youth health services

The core of youth health services that can truly be implemented and effective is not to pile up standardized physical examinations and screening packages in batches, but to break through the information barriers in the four scenarios of schools, communities, families, and medical institutions, and to provide adaptive services for teenagers at different growth stages, different family backgrounds, and different health needs. This is the core conclusion that I have concluded after participating in the implementation of 12 prefecture-level youth health projects in the field of public health in the past six years and going through countless pitfalls.

Last month, my colleagues from the Center for Disease Control and Prevention went to a district in Guangzhou to investigate junior high school students, and we came across a typical counterexample: a 15-year-old boy with 650 degree myopia and a BMI (body mass index) of 28, which is considered overweight. A score of 11 on the PHQ-9 depression scale administered by the school indicates mild anxiety. Three reports can be given to parents and parents respectively. It was stored in the school file and kept in the disease control system. The information from the three parties was not connected. The parents only got the conclusion of the physical examination, thinking that the child was "lazy, not interested in sports, and afraid of going to school." It was not until we came to visit that we found out that the child had fallen asleep at more than 12 o'clock every day for three months in a row. His shoulders and neck hurt so much that he couldn't even lift his arms.

In fact, the debate between academic circles and practitioners on the path of adolescent health services has been going on for almost ten years. One group is the supply side who advocates "standardization first". They feel that adolescent health services in most parts of the country are still at the "have or don't have" stage. They should first uniformly configure a basic package of 1 routine physical examination per year, 2 psychological screenings, and 4 health classes per semester, so as to cover the widest range of people at the lowest cost. This view is not unreasonable. Many middle schools in western counties that I have visited could not even do basic vision tests before. The unified supply of basic packages at least solves the problem from 0 to 1. But the other group that advocates "personalized adaptation" also has very practical opinions: For the same 14-year-old children, students in key middle schools in Beijing, Shanghai and Guangzhou may already be troubled by academic anxiety and lack of sleep. Boarding students in remote areas may still face problems of insufficient nutritional intake and infectious disease prevention and control. Sports students should pay attention to sports injuries, and children with congenital diseases need special health management. It is impossible for a standardized package to suit everyone.

I saw a better balance between the two in a community in Yuhang, Hangzhou last year: they did not engage in fancy projects. First, they opened up all the health files of teenagers aged 12 to 18 in the jurisdiction. The school's physical examination data, community medical records, and hospital follow-up information were all stored in the same dynamic file. Then they set up a "Youth Health Station" in the community service center. Every day It is open for 2 hours after school. There are stationed ophthalmologists and psychological social workers on duty. Children passing by can have their eyesight tested and chat with the social workers about their troubles. There is no need to go through the registration process, and the chat content will not be told to parents casually. There will also be a parent tea party once a month. Instead of talking about empty truths, they will talk about the impact of short videos that children like to watch recently on their eyesight, and how to ask children about their emotions without being criticized. Last month, they also linked up with nearby orthopedic hospitals to provide free weekend correction classes to 27 children who were screened for scoliosis. Parents were not required to go through any formalities. The school adjusted classes and sent them to and from school uniformly. Parents only needed to sign and agree. After three months of follow-up, the scoliosis degrees of 21 children had dropped.

Of course, not all places have the conditions to implement this model. Last year, I went to a middle school in a county in eastern Guangdong for research. There was only one school doctor in the entire school, who also had to take care of logistics and epidemic prevention. There was not even a full-time psychology teacher. It is simply unrealistic for you to ask him to develop dynamic files and provide on-site services. The local compromise plan now is also very practical: instead of pursuing a comprehensive plan, we will first focus on the three most common problems of myopia, scoliosis, and adolescent depression. We have signed a green channel with the County People's Hospital. The school will test the vision once a month and do a simple psychological screening every quarter. If problems are found, they will be transferred directly to the hospital without going through the ordinary registration process. The most urgent problems will be solved first, and then other services will be added slowly.

After working in this industry for so long, my biggest feeling is that the most common mistake made by adolescent health services is "adults think you need it". There used to be a place where health education was conducted, and the whole school was invited to listen to a two-hour lecture on "The Importance of Youth Health" under the sun. The children were so drowsy that they turned around to check their mobile phones with their heads down. Later, we changed the approach and created a health challenge game at the school gate. After passing five levels, you can get milk tea coupons. The levels are to test your eyesight, walk in the correct sitting posture, and answer a small question about sleep. In one afternoon, most of the students learned that they should not continuously use their mobile phones for more than one hour, and that incorrect sitting posture can easily lead to scoliosis. The effect was better than ten lectures.

To be honest, there is no one-size-fits-all standard answer for youth health services. We don’t need to pursue high-end configurations or perfect processes. As long as children are willing to take the initiative to talk about their health problems, parents can get accurate information and know how to cooperate, and grassroots staff can implement it easily, it is the best service. After all we have done so much, the ultimate goal is just to let every child grow up healthy.