作者： admin

　　Problems and suggestions on the construction of public health system and the reform of medical system

　　—— Excerpts from the communication seminar on "Prevention and Control of Epidemic Situation in COVID-19 and Promoting Healthy China Action" (1)

　　Guangming. com (Reporter Wu Pengfei) Recently, a communication seminar on "COVID-19 Epidemic Prevention and Control and Promoting Healthy China Action" was held, which was jointly sponsored by the Organizing Committee of (Yanqi Lake) Healthy Development Forum, Guangming. com, China Health Management Association, China Minsheng Bank Research Institute and Beijing Reform and Development Research Association. Experts and scholars from China Academy of Social Sciences, Central Party School (National School of Administration), Peking University, Tsinghua University, China Renmin University and other institutions attended. The theme of this seminar was

　　Jian Chen, Executive Director of Health Development Forum (Yanqi Lake)It is said that the old saying goes, "Go to the hospital to cure the country, and then save people." The ancients believed that the principles of governing the country and governing the body were interlinked, and the theory of governing the country with medicine reflected the feelings of ancient doctors about home and country. The sudden outbreak has affected China and even the whole world. Epidemic prevention and control is actually a big test of the national governance system and governance capacity, with both experience and lessons. Since its establishment, (Yanqi Lake) Healthy Development Forum has taken the promotion of Healthy China as its own responsibility. The experts who participated in the discussion of "Public Health System Construction and Medical System Reform" were Tian Xueyuan, the chief expert of (Yanqi Lake) Health Development Forum, Song Xiaowu, former president of china society of economic reform, Liu Wanling, vice president of china society of economic reform, Huang Jianhui, president of China Minsheng Bank Research Institute, and Jiang Huicheng, chairman of Hainan Cancer Hospital.

　　People-oriented: Thinking and Decision-making Choice of Deepening Medical and Health Reform

　　Tian Xueyuan, Chief Expert of Health Development Forum (Yanqi Lake) and Member of Chinese Academy of Social Sciences.

　　To sum up this fight against epidemic disease, the most fundamental lesson is that we should always stick to the people-oriented position and stick to and practice the ideological line of seeking truth from facts. This time, the CPC Central Committee and relevant departments adopted reasonable suggestions including Academician Zhong Nanshan and Academician Li Lanjuan, and decisively took the most severe measures to turn the tide, stop the epidemic from spreading and usher in a better situation in the whole country.

　　First, actively promote the reform of rational and effective allocation of medical resources

　　Medical reform has been carried out for many years, and many achievements have been made, but it is still not ideal. The main point is that there is no reasonable and effective allocation of medical resources, especially high-quality medical resources, according to market demand. Therefore, when the epidemic strikes, prevention, control, treatment, etc. are caught in a dilemma that is hard to cope with effectively.

　　1. Expand and rationally distribute comprehensive 3A hospitals.

　　First of all, in the first-tier cities such as Beijing, Guangzhou and Shenzhen, the top three hospitals will be expanded in scale. Secondly, to speed up and improve the construction of third-class hospitals in second-tier cities such as provincial party committees, big cities can take the lead. Thirdly, gradually expand to prefecture-level cities. First, we must adhere to high standards in the construction of top three hospitals. The second is to buy time. Strive to form a network distribution pattern of the top three hospitals in China in a relatively short period of time, such as three to five years, and make it a comprehensive medical and treatment center and backbone with reasonable distribution throughout the country.

　　2. Establish a medical group led by a well-known and specialized hospital.

　　For example, if Beijing Xuanwu (Brain), Tongren (Eye), Fuwai (Chest) and Jishuitan (Bone) Hospital take the lead, corresponding branches of provinces, autonomous regions and municipalities directly under the Central Government will be established. The lead hospital is mainly responsible for scientific and technological research and development, technical guidance, personnel training, regular rounds and other services. The local authorities are mainly responsible for hospital construction, administrative management and overall business operation. The group takes the state-owned as the main body, and can also adopt the joint-stock system and joint-stock cooperative system with the state-owned as the main body.

　　3. Encourage the coordinated development of private and joint-venture small and medium-sized hospitals.

　　This is the microcirculation system of the medical network system, and it is an extension and supplement of the state-owned backbone medical network, which is indispensable. It is necessary to form a medical grid structure that complements large, medium and small scales and combines state, collective and individual ownership.

　　4. Scientifically promote the reform of integrated traditional Chinese and western medicine

　　The combination of traditional Chinese and western medicine is a controversial topic for a long time. However, its role in the contemporary fight against malaria, influenza, SARS and COVID-19 has been confirmed by practice. Although it is not clear what the meridians of traditional Chinese medicine are, their functions in disease prevention, treatment and rehabilitation are obvious and objective. We should take the test of practice as the standard, seek common ground while reserving differences, learn from each other’s strengths and make up for each other’s shortcomings, and develop in a coordinated way. On this basis, it is summarized, accumulated and refined into a relatively systematic theory centered on anti-epidemic, disease prevention and treatment, and promotes the integration of traditional Chinese and western medicine into a new stage.

