Ambient Temperature Effects on Hospitalization Risk Among Farmers: A Time-Series Study on Multiple Diseases in Vietnam.

OBJECTIVE: The aim of the study is to assess the effect of high temperatures on hospitalization for all causes and heat-sensitive diseases among Vietnamese farmers. METHODS: The Poisson generalized linear model and distributed lag nonlinear model were used to investigate the temperature-hospitalization association for all causes and seven cause-specific disease groups. RESULTS: Every 1°C increase in daily mean temperature above the threshold increased the estimated relative risk (95% CI) of all-cause hospitalization by 1.022 (0.998-1.047) at the country level, 1.047 (1.007-1.089) in the south, and 0.982 (0.958-1.006) in the north. Infectious disease hospitalization was most affected by high temperatures (1.098 [1.057-1.140]). High temperatures significantly increased the risk of all-cause hospitalization for farmers 60 years and younger in three of the six provinces. CONCLUSIONS: The findings emphasized the need for health promotion programs to prevent heat-related health issues.

Immunity debt: Hospitals need to be prepared in advance for multiple respiratory diseases that tend to co-occur.

As SARS-CoV-2 transitions from a pandemic to an endemic presence, a significant rise in respiratory diseases such as influenza and Mycoplasma pneumonia is challenging healthcare systems weakened by the impact of COVID-19. This commentary examines the global resurgence of respiratory pathogens, heightened by the post-pandemic "immunity debt", through an analysis of WHO surveillance data and national health reports. Findings reveal a substantial increase in respiratory illnesses, notably among children, compounded by a shortage of pediatricians and growing antimicrobial resistance. This underscores the need to improve hospital preparedness, optimize clinical responses, and enhance public health strategies to effectively navigate the impending peak of concurrent respiratory infections.

Health Problems of Increasing Man-Made and Climate-Related Disasters on Forcibly Displaced populations: A Scoping Review on Global Evidence.

Forcibly displaced populations are among the most vulnerable groups in disasters. They experience poorer health conditions compared with nondisplaced individuals. However, a clear picture is lacking regarding the overall health problems encountered by disaster-induced mid- to long-term displaced people. This study investigated these disorders prevalence and identified their correlates among long-settled displaced populations worldwide. The current scoping review follows the PRISMA-ScR guidelines; a systematic search was conducted on PubMed, Web of Science, and CINAHL and included original peer-reviewed studies, commentary, reviews, and grey literature published in English between January 1990 to June 2022. In the thematic and content analysis, the authors applied the narrative review approach to identify themes and sub-themes. Forty-eight documents were identified as fully relevant to this study. The largest number of published papers were from Asia, followed by the Middle East, the United States, and Europe. IDPs in developed countries were the most researched populations. Human-made disasters were addressed by 89% of the included studies. The four main thematic categories included were "physical health," "mental health," "inadequate facilities," and "lack of healthy behaviour." The worsening of noncommunicable diseases had the highest prevalence, followed by communicable diseases. Due to their condition, forcibly displaced migrants face a triple burden of communicable diseases and noncommunicable diseases such as mental health issues. Health-related research and policy need to consider the links among disasters, health problems, and forced migration as a determinant of health in the new era of climate change-driven displacements.

A Research Translation, Implementation and Impact Strategy for the Australian Healthy Environments and Lives (HEAL) Research Network.

Healthy Environments And Lives (HEAL) is the Australian national research network established to support improvements to health, the Australian health system, and the environment in response to the unfolding climate crisis. The HEAL Network comprises researchers, community members and organisations, policymakers, practitioners, service providers, and other stakeholders from diverse backgrounds and sectors. HEAL seeks to protect and improve public health, reduce health inequities and inequalities, and strengthen health system sustainability and resilience in the face of environmental and climate change, all with a commitment to building on the strengths, knowledge, wisdom, and experience of Aboriginal and Torres Strait Islander people, culture, and communities. Supporting applied research that can inform policy and practice, and effective research translation, implementation, and impact are important goals across the HEAL Network and essential to achieve its intended outcomes. To aid translation approaches, a research translation, implementation, and impact strategy for the HEAL Network was developed. The strategy has been created to inform and guide research translation across HEAL, emphasising communication, trust, partnerships, and co-design with communities and community organisations as well as the decision-makers responsible for public policies and programs. Development of the strategy was guided by research translation theory and practice and the Health in All Policies and Environment in All Policies frameworks. As described in this paper, the strategy is underpinned by a set of principles and outlines preliminary actions which will be further expanded over the course of the HEAL Network's activities. Through these actions, the HEAL Network is well-positioned to ensure successful research translation and implementation across its program of work.

