what really matters: living longer or living healthier; comment on “shanghai rising: health improvements as measured by avoidable mortality since 2000”

the decline in avoidable mortality (am) and increase in life expectancy in shanghai is impressive. gusmano and colleagues suggested that shanghai’s improved health system has contributed significantly to this decline in am. however, when compared to other global cities, shanghai’s life expectancy at birth is improving as london and new york city, but has yet to surpass that of hong kong, tokyo, and paris. over the past decade, the reduction in am of shanghai is just in line with the international experience in reducing avoidable premature deaths. we suggest that a more elaborate research design is needed to examine the impact of the improvement in shanghai’s health system on its population health status.