Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning...

28
Occupational Poisoning in China C M Y CM MY CY CMY K AMRC English.pdf 1 10/18/2013 4:17:20 AM

Transcript of Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning...

Page 1: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

Occupational Poisoning

in China

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 1 10/18/2013 4:17:20 AM

Page 2: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

Occupational Poisoning

in China

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 2 10/18/2013 4:17:22 AM

Page 3: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

Contents

- Introduction P.2

- Occupational Poisoning in China: An Overview P.3 By China Labor Support Network

- Benzene-Poisoned Workers: Two Stories P.12 Youwei Worker Service Center

- Ban Benzene Campaign in China P.15

- Diagnostic Criteria of Benzene Poisoning P.20

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 3 10/18/2013 4:17:22 AM

Page 4: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

�e number of victims of occupational diseases, such as pneumoconiosis, heavy metal and solvent poisoning, are increasing at a fast rate in Asia. �e number is much higher than that su�er-ing from workplace injury and this phenomenon has become a very important issue for workers. Not only are the workers su�ering from occupational diseases very helpless, they o�en face also numerous predicaments in their process of diagnosis and treatment, and their ways to �ght for compensations and justice. It is a long and di�cult battle for them, especially when confronting the government-enterprise coalition. It usually takes the victims several years to obtain compensation from the government and enterprises. �is has caused much di�culty, especially �nancial ones, to the workers and their families.

Most importantly, workers are not meant to sacri�ce their life nor health to their occupations and the economic bene�ts of their employers. It is unquestionable that diagnosis, compensation and treatment to workers are essential and necessary; however, no matter how high the compensation is, the life and health of workers and their disrupted families can never be compensated. For many occupational diseases, the victims cannot become fully healthy ever again – the damages on health and the ability to work are usually irreversible. Prevention is therefore always better than treatment. Knowledge and awareness of workers must be promoted, so that they may have strong bargaining power to monitor their employers and law enforcers and advocate for a policy change. �e end goal is a safe working environment for all.

Due to the above situations, the Asia Monitor Resource Centre has organized a workshop in mainland China during August, in order to facilitate information exchange between organizations, and promote the understanding of chemical poisoning in China and other regions with the input of other Asian experiences on labor health, including India, Indonesia and Taiwan.

In this booklet, there will be an overview and analysis of the situation of chemical poisoning in China, stories of workers su�ering from chemical poisoning, and information regarding the ongoing campaigns on the chemical poisoning issue. We hope that through this booklet, the reader may gain understanding on the circumstance of workers in China and the chemical hazards they are constantly facing.

Asia Monitor Resource Centre

Introduction

2

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 4 10/18/2013 4:17:22 AM

Page 5: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

�e notoriously tricky issue of ascertaining and grappling with cases of occupational poison-ing – from the diagnosis of them, the related supervisory and compensation issues as well as in defence of those a�icted – has for quite some time been a focus of social concern in China. �e country’s collective conscience was pricked by outrageous cases such as the predicament of Zhang Haichao, a worker from Henan Province, who had to put up with a highly invasive biopsy procedure a�er a long saga of having his medical condition denied, for the mere purpose of getting a diagnosis of his lung a�iction from occupational causes. People’s jaws dropped learning about the agony of workers who were poisoned by organic tin compounds being recklessly misdiagnosed as having psychotic disorders.

Occupational poisoning has become one of the gravest occupational diseases in China and they tended to happen in clusters around some industries, leading to instances of group a�ictions popping up all over the place. Occupational poisoning is not just a threat to occupational safety and health, but can also in�ict a toll on the economy and can even undermine social harmony and stabil-ity. �is paper seeks to ascertain the state of play and the tempo of the problem of occupational poisoning in China today, with a particular focus on Guangdong Province1. It will do so by way of statistical analysis of the o�cial data on the issue as well as of the associated literature and reports in the country’s publicly available magazines.

1. Data sources

�e Ministry of Health’s occupational disease reports between 2007 and 2012, and the writ-ings and news reports on the issue as published in magazines in China which are publicly available.

