this success as "an unrivaled achievement among low-income countries." In the 1980s, with the disappearance of the people's communes and the rural cooperative medical system, the barefoot doctor system lost its base and funding. The Chinese government began to push for privatization of health care and, as a result, stopped providing necessary funding. Instead, according to Blumenthal et al. (2005), individual towns were now responsible for ensuring that people were receiving adequate health care, which caused disparities between wealthier and poorer regions.
Despite the decline of the public health care system during the first decade of the reform era, Chinese health improved sharply as a result of greatly improved nutrition, especially in rural areas, and the recovery of the epidemic control system, which had been neglected during the Cultural Revolution.
2003 - present
From late 2002 to early 2003 the SARS (severe acute respiratory syndrome) outbreak began in China and spread across the world. In the early stages of disease spread, the Chinese government withheld information and may have contributed to the further spreading of the disease. In addition, China's health care system was still fairly decentralized, with a noticeable lack of oversight and little potential for rapid coordination. Despite debates surrounding the effectiveness of China's revamped health system, the COVID-19 outbreak of 2019-2020 has shown that things have changed since the SARS outbreak of 2003. Specifically, the Chinese government notified their citizens and the rest of the world of the first cases of the outbreak much sooner than SARS in 2003. While it took around four to five months for a public statement on SARS after the first case, it only took about one month for the COVID-19.. Since 1949, China had a huge improvement in population's health. There are health related parameters:
{| class="wikitable"
|-
! !! 1950 !! 1960 !! 1970 !! 1980 !! 1990 !! 2000 !! 2011
|-
| Life expectancy || 41.6 || 31.6 || 62.7 || 66.1 || 69.5 || 72.1 || 75.0
|-
| Total Fertility Rate || 5.3 || 4.3 || 5.7 || 2.3 || 2.5 || 1.5 || 1.7
|-
| Infant Mortality Rate || 195.0 || 190.0 || 79.0 || 47.2 || 42.2 || 30.2 || 12.9
|-
| Under 5 Mortality Rate/Child mortality || 317.1 || 309.0 || 111 || 61.3 || 54.0 || 36.9 || 14.9
|-
| Maternal Mortality Ratio || || || || 164.5 || 88.0 || 57.5 || 26.5
|}
- data from www.gapminder.org.
In general, all indices showed improvement except the drop around 1960 due to the failure of the Great Leap Forward, which led to the starvation of tens of millions of people. From 1950 to 2012, life expectancy nearly doubled (41.6-75.1). Total Fertility Rate changed from 5.3 to 1.7 which mainly caused by One-child policy. Infant Mortality rate and Under-5 mortality rate went down sharply. Though there is no data from 1963 to 1967, we can see the trend. The gap between IMR and U5MR became smaller and smaller, which indicates health in children has been promoted.
Maternal Mortality Ratio is not shown in the graph due to having insufficient data, but it did go down from 164.5(1980) to 26.5(2011).
As of at least 2023, China's life expectancy exceeds 78 years and is slightly higher than life expectancy in the United States.
One-child policy
thumb|A poster from 1982 showing a Chinese family with one child
Created in 1979, under Deng Xiaoping, the One-child policy incentivized families to have children later and to only have one child or risk penalization. The One-child policy was a program created by the Chinese government as a reaction to the increasing population during the 1970s, that was thought to have negatively impacted China's economic growth. Implementation of the program included rewarding families who followed the program, fining families who resisted the policy, offering birth control/ contraceptives, and in some cases forced abortions. The policy was unevenly implemented throughout China and was easier established in urban areas rather than rural, because of ideals about family size and gender preferences. Prior to the One-child policy, the Chinese government had encouraged families to have more children in order to increase the future workforce, however, this promotion made the population of China in the 1970s increase at an alarming rate. Additionally, voluntary programs, involving family planning and contraceptive use, were proposed before the One-child policy was fully enforced. With this, scholars began evaluating the effects of the one-child policy. The One-child policy was successful in halting China's increasing population and decreased both the birth rate and population, however, the harsh enforcement of the policy created long-term changes to some of China's health indicators. For instance, favoring males over female children lead to many forced abortions, infanticide and abandoned female children which led to an imbalance of men to women in China. Additionally, birth rates and rate of natural increase decreased as a result of the One-child policy. Other consequences of the One-child policy include difficulties accessing education and employment as a result of being an undocumented birth. Zhang (2017) notes that one predicted positive outcome of having less children was that families would invest more money and other resources in the children they did have, leading to a healthier and more successful population. One of the most direct consequences of the popularity of smoking in China is lung cancer, and lung cancer is the single biggest contributor to the frequency of cancer in China. As a result, although movements for tobacco smoking cessation exist and have been gaining popularity, the financial benefit of the smoking industry stands in the way of more effective cessation programming. In addition, the practice of smoking is intertwined with Chinese culture which further complicates the relationship between China and smoking. Smoking is central to socialization in many public spaces, although mainly men participate in the practice.
