The Lancet has published a report on a large cross-sectional survey of school health monitoring in 17 provinces in China. The study used data from 2428 schools from 17 provinces in China in 2018. Data were collected using a questionnaire administered by the Ministry of Education through its monitoring system, and included infectious diseases (e.g., reporting system for student infectious diseases), non-communicable diseases (e.g., regular student health examinations), and school physical environments (e.g., monitoring of classroom light, microclimate and drinking water). "Findings: Overall, the coverage rate of full school health monitoring systems was 16·6%. The coverage rates of school health monitoring systems for infectious diseases, non-communicable diseases, and school physical environments were 71·2%, 68·5%, and 24·9%, respectively. Coverage was higher in schools from urban rather than rural areas, in schools from areas with greater wealth, and in senior secondary schools rather than junior secondary and primary schools. Overall, the coverage of school health services monitoring was higher in urban areas, in wealthier areas, and in senior secondary schools."

The monitoring of infectious diseases is likely higher than most other countries. "The proportion of schools with all infectious disease monitoring systems was 71·2%. Overall, infectious disease monitoring systems were established in more than 90·0% of schools. The exception was in the use of student enrolment inoculation cards, which were adopted by only 76·4% of schools. The use of enrolment inoculation cards requiring an inspection system varied by school type, being highest in primary schools (96·4%), followed by junior secondary schools (47·3%) and senior secondary schools (25·6%)." Further "Since the SARS outbreak in 2003, the Chinese government has invested heavily in infectious disease control and prevention, with demonstrated improvements in disease surveillance.
This may explain why we found few differences in the coverage of infectious disease prevention and monitoring systems between urban and rural locations, regional SES groups, and primary and secondary schools, which is consistent with the widespread implementation of school-based monitoring systems around infectious diseases. Among the components of infectious disease monitoring in schools, the one exception to high coverage was around a system to review student enrolment inoculation cards (a certificate inspection system) which was evident in only 76·4% of schools, well lower than for other components." .

ISHN Comments: This Chinese example of SH monitoring is likely among the best in the world and underlines the need to better surveillance policies and practices. The relative "problems" with tracking student vaccination rates would be likely be seen as a success in most other countries. The discussion of monitoring and reporting (See the ISHN and FRESH Partner (pp 38-39) summaries on Monitoring, Reporting, Evaluating & Improving) should be linked directly to improvement planning and policy-making. Countries could learn more from each other on implementing better MREI practices which have been underlined  by the recent Covid pandemic.

Read the Lancet article here

(From the ISHN Member information service)  Another Canadian youth health survey was released in January 2015. This one is from the province of Manitoba, with data collected in schools in 2012/13, and sponsored by the Manitoba cancer organizations. This is the second time the survey has been done, with a promise of another round in 2016-17. The news story suggests that this provincial survey is unique in Canada but it is not. Several provinces already have similar surveys and Canada participates in the HBSC survey every five years. As well, there are provincial surveys on alcohol/drug use and other federal surveys with youth data. While the survey is a good one and there are questions unique to cancer risks (eg tanning beds), there is something wrong with the picture produced from the survey as well as with the duplication with other surveys. We need more analysis, timely analysis that is more closely correlated with policies and programs. We need regular reports on the status of youth health policies and programs, not just health status or behaviours. We need trends analysis over time (The news story notes that body weights and physical activity have deteriorated slightly since the first survey done in 2003-04 but the report does not include such discussion.). We need reasonable comparisons with similar jurisdictions. We need policy-related discussions. For example, Manitoba combined its health and PE curricula a few years ago...did that have an impact? As well, the province, like most jurisdictions around the world has focused efforts on childhood obesity, with apparently little effect. We are not picking on this survey. It is a good one, with several important questions that ask questions about new items such as transportation to school as part of the physical activity section. But it needs to be part of an overall monitoring and reporting system that is tied to policy-making. (This report on the survey was published on a non-government web site.) It needs to be tied into a national reporting system that can help make the reasonable comparisons between provinces. Canada used to have a regular report that pulled together the various survey results and offered cogent discussion about policies and programs but the funding for that regular report was cut several years ago. A related attempt to coordinate the various national and provincial surveys in that country suffered a similar fate. Canada is not alone in the avoidance of a national monitoring and reporting system. Many countries participate in the Europe-based Health Behaviours of School-age Children (HBSC) survey and a similar WHO Global Student Health Survey (GSHS) but those reports are rarely connected to transparent government policy making. Researchers are usually the ones controlling both the data and the selected analysis. National and state/provincial surveys also need to be part of similar international analysis that permits other useful perspectives and analysis. With the publication of a core set and several thematic of policy/program surveys by several UN agencies under the FRESH school health framework, there is an opportunity to more forward. Can we ensure that future surveys with be part of a systematic monitoring and reporting system in the future?   Read the Manitoba report>>