2. Analysis of the state of play of occupational poisoning in China

2.1 Occupational poisoning in China – where things are at

Occupational poisoning has a�icted a big number of people across various industries in China, putting 220 million workers in 370,000 enterprises at risk as at the end of 2012.[1] 2

�ere were 807,269 cases of occupational diseases accumulatively registered in China from the 1950s to 2012, with pneumoconiosis accounting for 727,148 cases of them (of which 527,431 were ongoing cases and in 149,110 other cases the a�icted workers are already dead by end of 2010[2]). With respect to occupational poisoning in particular, there were 50,851 cases registered accumulatively, of which 25,202 were of an acute nature and 25,649 were chronic cases.

Occupational Poisoning in China: An Overview By China Labor Support Network 2013.9.28

(�e Chinese version of this article was presented at a chemical poisoning meeting held at Guang-zhou, China in late August 2013)

31. Please see the location of Guangdong on the map at the Appendix. 2 .Direct quotes from original sources were presented in this document in italics.

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 5 10/18/2013 4:17:22 AM

Page 6: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

4

Based on the statistics on occupational diseases released by the Ministry of Health between 2007 and 2012,Table 1 and Chart 1 present a picture covering the total number of those a�icted by occupa-tional diseases as well as their changes over time, the pneumoconiosis cases, the acute and chronic cases of occupational poisoning, the chronic cases of poisoning by lead and compounds, the chronic cases of benzene poisoning and the cases of leukemia induced by benzene poisoning.

Table 1. Changes in the number a�icted by occupational diseases in China, 2007-2012, by main categories

Chart 1. Changes in the number of people a�icted by occupational diseases in China, 2007-2012, by main categories

It’s evident from Table 1 and Chart 1 that over the 2007 to 2012 period, the number of workers newly a�icted with occupational diseases in general and pneumoconiosis in particular has both been on the rise, with the exception of 2008 and 2012 when there was a minor dip. It’s also unmistakable that the extent of those increases had more or less shadowed the pattern of GDP growth.[5] Pneumoconiosis has repeatedly accounted for record-breaking highs – of between 77% and 89% 3 – of the new cases of occupational diseases. �e number of new a�ictions of occupational poisoning has been escalating as well, yet its extent of increase was dwarfed by the surge in the new cases of occupational diseases and pneumoconiosis.

3 . To simplify the statistics, all �gures have been rounded to the nearest whole number.

2007 2008 2009 2010 2011 2012Total number of occupational diseases (new a�ictions only) 14,296 13,744 18,128 27,240 29,879 27,420Pneumoconiosis 10,963 10,829 14,495 23,812 26,401 24,206Occupational Poisoning 2,238 1,931 2,464 2,034 2,131 1,641Chronic cases 1,638 1,171 1,912 1,417 1,541 1,040Acute cases 600 760 552 617 590 601Chronic cases of poisoning by lead and compounds 849 617 1,082 499 621 197Chronic causes of benzene poisoning 225 185 208 272 354 329Benzene poisoning-triggered leukemia 16 17 22 49 52 53GDP (100m yuan) 257,306 314,045 335,353 397,983 471,564 519,322

unit: 100 million yuan

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 6 10/18/2013 4:17:22 AM

Page 7: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

5

In the view of some professional observers, the fact that the current statistics of occupational diseases were merely generated from the occupational health surveillance mechanism which has a coverage of only about 10% of the industries, has indicated that the actual number of a�ictions should be much higher than the reported �gures. [6]

2.2 Key features of the occupational poisoning cases in China

2.2.1 �e toxic chemicals that were mainly responsible for occupational poisoning cases came from a limited list and such incidents occurred in a small number of industries.

An overview of the toxic chemicals that were responsible for the acute and chronic occupational poisoning cases during 2007- 2010 was provided in Table 2.

