Country Profile

China

The Status of Chinese People's Physical Fitness and Health and Future Prospectives

by Professor Yu DaoZhong, Director of Mass Physical Education at China's National Research Institute of Sports Science

 

I. Introduction

I am Professor Yu DaoZhong, the director of the Department of Mass Physical Education at China's National Research Institute of Sports Sciences. I am also the deputy director and secretary of the Chinese National Academic Association of Physical Fitness and Health.

In June, 1996, at the invitation of Dr. Karch, Professor Gao DaAn and another research scholar in our Institute visited Washington, DC. They participated in the inaugural meeting of the International Institute of Health Promotion (IIHP) and set up friendly interrelationships with the participating scholars from all over the world.

Soon after that, we founded China's Institute of Health Promotion (CIHP). As the vice director of China's National Research Institute of Sports Sciences and the director of the Chinese National Academic Association of Physical Fitness and Health, Professor Gao was elected to be the chairman, and I was elected to be the vice-chairman of CIHP.

CIHP has two solid academic foundations. The first is China's National Research Institute of Sports Sciences, which was founded 39 years ago. It is the largest comprehensive research institute in China's sports science field and has many nationally known scholars. There are more than 200 researchers in it, including 25 professors and 34 associated professors. The second is the Chinese National Academic Association of Physical Fitness and Health. Combined with many famous specialists, not only from the sports sciences, but also from medicine, public health, education, and other scientific domains. This association has made a great contribution in making the strategies and projects for promoting Chinese people's physical fitness, life quality, and health. Because of these reasons, the CIHP sincerely wishes to have close relationships with IIHP, to strengthen the interchanges of technical information between us, and to make more contributions to the health levels of people in China, in U.S.A., and in the whole world. The activities of CIHP need as wide as possible support, both from the government and society. Since the establishment of the People's Republic of China, the government has always placed great emphasis on public health, social welfare, and mass physical education, especially for the children, adolescents, and women. In many government organizations, there are special administrative structures. For instance, there is a Department of Mass Physical Culture in the State Physical Culture Commission, a Department of Maternal and Child Health in the ministry of Public Health, and a Department of School Health and Physical Culture in the State Education Commission, etc.

Since the 1990s, a national working community, the "Maternal and Child Health Working Community", has been set up in our country, which is lead directly by the Central Government, the National Council of China. There are many social organizations that emphasize promoting mass physical education and health. It should be noted that most of the great achievements have been in the area of child and youth physical fitness and health, based on the nationwide school health promotion system, which was established the 1980s. Most of the progress in promoting adult physical fitness and health has been made in the last five years.

II. Achievements in Health Promoting Progress of China

1. The Nationwide Surveillance on the Different Populations

Now, a nationwide surveillance network on people's physical fitness and health is being perfected in China. Several epidemiological surveys have been made in the whole country in order to know the basic levels of health status and physical fitness of different populations in different age periods. For instance, the Ministry of Public Health organized three national surveys, including the 1975, 1985, and 1995 Children's Growth, Development and Health Surveys. In each of these studies, more than 2OO,OOO children aged 0 through 6 years participated. In addition, the State Physical Culture Commission and the State Education Commission organized the 1979, 1985, 1991, and 1995 National Surveys on Physical Fitness and Health of Chinese school students. Each time, more than 300,000 students aged 7 through 22 years participated in the survey. The 1985 national survey has been the largest one so far in Chinese history, not only shown in its large samples (more than one million participants), but also shown in the data of 27 minority nationalities who have never been investigated before.

In 1994, joining with China's State Trade Union, the State Physical Culture Commission organized the first survey on the health status and physical fitness of Chinese adult workers and staff members. In total, there are more than 120,000 adults aged 18 through 59 years old (18-54 years for the females) who came from 22 provinces. Twenty-one trades participating in this survey.