　　Second, deepen the reform of the public health system

　　Whether the epidemic situation including Covid-19 can be effectively prevented and controlled, as mentioned above, the medical system, system and affordability are the first to bear the brunt. However, the prevention and control of epidemic diseases is not only a medical matter. The prevention, treatment and rehabilitation of major infectious diseases involve monitoring, evaluation, policies, systems, supply, security, publicity, social coordination and many other aspects, and more belong to the public health system. In this sense, the Covid-19 epidemic is a severe test for the public health system.

　　The essence of public health can be expressed as a scientific and social public system to prevent diseases and promote people’s health through monitoring and evaluation, policies and systems, guarantees and actions. In short, it is the science of disease prevention and control and its social public system. The following suggestions are put forward for the reform of public health system:

　　1. Reform and improve the epidemic monitoring and evaluation system.

　　There are some prominent contradictions and problems in the existing epidemic monitoring and evaluation system, especially which department is responsible, who is responsible for monitoring and evaluation and information release. For example, the National Health and Wellness Committee has institutions such as the Bureau of Disease Control and Prevention and the Health and Wellness Supervision Center. In addition, there is China Center for Disease Control and Prevention (China CDC), and corresponding branches have been set up in various provinces, autonomous regions and municipalities directly under the Central Government. These organizations are responsible for the prevention and control of diseases, especially epidemic diseases, with the aim of creating a healthy environment and promoting people’s health. However, in the face of the epidemic examination, such institutional setup has some problems, such as overlapping institutions, overlapping functions, low efficiency, and even delaying fighters, ineffective command, mutual blame and so on, which need to be changed and reformed urgently.

　　To this end, first of all, clarify the responsible institutions for epidemic monitoring and evaluation. It is suggested that the National Health and Wellness Committee should assume the overall responsibility and set up a National Epidemiology Steering Committee composed of a deputy director, principals of relevant departments and relevant well-known experts. The steering committee is responsible for the review, approval and release of epidemic diseases, especially major infectious diseases. Secondly, at the same time, the National Epidemiology Administration was established, which was subordinate to the State Council, and its daily work was managed by National Health Commission. The National Epidemiology Administration is mainly responsible for monitoring and evaluating epidemic diseases, especially major infectious diseases, presenting epidemic reports and submitting them to the National Health Commission Epidemiology Steering Committee for review, approval and release.

　　2. Formulate laws and policies to deal with epidemic diseases.

　　It is necessary to strengthen the legal construction of epidemic prevention and control and introduce the Epidemic Prevention and Control Law as soon as possible. "Epidemic Prevention and Control Law" should embody the purpose of people-oriented and people’s health as the center. The provisions should absorb the common norms of the international community and proceed from the reality of China, which is a common law and regulation that is generally applicable to the prevention and control of various epidemics. At the same time, we should leave room to formulate national or local supplementary laws and regulations and corresponding policies according to the specific conditions of different epidemic diseases.

　　3. Accelerate the construction of epidemic emergency facilities and logistics support.

　　This sudden large-scale outbreak of the COVID-19 epidemic has caused medical and public health facilities, such as hospitals and sickbeds; The supply of materials such as masks and disinfectant is in short supply, which is quite scarce. After the epidemic, it is necessary to evaluate the consumption and demand of facilities and materials, and draw up a balance list of supply and demand of materials according to the actual material consumption of the number of cases, deaths and severe cases finally diagnosed during the epidemic. Taking this as a reference, the demand forecast of epidemic emergency facilities, high, medium and low logistics support is made, which provides a plan for coping with future epidemic logistics support.

　　At present, the more economical way is to increase investment, improve quality, taste and scale on the basis of new temporary hospitals, vaccines and other new drug production lines built during the epidemic period, and strive to achieve scale and modernization and become a logistics support base to deal with various new epidemics. After the hospital is completed, it can be put into use to make up for the difficulty of seeing a doctor and being hospitalized. The production of new drugs needs to be scientifically determined according to market demand, and a reasonable reserve should be maintained on the basis of meeting current demand.

　　The construction of public health system urgently needs to fill shortcomings and loopholes.

　　Song Xiaowu, former deputy director of the State Council Northeast Office and former president of china society of economic reform.

　　Since the fight against SARS virus in 2003, China has made great achievements in the construction of public health system, and achieved remarkable results in preventing and resisting H1N1 in 2009 and H7N9 and avian influenza in 2013. However, we should also see that the COVID-19 epidemic has exposed some shortcomings in the public health and medical service system, which is worth summing up and thinking about.

　　First, there is a shortage of relevant professionals in the construction of public health system. According to national statistical data, the proportion of health personnel in CDC has dropped from 2.53% in 2009 to 1.53% at present, and the absolute number of people engaged in public health has dropped. In recent years, the country has put forward the development strategy of healthy China, and defined the guiding ideology of public health with prevention as the priority, but the actual situation shows that there is still a lack of corresponding implementation mechanism. For example, the cultivation and growth of public health talents should be a priority for the government to increase investment.

　　Second, after the SARS epidemic in 2003, the state invested a lot of manpower and material resources to establish a direct online reporting system for legal infectious diseases. This system has played an active role in preventing the spread of several major epidemic diseases. However, in the early days of the outbreak of Covid-19, the online direct reporting system of infectious diseases failed for a time, and the public health and epidemic prevention system failed to play its due role in the early days. This lesson needs to be earnestly summed up and remembered in a realistic way, and the causes of the artificial expansion of the epidemic need to be deeply reflected.