The Scorching Truth: Investigating the Impact of Heatwaves on Selangor's Elderly Hospitalisations.

Global climate change has contributed to the intensity, frequency, and duration of heatwave events. The association between heatwaves and elderly mortality is highly researched in developed countries. In contrast, heatwave impact on hospital admissions has been insufficiently studied worldwide due to data availability and sensitivity. In our opinion, the relationship between heatwaves and hospital admissions is worthwhile to explore as it could have a profound impact on healthcare systems. Therefore, we aimed to investigate the associations between heatwaves and hospitalisations for the elderly by age group in Selangor, Malaysia, from 2010 to 2020. We further explored the impact of heatwaves on the risks of cause-specific hospital admissions across age groups within the elderly. This study applied generalized additive models (GAMs) with the Poisson family and distributed lag models (DLMs) to estimate the effect of heatwaves on hospitalisations. According to the findings, there was no significant increase in hospitalisations for those aged 60 and older during heatwaves; however, a rise in mean apparent temperature (ATmean) by 1 °C significantly increased the risk of hospital admission by 12.9%. Heatwaves had no immediate effects on hospital admissions among elderly patients, but significant delay effects were identified for ATmean with a lag of 0-3 days. The hospital admission rates of the elderly groups started declining after a 5-day average following the heatwave event. Females were found to be relatively more vulnerable than males during heatwave periods. Consequently, these results can provide a reference to improve public health strategies to target elderly people who are at the greatest risk of hospitalisations due to heatwaves. Development of early heatwave and health warning systems for the elderly would assist with preventing and reducing health risks while also minimising the burden on the whole hospital system in Selangor, Malaysia.

Treatment cost assessment for COVID-19 inpatients in Shenzhen, China 2020-2021: facts and suggestions.

Background: Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020-2021. Methods: It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis. Results: The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%-51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively. Conclusions: Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.

Association Between Hydrological Conditions and Dengue Fever Incidence in Coastal Southeastern China From 2013 to 2019.

Importance: Dengue fever is a climate-sensitive infectious disease. However, its association with local hydrological conditions and the role of city development remain unclear. Objective: To quantify the association between hydrological conditions and dengue fever incidence in China and to explore the modification role of city development in this association. Design, Setting, and Participants: This cross-sectional study collected data between January 1, 2013, and December 31, 2019, from 54 cities in 4 coastal provinces in southeast China. The Standardized Precipitation Evapotranspiration Index (SPEI) was calculated from ambient temperature and precipitation, with SPEI thresholds of 2 for extreme wet conditions and -2 for extreme dry conditions. The SPEI-dengue fever incidence association was examined over a 6-month lag, and the modification roles of 5 city development dimensions were assessed. Data were analyzed in May 2022. Exposures: City-level monthly temperature, precipitation, SPEI, and annual city development indicators from 2013 to 2019. Main Outcomes and Measures: The primary outcome was city-level monthly dengue fever incidence. Spatiotemporal bayesian hierarchal models were used to examine the SPEI-dengue fever incidence association over a 6-month lag period. An interaction term between SPEI and each city development indicator was added into the model to assess the modification role of city development. Results: Included in the analysis were 70 006 dengue fever cases reported in 54 cities in 4 provinces in China from 2013 to 2019. Overall, a U-shaped cumulative curve was observed, with wet and dry conditions both associated with increased dengue fever risk. The relative risk [RR] peaked at a 1-month lag for extreme wet conditions (1.27; 95% credible interval [CrI], 1.05-1.53) and at a 6-month lag for extreme dry conditions (1.63; 95% CrI, 1.29-2.05). The RRs of extreme wet and dry conditions were greater in areas with limited economic development, health care resources, and income per capita. Extreme dry conditions were higher and prolonged in areas with more green space per capita (RR, 1.84; 95% CrI, 1.37-2.46). Highly urbanized areas had a higher risk of dengue fever after extreme wet conditions (RR, 1.80; 95% CrI, 1.26-2.56), while less urbanized areas had the highest risk of dengue fever in extreme dry conditions (RR, 1.70; 95% CrI, 1.11-2.60). Conclusions and Relevance: Results of this study showed that extreme hydrological conditions were associated with increased dengue fever incidence within a 6-month lag period, with different dimensions of city development playing various modification roles in this association. These findings may help in developing climate change adaptation strategies and public health interventions against dengue fever.

