Dec 09, 2017 Volume 390 Number 10112 p2527-2604 e50
Putting research evidence at the heart of policy making
To improve patient outcomes, research must inform and shape policy. As history sadly teaches, this ideal is not always realised. But in today’s Lancet, two Articles display how research addressing knowledge gaps can inform policy for hypertension control in China.
Stroke is the leading cause of death in China, driven largely by uncontrolled hypertension. Jiapeng Lu and colleagues estimate that 37·2% of Chinese adults aged 35–75 years have hypertension (defined as a blood pressure in excess of 140/90 mm Hg or a patient receiving antihypertensive medications). Among the population with hypertension, 22·9% take prescribed antihypertensive medicines, but only 5·7% achieve hypertension control. In an accompanying paper, Meng Su and colleagues report huge gaps in the availability and prescription of antihypertensive medications in primary health-care centres (PHC) in China. 8·1% of PHCs stocked no antihypertensive drugs. Low-cost and effective medications recommended in Chinese guidelines were only prescribed in 11·2% of PHCs.
The two studies, funded by China National Development and Reform Commission and National Health and Family Planning Commission (NHFPC), have profound implications for China’s health policy. Using the evidence generated from this work, the NHFPC established the National Primary Healthcare Hypertension Management Office in March, 2017. The office will guide hypertension management, provide training for PHC professionals, collect data, and assess the quality of care in PHCs in terms of hypertension control. In September, 2017, new PHC hypertension control guideline and quality measurement indicators were integrated into the Basic Public Health Service Program. Notably, hypertensive medication availability is now included as one of the indicators to evaluate PHC performance.
China’s story of putting research evidence at the very heart of policy making sets an important example for applying the best solutions to the most burdensome health problems, and fitting those solutions into a health service to bring about system change. The next vital step for China to continue to improve its health outcomes would be through the evaluation of policy change via robust research.