　　Third, patients and hospital doctors must be the first to find infectious diseases. How to organically combine social public opinion with the release of major epidemics through formal channels is a big problem that needs to be discussed. How to strictly control the reporting and publishing procedures of major epidemics, and properly handle the direct response of front-line doctors and the general public to epidemics is a major issue that needs to be addressed and studied in the construction of public health and epidemic prevention system. The construction of public health system should be coordinated with the reform of medical institutions. First, because the public health system is largely based on medical institutions. For example, medical treatment in the public health system, including infectious disease specialist hospitals, infectious disease wards in general hospitals, specialist prevention and control institutions, emergency departments of hospitals, pre-hospital first aid institutions and treatment institutions for occupational poisoning and nuclear radiation, are mostly related to hospitals and closely related to hospitals. Therefore, the construction of public health system can not be separated from the system reform and career development of medical institutions. Second, the jobs between the public health system and the medical service system are highly interchangeable and replaceable, and the mobility of medical staff between the two systems is very large. If the system connection between the two systems is not smooth and the operation mechanism is not harmonious, for example, the income distribution gap of medical staff at the same level is too large, which will lead to the unreasonable flow of medical staff. Therefore, in practical work, the construction of public health system cannot be promoted independently from the reform of medical institutions, and the two must be promoted in a coordinated manner.

　　In addition, it is worth noting that we can’t use special measures in public health emergencies to measure the way of medical service provision under normal circumstances. The public health service system is closely related to the new medical service system, and there are also significant differences. Public health and epidemic prevention is the responsibility of governments all over the world. The government plays an unshirkable role in public health, but it does not deny the role of non-public medical institutions in providing daily medical services to residents.

　　Eight countermeasures to promote the reform of medical and health system and mechanism

　　Huang Jianhui, Dean of China Minsheng Bank Research Institute

　　The public health shortcomings exposed by the COVID-19 epidemic have aroused widespread concern among the general public about the shortcomings of the current medical and health system and mechanism. We should respond to people’s concerns and accelerate the construction of public health system and the reform of medical system.

　　First, straighten out the relationship between the government and the market, and promote the implementation of the medical reform policy as a whole.

　　Promote the improvement of legislation and provide legal guarantee for the reform of medical and health system. Based on the Basic Medical and Health Law of People’s Republic of China (PRC), we will revise and improve the Social Insurance Law, the Law on Prevention and Treatment of Infectious Diseases, the Law on Traditional Chinese Medicine, the Regulations on Prevention and Treatment of Medical Disputes and other laws and regulations, and strengthen supervision according to law to increase the cost of violating laws and regulations.

　　Fill in the shortcomings of public health management and form a development model of "paying equal attention to prevention and treatment". Improve the management level of CDC and strengthen its powers and responsibilities. The central government will directly lead and conduct vertical management to improve the emergency management ability of public health emergencies.

　　Transform government functions. Promote "separation of management and administration" and "separation of government affairs" to improve the operational efficiency and service level of the medical service supply system; We will improve the coordinated promotion mechanism of medical care, medical insurance and medicine, and completely get rid of "supplementing medicine with medicine".

　　Promote the supply-side reform in the field of drug production and circulation, and improve the drug supply guarantee system. Take multiple measures to accelerate the realization of a "full coverage, basic protection, multi-level and sustainable" medical security system. With the goal of "making the whole people enjoy fair and accessible health services", we will continue to improve and optimize the basic medical security system for all; Give full play to the supplementary role of commercial medical insurance; Effectively safeguard the safety of medical insurance funds and improve the efficiency of fund use.

　　Two, to share the fruits of economic development as the guide, increase financial investment in health care.

　　Gradually increase the proportion of medical and health financial expenditure. Clear the target of medical and health financial expenditure that is compatible with the level of economic development, and realize a moderate increase in the proportion of health expenditure in financial expenditure.

　　Promote the rational use of financial funds. Increase investment in public health, innovative research and development, and medical and health education; Increase the input of resources in rural areas, grassroots areas and poverty-stricken areas in the central and western regions; Subsidize public hospitals to reduce medical expenses, and subsidize medical insurance to reduce residents’ direct medical expenses.

　　Third, focus on strengthening the construction of a public medical system covering urban and rural areas and the whole people, and strive to reform the management system and mechanism.

　　Promote the establishment of a public medical system covering urban and rural areas and the whole people. Accelerate the optimal allocation of medical resources at regional, urban and rural levels; Improve the graded diagnosis and treatment system of "first diagnosis at the grass-roots level, two-way referral, rapid and slow division and treatment, and linkage from top to bottom".

　　Promote the reform of the management system of public hospitals. Change the current situation of direct control of public hospitals by health authorities; Strengthen the functions of health administrative departments and market supervision; Clarify the relationship between the government and the party group of public hospitals and the corporate governance structure of public hospitals.

　　Improve the management mechanism of modern public hospitals. Establish a performance appraisal mechanism oriented to public welfare and operational efficiency, and a "patient-centered" service mechanism; Strengthen budget management and cost accounting mechanism; Gradually implement the filing system for public hospitals.