The Prevalence of Heat-related Illnesses and Associated Factors among Rice Farmers in Vietnam.

Objective: The aim of this study was to examine the prevalence of heat-related illnesses (HRI) and their associated factors among rice farmers in Central Vietnam. Methods: A cross-sectional study was conducted using a sample of 379 farmers from August to September 2021 in Ha Tinh province on the north-central coast of Vietnam. A structured questionnaire was used to collect demographic information, farming activities, heat exposure, and health issues. Multivariable logistic regression was used to identify the factors associated with HRI. Results: At least one HRI symptom was experienced by 83.4% of farmers, and two or more HRI symptoms were experienced by 55.1% of farmers during the last harvesting season (the summer-autumn rice season, 2021). Factors significantly associated with HRI were age, having chronic diseases, type of farming tasks, the number of hours working in the heat, and water intake. Farmers working outdoors for more than 4 hours in the heat were 2.3 times [95%CI: 1.14-4.69] more likely to experience HRI than those working fewer than 2 hours. A higher risk of HRI was also associated with heavy farming tasks (OR = 2.35, [1.34-4.14]), having hypertension (OR = 3.75, [1.90-7.81]), cardiovascular diseases (OR = 2.53, [1.03-6.93]), and other chronic conditions (OR = 2.51, [1.51-4.25]). In contrast, a lower risk of HRI was found in the older group (OR = 0.44, [0.22-0.87]) and increased water intake (OR = 0.46, [0.27-0.77]). Conclusions: Hot weather is a significant occupational health risk for farmers in Vietnam. Changing the working schedule, working in shorter intervals, and remaining well-hydrated should be considered in HRI prevention strategies.

Study on the death and disease burden caused by high sugar-sweetened beverages intake in China from 1990 to 2019.

BACKGROUND: To analysis the death and disease burden caused by high sugar-sweetened beverages intake in China from 1990 to 2019. METHODS: Data were obtained from the 2019 Global Burden of Disease Study. We analyzed the death cases caused by high sugar-sweetened beverages intake in China and provinces from 1990 to 2019, as well as the disease burden (including disability-adjusted of life year), years of life lost and years lived with disability, and compared the changes of death in 1990 and 2019. RESULTS: In 2019, the number of deaths attributed to sugar-sweetened beverages in China reached 46 633 with an increase of 95% compared with 1990. The proportion of deaths caused by excessive consumption of carbon-containing beverages increased from 0.34% in 1990 to 0.46% in 2019, an increase of 35%. In 2019, the top five provinces in China with more deaths caused by excessive intake of sugary beverages were Shandong, Henan, Hebei, Hunan and Guangdong, with the number of death cases 4337, 3881, 3010, 2762 and 2611, respectively. CONCLUSIONS: The number of deaths and disease burdens caused by high sugar-sweetened beverages intake in China has increased significantly over the past three decades. The burden of disease due to high intake of sugary beverages varies widely from province to province. We suggest that attention should be paid to the problem of excessive intake of high sugar-sweetened beverages for Chinese population. In addition to regular monitoring and investigation of sugar-sweetened beverage intake, comprehensive measures should be taken in China's sugar control work.

