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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.