　　Fourth, promote diversified, high-quality and efficient supply and demand matching

　　Speed up opening to the outside world and actively develop private hospitals; Accelerate opening to the outside world and actively introduce foreign-funded hospitals.

　　Fifth, actively deploy digital Internet medical care

　　Be good at digital service process and introduce digital medical technology. Establish an Internet grading diagnosis and treatment platform and promote online appointment; Use cloud computing, big data, artificial intelligence and other technologies for monitoring and analysis, health management, technology research and development, emergency management, etc.

　　Promote online diagnosis and treatment of "internet plus". Online follow-up visits for some common diseases and chronic diseases; Carry out telemedicine, health consultation and health management services; Establish a network medical science popularization platform to improve residents’ self-health management ability.

　　Six, effectively protect the legitimate rights and interests of medical personnel.

　　Gradually increase the average salary level of medical staff, take medical skills, patient satisfaction, clinical performance or the actual contribution of research to the clinic as the leading assessment indicators, and promote the legalization, rationalization and sunshine of medical staff’s income; Strengthen the protection of rights and interests and publicity and guidance to improve the professional dignity of medical staff.

　　Seven, for the purpose of improving patient satisfaction, the establishment of medical and health consumer rights protection bureau.

　　Set up health care consumer rights protection bureaus within health care committees at all levels, improve consumer rights protection mechanisms and measures in the field of health care, organize the acceptance, investigation and mediation of complaints about health care consumption, and carry out supervision, inspection, education and consultation.

　　8. Strengthen international cooperation in the field of medical and health care and practice building a community of human destiny.

　　Improve the international cooperation mechanism for dealing with major public health incidents and jointly safeguard world public health security; Strengthen international cooperation in pharmaceutical innovation and research and development; Promote the modernization of Chinese medicine industry, and continue to promote the integration of Chinese and Western medicine from the aspects of personnel training, theoretical research and clinical application.

　　Seize the new opportunity brought by the epidemic to medical insurance reform

　　Liu Wanling, Vice President of china society of economic reform.

　　Medical security has played an important role in fighting the epidemic, and it has also deepened our understanding of the importance and necessity of accelerating the construction of medical security system. We should seize the opportunity of medical security reform brought by this epidemic and speed up the improvement of our medical security system.

　　First, improve the medical treatment system during major epidemics.

　　In emergencies such as sudden epidemic, in order to ensure that patients can be treated as soon as possible, medical institutions should treat them first and then charge them, giving priority to saving patients’ lives. Explore the establishment of a medical fee exemption system for special groups and specific diseases. Improve the proportion of payment to primary medical institutions, ensure the demand for funds, and simplify the settlement method.

　　Second, establish a reasonable fund raising system

　　Fund is the basic guarantee for the operation of medical security. The level of medical security should adapt to the level of economic development. We should proceed from the reality of China’s national conditions, adhere to the reasonable burden of the state, units and individuals, not only ensure the basic medical care for employees, but also consider the affordability of finance and enterprises, and establish a financing mechanism that is suitable for the basic national conditions in the primary stage of socialism, matches the affordability of all parties, and coordinates with the basic health needs.

　　Third, improve the multi-level medical security system

　　In view of the insufficient imbalance in the development of medical security, we will speed up the establishment of a multi-level medical security system with basic medical insurance as the main body and medical assistance as the foundation, supplemented by medical insurance, commercial health insurance, charitable donations and medical mutual assistance. In particular, we should learn from foreign advanced experience, accelerate the development of commercial health insurance, and make it an important supplementary level of medical security.

　　Four, improve the medical insurance fund supervision mechanism

　　The medical insurance fund is the "life-saving money" of the people. Maintaining the security of the fund should be the primary task. Strengthen the establishment of a systematic and integrated comprehensive supervision system, establish and improve a strict management and supervision system, implement a strict accounting system, and give play to the role of supervision of medical insurance public service institutions, departmental coordination supervision, third-party supervision and social supervision. Innovate fund supervision methods, make full use of information technology, implement real-time dynamic intelligent monitoring of big data, and establish a normal mechanism for supervision and inspection. Improve the social supervision and incentive mechanism of medical security.

　　Vigorously promote the construction of public health emergency management system

　　Jiang Huicheng, Chairman of Hainan Provincial Cancer Hospital

　　In the process of epidemic prevention and control, the shortcomings and shortcomings of the public health emergency system were exposed. We should comprehensively improve the construction of public health and the capacity building of public health emergencies. Improve public health and medical service capabilities, speed up the improvement of major epidemic prevention and control systems and mechanisms in various regions, focus on the goal of "early detection, early reporting and early disposal", strengthen the information collection, analysis and utilization capabilities of disease control institutions at all levels, continuously strengthen the graded diagnosis and treatment mechanism, optimize the layout of public health resources, and strengthen grassroots infrastructure construction.

　　The first is to build an intelligent emergency system. It is suggested to accelerate the construction of "Internet+Medical" platform, make full use of digital technologies such as big data, cloud computing and informatization, improve the data interconnection between public health platform and medical institutions, and realize the intelligence, informatization and convenience of emergency system for public health emergencies. Improve the concept, means and technology of "smart health" throughout the construction of emergency system for public health emergencies, accelerate the construction of a moderately advanced, interconnected, safe, efficient, intelligent and green modern infrastructure system, create an intelligent emergency system, and continuously improve the modernization level of governance system and governance capacity.