Gaps and Directions in Addressing Non-Communicable and Chronic Diseases in China: A Policy Analysis.

OBJECTIVE: Non-communicable and chronic diseases (NCDs) have become a public health problem that seriously threatens the population's health, especially in rapidly industrialized countries. Given the complexity of managing NCDs, there is growing evidence that interventions embedding or incorporating health promotion strategies can help reduce the disease burden of NCDs. This review aims to identify and map existing control and prevention policies for NCDs in China and identify gaps or opportunities for policy modifications and development, to transfer evidence-based guidelines into empirical public health intervention practices and research. DESIGN: A review was conducted to evaluate the policy documents to manage NCDs in China. Keywords "chronic disease", "health", and "policy" were used to search documents published on the Chinese official national websites. Nvivo 12.0 was used to conduct a content analysis of the policy documents. RESULTS: Fifty-six NCD prevention policies were retrieved from the search, and ten documents that incorporated the health promotion component were analyzed. The Healthy China 2030 Plan and Recommendations on Implementing the Healthy China Action are the core health policies of China's Central Government. These, coupled with three nationwide community-based projects, have provided a foundational transformation platform for health promotion implementation. CONCLUSION: This review revealed the Chinese Government's determination and commitment toward the prevention and control of NCDs and the promotion public health. Additional efforts and a focus on accelerating policy transformation and strengthening policy evaluation are required to achieve this commitment.

Healthy cities initiative in China: Progress, challenges, and the way forward.

China implemented the first phase of its National Healthy Cities pilot program from 2016-20. Along with related urban health governmental initiatives, the program has helped put health on the agenda of local governments while raising public awareness. Healthy City actions taken at the municipal scale also prepared cities to deal with the COVID-19 pandemic. However, after intermittent trials spanning the past two decades, the Healthy Cities initiative in China has reached a crucial juncture. It risks becoming inconsequential given its overlap with other health promotion efforts, changing public health priorities in response to the pandemic, and the partial adoption of the Healthy Cities approach advanced by the World Health Organization (WHO). We recommend aligning the Healthy Cities initiative in China with strategic national and global level agendas such as Healthy China 2030 and the Sustainable Development Goals (SDGs) by providing an integrative governance framework to facilitate a coherent intersectoral program to systemically improve population health. Achieving this alignment will require leveraging the full spectrum of best practices in Healthy Cities actions and expanding assessment efforts. Funding: Tsinghua-Toyota Joint Research Fund "Healthy city systems for smart cities" program.

The role of influenza in the era of COVID-19: Can we forget it?

COVID-19 has been a topic of interest since a pandemic struck in 2019. The morbidity of influenza tended to decrease due to the measures to prevent COVID-19. Indeed, influenza seems to be "ignored" in this era of COVID-19. However, influenza has not disappeared from the scene. Presented here are two examples of recent influenza epidemics in China and Australia. Possible interactions between COVID-19 and influenza are discussed. Measures against COVID-19 may reduce contact with influenza, subsequently reducing adaptive immunity against influenza in the general population. Influenza might not be center stage right now, but insufficient adaptive immunity in the population may potentially trigger a future influenza pandemic. Coinfection with COVID-19 and influenza might potentially be a thorny problem. Hence, influenza cannot be ignored. Governments around the world should take measures to prepare for a possible influenza pandemic in the future.

The effect of high temperatures on risk of hospitalization in northern Vietnam.

