Industrial Growth and China's Occupational Health
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During the last two decades of rapid industrialization, the government of the People's Republic of China has paid increasing attention to the potential environmental and occupational health problems posed by urban and township industries.
Since 1985, the University of Michigan/World Health Organization Collaborating Center in Occupational Health has been working with colleagues at the Shanghai and Beijing Medical Universities to evaluate air contamination from industrial sources and train students to perform this work.
The Chinese government has declared an environmental goal: "Health for All by the Year 2000." It is clear that, if China is to improve occupational health during a time of explosive industrial growth, it needs a strong occupational health infrastructure. This infrastructure must: (1) integrate occupational health services with local, provincial, and industrial activities; (2) improve grassroots networks to perform occupational health services; and (3) search for and recommend appropriate technology for hazard control and personal protection.
An enterprise's responsibility for controlling pollution and protecting worker health has been clearly established by the Ministry of Public Health, the National Environmental Protection Agency and the Ministries of Labor and Agriculture. Any person or organization wanting to construct a new industrial facility, or expand or change an existing facility or production process must undergo a preventive occupational health inspection to determine if that facility has actual or potential hazards. Such inspections include reviewing the project design and giving an acceptance check before the enterprise is put into operation. Every enterprise with occupational hazards is required to set up regular worksite monitoring schedules.
In order to strengthen this process, the Ministry of Public Health is drafting a new Occupational Disease Control Act which would make occupational health of primary importance.
These regulatory initiatives are paralleled by a steady stream of publications outlining or detailing the results of occupational health studies in China. These studies have reported on, for example, the incidence of lung cancer among tin miners, wood dust exposure among carpenters, silica exposure among mine and pottery workers and dust exposure among textile workers. Such studies have been noted in the literature of occupational health and cooperation between Chinese professionals and those working in the U.S. and Australia.
The importance of these measures is underscored by the fact that, from 1978 to 1991, the number of business enterprises in rural areas alone increased 11.5 times; their number of employees increased 2.4 times; fixed assets increased 13.7 times; and the value of their total output increased 22.5 times. In 1992, for example, the value of industrial output from township enterprises surpassed $166.7 billion and accounted for 30.8 percent of the total value of national industrial production.
Guidelines and equipment for the sampling and analysis of airborne dusts are the principle tools of an occupational health program that recognizes, evaluates and controls workplace hazards. One specific guideline is the internationally recognized list of Maximum Allowable Concentrations (MACs) of airborne chemical substances. While the Ministry of Public Health, in conjunction with other ministries (such as Labor, Coal and Mines) is concerned with occupational health sampling and analytical requirements, it has yet to demonstrate the extent to which their standards conform to the values of threshold and permissible exposure limits in the U.S. and other industrialized nations.
Availability of equipment is another important factor, both in terms of whether there is enough equipment to perform workplace evaluations, and whether the equipment is adequate for the task of quantitative sampling and analysis. A recent survey of the availability of sampling devices for rural Chinese industries revealed a significant disparity between the available and the required equipment.
In order to achieve the officially promoted health goals by the year 2000 in the face of such rapid industrialization, significant resources will have to be brought to bear. In the area of air sampling and analysis, three steps in particular should be considered: (1) formal collaboration between officials in the Chinese Ministry of Public Health and those groups in fully industrialized nations which have the responsibility to establish maximum allowable concentrations and threshold values; (2) collaboration between Occupational Health Standards Methods committees of both Chinese ministry officials and their counterparts elsewhere, with the goal of ensuring that the sampling and analysis methods are of the highest quality and based on the latest information; and (3) a funded program of technology transfer that ensures that the Chinese have the most effective technology for use in sampling and analysis of airborne workplace hazards.
It is inevitable that a rapidly industrializing country will have many environmental and occupational health problems. These problems are very serious in China, especially among the older, larger state-owned industries and the newer, smaller township enterprises. This situation requires preventive interventions by government and health workers, along with international cooperation through the World Health Organization.
Steven Levine is Professor in the School of Public Health.