2Robert Wagner School of Public Service, New York, USA
3Vital Statistics Division, Shanghai Municipal Center for Disease Prevention and Control, Shanghai, China
4The International Longevity Center, Columbia University, New York, USA
5School of Public Health, Shanghai, China
Over the past two decades, Shanghai, the largest megacity in China, has been coping with unprecedented growth of its economy and population while overcoming previous underinvestment in the health system by the central and local governments. We study the evolution of Shanghai’s healthcare system by analyzing “Avoidable Mortality” (AM) – deaths amenable to public health and healthcare interventions, as previously defined in the literature. Based on analysis of mortality data, by cause of death, from the Shanghai Municipal Center for Disease Control and Prevention, we analyze trends over the period 2000–10 and compare Shanghai’s experience to other mega-city regions – New York, London and Paris. Population health status attributable to public health and healthcare interventions improved dramatically for Shanghai’s population with permanent residency status. The age-adjusted rate of AM, per 1,000 population, dropped from 0.72 to 0.50. The rate of decrease in age-adjusted AM in Shanghai (30%) was comparable to New York City (30%) and Paris (25%), but lower than London (42%). Shanghai’s establishment of the Municipal Center for Disease Control and Prevention and its upgrading of public health and health services are likely to have contributed to the large decrease in the number and rate of avoidable deaths, which suggests that investments in public health infrastructure and increasing access to health services in megacities – both in China and worldwide – can produce significant mortality declines. Future analysis in Shanghai should investigate inequalities in avoidable deaths and the extent to which these gains have benefitted the significant population of urban migrants who do not have permanent residency status.
Cheng TM. Explaining Shanghai’s health care reforms, successes, and challenges. Health Aff (Millwood) 2013; 32: 2199-204. doi: 10.1377/hlthaff.2013.1136
Peng J, Zhang SN, Lu W, Chen AT. Public health in China: The Shanghai CDC perspective. Am J Public Health 2003; 93: 1991-3. doi: 10.2105/AJPH.93.12.1991
On improving the city's community health services: research report. Shanghai Municipal Health Bureau; 2010.
Wei X, Zakus D, Liang H, Sun X. The Shanghai case: A qualitative evaluation of community health reform in response to the challenge of population ageing. Int J Health Plann Manage 2005; 20: 269-86.
Tang S. Public Health Programs in China: Has Reform Improved Equity and Effectiveness? China Health Policy Report. Duke Global Health Institute; 2013.
Claeson M, Wang H, Hu S. A Critical Review of Public Health in China. Washington, DC: World Bank; 2004.
Li Z, Jiale H, Lin L, Shenglan T, Jin M. On residents’ satisfaction with community health services after health care system reform in Shanghai, China. BMC Public Health 2012; 12: S9. doi: 10.1186/1471-2458-12-s1-s9
Shanghai Municipal Health Bureau. On improving the city's community health services: research report; 2010.
Preston SH, Ho J. Low life expectancy in the United States: Is the health care system at fault? PSC Working Paper Series; 2009.
Schroeder S. We can do better: Improving health for the American people. N Engl J Med 2007; 357: 1221-8. doi: 10.1056/nejmsa073350
Rosenfield A, Maine D. Maternal mortality – a neglected tragedy: Where is the M in MCH? Lancet1985; 326: 83-5. doi: 10.1016/s0140-6736(85)90188-6
Peto J, Gilham C, Fletcher O, Matthews FE. The cervical cancer epidemic that screening has prevented in the UK. Lancet 2004; 364: 249-56. doi: 10.1016/s0140-6736(04)16674-9
Rutstein DD, Berenberg W, Chalmers TC, Child CG, Fishman AP, Perrin EB. Measuring the quality of health care. N Engl J Med 1976; 294: 582-8.
Holland W. European Community Atlas of Avoidable Death. Oxford: Oxford University Press; 1993. p. 1985-9.
Gay J, Paris V, Devaux M, de Looper M. Mortality amenable to health care in 31 OECD countries: Estimates and methodological issues. OECD Health Working Papers, OECD Publishing, No. 55; 2011. doi: 10.1787/5kgj35f9f8s2-en
Nolte E, McKee M. Does health care save lives? Avoidable mortality revisited. London: Nuffield Provincial Hospitals Trust; 2004.
