Toxicology 198 (2004) 55–61

Occupational health management and service forsmall-scale industries in Shanghai

Lu Wei∗, Wu Shi-da

Shanghai Municipal Center for Disease Control and Prevention, Shanghai, PR China

Abstract

Because occupational hazards of small-scale industries were severe and the occupational health management lagged behindin Shanghai, we selected some districts as experimental units to explore a model of community management and service forthe occupational health in small-scale industries for controlling occupational hazards. The results indicated that the model isuseful. The features of occupational health in these small-scale industries have been improved markedly. For example, themonitoring rate of occupational hazards increased, the rate for occupational health recording and training also increased, andthe knowledge of the occupational health among managers and employees has been also enhanced after implementing thenew management model. The practice has shown that it is a low-cost and wide-covered, effective model. The communitiesmay offer the standard, agreeable and low-price occupational health management and service to the small-scale industrieswhich are able to pay the service fee although their economic base is comparatively weak. A solution for protecting theoccupational population with relatively high mobility and keeping small-scale industries sustainable development has beenreported.© 2004 Published by Elsevier Ireland Ltd.

Keywords:Small-scale industry; Occupational health; Management and service model; Community

1. Introduction

In order to help control occupational hazards andmaintain economy sustainable development in thedistricts, we selected some districts as experimentalunits to explore a model of community managementand service for occupational health in small-scaleindustries. This has been done to enhance occupa-tional health and to satisfy the essential requirementby management and the communities (Shi-da et al.,2000).

∗ Corresponding author.E-mail address:weiloo@scdc.sh.cn (L. Wei).

2. The basic circumstance of occupational healthin Shanghai

2.1. Severe occupational hazards in small-scaleindustries

Based on incomplete statistics there were 6920small-scale enterprises with 459,540 employees inShanghai. Most of them had hazards including occu-pational diseases in different degrees (Table 1). Ourinvestigation indicated that only 19.7% of the enter-prises had occupational diseases protection equip-ments, and only 12.0% provided personal protectiondevices for those workers in hazardous workplaces.

0300-483X/$ – see front matter © 2004 Published by Elsevier Ireland Ltd.doi:10.1016/j.tox.2004.01.019

56 L. Wei, W. Shi-da / Toxicology 198 (2004) 55–61

Table 1The occupational hazards in small-scale industries in Shanghai

Name of the occupational hazardous agent Number ofsmall-scaleindustries

Numberof staff

Number ofworkers

Number of workersexposed tooccupational hazards

Heat stress 1156 96594 67498 48657Noise 1014 77215 51621 5951Xylene 1000 68900 44384 2629Welding fume 696 57962 35209 3117Toluene 579 43879 29218 1751Ultraviolet radiation (UV) 552 39791 25554 2608Cast dust 384 26659 17788 120Benzene 323 17362 12751 1229Solvent gasolines 263 17303 9993 1026Wood dust 254 19822 12995 821Hydrogen chloride and chlorhydric acid 253 14025 9514 1003Lead and its inorganic compounds 249 9909 6536 1285Sulfuric acid and sulfur trioxide 213 18027 11743 781Carbon black dust 153 17955 12015 655Coal dust 148 13561 8951 556Talc dust 112 5970 3738 316Cotton dust 108 7356 4982 422Cyclohexanone 101 6090 3397 405Ionizing radiation 87 13200 7733 320Dust of aluminium, aluminium oxide

and aluminium alloys87 6306 4110 569

According to government statistics, there were12,458 occupational disease cases from 1998 to 2002in Shanghai. The small-scale industries accounted for15.6%, with 1939 cases. Of the 833 cases of acutepoisoning in Shanghai, the small-scale industries were24.5%, with 204 cases (Table 2).

The data suggested that the rate of occupationalhazards detected in small-scale industries was belowthe Shanghai’s average level from 1998 to 2002. Inrecent years, the situation has improved even more(Table 3).

2.2. Occupational health management lagged behind

By the end of the 1990s, our research found thatin 90% of the small-scale industries, there existed avariety of hazards of occupational diseases, includingabout 100 occupational hazardous agents. Ninety-fivepercent of those factories were not subject to preven-tive health supervision at the start. The situation wasimproved after the Law on the Prevention and Con-trol of Occupational Diseases was issued and exe-cuted, but most of the small-scale industries did notpass the occupational disease pre-evaluation and the

control-effect evaluation. In general, almost all of thesmall-scale industries did not declare the potential haz-ards of occupational diseases according to the Law,and did not establish occupational health records asrequired by the Law.

As for the causes, the first was the fact that the man-aging personnel of the small-scale industries were notaware of law and did not recognize the occupationalhazards. They did not implement effective occupa-tional health management practices in their enterprisesconsciously, and their health administration capacitywas insufficient. Nevertheless, a few tried to carrythrough the occupational health management programaccording to the Law. The second reason was that therewas a lack of administering human resources in thedistrict health service, that resulted in some vacancyfor the occupational health management in some partsof the small-scale industries.