　　The second is to improve the emergency material reserve system. Establish and improve relevant laws, regulations and rules and regulations around the material reserves for handling public health emergencies, so that there are laws and regulations for the management of materials for handling public health emergencies. The government reserve and enterprise reserve, non-governmental organization reserve and family reserve are adopted to carry out diversified emergency materials reserve for public health emergencies. In addition, we will improve the emergency material reserve system by building, rebuilding, leasing emergency material storage facilities and entrusting enterprises to purchase services.

　　Only by promoting the construction of public health emergency management system can we enhance our ability to deal with public health emergencies.

　　Children’s Day is approaching. In shopping malls, supermarkets and major e-commerce platforms, children’s products have become the hottest promotion keywords, and children’s foods are more diverse and dizzying. Some parents often feel confused when shopping. How to buy nutritious snacks for their children during the critical period of their physical growth and prevent them from buying junk food and fake and shoddy food has become the most concerned issue for parents. The reporter recently conducted an in-depth visit to the children’s snack market with many problems reflected in readers’ letters and formed an investigation report.

　　The children’s snack market has great potential.

　　Snacks play an increasingly prominent role in the daily diet of children and adolescents in China and have become an important dietary component. At the end of 2019, the number of children under 16 in China was 249.77 million, accounting for 17.8% of the total population. The huge population of children means huge potential market demand, and the children’s snack market is rising rapidly. It is estimated that the children’s snack market will grow steadily at a compound annual growth rate of 10% to 15% from 2019 to 2023.

　　On May 17th, the White Paper on Market Investigation of Children’s Snacks (hereinafter referred to as the White Paper) jointly formulated by China Non-staple Food Distribution Association, Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs was officially released. The White Paper pointed out that the problems of nonstandard labeling of children’s food, worrying nutritional value of children’s snacks and low trust of parents in domestic children’s food brands have restricted the healthy development of children’s snack market.

　　Some children’s foods are added with various additives to increase the taste; Some snacks use the concept of "children", but the ingredients are actually no different from those of ordinary food; Some foods claim to be suitable for people, but the ingredients are not in line with reality.

　　Experts say that the quality of children’s snacks will affect children’s nutritional status to a certain extent, and children’s immunity and physical function can’t be compared with adults. Healthy children’s snacks suitable for children’s nutritional needs will be more conducive to the healthy development of children’s bodies. However, in the current children’s snack market, the product quality is mixed, including high-end snacks specially developed for children, unhealthy snacks with high sodium and fat, and even "spicy" snacks with no products. In terms of snacks, most of them are candy, biscuits, puffed snacks and other popular snacks, which are not obviously different from adult snacks, and the product definition is vague.

　　Children’s soy sauce, children’s biscuits, children’s milk, children’s milk drinks and other foods labeled as "children" flooded major stores and supermarkets and were favored by young parents. In fact, there is no difference in ingredients between children’s food and ordinary food, but the price is more expensive than ordinary food. At present, some children’s foods on the market only have the name of "children" but are not "special", but are only market means to subdivide products. Some businesses take advantage of parents’ neglect of children’s food nutrition labels, seize its loopholes, exaggerate in propaganda and mislead consumers. Therefore, parents must carefully screen when purchasing children’s food, and don’t fall into the trap of merchants.

　　This year’s "children’s food"

　　Plan to sample 3522 batches.

　　In 2020, the Market Supervision Committee plans to carry out sampling inspection and monitoring of "children’s food", and plans to carry out a total of 3,522 batches, including 353 batches of dairy products, 928 batches of beverages, 270 batches of biscuits, 278 batches of frozen drinks, 426 batches of potatoes and puffed food, 622 batches of candy products and 645 batches of fruit products.

　　Health tips

　　Establish a balanced diet

　　Rational nutrition concept

　　How should we guide children and adolescents to establish the concept of balanced diet and reasonable nutrition from an early age, and reduce or correct bad snack consumption behavior? In 2018, the Institute of Nutrition and Health of China Center for Disease Control and Prevention and the Nutrition Society of China jointly compiled the Snack Guide for Children and Adolescents in China 2018. "In recent years, the dietary nutrition status of children and adolescents in China has been greatly improved, but there are also problems such as excessive snack consumption and lack of scientific guidance." Zhang Bing, deputy director of the Institute of Nutrition and Health, China Center for Disease Control and Prevention, said. The consumption rate of snacks among people aged 2 and over in China has increased from 11.2% in the 1990s to 56.7% recently, and snacks provide about 10% of the total daily energy. Children and adolescents are in a critical period of growth and development, and it is also an important stage to develop good eating habits. Excessive or unreasonable snack consumption behavior may increase the risk of obesity and related chronic diseases.

　　The Guide is divided into three volumes according to age groups, which are applicable to 2— 5-year-old preschool children, 6-mdash; 12-year-old school-age children and 13-mdash; 17-year-old teenagers.