Table 2. Key chemicals which were responsible for the acute and chronic occupational poisoning cases in China

�e two toxic chemicals that accounted for most cases – more than 51% – of chronic occupation-al poisoning were lead and compounds as well as benzene. �ey were mainly deployed by industries such as non-ferrous metals, light industries, the metallurgical industry, the electronics industry and the machine industry.

It is alarming that benzene has persistently claimed the number two spot of the chemical sub-stance culprits (claimed to the top in 2012) that were responsible for the occurrence of chronic occupa-tional poisoning. �e new cases of benzene poisoning accounted for 11%-32% of the cases of chronic occupational poisoning and they are on the rise, as indicative in Chart 2.

Chart 2. �e relative weight of chronic benzene poisoning and chronic poisoning by lead and its com-pounds among chronic occupational poisoning cases.

Main culprits in acute cases Main culprits in chronic cases2007 Carbon monoxide, hydrogen sul�de Lead and compounds, benzene, trinitrotoluene2008 Carbon monoxide, hydrogen sul�de Lead and compounds, benzene, n-hexane2009 Carbon monoxide, chlorine Lead and compounds, benzene, arsenic and its compounds2010 Carbon monoxide Lead and compounds, benzene, arsenic and its compounds2011 Carbon monoxide Lead and compounds, benzene, arsenic and its compounds2012 Carbon monoxide, dichloroethane, chlorineBenzene, lead and compounds (tetraethyl lead excluded), arsenic and compounds

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 7 10/18/2013 4:17:22 AM

Page 8: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

6

2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational disease a�ictions.

As revealed in Table 3, the acute and chronic cases of occupational poisoning in small and medi-um-size enterprises were accountable for way more than half of occupational poisoning a�ictions.

Table 3. �e share of occupational poisoning in China that occurred in small and medium-size enter-prises

Notes: According to �e Methods in Categorising Micro, Small, Medium and Large-Size Enterprises Statistically, the de�nition of scale of enterprises are as follows:

3 Analysis of the state of play of occupational poisoning in Guangdong Province4

3.1 Occupational poisoning in Guangdong Province – where things are at

�ere were 582 cases of occupational poisoning reported in Guangdong Province between 2006 and 2010. �ere was a drop in such Guangdong cases in the 2006-2008 period but then they crept back up again a�er 2009. �e share of occupational poisoning against occupational diseases of all sorts, however, has been on a downward trend, details of which are in Table 4. Most of such cases – 411 or 71% (411/582) – were of a chronic nature. See Chart 3.

Table 4. Changes in the number a�icted by occupational poisoning in Guangdong, 2006-2010

Chart 3. Distribution of acute and chronic occupational poisoning cases in Guangdong, year-on-year.

4. �is section was sourced heavily from the work of Hu Shijie, Jin Jiachun, Jiang Jiaxin, Huang Yongshun, An Analysis into the Features of Occupational Poisoning in Guangdong Province and a Probing into Related Preventive Measures, 2006-2010 [J]. South China Journal of Preventive Medicine, 2012,03:22-24+28.

2007 2008 2009Acute occupational poisoning 52% (private enterprises) 48% (private enterprises) 67%

Chronic occupational poisoning 83% 70% /

Name of Industry Indicator Unit of Measure Large Medium Small MicroEmployee (X) People X≥1,000 300≤X<1,000 20≤X<300 X<20

Operating Income (Y) 10,000 Yuan Y≥40,000 2,000≤Y<40,000 300≤Y<2,000 Y<300Industry

2006 2007 2008 2009 2010Total number of occupational diseases (new cases) 281 278 305 388 565Occupational poisoning cases 151 89 87 110 145Share of occupational poisoning among all occupational diseases 54% 32% 29% 28% 26%

Occupational Poisoning Acute Occupational Poisoning Chronic Occupational Poisoning

Number ofnew a�ictions

(unit: cases)

Year

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 8 10/18/2013 4:17:22 AM

Page 9: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

Occupational poisoning is a rather severe problem in Guangdong. While the relative weight of occupational poisoning against the total number of occupational diseases has not changed much, new occu-pational poisoning cases have increased in absolute terms year by year. �ese poisoning a�ictions were mostly of a chronic nature, which has accounted for 71% of all occupational poisoning cases (i.e., 411/582) [7].

