Major Socioeconomic Driving Forces of Improving Population Health in China: 1978–2018

China's post-Cultural-Revolution reform generated rapid economic growth. But it also brought about major negative changes, especially in the early stage, which jeopardized population health and mortality gains. Nonetheless, improvements continued. China had achieved the Millennium Development Goal target 4 of reducing under-5 mortality by two-thirds well before the target year of 2015. Life expectancy continued to rise and reached 76.6 years by 2018, notably higher than the world average and that recorded in many countries with similar per capita GDP. By describing China's recent economic growth, the rebuilding of nationwide health insurance systems, the development of medical financial assistance, and poverty alleviation programs, this paper shows how these improvements were achieved. Vulnerability to health and mortality risks has been reduced; the availability of, and people's access to, health insurance have increased; and better medical treatments and health services have become available and accessible. These macro-socioeconomic determinants have played the central role in achieving further population health and mortality progress in China in the past four decades.