China's Belt and Road Initiative from a global health perspective

As China implements its 13th 5-year plan for national economic and social development, one might ask how efforts being proposed will affect global health through the so-called Belt and Road Initiative. The Belt and Road Initiative aims to connect the Asian–Pacific Economic Area with the European Economic Area by building up two maritime routes, referred to as the 21st century Silk Road. Thus, although its primary aim relates to trade, the initiative has many implicit influences on global health, some of which we provide insights into here. The current 5-year plan deviates from the previous 12 strategic plans, which focused on domestic economic growth. The proposed Belt and Road Initiative will provide a channel through which China will facilitate its global health strategy, especially in the global south, through commercial, cultural, and personnel exchanges that will improve bilateral and multilateral regional cooperation.1National Development and Reform CommissionMinistry of Foreign AffairsMinistry of Commerce of the People's Republic of ChinaVision and actions on jointly building Silk Road Economic Belt and 21st century Maritime Silk Road. Chapters I–V.http://en.ndrc.gov.cn/newsrelease/201503/t20150330_669367.htmlDate: March 28, 2015Google Scholar With the rapid pace of globalisation, health problems are no longer issues for a single nation. Collective action by multiple countries are necessary to combat global health crises, such as infectious diseases, lifestyle risks, and health inequity, which all span beyond one's sovereign border.2Gostin LO Sridhar D Global health and the law.N Engl J Med. 2014; 370: 1732-1740Crossref PubMed Scopus (42) Google Scholar Disease threats originating from China, such as the SARS outbreak in 2003 and the avian influenza H7N9 pandemic in 2014, could quickly affect the whole world. Similarly, China is confronted by threats from other nations; examples include the 2011 polio outbreak,3Luo H-M Zhang Y Wang X-Q et al.Identification and control of a poliomyelitis outbreak in Xinjiang, China.N Engl J Med. 2013; 369: 1981-1990Crossref PubMed Scopus (74) Google Scholar Zika virus in 2016, and the westernisation of its traditional diet, which has led to an increased incidence of type 2 diabetes and cardiovascular disease.4Pan A Malik V Hu FB Exporting diabetes to Asia: the impact of Western-style fast food.Circulation. 2012; 126: 163-165Crossref PubMed Scopus (42) Google Scholar The conventional conceptualisations of protectionism and geopolitics are being challenged because determinants of health often span one's borders and a comprehensive and systematic approach is necessary to find solutions. Concerted efforts to fight chronic diseases, such as diabetes, can advance health equity and development, both nationally and globally.5Geneau R Stuckler D Stachenko S et al.Raising the priority of preventing chronic diseases: a political process.Lancet. 2010; 376: 1689-1698Summary Full Text Full Text PDF PubMed Scopus (202) Google Scholar The Belt and Road Initiative also provides a common platform to improve the capability of handling regional public health emergencies through epidemic information sharing, exchange of preventive and interventional methods, and training health professionals. China has committed to provide medical assistance and emergency medical aid to Belt and Road partners, and to carry out regional cooperation and coordination in maternal and child health, disability rehabilitation, and management of major infectious diseases, including HIV, tuberculosis, and malaria.2Gostin LO Sridhar D Global health and the law.N Engl J Med. 2014; 370: 1732-1740Crossref PubMed Scopus (42) Google Scholar China agreed to increase regional cooperation in science and technology through establishing joint laboratories or research centres, international technology transfer, and knowledge translation centres. The Belt and Road Initiative complements the Asian Infrastructure Investment Bank, the development of which China is leading, in its aim to improve regional cooperation, and empower economic and social changes. The Chinese Government realises that economy and health are interlinked.6Minghui R Guoping L China's global health strategy.Lancet. 2014; 384: 719-721Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar Increases in gross domestic product and national income in China resulted in substantial health improvements.7Gao J Qian J Tang S Eriksson BO Blas E Health equity in transition from planned to market economy in China.Health Policy and Planning. 2002; 17: 20-29Crossref PubMed Scopus (108) Google Scholar China has adopted a project approach to its international health aid programme by donating drugs and equipment, providing medical aid teams, training health personnel, and building health facilities that can be transferred to local authorities.8Liu P Guo Y Qian X Tang S Li Z Chen L China's distinctive engagement in global health.Lancet. 2014; 384: 793-804Summary Full Text Full Text PDF PubMed Scopus (74) Google Scholar Demonstrated leadership is crucial to the future of global health laws.2Gostin LO Sridhar D Global health and the law.N Engl J Med. 2014; 370: 1732-1740Crossref PubMed Scopus (42) Google Scholar The Belt and Road Initiative provides a consistent mechanism for negotiation, adoption of collective action, and monitoring of normative rules. It also provides an opportunity for the global north to connect with the global south through this common platform of economic security, which aligns with many objectives of the UN's Sustainable Development Goals.3Luo H-M Zhang Y Wang X-Q et al.Identification and control of a poliomyelitis outbreak in Xinjiang, China.N Engl J Med. 2013; 369: 1981-1990Crossref PubMed Scopus (74) Google Scholar, 9UNSustainable development goals.http://www.un.org/sustainabledevelopment/sustainable-development-goals/Google Scholar This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on July 26, 2017 This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on July 26, 2017 We declare no competing interests. This work was supported by the Grant Global Health Governance and Soft Law, funded by the Soft Law Board of National Behaviour at the Law Science Academy of China and Peking University. The authors thank David Lim (Flinder University, Adelaide, Australia) and Xue Pan (Sun Yet-sen University, Guangzhou, China) for their editing assistance. Correction to Lancet Glob Health 2017; 5: e752–53Ruwei Hu, Ruqing Liu, Nan Hu. China's Belt and Road Initiative from a global health perspective. Lancet Glob Health 2017; 5: e752–53—In this Comment, Ruqing Liu was incorrectly listed as Ruging Liu. The author list has been corrected as of July 26, 2017.