London School of Hygiene & Tropical Medicine

School experts have welcomed research showing life expectancy has risen in all provinces in China over the past two decades. However, they warn that substantial inequalities still exist, and that China must prioritise population health and environmental sustainability as part of its economic development.

The study was conducted by researchers in China and the US and is published in The Lancet. It looked at how patterns in 240 causes of deaths have changed in recent decades, and examined differences in mortality in each of China's 33 province-level administrative units, including Hong Kong and Macau.

In a comment piece for The Lancet, Dr James Milner and Professor Paul Wilkinson from the London School of Hygiene & Tropical Medicine, write:  "The results of the study show the huge progress that has been made throughout China… The shift towards non-communicable disease has occurred in all provinces, but the major causes of death vary greatly."

The findings show Shanghai City had the highest life expectancy in China in 2013, at 80.2 for men and 85.2 for women. These figures are comparable to countries such as Japan or France, which have the highest life expectancies in the world, and represent a gain of around six years on the highest life expectancies seen in China in 1990.

However, despite the gains in life expectancy seen across China, thought to be linked to increasing GDP and improved maternal education, large inequalities between provinces remain, with life expectancy around 10 years lower for both men and women in some provinces in the west part of China, comparable to less developed countries like Bangladesh.

The study also reveals striking differences in the leading causes of death in different provinces.  Nationwide, cerebrovascular disease (the main cause of stroke) is the leading cause of death for both men and women, and is generally responsible for more deaths in poorer provinces.  But some provinces, notably Yunnan province on China's southern border, have much lower rates of death from cerebrovascular disease. 

In Yunnan, chronic obstructive pulmonary disease (COPD), associated with smoking and air pollution, is the leading cause of death, as it is in many southern and western provinces (including Chongqing, Sichuan, Gansu, Qinghai, and Guizhou). Northern provinces are generally worst affected by heart disease as a cause of death, with Heilongjang, the most-affected province, having a death rate due to heart disease that is four times greater than Zhejiang, the least-affected province.

Dr Milner and Prof Wilkinson write: "The large gradients in causes of mortality across the country pose very different challenges to local health systems.

"China now faces the challenge of achieving further prosperity in a way that prioritises population health and environmental sustainability.

"There are encouraging recent signs. The Chinese Government has outlined plans for expansion of the health-care sector during the next five years, and Premier Li Keqiang has 'declared war' on environmental pollution. Even more promisingly, China has proposed plans for action to tackle climate change, pledging substantial cuts in greenhouse gas emissions and increases in low-carbon energy generation. If these and other commitments are kept, China has an opportunity to show that economic development does not have to be achieved at any cost."

Publication:

• James Milner and Paul Wilkinson, Trends in cause-specific mortality in Chinese provinces, The Lancet. DOI: 10.1016/S0140-6736(15)00553-X