Collaborations between Peking University and the Centre for Adolescent Health (UOM Department of Paediatrics, School of Medicine, MCRI and RCH)

Susan Sawyer shares her reflections on the relationship between Peking University and the Centre for Adolescent Health.

China has the 2nd largest population in the world and is home to 232 million children and adolescents. Like many other countries, adolescent health has been neglected in China. Yet new health challenges are rapidly emerging which requires both clinical treatment as well as a shift in preventive policies and actions. For example, long focussed on addressing malnutrition, the greater policy challenge is now obesity. Despite China’s large population of children and adolescents, the Institute for Child and Adolescent Health at Peking University is one of very few academic programs in China to focus on adolescent health. Since 2016, researchers at the Centre for Adolescent Health have developed a deep collaboration with academics at Peking University’s Institute for Child and Adolescent Health which is supporting them to support their government to better orientate policy responses towards school aged children and adolescents.

In mid-2024, I had the pleasure of visiting Beijing where Richard Horton (Editor, The Lancet) and I were invited to launch a paper on child and adolescent health that was published in The Lancet in April 2024 that is intended to shape future multisectoral policy responses. At that visit I appreciated how much our collaboration has reinforced our Chinese colleague’s commitment to advancing their institution’s academic leadership to adolescent health.

Specifically, the collaboration with the Centre for Adolescent Health has:

  • Validated their expertise, encouraged their leadership in adolescent health and strengthened their ability to train more researchers dedicated to the health of Chinese children and adolescents.
  • Supported them to extend beyond their core role leading a public health training program on child and adolescent health to consider how they might engage with government and clinical programs for children and adolescents. For example;
    • As a result of the new policy paper, their engagement with the Chinese government about the lack of population studies on adolescent mental health resulted in the development of China’s first national survey on adolescent mental health.
    • As a result of the wider body of work, notably paper #3 (which describes the impact of economic development on the nutritional transition in China which has seen a reversal of the previous pattern of obesity being more common in urban communities to where it is now more common in rural communities), I am told that various policies in China are now more specifically reorienting resources for the prevention and control of child and adolescent obesity from urban areas which had previously been the focus, to rural areas that we have shown are now the most disadvantaged.
    • A new national project has been established to monitor the prevalence of common diseases among students that is being led by Peking University.
  • Enhanced their teaching. For example, Professors Sawyer and Patton developed a Massive Open Online Course on Adolescent Health that, since 2015, continues to be delivered by the University of Melbourne (Coursera) twice a year. In 2021, Dr Zhou translated this material into Mandarin and now runs an annual postgraduate course for about 8 postgraduate students from different medical specialties each year. Over 40 Chinese postgraduate students have completed this course on adolescent health.
  • Extended collaborations. For example, Professor Sawyer’s engagement at the launch, which was supported by UNICEF China, led to an emerging collaboration with the UNICEF China office around a new policy paper that describes the low level of investment in adolescent health by government in China. It has also resulted in links to China’s leading children’s hospitals (eg Beijing Children’s Hospital, Tongji Children’s Hospital) with future opportunities to influence clinical practices.

This collaboration started when Professor Sawyer was president of the International Association for Adolescent Health (IAAH). At the time of the IAAH world congress on adolescent health in 2017 in Delhi, India, Professor Susan Sawyer and Professor George Patton met Professor Jun Ma, director of the Institute for Child and Adolescent Health which quietly led to the series of academic collaborations (detailed below), which are now actively supported by their current director, Professor Yi Song.

The initial interest from China was primarily to enhance the quality of their population studies in child and adolescent health with them well aware that publications in high impact journals achieve greater policy impact. We have prioritised this collaboration as it also provides us with access to extremely large population studies that enables us to mutually address questions that, due to the much smaller scale of studies in Australia, are unable to be addressed here. As outlined below, we have published 19 collaborative publications since 2018 of which 12 have been in the Lancet stable of publications (see list below) and many others have also been in highly impactful journals such as the British Medical Journal, JAMA Paediatrics, and Journal of Adolescent Health (the leading adolescent health journal).

