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.