The China Programme: Policy Supply Characteristics for the Sustainable Promotion of Adolescent Physical Health

Abstract

Adolescent Physical Health is crucial for personal growth, family well-being, and the future of the nation, serving as an engine for healthier, sustainable social transformation. In recent years, the continuing decline in Adolescent Physical Health has become a global problem, with adolescents in various countries and regions facing different physical issues and challenges. The aim of this study is to explore the content structure, supply characteristics, and potential problems of current policies using a sample of Chinese Adolescent Physical Health policy documents in order to provide policy optimization recommendations for the promotion of Adolescent Physical Health, both in China and worldwide. Taking 33 Adolescent Physical Health policies enacted at the national level in China from 1979 to 2023 as a research sample, an analytical framework based on the three dimensions of policy tools, facilitating elements, and policy strength was constructed. Using the content analysis method, the policy texts were individually coded in order to analyze the content structure and supply characteristics of China’s Adolescent Physical Health policy, allowing research conclusions to be drawn and policy recommendations to be put forward. Through quantitative statistical analyses, we found that Chinese Adolescent Physical Health policies tend to use supply- and environment-side policy tools, while demand-side policy tools are less frequently used, leading to problems such as an over-reliance on supply-side policy tools and under-use of demand-side policy tools. Physical education teaching is dominant in the facilitating elements dimension, with an overall discrete distribution of characteristics. The types of policies are mainly notices, with a lack of strong normative documents such as laws, regulations, and statutes; therefore, the overall policy strength is weak. Accordingly, it is recommended that the top-level design of policy for Adolescent Physical Health promotion be continuously optimized in three key areas: enhancing the internal structure of policy instruments, improving the distribution of facilitating elements and policy tools, and strengthening the implementation of policies.

1. Introduction

Adolescent Physical Health is increasingly important in the era of the Sustainable Development Goals [1]. Health is a state of complete physical, mental, and social well-being [2] and is the most important aspect in promoting the happiness of people [3]. The measure of happiness often overlaps with physical and mental health indicators [4], in which physical health is one of the most important evaluation indicators, mainly including whether they have a good physical function and an ability to adapt to the environment and society. Promoting health and well-being in adolescents is crucial for fostering healthier and more sustainable social change [5].

Since the 18th Party Congress, the Chinese government has prioritized the healthy development of adolescents, implementing a series of strategies to enhance their physical health. This includes a commitment to health-first education, enhancing school physical education, and providing comprehensive physical education classes to bolster Adolescent Physical Health through physical activity. In October 2016, the State Council of China issued the Outline of the “Healthy China 2030” Plan, which serves as the latest guideline for implementing the Healthy China Strategy. This policy aims to promote the construction of a healthy society and enhance public health. The outline delineates specific requirements for cultivating sports interests among young people, emphasizing that they should acquire proficiency in multiple sports skills. Furthermore, it sets a target for students’ physical health standards to reach or exceed 25%, reflecting that the promotion of Adolescent Physical Health has been elevated to the national level [6]. Despite ongoing attention from the government, challenges in the context of Adolescent Physical Health persist, with significant discrepancies between the current conditions and desired outcomes [7]. According to the Eighth National Adolescent Physical Health Research Report, only 23.8% of adolescents were rated as having excellent physical health, with notable declines in lower limb explosive strength and speed, alongside a drop in overall physical fitness [8]. Furthermore, other statistics indicate adolescent overweight and obesity rates to be 25.2% and 8.5%, respectively [9]. Addressing these critical issues to effectively and sustainably promote Adolescent Physical Health is an urgent and vital topic.

