中国3岁以下儿童系统管理的纵向变动与横向差异

Systematic Health Management for Children under Three Years Old in China: Temporal Changes and Regional Differences

背景 儿童的健康权一直是社会普遍关注的焦点。儿童系统管理率是反映促进儿童体格生长发育和心理行为发育的监测管理工作开展与落实情况的核心指标。儿童系统管理领域现有研究多为实证研究,多聚焦模式探索,少有研究者从整体性和历时性角度对全国层面儿童系统管理水平及其变化情况进行深入剖析。目的 通过分析2010—2019年3岁以下儿童系统管理率,把握3岁以下儿童系统管理水平的纵向变动与横向差异,力求为3岁以下儿童系统管理水平的巩固与提升、促进儿童健康水平的提高提供一定的参考与借鉴。方法 于2021年11月,以2011—2020年《中国卫生健康统计年鉴》作为数据来源,提取2010—2019年3岁以下儿童系统管理率数据。采用描述性分析法,对2010—2019年3岁以下儿童系统管理情况进行纵向与横向比较分析。结果 2010—2019年,我国3岁以下儿童系统管理率总体呈现不断增长的趋势,2019年为91.9%,与2010年(81.5%)相比,增幅达12.8%;北京市、内蒙古自治区、辽宁省、上海市、江苏省、浙江省、山东省、广东省、陕西省历年3岁以下儿童系统管理率>90.0%;西藏自治区历年3岁以下儿童系统管理率较低(2019年为71.9%),距离实现政策目标还有一定的距离。从历年变化趋势、不同省份差异和区域角度来看:2010—2019年3岁以下儿童系统管理率均高于同期全国水平、均低于同期全国水平、围绕全国水平上下波动的省份分别占41.9%(13/31)、22.6%(7/31)、35.5%(11/31);2010—2012年,同期省际3岁以下儿童系统管理率差异较大,2015年后,同期省际3岁以下儿童系统管理率差距逐渐缩小;3岁以下儿童系统管理率总体呈现出东北地区>东部地区>西部地区>中部地区的特点;2019年西部地区内部省际3岁以下儿童系统管理率差异仍较大。结论 3岁以下儿童系统管理成效明显。在3岁以下儿童系统管理水平的提升中,要重点关注西部地区,尤其是西藏自治区。未来,应不断提升基本医疗服务的公平性和可及性,缩小区域间资源配置及公共卫生服务差距。通过推广先进地区的儿童系统管理经验,充分借助“大数据”“互联网+”等技术手段,加强社区儿童健康管理团队建设等途径,进一步提高、巩固儿童系统管理水平。

Background The right to health of children has been a general concern of the society.The rate of systematic health management for children is a core indicator effectively reflecting the monitoring and management of children’s physical growth and psycho-behavioral development.Most of the studies on systematic health management for children use an empirical design,mainly focusing on explorations of management models,while few have made in-depth analysis of the national status from temporal and geographical perspectives.Objective To analyze the temporal changes and regional differences in terms of the rate of systematic health management of children under three years old from 2010 to 2019,providing valuable evidence for the consolidation and improvement of the health management level in this group,and for promoting health level in children.Methods In November 2021,data about health management of children under three years old in China during 2011—2020 were extracted from 10 volumes of China Health Statistics Yearbook published annually from 2011 to 2020.A descriptive analysis was used to conduct temporal and geographical analysis of the systematic health management for children.Results As a whole,the national health management rate for children under three years old showed a continuous upward trend increased from 81.5% in 2010 to 91.9% in 2019,with a 12.8% increase.The annual rate of systematic health management of the children during the period was greater than 90.0% in Beijing,Inner Mongolia Autonomous Region,Liaoning Province,Shanghai,Jiangsu Province,Zhejiang Province,Shandong Province,Guangdong Province and Shaanxi Province,but was relatively low in the Tibet Autonomous Region(71.9% in 2019),indicating that there was still a certain gap between the local level and policy goals in this region.The analysis from temporal changes and regional differences as well as regional perspective revealed the following findings:the rate of systematic health management for children under three years during 2010—2019 was higher than the national level in 13(41.9%)out of 31 regions in China,lower than the national level in 7 regions(22.6%),and moved around the national level in 11 regions(35.5%).The systematic health management rate of children under 3 years old varied greatly between regions during 2010—2012,but the inter-regional differences gradually narrowed after 2015.The rate of systematic health management for children under 3 years old was the highest in northeast China,followed by eastern China,western China and central China.In 2019,there was still large differences in the rate of systematic health management for these children among regions in western China.Conclusion China has achieved remarkable results in systematic health management for children under 3 years old.More attention should be given to the regions in western China,especially the Tibet Autonomous Region during the improvement of the management for these children.To further improve and consolidate the health management level of children,it is suggested to make efforts to improve the equity and accessibility of essential medical services,narrow the inter-regional differences between health resource allocation and public health services,learn and apply relevant good management methods from advanced regions,make full use of big data and internet techniques,and strengthen the construction of community pediatric health management team.