Occupational health

Reports from the WHO regions and from ILO

Basic occupational health services in China

Dr Fanxiao Jian, WPRO, China jiangf@wpro.who.int

China is one of the most rapidly developing countries in the world. The current pattern of economic development has increased the number and frequency of occupational hazards and incidents. Occupational diseases exist in a wide range of industries and are rampant in middle and small scale enterprises. There are occupational hazards in traditional industries like coal mining and metallurgy as well as some newly emerging industries like automobile manufacturing and bioengineering.) [1]( Almost more than 90% of enterprises in China are middle and small scale enterprises which employ a large number of laborers especially migrant farmers from rural areas.) [1]

The population in China reached about 1,314.48 million by the end of 2006.) [2] There are now between 100 and 200 million migrant workers, mostly moving from rural to urban areas, [3] who are increasingly exposed to occupational hazards. These workers often move from one employment setting to another and do not receive appropriate training.

By the end of 2007, there were 690,858 cases of occupational diseases in China, of which 90.8% (627,405 cases) were pneumoconiosis. Experts estimate that in the next 10 to 15 years, the trend of occupational diseases will be on the rise.[4]

In comparison to industrialized countries, where occupational health services coverage ranges from 20-50%, [5], the coverage in China is estimated to be in the 10% average. [6] Workers engaged in agriculture, forestry, middle and small scale enterprises, self-employed and the informal sectors, including migrant workers get limited or no occupational health service at all. In order to protect workers' health and to enhance occupational health service in China, in 2005, the Ministry of Health of P.R.China made the decision to launch the pilot study of basic occupational health service (BOHS) in 19 counties of 10 provinces. These provinces include Beijing, Hebei, Shanghai, Anhui, Fujian, Hunan, Guangdong, Chongqing, Guizhou and Guangxi.

The objectives of the pilot projects were to: explore various models of occupational health service(OHS) at different levels; develop working mechanisms for resource allocation, improve multi-sector cooperation and worker’s participation; expand coverage of compulsory work-related injury insurance; expand program service network; integrate occupational health service to primary health care at county & community level and to provide relevant training..

WHO has contributed to the development of the BOHS in China by technical expertise and funding support. An amount of USD$400,000 was allocated for the year from 2006 to 2009.

The BOHS pilot projects that were implemented for more than three years, have resulted in many benefits. Some of achievements are highlighted below:

  • The BOHS concept, principle, implementation approach and the specific technical guidelines on work environment surveillance, workers health surveillance, risk assessment and accident prevention that were developed by Professor Jorma Rantanen, WHO consultant, and the guidelines have been translated into Chinese to be used in pilot sites.
  • The base-line surveys on BOHS in 19 pilot counties have been completed, including general background of the local population, business and economic development, and basic information on occupational hazards, diseases and occupational health structure and systems.
  • The awareness of BOHS in all pilot sites has increased with most of county-governors promising to OHS plan into their agenda and providing pilocy and funding support. For instance, the government of Bao’an district included the “the coverage of workers’ occupational health services” as one of the “tenth morale projects of Bao’an district in 2007”, which increased the coverage from 24% in 2004 to 68% in 2006. [7]
  • A series of training workshops, seminars were conducted in all pilot sites of the 10 provinces. Several thousand people including the heads of local government, staff from health bureau, health inspection, local CDC, the local clinics and the community, and representatives from safety department, enterprises, and Trade Union sectors were trained in BOHS.
  • The structure of occupational health sectors has been strengthened. The county CDCs have set up the independent occupational health division, with more than 5 part-time or full-time staff with basic health facilities. Most pilot counties have also set up a supervision division on occupational health with responsibility for workplace monitoring and inspection.
  • The provision of occupational health services at township level was reorganized and inproved.

Taking Bao'an District of Shengzhen City as an example, a three-level of administration system was established as shown in figure1.

The BOHS as implemented in the pilot counties have resulted in many positive outcomes. However, there is still a need to emphasize the primary prevention and enhancing working environment monitoring and surveillance. A stronger public awareness campaign is needed with strengthened coordination and cooperation among the enterprise, employee and trade union. Adequate funding should also be mobilized to sustain the BOHS at all levels, particularly in poor counties.


  • China Statistics Report on the Development of Labor and Social Security
  • Statistical Communiqué of the P.R.China on the 2006 National Economic and Social Development
  • WHO Commission on Social Determinants of Health, 2007
  • National Report System for Occupational Diseases, 2008
  • Global Action Plan for Worker's Health---WHO HQ
  • Presentation —from Professor Jorma Rantanen, WHO consultant
  • China Report on BOHS—Dr Su Zhi, Former Director-General, Bureau of Health Supervision and Inspection, 2007
  • Pilot report on BOHS—developed by project office of Guangdong Province, 2008