2.3. Insufficiency of the occupational health serviceto the small-scale industries

The occupational service was insufficient for thesmall-scale industries. Only 9.6% of 206 enterprises

L.

We

i,W

.S

hi-d

a/

Toxico

logy

19

8(2

00

4)

55

–6

157

Table 2The incidence of the occupational diseases in Shanghai

Year Acute poisoning Chronic poisoning Pneumoconiosis Others Total

All Township % All Township % All Township % All Township % All Township %

1988 39 6 15.38 53 28 52.83 136 10 7.35 1475 181 12.27 1703 225 13.211989 99 51 51.52 78 38 48.72 221 28 12.67 997 85 8.53 1395 202 14.481990 79 8 10.13 71 23 32.39 138 10 7.25 1530 97 6.34 1818 138 7.591991 58 5 8.62 63 19 30.16 124 19 15.32 1222 113 9.25 1467 156 10.631992 47 4 8.51 26 11 42.31 66 11 16.67 793 83 10.47 932 109 11.701993 43 12 27.91 33 15 45.45 83 10 12.05 494 77 15.59 653 114 17.461994 66 10 15.15 28 13 46.43 18 1 5.56 598 66 11.04 710 90 12.681995 37 13 35.14 16 1 6.25 33 8 24.24 599 128 21.37 685 150 21.901996 36 5 13.89 17 6 35.29 22 1 4.55 370 134 36.22 445 146 32.811997 41 8 19.51 21 5 23.81 24 2 8.33 354 91 25.71 440 106 24.091998 45 13 28.89 17 5 29.41 12 0 0.00 292 82 28.08 366 100 27.321999 73 28 38.36 9 2 22.22 36 8 22.22 198 56 28.28 316 94 29.752000 51 9 17.65 21 5 23.81 151 10 6.62 233 56 24.03 456 80 17.542001 59 9 15.25 21 6 28.57 122 10 8.20 264 65 24.62 466 90 19.312002 60 23 38.33 24 6 25.00 124 12 9.68 398 98 24.62 606 139 22.94

Total 833 204 24.49 498 183 36.75 1310 140 10.69 9817 1412 14.38 12458 1939 15.56

58 L. Wei, W. Shi-da / Toxicology 198 (2004) 55–61

Table 3The qualified rate of the monitoring worksites in Shanghai

Year Qualified rate of dust (%) Qualified rate of toxicant (%) Qualified rate of physicalagents (%)

Total

Shanghai Township Shanghai Township Shanghai Township Shanghai Township

1988 48.6 28.0 82.1 82.1 59.7 44.3 67.3 57.11989 58.2 47.5 74.1 75.0 54.7 47.1 66.7 62.71990 41.5 27.5 78.6 74.2 53.2 47.3 60.3 49.11991 56.3. 51.5 77.3 73.2 59.0 55.9 65.2 58.91992 63.8 68.7 79.6 74.5 61.6 55.6 68.2 67.31993 66.9 67.9 79.7 78.9 55.9 44.0 68.3 67.51994 67.2 65.4 78.2 74.3 53.9 44.0 68.4 64.81995 67.5 55.7 81.8 82.7 55.8 51.9 68.9 64.61996 68.0 63.1 82.9 77.4 57.3 47.0 69.2 62.41997 67.5 62.5 81.2 80.5 54.2 50.3 67.9 64.21998 78.9 78.3 88.0 87.2 63.4 64.9 77.6 76.91999 86.2 81.2 88.7 84.5 54.5 56.4 78.7 75.32000 83.9 85.1 89.8 90.8 60.3 58.4 80.5 80.22001 86.1 86.1 91.6 93.1 50.9 49.4 80.3 81.12002 89.8 91.0 91.3 89.7 62.2 65.1 82.8 82.9

had occupational hazard monitoring systems. Only31.5% of the enterprises had occupational physical ex-aminations and just 17.1% of the employees have beenexamined. Only 23.9% of the employees received ed-ucation and training on occupational health and safety.

The reason for the issues were two-fold. First,except for being unaware of the law and a lack ofunderstanding of the occupational diseases, it wasdeficiency of occupational health specialists and pro-fessional workers, and the fact that the small-scale in-dustries could not develop the necessary occupationalhealth services by themselves. The second reasonwas that the occupational health institutions of thegovernment did not offer the full occupational healthservices because of inadequate manpower, materialsand financial resources (Liang and Su, 1994).

In exploring the model of occupational health man-agement and service to small-scale industries in com-munities, we adopted some measures, with the activeexploring of the occupational health management andservice model, to strengthen the program. The resultof this study of the occupational health and manage-ment in the small-scale industries was effective andproductive. We have elaborated the model as follows.