Betel chewing
Chewing betel nut, an addictive group 1 carcinogen, is popular in China. According to research predictions, by 2030, the number of betel nut related oral cancer cases in China will exceed 1 million. The medical burden caused by betel nut related oral cancer in China will exceed 200 billion yuan.
Sex education, contraception, and women's health
Sex education lags in China due to cultural conservatism. From ancient China to the first half of the 20th century, formal sex education was not taught. Instead, a woman's parents were mostly responsible for her sex education after she is wed. Many Chinese people feel that sex education should be limited to biological science. Combined with migration of young unmarried women to the cities, lack of knowledge of contraception has resulted in increasing numbers of abortions by young women.
The Basic Health Services Project piloted strategies to ensure equitable access to China's rural health system; health outcomes for women improved significantly, with substantial declines in maternal mortality due to increased coverage of maternal health services.
SARS
thumb|Graphic showing the number of probable cases of SARS worldwide
Although not identified until later, China's first case of a new, highly contagious disease, severe acute respiratory syndrome (SARS), occurred in Guangdong in November 2002, and within three months the Ministry of Health reported 300 SARS cases and five deaths in the province. Dr. Jiang Yanyong exposed the level of danger the SARS outbreak posed to China. By May 2003, some 8,000 cases of SARS had been reported worldwide; about 66 percent of the cases and 349 deaths occurred in China alone. By early summer 2003, the SARS epidemic had ceased. A vaccine was developed and first-round testing on human volunteers completed in 2004.
The 2002 SARS in China demonstrated at once the decline of the PRC epidemic reporting system, the deadly consequences of secrecy on health matters and, on the positive side, the ability of the Chinese central government to command a massive mobilization of resources once its attention is focused on one particular issue. Despite the suppression of news regarding the outbreak during the early stages of the epidemic, the outbreak was soon contained and cases of SARS failed to emerge. Obsessive secrecy seriously delayed the isolation of SARS by Chinese scientists. On 18 May 2004, the World Health Organization announced the PRC free of further cases of SARS.
COVID-19 pandemic
A coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, started in December 2019. It was first identified in Wuhan, the capital of Hubei, China. Its severity has surpassed of the 2003 SARS outbreak. On 30 January, the outbreak was declared to be a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). Wider concerns about consequences of the outbreak include political and economic instability. Political fallout has included the firing of several local leaders of the Chinese Communist Party for their poor response to the outbreak. Outbreak-related incidents of xenophobia and racism against people of Chinese and East Asian descent have been reported in several countries. The spread of misinformation and disinformation about the virus, primarily online, has been described as an "infodemic" by the WHO.
Hepatitis B
Work with the CDC has created goals of decelerating the spread of Hepatitis B through immunization efforts. However, Hepatitis B is still widespread in China and has been determined by Wang et al. (2019) to have "higher intermediate prevalence (5-7.99%)". In fact, no country has a higher prevalence of Hepatitis B than China and one third of the world's Hepatitis B-afflicted individuals are thought to reside in China. Hepatitis B in China was even described as an "epidemic" in Chen et al. (2018). These combine to cause a situation where many people in China do not even realize that they are infected with the disease and thus unknowingly may succumb to the disease or pass it on to others. HIV was transmitted via blood sale. Blood plasma mixture from several persons was returned so that same person could give blood up to 11 times a day. The disaster was only recognized in 2000 and found out abroad in 2001. Pensioner Gao Yaojie sold her house to deliver data leaflets of HIV to people, while officials tried to prevent her. Some local officials and politicians were involved in the blood sale. In 2003 only 2.6% of Chinese knew that a condom could protect from AIDS.
