China has the largest working population in the world with about 776 million workers in 2018, and most of them spend half of their life cycles working (1). As a rapidly developing country, the remarkable socioeconomic changes during the last 30 years have posed increasing risk of occupational hazards. According to a series of national occupational disease reports, annual new cases of occupational diseases rose steadily from 12,511 in 2003 to 31,789 in 2016 (2), and over 975,000 cases of occupational disease have been reported cumulatively by the end of 2018, of which 90% were pneumoconiosis (about 873,000 cases) (3). However, the actual burden of occupational diseases in China was likely to have been underestimated due to low rates of occupational health examinations. In addition, the transformation and upgrading of the economy and technology have led to work-related mental illness and musculoskeletal disorders resulting from psychosocial and ergonomic factors, which pose great challenges in protecting worker health. The Chinese government has always prioritized occupational disease control and prevention as the National Health Commission and other agencies have introduced 11 regulations and more than 700 standards on occupational health and has issued a five-year plan (2016–2020) on the control and prevention of occupational diseases including pneumoconiosis. In 2019, a series of national action plans has been implemented to prevent and control occupational diseases and to protect worker’s health.
To ensure full implementation of the Healthy China 2030 blueprint, the State Council has released Opinions of the State Council on Implementing the Healthy China Initiative in July 2019 with new paradigm shifts from treating diseases to providing full-lifecycle health services (4). With emphasis on disease prevention and health promotion, an action plan from 2019 to 2030 was unveiled to “intervene in health influencing factors, protect full-life-cycle health, and prevent and control major diseases.” Consisting of 15 special campaigns, it specified the objectives and tasks of each campaign and the responsibilities of different sectors in the campaigns. As one of these campaigns, the OHPC focuses on protecting occupational health and the wellbeing of almost 776 million workers in China and proposed medium to long-term action plans to provide comprehensive occupational health services from 2019 to 2030 (5).
OHPC strategies are embodied at three levels including employees, employers, and government. Strategies for employees include promoting healthy working styles; fostering occupational health awareness; increasing consciousness of occupational laws and regulations; strengthening personal protection at work; improving emergency response capabilities; enhancing chronic and non-communicable disease prevention and control; protecting employees who work at desks or maintain forward sitting positions for a long periods (such as white-collar workers); protecting employees who stand for long periods while working (such as teachers, traffic police, doctors, and nurses); and protecting employees who keep fixed positions at work (such as drivers).
For employers, the strategies focused on the following: establishing an accountability system for occupational disease control and prevention, especially primary-responsibility legal bodies for enterprises; strengthening the source control of occupational hazards, specifically construction enterprises or institutions that should fulfill the responsibility of controlling, preventing, and eliminating occupational hazards; building clean, hygienic, green, comfortable, and pleasing working environments; implementing protection measures for workers’ health (such as work-break exercise and smoke-free programs); and establishing overall management strategies for employment including labor contracts, work-related injury insurance, occupational hazard reporting, routine surveillance, occupational diagnosis, health insurance for workers, etc.
Supported by joint efforts of 10 ministries and commissions, the OHPC has also developed strategies for government including the following: reviewing relevant laws and policies including the Code of Prevention and Control of Occupational Disease and other relevant rules and regulations; developing and promoting innovative technology, facilities and materials to protect workers’ health; improving occupational disease prevention and control systems; enhancing the regulatory and supervisory system of occupational health; strengthening supervision of occupational disease prevention on labor dispatch units, especially starting with rural migrant workers; improving reporting of occupational hazards by establishing a united and efficient data management mechanism of law enforcement and supervision; and incorporating the Healthy Enterprises as a priority into the Healthy Cities program, as well as enriching the scope of occupational health with an emphasis on job stress, musculoskeletal disorders, and other emerging occupational exposures.
Complemented by the National Plan on Occupational Disease Prevention and Control Program (2016–2020), the OHPC proposed 3 major outcome indices as listed in Table 1. In addition, it also included several other advocated indices and the awareness of work-related hazards and protection knowledge, health management, and comprehensive strategies such as advancing technology and adjusting schedules to protect employees from monotonous, repetitive, and stressful work conditions.
Indices Targeted data 2020 2020 Coverage of industrial injury insurance Steadily improved; Baseline: 236 million in 2018 Achieved legally full coverage New pneumoconiosis cases among workers with exposure to dust ≤ 5
years accounted for all reported cases per year (%)
Significantly declined Continuously declined Rates of occupational health inspection and coverage of diagnostic service ≥80% ≥90%
Table 1. Major outcome indices by the Occupational Health Protection Campaign.
The transformation of economic growth in China from a high-speed mode to a high-quality mode with constant changes in industrialization, urbanization, population aging, occupational disease spectrum, ecological environment, and lifestyle has led to new occupational health problems. Pneumoconiosis, chemical poisoning, occupational hearing loss, and radiation sickness resulting from traditional occupational hazards pose a serious threat to workers’ health. Meanwhile, teachers, traffic police, healthcare workers, and other key populations highlighted by OHPC are facing increasing work-related exposures. Although these disorders were not legally included in the Classification and Categorization of Occupational Diseases, certain diseases such as cervical spondylosis and work-related stress have become increasingly common among office employees (2). In the progress of the Healthy China 2030 initiative, resolving this situation is necessary through designing political strategies and guidelines to protect key occupational populations. This campaign advocates to strengthen the promotion and training for knowledge of occupational disease prevention and prevent both occupational diseases and other work-related diseases at this stage. Employers are encouraged to improve technique and working systems to prevent fatigue and other related disorders and take integrated measures to reduce job stress and other negative health effects.
Protecting occupational health is an important basis for improving people’s health, wellbeing, and quality of life. By prioritizing the people’s health, the National Health Commission is cooperating closely with other agencies to accelerate the switch from hazard control and disease treatment to workers’ health by holding workplaces accountable for preventing, treating, and controlling diseases and promoting health protection knowledge. Dedicated to comprehensive health protection for workers, related departments, government, and society at all levels should fulfill their responsibilities and enhance coordination to ensure the achievement of Healthy China Initiative 2030 goals.