Public policy is a series of guidelines for action formulated by the party and the government to achieve specific goals, which is considered a strategic element in solving the problems associated with Adolescent Physical Health [10]. The promotion of Adolescent Physical Health is based on the use of public policy as a vehicle, and an analysis of the structure and function of relevant policies can reveal the current state of national governance [11]. How Adolescent Physical Health is promoted in our country is primarily reflected in policies related to Adolescent Physical Health, encompassing ideology, outlines, dimensions, and tools [12]. However, China’s Adolescent Physical Health policies face challenges associated with their rapid development, including insufficient legal effectiveness, fuzzy content standards, and internal structural imbalances. These issues prevent the policies from fully achieving their intended effects and, consequently, impact the promotion of Adolescent Physical Health. For example, in terms of their insufficient legal effect, although the Adolescent Physical Health policy documentation involved the formulation of legal liability provisions for the monitoring of Adolescent Physical Health, the specific penalties for legal liability are more general, and there is no specific stipulation regarding the kind of legal liability that should be borne [13]. In terms of policy content, most of China’s policies on Adolescent Physical Health are merely a reiteration of previous policies rather than a supplement to them, with no obvious hierarchical progression and poor articulation. At the same time, the policy content contains numerous ambiguous terms, such as “should” and “a certain amount”, which provide local governments with relatively wide maneuverability in dealing with the issue [14], thus leading to differences in the understanding and implementation of the policies between the upper and lower levels. To ensure that China’s Adolescent Physical Health policy achieves its intended health-promoting goals, it is necessary to study the Adolescent Physical Health policy developed in China in recent decades.

Both domestic and international researchers are increasingly examining the relationships between policies and the promotion of Adolescent Physical Health, with a particular emphasis on policy evaluation. International scholars have focused on the implementation of measures and policies to promote Adolescent Physical Health, the effectiveness of their implementation, and the evaluation feedback mechanism; for example, through a random sampling method, it has been found that more than 80% of the world’s adolescents have insufficient physical activity, and it is believed that this is the result of a lack of policies and social designs [15]. At the same time, it was highlighted that policy actions to increase physical activity would help to support the achievement of multiple Sustainable Development Goals simultaneously. Policymakers and stakeholders should be encouraged to take immediate action to safeguard the health of current and future generations [16]. In addition, a survey of eight groups of adolescents found that their perceptions of health can inform policy design and planning and that adolescents should be understood before health policies are developed [17]. Foreign studies have shown that public policy is increasingly recommended as a key strategy for addressing Adolescent Physical Health [18]. Domestic scholars have analyzed policies at both the macro and micro levels. At the macro level, studies include those on the evolution of Adolescent Physical Health policies and their deficiencies and improvements. In the view of Changdian Huan, Adolescent Physical Health policy has gone through four stages: the stage of stress reduction, the stage of stagnation, the stage of improvement of policies and regulations, and the stage of coordination of policies in multiple fields. It was then proposed that Adolescent Physical Health policy should focus on the roles of schools and teachers [19]. By constructing a PMC index model, Chongyan Shi et al. found that the average effectiveness of Adolescent Physical Health policy texts in China was low and that the policy content was mainly “focused on the school field, with physical education and sport as the main means, with students or adolescents as the main target, and with the promotion or improvement of physical fitness or health as the main goal” [20].

At the micro level, existing research has primarily focused on examining the mechanisms and effects associated with individual policies. According to Tian Siyuan, within the context of integrating sports and education, the legal framework governing Adolescent Physical Health policy is evidently lagging; at present, there exists only one official sports law in China. Furthermore, the phenomenon of “substituting regulations for laws” is notably prevalent in policies aimed at promoting Adolescent Physical Health, resulting in a lack of momentum regarding the reformation of school physical education curricula [21].

To summarize, relevant studies have clarified the theory and connotation of Adolescent Physical Health policies and have sorted out and analyzed relevant policies. However, there are still some shortcomings: First, the research samples have been mostly limited to special documents, and most of them are single policies in a certain vertical field of Adolescent Physical Health, thus lacking a “panoramic presentation” of Adolescent Physical Health policies. Second, most of the studies involved use cases and qualitative analyses, and there is a lack of quantitative analysis based on theoretical models. A quantitative analysis of Adolescent Physical Health policies can overcome the subjectivity and uncertainty of qualitative research to a large extent. Third, research on Adolescent Physical Health policy has mainly focused on the phased characteristics and evolution of the policy, and the use of policy tools, promoting factors, policy types, and the characteristics of promulgation units have not been discussed in the context of China as a whole. Fourth, there are multiple dimensions of existing research and analyses, but the analysis between each dimension has generally been independent, and no objective connection between the dimensions has been determined. Therefore, this study screens the policy content related to Adolescent Physical Health and constructs an analytical framework integrating policy tools (X), facilitating elements (Y), and policy strength (Z) in a three-dimensional manner, which has the advantage of focusing on the internal information as well as the external key information of the policy text. The content analysis method is also used to study the Adolescent Physical Health policy, and we attempt to answer the following three questions: (1) What types of tools are employed in China’s Adolescent Physical Health Policy? What characteristics do they all have? (2) What are the specific facilitating elements that China’s Adolescent Physical Health policy adopts to promote the improvement of Adolescent Physical Health, and what are the characteristics that correlate it with the policy tools and policy efforts? (3) What are the characteristics of China’s Adolescent Physical Health policy efforts, including the types of policies, and what are the enacting units? Through an in-depth discussion of the above issues, further suggestions for the optimization of Adolescent Physical Health policy in China are proposed.

