The Chinese farmer’s achievements in rural industrialization and in developing township enterprises (table 1) have been remarkable. This development has indeed been the most important opportunity for rural people to escape poverty quickly. Since about the seventies, more than 100 million farmers have moved to township enterprises, a number of workers exceeding the total number of employees then in state-owned and city/collectively owned enterprises. At present, one out of every five rural labourers works in various township enterprises. A total of 30% to 60% of the total average personal net income of rural people comes from the value created by township enterprises. The output value from township industries accounted for 30.8% of the total value of national industrial production in 1992. It is predicted that by the year 2000, more than 140 million surplus farm labourers, or some 30% of the estimated rural labour force, will be absorbed by township industries (Chen 1993; China Daily, 5 Jan. 1993).

Table 1. Development of China’s township enterprises

This quick transfer of the labour force from agriculture to non-agricultural work in rural areas has imposed heavy pressure on the resources of occupational health services. The Survey on Occupational Health Service Needs and Countermeasures in Township Industries (SOHSNCTI) in 30 sample counties of 13 provinces and 2 municipalities, organized by the Ministry of Public Health (MOPH) and the Ministry of Agriculture (MOA) jointly in 1990, showed that most township enterprises had not provided basic occupational health service (MOPH 1992). The coverage of five routine occupational health service activities provided for township enterprises by local occupational health institutions (OHIs) or health and epidemic prevention stations (HEPSs) was very low, only 1.37% to 35.64% (table 2). Those services which need complicated techniques or well-trained occupational health professionals are particularly limited. For example, preventive occupational health inspection, physical examination for workers exposed to hazards, and workplace monitoring were evidently insufficient.

Table 2. The coverages of OHS provided to township industries by county HEPS

Meanwhile, there is a trend that occupational health problems in rural enterprises are worsening. First, the survey showed that 82.7% of rural industrial enterprises had at least one type of occupational hazard in the workplace. Workers exposed to at least one kind of hazard accounted for 33.91% of the blue-collar workers. The air samples of lead, benzene analogues, chromium, silica dust, coal dust and asbestos dust at 2,597 worksites in 1,438 enterprises indicated that the total compliance rate was 40.82% (table 3); the compliance rates with respect to dusts were very low: 7.31% for silica, 28.57% for coal dust, and 0.00% for asbestos. The total compliance rate for noise in 1,155 enterprises was 32.96%. Physical examinations for workers exposed to more than seven hazards were conducted (table 4). The total prevalence of occupational diseases caused only by exposures to these seven types of hazard was 4.36%, much higher than the prevalence of total compensable occupational diseases in state-owned enterprises. There were another 11.42% of exposed workers suspected of having occupational diseases. Next, hazardous industries continue transferring from urban to rural areas, and from state-owned enterprises to township enterprises. Most of the workers in these industries used to be farmers before employment and lacked education. Even the employers and the managers still have very little education. A survey covering 29,000 township enterprises indicated that 78% of the employers and managers had only junior middle school or primary school education and that some of them were simply illiterate (table 5). A total of 60% of employers and managers were not aware of governmental occupational health requirements. It predicted that the prevalence of occupational diseases in rural industries will increase and reach a peak by the year 2000.

Table 3. The compliance rates of six hazards in worksites

¹ Mercury was not found in sample areas.
² The compliance rate for noise was 32.96%; see text for details.

Table 4. The detectable rates of occupational diseases

¹ Benzene, toluene and xylene, measured separately.
² Hearing impairment in sound frequency.
³ Hearing impairment in high frequency.

Table 5. Distribution of hazardous working and the education of employers

The Challenge of the Mass Migration of the Labour Force

The social labour force in China in 1992 was 594.32 million, of which 73.7% were classified as rural (National Statistics Bureau 1993). It is reported that one-third of the country’s 440 million rural labourers are actually unemployed (China Daily, 7 Dec. 1993). The vast surplus of labourers who have far exceeded the pool of employability in rural industries are migrating towards urban areas. The mass movement of farmers to the urban areas over the last few years, especially heavy since the beginning of the 1990s, has been the big challenge to the central and local governments. For example, in the first half of 1991, only 200,000 farmers left their hometowns in Jiangxi province, but in 1993, more than three million followed the tide, which accounted for one-fifth of the province’s rural labourers (China Daily, 21 May 1994). On the basis of state statistics, it has been predicted that 250 million rural workers would hit the urban labour market by the end of the century (China Daily, 25 Nov. 1993). In addition, there are about 20 million young people every year entering legal employment age in the entire country (National Statistics Bureau 1993). Thanks to widespread urbanization and the extensive opening to the outside world, which is attracting foreign investment, more job opportunities for migrant rural labourers have been created. The migrants are engaged in a greater variety of business in the cities, including industry, civil engineering, transport, commerce and service trades and most high-risk or hazardous work which urban people do not like to do. These workers have the same personal background as those in the rural township enterprises and are facing similar occupational health problems. In addition, because of their mobility, it is difficult to trace them and employers could easily escape from their responsibilities for the workers’ health. Furthermore, these workers are often involved in various occupations in which the health risk from hazardous exposures might be complicated and it is hard to provide them access to occupational health services. These conditions make the situation more serious.