Authorities blocked protests over ineffective drug treatments, cancelled meetings on HIV groups, and detained or put under house arrest prominent activists including the 2005 Reebok Human Rights Award winner Li Dan, eighty-year-old AIDS activist Dr. Gao Yaojie, and the husband-and-wife HIV activist team of Hu Jia (activist) and Zeng Jinyan.
China, similar to other nations with migrant and socially mobile populations, has experienced increased incidences of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). By the mid-1980s, some Chinese physicians recognized HIV and AIDS as a serious health threat but considered it to be a "foreign problem". As of mid-1987 only two Chinese citizens had died from AIDS and monitoring of foreigners had begun. Following a 1987 regional World Health Organization meeting, the Chinese government announced it would join the global fight against AIDS, which would involve quarantine inspection of people entering China from abroad, medical supervision of people vulnerable to AIDS, and establishment of AIDS laboratories in coastal cities. Within China, the rapid increase in venereal disease, prostitution and drug addiction, internal migration since the 1980s and poorly supervised plasma collection practices, especially by the Henan provincial authorities, created conditions for a serious outbreak of HIV in the early 1990s.
As of 2005 about 1 million Chinese have been infected with HIV, leading to about 150,000 AIDS deaths. Projections are for about 10 million cases by 2010 if nothing is done. Effective preventive measures have become a priority at the highest levels of the government, but progress is slow. A promising pilot program exists in Gejiu partially funded by international donors.
Tuberculosis
100px|right|thumb|Scanning electron micrograph of [[Mycobacterium tuberculosis]]
Tuberculosis is a major public health problem in China, which has the world's second largest tuberculosis epidemic (after India). Progress in tuberculosis control was slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and multidrug-resistant tuberculosis was a major problem. These signs of inadequate tuberculosis control can be linked to a malfunctioning health system. Prevalent smoking aggravates its spread.
Leprosy
Leprosy, also known as Hansen's disease, was officially eliminated at the national level in China by 1982, meaning prevalence is lower than 1 in 100,000. There are 3,510 active cases today. Though leprosy has been brought under control in general, the situation in some areas is worsening, according to China's Ministry of Health.
Malaria
thumb|Population denominator for case incidence and mortality rate, and estimated malaria cases and deaths in China, 2000–2019
Plasmodium vivax malaria is the most common malaria in China, followed by P. falciparum malaria, while Plasmodium vivax malaria and Plasmodium ovale malaria are less common. P. falciparum malaria occurs mainly in the southwest and Hainan, while P. vivax malaria occurs in the northeast, north and northwest of China.
thumb|Malaria incidence in China from 1949 to 2020
Since the 1950s, Chinese health authorities have worked to detect and prevent the spread of malaria by providing prophylactic anti-malarial drugs to people at risk of malaria and treating patients, and in 1967 the Chinese government launched the research "Project 523". This work resulted in the antimalarial artemisinin-based combination therapies. One of the team members, Tu Youyou, was awarded the 2015 Nobel Prize in Physiology or Medicine for her work.
In the 1980s, began to experiment on a large scale with the use of drugs to prevent malaria. By 1988, the use of nets greatly reduced the incidence of malaria. By the end of 1990, the number of malaria cases in China had fallen to 117,000, and deaths had been reduced by 95 per cent. China was free of malaria cases for four consecutive years starting in 2017. The World Health Organization (WHO) confirmed that malaria had been eliminated in China in 2021.
Mental health
100 million Chinese people have mental illnesses that are varying degrees of intensity. Currently, dilemmas such as human rights versus political control, community integration versus community control, diversity versus centrally, huge demand but inadequate services seem to challenge the further development of the mental health service in the PRC. China has 17,000 certified psychologists, which is ten percent of that of other developed countries per capita. This shows the huge disparity between urban and rural areas. In 2002, Svedberg found that stunting rate in rural areas of China was 15 percent, reflecting that a substantial number of children still suffer from malnutrition. Another study by Chen shows that malnutrition has dropped from 1990 to 1995 but regional differences are still huge, particularly in rural areas.
