China’s legendary village-based health care system, known as the barefoot doctors program, helped inspire a global movement. In 1978, the World Health Organization successfully persuaded 134 health ministries to sign on to a “health for all” declaration at the International Conference on Primary Care in Alma-Ata, in the Soviet Union, in 1978.

China’s emphasis on providing primary health care to even the most remote areas has paid off. Yet, despite impressive health progress, massive disparities persist within China.

A new study published this week in The Lancet by researchers from the Institute for Health Metrics and Evaluation (IHME) and from government agencies and research centers in China shows that the country reduced its under-5 mortality by 70 percent from 1996 to 2013. More than 2,500 counties in China achieved the fourth Millennium Development Goal (MDG 4) of a 4.4 percent or greater annual rate of decline in under-5 mortality. The authors also looked at under-5 mortality in ethnic minority groups. They found that 23 out of 25 minority groups had achieved MDG 4 with an annual rate of decline that actually exceeded 4.4 percent.

Annualized rate of decline in under-5 mortality by county, 1996-2012

Source: Under-5 mortality in 2,851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China

Despite all this progress, authors found huge disparities in child mortality across the country. The counties with the lowest rates of under-5 deaths in China have levels similar to high-income countries including Japan, Australia and Germany. In the counties with the highest levels of under-5 mortality, however, death rates are similar to those seen in sub-Saharan African countries such as Burkina Faso and Cameroon.

A second study also published this week in The Lancet by the same authors examined life expectancy and causes of death across Chinese provinces.

Source: Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013

Life expectancy rose in all provinces, and the gap among provinces with the highest life expectancy and lowest life expectancy shrank over time from 19 years in 1990 to 12 years in 2013. In 2013, life expectancy was highest in provinces such as Shanghai, Beijing, and Hong Kong (around 80 years), which was comparable to levels seen in countries with the highest life expectancy in the world, such as Switzerland, Sweden and Australia. In provinces with the lowest life expectancy (around 68 years), including many of the southern provinces, life expectancy is comparable to countries such as Indonesia, Nepal and Bangladesh.

As life expectancy has risen in China, non-communicable diseases have become major health threats. For example, stroke was the leading cause of death in 27 out of 33 provinces in 2013.

Also, as the country has grown economically, road injuries have become a leading killer. Road injuries were among the top 10 causes of death in every province in China. Most of these deaths occurred in pedestrians and motorcyclists.

You can also visit IHME’s website to explore disease trends across the country. For example, the screenshot below, taken from the GBD Compare tool, shows disease burden patterns in the different provinces. The red and pink shading shows that provinces such as Xinjiang and Guizhou have the highest rates of disease burden from communicable, maternal, newborn and nutritional diseases.

Burden of disease by province, both sexes, China, 2013

Source: Global Burden of Disease 2013 Study; GBD Compare http://ihmeuw.org/3p8k

Note: Data show rates of disease burden measured in disability-adjusted life years.

Even as China’s economy and global influence grows and it provides increasing amounts of foreign aid, it faces large health disparities within its own borders. Given the tremendous health progress the country has made to date, however, it seems likely that these disparities will continue to shrink.