The Occupational Health Problems Faced in Foreign-Funded Industries

There are currently more than 10 million domestic labourers nationwide employed in over 70,000 foreign-funded enterprises. Preferential policies for encouraging investment of foreign capital, the existence of vast natural resources and a cheap labour force are attracting more and more investors. The State Planning Commission of the State Council has decided to impose fewer administrative examinations on applicants. Local governments were given more power to approve the investment projects. Those involving funding under US$30 million can be decided by local authorities, with registration at the State Planning Commission, and foreign enterprises are encouraged to bid for them (China Daily, 18 May 1994). Of course, foreign-funded enterprises are also very attractive to many Chinese labourers, mainly because of the higher wages to be earned.

During the course of encouraging foreign investment, hazardous industries have also been transferred to this country. The MOPH and other related agencies have long been concerned for the occupational health of the workers in these sectors. Some local surveys have indicated the magnitude of the problem, which involves high exposure to occupational hazards, long working hours, poor working arrangements, special problems for female workers, no proper personal protection, no health examination and education, no medical insurance and discharge of workers who are affected by occupational diseases, among other problems.

The incidence of chemical poisoning accidents has been increasing in recent years. Information from the Guangdong Provincial Institute of Occupational Disease Prevention and Treatment in 1992 reported that two accidents of solvent poisoning happened simultaneously in two overseas-funded toy factories in the Zhuhai special economic zone, resulting in a total of 23 cases of worker toxicity. Of these, 4 persons were afflicted by 1,2-dichloroethane poisoning and three of them died; another 19 cases had benzene analogues (benzene, xylene and toluene) poisoning. These workers had worked in the factories for just less than one year, a few of them for only 20 days (Guangdong Provincial Occupational Disease Prevention and Treatment Hospital 1992). In the same year, two poisoning accidents were reported from Dalian City, Liaoning Province; one had involved 42 workers and another involved 1,053 workers (Dalian City Occupational Disease Prevention and Treatment Institute 1992b). Table 6 shows some basic occupational health–related conditions in three special economic zones (SEZs) in Guangdong and the Dalian Economic and Technological Development Area, surveyed by local OHIs or HEPSs (Dalian City Occupational Disease Prevention and Treatment Institute 1992b).

Table 6. Occupational health-related background in foreign-funded enterprises

¹ Any form of occupational health and safety organization in plan, e.g. clinics, OHS committee, etc.
² The survey in 1992, in three special economic zones (SEZs): Shenzhen, Zhuhai and Shantou.
³ The survey in 1991 in Dalian Economic and Technological Development Area.

The employers of foreign-funded enterprises, especially small manufacturing factories, ignore governmental regulations and rules in protecting workers’ rights and their health and safety. Only 19.6% or 31.2% of workers in three Guongdong SEZs could get any kind of health examination (see table 6). Those enterprises making no provision for personal protective equipment for exposed workers accounted for 49.2% and only 45.4% of the enterprises provided hazard exposure subsidies (China Daily, 26 Nov. 1993). In Dalian, the situation was even worse. Another survey conducted by the Guangdong Provincial Trade Union in 1993 indicated that more than 61% of employees worked over six days a week (China Daily, 26 Nov. 1993).

Female workers suffer even more from appalling work conditions, according to a report released in June by the All-China Confederation of Trade Unions (ACFTU). A poll conducted by the ACFTU in 1991 and 1992 among 914 foreign-funded enterprises showed that women accounted for 50.4% of the total 160 thousand employees. The proportion of women is higher in some areas in recent years. Many foreign firms did not sign labour contracts with their employees and some factories hired and fired woman workers at will. Some overseas investors employed only unmarried girls between the ages of 18 and 25 years, whom they dismissed once they got married or became pregnant. Meanwhile, many women were often forced to work overtime without extra pay. In a toy factory in Guangzhou, capital of Guangdong Province, workers, most of them women, had to work 15 hours a day. Even then, they were not allowed to take Sundays off or enjoy any annual holiday (China Daily, 6 July 1994). This is not a very rare phenomenon. Details of workers’ occupational health status in foreign-funded enterprises have not yet been made known. From the information above, however, one can imagine the gravity of the problem.

New Problems in State-Owned Enterprises

In order to meet the requirements of a market economy, the state-owned enterprises, especially the large and medium ones, have to transform the traditional operational mechanism and establish a modern enterprise system which would clearly outline property rights and enterprise rights and responsibilities and at the same time push the state-owned enterprises into the market to increase their vitality and efficiency. Some small state-owned enterprises may be leased or sold to collectives or individuals. The reforms have to affect every aspect of business, including occupational health programmes.