3.2 Key features of the occupational poisoning cases in Guangdong

3.2.1 �e occupationally poisoned groups are young and have a relatively short history of service

In 334 cases (57%) of the Guangdong occupationally poisoned group, the a�icted person was a man, as opposed to in 248 other cases (43%) where a woman was a�icted. �ese a�icted parties fell into the 16-48 age group, with a median age of 30(P25=20 years of age,P75=38 years of age). In 25 of such cases, the a�icted party was an under-age worker of less than 18 of age. �e median period of service among the occupationally poisoned group is 1 year and 3 months (P25= 4 months,P75= 4 years). Among the acute cases, their median period of service is a month (P25= 1 month,P75= 3½ months) while that in the chronic cases is 2 years (P25=1 month, P75= 5 years).

�e statistics seem to suggest that the younger and therefore generally less experienced a�icted groups and those with shorter histories of services were more prone to violate operational and preventive guidelines and that their greenness would have been more likely to get them into poisoning emergencies in the �rst place. �e short average history of service of the chronic occupationally poisoned group (with a median service period of only 2 years) suggested that the workplace was seriously strewn with occupational hazards and that prescribed limits of various production parameters could have been breached. Long working hours might also have contributed to truncating the condition’s dormant phase.[7]

3.2.2 �e toxic chemicals that were mainly responsible for the occupational poisoning cases fell within a narrow range and these incidents occurred in a small number of industries.

Benzene was the culprit responsible for the biggest number of chronic occupational poisoning cases, to the tune of 47% (193/411) of the total. See Chart 4. �ere were 95 acute occupational poisoning cases (of which 6 were major incidents5 and the remaining 89 were of a more average nature). �e main culprit in acute occupational poisoning cases was trichloroethylene (which led to trichloroethylene poisoning and eruption-like dermatitis), which has accounted for 32% (30/95) of the acute cases. See Chart 5.

Chart 4. Toxic chemicals responsible for the chronic occupational poisoning cases in Guangdong, 2006-2010

7

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 9 10/18/2013 4:17:22 AM

Page 10: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

8

Chart 5. Toxic chemicals responsible for the acute occupational poisoning cases in Guangdong, 2006-2010

Occupational poisoning has happened in a wide spectrum of industries with manufacturing stand-ing out as its most proli�c area, where 63% (366/582) of the cases took place. �e computer and other electronics industry came next, accounting for 12.71%(74/582) of the cases, followed by the leather and fur, and the feather (down) industries (10.14%, 59/582), metal works (4.47%, 26/582), chemical mate-rials and chemical manufacturing (2.58%, 15/582) and others (7.22%, 42/582). �e “others” category comprised 17 industries that include real estate, education, agricultural by-products processing, non-ferrous metal smelting and rolling processing [7].

Occupational poisoning happened mostly in small and medium-size enterprises, in 65% (378/582) of the cases. In terms of economic categories, those employers were mainly wholly-owned [mainland Chinese owned] private enterprises or those wholly-owned by Hong Kong, Macau or Taiwan investors, which has accounted for 39 % (228/582) and 14% (80/582) of the cases respectively. �e concentration of such poisoning events in these smaller and private �rms could be due to these �rms’ rela-tively poor understanding of occupational hazards and their chaotic management which were partly trans-lated into poor awareness in hazards prevention and safeguards. Management incompetency in dealing with related emergencies would have played a part, not to mention these �rms’ shoddy provisions of indus-trial safeguard devices or their most probable deployment of substandard and inferior raw materials, which all would in�ate the a�iction rates in these workplaces. [7]