Vietnam is one Southeast Asian country most vulnerable to climate change. By the end of the twenty-first century, temperature could rise above 5°C across Vietnam according to the IPCC highest emission pathway scenario. However, research on the temperature-health effects from the geographically diverse sub-tropical northern region of Vietnam is limited making location specific health system preparedness difficult. This study examines the elevated temperature-hospitalization relationship for the seven provinces in northern Vietnam by using generalized linear and distributed lag models. A random-effect meta-analysis was used to estimate the pooled temperature hospitalizations risks for all causes, and for infectious, cardiovascular, and respiratory diseases. The pooled estimates show a significant effect of high temperature on hospitalizations for the same day (lag 0), when a 1°C increase in temperature above 24°C was significantly associated with 1.1% (95% CI, 0.9-1.4%) increased risk for all-cause hospital admissions, 2.4% (95% CI, 1.9-2.9%) increased risk for infectious disease admissions, 0.5% (95% CI, 0.1-0.9%) increased risk for cardiovascular disease admissions, and 1.3% (95% CI, 0.9-1.6%) increased risk for respiratory disease admissions. This research adds to the scant evidence examining heat and health morbidity effects in sub-tropical climates and has important implications for better understanding and preparing for the future impacts of climate change related temperature on Vietnam residents.

Sociodemographic, lifestyle, behavioral, and parental factors associated with sugar-sweetened beverage consumption in children in China.

OBJECTIVE: Evidence shows sugar-sweetened beverage (SSB) consumption is a risk factor for obesity and non-communicable diseases (NCDs) in children. Investigating the influential profiles, which have been examined insufficiently, will help to inform the reduction of SSB consumption. The present research examines the current trend in SSB consumption and associated factors among children in China, in order to inform policy development. METHODS: Secondary data was extracted from China's Health and Nutrition Survey (CHNS; 2004, 2006, 2009, and 2011), a repeated cross-sectional research, and a Chi-squared test was applied to compare SSB consumption in the last year, queried by social demographical, `environmental, behavioral, and parental factors. Multilevel mixed-effects logistic regression was employed to examine the trend and effects of the multiple factors. RESULTS: A total of 6015 Chinese children aged 6-17 years were investigated. From 2004 to 2011, the percentage of SSB consumption in children increased from 72.6% to 90.3%. The prevalence in urban areas was higher than the prevalence in rural areas, higher in high schools than primary and middle schools, higher in east coast affluent provinces than other provinces, and higher in high-income households than low-income households. Other associated factors include children's fast food and salty snacks preference, level of physical activity, sedentariness, and parental education. The strongest association with SSB consumption in children was the mother's SSB consumption (adjusted odds ratio: 5.54, 95% CI: 3.17-9.67). CONCLUSION: Children's SSB consumption has increased significantly in China, and is associated with socio-economic, demographic, level of physical activity, food preference, and parental factors. Future strategies aimed at reducing SSB consumption among children need to consider these factors.

Probabilistic health risk assessment of chlorpyrifos exposure among applicators on rice farms in Ghana.

Human health risk assessments of exposures to non-carcinogenic occupational and environmental toxicants have mostly been undertaken using the Hazard Quotient (HQ) approach, which largely ignores variabilities in both exposures and associated adverse health outcomes, unlike probabilistic approaches. Chlorpyrifos is a neurotoxic insecticide that is commonly applied by farmers in Ghana with limited research on associated health risks among applicators. The objective of this study was to assess health risks associated with chlorpyrifos exposure among applicators on rice farms in Ghana, using advanced probabilistic approaches that incorporate variability in both exposure doses and adverse response doses obtained from human epidemiological studies. Urine samples obtained from the applicators were analyzed for 3,5,6-trichloro-2-pyridinol (TCP)from which Absorbed Daily Dose (ADD) and Lifetime Average Daily Dose (LADD) levels of chlorpyrifos were estimated. The scientific literature was searched to identify human epidemiological data from studies that have reported chlorpyrifos adverse effects and their corresponding exposure levels. Equivalent ADD and LADD of chlorpyrifos were estimated from the human epidemiological data to obtain chlorpyrifos Toxicant Sensitivity Distributions (TSDs). Using the applicators' chlorpyrifos dose distribution and TSDs, adverse health risks among the applicators were characterized using the probabilistic approaches, Overall Risk Probability (ORP) and Monte Carlo Simulation (MCS). The probabilities of chlorpyrifos adverse health effects occurring under the chronic exposure scenarios ranged from 1 to 8%, while those for acute exposure scenarios ranged from 31 to 34%. This study indicates that while the risks of chronic adverse health effects from chlorpyrifos exposure among the applicators were low, acute health risks were high.

