Adolescent health and Healthy China 2030: a cross-sectional study. (October 2018) - Dong, Bin
Abstract: Background: The Chinese government approved the Outline of the Healthy China 2030 (HC2030) Plan in 2016, and made public health a priority for all future economic and social development. Studies have demonstrated the importance of investment in health care throughout the 8000 days that it takes for a human to develop, on reducing the disease burden in this group. Therefore, as well as children, adolescents should be recognised as an essential target population for health-care investment, and HC2030 plans to achieve key goals in adolescent health. This study aims to explore the gaps in adolescent health care that must be bridged, and to examine experiences from previous policies for lessons that will help the goals of HC2030 in adolescent health to be realised. Methods: Policies relating to adolescent health issued by the Chinese government during the past three decades were reviewed. Data from the Global Burden of Disease study (1990–2016) and seven cycles of national successive cross-sectional survey, the Chinese National Survey on Students' Constitution and Health (1985–2014), were used. Trends and geographical distribution of essential indicators, including overweight and obesity, stunting, poor vision, oral health, physical activity, and smoking, were analysed in students aged 10–19 years who were selected from primary and secondary schools in 31 provinces of mainland China using a multistage cluster sampling method. The current situation was compared with the targets of the HC2030 to identify gaps between the two. This study was approved by the Ethic committee of Peking University Health Science Center (IRB00001052-18002) and informed verbal consent was obtained from participants or their guardians. Findings: Policies issued by the Chinese government have contributed to great improvements in adolescent health. For example, all-cause mortality has halved in the past 26 years, and the prevalence of stunting declined from 16·1% in 1985 to 2·8% in 2014. However, critical challenges to reaching the goals of HC2030 were also observed. The prevalence of overweight and obesity increased from 1·1% in 1985 to 18·2% in 2014, and only 1·6% of adolescents in 2014 had excellent physical fitness based on the National Student Physical Fitness Standard. According to the goals of HC2030, the increasing prevalence of overweight and obesity should be controlled, and 25% of adolescents should have excellent physical fitness in 2030. Thus, there is a substantial gap to be bridged by 2030. Additionally, the geographical imbalance in health achievements is substantial (eg, the prevalence of stunting was 0.48% in Beijing, but 11·1% in Guizhou province in 2014). Interpretation: Although great achievements have been obtained, our findings call for strengthened practical policies to improve adolescent health, reduce the geographical imbalance in health achievements, and to achieve the goals of HC2030. Funding: This work was supported by the National Natural Science Foundation (81673192 to JM and 81773454 to ZZ), and the Excellent Talents Fund Program of Peking University Health Science Center (BMU2017YJ002 to BD).