Health of Adolescents in

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C

hina spans a wide expanse with large variations in health status between the more developed coastal areas and the growing central and western regions. The risk of natural disaster in less-developed regions is also five times higher than the national average.¹ Some key adolescent health issues that China is concerned with include sex and reproductive health education, an increasing trend towards being overweight in certain parts of the country, psychological problems faced by adolescents and a high suicide rate, with women in the 15–24 year old age group being particularly vulnerable.²

POPULATION

The World Population Prospects estimates that in 2010, Chinese adolescents (10–19 years) made up about 14.8%

of the total population, with males outnumbering females in all age groups.³ (Table 1)

EDUCATION

Legislation: China mandates nine years of compulsory education.

Student enrolment: By the end of 2009, primary net school enrolment rate was 99.4% (99.4% for boys and 99.4% for girls). The gross enrolment rate in junior secondary education reached 99% and the nine-year compulsory education retention rate was 90.8%.⁴

Educational attainment: China’s 2005 youth employment report stated that 72% of the employed population aged 16–

1 China’s progress towards the Millennium Development Goals: 2008 Report.

Ministry of Foreign Affairs of the People’s Republic of China and United Nations System in China, 2008. [cited 15 September 2010]. Available from:

http://www.undp.org.cn/modules.php?op=modload&name=News&file=articl e&catid=18&topic=4&sid=4354&mode=thread&order=0&thold=0 2 China: The children - Adolescence. China: United Nations Children’s Fund.

[cited 8 October 2010]. Available from: http://www.unicef.org/china/

children_877.html

3 World Population Prospects: The 2008 Revision. Population Division, Department of Economic and Social Affairs, United Nations. [cited 15 September 2010]. Available from: http://esa.un.org/unpp

China: Ministry of Foreign Affairs of the People’s Republic of China and United Nations System in China, 2010.

Area: 9.6 million sq km^a

Population, 2010: 1 339 724 852^b

Rural-Urban Population, 2010: 50.3%/49.7%^b Crude birth rate / Crude death rate, 2009: 12.13 per 1000/7.08 per 1000^c

Annual population growth rate, 2009: 0.51% per annum^c Human Development Index (HDI), 2010: 0.663 (Rank:

89th of 169 countries)^d

Multidimensional Poverty Index, 2000–2008: 0.056^e Gross National Income per capita (PPP int. $), 2009:

US$ 6890^f

Population living on <$1 (PPP int. $) a day, 2005: 15.9%^g Population below the national income poverty line, 1998 and 2004: 4.6% in 1998 and 2.8% in 2004⁷

19 years had a junior high school education, 19% had primary school, 6.7% had senior high school and 0.5% had a college education; 1.8% were illiterate.⁵

Figure 1 shows that 21% of urban youth had a university education compared with 6% of rural youth. A 2004 survey revealed that only 17% of migrants had a high school education and only 18% had received skills training.⁶

5 China Youth Employment Report: analysis report of China’s survey on school to work transition. Youth Employment Network Office China, Research Institute of Labour Sciences of Ministry of Labour and Social Security, International Labour Organization, 2005.

6 MDGF-1880: Protecting and promoting the rights of China’s vulnerable migrants. Millennium Development Goals Achievement Fund. [cited 8 October 2010]. Available from: http://sdnhq.undp.org/opas/fr/proposals/

suitable/1083

Health of Adolescents in

China

Table 1: Estimated number and percent of young people by age and sex in China, 2010

Age (years) Male Female Total

Number (000s)

(%) of Total Pop

Number (000s)

(%) of Total Pop

Number (000s)

(%) of Total Pop

10–14 51 390 3.8 43 162 3.2 94 552 7.0

15–19 56 886 4.2 49 231 3.6 106 117 7.8

20–24 64 150 4.7 58 396 4.3 122 546 9.0

Total 172 426 12.7 150 789 11.1 323 215 23.8

Source: World Population Prospects: The 2008 Revision. Population Division, Department of Economic and Social Affairs, United Nations. [cited 15 September 2010]. Available from: http://esa.un.org/unpp

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Figure 1: Differences in educational level between urban and rural young population

Post-graduate University

College Senior Middle

Vocational School Junior Middle

Primary

rural urban

1% 5%

6%

17%

20%

45%

6% 1%

17%

21%

19%

27%

14% 1%

Source: Extracted from China Youth Employment Report: analysis report of China’s survey on school to work transition. Youth Employment Network Office

China, Research Institute of Labour Sciences of Ministry of Labour and Social Security, International Labour Organization, 2005.

