Utilize System Advantages to Improve the National Health System
By DSM（China）Co.，Ltd.
The beginning of 2020 witnessed the unexpected outbreak of COVID-19 which has caused great harm to Chinese people’s health and implicated severe challenges to Chinese economy. In adversity，the Chinese government has effectively responded to the epidemic，showing its system advantages in mobilization，coordination，organization and implementation. The remarkable speed，scale and efficiency of China have been highly praised and recognized by the international community.
Undeniably，the epidemic has seriously affected not only people’s normal life but also the operation of national economy. Therefore，we must reflect on the epidemic and learn from it to maintain long-term economic prosperity after COVID-19 in order to safeguard people’s well-being and achieve a moderately prosperous society in all respects. The epidemic is also an opportunity for us to identify and make improvements in areas that are lacking. To this end，according to the Healthy China 2030 Planning Outline，we focus on how to give play to system advantages and better implement President Xi Jinping’s people-centered development concept and propose to improve people’s health.
1 Improve national health education
The Law of the People’s Republic of China on the Promotion of Basic Medical and Health Care passed at the 15th session of the Standing Committee of the 13th National People’s Congress of the People’s Republic of China on December 28，2019 will come into force on June 1，2020. According to Article 68 of the law，“the state shall incorporate health education into the national education system. Schools shall use various forms to implement health education，popularize health knowledge and the awareness of proactive prevention of diseases，and develop good health habits and healthy behaviors.” In view of this epidemic，the promulgation of this law is very important and timely. Therefore，we would like to propose the incorporation of national health education into the mandatory courses of primary schools，middle schools and universities；Furthermore，we advocate the education of personal hygiene habits and observation of sanitary requirements for public places starting from kindergartens，and to include basic knowledge about diet，nutrition and sports in the syllabus. We also propose to educate people to become more considerate of others，for example，wearing a mask when feeling under the weather，which can protect both ourselves and others. This is not just about forming good habits but also becoming better citizen.
In addition to school health education，continuous social health education is of equal importance. Health education is the most direct fulfillment of the principle of “prevention first”，preventing and reducing diseases with health knowledge and skills. With the improvement of people’s living standards and technology，media such as radio，television，Internet and mobile phones have covered the majority of people. These media undertake tasks of disseminating，exchanging and sharing public information. And it is the best way to make full use of them to carry out targeted public health education，which will have a positive impact on the improvement of people’s health knowledge and the prevention of diseases. Currently，considering the 1.1 billion WeChat users in China，using this platform for public health education and disseminating public health information will get more results with less effort，and this is the best way to make full use of system advantages to implement the people-centered concept. In addition，we propose that public service advertisements on health knowledge and behaviors be increased on radio and television，so that good habits can become people’s unconscious actions.
2 Support the community health service system
In the initial stage of the outbreak and spread of COVID-19 in Wuhan，almost all hospitals above the second class were greatly impacted and couldn’t address the rapidly spread epidemic fast enough. On the other hand，community hospitals which should have played the most basic and important role at that time failed to function. Learning from the experience of other countries，we found that，in the case of epidemics and infectious diseases，patients could go to family doctors and community hospitals first for preliminary diagnosis and screening，and might then be sent to higher-level hospitals for further examination and treatment according to the results. Especially in the case of major public health emergencies，community hospitals serve as the first point of contact，and should play the role of a rapid response mechanism，thus realizing early control of the epidemic. However，if the community medical system is weak，and its medical level and credibility are not trustable，or even cannot screen and distribute patients，then people will inevitably swarm to large hospitals for medical treatment，which will inevitably increase the chance of cross-infection and the pressure on the medical system and doctors，thus missing the best window period to control the rapid spread of the epidemic.