2. Study Design

2.1. Framework Construction

Policy denotes the process of governments designing, selecting, and implementing policy instruments [22]. A well-structured policy analysis framework is essential for examining the decision-making characteristics of governments in the realm of public policy. Policy tools can be used to analyze the main content of Adolescent Physical Health policy from an important analytical dimension; however, its characteristics and its law cannot be singularly described through an analysis of the policy tool dimension. Facilitating elements are the basic means of guaranteeing the promotion of Adolescent Physical Health, At the same time, it is also the focus of the use of policy tools. These two factors are related to the content of the Adolescent Physical Health policy, considered as “two sides of the same body, closely linked to each other, interdependent”. Policy strength corresponds to the degree of coerciveness and implementation of the policy, as well as the credibility and authority of the main body of policy formulation [23]. The higher the level of the issuing authority, the stronger the binding force and influence of the Adolescent Physical Health Policy, which is conducive to promoting the effectiveness of the policy. As the abovementioned factors are inter-related, policy tools are taken as a basis in this study, and a three-dimensional analysis framework covering policy tools, facilitating elements and policy strength is constructed, allowing a quantitative study on the Adolescent Physical Health policy text in China to be carried out (see Figure 1).

(1)

Dimension X: Policy tool

In this article, policy tools are considered as the main dimension of Youth Physical Health policy analysis (i.e., the X dimension) in order to describe and analyze the overall use of policy tools to promote the policy. Research on policy instruments generally focuses on understanding how multiple instruments are combined and how they interact when combined. There are three main representative views on the classification of policy instruments: first, McDonnell and Elmore, R. F., among others, divided policy instruments into four categories based on their ultimate purpose—namely, instructions, incentives, capabilities, and institutions—and later added exhortation tools [24,25]. Second, Howlett and Ramesh, M., based on the degree of government involvement, divided policy tools into mandatory, mixed, and voluntary types [26]. Third, based on the different effects associated with the roles of policy tools, Rothwell divided them into three levels: supply-side, demand-side, and environmental-side policy tools [27].

According to the structural characteristics of China’s Adolescent Physical Health policy, the policy tool classification standard proposed by Rothwell et al. was selected to classify China’s Adolescent Physical Health policy tools into supply-side, demand-side, and environment-side, and 15 sub-tools were formed after subdividing and adjusting them in accordance with the actual application. Compared with other policy tool classifications, this theoretical framework advocates changing government functions, emphasizing the role of the market, and stressing regulation of the balance between supply and demand, and has been widely adopted in policy research. Among them, the supply-side policy tools are related to the government’s promotion of Adolescent Physical Health policy through financial input, talent training, and other policy measures, which is expressed as a driving force; the environment-side tools are related to the government’s provision of a strong external environmental support through policy measures such as target planning, regulation and control, supervision and assessment, and the public opinion regarding the environment, which is expressed as an influence; and the demand-side tools are related to the policy’s provision of a strong external policy support environment through consumption subsidies, government purchasing, and other aspects. In particular, the demand-based policy tools reflect the policy developed to satisfy the needs of young people themselves and their various types of needs through consumption subsidies, government procurement, and other policy measures, which are expressed as pulling power. The relationships between the three different policy instruments are shown in Figure 2.