Gender parity index (GPI): In 2009, the five-year primary school retention rates for boys and girls were 99.4% and 99.3%, respectively, which indicates that gender disparities had been eliminated. The GPI for the three-year retention rate of junior middle schools was 102%, also suggesting that there was no gender disparity.⁷

The number of girls in senior middle school reached 46.4 million, accounting for 46.9% of the total number of senior middle school students. The number of women attending college/university was 10.83 million, accounting for 50.5%

of the total. These figures indicate that China has made remarkable progress in achieving gender equality at all levels of education.⁸

ECONOMICS

Legislation: Chinese law bans the employment of minors under age 16.

Employment: By the end of 2009, the employment rate for 2009 college graduates was 87.4%.⁹

In 2000, of the 370.37 million women of working age (16–

54 years), 14.8% (54.8 million) were employed and aged between 16 and 24. Of the 415 million men of working age (16–59 years), 14.0% (58.1 million) were employed and aged between 16 and 24.¹⁰

8 Ibid.

9 Ibid.

10 Women and Men in China: Facts and Figures 2004. Department of Population, Social Science and Technology, National Bureau of Statistics, 2004. Available from: http://www.stats.gov.cn/english/statisticaldata/

otherdata/men&women_en.pdf

Adolescents (16–19 years) made up 6.0% of the total number of females (6.03 million) and 3.7% that of males (4.86 million) employed in urban areas. In the rural areas, adolescents (16–19 years) made up 6.4% of the total number of females employed (13.85 million) and 6.0% of males (15.08 million).¹¹ Nonemployment: In 2000, of the male and female nonemployed population aged 16–19, 80.9% and 79.1%, respectively, were students. However, 12.4% of the female nonemployed population aged 16–19 years registered themselves as unemployed, as did 13.7% of males.¹²

Unemployment: According to 2000 figures, in urban areas, there were 9.88 million females and 10.79 million males unemployed. The 16–19 age group made up 13.4% of the total female unemployed population and 15.8% of the total male unemployed population. This age group also had the highest unemployment rate (17.8% of female adolescents and 25.9% of males).¹³ (Table 2.) In a 2005 report, more than 60% of unemployed young people aged 15–29 agreed that low educational level was one of the main causes for their unemployment.¹⁴

Table 2: Percentage distribution of urban unemployed and unemployment rate by age, China, 2000

Age Percentage distribution (%) Unemployment rate (%)

Female Male Female Male

16–19 13.4 15.8 17.8 25.9

20–24 21.1 19.8 12.8 13.1

25–29 18.1 14.3 9.1 6.7

29 and above 47.4 50.1 - -

Total 100.0 100.0 - -

Source: The fifth population census of China, 2000. In: Women and Men in China: Facts and Figures 2004. Department of Population, Social Science and Technology, National Bureau of Statistics, 2004.

Migrant labour force: China has the world’s largest migrant population estimated at 145.33 million, of whom 34.9% are women.¹⁵ Although the employment rate for migrant workers was 97% in 2009, informal employment is a concern as this

11 Ibid.

12 Ibid.

13 The fifth population census of China, 2000. In: Women and Men in China:

Facts and Figures 2004. Department of Population, Social Science and Technology, National Bureau of Statistics, 2004. Available from: http://www.

stats.gov.cn/english/statisticaldata/otherdata/men&women_en.pdf 14 China Youth Employment Report: Analysis Report of China’s Survey on School

to Work Transition. Youth Employment Network Office China, Research Institute of Labor Sciences of Ministry of Labor and Social Security, and International Labor Organization, 2005.

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means that workers do not have adequate social protection.^16,17 Data from 2002 indicated that 5% were covered by a pension scheme, less than 2% by unemployment insurance and 3% by medical insurance.¹⁸

In 2006, there were about 132 million rural migrant workers.¹⁹ In 2004, 45% of the rural migrant workers were 16-25 years old.²⁰ (Figure 2)

Figure 2: Age break-down of rural migrant workers, 2004

16-25 years 26-30 years

31-40 years 41 years and above

45%

16%

23%

16%

Source: Data from Rural Migration Survey. National Bureau of Statistics, 2006.

Extracted from Li, S. Rural migrant workers in China: scenario, challenges and public policy. Working paper No. 89. International Labour Organization, 2008.

SEXUAL AND REPRODUCTIVE HEALTH

Legislation: (i) The Criminal Law revised in 1997 states that the legal age of consent for sexual activity is 14 years. (ii) The Marriage Law of 1981 stipulates that the legal minimum age of marriage in China is 22 years for men and 20 years for women.

(iii) Induced abortion was legalized in China in 1957. The Regulation on Prohibiting Fetal Sex Identification and Selective Termination of Pregnancy for Non-medical Reasons of 1999 prohibits abortion if women have a planned pregnancy, except in cases where the fetus has a serious hereditary disease or deficiency, where continuing the pregnancy endangers the health or life of the pregnant woman and in special cases is approved by the family planning departments of the local government above the county level.