In a recent report by The Rural Education Action Project on children in rural China, many were found to be suffering from basic health problems. 34% have iron deficiency anaemia and 40 percent are infected with intestinal worms. Many of these children do not have proper or sufficient nutrition. Often, this causes them not being able to fully reap the benefits of education, which can be a ticket out of poverty.
One possible reason for poor nutrition in rural areas is that agricultural produce can fetch a decent price, and thus is often sold rather than kept for personal consumption. Rural families would not consume eggs that their hen lay but will sell it in the market for about 20 yuan per kilogram. The money will then be spent on books or food like instant noodles which lack nutrition value compared to an egg. A girl named Wang Jing in China has a bowl of pork only once every five to six weeks, compared to urban children who have a vast array of food chains to choose from.
A survey conducted by China's Ministry of Health showed the kind of food consumed by rural households. 30 percent consume meat less than once a month. 23 percent consume rice or egg less than once a month.
In a 2008 Report on Chinese Children Nutrition and Health Conditions, West China still has 7.6 million poor children who were shorter and weigh lesser than urban children. These rural children were also shorter by 4 centimetres and 0.6 kilograms lighter than World Health Organization standards. Its findings are discussed in The China Study by T. Colin Campbell.
Environment and health
thumb|A factory in China along the Yangtze River, illustrating one of the factors contributing to China's air pollution
China's rapid development has led to numerous environmental problems which all have a direct impact on health. According to Kan (2009) the environmental issues include "outdoor and indoor air pollution, water shortages and pollution, desertification, and soil pollution". Of these, Kan (2009) states that the most detrimental one is the outdoor air pollution for which China has become known. The air pollution is not limited to industrial cities. In fact, due to the fact that rural Chinese people still use fuels such as coal for cooking, the World Health Organization attributes more premature deaths to that sort of air pollution than to China's ambient air pollution.
Finally, as described by Kan (2018) and Wu, et al. (1999) another major contributor to adverse health effects related to environmental issues is water pollution.
Pig-human transmission of the Streptococcus suis bacteria was reported in 2005, which led to 38 deaths in and around Sichuan province, an unusually high number. Although the bacteria exists in other pig rearing countries, the pig-human transmission has only been reported in China.
Hygiene and sanitation
Many of China's water sources, including underground sources and rivers, have been heavily polluted because of industry and economic growth. Increased exposure to polluted water and air has created "cancer villages" and further health and environmental problems. A majority of groundwater and shallow wells surveyed in China showed signs of heavy pollution, by measuring nitrate levels which indicate water contamination
The lack of sanitation in multiple areas of China has affected many student for decades. An absence of modern-day toilets and hand washing areas have directly affected students nationwide. The lack of reliable drinking water and sanitation areas, along with many others health issues, has directly led to 1/3 of young students in China having intestinal parasites.
The Patriotic Health Campaign, first started in the 1950s, are campaigns aimed to improve sanitation and hygiene in China. UNICEF also plans to incorporate government programs and policies in order to improve normal health standards in China. The programs and policies are used to teach students about basic hygiene and form campaigns encouraging people to wash their hands with soap instead of water only.
The healthcare system in China is a mix of public and private providers, with the government responsible for providing basic healthcare services to the population. However, there are significant disparities in access to healthcare between urban and rural areas, as well as between different socioeconomic groups.
In recent years, China has made efforts to improve its healthcare infrastructure, including investing in the development of primary healthcare facilities and expanding health insurance coverage. Additionally, the government has implemented a number of public health campaigns, such as anti-smoking and anti-obesity initiatives.
Despite these efforts, there is still much work to be done to improve health outcomes in China. Ongoing efforts are needed to address the root causes of health disparities and to promote healthy lifestyles and behaviors among the population.
The Human Rights Measurement Initiative finds that China is fulfilling 98.4% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, China achieves 98.6% of what is expected based on its current income.