Myopia prevalence among primary school students across different districts in Guangzhou: insights from a large-scale school-based screening – BMC Public Health

Report on Myopia Prevalence in Guangzhou and its Implications for Sustainable Development Goals

Introduction: Aligning Vision Health with Global Sustainability Targets

This report analyzes the prevalence of myopia among primary school children in Guangzhou, China, contextualizing the findings within the framework of the United Nations Sustainable Development Goals (SDGs). The study reveals significant disparities based on geography, gender, and grade level, highlighting the interconnectedness of public health with goals concerning health and well-being (SDG 3), quality education (SDG 4), gender equality (SDG 5), reduced inequalities (SDG 10), and sustainable cities (SDG 11). Addressing childhood myopia is presented as a critical component of achieving these global targets.

Regional Disparities and SDG 10 (Reduced Inequalities)

The study documents significant inequalities in myopia prevalence both within Guangzhou and in comparison to other regions, underscoring the challenges in achieving SDG 10. Health outcomes are shown to be heavily influenced by geographic and socioeconomic factors.

Intra-City and National Disparities

• Guangzhou Districts: Prevalence varied significantly across the three districts surveyed: Huadu (38.92%), Yuexiu (37.67%), and Panyu (32.56%).
• National Comparison: These rates reflect broader national trends of inequality. For instance, urban centers like Shanghai report a prevalence of 51.1%, starkly contrasting with the 25.5% found in rural Yunnan. This urban-rural divide points to systemic inequalities in environmental and educational pressures that impact child health.

International Context

When compared internationally, the prevalence in Guangzhou is notably higher than in other nations, indicating a global disparity in the burden of myopia.

• Kazakhstan: Reported an overall prevalence of 28.3% in children aged 6–16.
• Rural Mongolia: Showed a markedly lower prevalence of 5.8%.
• Russian Federation: Exhibited wide variation, with urban schools reaching rates as high as 50.7%, comparable to Guangzhou’s more urbanized districts.

This regional heterogeneity highlights how unequal development, educational systems, and public health infrastructure contribute to disparate health outcomes, directly challenging the objective of SDG 10 to reduce inequality within and among countries.

Urbanization’s Impact on Public Health: A Link to SDG 3 and SDG 11

The geographic stratification of the three districts provides a clear illustration of how urban development patterns impact public health, linking directly to SDG 3 (Good Health and Well-being) and SDG 11 (Sustainable Cities and Communities).

1. Yuexiu (Central): As the traditional city center with high population density and academic competitiveness, it exhibits a high myopia rate, reflecting the health costs of intense urbanization.
2. Panyu (South): Located on the urban-rural fringe, this district’s more balanced development and greater environmental exposure correspond to the lowest myopia prevalence, suggesting that sustainable urban planning can yield positive health outcomes.
3. Huadu (North): A zone of rapid urbanization, this district recorded the highest prevalence. This suggests that development has outpaced public health infrastructure and literacy, creating an environment detrimental to children’s vision health.

These findings emphasize that creating sustainable cities under SDG 11 requires integrating public health strategies into urban planning. Ensuring access to outdoor spaces and balancing educational intensity are crucial for promoting the well-being of urban populations, a core tenet of SDG 3.

Gender-Based Disparities: Addressing SDG 5 (Gender Equality) in Health Outcomes

A consistent and statistically significant finding across all districts was the higher prevalence of myopia in female students, highlighting a key challenge for SDG 5 (Gender Equality). This health disparity can impede educational and developmental opportunities for girls.

• Yuexiu District: 40.10% in females vs. 35.53% in males.
• Panyu District: 34.83% in females vs. 30.57% in males.
• Huadu District: 43.09% in females vs. 35.52% in males.

The report attributes this disparity to both physiological and behavioral factors, such as girls being more likely to engage in sustained near-work and spend less time outdoors. Addressing this gender gap through targeted interventions—such as promoting outdoor activity specifically for girls—is essential for ensuring equal health outcomes and opportunities, thereby advancing the goals of SDG 5.

Educational Impact and the Critical Window for Intervention: A Focus on SDG 4 (Quality Education)

The study identifies a clear correlation between educational progression and myopia onset, directly implicating the educational environment in student health and linking the issue to SDG 4 (Quality Education). A progressive increase in prevalence was observed from Grade 1 to Grade 6, with a critical acceleration period between Grades 3 and 4. This period coincides with increasing academic demands, homework, and screen-based learning. This finding suggests that the pursuit of quality education must not come at the expense of student health. Recognizing Grades 3-4 as a window of heightened vulnerability allows for targeted interventions, such as school-based screening and lifestyle education, to ensure that educational systems support, rather than undermine, the long-term well-being of students.

Strategic Interventions and Collaborative Models for Sustainable Health Outcomes

The effectiveness of public health interventions was found to vary by district, offering lessons for implementing strategies aligned with SDG 3. The contrast between Panyu and Huadu is particularly instructive.