3.2.3 Group occupational poisoning events popped up reasonably frequently

�e 582 occupational poisoning events took place mainly in 298 factories, with 263 of these work-places – or 88% (263/298) – having been hit by less than 3 such cases while 35 others – or 12% (35/298) – having been struck on 3 occasions or more (henceforth dubbed “group poisoning”). Under the “group poisoning” category, 29 factories – or 10% (29/298) – had experienced 3-9 poisoning cases each while 6 others – 2 % ( 6/298) – had been hit by 10 cases or more. Also included under the “group poisoning” head-ing were the acute dimethylformamide poisoning of 33 people in one hit in a handbag factory, the chloro-form poisoning of 29 people in an electronics factory, 34 and 11 cases of chronic n-hexane poisoning respec-tively in 2 technology related factories and 15 and 14 cases respectively of chronic lead poisoning in 2 battery factories.[7]

Group occupational poisoning events have occurred every now and then, involving toxic chem-

5. “Incidents of a more average nature” were acute cases that involved fewer than 10 a�icted victims. Major incidents were acute cases that a�icted between 10-50 people or involved up to 5 deaths. Extraordinary incidents were acute cases that a�icted more than 50 people or involved more than 5 deaths.

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 10 10/18/2013 4:17:23 AM

Page 11: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

9

icals such as n-hexane, chloroform and dimethylformamide. Contributing to such events were the fact that a small number of employers have fallen far short in being vigilant about taking preventive mea-sures and were behind on tasks such as the occupational health assessments of their workplace as an ongoing project, the monitoring of every day occupational hazard risks as well as on occupational health inspections.

3.2.4 Organic solvents remain the main culprits of occupational poisoning events

Over the 5 years to 2010, there were 439 cases of occupational poisoning in Guangdong that were sparked o� by organic solvents, which have accounted for 75% (439/582) of the province’s total occupa-tional poisoning cases. For any one of the years in question, the number of organic solvents-triggered cases hovered between 62% (55/89) and 84% (73/87). See Chart 6.

Particularly for Guangdong’s acute cases, occupational poisonings were most o�en caused by organic solvents such as dimethylformamide, dichloroethane, chloroform and trichloroethylene. �e culprits for Guangdong’s chronic cases were more associated with benzene, n-hexane and lead. Nationally, the culprits held responsible for the acute occupational poisoning cases in the same period were carbon monoxide, hydrogen sul�de and chlorine, which were quite di�erent from the picture in Guangdong. �e causes in the chronic cases of the same period were much more similar, with benzene and lead being the main triggers for China as a whole. [2] More and more chronic cases, however, have been associated with n-hexane. �ese seem to suggest that Guangdong’s e�orts to prevent the occurrence of occupational poisonings should feature around a prudent management of organic solvents.

Chart 6 : Occupational poisoning triggered by organic solvents, year-on-year, 2006-2010

4. Postscript

In the past decade, China’s economy has expanded at a cracking pace as re�ected remarkably in the country’s GDP growth. However, China’s occupationally poisoned population has also been on the rise with each passing year, at a rate that’s more or less shadowing the country’s GDP growth. Fuelled by the

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 11 10/18/2013 4:17:23 AM

Page 12: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

10

euphoria of the neck-breaking pace of economic expansion, many enterprises were on the one hand so preoccupied with making a quick buck that they sought to minimise production costs by deploying shoddy raw materials, even to the extent of compromising the health of their workers. On the other hand, the enterprise managements’ poor awareness of labour protection issues also played a role, result-ing in minimal attention on the shop�oor on occupational health and safety issues. Anchoring econom-ic development at the expense of workers’ life and health is a step too far!

In trying to piece together a picture on the scale and severity of occupational poisoning in China, the inadequate or even non-existent availability of o�cial statistics to the public stood out as a major problem.

Occupational ailments remain a huge prevalent issue in China, which cried out for much improved regulatory oversight on the part of the government, public opinion and the immediate parties involved. As a crucial starting point, the government should report and make publicly available on a regular basis what it has done in trying to contain occupational ailments with more details.

We know full well any o�cial data that might be released would far from reveal the entirety of the problem. It would still be a useful start, however. As some professional opinion has pointed out, the ongoing public data on the new occupational hazard cases were collected by the occupational health surveillance mechanism based on a mere 10% or so coverage of the targeted a�ected parties, adding that one can prudently assume the actual scale of the problem is much bigger than what the �gures seem to suggest.