(2)

Dimension Y: Facilitating elements

While the division of policy tools by Rothwell et al. has strong applicability, the utilization of a single dimension does not completely and accurately reflect the intent of the policy text. Facilitating elements are ways and means through which Adolescent Physical Health can be promoted, and a reasonable policy structure should be studied in the context of its facilitating elements. The policy “Deepening the Integration of Physical Education and Sports, Promote the Healthy Development of Adolescents,” promulgated by the State General Administration of Sports and other departments in 2020, mentions specific elements and methods for promoting adolescent Physical Health. Therefore, with reference to the content and the reality of adolescent health promotion policies, the associated facilitating elements are considered to comprise five components: physical education teaching, youth sports organization, after-school sports training and competitions, physical education curriculum reform, and after-school physical education activities. These elements were considered as the Y dimension in the policy analysis approach of this study.

(3)

Dimension Z: Policy Strength

Considering that Adolescent Physical Health policies enacted by the Government are not only related to the policy tools and specific Facilitating elements but also to the level of the enacting ministry and the type of policy. So, this paper introduces policy strength as the Y dimension of the study. Policy strength is a response indicator of the authority, importance, and influence of a policy, depending on the policy issuing department’s level and the policy type. Based on reading the State Council’s “Regulations on the Procedures for the Formulation of Rules and Regulations”, this paper combines the relevant studies on legal rank and policy effectiveness levels to classify the strength of Adolescent Physical Health policies into six policy strength levels, which are assigned a value of 1 to 6 points, the higher the value indicating, the stronger the policy strength [28]. This classification method has been widely used in the study of policy strength in various fields, such as medicine and health care [29], the Photovoltaic Industry [30], etc. It is a more mature classification method and an accurate way to look at policy strength, as detailed in

Table 1. Criteria for classifying policy strength.

Evaluation Criteria	Score (Points)
Issued by the Standing Committee of the National People’s Congress	6
Jointly issued by the Central Committee of the Communist Party of China and the State Council	5
Issued by the State Council	4
Joint issuance by three or more ministries	3
Two parts jointly issued	2
Separate communications from ministries	1

.

2.2. Sampling Technique and Procedures

With the reform and opening up, China’s Adolescent Physical Health policy has gradually become a system that is easy to organize and analyze. Thus, the following procedures were used in this work to search for and retrieve the policy texts issued from December 1978 to February 2024: Using keywords including “youth + sport”, “adolescent + sport”, “teens + physical health”, and “young + school sports”, etc. searches were first made on the official websites of the Ministry of Education and the General Administration of Sport, in order to find pertinent policy documents regarding the physical health of adolescents. Second, databases such as the China Laws and Regulations Network and Peking University’s Magic Weapon were additionally searched, and 279 policy documents related to Adolescent Physical Health were initially retrieved. Specific information can be found in the supplementary material below.

In order to ensure the representativeness and accuracy of the policy texts, the following screening conditions were used:

• The policy documents are closely related to the promotion of the Adolescent Physical Health policy, and the content of the documents should directly stipulate and embody the objectives and measures for the physical promotion;
• The full text of the policy texts can be downloaded or accessed;
• The types of policy texts should be laws, regulations, opinions, methods, notices, announcements, and so on;
• The policy texts have been issued at the national level;
• Policy texts must be maintained in a current and non-overlapping manner, meaning that only the policy text currently in effect should be included, excluding any policies that have been repealed. At the same time, in order to ensure the originality of the policy release, the same policy content published by the same policy subject is deleted. According to the above collection steps and screening conditions, 33 valid samples were collected. The selected policy documents are listed in

  Table 2. Main policy texts on Adolescent Physical Health since the reform.

  Number	Policy Name	Issuing Unit	Date of Issue
  1	Petition to Further Create New Horizons in Sports	State Council (PRC)	October 1983
  2	Measures for the Implementation of Physical Education Qualification Standards for Secondary School Students	State Education Commission (SEC)	May 1991
  3	Opinions on Further Strengthening Physical Education and Health Work in Schools and Improving Students’ Health Level	National Sports Commission	September 1992
  ……	……	……	……
  31	Sports Law of the People’s Republic of China (Revised 2022)	Standing Committee of the National People’s Congress	June 2022
  32	Work Programme of the Action to Enhance Fitness Facilities for All (2023–2025)	State General Administration of Sport	May 2023
  33	Implementation Views on Enhancing and Improving the Work of Youth School Football in the New Period	Ministry of Education	February 2024

  (Search terms: ‘‘youth+sports”, “Adolescent+sports”, “Teenagers+Physical healthcar”, “Young people+School sports”, “youth Children+physical health’’).