Sexual behaviour: Preliminary findings of China’s First National Youth Reproductive Health Survey in 2009 indicated that about 60% of unmarried youth aged 15–24 were open to

16 Ibid.

17 Zhao, L. and Huang, Y. Unemployment problem of China’s youth. East Asian Institute Background Brief No. 523. Published: 28 April 2010.

18 Li, S. Rural migrant workers in China: scenario, challenges and public policy.

Working paper No. 89. International Labour Organization, 2008.

19 Situation of rural migration in China in 2006. Internal Research Report No.

18, 2007. China: National Bureau of Statistics, 2007. In: Li, S. Rural migrant workers in China: scenario, challenges and public policy. Working paper No.

89. International Labour Organization, 2008.

20 Li, S. Rural migrant workers in China: scenario, challenges and public policy.

Working paper No. 89. International Labour Organization, 2008.

having sex before marriage and 22.4% had sex, with over half of them not using any contraceptive method during their first sexual act.²¹

In a 2001 study of unmarried young people aged 15–22 in Shanghai, 31% of girls and 44% of boys were sexually active.

The mean age of sexual debut was just under 19 for girls and just under 20 for boys.²²

Marriage: Figures from 1999 showed that the female’s mean age at marriage was 23.1 years and 24.8 years for males.²³ In 2002, young Chinese were found to have their first marriage at about age 25 years.²⁴

Regardless of educational level, most women tended to marry between the ages of 20 and 24. Among women with a primary level education, 52.7% got married between the ages of 20 and 24; for women with a college or higher education, 56.9% had their first marriage between the ages of 20 and 24. This was similar for men, except for those with a college education. More than half (53.8%) of men with a college or higher education married later, between the ages of 25 and 29.²⁵ The rate of early marriage for young women aged 15–19 years fell from 4.6% in 1990 to 1.2% in 2000 and from 1.8%

to 0.3% for young men.²⁶

Contraceptive knowledge and use: In a 2003 survey of 8400 women aged 15–49 years, the knowledge of any contraceptive method among never-married women was 58.2%, most of whom (92.4%) were between 15 and 24 years old. The awareness of condoms among never-married women was 40%.²⁷

21 Preliminary findings of First National Youth Reproductive Health Survey released. United Nations in China. [updated 4 May 4 2010; cited 10 October 2010]. Available from: http://www.un.org.cn/cms/p/news/27/1414/content.

html

22 Dehne, K. and Riedner, G. Sexually transmitted infections among adolescents:

the need for adequate health services. World Health Organization, 2005.

23 UNPD’s World Fertility and Marriage Database 2003. In: China. Singulate mean age at marriage. United Nations Statistics Division. [cited 17 September 2010]. Available from: http://data.un.org/Data.aspx?q=marriage&

d=GenderStat&f=inID:20

24 China Youth Employment Report: analysis report of China’s survey on school to work transition. Youth Employment Network Office China, Research Institute of Labour Sciences of Ministry of Labour and Social Security, International Labour Organization, 2005.

25 China population census in 2000. In: Women and Men in China: Facts and Figures 2004. Department of Population, Social Science and Technology, National Bureau of Statistics, 2004. Available from: http://www.stats.gov.cn/

english/statisticaldata/otherdata/men&women_en.pdf

26 Women and Men in China: Facts and Figures 2004. Department of Population, Social Science and Technology, National Bureau of Statistics, 2004. Available from: http://www.stats.gov.cn/english/statisticaldata/

otherdata/men&women_en.pdf

27 China/United Nations Population Fund Reproductive Health/Family Planning CPR/03/P01. Baseline Survey Report 2003: Key Findings. China Population and Development Research Centre, National Centre for Women & Children Health, Chinese Centre for Disease Control and Prevention & Southampton Statistical Sciences Research Institute, University of Southampton, 2004.

[cited 15 September 2010]. Available from: http://www.cpirc.org.cn/en- cpdrc/en-file/cp5report-may06.pdf

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The 2009 National Youth Reproductive Health Survey found that only 4.4% of youth were well informed about reproductive health. About 60% of youth’s need for counselling and more than 50% of their need for reproductive health services were not met.²⁸

In one report, unmarried young female migrant workers were found to have mistakenly thought that family planning distribution centres were only for married women. They also felt embarrassed about obtaining contraceptives and feared that their sexual activity status would be exposed.²⁹

According to the 2001 National Family Planning and Reproductive Health Survey, the contraceptive prevalence rate among adolescents aged 15–19 years was 30.9%, lowest among all age groups.³⁰

Childbearing: From the 1990s to 2005, the median age at childbearing of Chinese women had been about 25 years.³¹ Adolescent birth rate: According to the 2008 National Demographic Change Sampling Survey, the birth rate of adolescents aged 15–19 was 5.3 per 1000 women.³² In 2006, the adolescent fertility rate was at 4.6 per 1000 women aged 15–19 years, lower than in 2004 (5.6 per 1000 women aged 15–19) and in 2005 (6.3 per 1000 women aged 15–19).³³ Abortion: The 2009 National Youth Reproductive Health Survey found that among female youth who have had sex, 20%

had unplanned pregnancies and 91% had resorted to abortion.³⁴ According to the 2001 Almanac of China’s Health, as many as 10 million induced abortions were performed annually in China and

