Education Policy & Public Health

China's 'Healthy School' Initiative: From Exam Scores to Health First

The Ministry of Education's 2026 guideline on building "healthy schools" marks a systematic shift — replacing the score-first culture with measurable health targets that range from physical fitness to mental well-being.

• Core metrics called "four increases, four decreases" track physical fitness, myopia, obesity, mental health, and school medical resources.
• Mandatory minimum of 2 hours of daily physical activity for primary and secondary school students.
• The initiative aims to raise the rate of students with good or excellent physical fitness while reducing myopia rates, obesity growth, and psychological problem detection.

In February 2026, the Ministry of Education released its "Guidance on Comprehensively Promoting the Construction of Healthy Schools" (Document No. 3 of 2026), framing student health as a national priority rather than an afterthought. The document emerged from the Ministry's "New Year's First Meeting" — a deliberate signal that health takes precedence over exam rankings in the current policy cycle.

The framework is built around what officials call the "four increases, four decreases" (四升四降) indicator system. On the increase side: the rate of students meeting or exceeding the National Student Physical Fitness Standard; the rate of students demonstrating artistic literacy; the ratio of school medical staff to students; and the rate of schools equipped with automated external defibrillators (AEDs). On the decrease side: the myopia rate among students; the rate of overweight and obesity; the rate of detected mental health problems; and the rate of sports injury incidents.

The most concrete and immediately enforceable target is the "two hours of daily physical activity" mandate. Schools must ensure every student gets at least one hour of structured physical education plus one hour of physical activity outside of class — including recess, extracurricular sports, or after-school exercise programs. Provincial education departments are expected to enforce this through inspections, and schools that fail to meet the requirement face administrative review.

The guideline also emphasizes mental health infrastructure. Schools are required to establish psychological counseling rooms staffed by qualified personnel, conduct regular mental health screenings, and create referral pathways for students needing professional intervention. This follows a broader trend in Chinese education policy that has increasingly recognized the psychological toll of high-stakes exam culture.

Nutrition is another pillar. The guideline calls for improved school meal standards, regulation of campus vending machines, and health education curricula that teach students to recognize ultra-processed foods and understand basic nutritional science. Combined with the physical activity mandate, the policy targets the dual burden of malnutrition and rising obesity rates — a public health challenge that China shares with many middle-income countries.

The healthy school initiative assigns specific responsibilities: local education bureaus conduct annual evaluations, school principals bear direct accountability, and the Ministry will conduct random national sampling. The reference standards for primary, secondary, and tertiary institutions are published as annexes to the guideline, providing detailed checklists that schools can use for self-assessment. The policy is designed to be rolled out in phases, with pilot schools in major cities beginning implementation in spring 2026 and nationwide adoption targeted by 2028.