A key component of achieving national health coverage is ensuring high-quality healthcare access for all people. As the world’s second largest economy，China has made remarkable progress in the healthcare system in recent years. According to a study released in 2018 by The Lancet，an authoritative medical journal，on the healthcare access and quality index for 195 countries and regions from 1990 to 2016，China ranked 48th，and the country has a significant issue of imbalanced development in various regions：the difference between the highest value（91.5 for Beijing）and the lowest value（48.0 for Tibet）of HAQ is 43.5；the HAQ index of eastern provinces is higher than that of western provinces. We attribute this to the uneven allocation of medical resources. For example，there is still a large gap in medical resource allocation between urban and rural areas，and between coastal and inland areas. The medical systems of Beijing，Shanghai and Guangzhou may reach European and American levels，but those of other provinces and cities and some relatively poverty-stricken areas are not even close. The problems are particularly prominent in healthcare systems at the grassroots level.
For all，we are glad to see that the Communist Party of China（CPC）Central Committee and the State Council published the Opinions on Intensifying the Reform of Healthcare Security System on February 25，2020. Regarding the coordinated advancement of the reform of the supply side of medical services，it clearly requires to improve the modern medical service system featured by division of labor and cooperation of general and specialized medical services，and enhance general medical services at the grassroots level. We believe that this is the most urgent task to make use of system advantages，support the community health service system，reasonably allocate and leverage resources，improve service functions，make full use of modern information technology，establish a big data-based resident health database，conduct online inquiry and remote diagnosis，and develop targeted and personalized services. We propose paying attention to and intensifying the training of talents in community medical institutions including the training of general practitioners，encouraging medical graduates and doctors to work in community health service centers，and effectively improving the treatment capacity and facilities of community hospitals to entitle residents to convenient and high-level community medical services，thus improving people’s medical experience and well-being.
3 Focus on malnutrition and hidden hunger
According to the Healthy China 2030 Planning Outline，national health is the fundamental purpose of building a healthy China. It is required to focus on the whole population and the entire life cycle，and provide fair，accessible，systematic and continuous health services to achieve a higher level of national health. It is also required to cover the entire life cycle，and identify several priority areas and strengthen intervention based on the main health problems and main influence factors at different stages of life，thus achieving health services and health security covering the entire life circle，and comprehensively maintaining people’s health. To achieve this，we believe that prevention of diseases should be more important than treatment，and the most effective way to prevent diseases is to improve people’s immunity and nutrition. Therefore，we propose that following：
（1）Focus on nutrition and health intervention in infancy and of preschoolers
Foreign scientific research results show that maternal and infant nutrition during the first 1，000 days of life，i.e. from pregnancy to two years of age，affects the health of a person’s whole life. Thus early nutrition intervention is a window period for improving health. Ministry of Health released the Report on the Nutrition Development of Children Aged between 0 and 6 in China（2012），introduced to the public the development status of children’s nutrition in China and arouse the attention and concern of the whole society to the problem of children’s nutrition. the nutritional status of children is the most sensitive indicator of the measurement of the nutritional status of the whole population，as well as the basis of national health. Internationally，the nutritional status of children under the age of five is usually regarded as an important indicator of the social and economic development of a country，and is emphasized as an important issue related to the survival and development of human beings.
According to the Implementation Plan for the Three-Year Action on Health and Poverty Alleviation jointly formulated and issued by the National Health Commission and other units in 2018，China will implement a nutrition improvement program for children in poverty-stricken areas，and provide a nutrition package for each child aged 6-24 months free of charge every day to help infants realize optimal growth，development and health. Besides，with the economic and social development，we also need to pay attention to some nutrition issues for other children. For example，the nutritional status of vulnerable children such as migrant children and left-behind children desperately needs improvement. All these require the attention and support of various departments and the joint efforts of the whole society.
At present，China has a nutrition package intervention policy for children aged 6-24 months in poverty-stricken areas and a nutrition meal program for students receiving compulsory education above six years old in poverty-stricken areas. But China still lacks mature support policies for underprivileged children aged 3-5 years on the problem of malnutrition，and only some charity organizations are helping a limited number of children. We consider poverty alleviation to be important and extremely urgent，because malnutrition will not only lead to reduced GDP，but also cause intergenerational transmission in the population，resulting in a vicious circle from poverty to malnutrition and then to poverty again. Therefore，it is necessary to pay attention to preschoolers aged 3-5 years，and precisely intervene in the situation with better policies. Improving the nutrition and health of children in poverty-stricken areas is related to population quality，economic and social development，and international competitiveness of China in the future，and it is also a concrete action to implement the Healthy China 2030 Planning Outline and truly achieve the objectives in it.