28 Preliminary findings of First National Youth Reproductive Health Survey released. United Nations in China. [updated 4 May 4 2010; cited 10 October 2010]. Available from: http://www.un.org.cn/cms/p/news/27/1414/content.

html

29 Young female migrant workers in China in need of reproductive health information and services. Social science research policy briefs. Series 2, No. 2, May 2002. United Nations Development Programme, United Nations Population Fund, World Health Organization and World Bank Special Programme of Research, Development and Research Training in Human Production.

Department of Reproductive Health and Research. World Health Organization.

30 National Family Planning and Reproductive Health Survey 2001. Source:

Department of Planning and Accounting. State Family Planning Commission of China. In: China Population and Development Research Centre.

[cited 12 September 2010]. Available from: http://www.cpirc.org.cn/en/

enews20020710-1.htm 31 Ibid.

33 Survey 2003-2004 National Sample Survey on Population Changes; Survey 2004-2005 1% Population Sample Survey; Survey 2005-2006 National Sample Survey on Population Changes. In: 2010 Update for the Millennium Development Goals Database: Adolescent Birth Rate. POP/DB/Fert/A/MDG2010.

Department of Economic and Social Affairs, Population Division, United Nations.

[cited 20 September 2010]. Available from: http://www.un.org/esa/population/

publications/2010_MDGDatabase/2010_Update_MDG_ABR.xls 34 Preliminary findings of First National Youth Reproductive Health Survey

released. United Nations in China. [updated 4 May 2010; cited 10 October 2010]. Available from: http://www.un.org.cn/cms/p/news/27/1414/content.

html

about 20%–30% were provided to unmarried young women.³⁵ In China, the proportion of induced abortions appeared stable at about 27 among per 100 known pregnancies.³⁶

Sexually transmitted infections (STIs): In 2010, 358 534 syphilis cases and 105 544 gonorrhoeae cases were reported in China, with an increase of 17% for syphilis and a decrease of 11.9% for gonorrhoeae compared with cases reported in 2009.³⁷ In a 2000 cross-sectional survey of 505 sex workers, more than half were under 25. The most prevalent STI was Chlamydia Trachomatis (58.6%) followed by Trichomonas Vaginalis (43.2%) and Neisseria Gonorrhoeae (37.8%). The highest prevalence of Chlamydial infection or gonorrhoeae was among the 15–19 and the 20–24 age groups.³⁸

STI knowledge: A 2003 survey of 8400 women aged 15–49 years found that 60% of never-married females, most of whom were between 15 and 24 years old, who have heard of STIs did not report awareness of any symptoms associated with STIs.³⁹ Adolescent-Friendly Health Services (AFHS): The National Population and Family Planning Commission and the Ministry of Health, with support from the United Nations Population Fund, have implemented a reproductive health/family planning project in 30 counties with one in each of the 30 provinces (municipalities and regions). The project components were to promote adolescent reproductive health, emphasize reproductive health and sex education for teenagers and pilot the provision of youth friendly services at the county service delivery points for maternal and child health care under the Ministry of Health.

Currently, there is no standardized system to provide young people or the unmarried with reproductive health information, services and education. Recommendations have been made for strategies to be formulated and implemented, including promoting the provision and access of services within the migrant population and in the central and western parts of China.⁴⁰

35 Liu X and Liu Y, eds. Almanac of China’s Health 2001. Beijing: People’s Health Publishing House, 2001. In: Wang, B. et al. The potential of comprehensive sex education in China: Findings from suburban Shanghai. International Family Planning Perspectives, 2005; 31(2). [cited 20 September 2010]. Available from:

http://www.guttmacherinstitute.org/pubs/journals/3106305.html 36 Henshaw, S., S. Singh, T. Haas. The incidence of abortion worldwide. Family

Planning Perspectives, 1999; 25 (Suppl.). In: Li, S. Wei, Y. and Feldman, M.

(2005). Son preference and induced abortion in rural China: Findings from the 2001 National Family Planning and Reproductive Health Survey.

37 Online Case reporting system of Infectious Disease (by the end of December 2010)

38 STI/HIV: Prevalence survey of sexually transmitted infections among female sex workers and truck drivers in China, 1999-2000. World Health Organization Regional Office for the Western Pacific and National Center for STD and Leprosy Control, Ministry of Health of the People’s Republic of China, 2001.

39 United Nations Population Fund. Quality of care in reproductive health/family planning. Fifth Country Programme 2003-05. Quantitative Evaluation Report.