2.3. Analysis Strategy

This study used content analysis to code, classify, and quantify the Adolescent Physical Health policy texts, and the NVIVO 12.0 software was selected to carry out the analysis. Content analysis takes qualitative issues as the starting point, conducts quantitative statistical analysis, and draws research conclusions, making it a scientific, objective, and systematic method that combines quantitative and qualitative approaches. The content analysis method has been applied in various fields of policy analysis and research [31] and, as a non-directive intervention analysis method, it is capable of avoiding the interference of the researchers’ subjectivity on the results of the study to a certain extent, and guarantees the objectivity, credibility, and scientificity of the results of the analysis, allowing a clearer understanding of the intrinsic structure of the Adolescent Physical Health policy text and development trends to be obtained [32,33]. The specific research steps are as follows:

• Define the research question and sample selection, and conduct scientific screening and in-depth research on Youth Physical Health policies formulated and implemented at the central level after the reform and opening up.
• Construct the dimensions and framework for Adolescent Physical Health policy analysis.
• Systematically code, classify, and quantitatively analyze the selected policies. In the coding process, a format of “serial number-chapter-clause-statement” is employed. For instance, “2-2-7-1” denotes the first sentence of Article 7 in Chapter 2 of the second policy: ‘The school shall establish a “physical education qualification registration card” for students.’ Furthermore, when the content of a clause encompasses multiple policy instruments simultaneously, subdivision coding continues according to the sequence of clauses presented in the text.
• Evaluate the coding structure for reliability. The results of the coding classification were statistically analyzed using the Kappa coefficient to mitigate any potential influence of coder subjectivity on the coding process. The test outcomes indicated that the Kappa coefficient for each node exceeded 0.810, demonstrating a high level of reliability.
• Analyze the data results and interpret them comprehensively within the framework of policy enactment, allowing optimization strategies to be proposed. A selection of the coding results is presented in

  Table 3. Example unit codes of Adolescent Physical Health policy text (part).

  Code	Name	Text Analysis Module	Policy Tools
  1-2-1-1	Petition to further create new horizons in sports	Several provinces and cities in the country should include sports interactions in their dealings	International exchange
  2-2-7-1	Measures for the Implementation of Physical Education Qualification Standards for Secondary School Students	Schools are required to establish a ‘sports pass register’ for students	Information service
  9-6-1-1	A national programme of sunshine sports for hundreds of millions of students launched	Vigorously promote sunshine sports and widely disseminate the concept of health	Public opinion environment
  10-3-1-1	Further strengthening school sports work and effectively improving the health of our young people	Seriously implement the Compulsory Education Act and the Physical Education Act, and conduct regular inspections of their implementation	Oversight and assessment
  20-4-9-1	Strengthening school sports to boost kids’ overall physical and mental health	Physical education educators and researchers should be systematically distributed across all regions in accordance with established standards	Personnel training

  .

2.4. Ethical Criteria

The study was conducted in accordance with the Declaration of Helsinki and received approval from the Ethics Review Committee of China University of Mining and Technology. The date of approval is 15 April 2024.

3. Three-Dimensional Analysis of Adolescent Physical Health Policy Texts

3.1. Dimension X: Analysis of Policy Instruments

Figure 3 and Figure 4 illustrate the distributions of the various policy tool types employed for Adolescent Physical Health in China and their content structure. The findings indicate that among the three categories of policy instruments—namely, supply, environmental, and demand policies—a total of 236 policy codes were identified. Among them, the supply-side policy tools were used in the highest proportion [48.8% (115/236)], followed by the environment-side tools [37.5% (89/236)], while the demand-side policy tools were used in the lowest proportion [13.7% (32/236)]. It can be seen that there is a certain tendency in the use of Adolescent Physical Health policy tools in our country, showing a distribution structure with supply type as the main tools, environment type as auxiliary tools, and demand type as the least common. This tendency indicates that, in the design phase of the Adolescent Physical Health policy, the focus of policy design was primarily placed on the field facilities, teachers’ team building, and target planning. Government departments have promoted Adolescent Physical Health mainly through supply-based and environment-based policy tools. In contrast, demand-based policy instruments are affected by factors such as the immaturity of the sports market and sports social organizations and have been more often used as an auxiliary means to promote Adolescent Physical Health.