• Panyu District: Achieved a lower prevalence rate, which is associated with stronger cross-sector collaboration between education and health authorities and higher parental engagement (62% query rate). This integrated approach improved follow-up and compliance.
• Huadu District: Despite the highest prevalence, it had the lowest parental query rate (47.2%), indicating a gap in health literacy and engagement. The pilot of “Eye Health Corners” represents an innovative strategy to compensate for this gap.

These findings demonstrate that achieving sustainable health outcomes requires not only standardized protocols but also localized strategies that foster community engagement and multi-sectoral partnerships, which are foundational principles for the successful implementation of the SDGs.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The entire article focuses on the prevalence of myopia, a significant public health issue affecting the well-being of children. It discusses screening, prevention, and intervention strategies.
• SDG 4: Quality Education: The article links the rise in myopia to educational factors, such as “educational intensity,” “heavier homework load,” and “academic competitiveness,” suggesting that the nature of the educational environment has a direct impact on student health.
• SDG 5: Gender Equality: The article explicitly identifies and analyzes gender-based disparities, noting that “female students consistently exhibited a higher prevalence of myopia than males,” which points to inequalities in health outcomes between genders.
• SDG 10: Reduced Inequalities: The study highlights significant inequalities in myopia prevalence based on geographic location and socioeconomic development, comparing different districts within Guangzhou (Huadu, Yuexiu, Panyu) and contrasting urban versus rural regions (Shanghai vs. Yunnan).
• SDG 11: Sustainable Cities and Communities: The article discusses how “urbanization,” “population density,” and different stages of “urban development” across the three districts influence public health outcomes, emphasizing the need for tailored health strategies within metropolitan areas.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article’s focus on myopia, a non-communicable condition, aligns with this target through its emphasis on large-scale screening, early intervention, and prevention strategies like “increasing outdoor activity and regulating near work” to improve children’s well-being.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services… The implementation of a “unified screening protocol” across different districts represents an effort to provide essential health services. The article also highlights challenges in access and effectiveness, such as variations in “parental engagement” and “follow-up compliance,” which are central to achieving universal health coverage.

2. SDG 4: Quality Education

   • Target 4.a: Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for all. The article implies that current learning environments, characterized by “intensive literacy and screen-based learning” and “reduced outdoor activity,” are contributing to negative health outcomes. The call for interventions like increasing outdoor time is a call to create healthier and safer learning environments for children.

3. SDG 5: Gender Equality

   • Target 5.1: End all forms of discrimination against all women and girls everywhere. The article’s finding of a “statistically significant” higher prevalence of myopia in girls across all districts highlights a systemic health inequality. The recommendation for “Targeted interventions addressing modifiable behaviors” for female students is a direct response to this gender-specific vulnerability.

4. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status. The article documents health inequalities based on geographic location, noting that districts with different levels of urbanization and socioeconomic development (e.g., Panyu vs. Huadu) have different myopia rates. Addressing these “spatial stratification” issues is key to reducing health inequalities.

5. SDG 11: Sustainable Cities and Communities

   • Target 11.3: By 2030, enhance inclusive and sustainable urbanization and capacity for participatory, integrated and sustainable human settlement planning and management in all countries. The analysis of the three districts as a “geographic cross-section of Guangzhou’s urban development” and the conclusion that public health strategies must be adapted to “geographic and developmental gradients” directly relates to integrated urban planning that considers public health.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Prevalence of myopia: This is the primary quantitative indicator used throughout the article. It is measured and reported for different populations, such as the overall rates in Huadu (38.92%), Yuexiu (37.67%), and Panyu (32.56%). This directly measures the burden of a non-communicable disease (SDG 3).
• Gender-disaggregated prevalence rates: The article provides specific data on myopia prevalence for females versus males (e.g., in Yuexiu, “40.10% in females versus 35.53% in males”). This serves as a direct indicator for measuring health inequalities between genders (SDG 5).
• Prevalence rates by geographic area: The comparison of prevalence rates between different districts (Huadu, Yuexiu, Panyu) and between urban and rural settings (Shanghai vs. Yunnan) acts as an indicator of inequality within and between communities (SDG 10, SDG 11).
• Prevalence rates by grade level: The article notes the “progressive increase in myopia prevalence from Grade 1 to Grade 6,” identifying Grades 3-4 as a “critical onset window.” This age-stratified data can be used as an indicator to track the effectiveness of early intervention programs (SDG 3, SDG 4).
• Parental query rate: The article mentions this as a measure of engagement, stating Huadu had the “lowest parental query rate (47.2%)” while Panyu had a “higher query rate (62%).” This is an implied indicator of public health literacy and the effectiveness of communication strategies in health programs (SDG 3).
• Time spent outdoors and near work: While not quantified, the article identifies “limited outdoor activity” and “sustained near work” as key risk factors. Measuring changes in these behaviors is an implied indicator for assessing the success of preventative health interventions (SDG 3, SDG 4).

4. Table of SDGs, Targets, and Indicators

Source: bmcpublichealth.biomedcentral.com