Our Institute also had two Sino-Japanese cooperative studies with the Japanese scholars. The first was a comparative study of ordinary children and youth in 1986. The subjects were from Beijing and Tokyo, respectively. The second was held in 1989, which focused on comparing the different physical fitness levels of track and field juvenile sportsmen in China and Japan. By doing these investigations and surveys, we found the baselines for physical fitness of different Chinese populations and explored many intervention strategies and methods for promoting the health status and physical fitness of various populations. These studies also have comprised the basis of setting up the national surveillance network.

2. Achievements in the Population Health Status

Here, let me focus on reporting the rapid progress of health promotion in China, and the great achievements in maternal and child-health.

A. The progress of maternal health is developed from no baseline. There wasn't any maternal health system forty-five years ago. Since the establishment of People's Republic of China, the maternal health network has been set up. In 1995, the cover rate of this network reached about 97% of all Chinese living in the urban areas, whereas the cover rate in the rural areas had reached about 66%. Thus, the mortality of pregnant women in 1995 has been significantly decreased, to only 1/7 to 1/6 of the mortality in 1950.

B. The mortality of infant and young children has been significantly decreased (eg. the infant mortality was 67% in 1995, 73.2% lower than that it was in 1950). The mortality of the young children below age 5 years has gone down to 43%, which was 85.7% lower than it was in l950. In Beijing, Shanghai and several other metropolises, the mortalities of infant and young children are even lower than 1O%.

C. The health status of children has greatly improved (e.g., many infectious and deadly diseases, such as tetanus infection, measles, pertussis, diphtheria, etc., have already been stamped out or have been steadily controlled).

D. The growth and development of children has significantly (e.g. the mean stature of infants in 1995 is 3.5 cm for the boys and 3.6 cm for the girls, respectively, higher than those in 1955). The means of body weight of one-year infants in 1995 are 1.25 kg for boys and 1.04 kg for girls respectively, higher than those in 1955 . As for the youths aged 7 through 17 years old, the means of stature in 1995 are 3.28 cm (for boys) and 2.68 cm (for girls) respectively, higher than those in 1985, whereas the means of body weight in 1995 are 1.56 kg for boys and 2.56 kg for girls, respectively higher than those in 1985.

Accompanying the improved energy-protein intake, the nutrition status of children and youths, especially for those in early childhood, is also greatly improved. The morbidity of iron-deficient anemia is down, whereas the serious degree of anemia has almost disappeared in Chinese children.

E. Accompanying development, the Chinese youth's physiological functions and motor abilities has also risen steadily. Compared with that in 1985, several items of motor ability of the Chinese youth, such as the minimum velocity, muscle strength, agility, and jumping in 1995 are evidently higher.

F. Strongly pushed forward by the "Chinese Entire People Physical Exercise Promotion Project", mass sports activities are very active in China during recent years. Many young and middle age adults take an active part in the physical exercises. In the metropolises, 50% of the workers and staff members perform different kinds of sports and exercises regularly. The "Chinese National Standard of Physical Exercise" has already spread over the primary and secondary schools, colleges, and universities all over the country. From 1983 to 1995, the number of students who have passed the national physical exercise standards increased by 7,000,000 every year in China. At the end of 1995, the schools which had carried out the "Chinese National Standard of Physical Exercise" numbered 88.8% of the total schools, and of that total there were more than one hundred million students who had passed the exercise standard.

III. Existing Problems in Health Promotion Progress in China

There are still many problems and shortcomings in the health promoting progress in China. These problems should be overcome as soon as possible.

1. The Problems in the Prevention and Therapy of Child Diseases Pneumonia and Diarrhea are still the most common diseases which are seriously imperiling the life of Chinese infants. The early prevention, diagnosis, and treatment of these diseases in some rural and outlying districts have to be improved as soon as possible. Some infectious diseases, such as the epidemic cerebrospinal meningitis, influenza, mumps, pertussis, diphtheria, tuberculosis, A-type hepatitis, B-type hepatitis, and bacillary dysentery are still present in scattered rural areas. In 3-5 year olds, there will be a small prevalence in some districts.

Because of the fact that more than 90% of the Chinese population live in the iodine-deficient areas, the iodine-deficient disease is still seriously impelling the children's health.