Key Findings. China Population and Development Research Centre, National Centre for Women & Children Health, Chinese Centre for Disease Control and Prevention and Southampton Statistical Sciences Research Institute, University of Southampton, United Kingdom, 2006.

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HIV prevalence and infection:

Data from 2010 showed that adolescents aged 10–19 accounted for 3.9% of cumulative reported HIV infections, 1.6% of cumulative reported AIDS cases and 1.7% of cumulative reported AIDS-related deaths (Table 3). Of the estimated 740 000 people living with HIV/

AIDS by the end of 2007, 44.3%

were infected by heterosexual transmission, 32.2% through intravenous drug use and 14.7%

through men having sex with men.⁴¹ HIV knowledge: A 2008 report stated that about half of young men and women (15–24 years) could correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission.⁴² The 2009 National Youth Reproductive Health Survey found that only 14.4% of youth aged 15–24 had correct knowledge on how to prevent HIV infection.^43,44

NUTRITIONAL STATUS &

PHYSICAL ACTIVITY

The Global School-based Student Health Survey (GSHS) showed that across four survey sites in China, the percentage of students aged 13–15 years who were overweight ranged from 7.9% to 19.2%; those who

were obese ranged from 1.5% to 9.5%. Levels of physical activity ranged from 10.7% to 21.0%.⁴⁵ (Table 4)

An October 2009 survey of rural boarding schools in Ma Shan County in Guangxi’s Nanning Municipality found that the average height and weight of secondary school boarding

41 China 2010 UNGASS Country Progress Report. by Ministry of Health of the People’s Republic of China 2010.

42 2008 Report on the Global AIDS Epidemic. Joint United Nations Programme on HIV/AIDS, 2008.

43 Students in hot pursuit of education. China Daily. In: National Population and Family Planning Commission of China. [updated 15 September 2010; cited 19 September 2010]. Available from: http://www.npfpc.gov.cn/en/detail.aspx

?articleid=100915175436948988

44 Preliminary findings of First National Youth Reproductive Health Survey released. United Nations in China. [updated 4 May 2010; cited 10 October 2010]. Available from: http://www.un.org.cn/cms/p/news/27/1414/content.

html

45 China (Beijing, Hangzhou, Wuhan, Wurumqi) 2003 Fact Sheet. Global School-based Student Health Survey. World Health Organization. [cited 18 September 2010]. Available from: http://www.who.int/chp/gshs/factsheets/

en/index.html

pupils in every age group and primary school pupils aged 6–16 in poor towns and villages was lower than that in the region as a whole. The average height of boys was 5.7 cm lower than the norm while that of girls was 5.5 cm lower. The average weight of boys was 2.4 kg lower than the norm while that of girls was 2.0 kg lower.⁴⁶

MENTAL HEALTH

More than 30 million children and adolescents under 17 years old had behavioural and emotional problems, of which about 50%–70% needed mental health services but remained untreated.⁴⁷

47 National Project on Mental Health (2002-2010), China Department for Disease Control and Prevention, Ministry of Health, 2002. In: China Health Information Profile. World Health Organization Regional Office for the Western Pacific, 2010.

Table 3: Percentage distribution of HIV infections, AIDS cases and AIDS-related deaths by age, China, 2007

Age group (years)

HIV Infections AIDS Cases AIDS-related Deaths

2007 Reported (%)

Cumulative reported (%)

2007 Reported (%)

0~ 1.3 1.1 1.6 1.6 1.7 1.6

10~ 3.0 3.5 2.2 1.8 1.6 2.3

20~ 33.3 34.2 20.8 15.6 16.2 19.5

30~ 39.5 35.8 37.9 34.0 35.8 33.3

40~ 13.5 12.2 20.1 20.3 21.2 19.2

50~ 5.2 4.4 10.1 9.3 11.3 9.5

60~ 4.2 2.2 7.3 3.2 7.3 4.2

Unknown 0.0 6.6 0.0 14.2 4.9 10.4

*HIV infections, AIDS cases and AIDS-related deaths reported during January to October 2007;

**Cumulative HIV infections, AIDS cases and AIDS-related deaths by end of October 2007.

Source: A Joint Assessment of HIV/AIDS Prevention, Treatment, and Care in China. Jointly prepared by State Council AIDS Working Committee Office and UN Theme Group on AIDS in China, 2007.

