Building a healthy China by enhancing physical activity: Priorities, challenges, and strategies

Dear editor,

In 2016, several landmark government initiatives were launched in an effort to build a more healthy China. In March, the National People's Congress of China adopted the 13th Five-Year Plan, which sets out new objectives, principles, and targets for 2016–2020,¹ including action plans for enhancing environmental protection and green growth, promoting individual and population health, and improving the health care system and services. In June, the central government launched a strategic plan to implement a program to improve the nation's physical fitness and health levels.² In August, in an effort to fulfill China's commitment to the United Nations 2030 Agenda for Sustainable Development,³ the Political Bureau of the Chinese Community Party adopted the “Healthy China 2030” plan as part of a comprehensive strategy to improve the general health of the Chinese people.⁴

The release of these initiatives, especially the National Fitness Program (NFP),² has not only established the health of the Chinese population as a national priority but also provided opportunities for addressing some of the urgent public health issues that have resulted from the country's recent economic reforms and related developments that have led to unprecedented industrialization, urbanization, and environmental pollution. With these dramatic policy transitions taking place, China is now poised to address a major emerging health threat—noncommunicable diseases (NCDs) such as diabetes, heart attacks, stroke, and cancer.⁵ These NCDs are estimated to account for more than 80% of China's disease burden,5, 6 and the number of individuals afflicted with NCDs is expected to increase as the population ages over the coming decades.⁵ Unhealthy lifestyles, as reflected in decreases in physical activity (PA)7, 8 and increases in poor diet,⁹ represent another area of concern that can lead to increased risk for developing NCDs.

One key target of the NFP is to increase the number of people who participate in PAs, with the goal of 700 million people engaging in exercise at least once a week and 435 million exercising regularly. The NFP also calls for increasing sports expenditures to 0.2 trillion U.S. dollar per year and building enough sports fields to have 1.8 m² of space per capita dedicated to that purpose.

Although these goals are laudable from a public health perspective, strategies are needed to successfully implement the NFP and achieve its goals despite the significant challenges it presents.¹⁰ For example, there is no general consensus among public health authorities as to what constitutes the most beneficial forms and/or levels of PA. Similarly, there is a lack of evidence-based PA guidelines that can aid policymakers and public health authorities in making specific recommendations to the Chinese population about proper levels of PA. The health benefits of many traditional outdoor PAs and sports11, 12 have been reduced owing to worsening ambient air pollution.¹³ Rapid growth in urbanization has also resulted in limited availability of open spaces and community-based public facilities for PAs, and there is a large rural–urban gap in PA levels. Finally, although there are some national-level data available on PA and fitness,14, 15 there are no surveillance systems or mechanisms for monitoring PA trends over time, either locally or nationally.

If key PA goals are to be achieved, a number of steps need to be taken. First, a collaborative, coordinated effort that involves various central and local government authorities (e.g., those responsible for public health, health care, city planning, transportation, education, and the environment) is needed to both prioritize the NFP's activities and develop specific PA promotion guidelines and policies. Second, the government and public health sectors must undertake large-scale campaigns aimed at (1) promoting safe and clean environments for physical exercise, (2) increasing the level of PA taking place in multiple settings (e.g., workplaces, neighborhoods, schools, and rural areas), and (3) making accessible and walkable places and facilities available for PAs. It is also important to develop a national PA research agenda that includes epidemiologic studies and the use of evidence-based information to guide the development of PA initiatives and policies for increasing PA in communities. Finally, establishing a surveillance system is necessary to systematically track PA behaviors at the local and national levels, thereby creating dependable tools for assessing energy expenditure and more accurately estimating levels of PA.

Authors' contributions

SW carried out the study, obtained research grants for this study, and drafted the manuscript; MB helped to conceive of the study and helped to draft the manuscript; YL and XQ participated in its information collection and coordination. All authors have read and approved the final version of the manuscript, and agree with the order of presentation of the authors.

Competing interests

None of the authors declare competing financial interests.