　　2— 5-year-old preschool is the key stage of children’s growth and development. At this stage, three rich meals and two moderate meals are the guarantee for preschool children to get comprehensive nutrition. If you need to add snacks, you should add a small amount and choose healthy snacks. Therefore, for 2— The core recommendations of 5-year-old preschool children include: 1. Eat a good dinner, add a proper amount of meals and a small amount of snacks; 2. Snacks are preferably fruits, milk and nuts; 3. Eat less snacks with high salt, sugar and fat; 4. Do not drink or drink less sugary drinks; 5. Snacks should be fresh, diverse, digestible, nutritious and hygienic; 6. Eat snacks quietly and beware of choking; 7. Keep your mouth clean and don’t eat snacks before going to bed.

　　6— The dietary pattern of 12-year-old school-age children has gradually changed from three meals and two meals in preschool to three meals a day, and the food intake for dinner has increased. However, due to the long interval between meals, it is easy to feel hungry, and because of the continuation of preschool eating habits, it is easy to produce snack consumption demand. Therefore, for 6— The core recommendations of 12-year-old school-age children include: 1. Main meals, reasonable breakfast and small snacks; 2. Appropriate meals between classes, preferably fruits, milk and nuts; 3. Eat less snacks with high salt, sugar and fat; 4. Do not drink or drink less sugary drinks, and do not drink alcoholic and caffeinated drinks; 5. Snacks are fresh, nutritious and hygienic; 6. Keep your mouth clean and don’t eat snacks before going to bed.

　　13— 17-year-old teenagers are experiencing the second peak of growth and development-puberty development stage. Teenagers in this period need a lot of energy and nutrients, and they are more autonomous and independent in food choice, which is easy to produce impulsive food consumption and even rely on some snacks. Therefore, for 13— The core recommendations of 17-year-olds include: 1. Eat three meals well and avoid snack substitution; 2. Learn nutrition knowledge, reasonably choose snacks, preferably fruits, milk and nuts; 3. Eat less high-salt, high-sugar, high-fat and smoked fried snacks; 4. Do not drink or drink less sugary drinks, and do not drink alcohol; 5. Snacks are fresh, nutritious and hygienic; 6. Keep your mouth clean and don’t eat snacks before going to bed.

　　Authoritative voice

　　The market supervision Committee will focus on the supervision of children’s food.

　　Whether children’s food is safe or not is related to children’s physical and mental health, and parents are particularly concerned. It is in view of this special nature that the market supervision department, in accordance with the provisions of the Interim Measures for the Risk Classification Management of Food Business in Tianjin, takes food operators such as small supermarkets, grocery stores and food mobile vendors around the campus, the urban-rural junction and the rural food market as the key targets of daily supervision, and conducts special law enforcement inspections on snacks such as fried noodles, puffed food, bean products, candy and fruity drinks. In accordance with the deployment requirements of the General Administration of Markets, special rectification actions were carried out on solid drinks, pressed candy, substitute tea and other foods.

　　According to the relevant person in charge of the Market Supervision Committee, in the ongoing special supervision and inspection of school food safety in the spring, food operators around the campus have been listed as special inspection targets. On the basis of daily supervision and inspection, full coverage supervision and inspection will be further carried out to increase the supervision and inspection of children’s food, focusing on cracking down on illegal activities such as selling fake and shoddy food, expired food, and "two super foods and one non-food". In the daily supervision and inspection, we also require food operators to post the record form of daily supervision and inspection results filled out by the market supervision department in a prominent position in the business premises for publicity, so as to facilitate consumers to understand food safety-related information.

　　In the daily supervision, the market supervision department focuses on the inspection of food sales units such as small supermarkets, grocery stores, food vendors, maternal and child stores, pharmacies, hospitals, etc. on campus and surrounding areas to check whether their main qualifications are legal; Check whether the food manufacturer, production date, shelf life, food production license and food label are legal and compliant; Whether there are expired and deteriorated foods, fake and shoddy foods, and whether the food sold has complete procedures and legal sources can be obtained by checking the ticket.

　　Food operators around the campus are rated as the highest risk level.

　　The Market Supervision Committee will further strengthen the supervision of children’s food, strengthen the supervision of food quality and safety, and ensure the health of children.

　　The person in charge said that when revising the Interim Measures for the Risk Classification Management of Food Business in Tianjin, the food operators around the campus will be designated as the highest risk level D, the frequency of supervision and inspection will be increased, and the food safety supervision around the campus will be effectively strengthened. At the same time, further strengthen the implementation of the main responsibility of food operators, and strictly publicize the responsibility of information such as daily supervision and inspection results, so that parents can know the food safety status of food operators in time. "We will also cooperate with the education department to carry out food safety on campus and compile food safety knowledge books for primary and secondary schools to increase children’s food safety knowledge and raise their awareness of self-protection."

　　When parents and children buy children’s food, first, they should pay attention to checking the business qualifications of the merchants and see if the sellers have obtained the relevant license certificates for operating such foods; Whether the stated business items are consistent with the products actually sold. The second is to ask for purchase vouchers to ensure the legitimacy and traceability of the purchased food sources. The third is to understand the difference between ordinary food, infant formula food and special medical food, and to prevent illegal business practices such as false propaganda of stores. The fourth is to check whether the label identification is standardized, and whether the production date and shelf life of the food labels sold are significant and easy to identify, and whether they comply with laws and regulations.