Table 4: 2003 China (Beijing, Hangzhou, Wuhan, Wurumqi) Global School-based Student Health Survey results for students aged 13–15 (boy-girl) (%)

Indicator Beijing Hangzhou Wuhan Wurumqi

Percentage of students who went hungry most of the time or always during the past 30 days because there was not enough food in their home

2.4 (2.9 & 1.9)

2.6 (3.3 & 1.9)

1.9 (1.9 & 2.0)

2.3 (2.6 & 2.0)

Percentage of students who were overweight

18.6 (24.2 & 13.0)

7.9 (10.1 & 5.6)

19.2 (25.0 & 12.8)

9.1 (13.7 & 4.4) Percentage of students who were

obese

5.9 (8.8 & 3.0)

2.1 (2.7 & 1.4)

9.5 (10.8 & 8.1)

1.5 (2.4 & 0.6) Percentage of students who were

physically active for a total of at least 60 minutes per day on all 7 days during the past 7 days

21.0 (24.9 & 17.2)

10.7 (12.1 & 9.0)

14.6 (18.6 & 10.0)

15.9 (20.7 & 10.7)

Source: China (Beijing, Hangzhou, Wuhan, Wurumqi) 2003 Fact Sheet. Global School-based Student Health Survey.

World Health Organization.

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The GSHS revealed that 14.3%–21.3% of students aged 13–15 years across the four survey sites had seriously considered attempting suicide during the past 12 months and 5.0%–8.8% of those surveyed had experienced loneliness and had reported no close friends.⁴⁸

Depression is a major risk factor for suicide in China. In 2002, the suicide mortality in the 15–29 age group was more than 50 000.⁴⁹ (Figure 3) Someone takes his or her own life in China about every two minutes.⁵⁰ Women in China have a suicide rate that is twice that of women in other parts of the world.⁵¹ Easily accessible toxic pesticides contributed to high suicide burden in rural areas of China, with 166 000 people having used this method.⁵²

SUBSTANCE USE

Legislation: In 2006, China implemented the alcohol circulation management regulation, which prohibits alcohol vendors from selling alcoholic drinks to minors under the age of 18.⁵³

Tobacco use: The GSHS found that between 3.5% and 8.7%

of students aged 13–15 across four survey sites had smoked cigarettes in the past month.⁵⁴

The 2005 Global Youth Tobacco Survey data in Table 5 also offers insights into the prevalence of current cigarette smoking among young adolescents, which ranged from 1.9% to 2.6%

across the four survey sites. In the World Health Statistics 2010, city figures extrapolated into country figures indicated that about 7.1% of male and 4.1% of female students aged 13–15 were current tobacco users. ⁵⁵

Alcohol use: WHO’s Multi-Country Survey Study 2000–2001 showed that the rate of heavy episodic drinking for youth aged

en/index.html

49 Turning the tide: injury and violence prevention in China. Beijing, China: World Health Organization, 2006.

50 Source: WHO Global Burden of Disease (GBD) 2002 estimates (Version 3).

[cited 3 August 2006]. In: Turning the tide: injury and violence prevention in China. Beijing, China: World Health Organization, 2006.

51 The Injury Chartbook: A graphical overview of the global burden of injuries.

Department of Injuries and Violence Prevention, Noncommunicable Diseases and Mental Health Cluster, World Health Organization, 2002.

53 China bans selling alcohol to minors. Laws and Regulations. News Guangdong. [updated 6 January 2006; cited 20 September 2010]. Available from: http://www.newsgd.com/business/laws/200601060029.htm 54 China (Beijing, Hangzhou, Wuhan, Wurumqi) 2003 Fact Sheet. Global

School-based Student Health Survey. World Health Organization. [cited 18 September 2010]. Available from: http://www.who.int/chp/gshs/factsheets/

en/index.html

55 China (Shanghai, Tianjin, Zhuhai, Puyang) 2005 Fact Sheets. Global Youth Tobacco Survey. Available upon request from the Tobacco Free Initiative, World Health Organization Regional Office for the Western Pacific, Manila, Philippines.

15–19 years was 1.3% (male 2.5% and female 0.0%) and for youth aged 15–24 years, the corresponding rate was 2.1%

(male 3.9% and female 0.3%).⁵⁶

The GSHS results showed that across the four survey sites, 13.0%–18.1% of boys and girls aged 13–15 were consuming alcohol and 8.4%–13.5% of them have “even consumed so much till they were drunk”.⁵⁷

VIOLENCE AND INJURIES

Leading causes of death for young people: According to the World Health Report 2005, surveys conducted in 2003 showed that the leading causes of death among 5–29 year olds in China were injuries followed by noncommunicable diseases and communicable, maternal, perinatal and nutritional diseases. China has one of the highest mortality rates for injury in the Western Pacific Region.⁵⁸ For people aged 15–24, the leading causes of death in urban areas were traffic injuries, suicide and drowning in urban areas and traffic injuries, drowning and suicide in rural areas.⁵⁹

56 Ustun TB et al. World Health Organization Multi-Country Survey Study on Health and Health System Responsiveness 2000–2001. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva: World Health Organization, 2003. In: Global Status Report on Alcohol 2004. Country Profiles. World Health Organization Regional Office for the Western Pacific, 2004. [cited 15 September 2010].