Myopia is the most common physical deficiency in the Chinese school age children and youth. The incidence of myopia are 20.6%, 49.8%, and 65.0% in the primary school, junior middle school and senior middle school students, respectively. Moreover, the incidence of myopia still shows a generally rising tendency, especially in the school girls and especially among the rural populations. (e.g., it rose from 10.4% to 11.3% in the primary school boys and from 14.4% to 15.7% in the primary school girls, and it rose from 37.9% to 44.6%, and from 59.29% to 64% in the junior and senior middle school girls respectively, during the 1985-1995 period). The incidence of myopia is even as high as 76.74% in the college students, and has risen in the last ten years from 63.9% to 71.7% and from 67.2% to 77.6% in the males and females, respectively.

2. The Problems of children's nutrition status

Although the energy-protein intake of Chinese children and youth has been significantly increased during the recent 20 years, mild malnutrition is still a big problem in China. On the other hand, overweight and obesity has become a more prevalent problem in the metropolitan populations (e.g. an epidemiological survey shows that among the students aged 7 through 12 years in Beijing, 6.9% of boys and 6% of girls are overweight whereas 29% of the boys and 28% of the girls are in the underweight or malnutrition category, according to the NCHS norm which is recommended by WHO). We call this the "two-peaks phenomenon of nutrition problem". It clearly means that in order to improve the population's health status, we have not only to increase the children's food intake, but also have to popularize the nutritional knowledge in the children's family, and help the children and youth to set up good dietary and physical exercise habits, in order to improve their life quality.

3. The Prevalence of "modem civilization syndromes"

Accompanying the rapid socioeconomic progress, some so-called "modem civilization syndromes" are now spreading over China's relative developed areas. These syndromes, such as the "exercise-deficiency syndrome", "TV overview syndrome", "emotional self-closed syndrome", and "city-crowded syndrome" , have different special psychological, emotional and behavioral aspects. Some of these problem are already widespread over the newly developed countries. Some of them have spread to China's districts, especially because of the popularization of one-child families in the urban areas, and because of the over crowding of children in these families. These modem civilization syndromes will directly or indirectly cut down the adaptive ability of children to the social and environmental changes, and decrease the natural immuniological resistance to the bacterium, virus, and parasitic invasions.

4. The Reductive Tendency of Physical Endurance of Chinese Youth

Reported by the 1995 National Surveillance on Physical Fitness and Health in Chinese School Students", the physical endurance of Chinese youth, especially in the urban population, are generally showing a reductive tendency. These inadequate physical fitness scores are not only shown by several physiological measures, such as the vital capacity, but also shown by many motor fitness scores, such as those reflected by the sit-up, pull-up, endurance run and trunk flexion, etc. In the 1995 sample, about 70%-85% of the sex-age groups youth aged 7 through 22 years old showed greater evidence of inferiority of physical endurance than that in the 1985.

5. The Difficulty in the Popularization of Mass Physical Exercise

According to the 1992 National Survey on Physical Fitness and Health Status of Chinese Workers and Staff Members, the entire physical exercise promotion program is still in its starting point. Most of the Chinese adults who have enthusiasm for doing physical exercise concentrate on the youngsters aged 18 through 29 years, as well as in the middle age groups older than 50 years. The youngsters like doing sports, but they select the sports not for the purpose of improving their physical fitness but to their self-interest. Most of them do not participate sports and exercise regularly, e.g., three or four times in every week. The middle age adults older than 50 years put even more enthusiasm than the youngsters in participating the sports. However, most of them haven't mastered the motor skills. They are also eager to know how to use the scientific knowledge to raise their physical fitness and health status through exercises. However, the biggest problems exist among the population of golden- working -ages (30-50 years old adults). Both because of the hard stress of working and household lives, and because of the low enthusiasm for participating sports, only 10.3% of them regularly take an active part in the "Entire People Physical Exercise e Promotion Activity".