　　Law enforcement forces focus on investigating and handling illegal activities in children’s food production and operation.

　　The relevant person in charge of the Tianjin Municipal Market Supervision Comprehensive Administrative Law Enforcement Corps said that in order to effectively protect the food safety of the people in our city, combined with the actual food safety supervision in our city, the Market Committee formulated the "Tianjin Municipal Market Supervision and Management Committee’s Implementation Plan for Strengthening the Investigation and Handling of Food Cases in 2020".

　　Illegal activities in food production and operation such as "black factories", "black workshops" and "black dens"; Illegal activities in the production and operation of campus food safety; Illegal activities in the production and operation of food for infants and children have been included in this year’s key investigation targets.

　　Focus on investigating and handling cases of food safety violations that occurred in and around the campus, catering gathering areas, farmers’ wholesale markets, rural and urban-rural junctions, food and non-staple food wholesale markets, cold storage centers, off-campus training institutions and other places.

　　Law enforcement departments will continue to intensify law enforcement supervision and inspection of food shops and small stalls on campus and its surrounding areas, further standardize the business behavior of operators, and focus on the management of food business by mobile vendors on campus and its surrounding areas. At the same time, increase the frequency of food sampling inspection, find out the problem products in time, establish and improve the long-term supervision mechanism of food safety, focus on solving the outstanding problems in the field of food safety, effectively enhance the people’s sense of acquisition, happiness and security, and ensure "safety on the tip of the tongue".

　　Expert advice

　　Snacks that simply pursue taste are not recommended.

　　On the issue of children’s snacks, the reporter also interviewed Professor Yu Jinghua from the College of Food Science and Engineering of Tianjin University of Science and Technology. He introduced that children’s snacks in the market are mainly divided into three categories: the first category is snacks produced according to the needs of children’s nutrition. Although there are no relevant standards and norms for children’s snacks in China, nutrition has recommended amounts of various nutrients needed by children at all ages. Therefore, this kind of children’s snacks is to produce snacks suitable for children according to the guidance of nutrition. The second category is actually just ordinary snacks, and the ingredients are no different from those of adults. However, in order to point the marketing target at children, it is designed to look like children’s favorite in the outer packaging or eating methods. At present, there are no standards and norms for children’s snacks in China, so this kind of snacks does not meet the requirements of children in terms of nutrition itself. The third kind of snacks is completely for attracting people’s attention, attracting children and parents, and adding some functional ingredients that are beneficial to children symbolically. There is no basis for designing and manufacturing snacks in nutrition, and it is purely for sales.

　　Many parents smell "additives", but nowadays there are almost no snacks without additives. In the interview, the reporter found that many parents favor the so-called homemade snacks, in fact, it is largely because the seller said that there are no additives. In this regard, Professor Yu Jinghua said that most of the additives in snacks are required by the process. If added according to laws and regulations, it will not harm people’s health. For example, jelly must be added to solidify fruits and juices. Colloid is also an additive. If not added, this jelly will not become jelly, so additives are not all bad. However, blindly pursuing the flavor and taste brought by an additive is only to make snacks taste better. If children eat them for a long time, it will inevitably stimulate the taste buds too much, thus affecting the taste recognition of children as adults.

　　In recent years, some home-made foods have become very popular on the Internet. However, Professor Yu Jinghua reminded parents that home-made food has no product standards, no safety inspection, and no elements of food circulation, so it is difficult to guarantee safety. The so-called preservative-free, food is easy to deteriorate without preservatives, how can we ensure that food does not deteriorate during online shopping and logistics transportation? If you cook and eat now, you may have a very good taste and nutrition. However, if you sell it online, after a few days of logistics arrival, the taste and organizational status will become worse, especially the microbial indicators cannot be guaranteed. How dare you give it to children?

　　Many parents think that children should eat more vegetables and fruits, and there is no need to eat snacks. Professor Yu Jinghua said that in fact, snacks should be supplemented with nutrition in essence, such as protein, vitamins, trace elements, energy, etc. If these functions can be achieved, it is still necessary for children to eat some properly. However, if it is purely for the taste and to meet the needs of taste buds, such as snacks with strong flavor and high sugar content, it is really unnecessary to give them to children.

　　He suggested that parents should buy snacks for their children, or should go to supermarkets or shopping malls to buy regular brands of goods, with complete packaging and clear nutrition labels, so that parents can identify and distinguish purchases; Once there is a quality problem, the traceability channel is smooth and the rights and interests are guaranteed. Some parents go to the market to buy bulk food for their children, whose composition is unknown and the source is unknown; In addition, food is often aired outside, and the hygienic condition of exposure to the air is not guaranteed. The microbial index of food is easy to exceed the standard, so it should be purchased with caution.

　　Typical problem

　　Online shopping for homemade food is mostly "three noes"

　　Duoduo (pseudonym) is two years old this year. Since she was one year old, she could eat a lot of complementary food. Her mother began to buy her homemade yogurt, dissolved beans, fruit crisp and other foods online. Her mother saw a "Erwa Mom" researching and making complementary food on the Tik Tok. She felt that there were no additives, and they were all made of natural ingredients, which was good for children’s health, so she started online shopping. The reporter saw in Duoduoma that this kind of self-made complementary food has only a simple outer packaging, no ingredient list, no production date and shelf life, and no food safety certification. The price is more expensive than that of similar products of regular brands, such as yogurt and dissolved beans. The price of the same product in the market is around 20 yuan, but a small bag bought online by Duoduoma is 25 yuan. "After all, people are the mothers of two children, and they have experience with their babies, so they trust her more." Duo Duo Ma said.

