CMAJ: Lower death rates for most diseases in Shanghai, China, associated with socioeconomic changes over many years & How to improve health care in Canada

Embargoed until Monday, October 1, 2018

Please credit CMAJ, not the Canadian Medical Association (CMA). CMAJ is an independent medical journal; views expressed do not necessarily reflect those of its owner, Joule Inc., a CMA company, or CMA.

CMAJ headlines:

Lower death rates for most diseases in Shanghai, China, associated with socioeconomic changes over many years

How to improve health care in Canada

Shifting causes of death in Shanghai, China, over many decades

Socioeconomic improvements likely driving improvements in Chinese population health

A large study conducted over 42 years in Shanghai — China’s largest city — indicates that socioeconomic development most likely contributed to lower death rates for most diseases (except for cancer and diabetes, for which death rates increased), likely because of lifestyle factors. The study is published in CMAJ (Canadian Medical Association Journal).

The study looked at data on deaths among inhabitants of Yangpu, an area of Shanghai with a relatively stable population and low levels of people moving in or leaving. The study period included several key events in recent Chinese history, including the rise of polluting industries (1949 to the 1980s), the Great Chinese Famine (1959 to 1961), the Cultural Revolution (1966 to 1976) and economic reforms (1979 to present).

Out of almost 42 million person-years, there were 290 332 deaths categorized into cause groups: infectious diseases, maternal, perinatal and nutritional issues (group 1), chronic diseases (group 2) and injuries (group 3).

Researchers found that deaths from causes in groups 1 and 3 decreased between 1974 and 2015. After 1988, age-standardized deaths in group 1 decreased because of public health and health care improvements and the removal of polluting industries in that decade. People who experienced severe starvation in utero or in infancy during the Great Chinese Famine were more likely to die from heart disease, stroke, cancer and diabetes. Deaths from chronic diseases reduced over time, except for people born after 1949, among whom deaths from cancer and diabetes increased.

Prior to 1994, Shanghai was a low-income region according to World Bank income categories, but by 2006 it had become an upper-middle income area.

“Socioeconomic development has contributed to a decrease in deaths from most diseases in China,” says Dr. Guangwen Cao, Department of Epidemiology, Second Military Medical University, Shanghai, China. “However, for cancer and diabetes, the benefits from socioeconomic development appear to be overridden by new risk factors, such as changing diets and alcohol consumption, smoking, lack of physical activity, overweight and obesity.”

Few studies have looked at the effect of socioeconomic events on deaths from specific causes. The authors hope their study will help with health-system planning and disease-control strategies.

The authors note that, as this is a descriptive study, it is difficult to determine if socioeconomic events and cause-specific mortality are causal or represent an association.

“Influence of socioeconomic events on cause-specific mortality in urban Shanghai, China, from 1974 to 2015: a population-based longitudinal study” is published October 1, 2018.

MEDIA NOTE: Please use the following public links after the embargo lift:

Research:http://www.cmaj.ca/lookup/doi/10.1503/cmaj.180272

Media contact: Dr. Guangwen Cao, Second Military Medical University, Shanghai,

China, gcao@smmu.edu.cn or aoguangwen1965@gmail.com

How to improve health care in Canada

Expanding public funding for cost-effective treatments, investing in primary care, embracing technology and engaging patients are some of the ways Canada can improve the quality of health care, according to an analysis in CMAJ (Canadian Medical Association Journal).

“The quality of health care in Canada is good, but arguably not great,” write Drs. Irfan Dhalla and Joshua Tepper of Health Quality Ontario. “With thoughtful change, we could all benefit from a health care system that provides safe, timely, effective, efficient, equitable and patient-centred care at every opportunity.”

The article looks at the quality of health care in Canada and outlines strategies to improve it at the system level.

“We generally focus our attention at the national level; inevitably, this obscures important differences within Canada, between provinces and territories, and also between groups (e.g., Indigenous peoples and non-Indigenous Canadians),” write the authors. “Also, although we focus here on health care, this does not diminish the importance of income, housing, education, social networks and other determinants of health.”

The authors suggest the following to improve care:

Expand public funding for treatments shown to be cost-effective — for example, funding psychotherapy for people with depression

Invest in primary care – there is still a gap in primary care, and efforts should move beyond payment reform alone to improve this important area

Use electronic information systems that help doctors work together — growing evidence speaks to the benefits of health care records that can be accessed by patients and physicians alike

Engage patients to help determine what services should be offered — for example, patients at a large Ontario family practice clinic suggested new ways to improve services that staff had not considered

Standardize and embed quality-improvement tools, such as guidelines — this will help standardize practice and reduce variability based on clinical knowledge or available resources

Improve transparency

Ensure meaningful involvement of physicians — decision-makers should involve physicians early in efforts to improve health care

Ensure health education supports high-quality care Support wellness of health care professionals

The authors hope that decision-makers will consider these suggestions as a way forward for improving health care quality in Canada.

“Improving the quality of health care in Canada” is published October 1, 2018

MEDIA NOTE: Please use the following public links after the embargo lift:

Analysis: http://www.cmaj.ca/lookup/doi/10.1503/cmaj.171045

General media contact: Kim Barnhardt, Communications, CMAJ, kim.barnhardt@cmaj.ca

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