Shanghai’s Track Record in Population Health Status: What Can Explain It? Comment on “Shanghai Rising: Health Improvements as Measured by Avoidable Mortality Since 2000”

Health reforms that emphasize public health and improvements in primary care can be cost-effective measures to achieve health improvements, especially in developing countries that face severe resource constraints. In their paper “ Shanghai rising: health improvements as measured by avoidable mortality since 2000 ,” Gusmano et al suggest that Shanghai’s health policy-makers have been successful in reducing avoidable mortality among Shanghai’s 14.9 million (2010) registered residents through these policy measures. It is a plausible hypothesis, but the data the authors cite also would be compatible with alternative hypotheses, as the comparison they make with trends in amenable mortality-rate (AM) in large cities in other parts of the world suggests