6. The Urgent Tasks in Preventing the Early Degeneration in Adults

The 1992 National Survey also shows that among the Chinese workers and staff members, the morbidities of several diseases, such as the hypertension, coronary heart diseases, diabetes mellitus, and other diseases occur in the pulmonary, liver, kidney organs, increase rapidly with age. About 20% of the people aged 41-50 years have at least one of the symptoms mentioned above, whereas total morbidity of these degenerative diseases rises to 30% of the population. To take the male's 56-59 years group as an example, the morbidities is 10.9% for hypertension, 4.8% for coronary diseases, 1.4% for diabetes mellitus, 0. 8% for pulmonary dysfunction, as well as 1.1% for the urinary dysfunction.

IV. The strategies and methods for promoting health in the prospective future

In order to push the "National Entire People Physical Exercise and Health Promoting Project" forward all over our country, the Chinese government has formulated a special policy, and made and enacted a series of laws and decrees. According to these policies, laws, and decrees, combined with specialists in other domains, the of Health Promotion (CIHP) also made a series of strategies, methods and intervention projects, for the purpose of promoting the entire Chinese people's health, physical fitness and life-quality.

1. Strategic targets for promoting child health

According to the "1990's Child Developmental Project Outline China", the following targets are projected to be fulfilled in 2OOO.

A. Cut down the mortality of children. In 2000, the infant mortality and the mortality- of young children aged 5 years below should have been 1/3 lower than that in 1990.

B. Increase the cover rate for child health network. In 2000, the cover rate of child health network should be increased to 85% of the total population in each of the provinces in China.

C. For the purpose of improving children's nutrition status, ensure, that in 2000, more than 8O% of the children in malnutrition status can get basic food supplements and nutritious foods. The production of these foods and supplements in the factories should be strictly made according to the national industry food additive standards.

D. Cut down the incidence of middle and severe malnutrition in children by 2000.

E. Extend the cover rate of immunizations. In Chinese rural areas, to raise the cover rate of the immunization system from 80% in 1990 to 90% in 2000.

F. Eliminate the poliomyelitis infection in Chinese children. Cut down the mortality and morbidity of measles by 95% and 95%, respectively; lower than that before the WHO Global Expended Program on Immunization (in 1979).

G. Cut down the mortality of diarrhea. In 2000, the mortality and morbidity of diarrhea in young children aged 5 years below should be 50% and 25%, respectively, lower than that in 1990.

H. Ensure that in 2000, more than 90% of the child patients with acute pulmonary infections can get early treatment and health care. Cut down the mortality of acute pulmonary diseases. Let it be 1/3 lower than that in 1990.

L. Eliminate the Iodine-deficient disease in childhood, and effectively control the Vitamin A-deficient disease.

J. Expend the cover rate of health education in pre-school children. Ensure that in 2000, this cover rate will reach to 90% in cities and 80% in the countryside, respectively.

K. Raise the quality of education and environmental health significantly for the pre-school children. Ensure that in 2000, 80% of the nurseries and kindergartens in the cities and 50% of them in the rural areas will pass the annual monitoring of administrative agencies.

L. Cut down the mortality of unexpected accidents in the pre-school children. Let it be lower than 10- 15/100,000 in the cities and 20-30/100,000 in the rural areas, respectively.

M. Cut down the morbidity of myopia in the school age children and youth. Let it be lower than 12% in the cities and 8% in the rural areas by 2000, respectively.

N. Cut down the infectious rate of roundworm (the main parasitic disease in China) in pre-school and school age children. Let it be lower than 1O% in the cities and 25% in the rural areas, respectively by 2000.

0. Cut down the morbidity of iron-.deficient anemia in school age children and youth. Let it be lower than 3O% in the cities and 4O% in the rural areas by 2000, respectively.

P. Cut down the incidence of dental caries in the pre-school age and school age periods. For the 5-6 years old pre-school children, for example, the incidence of children with non-dental caries should have risen to 20% in the cities and 25-30% in the rural areas by 2000, respectively.