At present, losing money is a serious problem faced by many state-owned enterprises. It is reported that about one-third of the enterprises are in deficit. The reasons for this are diverse. First, there is a heavy tax and financial burden intended to take care of a large contingent of retired employees and to provide a host of social welfare benefits to current workers. Second, a huge surplus labour force, about 20 to 30% on average, in an enterprise cannot be released into the existing fragile social security system. Third, the outdated management system was adapted to the traditional planned economy. Fourth, the state-owned enterprises have no competitive policy advantages over foreign-funded firms (China Daily, 7 April 1994).

Under these circumstances, occupational health in the state-owned enterprises tends to become inevitably weakened. First, financial support for health programmes has been reduced in the case of some enterprises and the medical/health institutions in enterprises which used to offer health care only to their own employees before are opening them now to communities. Second, some in-plant health facilities are being divorced from affiliation with enterprises as part of an effort to shift the burden of costs from state-owned enterprises. Before the new social security system was set up, there was concern, too, that funding for occupational health in-plant programmes might also be affected. Third, much outdated technology and equipment has been operating for decades, usually with high levels of hazardous emissions, and cannot be improved or replaced in a short period of time. More than 30% of the worksites of state-owned and city-collective enterprises are not in compliance with national hygienic standards (MAC or MAI). Fourth, the implementation of occupational health regulations or rules has been weakened in recent years; of course, one of the reasons for this is the incompatibility between the old management system of occupational health in the days of central planning with the new situation of enterprise reform. Fifth, to decrease the cost of labour and to offer more widespread employment opportunities, the hiring of temporary or seasonal workers, most of whom are migrants from rural areas, to engage in hazardous work in state-owned enterprises has become a common phenomenon. Many of them cannot get even the simplest personal protective equipment or any safety training from their employers. This has continued to be a potential health threat affecting the working population of China.

Problems in the Occupational Health Service System

The coverage of occupational health services is not extensive enough. As mentioned above, only 20% of the workers exposed to hazards can be covered by periodic health examination, most of whom are working in state-owned enterprises. The reasons why the coverage is so low are as follows:

First, the shortage of occupational health service resources is one of the main factors. This is especially the case for rural industries, which have no capacity to provide such services themselves. The data from the SOHSNCTI has shown that there were 235 occupational health professionals in county HEPSs in 30 sampled counties. They have to deliver occupational health service to 170,613 enterprises with 3,204,576 employees in those areas (MOPH 1992). Thus, each full-time occupational health worker covered an average of 1,115 enterprises and 20,945 employees. Also emerging from the 1989 survey was the fact that the health expenditures of 30 county governments accounted for 3.06% of the total county government expenditures. The total expenditures for both disease prevention and health inspection accounted for only 8.36% of the total county governmental health expenditures. The fraction expended purely on occupational health services was even smaller. Lack of basic equipment for occupational health service is a big problem in the surveyed counties. The average availability of thirteen categories of equipment in 28 of the 30 counties was only 24% of the requirement defined in the national standard (table 7).

Table 7. Routine instruments for occupational health in HEPS of 28 countries in 1990, China

Second, low utilization of existing occupational health facilities is another factor. The shortage of resources on the one hand and insufficient utilization on the other is the case with occupational health service in China right now. Even at higher levels, for example, with the provincial OHIs, the equipment is still not being fully put to use. The reasons for this are complicated. Traditionally, occupational health and various preventive medical services were all financed and maintained by government, including the wages of health workers, the equipment and buildings, routine outlays and so forth. All occupational health services provided by governmental OHIs were free of charge. With the rapid industrialization and economic reform since 1979, the needs of society for occupational health service have been increasing, and the cost for providing services at the same time increased rapidly, reflecting an increasing price index. The budgets of the OHIs from government, however, have not increased to keep pace with their needs. The more services an OHI provides, the more funding it needs. To promote the development of public health service and meet growing social needs, the central government has instituted the policy of allowing the public health sector to subsidize payments for services, and stipulations have been made to control the price of health services. Because of weak compulsory legislation in providing occupational health service for enterprises in the past, OHIs are finding it difficult to maintain themselves by collecting payment for services.

Further Policy Considerations and Trends in Occupational Health Services

Without doubt, occupational health service is one of the most important issues in a developing country like China, which is undergoing rapid modernization and possesses such huge numbers of workers. While facing the great challenges, the country is also, at the same time, welcoming the great opportunities arising from present social reforms. Many successful experiences exemplified across the international scene can be taken as references. In opening up so widely to the world today, China is willing actively to absorb the advanced occupational health managerial ideas and technologies of the broader world.

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