The model for community management and ser-vice to small-scale industry consists of a series ofelements such as organization structure, governmentdepartments’ participation, service objects, service

pathway and scope as well as designing and executingthe program, forming of due objectives and indexes,and establishing the compensatory mechanism andthe complete evaluation of the service model (Shidaet al., 1999).

3. The organization model of communitymanagement and service

The organization model is to form an effective,multi-sectional participating mechanism of manage-ment and service that is accepted by small industrieswith the support from government leaders and har-monizing management. The organization model in-cludes the leading group of the community occupa-tional health, the instruction group of the occupationalhealth technology, the service center of the occupa-tional health, and the managing network of small-scaleindustry’s occupational health in the community.

The leading group of the community occupationalhealth consists of the related governors of the localgovernment, the health supervision institution andthe district center for disease control and prevention.This group arranges and designs the entire programfor the occupational health service to the small-scaleindustries in the community. The instruction group ofthe occupational health technology in the community

L. Wei, W. Shi-da / Toxicology 198 (2004) 55–61 59

consists of related professional persons. And it helpsthe community to establish the occupational healthprogram of the small-scale industries, and offer thetechnical instruction for implementing and evaluatingthe program.

The community service center of the occupationalhealth, as an organization of the occupational healthservice, is responsible for providing the standard, ba-sic occupational health service and usual technical in-struction.

The full-time/part-time person(s) responsible foroccupational health in the health section of the localcommunity government and the village industry andenterprise, form the three-level management networkof occupational health in the community. They areresponsible for propaganda, carrying through and im-plementing the Law on the Occupational Disease Pre-vention and Control, occupation health regulations,criteria and standards, and complex treatment of theoccupational hazards in the small-scale industries inthe community.

3.1. The running model of occupational healthservice in the community

The running model is primarily designing and ex-ecuting the program of occupational health, formingthe objectives and indexes, reasonable distribution ofthe health resources, clearly defining the service ob-jects and scope, and forming the network of the occu-pational health management and service. The runningmodel includes constituting the program, implement-ing the management, developing the service of the oc-cupational health and establishing the compensatorymechanisms (Shida et al., 2000).

According to the rules of the law, regulations, cri-teria and standards set by the central and local gov-ernments in view of the requirements of small-scaleindustries, we establish the work program of the occu-pational health, which included clear objects, broughtforward a series of indexes, and adopting related in-terfering measures and gave the guarantee of organi-zation and resources for accomplishing the program.

We regulated the occupational health managementof the small-scale industries through the network of oc-cupational health management and community occu-pational health service center. The management workcomprised such things as checking the executing of

the law, regulations, criteria and standards of occupa-tional health, establishing the health record and de-veloping the registering and analyzing occupationaldiseases, injury accidents, work-related diseases, andother common diseases. The standard, basic occupa-tional health service and technical instructions are of-fered by the community occupational health service.We offer standard, basic occupational health serviceand regular technical instruction through the commu-nity occupational health service center. It consisted ofassisting the enterprises to establish archives of occu-pational health records and health surveillance, to con-stitute a system and operational rules of occupationalhealth, to instruct the check-up procedure of construc-tive project about the occupational health, to orga-nize the occupational health training of the managersand those workers exposed to occupational hazards, totake charge of detecting the occupational hazards intheir work environment, to organize the occupationalhealth examination, and to offer consultation aboutoccupational health technology, etc. In the interest ofthe sustainable development of the community occu-pational health service center, according to the princi-ple of “who gain the benefit, who pay”, we establisheda compensatory mechanisms of occupational health.For those enterprises who volunteered to accept thecommunity occupational health service, we charged afee as a regular outlay for our institution by signing anagreement. The fee charged was based on the size ofthe enterprises and the degree of occupational hazards.An additional fee for occupational health examinationand for diagnosis and treatment of common diseaseswas also charged according to the regulation.

4. The assessment of community occupationalhealth management and service model ofsmall-scale industries

We consider that the community occupationalhealth service model of small-scale industries is fea-sible by the assessment of the experimental district.A series of evaluating indexes and analysis also indi-cated that the model works effectively.

