Correspondence www.thelancet.com Vol 388 September 24, 2016 1279 use of alcohol and the commitments to increase trade liberalisation in the UN’s Sustainable Development Goals 2016–30, which are leading to increasing alcohol availability. Such conflict has affected China. Along with rapid economic growth, Chinese alcohol consumption (in individuals aged 15 years and older) increased dramatically from 2·5 L per capita in 1978 to 6·7 L in 2010, and an estimated consumption of 8·8 L in 2012. 2,3 After a small decline in consumption in 2013 due to the government’s anti-extravagance campaign, China’s alcohol imports increased in value by 30% between 2014 and 2015, 4 and the Australian Government predicts a rapid growth in Australian wine sales in China following the China–Australia Free Trade Agreement, which came into effect on Dec 20, 2015. 5 The Chinese Government regards free trade agreements as a new platform to increase national sustainable development, and an effective approach for integration into the global economy and to strengthen economic cooperation with other countries. The potential for adverse public health effects from some commodities covered by the agreements does not seem to be noted or taken into account. Although alcohol has been recognised as an important health risk factor in China, the social and health issues associated with alcohol use and abuse, particularly with respect to non-communicable diseases and injuries, have been largely neglected. The 2013 Global Burden of Disease Study showed that alcohol use was ranked as the greatest risk factor for men in China aged 15–49 years in terms of attributable disability-adjusted life-years (DALYs) lost, contributing to more than 120 000 deaths and over 8 million DALYs among young and middle-aged men each year. 6 Furthermore, there is almost no alcohol control policy in China, unlike in other countries. 7 activity trends over time, locally and nationally. Worsening ambient air quality and a paucity of protective measures present a serious problem to the promotion of healthy and safe community-based outdoor physical activity. Additionally, high- quality epidemiological evidence or prevalence data to guide and evaluate population activity are scarce. Overall, the plan represents a timely and needed public health initiative, but the need for a more comprehensive and sustainable solution remains. We declare no competing interests. *Fuzhong Li, Yu Liu, Wenfei Zhu, Peter Harmer fuzhongl@sus.edu.cn Oregon Research Institute, Eugene, OR, USA (FL); Key Laboratory of Exercise and Health Sciences, Ministry of Education, Shanghai University of Sport, Shanghai 200438, China (FL); Shanghai University of Sport, Shanghai, China (YL); School of Physical Education, Shaanxi Normal University, Xi’an, Shaanxi, China (WZ); and Willamette University, Salem, OR, USA (PH) 1 The State Council, The People’s Republic of China. China to implement national fitness program. 2016. http://english.gov.cn/policies/ latest_releases/2016/06/23/content_2814753 78214258.htm (accessed June 24, 2016). 2 Mi YJ, Zhang B, Wang HJ, et al. Prevalence and secular trends in obesity among Chinese adults, 1991–2011. Am J Prev Med 2015; 49: 661–69. 3 Tian Y, Jiang C, Wang M, et al. BMI, leisure-time physical activity, and physical fitness in adults in China: results from a series of national surveys, 2000–14. Lancet Diabetes Endocrinol 2016; 4: 487–97. 4 Ng SW, Howard AG, Wang HJ, Su C, Zhang B. The physical activity transition among adults in China: 1991–2011. Obes Rev 2014; 15 (suppl 1): 27–36. 5 The World Bank. Toward a healthy and harmonious life in China: stemming the rising tide of non-communicable diseases. Washington, DC: World Bank, 2011. http://www.worldbank.org/content/dam/ Worldbank/document/NCD_report_en.pdf (accessed June 24, 2016). health, which is increasingly adversely affected by the unprecedented economic development in the world’s most populous country. Three decades of economic reforms and urbanisation have brought unintended health consequences across Chinese society. These consequences include an increased prevalence of overweight and obesity among Chinese adults in the past 20 years, 2,3 which has been accompanied by a steady decrease in physical activity 4 and an increase in poor diet; both contributing to the risk of developing non- communicable diseases (NCDs). More than 580 million Chinese adults are estimated to have at least one NCD, which account for more than 80% of China’s 10·3 million annual deaths and 68·6% of the total disease burden. 5 These changing realities have finally resulted in this call for increased public health efforts to expedite the promotion of physical activity and health among Chinese adults. The plan is commendable, but falls short in key aspects. Firstly, although substantial investment is expected, the plan does not identify specific targets or health outcomes to be achieved. Secondly, it gives insufficient attention to the development of evidence-based exercise interventions to promote physical activity in the overall population or in subpopulations that are most at risk of physical inactivity and NCDs. Finally, the plan, which is primarily policy driven, has few specific public health strategies that recognise variations in individual, social, and environmental factors to allow implementers to maximise local collaborations of physical activity promotion for the greatest community impact. The plan also faces significant challenges. Apart from an absence of national physical activity guidelines, there are no surveillance systems at the various levels of implementation necessary to monitor physical Alcohol and the Sustainable Development Goals The Comment by Jeff Collin and Sally Casswell (June 25, p 2582) 1 describes the conflict between public health policy on reducing harmful 06photo/Shutterstock.com