　　Tu Tu (a pseudonym) is three years old and doesn’t like drinking water. His mother listened to a friend’s introduction and joined a group built by Wechat business’s mother. This mother specializes in selling homemade autumn pear cream, saying that it is completely handmade, without any additives and preservatives. As long as a teaspoon is given to the child at a time, it can moisten the lungs and relieve cough. A small bottle of 150 grams, priced at 149 yuan, also has no ingredient list, no production date and shelf life, and no food safety certification. In the supermarket, a bottle of 290 grams of brand autumn pear cream for children is only 10 yuan. "I was a little worried about food safety at first, but I thought that so many parents in the group were rushing to buy her autumn pear cream, and it was still limited. I thought it should be right, so I bought it boldly." Tu Tu’s mother said.

　　There is no yogurt in "dry yogurt"

　　On May 28, the reporter saw in a convenience store in the urban-rural fringe that a small candy called "dry yogurt" on the counter was very popular with children, and the price was cheap, 10 pieces for one yuan. During this period, two teenagers bought 80 tablets at 8 yuan. The reporter saw that on this candy package, the word "dry yogurt" was very eye-catching, and the font height accounted for one-third of the packaging height. It is also marked in English: Pure milk candy, which means pure milk candy. Looking at the ingredients list on the back, I found that the ingredients of this candy are glucose syrup, white sugar, cocoa butter substitute, edible spices, etc., but there is no ingredient of yogurt or milk. One of the inconspicuous words reads the name: yogurt-flavored sugar, which means that this so-called "dry yogurt" candy has nothing to do with yogurt and milk. Such labeling of product packaging is tantamount to deceiving consumers. If you don’t look carefully, you can’t judge at all.

　　Multicolored chocolate beans have three products.

　　At a booth selling homemade cakes, the reporter saw that there were some children’s snacks besides cakes, among which a transparent plastic bottle filled with colorful chocolate beans was placed in a conspicuous place. The reporter picked it up and found that there was no production date, manufacturer, food license number or even name on the bottle. The reporter asked quickly, "Did you do this?" The merchant replied, "How can we have this ability? This is the goods from the wholesale market, which can be sold well." Just then, a little girl bought this product.

　　Milk-containing drinks promote the edge ball

　　Ms. Lei, a citizen, said that her children don’t like to drink milk, but they like to drink milk-containing drinks. Every time they are not allowed to drink, the children are eloquent. This is also a kind of milk, and it tastes sweet.

　　Judging from the reporters’ on-the-spot visits, including the large-scale brand supermarket chains, the salespeople of dairy products are mostly vague about the specific differences of dairy products. Some directly write children’s yogurt or milk, but some signs are added at the back to inform that other ingredients are added. The reporter saw in a supermarket on the middle road around the lake that the words "children’s yogurt" were written on the shelf, and the place of origin was "Thailand". After the reporter bought it, he looked at the ingredients list at the back and found that yogurt accounted for 52% (milk, reconstituted milk, lactic acid bacteria), and the rest were 10 kinds of additives such as white sugar, pectin and sunset yellow. The name on the package is also vague, and it says "orange yogurt drink".

　　The reporter learned that some parents will prepare some dairy drinks for their children in order to make up for their children’s lack of drinking milk in the morning. Although dairy drinks will have a certain proportion of milk as raw material, it will add some auxiliary materials such as sucrose, concentrated juice and essence. After treatment, although it is very suitable for children’s tastes, its nutritional value is greatly reduced.

　　A packet of spicy strips contains 15 kinds of additives.

　　At 18: 30 on May 28th, the reporter randomly bought 9 kinds of snacks in the vegetable market and shopping mall near huaming town in Dongli District. After careful observation, it was found that two of them had no production date, while some sweets were simply packed in plastic bags or glass bottles, and the packaging was easily damaged without sealing. There is not even a basic product name on the outer packaging.

　　Some snack packaging names are very deceptive, which seem to be similar to the packaging of well-known biscuit brands, but they are two completely different things. Some chocolate beans are also packed in bottles similar to well-known drinks, which is confusing.

　　In terms of ingredients, it is even more surprising: a bag of spicy strips named "Xiangbalao" has the words "seasoning noodle products" clearly written on the product type, and the net content is "28 grams", which is accurately divided into "ingredients" and "food additives". "Ingredients" include seven ingredients such as wheat flour, natural spices and edible salt, while "food additives" column includes 15 kinds of food additives such as sodium glutamate, sodium cyclamate, chicken powder, sodium stearoyl lactate and disodium dihydrogen pyrophosphate. A pack of dried adzuki beans contains as many as seven or eight kinds of additives.

　　Although these terms are very detailed and seemingly professional, parents are inevitably worried. Ms. Wang said: "There are too many additives. What is it? What effect will children have if they eat it? "