The features of the small-scale industry’s occupa-tional health have been improved markedly, for exam-ple, the monitoring rate of occupational hazards hasincreased, and the rate of occupational health records

60 L. Wei, W. Shi-da / Toxicology 198 (2004) 55–61

Table 4The comparison of occupational health in small-scale industries

Contrast item Basic line (%) Contractedenterprise (%)

X2

The coverage rate of factories with monitoring in the workplace 9.6 88.1 260.03∗∗The coverage rate of monitoring-sites 10.0 96.7 964.11∗∗The qualified rate of monitoring-sites 50.8 59.5 1.74∗The coverage rate of factories with occupational physical examination 31.5 52.3 13.00∗∗The physical examination rate 17.1 25.6 46.53∗∗The coverage rate of occupational health’s education and training 23.9 100.0 159.88∗∗The coverage rate of audited factories 0.5 18.3 35.66∗∗The rate of occupational health record rate 17.9 100.0 168.16∗∗The coverage rate of factories with operating procedure 40.8 74.3 29.26∗∗The coverage rate of factories with occupational health professional 4.3 19.3 17.68∗∗

∗ P > 0.05.∗∗ P < 0.001.

Table 5Comparison of occupational health’s awareness rate in small-scale industries

Contrast item Basic line (%) Contractedenterprise (%)

X2

The knowledge rate of occupational health’s regulation in the managers 59.8 100.0 162.83∗∗The knowledge rate of occupational health’s standard in the managers 16.9 65.1 221.14∗∗The knowledge rate of preventive health supervision in the managers 55.6 100.0 187.71∗∗The knowledge rate of occupational hazards harm in the managers 71.0 100.0 105.21∗∗The knowledge rate of occupational health regulation in the workers 4.6 58.6 968.97∗∗The knowledge rate of occupational hazards in the workers 32.0 69.5 553.09∗∗The knowledge rate of occupational hazards harm in the workers 11.7 65.5 1036.27∗∗

∗∗ P < 0.001.

and occupational health training also has increased(Table 4). The knowledge and recognition rate for oc-cupational health among managers and employees alsohave been enhanced after the service model was im-plemented (Table 5).

5. The sustainable development of smallindustry’s occupational health managementand services

A survey showed that we are welcome by enter-prises while the features of small-scale industry’s oc-cupational health are improved gradually through run-ning the community management and service model.In Shanghai, in the experimental district, during lastyear the increase in the number of enterprises thatasked for the community occupational health manage-ment and service rose by 118%. The overall rate ofoccupational health service to these enterprises is over90%.

We mobilized the potential of the existed occupa-tional health institution by wielding the rule of themarket economy to provide standard and cost effec-tive occupational health management and service tosmall-scale industries without the capacity of estab-lishing occupational health service by themselves orto do it by themselves but at greater cost. The newmodel of the community occupational health manage-ment and service is in all accord within the require-ments of social and economy development and willhelp sustainable development.

6. Discussion

In order to improve the under-developed occupa-tional health management and service in Shanghai,a series of measures were taken. Some measuresaimed to improve the consciousness of executingthe occupational health law in small-scale industries.Along with popularizing the Law on the Occupational

L. Wei, W. Shi-da / Toxicology 198 (2004) 55–61 61

Diseases Prevention and Control and various spe-cial projects for improving occupational health, weenhanced understanding the legal system of the oc-cupational health and the strength of executing thelaw and governmental supervision. We urged own-ers and managers of small-scale industries to changetheir concept and helped them how to execute theLaw on the Occupational Diseases Prevention andControl. If they can not offer self-service of occupa-tional health, they can apply the social occupationalhealth service from the market. Some measures weretaken to improve the capability of self-managementand self-service, along with implementing healthpromotion in these enterprises. The small-scale in-dustries were also encouraged to carry out healthpromotion. By health promotion, we expect thatthe managers’ technique and ability of occupationalhealth management will be improved in small-scaleindustries. The distribution of the resources of occu-pational health will be optimized to satisfy the in-creasing demand of occupational health managementand services in small-scale industries. The commu-nity may offer occupational health management andservice.

The practice shows that the community occupa-tional health management and service model is a

low-cost and effective model that the communitymay offer the standard, agreeable and cost effec-tive occupational health management and service tosmall-scale industries. The small industries with com-paratively weak economic base and high mobility inthe occupational population will be greatly helped.Implementing the new model of occupational healthmanagement and service will improve the servicelevel of the occupational health in the small-scale in-dustries, and will reduce the workers’ worries. It alsowill help keep employment steady. It is a better wayto enhance working efficiency.

References

Shi-da, W.U., Ming-xi, S.H.E., Xiao-Ping, G.U. et al., 2000. Theresult assessment of the occupational health service model incommunity. J. Labor Med. 18 (6).

Liang, X.Y., Su, Z., Zhang, S.-L. et al., 1994. Internationaltrend on occupational health services for small industries, J.Occup. Med. 21 (3).

Shida, W.U., Juan, L.U., Ping, L.I.U., et al. 1999. The researchon the occupational health for the small industries in Tao PuDistrict of Shanghai. J. Labour Med. 16 (3).

Shida, W.U., Mingxi, S.H.E., Juan, L.U., et al. 2000. Researchon occupational health serviced model adopted in small scaleindustries. J. Labour. Med. 17 (3).