（2）Focus on “hidden hunger” and improve national health
The WHO refers to undernutrition or nutritional imbalance as hidden hunger. Modern medicine found that 70% of chronic diseases include cardiovascular disease，diabetes，cancer，obesity and sub-health status are all related to the imbalanced intake of nutrient elements，and hidden hunger poses a great threat to human health. According to the Report on the Status of Nutrition and Chronic Diseases of Chinese Residents prepared by National Health and Family Planning Commission in 2015，Chinese residents take in excessive fat，with the average energy supply ratio of dietary fat exceeding 30%. At the same time，a fairly large number of Chinese residents still lack such nutrients as calcium，iron，vitamin A and vitamin D. According to nutritionists，urban residents eat too much animal food，and some people don’t eat staple food and eat less cereals for fear of getting fat. Say dominant hunger is caused by lack of nutrients such as energy，protein and fat，and can be solved by eating one’s fill，then hidden hunger arises from imbalanced nutrition and lack of micronutrients，vitamins and minerals，which needs to be solved by eating right and well.
According to the National Nutrition Plan（2017-2030），in recent years Chinese people have experienced continuously increased living standards，significantly enhanced nutrition supply capacity，and obviously improved nutrition and health，but there are still such problems as residents suffering from coexistence of inadequate and excessive nutrition and frequent occurrence of nutrition-related diseases，and non-popularized healthy lifestyles，which have become important factors affecting national health.
In view of this，we propose strengthening healthy diet education，advocating a reasonable and balanced diet and appropriate dietary supplements，comprehensively popularizing dietary nutrition knowledge，and guiding people to develop scientific dietary habits and a reasonable dietary structure. It is necessary to publicize and implement the strategies and actions of the National Nutrition Plan（2017-2030），and advocate the concept of active prevention of diseases instead of passive treatment of them.
The promulgation of the Healthy China 2030 Planning Outline and the National Nutrition Plan（2017-2030） has made national nutrition and health a national policy. As the world’s largest nutrition provider，Royal DSM N.V.，a global purpose-led，science-based company active in Nutrition，Health and Sustainable Living has been working closely with governments，international organizations and industry associations to facilitate nutrition improvement. DSM and The Chinese Nutrition Society jointly established the “Nutrition Research Fund of Chinese Nutrition Society—DSM Special Research Fund” with the sole purpose to advance the development of China’s nutrition science and technology，provide scientific basis for the development of nutritious and healthy food，and improve people’s health. Since DSM established a strategic partnership with UNWFP in 2007，we have leveraged our expertise in nutrition and food fortification to develop cost-effective，sustainable and nutritious food solutions for those in need，and contributed to the Sustainable Development Goals of the United Nations. DSM actively cooperates with government departments，non-governmental organizations and the private sector in China to implements sustainable nutrition improvement programs for the undernourished populations. For example，DSM has participated in the “Elimination of Infantile Anemia” project jointly conducted by All-China Women’s Federation，Ministry of Health，and China Children and Teenagers’ Fund，and the pilot project of “Social Equity—Early Childhood Development in Poverty-Stricken Areas” launched by China Development Research Foundation in Qinghai and Yunnan，providing comprehensive technical support and high-quality nutrition packages. DSM has also participated in the “Supporting ‘Five’—Nutrition Improvement Program for Preschoolers” conducted by Amway Charity Foundation together with China Development Research Foundation，China Children and Teenagers’ Fund and other organizations，which aims to help underprivileged children grow up healthily by distributing children’s nutritional chewable tablets to children aged 3-5 years in poverty-stricken areas in China free of charge.
DSM hopes to work with China on nutrition improvement solutions，and safeguard the health and well-being of the Chinese people with our knowledge and expertise！