Despite an economic boom and growth in modern medical services, China has been experiencing a decline in its public health system. Fewer people have access to basic health care, and international health authorities are concerned that the next deadly influenza pandemic could arise in China.
Health executives from China attended three weeks of workshops at HSPH
"This class is held at a critical time in history," said Yuanli Liu, assistant professor of international health in the Department of Population and International Health at HSPH. "The central government of China is committed to developing and implementing brand-new health policies beginning early next year to reform China's health care system. So the level of awareness of major problems faced by the Chinese health system is unprecedented. These people came with major burning questions in mind."
The goal of the China Initiative is to bring together policymakers, academic scholars, and practitioners so that China can respond rapidly and effectively to its most pressing public health challenges. Two other components of the Initiative include expanded applied research and regular forums to discuss public health concepts and social sector development issues with policy analysts and policymakers in China.
"The three components mutually reinforce each other," Liu said. "Health leaders need evidence. We need to conduct research to get the evidence. To make the research more influential, we need to conduct policy forums to discuss the major issues." In an example of how research has influenced health policy, a calculation by Liu and his colleagues that medical expenses were increasing the poverty rate in rural areas by 44 percent each year prompted leaders in China to initiate a pilot rural health insurance program.
The intensive HSPH training program began with one week at Tsinghua University in Beijing, a partner in the Initiative. There, the group discussed a health system analytical framework and how it can be applied to major issues in China. The group was divided into five study subgroups to discuss and develop policy recommendations for different aspects of the health care system over the training period. Then, the entire group traveled to Boston for three more weeks of lectures, case studies, and discussions led by 25 faculty members from HSPH, HMS, KSG, and other experts.
William Hsiao
Week one at HSPH covered tools and economic, organizational, political, and ethical frameworks for policy analysis and policy making. One afternoon, the group visited the Massachusetts State House to learn more about the first state-mandated universal health insurance coverage in the U.S. from house speaker Sal DiMasi.
In one of the classes, HSPH Dean Barry Bloom noted the gains that could come with public investments in disease prevention, occupational injury prevention, smoking cessation, and basic health care services.
Week two at HSPH focused on international experiences and perspectives on regulating and managing the health sector, including public health agencies, hospitals, and the medical device and pharmaceutical industry. Former Massachusetts Commissioner of Public Health Howard Koh, who heads the HSPH Division of Public Health Practice, fielded many questions on how decisions are made about budgets, personnel, drug formularies, provider choices, division of labor, and more.
The third week focused on other important issues, such as HIV/AIDS, obesity and other non-communicable disease risks, occupational and environmental health, and emergency responses.
The presentations provoked practical questions from the group. For example, after a talk by HSPH Associate Professor of Epidemiology Marc Lipsitch on controlling avian flu, Lixun Huang, deputy director-general of the Shaanxi Province health department, asked how large an area to isolate and how many people to quarantine. Huang was seeking more scientifically precise strategies that could lower the social and economic costs of preventing the spread of disease.
"In China, we have done a lot of work to prepare for a possible outbreak of avian flu," said Huang through interpreter Ning Yi, a doctoral student in nutrition at HSPH who used to work at the Ministry of Health. "We often talk about the biology of when and where and how to control avian flu."
Another participant in the training, Enling Ma, a surgeon at Peking Union Medical College Hospital, appreciated the unprecedented opportunity to talk with so many of his country's key policy makers and to lend a physician's perspective to the discussions. The training program needs to reach many more policy makers, he said, so that public health messages are not coming from one person in each province.
The training component of the Initiative is scheduled to continue for four more years, Liu said.
—CCM
Copyright, 2007, President and Fellows of Harvard College