Available from: http://www.who.int/substance_abuse/publications/

statusreportalcoholwpro/en/index.html

en/index.html

58 Cited source: WHO Global Burden of Disease (GBD) 2002 estimates (Version 3). [cited 3 August 2006]. In: Turning the tide: injury and violence prevention in China. Beijing, China: World Health Organization, 2006. In: China Health Information Profile. World Health Organization Regional Office for the Western Pacific, 2010.

59 Country Profile on Injury and Violence Prevention: China. World Health Organization Regional Office for the Western Pacific. [cited 15 May 2011].

Available from: http://www.wpro.who.int/NR/rdonlyres/0ECED507-01F2- 44EB-8C58-0F177B16CC65/0/CPCHN.pdf

Figure 3: Suicide mortality, China, 2002

0 10 000 20 000 30 000 40 000 50 000 60 000 70 000

80 000 100

90 80 70 60 50 40 30 20 10 0 0-4 5-14 15-29 30-44 45-59 60-69 70-79 80+

Age group Self-inflicted injury deaths

Self-inflicted injury mortality rate per 100 000 population

Deaths Mortality

rate

Source: Turning the tide: injury and violence prevention in China. Beijing, China:

World Health Organization, 2006.

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Physical violence: The GSHS data from the four survey sites showed that 15.8%–22.0% of students had engaged in a physical fight one or more times in the past year, 16.4%–

24.7% had been seriously injured one or more times in the past year and 20.2%–33.2% had been bullied on one or more days in the past month.⁶⁰ For those aged 15–29, homicide was estimated to be the fourth leading cause of death. An estimated 38 000 people died from homicide-related injuries in 2002.⁶¹

Domestic violence: Figure 4 shows that those aged 5–14 and 15–29 accounted for 41% of violent deaths (more than 15 000) in China in 2002.⁶²

Drowning: WHO estimated 112 000 deaths from drowning each year in China. Half of all drowning deaths (about 56 000) occured among children under 15 followed by those in the 15–29 year age group (19%). The drowning mortality rate in rural areas for children aged 10–14 years was 14.0 per 100 000 population; in urban areas, the rate was 1.4 per 100 000 population.⁶³ Risk factors for drowning were widespread. A 2004 survey estimated that 80% of urban Chinese children could not swim.⁶⁴

en/index.html

62 Source: WHO Global Burden of Disease (GBD) 2002 estimates (Version 3).

[cited 3 August 2006]. In: Turning the tide: injury and violence prevention in China. Beijing, China: World Health Organization, 2006.

63 Ibid.

64 Injury prevention. World Health Organization Representative Office in China.

[cited 8 October 2010]. Available from: http://www.wpro.who.int/china/sites/

injury_prevention/

LIST OF LEGISLATION AND CONVENTIONS THAT IMPACT ADOLESCENT HEALTH AND WELFARE

Employment

• Labour Act, 1994 Education

• Compulsory Education Law, 1986 Health and Welfare

• Marriage Law, 1981

• Law on the Protection of Minors, 1992

• Road Traffic Safety Law, 2004 Sexual and Reproductive Health

• Criminal Law, revised 1997

• Population and Family Planning Law, 2002

• Law on Maternal and Infant Health Care, 1995

• Termination of Pregnancy for Non-medical Reasons, 1998 Substance Use

• Alcohol circulation management regulation, 2006

• Regulations for alcohol advertising, 2006 Crimes, Violence and Injuries

• Law on the Protection of Rights and Interests of Women, 1992

Conventions

• World Health Organization Framework Convention on Tobacco Control, 2005

• The Optional Protocol to the United Nations Convention on the Rights of the Child on the Sale of Children, Child Prostitution, and Child Pornography, 2002

• International Labour Organization’s (ILO) Convention No.

182 “Worst Forms of Child Labour Convention”, 2002

• ILO Convention No. 138 “Minimum Age for Admission to Employment”, 1999

Table 5: 2005 China (Shanghai, Tianjin, Zhuhai) Global Youth Tobacco Survey Results for students aged 13–15 (boy-girl) (%)

Indicator Shanghai Tianjin Zhuhai Puyang

Percentage who currently smoked cigarettes

2.0 (3.3 & 0.9)

1.9 (3.8 & 0.0)

4.3 (7.8 & 1.0)

4.9 (10.6 & 0.5) Percentage who

currently used tobacco products other than cigarettes

4.2 (4.7 & 3.7)

2.6 (5.6 & 3.3)

5.0 (6.5 & 3.8)

4.4 (5.0 & 3.8)

Percentage who lived in homes where others smoke in their presence

50.0 48.3 47.1 36.9

Percentage who ever received help to stop smoking

- - 56.6 38.0

Percentage who desired to stop smoking

42.1 - - -

Source: China (Shanghai, Tianjin, Zhuhai, Puyang) 2005 Fact Sheets. Global Youth Tobacco Survey. Available upon request from the Tobacco Free Initiative, World Health Organization Regional Office for the Western Pacific, Manila, Philippines.