2. The Focal Points for Fulfilling the Strategic Targets of Child Health Promotion

In order to fulfill the strategic targets of child health promotion, our country enacts the following four focal points:

A. In the supplementation and distribution of financial resources, put the stress in the rural areas.

B. In the supplementation and distribution of technical resources, put the stress on the local doctors and health promotion personnel. (e.g. conduct training, courses regularly, in order to raise their preventive ability of planing immunization and monitoring the growth and development surveillance of young children, and raise their therapeutic ability in the diagnoses and treatment of pneumonia, diarrhea, anemia and rickets.

C. In the management of maternal-child health promotion, put the stress on the establishment of three-grade health network. That is, the province-county village health network in the rural areas, and the city-district-residential community in the urban areas.

D. Focus on helping and protecting special groups of children. For example, eliminate the sex discriminate in some remote and rural areas, and protect their rights in childbearing, entering school, and obtaining employment. Set up living and health centers for the crippled and handicapped children. Enhance the early diagnosis, treatment, and rehabilitation of the blind, deaf-mute, disabled, and mentally retarded children. In order to enable children living in impoverished families to receive education, we are going to enhance the national "Educational Hope Project"

3. The Intervention Methods for Fulfilling the Strategic Targets of Child Health Promotion

A. Push forward the formulation and perfection of laws and decrees, such as the "Law of Family Education "Manage law of Child Health Practice", "Protection Law of the Minor Children", "Sales Law of Breast-Milk Substitutes etc., in order to facilitate the rapid progress of the health promotion project.

B. Push forward the social responsibility system, to facilitate the progress of service network of child health insurance.

C. For the purpose of raising people's life quality from the early days, we initiate three principles of childbearing in the whole society. These principles are: good birth, good bringing-up, and good education.

D. Based on the day-care center, nursery, and kindergarten, develop a school-family-society three-dimensional educational system for the pre-school children.

E. Provide enough administrative support, to encourage the manufacture, sales, and production of children's special food, toys and living apparatus, for the purpose of promoting their physiological and psychological growth and development.

F. Provide well-equipped places and healthy out of school courses for the school age children. During the architectural design of each newly resident community and new countryside, enough and safe playing sites for the children is the first factor to be considered.

G. Based on the resident community, we plan to hold special training courses, for the newly married couples, pregnancy women, and the children's parents, respectively, in order to popularize the scientific knowledge and skills of childbearing.

4. Strategic Targets for Promoting School Children's Health Status and Physical Fitness

As we have mentioned above, although there was a strong accelerating trend of physical growth existing among the Chinese students, their physiological functions and physical endurance generally doesn't show the corresponding improvement. Another problem needed to be overcome is the rapid increase of myopia, dental carries, and other school deficits. The factors for causing these differences are as follows:

A. In China, school health and physical exercise haven't gotten enough emphasis from most of the school administrative authorities. There are serious shortcomings in the financial supplementation for promoting the school health service. The school physical exercise is also seriously limited by the shortcoming, of well-equipped sports places and apparatus in most of the primary and secondary schools, especially in the rural areas.

B. Both the school authorities and the parents focus on encouraging the children to rise to the high-quality schools. The students have too much housework to do. They can't get enough time for playing and doing out of school exercise.

C. Although the life condition has significantly improved in China during the recent years, most of the children's families still are absent in nutritional knowledge. Thus, many children don't get balanced nutrients. They diets are also not reasonable.

D. In many one-child families, the parents over drown their children. This prevents these children from having the chance to learn how to raise their patience and resistance to stress. Many children haven't the enthusiasm to do endurance exercises.

In order to overcome the problems mentioned above, we are going to take the following improving methods.

A. By using the influence of all kinds of mass communication; to publicize the importance of school health-exercise practice in promoting children's health status and life quality, to construct a good environment which can encourage both the parents and school authorities, and to support children's health promoting practice.

B. Seriously carry out the "Regulations Regarding the School Health Practice" and the "Regulations Regarding the School Physical Education" enacted by the central government of China. We are going to improve the guidance, administrative management and regular monitoring of the school health-exercise works.