In detail, among the supply-type policy tools, talent cultivation (33.9%) and venue facilities (23.5%) received significant attention and were used in the highest proportion, while information services (11.3%) were used in the lowest proportion. At this stage, several Adolescent Physical Health policy documents have mentioned the construction of youth sports venues, teachers, and other aspects of the work. However, we must also note that the effectiveness of financial input as a supply-type policy tool is not fully reflected. In addition, insufficient use of information services will affect the depth, breadth, and efficacy of the work carried out for the promotion of Adolescent Physical Health. Information service tools are the most commonly used supply-based policy tools, and only through the continuous intervention of digitalization, informatization, and other technological support can we truly provide technological protection and technical support for the effective implementation of Adolescent Physical Health policies.

Among the environment-based policy tools, strategic measures (32.6%) and goal planning (24.7%) were used in the highest proportion—especially strategic measures—while the public opinion environment (7.9%) was used in the lowest proportion. This situation indicates that China’s Adolescent Physical Health policy is overly focused on top-level planning; however, the existing top-level planning approach also mostly focuses on long-term goals, with more emphasis on quantity than quality. Combined with the data from the Eighth China Student Physical Health Survey, it can be seen that the translation of Adolescent Physical Health policy goals into practice has been inefficient. For example, in the National Student Physical Fitness Test, the Adolescent Physical Health Achievement and Excellence Rate was only 23.8%, which is still far from the target of a 60% Achievement and Excellence Rate by 2030, as stated in the Opinions on the Implementation of the Action for a Healthy China [34]. In addition, the frequent use of ‘strategic measures’ and ‘target planning’ also reflects the government’s eagerness to rapidly enrich the environmental policy tools for Adolescent Physical Health in a ‘top-down’ manner.

Among the demand-based policy tools, social organizations (50%) had the highest proportion of use, while consumption subsidies (6.2%) had the lowest proportion of use. The application of the demand-based policy tools was relatively homogeneous, with weak international communication (9.4%). Appropriate consumption subsidies can increase the scale of youth sports equipment purchases and may also cultivate youth sports habits. However, the results of the data analyses revealed that this policy tool has been used sparingly.

3.2. Dimension Y: Analysis of Facilitating Elements

Figure 5 presents the coded distributions of the considered Adolescent Physical Health facilitating elements and the proportion of their content structure. The results of the study indicated that a total of 303 codes were obtained in the facilitating element dimension. Among them, the largest number of entries [32.6% (99/303)] was related to physical education teaching, which dominated the five facilitating elements, while the smallest number of entries [10.5% (32/303)] was related to extracurricular sports training and competition. Extracurricular sports activities, youth sports organizations, and physical education curriculum reform entries accounted for 21.1% (64/303), 20.4% (62/303), and 15.1% (36/303), respectively.

At this stage, the teaching of physical education classes and the reform of the physical education curriculum are the focus of Adolescent Physical Health policy, and the Chinese government has emphasized the need to ensure that adolescents are given time for physical education and sports at school and to at least double the frequency of weekly physical education classes in several policies. Although this series of policy instruments has dramatically increased the frequency of physical education classes and other sports time for adolescents, the Adolescent Physical Health policy still has not provided a strong solution to the drawbacks faced by China’s physical education classes, such as their lack of intensity and lack of content. In addition, there is an imbalance in the use of ‘after-school sports training and competition’ as the driving force for the development of young people’s sports reserves, which requires further attention.

3.3. Dimension Z: Analysis of Policy Strength

Figure 6 demonstrates the statistics and frequency distributions of Adolescent Physical Health policy strength scores in China. In terms of the Z dimension, the majority of Adolescent Physical Health policies issued at the national level in China were circulars [66.7% (22/33)], the policy-making units are mainly individually enacted [39.4% (13/33)], and the Ministry of Education/State Education Commission has issued the most documents [51.5% (17/33)], followed by the General Administration of Physical Education of the People’s Republic of China/State Sports and Physical Education Commission [39.3% (13/33)]. The results demonstrated that there were only two documents with a score of 6, and the average strength value of the Adolescent Physical Health policy texts was 2.6. Considering the results among the Adolescent Physical Health policy texts, more policy documents with a policy strength score of at least 5 need to be issued.