The new policy paper (#17 on the list below) is likely to be particularly impactful. Published in The Lancet in 2024 and focussed on 6–19-year-olds, it is a critique of how well the policy landscape around child and adolescent health in China is matched to the health needs of contemporary children and adolescents – or not. Our Chinese colleagues have had a series of meetings with the Chinese government to consider their policy responses to this work.

The collaboration has involved:

Hosting extended visits to the CAH from academic staff at Peking Univesrsity, which aim to enhance their capability to lead high impact papers. 

  • Dr Yanhui Dong, a post-doctoral fellow, spent 12 months with us in 2018. Since his return to China, he has led a series of highly impressive collaborative publications. He has received awards from Peking University an/d was evaluated as a high-level adolescent health researcher by the Chinese government. He has become a critical member of the adolescent health research team at Peking University.
  • Dr Zhiyong Zou, a post-doctoral fellow, also spent 12 months with us in 2019. After returning to China, he has continued to pursue research studies that aim to improve adolescent health policies.
  • Associate Professor Tian-Jiao Chen spent 12 months with us in 2023, which focussed on her authorship of the recent policy paper on child and adolescent health in The Lancet.

Supporting PhD students, both those enrolled at The University of Melbourne and at the University of Peking at the CAH.

  • Ms Dongmei Luo is currently enrolled as a PhD student at the University of Melbourne, supervised by Prof Sawyer, Dr Nandi Vijayakumar and Dr Ghazaleh Dashti where she is focused on the role of pubertal hormones in mental health. She previously did her masters at Peking University (her key masters paper was coauthored with Profs Sawyer and Patton).
  • Ms Luo Li is currently enrolled as a PhD student at the University of Melbourne, supervised by Profs Azzopardi and Sawyer, with a focus on the measurement of adolescent wellbeing.
  • Ms Rui Deng is a PhD student at Peking University who spent 12 months with us in 2024 where she engaged in a series of comparative analyses from longitudinal cohorts in Australia and China on the impact of early growth patterns on pubertal timing.
  • Mr Yunfei Liu is a PhD student at Peking University who arrived in September 2024 for 12 months to advance a series of analyses using global burden of disease data.

Participation in two-way academic collaborations

  • In 2020, the cooperation between the two sides deepened, and Professor George Patton was awarded the title of Honorary Professor of Peking University, the highest honorary title for foreign professors at Peking University, in recognition of his contributions to health research in China and Peking University.
  • Professor Patton contributed to the China Commission on Women’s, Children’s and Adolescents’ health, a major report that was published in The Lancet in 2021 (see Qiao J et al below under publications). I am told that this report has greatly changed China’s health policies.
  • Professor Patton invited Dr Yanhui Dong and Dr Zhiyong Zou to contribute to the Lancet series on Adolescent Nutrition that was published in 2022.
  • Professors Sawyer and Patton invited Professor Jun Ma, Prof Yi Song and Dr Yanhui Dong to be commissioners within the 2nd Lancet Commission on Adolescent Health that will be published in May 2025.
  • Our NHMRC-funded Centre for Research Excellence on Driving Global Investment in Adolescent Health (2020-25) has a focus on Australia, China and Indonesia, and built on the collaboration with Peking University. Their staff participate in our monthly seminar series, including giving presentations.
  • Together with the editor of The Lancet, Richard Horton, Professor Susan Sawyer was invited to Beijing in late June 2024 to celebrate the launch of a new policy paper on child and adolescent health. The launch was supported by UNICEF China, with participation from academic and clinical leaders across China. It was live streamed, with 15,000 people joining the meeting online.
  • Professor Sawyer was the keynote speaker at China’s annual academic forum on child and adolescent health run by the Institute for Child and Adolescent Health at Peking University in Changchun, Jilin in early July 2024.

