Establishment Of Indicator System Of Healthy Countryside In China

Objectives:To define the concept of healthy countryside with Chinese characteristics in the context of the two major strategies of rural revitalization and healthy China,and to build an indicator system for monitoring and evaluating the progress of healthy countryside at the county level in China so as to provide evaluation tools for monitoring and comprehensive evaluation of healthy rural construction as well as to provide scientific basis for promoting healthy rural construction and formulating relevant policies.Methods:Through policy analysis and theoretical research,we defined the concept of healthy countryside and the preliminary framework of the indicator system,and established a candidate pool of evaluation indicators for healthy countryside;based on predefined principles,we made the first draft of the indicator system and then we conducted two rounds of Delphi surevy with 31 experts.We then adjusted and improved the indicator system generated by the expert panel according to the pre-determined principles and standards to form a comprehensive evaluation indicator system of healthy countryside.We also used the Analytic hierarchy process to determine the weights of each indicator and used the Comprehensive index method to establish a mathematical model of comprehensive evaluation index for healthy countryside.Results:Through policy analysis and theoretical research as well as taking into consideration of the general requirements of the rural revitalization strategy,we defined healthy countryside as a comprehensive system that that focuses on the physical and mental health of rural residents and includes factors of social environment,natural environment,and ecosystem that affect human health.The contents of this comprehensive system from the core to the periphery are:population health,healthy behavior and lifestyle,healthy living environment,healthy working environment,sound health service system,sound medical insurance system,sound school education system,full employment and reasonable income,safe and harmonious community environment,healthy ecosystem,good leadership and governance.We then inviated 31 experts with senior professional titles from 19 provinces(municipalities)across the country including Beijing,Shanghai,Jiangsu,and Guangdong who has been engaged in researche on health,ecological environment,rural development,and public administration to form an expert panel for Delphi survey.After two rounds of Delphi survey and research group discussion,we generated a healthy countryside evaluation indicator system that consists of 179 indicators,of which 11 are first-level indicators,38 are second level indicators and 130 are third level indicators.The positive coefficients of expert panel in the two rounds of Delphi survey were 91.18%and 100%,respectively;the authority coefficients of experts were 0.86 and 0.87;the significance test of the two rounds of coordination coefficients were both P<0.05,indicating that the experts’ ratings of the indicators are consistent.The Consistency Ratio(CR)of the judgment matrix of the Analytic hierarchy process is all less than 0.1000,indicating that the consistency of the judgment matrix is acceptable,and the weighting result of each indicator is desirable.The indicator weight analysis results show that among the first-level indicators,"population health status(0.2007)","behavior,lifestyle and health literacy(0.1714)",and "human settlement environment(0.1386)" rank among the top three;for the combined weights of second-level indicators,,medical insurance(0.0752),air quality(0.0680),personal hygiene behavior(0.0578),comprehensive health level(0.0473),and reasonable diet behavior(0.0439)rank among the top five;combined weight values of three-level indicators,the top 10 rankings are:the percentage of days with good ambient air quality(0.0510),the rate of washing hands before eating and after defecation(0.0434),the per capita disposable income of rural residents(0.0381),the coverage rate of safe drinking water(0.0324),per capita daily salt intake(0.0293),life expectancy per capita(0.0255),incidence rate of acute pesticide poisoning(0.0249),basic medical insurance participation rate(0.0243),per capita water resources(0.0224),65-74 years old incidence rate of disability(0.0195).The mathematical model Y=∑WiYi of the comprehensive evaluation index of healthy countryside was initially established,and the calculation method of the comprehensive evaluation index of healthy countryside was determined.Conclusions:This study mainly used the Delphi survey and the Analytic hierarchy process to construct a comprehensive evaluation indicator system for healthy countryside at the county level in China,which provides effective tools for the monitoring and evaluation of healthy countryside construction in the context of rural revitalization,and fills the gaps of insufficient research on evaluation of healthy countryside in the context of "two grand strategies".The mathematical model of the comprehensive evaluation index of healthy countryside can be used to comprehensively evaluate the construction level of healthy countryside,to provide a reference for the policy planning of healthy countryside construction and the monitoring and evaluation of the construction process as well as the tracing of the root causes of related construction problems.However,the indicator system needs to be verified on the field.At the same time,we need to listen to the opinions of other stakeholders,such as rural residents and grassroots staff,and continuously modify and improve the indicator system to enhance its feasibility and operability.