3.4. Cross-Tabulation Analysis of X, Y, and Z Dimensions

3.4.1. X–Y Dimension

In terms of the match between the policy tools and facilitating elements, supply-side, environment-side and demand-side policy tools were found to be distributed in all five facilitating elements dimensions, as follows. In terms of facilitating the element dimensions, physical education teaching and youth sports organizations were mainly matched with supply-side tools; reform of physical education curricula and extracurricular physical education activities were mainly matched with supply-side and environment-side tools; and extracurricular physical education training and competitions were matched with all three types of policy tools. While supply-side and environment-side tools were more evenly distributed, demand-side tools were poorly distributed. Among them, physical education teaching was missing in relation to the demand-based tools and, in general, physical education teaching and extracurricular sports activities were used more than youth sports organizations and physical education curriculum reform, as shown in Figure 7.

3.4.2. X–Z Dimension

Different policy tools and policy strength combinations showed varying patterns, with supply-side, environment-side, and demand-side tools mostly distributed in the range of 1–4 points in terms of policy strength. Meanwhile, the distribution of different policy tools in policy texts with different strengths presented large differences. In particular, China’s Adolescent Physical Health policy was found to focus more on supply-type policy tools as the strength score increased, as shown in Figure 8.

4. Discussion

By conducting a quantitative analysis of 33 Adolescent Physical Health Policies implemented at the national level in China since the reform and opening up, this study yielded several significant findings:

(1) here is a certain tendency in the use of policy tools for Adolescent Physical Health in China, showing a distribution structure dominated by supply-oriented tools, supplemented by environment-oriented tools, and with minimal demand-oriented tools. These research results support existing conclusions [35]. Supply-type policy tools are a continuous driving force for the promotion of Adolescent Physical Health, and among these tools, information services were found to be used the least. In the information age, Internet technology and big data monitoring are playing an increasingly important role in promoting Adolescent Physical Health [36]; however, the government has not placed much emphasis on information technology. In addition, in terms of talent cultivation, although multiple policy documents mentioned the construction of sports teaching teams, many rural primary and secondary schools have not yet recruited a single physical education teacher, resulting in the frequent occurrence of other subject teachers taking on the role of teaching physical education [37].

Among the environmental-side policy tools, the government has adopted a large number of strategic measures that reflect its determination and strength in promoting the physical health of young people; however, some of these strategic measures are too vague, lack specific solutions to practical problems, and have not been implemented with sufficient strength. Professor Mao Zhenming pointed out the following when talking about the central document No. 7: “The macro role and significance are very obvious, but the micro role and significance are not significant” [38].

Finally, demand-side policy tools link market promotion with the needs of adolescents. In the long term, demand-side policy tools have been found to have great potential and effectiveness for promoting Adolescent Physical Health; however, demand-side policy tools were found to be used the least in existing policy. In particular, regarding demand-side policy tools, there was a low usage rate of policy tools, such as outsourcing of sports services and government procurement. This is mainly due to the value conflict between the educational attributes of schools and the commercial operation of education. Notably, outsourcing sports services on campus can alleviate the pressure on governmental finances and personnel to a certain extent.

(2) Policy tools were found to be imbalanced in terms of the quantity and proportion used in the facilitating element dimension and, in particular, a significant under-application of after-school sports training and competitions was observed in the facilitating element dimension.

After-school sports training and competitions are an important way to promote the physical health of students and are also the basic form of training to reserve talent for competitive sports in China. Many national documents emphasize the need to strengthen extracurricular sports training and competition for young students. For example, the opinions on comprehensively Strengthening and Improving School Sports Work in the New Era, issued by the General Office of the State Council, proposes that “a system of teaching, training and competition should be generally established” and that “students should be encouraged to actively participate in regular extracurricular training and sports competitions [39].” However, the reality is that Chinese primary and secondary schools have long placed a greater emphasis on intellectual education than on moral education and grades rather than quality. Extracurricular time is almost entirely taken up by heavy subject homework, and little time for extracurricular sports training is guaranteed.