Collaborations high impact publications  

  • Dong Y, Hu P, Song Y, Dong B, Zou Z, Wang Z, Xu R, Luo D, Gao D, Wen B, Ma Y, Ma J, Tian X, Huang X, Patton GC. Secular trends in mortality and causes of death among children and adolescents aged 1–19 years in China from 1953 to 2016: a national and subnational variations systematic analysis. The Lancet 2018 Oct 1;392:S60.
  • Dong Y, Jan C, Ma Y, Dong B, Zou Z, Yang Y, Xu R, Song Y, Ma J, Sawyer SM, Patton GC. Economic development and the nutritional status of Chinese school-aged children and adolescents from 1995 to 2014: an analysis of five successive national surveys. The Lancet Diabetes and Endocrinology 2019 1;7(4):288-99.
  • Dong Y, Lau PW, Dong B, Zou Z, Yang Y, Wen B, Ma Y, Hu P, Song Y, Ma J, Sawyer SM, Patton GC. Trends in physical fitness, growth, and nutritional status of Chinese children and adolescents: a retrospective analysis of 1·5 million students from six successive national surveys between 1985 and 2014. The Lancet Child and Adolescent Health 2019;3(12):871-80.
  • Dong Y, Jan C, Zou Z, Dong B, Wang Z, Yang Z, Li Y, Wen B, Ma Y, Song Y, Ma J, Sawyer SM, Patton GC. Effect of overweight and obesity on high blood pressure in Chinese children and adolescents. Obesity 2019;27(9):1503-12.
  • Luo D, Yan X, Xu R, Zhang J, Shi X, Ma J, Song Y, Patton GC, Sawyer SM. Chinese trends in adolescent marriage and fertility between 1990 and 2015: a systematic synthesis of national and subnational population data. The Lancet Global Health 2020;8(7): e954-64.
  • Dong Y, Wang L, Burgner DP, Miller JE, Song Y, Ren X, Li Z, Xing Y, Ma J, Sawyer SM, Patton GC. Infectious diseases in children and adolescents in China: analysis of national surveillance data from 2008 to 2017. British Medical Journal 2020;369.
  • Dong Y, Ma Y, Hu P, Dong B, Zou Z, Yang Y, Xu R, Wang Z, Yang Z, Wen B, Tan M, Feng J. He, Yi Song, Jun Ma, Susan M. Sawyer, George C. Patton. Ethnicity, socioeconomic status and the nutritional status of Chinese children and adolescents: Findings from three consecutive national surveys between 2005 and 2014. Pediatric Obesity 2020;15(11):e12664.
  • Dong Y, Hu P, Song Y, Dong B, Zou Z, Wang Z, Xu R, Luo D, Gao D, Wen B, Ma Y, Ma J, Tian X, Narayan A, Patton GC. National and subnational trends in mortality and causes of death in Chinese children and adolescents aged 5–19 years from 1953 to 2016. Journal of Adolescent Health 2020 Nov 1;67(5):S3-13.
  • Qiao J, Wang Y, Li X, Jiang F, Zhang Y, Ma J, Song Y, Ma J, Fu W, Pang W, Zhu Z, Zhang J, Qian X, Wang L, Wu J, Chang HM, Leung PCK, Mao M, Ma D, Guo Y, Qiu J, Liu L, Wang H, Norman RJ, Lawn J, Black RE, Ronsmans C, Patton G, Zhu J, Song L, Hesketh T. A Lancet Commission on 70 years of women’s reproductive, maternal, newborn, child, and adolescent health in China. The Lancet 2021 May 24.
  • Norris SA, Frongillo EA, Black MM, Dong Y, Fall C, Lampl M, Liese AD, Naguib M, Prentice A, Rochat T, Stephensen CB. Nutrition in adolescent growth and development. The Lancet 2022 Jan 8;399(10320):172-84.
  • Yan X, Hu P, Ma N, Luo D, Zhang J, Wang J, Dong Y, Xing Y, Song Y, Ma J, Patton GC, Sawyer SM. Coverage of school health monitoring systems in China: a large national cross-sectional survey. The Lancet Regional Health–Western Pacific 2022;19.