Figure 4: Violence mortality in China, 2002

6

5

4

3

2

1

0-4 5-14 15-29 30-44 45-59 60-69 70-79 80+ 0 Age group

Violence deaths

Violence mortality rate per 100 000 population 16 000

14 000 12 000 10 000 8000 6000 4000 2000 0

Deaths Mortality

rate

Source: Turning the tide: injury and violence prevention in China. Beijing, China:

World Health Organization, 2006. In: China Health Information Profile. World Health Organization Regional Office for the Western Pacific, 2010.

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• Convention on the Rights of the Child, 1992

• Convention on the Elimination of All Forms of Discrimination against Women, 1980

GOVERNMENT RESPONSES

Note: This is not meant to be a comprehensive list of all relevant government initiatives.

Economics

• 12th Five-Year Plan (2011–2015) Employment

• Series of policies to promote the employment of college graduates and women

Education

• National Development Through Science and Education

• National Medium and Long Term Education Reform and Development Plan Outline (2010–2020)

• In 2009, the central Government allocated US$ 316.9 millio to fund compulsory education for children of migrant workers.⁶⁵

• By 2012, the Government intends to allocate 4% of China’s national gross domestic product (GDP) to education.⁶⁶

• “Program for the Development of Chinese Women (2001–

2010)” and “Program for the Development of Chinese Children”

Sexual and Reproductive Health

• Ministry of Education’s Guideline to Health Education for University Students

• “Subsidies for Rural Women Delivering in Hospitals in Key Central and Western Areas” was implemented in 2008 and expanded to include all rural areas in 2009

66 Ibid.

• Basic public health service: All pregnant women are entitled to five free antenatal visits during their pregnancies and postpartum women are entitled to two free postnatal visits; provision of free folic acid supplements during the preconception and early pregnancy periods. The Government has increased the amount of public funds dedicated to the new cooperative medical scheme in rural areas.⁶⁷

• The State Council announced its “Regulations on Provision of Family Planning Services to the Migrant Population” in May 2009.

• Management Regulations for Technical Services in Family Planning

HIV/AIDS

• Regulations on HIV/AIDS Prevention and Treatment

• “Four Free One Care” Policy

• Notice of the State Council on Further Strengthening HIV/

AIDS Response

• China’s Action Plan for Reducing and Preventing the Spread of AIDS (2006-2020)

• China’s National Mid- and Long-term Strategic Plan for HIV/AIDS Prevention and Control 1998-2010

NUTRITION

• Outline for the Development of Food and Nutrition in China (2001–2010)

• Formulating “Outline for the Development of Food and Nutrition in China (2011–2020)

MENTAL HEALTH

• National Mental Health Project (2002–2010) INJURY PREVENTION

• 2008–2009 Ministry of Health/WHO Cooperation Plan

• Plan of Action for Women and Children 2006–2010

67 Ibid.

Sources:

a. China in brief. Travel in China – A brief introduction to China. National Tourism Administration of the People’s Republic of China. [cited 27 December 2010]. Available from: http://en.cnta.gov.cn/about/Forms/TravelInChina/AboutChina.shtml

b. Press release on major figures of the 2010 National Population Census. National Bureau of Statistics of China. [updated 28 April 2011; cited 15 May 2011]. Available from: http://www.stats.gov.cn/english/newsandcomingevents/t20110428_402722237.htm

c. National Bureau of Statistics in China. In: Main population data in 2009, China. National Population and Family Planning Commission of China. [updated 26 February 2010; cited 16 September 2010]. Available from: http://www.npfpc.gov.cn/en/detail.aspx?articleid=100226103318203294

d. Human Development Report 2010. Table 2: Human Development Index Trends, 1980-2010. United Nations Development Programme, 2010. [cited 6 November 2010].

Available from: http://hdr.undp.org/en/media/HDR_2010_EN_Table2.pdf

e. Human Development Report 2010. Table 5: Multidimensional Poverty Index. United Nations Development Programme. [cited 6 November 2010]. Available from: http://

hdr.undp.org/en/media/HDR_2010_EN_Table5.pdf

f. Gross national income per capita 2009, Atlas method and PPP. World Development Indicators Database, World Bank. [updated 14 April 2011, cited 15 May 2011].

Available from: http://siteresources.worldbank.org/DATASTATISTICS/Resources/GNIPC.pdf

g. China country data. Millennium Development Goals Indicators. United Nations Statistics Division, Department of Economic and Social Affairs, United Nations. [updated 23 June 2010; cited 6 November 2010]. Available from: http://mdgs.un.org/unsd/mdg/Data.aspx