(3) China’s Adolescent Physical Health policy texts typically exist in the form of plans, programs, notices, and opinions, with a lack of more prescriptive documents such as laws, regulations, and standards, which significantly limits their legal effect. The promotion of Adolescent Physical Health involves multiple entities, including the government, schools, families, and society. An overall lack of policy strength will lead to weakness in the process of promoting Adolescent Physical Health, making it difficult to effectively constrain the implementation of policy at the grassroots level. For example, the Regulations on School Sports Work clearly stipulate that necessary legal responsibilities should be investigated for “not opening physical education classes as required or stopping them at will”. However, in actual practice, the local education administrative department—as the supervisory body—limits the relevant legal responsibilities to criticism and administrative punishment [40]. This lack of application of the rule of law is also an important reason why policies aimed at promoting Adolescent Physical Health are difficult to implement effectively.

5. Conclusions

This study analyzed China’s Adolescent Physical Health policy from the perspective of policy tools. Coding through content analysis allowed the characteristics, strengths, and potential problems of China’s Adolescent Physical Health policy to be clearly presented. These findings can help guide policymakers in implementing future Adolescent Physical Health policies in order to promote and improve the physical health of adolescents more effectively.

The specific research conclusions are as follows: (1) The structural imbalance in the use of policy tools weakens their overall effect. The proportion of supply-side and environmental-side policy tools was found to reach more than 85%, meaning that the use of demand-side tools is insufficient. Government-led initiatives may lead to a loss of vitality among enterprises, the public, and other stakeholders. Therefore, it is important to consider the coordinated use of policy tools. (2) The degree of fit between policy tools, policy strength, and facilitating elements in existing policy was not high, and their synergy needs to be strengthened. For example, policy tools were found to have different strengths in the facilitating element dimension, had a low degree of coupling, and overall presented a discrete feature distribution. (3) The overall strength of the existing policy is weak, and its regulatory role needs to be strengthened urgently. Judging from the obtained statistics regarding the strength of China’s Adolescent Physical Health policy, the average score was 2.6 points, which is not high. Judging from the level of the policy issuing agency, the General Administration of Sport of China, the Ministry of Education, and various ministries and commissions, characterized by low administrative influence and legal effectiveness, are the main departments that issue policies.

6. Recommendations

Based on the above findings, this study proposes the following policy optimization recommendations to achieve the goal of sustainable promotion of Adolescent Physical Health.

First, it is necessary to reasonably adjust the structure of the three major types of policy tools by appropriately reducing supply-side policy tools, highlighting value orientation, and improving supply efficiency. At the same time, demand-side policy tools should be used more effectively, and the proportion of these tools should be moderately increased in order to effectively leverage the driving and safeguarding effects of the market and society, thus enhancing the “pull” effect of the policy.

Secondly, the distribution of policy tools, facilitating elements, and policy strength should be improved in order to enhance their synergistic capabilities. Facilitating elements are the basic guarantee for promoting Adolescent Physical Health. At present, there are significant differences and divisions in the use of policy tools among the various facilitating elements, which is not conducive to effectively leveraging the leading role of policies in promoting Adolescent Physical Health. The government needs to determine the connections between policy tools and facilitating elements and give full play to the driving role of these connection points. This will not only effectively save financial and material resources but also release the linkage effect of policies and allow their maximum effectiveness to be achieved. For example, while vigorously building sports facilities and venues, it is also necessary to actively cultivate awareness of physical exercise among young students, carry out after-school sports training and competition programs for young people, and so on. This will not only help to meet the demand for youth sports venues and facilities but also promote the concept of fitness, improve sports skills, and maximize the associated benefits.

7. Research Limitations

We must admit that this study has some limitations. First, we only collected Adolescent Physical Health policy texts at the national level in China and did not consider documents issued at the provincial and municipal levels. Second, this study only analyzed policies from the dimensions of policy tools, facilitating elements, and policy strength and did not cover other dimensions, such as policy objectives and policy themes.

In the future, policies issued at the provincial and municipal levels should be collected in order to expand the sample size and allow the application characteristics and degree of similarity between central and local policies to be analyzed. In addition, Chinese Adolescent Physical Health policies should be studied in terms of other dimensions.