Teenagers rank low in the list of priorities for the Chinese health service.  But how much do teenagers use health services?  What are their health needs and concerns?  University College London and Zhejiang Medical University carried out a survey amongst teenagers in both urban and rural parts of Zhejiang Province, China to assess health needs and service usage.

The study was carried out in November and December 1999, in the provincial capital, Hangzhou, and in Chunan, a poor mountainous area 150 kilometres to the south-west. 90% of families in Hangzhou have only one child while in Chunan only 8% have one child, reflecting the different family planning policy for rural areas. 

2 800 students completed the questionnaire, based on surveys used in the United States and the United Kingdom and adapted to the Chinese setting.  The students came from eight different schools, which differed widely in their academic performance.  In one school 85% of the pupils went on to higher education while in another the figure was only 20%.

The study found that Chinese teenagers are keen users of the health service and 73% take regular medication.  However 52% had never visited a dentist, despite intensive health campaigns. Findings also included:

• Girls complained of more minor illness than boys.
• The health of the Chunan teenagers was affected by level of poverty, poor hygiene or malnutrition.
• The differences between the health of teenagers living in the city and the countryside were quite small, although there were some identifiable variations between the two groups. For example, city teenagers reported more tonsillitis.
• The top three concerns for Chinese teenagers were performance at school, chronic fatigue and the amount of homework they had to do.
• Only a small proportion mentioned relationships and appearance; traditional teenage worries in the West.
• Only six out of 2 800 mentioned sexual concerns while drugs, alcohol, smoking and violence were barely mentioned.

Following these findings the report suggests that:

• the issues that concern Chinese teenagers are different to those of the ‘Western teenager’, who is often most concerned about relationships and appearance. Sex and drugs, has yet to make an appearance in Chinese society
• the higher levels of tonsillitis in the city is probably due to an overenthusiastic diagnosis of sore throats in an urban population that can afford antibiotics
• the high usage of the health service is due to easy access, to a cultural attitude where a trip to the doctor for minor ailments is expected and is encouraged by health providers who benefit financially.

The widespread use of painkillers, laxatives and sedatives amongst teenagers is a cause for concern.  Teenagers are targeted by drug companies with grandiose claims about the benefits of their products.  Education is needed to counter the claims of the advertising campaigns and to draw attention to the harmful effects of using these drugs regularly over a long period.

Source(s):
‘Health and health care-seeking behaviour of adolescents in urban and rural China’, Journal of Adolescent Health 33: 271-274, by T. Hesketh et al, 2003

Funded by: UK Department for International Development

id21 Research Highlight: 7 January 2004

Further Information:
Therese Hesketh
Centre for International Child Health
Institute for Child Health
London WC1N 1EH

Tel: +44 (0) 207 905 2253
Fax: +44 (0) 207 404 2062
Contact the contributor: t.hesketh@ich.ucl.ac.uk

Centre for International Child Health, Institute for Child Health, University College London

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