To what extent has justice been done by this narrowly based o�cial data in unveiling the true scale of the occupational hazard problem on the ground? Much remains to be done on the part of the a�icted workers and the associated social organisations in dealing with the real beast.

5. References(�e texts below are in Chinese only)

[1] 接触职业危害人数逾两亿防控当从何入手? ——访十届全国政协常委、中国职业安全健康协会 理事长张宝明. http://epaper.rmzxb.com.cn/2013/20130607/t20130607_500802.htm[2] 欧文. 卫生部通报 2010 年职业病防治工作情况和 2011 年重点工作[J]. 安全与健康(上半月版), 2011, (7):31. [3] 中华人民共和国卫生部 http://www.moh.gov.cn/zhuzhan/ [4] 林 琳 . 2010 — 2011 年 全 国 职 业 病 网 络 直 报 数 据 报 告 及 时 性 [J]. 职 业 与 健 康 , 2013, 06:758-759+761. [5] 徐桂芹. 2000-2009 年全国职业中毒状况规律分析和对策探讨[J].中国安全生产科学技术, 2011, 05:96-100. [6] 姬薇.一组“黑色数据”的背后:透视中国职业病现状[J]. 安全与健康, 2010, 15:35-37. [7] 胡世杰, 金佳纯 ,江嘉欣 ,黄永顺. 2006—2010 年广东省职业中毒特点分析与防治探讨[J]. 华南 预防医学, 2012, 03:22-24+28.

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 12 10/18/2013 4:17:23 AM

Page 13: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

Appendix: Map of China

11

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 13 10/18/2013 4:17:23 AM

Page 14: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

12

Benzene-Poisoned Workers: Two Stories By Youwei Worker Service Centre

My Youth, My Tears and My Hope Xiaojun

My name is Xiaojun. I am 26 years old and I am from Hunan. Born and raised in an underprivi-leged family, I had no choice but to quit high school a�er a year and join the workforce. Filled with ambitions, I le� my hometown in 2000 and came to Dongguan for work, but quitted it as I was under-paid. In April 2002, I joined an electronics factory, the one that I was injured at. �e Japanese-owned factory mainly produced remote controls and computer keyboards; toxic and harmful chemicals such as �inner and Naphtha were o�en used in the production process. I was responsible for quality control at the factory. �e workshop was always stu�ed with the smell of rubber and no equipment was provided by the factory for protection.

By the end of 2006, I started to feel very weak and my joints aching. I went to a hospital in Dong-guan for an orthopedic checkup, and I was diagnosed with Arthritis. A�er my conditions became severe even a�er two weeks of prescribed medicine, blood spots began to develop over my body. I soon returned to Hunan for a thorough medical check – it was in January 2007, when I was admitted for a bone marrow puncture and blood test. It turned out that I was su�ering from acute leukemia. My subsequent treatment at home has cleaned out my family, so my brother-in-law consulted the local Department of Labor for advice on the possibility of claiming medical bills from the factory that I worked in. �e authority returned to us, saying that all amounts may be reimbursed by the factory as long as we could establish an occupational disease case at my place of occupation. �us I returned to Dongguan for treatment, with the bene�t under its local social security system. I still remember my reply of a bitter smile when the nurse asked me if I have any idea what illnesses I have got.

I soon established my case of occupational disease with my brother-in-law’s help. �e ward has become my home. O�en in the quite nights I would imagine in a peaceful scene, surrounded by my beloved family…�e break was short-lived, According to the law, as long as my occupational disease was con�rmed, all medical expenses must be covered by the factory plus social security, so that the factory must pay for my medical bills, wages and meals during hospitalization, including all costs incurred during the suspected diagnosis period. Despite the legal requirement, the factory denied to pay. I therefore resorted to labor dispute arbitration, demanding all that I was entitled to. All the above were duly recovered a�er arbitration, but the living expenses claimed was lower than expected: I could only get 14 dollars per day, the same amount the factory asserted that travelling sta� get. In the end, I accepted the arbitrated result as appeals were time-consuming and the most important thing is to treat my disease.

