Urban health

Cultural impact in Shanghai, China

21 April 2021

4 min read

In Shanghai, we saw how the city’s approach to urban health recognises the significance of social and cultural factors on health.

This city profile is part of a series of ten, exploring how cities around the world are addressing health inequalities. Read the full report and sign up to receive more insights from us.

About Shanghai

Shanghai is China’s economic engine and most populous city. It is one of the largest cities in the world with more than 27 million residents (three times the population of London).

Shanghai’s downtown is densely built around its historic core along the Pudong River and has expanded outwards in former farmland areas now covered with medium to high-density residential complexes accommodating the emerging Chinese middle-class. Over the last decades the city has invested in an efficient public transport infrastructure, with over 400 stations and 700 km of subway lines, which serves some of the world’s densest residential urban neighbourhoods.

Life expectancy in the city has more than doubled since 1949 and Shanghai is the first city in China to match the profile of an ageing population, with 35% of the population 60 years or older. This ‘greying’ of Shanghai’s population also reflects changes in disease patterns, which have shifted from infectious diseases and infant health problems to non-communicable diseases such as diabetes, heart disease and stroke.

This shift in health patterns was likely both spurred by, and has continued to influence, health policy and public health approaches in Shanghai. The State Council has set out to limit the population of Shanghai to 25 million people by 2035 in an attempt to manage ‘big city disease’ associated with environmental pollution, traffic congestion and a shortage of public services. China also has an overarching national domestic population health policy – The Healthy China 2030 plan.

In numbers

27m

residents of Shanghai

40%

of the population are from other parts of China

150k

foreign residents are officially registered in the city

Taking a social and cultural approach to health

Understanding the influence of social and cultural factors on health in cities is vitally important. This initiative made the clear distinction between culture and ethnicity. Many of the barriers to good health encountered in this initiative related to culture – generational differences, habit and conventions that changed as people move and migrate within countries.

By making a clear distinction between ethnicity and culture, this project identified that transitioning from one place to another and the adjustment needed has a big impact on health – a finding that has clear implications for cities with high levels of ethnic and cultural diversity. As with any collaboration, reflective practice was key and even more important when exploring the nuances and unspoken rules of culture. By developing a shared framework and a willingness to reflect on emerging lessons, the team were able to adapt practices.

Initiative explored: Cities Changing Diabetes

Cities Changing Diabetes is a partnership programme launched by Novo Nordisk, University College London (UCL) and the Steno Diabetes Center. It explores the cultural and social factors driving type 2 diabetes in urban contexts and creates solutions according to local needs. Research by the University and local academic teams inform interventions locally. A distinctive feature of their approach is its engagement with culture and how cultural paradigms affect the way that people interact with spaces and services.

How has this approach supported improvements in health?

11.3% of the adult population (aged 20-79) in Shanghai has diabetes and the prevalence is projected to reach 18.2% in 2045 if action is not taken. The National Office for Diabetes Primary Care in Shanghai has created a network of directors of community health centres and primary care physicians. They meet regularly to improve the prevention and control of diabetes in community health centres. Standard diabetes treatment and referral guidelines have been created and shared.

While more than 2,000 healthcare professionals, including primary care physicians and nurses, have received training at over 240 community health centres in Shanghai. The programme has helped to create a unified approach to caring for people with diabetes and has also improved communication between policy makers and healthcare services in the city.

It’s really shifted the conversation. By pushing the word culture into mainstream discussions about diabetes, there is more conversation about social and cultural determinants than there ever has been.

Anna-Maria Volkmann UCL Research Lead, Cities Changing Diabetes, Shanghai and Mexico City

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