  • Liu Z, Gao P, Gao A, Lin Y, Feng XX, Zhang F, Xu LQ, Niu WY, Fang H, Zhou S. Li WH, Xu CX, Wu N, Li HJ, Wen LM, Patton GC. Effectiveness of a Multifaceted Intervention for Prevention of Obesity in Primary School Children in China: A Cluster Randomized Clinical Trial. JAMA Pediatr.2022;176(1):e214375.
  • Dong Y, Jan C, Chen L, Ma T, Liu J, Zhang Y, Ma Q, Zhong P, Song Y, Ma J, Patton GC, Sawyer SM. The Cumulative Effect of Multilevel Factors on Myopia Prevalence, Incidence, and Progression Among Children and Adolescents in China During the COVID-19 Pandemic. Translational Vision Science & Technology 2022;11(12):9-.
  • Huan Wang, Yi Song, Jun Ma, Sheng Ma, Lijuan Shen, Yangmu Huang, Pugazhenthan Thangaraju, Zarrin Basharat, Yifei Hu, Yuan Lin, Huan Wang, Yi Song, Jun Ma, Sheng Ma, Lijuan Shen, Yangmu Huang, Pugazhenthan Thangaraju, Zarrin Basharat, Yifei Hu, Yuan Lin, Amy E Peden, Susan M Sawyer, Hao Zhang, Zhiyong Zou. Burden of non-communicable diseases among adolescents and young adults aged 10–24 years in the South-East Asia and Western Pacific regions, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Child and Adolescent Health 2023;7(9):621-35.
  • Luo D, Ma N, Liu Y, Ya X, Ma J, Song Y, Patton GC, Sawyer SM. Long-term trends and urban-rural disparities in the physical growth of children and adolescents in China: an analysis of five national school surveys over three decades. The Lancet Child and Adolescent Health 2023;7(11):762-772.
  • Li Chen, Liping Wang, Yi Xing, Junqing Xie,; Binbin Su, Mengjie Geng, Xiang Ren, Yi Zhang,Jieyu Liu,Tao Ma, Manman Chen, Jessica E Miller, Yanhui Dong, Yi Song, Jun Ma, Susan M Sawyer. Persistence and variation of the indirect effects of COVID-19 restrictions on the spectrum of notifiable infectious diseases in China: analysis of national surveillance among children and adolescents from 2018 to 2021. JMIR Public Health Surveillence 2024;10:e47626 (DOI: 10.2196/47626)
  • Tian-Jiao Chen, Bin Dong, Yanhui Dong, Jing Li, Yinghua Ma, Dongshan Liu, Yuhui Zhang, Yi Xing, Yi Zheng, Xiaomin Luo, Fangbiao Tao, Yanqing Ding, Peijin Hu, Zhiyong Zou, Bailin Pan, Ping Tang, Dongmei Luo, Yunfei Liu, Luo Li, Geffrey Nan Li, Xiaobo Tian, Xiaona Huang, Yi Song, Jun Ma, Susan M Sawyer. Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents. The Lancet 2024:403(10438);1808 – 1820.
  • Luo DM, Dashti SG, Sawyer SM, Vijayakumar. Pubertal hormones and mental health problems in children and adolescents: a systematic review of population-based studies. EClinicalMedicine 2024;76:102828.
  • Song X, Zhou B, Baird S, Lu C, Ezzati M, Chen L, Liu J, Zhang Y, Wang R, Ma Q, Jiang J, Qin Y, Dong Z, Yuan W, Guo T, Song Z, Liu Y, Dang J, Hu P, Dong Y, Song Y, Ma J, Sawyer SM. Trends and inequalities in thinness and obesity among Chinese children and adolescents: evidence from seven national school surveys between 1985 and 2019. The Lancet Public Health 2024;9:e1025–36

We welcome this ongoing collaboration.

Prof Susan Sawyer AM

Director Centre for Adolescent Health

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