C. Ensure that in each of the primary schools, middle schools, and colleges, that there are enough time arrangements, ideal schedules, and well-equipped places and apparatus for the students to do physical exercises. In the arrangement of physical culture classes, out of class physical fitness courses and school sports activities, increase the items, contents and time for endurance exercises. The exercises concerning the pulmonary and cardiovascular fitness are specially encouraged. We also plan to enhance the training of patience, steadfast, bright, and cheerful personalities of the children and youth.

D. By using the school-life monitoring, to ensure that every school is carrying, out the limitation of students loan of housework.

E. By using school health education, to encourage the students to set up good dietary habits and eat nutrients-balanced foods. At the same time, we are also going to open a series of nutrition knowledge courses, especially in the schools for children's parents. The school lunch system is projected to be spread over Chinese urban areas in the future years. We will also make and enact corresponding regulations and rules for the scientific management of school lunch system.

F. Specially concern the school health and physical exercise practice in the remote and impoverished rural areas. Among all the interventions conduct, financial and technical support, as well as training courses for local teachers and school nurses, are the first things to be considered.

5. Pay More Attention to the Mass Physical Exercise. Further enhance the "National Entire People Physical Exercise Promotion Project"

The leaders of our government, such as Mao Zedong, Zhou Enlai, Deng XiaoPing, always emphasize the importance of raising the health status and physical fitness of the whole Chinese population. In a national administrative meeting in 1996, the present National Chairman, Mr. Jiang ZeMing said: "The most important task for all the physical culture personnel is to raise the health and physical fitness levels of our people. The physical fitness of 1.2 billions people has more crucial importance than the prosperous alone and economic status alone, because it is the signs of the strong and civilization of a country." As the premier of the China's State Council, Mr. Li Peng also told the commanding sports and physical culture officers coming from the provinces that "What is the Sports policy? I think that the crucial task of this policy is to really transfer the keys of sports and physical culture to the enhancement of people's physical fitness. Our responsibility is to put all of our stress into the work of promoting people's (here, I means the twelve hundred million Chinese people) physical fitness and health. These indications greatly encourage our spirits, and have strongly pushed forward the activities of the mass physical exercise all over the country.

Our strategies and emphasis the on promoting the "National Entire People Physical Exercise Promotion Project- are as follows.

A. Enhance the popularization of the physical exercise promotion project in the populations with as many different ages as possible. For fulfilling this task, the National State of Council formulated and published the "The Outline of Entire People Physical Exercise" in June, 1995. This outline asked to put the "National Entire People Physical Exercise Promotion Project" into the "China's General Program on National Economic and Social Development. The purpose for doing this is to enhance the promoting strengthen, make a unified plan with due consideration for all concerned, and ensure the work, in order to raise people's physical fitness as speedily as possible.

B. Perfect the construction of corresponding policy, regulations, rules, and decrees.

C. Combine with all the mass organizations and groups, to find gradually a perfect socialization network for health and life quality promotion.

D. Ensure that the financial support of this promotion project be

increased step by step.

E. Carry out the survey and measurement of population's physical fitness regularly and systematically.

F. Enact and carry out the "Technical Grade System for Social Physical Culture Guides". Bring the initiative of these guides into full play in promoting the mass physical exercise activity.

G. Explore, research, and spread the methods which can be successfully used in the mass physical exercise activities.

H. Put the constructions of physical exercise places into the entire social developmental program. Open the available place and apparatus to the society as widely as possible. Ensure that people's mass exercise become more and more convenient.

I. Gradually push forward the regular and systemic work of the network of national physical fitness and health surveillance. By using follow-up studies, to observe the dynamic changes, trends, problems and movements of people's physical fitness and health status among the different age and professional groups.

 

Prof. Yu DaoZhong is Director of Mass Physical Education at China's National Research Institute of Sports Science. He may be reached at: 11 Tiyuguan Road, Bejing 100061, China, Tel: (86)-10-67118019 / Fax: (86)-10-67146033.
 
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