Editorial
Improving occupational health in China
China has the largest working population in the world—
about 776 million in 2018, and most workers spend half
their lives working. The Chinese Government prioritised
occupational health in the action plan of Healthy China
2030 as one of its 15 major health projects. Last week,
the National Health Commission (NHC) announced
the latest official data on the country’s occupational
health status and unveiled China’s strategy to address
the challenges in occupational health. The total number
of reported occupational cases up until 2018 was
97 500, and 90% of reported occupational diseases
were pneumoconiosis. Of those sampled in 2018, about
12 million businesses presented occupational health risks,
with more than 200 million workers exposed to multiple
risks, including dust, chemicals, and poison. However,
the actual burden of occupational diseases in China is
likely to be underestimated because of the low frequency
of occupational health checks and the narrow range of
diseases defined in the occupational diseases list.
Several objectives to address occupational health as
well as indicators to monitor occupational health and
safety are included in the Healthy China 2030 action
plan. For instance, by 2020, 95% of workers who are
exposed to occupational risks for pneumoconiosis must
have health checks, and 80% of workers in the coal,
metal, and construction industries should be covered by
work-related injury insurance. To achieve these targets,
the Chinese Government has committed to revise and
improve occupational laws as well as occupational health
regulations; investigate and promote new technologies
and facilities that would benefit workers’ health;
strengthen the surveillance and reporting systems for
preventing and controlling occupational diseases; and
monitoring other occupational conditions such as work-
related mental health and musculoskeletal diseases.
Knowledge of occupational health has been heavily
based on evidence from higher-income countries. Com­
pared with the USA and the UK, for example, the field of
occupational health in China is in its infancy. The Chinese
Government acknowledged that holding employers
to account for healthy and safe working conditions is
the first and foremost principle in occupational health,
but also noted that more than 95% of businesses
were small or medium size and often provided poor
working conditions and could not protect workers’
www.thelancet.com Vol 394 August 10, 2019
safety and health. But even the largest industries in
China such as the coal industry cannot provide adequate
health standards. Many coal miners are exposed to
occupational hazards such as silica dust and coal dust,
China Photos/Stringer/Getty Images
which can lead to pneumoconiosis, and noise that
causes deafness. Furthermore, because of the absence
of safety inspections in the coal industry, occupational
injuries, accidents, and deaths frequently occur. Migrant
workers are at particularly high risk. In China, there
are 280 million internal migrant workers, many of This online publication has been
corrected. The corrected version
whom are employed in hazardous jobs such as mining, first appeared at thelancet.com
manufacturing, and construction. Most are paid low on August 23, 2019
wages and have no health insurance, which hinders their
access to proper and timely health care.
“Occupational health deals with all aspects of health
and safety in the workplace and has a strong focus
on primary prevention of hazard” according to WHO,
which means that health and safety are indispensable
elements for occupational health. But in China,
occupational disease prevention and occupational
safety sit under separate remits of the NHC and the
State Administration of Work Safety. The integrated
coordination among these different government sectors
is necessary for progress to be made.
Occupational health legislation is the fundamental
principle and guidance for occupational disease prevention
from any perspective. But the legislation system in China
is not equipped to deal with China’s rapid development
because a range of illnesses that constitute occupational
health, such as work-related mental disorders, is not picked
up by the system.
China’s rapid global economic progress is a double-
edged sword for occupational health, exposing workers,
particularly the poor and the disenfranchised, to unprece­
dented injuries and risks but also providing an opportunity
to promote workplace health and safety standards for the
country’s working population. China’s determination to
improve occupational health is a welcome step towards
translating its economic gains into health benefits for all
workers in China. Lessons learnt from China might have For more on China’s
important implications for other low-income and middle- occupational health see http://
www.ecns.cn/news/2019-07-31/
income countries like India and Brazil, where similar detail-ifzmnmiq8702457.shtml
actions are warranted to accelerate progress towards For the Chinese version see
http://www.nhc.gov.cn/xcs/
Sustainable Development Goal 8—”full and productive s7847/201907/4b98d63703954
employment and decent work for all”. n The Lancet 8889c3ebaab40878f3f.shtml
443