Shen Xiaoming: linking evidence to advocacy for health in China

When Shen Xiaoming was a young boy, he dreamed of being a professional table tennis player. Living in a small town south of Shanghai, “table tennis”, he recalls, “was the only way I had in mind to leave the town and learn more”. But Shen‘s life took another course after his parents realised the severity of the developmental problems his younger sister suffered. When local doctors could not help, the family began travelling further afield to find answers. “At that time, my parents had to work 6 days a week. Each Sunday they took my sister and me to hospitals, seeking a miracle”, he says.

These journeys went on for almost 6 years. Finally, Shen’s parents realised they were futile; wherever they went, the explanations offered were inconclusive. His sister‘s condition did not improve, and “fear and despair engulfedthe whole family”, he says. Then, in 1978, China resumed college entrance examinations and Shen suddenly saw a way to break free from small-town life. He stopped his table tennis training and began preparing for the followingyear’s exam, which he passed with flying colours. When heasked his parents what he should study, they urged him tobecome a paediatrician and help his sister. Out of duty, asmuch as anything, he followed their advice. At the end of hisdegree from Wenzhou Medical College, he began working inthe busy local children‘s hospital. “At that time, the countrylacked trained paediatricians”, he says. “I had to double ourworkload to make sure each patient on the waiting list couldbe seen in the same day. I saw approximately 100 patientsa day. I was totally exhausted.” Through the weariness, itstruck Shen that he’d be better off learning how to prevent diseases, rather than treating them one patient at a time.An opportunity to put that thought into action came in1989, when Shen treated a group of children with severe anaemia. He diagnosed them with lead poisoning, which at that time was not considered a public health threat in China.Over the next 15 years, he and his research team undertook a series of comprehensive studies on childhood lead poisoning in Shanghai and found that petrol was the major source of lead. Shen‘s work on lead poisoning didn’t stop with diligent research. He began lobbying government to introduce unleaded petrol, eventually succeeding when the Shanghai authorities phased out leaded petrol in 1997 as a pilot project. Quickly, the proportion of children with blood lead concentrations higher than 100 μg/L decreased-from 57·8% in 1997 to 25·7% in 1998. In July, 2000, leaded petrol was banned nationwide and the proportion of children with raised blood lead concentrations dropped further to 5·8%.

Between 1994 and 1996, Shen spent time in New York, working with John Rosen, an expert on childhood lead poisoning at Montefi ore Medical Center Albert Einstein College of Medicine. “Xiaoming is a remarkably creative and innovative force”, says Rosen. “He has been and still is a pioneer in advancing the health of children in Shanghai and all of China. I would state, unequivocally, that he is a genius in creativity coupled to productive clinical research.” While in New York, Shen noted that many children who were diagnosed early with congenital hearing loss, and off ered interventions, were able to attend regular school. On his return to China, he began working with ENT specialists and language therapists to establish a hearing screening and early

intervention system. After a successful pilot study, Shen and his team called for local government to add hearing screening to the neonatal screening programme. They succeeded and the Shanghai coverage of hearing screening rose from 51·5% to 98%. “I was fortunate”, he says, “that the data convinced the higher offi cials from the Ministry of Health and they believed this technology should be promoted nationwide and would be benefi cial to all kids and their families.”

“This combination of evidence-based proposals andpersis tent advocacy have transformed public health policy and governmental action”, says Ba Denian, an eminent immunologist and former President of the Peking Union Medical College. Shen himself sees the two as interlinked: “Without the support of research data, advocacy is feeble, while without advocacy, research would not be able to have a real impact on a large scale of the population.” In 2006, Shen was appointed Director General of the Shanghai Municipal Education Commission and introduced regulations to delay the start time of school, on the basis of research showing that over 70% of children slept too little, especially in Shanghai. The delayed start increased schoolchildren‘s sleep duration and decreased the prevalence of daytime sleepiness.

In 2008, Shen was elected Vice Mayor of Shanghai, responsible for science and technology, education, and health aff airs. It’s been a busy time and his focus is on tasks emphasised by central government: establishing a universal medical insurance system, implementing an essential drugs policy, building capacity for primary health care, ensuring equal access to basic public health services, and launching a pilot reform project of public hospitals. He has also initiated China‘s fi rst resident training programme with international standards and leads an e-health system in Shanghai to collect health informa tion on over 20 million people from before birth to death. To all these projects Shen brings a strong vision, as China’s Minister of Health, Chen Zhu, describes: “He is very visionary, as refl ected by his deep understanding of both science and society, as well as by the number of ideas and policy leads coming from his mind. He has great passion for his work and is always ready to face new challenges.” Stephen Pincock