I was given six chemotherapy treatments in the hospital later. �e agony and su�ering were beyond imaginable, but I eventually endured. Following that, the doctor told me the best way out is to perform a bone marrow transplant (BMT) on me. �erefore, we dealt with the factory side for a BMT

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 14 10/18/2013 4:17:23 AM

Page 15: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

13

subsidy for half a year, but they kept turning us down. As my conditions were gradually getting worse, to the point that the doctor insisted that the only remedy le� was a BMT. My brother thus sought response from the factory and help from the Department of Labor and the Department of Social Securi-ty. Day a�er day we kept �nding them, just for a tiny bit of hope of treatment. Finally, the factory agreed to subsidize my BMT. I was very lucky, because my sister, who volunteered for a donation, has her bone marrow chromosomes matching mine perfectly. Life seemed so hopeful for me, and I seemed to have reborn again… And so I was admitted into a Guangdong Hospital for my BMT operations in 2008. �e success rate was only 30% but I was very determined to survive. �e operation was followed by my rejection symptoms; I took liver medicines and anti-rejection drugs for a long time. My conditions have not improved until a�er two years. Eventually, I le� the hospital by the end of Sep 2008, and moved to Dongguan for rehabilitation therapy. At the same time, I started considering how to get back my entitled compensations from the factory. In early 2010, I have heard from a man in Dongguan that there was a time period for claiming such compensation, and that was one year. I became anxious: a�er all, it has been two years since the compensation should have been due. So I approached the factory for a negotiation. I researched for all relevant laws and articles with regard to compensations, and the factory had no choice but to pay me back the amount; however, the compensation between Jan 2007 and Dec 2007 cannot be retrieved, as I have already applied for arbitration and the di�erences may not be retrieved under the law. I have obtained 35 dollars per day counting since the start of 2009, but not since 2008. However, in the end, I started to stop here, as long as the factory wouldn’t give me trouble anymore. As the saying goes, com-promises are much better than con�icts. It has been three years and a half since my transplant surgery. �inking back, I surely do not know how I would have endured all these. Still, I have become a much tougher girl and have grown much during my battle with my illness, and I am glad about that.

~

Xiaoxiao’s Little Dream Xiaoxiao

My name is Xiaoxiao. I am twenty four years old, and I am just an ordinary village girl from Huchenzhou. Like all teenagers, I joined the working population a�er my graduation. Initially optimis-tic about the world ahead, my unexpected diagnosis with Leukemia, a�er just two years of work, almost destroyed my life and my family. Dreams have become meaningless in my conditions; grimaces and arguments have found their ways to my lovely family. One can only imagine how hopeless I felt… It all started four years ago, when I joined an electronics packaging company in Dongguan a�er I �nished school in March 2007. A�er �ve months in the company, I have become the production assis-tant under the factory manager. I spent much time in the production factory – I have worked countless nights in the enclosed environment without any protective equipment. Due to my previous background in design, I was assigned all works related to designing production catalogues, instruction manuals and factories blueprints, warehouse and production management etc…the overwhelming workload has

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 15 10/18/2013 4:17:23 AM

Page 16: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

14

caused me to quit the job in 2008, but I soon returned in 2009. In Feb 2009, I was always feeling dizzy, and my legs swelled so bad I could hardly walk. I went to the local hospital for a medical checkup, and the doctor suggested a bone marrow check for me. A�er a number of trips to di�erent hospitals, I ended up staying in Guangzhou for relevant checkups for a week. �e doctor subsequently told my parents that I was diagnosed with Chronic Granulocytic Leukemia (CGL), leaving me speechless.