Relationship between flood severity and risk of hospitalisation in the Mekong River Delta of Vietnam.

OBJECTIVE: To examine the relationship between flood severity and risk of hospitalisation in the Vietnam Mekong River Delta (MRD). METHODS: We obtained data on hospitalisations and hydro-meteorological factors during 2011-2014 for seven MRD provinces. We classified each day into a flood-season exposure period: the 2011 extreme annual flood (EAF); 2012-2014 routine annual floods (RAF); dry season and non-flood wet season (reference period). We used province-specific Poisson regression models to calculate hospitalisation incidence rate ratios (IRRs). We pooled IRRs across provinces using random-effects meta-analysis. RESULTS: During the EAF, non-external cause hospitalisations increased 7.2% (95% CI 3.2% to 11.4%); infectious disease hospitalisations increased 16.4% (4.3% to 29.8%) and respiratory disease hospitalisations increased 25.5% (15.5% to 36.4%). During the RAF, respiratory disease hospitalisations increased 8.2% (3.2% to 13.5%). During the dry season, hospitalisations decreased for non-external causes and for each specific cause except injuries. CONCLUSIONS: We observed a gradient of decreasing risk of hospitalisation from EAF to RAF/non-flood wet season to dry season. Adaptation measures should be strengthened to prepare for the increased probability of more frequent extreme floods in the future, driven by climate change.

Agriculture Development, Pesticide Application and Its Impact on the Environment.

Pesticides are indispensable in agricultural production. They have been used by farmers to control weeds and insects, and their remarkable increases in agricultural products have been reported. The increase in the world's population in the 20th century could not have been possible without a parallel increase in food production. About one-third of agricultural products are produced depending on the application of pesticides. Without the use of pesticides, there would be a 78% loss of fruit production, a 54% loss of vegetable production, and a 32% loss of cereal production. Therefore, pesticides play a critical role in reducing diseases and increasing crop yields worldwide. Thus, it is essential to discuss the agricultural development process; the historical perspective, types and specific uses of pesticides; and pesticide behavior, its contamination, and adverse effects on the natural environment. The review study indicates that agricultural development has a long history in many places around the world. The history of pesticide use can be divided into three periods of time. Pesticides are classified by different classification terms such as chemical classes, functional groups, modes of action, and toxicity. Pesticides are used to kill pests and control weeds using chemical ingredients; hence, they can also be toxic to other organisms, including birds, fish, beneficial insects, and non-target plants, as well as air, water, soil, and crops. Moreover, pesticide contamination moves away from the target plants, resulting in environmental pollution. Such chemical residues impact human health through environmental and food contamination. In addition, climate change-related factors also impact on pesticide application and result in increased pesticide usage and pesticide pollution. Therefore, this review will provide the scientific information necessary for pesticide application and management in the future.

Collaboration and Cooperation of Public Health Service Management in China.

OBJECTIVES: Collaboration and cooperation are critical for public health management. Nevertheless, collaboration and cooperation between government departments, as well as other entities, are still in a weak condition in China. This article analyzes the status of collaboration and cooperation in the management of public health services in China and explores the problems and gives strategic suggestions for strengthening collaboration and cooperation in the development of public health service systems in China, in order to provide a reference for improvement of public health management in the future. METHODS: This study uses a qualitative case study approach, including documents review, in-depth interview, and focus group. RESULTS: The main problems of collaboration and cooperation in public health service management in China include problems of effective collaboration and cooperation between institutions and relevant departments, public information platform, and implementation of public health and health promotion. On this basis, several relevant policy recommendations are put forward. CONCLUSIONS: Collaboration and cooperation are critical for the overall coordination and sustainable development of public health in China, and there is still work to be done in order to achieve appropriate cooperation and collaboration between different entities in the provision of public health services.