Nolte E, McKee M. Measuring the health status of nations: updating an earlier analysis. Health Aff (Millwood) 2008; 27: 58-71. doi: 10.1377/hlthaff.27.1.58
Niti M, Ng TP. Temporal trends and ethnic variations in amenable mortality in Singapore 1965-1974: The impact of health care in transition. Int J Epidemiol 2001; 30: 966-73. doi: 10.1093/ije/30.5.966
Schoenbaum S, Schoen D, Nicholson J, Cantor J. Mortality amenable to health care in the United States: The roles of demographics and health systems performance. J Public Health Policy 2011;32: 407-29. doi: 10.1787/eco_surveys-hun-2012-graph46-en
Mackenbach JP, Looman AL, Kunst JD, Habbena I, van der Maas PJ. Post-1950 mortality trends and medical care: Gains in life expectancy due to declines in mortality from conditions amenable to medical intervention in the Netherlands. Soc Sci Med 1998;27: 889-94. doi: 10.1016/0277-9536(88)90278-x
Charlton J, Silver R, Hartley R, Holland W. Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet 1983; 321: 691-6. doi: 10.1016/s0140-6736(83)91981-5
Nolte E, McKee M. In amenable mortality--deaths avoidable through health care--progress in the US lags that of three European countries. Health Aff (Millwood) 2012; 31: 2114-22. doi: 10.1377/hlthaff.2011.0851
Chau PH, Woo J, Chan KC, Weisz D, Gusmano MK. Avoidable mortality pattern in a Chinese population—Hong Kong, China. Eur J Public Health2010; 21: 215-20. doi: 10.1093/eurpub/ckq020
Weisz D, Gusmano MK, Rodwin VG, Neuberg LG. Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities. Eur J Public Health 2008; 18: 166-72. doi: 10.1093/eurpub/ckm084
Hoffman R, Plug I, Khoshaba B, McKee M, Mackenbach JP, AMIEHS working group. Amenable mortality revisited: the AMIEHS study. Gaceta Sanitaria 2013;27: 199-206. doi: 10.1016/j.gaceta.2012.08.004
Kraemer A, Fisscher F, Plass D, Pinheiro P, Ling L, Sang Y, et al. Burden of disease in China: Contrasting disease burden patterns of the general and the migrant workers populations. Working Paper 2014-11. United Nations Research Institute for Social Development; 2014.
Capewell S, Beaglehole R, Seddon M, McMurrey JJ. Explanation for the decline in coronary heart disease mortality in Auckland, New Zealand between 1982 and 1993. Circulation 2000; 102: 1511-6. doi: 10.1161/01.cir.102.13.1511
Klein RJ, Schoenborn CA. Age-adjustment using the 2000 projected U.S. population. Health People 2010 Statistical Notes No. 20; 2001.
Critchley J, Liu J, Zhao D, Wei W, Capewell S. Explaining the increase in coronary heart disease mortality in Beijing between 1984 and 1999. Circulation 2004; 110: 1236-44. doi: 10.1161/01.cir.0000140668.91896.ae
Park A, Cai F. The informalization of the Chinese labor market. In: Kuruvilla S, Lee CK, Gallagher M, editors. From Iron Rice Bowl to Informalization: Markets, State and Workers in a Changing China. Ithaca: Cornell University Press; 2011.
Yang W, Kanavos P. The less healthy urban population: income-related health inequality in China. BMC Public Health 2012; 12: 1-15. doi: 10.1186/1471-2458-12-804
Zhao Q, Huang ZJ, Yang S, Pan J, Smith B, Xu B. The utilization of antenatal care among rural-to-urban migrant women in Shanghai: a hospital-based cross-sectional study. BMC Public Health 2012;12: 1012. doi: 10.1186/1471-2458-12-1012
Zhao Y, Kang B, Liu Y, Li Y, Shi G, Shen T, et al. Health insurance coverage and its impact on medical cost: observations from the floating population in China. PLOS One 2014; 9: e111555. doi: 10.1371/journal.pone.0111555