I immediately resigned my job, and paid numerous trips to the doctors for hope of treatment. Despite all these, my conditions remain unchanged and my immune system got worse. I �nally was admitted into hospital in May 2010, due to several illnesses under my deteriorating immune system. In Dongguan’s hospital, I was eventually informed that my conditions may be related to my occupation, making me eligible for an occupational disease assessment. A�er a month of stay, I returned to my hometown, I discovered Youwei Legal Advice O�ce, which was mainly responsible for providing free legal consultation and assistance to workers and the public. From them, I have learnt the procedures and other relevant information about the application of occupational disease assessment. I have then prepared all things, but the key issue – a labor relationship – cannot be established due to the lack of evidence. I no longer have my sta� card; there was no salary vouchers issued to me; the labor contract signed was never returned to me. �e factory even denied any sort of labor relationship with me; the only response I got was “I’d love to help, but I can’t.” I thus visited both the local and the city’s Depart-ment of Social Security for proof of a labor relationship, and ended up in the Department of Labor. Still, they cannot provide me with the labor contract.

In the end, as labor arbitration cannot be done for the one-year time period has passed, the Department of Labor suggested establishing the relationship through legal actions in the courts. �ese legal measures were very complicated to me; fortunately, the Youwei sta� has helped me along the way in preparing my documents to sue and the relevant evidence. Eventually, my submission was accepted by the Court. It has acknowledged and established my labor relationship with the factory. I immediately submitted the judgment and all information to apply for an occupational disease case, and I was subse-quently classi�ed as an “occupational tumor (benzene poisoning)” case by the authorities. However, the factory disagreed with the classi�cation, and applied for a reassessment in March 2011. One month later, I decided to take another approach by applying for a workplace injury assessment instead, but the o�cials replied me that I must be accompanied by the factory sta�; otherwise, in an individual applica-tion case, the previous and subsequent reimbursements would all be covered, not by the Department but by the factory only. �e factory, of course, replied that they must wait for the occupational disease reassessment before the workplace injury assessment may be done. My conscience kicked in at that time; I decided not to apply individually as I did not want that much con�ict with the factory. However, one month later, an incident has le� me discovering that the factory lied to me about the authorities’ provisions: the factory was playing the system with me, so that my convenient dates of applying for reassessment would result in their best chance of not covering my medical expenses. I was furious about how evil and ugly they could be for their own economic interest. In the end, the Department of Social Security has accepted my workplace injury assessment application, and I was indeed classi�ed as a positive case. However, I must wait for the re-assessment result of occupational disease, in order to combine the two results and �nalize the compensation I was entitled to.

For victims of occupational diseases, it is indeed a long way to justice. �ere are much obstacles ahead; although I have considered giving up, I stopped the thought when I thought about my family. A�er all, a smooth and peaceful life is never guaranteed for everyone; I might just be travelling on a di�erent, di�cult, yet fruitful life.

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 16 10/18/2013 4:17:23 AM

Page 17: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

15

1. Ban Benzene Declaration(As translated from Chinese) by Labour Action China: http://banbenzenecampaign.weebly.com/ban-benzene-declaration.html

We are a group of benzene-poisoned patients and people concerned about the issue of benzene poisoning. Some of us are a�icted with leukemia, some with aplastic anemia, some with leukopenia. Most of our conditions are chronic and incurable. We are saddled with these diseases all because of the widespread use of a poisonous chemical in many factories - benzene!

Benzene has an exceptionally wide range of industrial and daily usage. It is found in the glues in shoe-making factories, in coatings on toys, in cleaning agents in the electronic industry, in paints on furniture, and in derusting agents in hardware industry. In the developing world, almost every industri-al process that involves painting, glueing or cleaning would involve benzene. Benzene is the most com-monly encountered partner of the front line workers.

Yet benzene is also a well-known carcinogen since the early 1900s. It has been proven that ben-zene can cause a number of blood anomalies and even birth defects. In China, new cases of benzene poisoning are uncovered daily, causing the death of many - including a lot of youngsters under 20. Benzene is highly toxic - even under a strict exposure limit of 1ppm, it would still lead to the death of 5 people per 1000 exposed. Given its current unregulated and widespread use in China, it is estimated that up to a million workers would be killed by benzene.

Benzene is not irreplaceable; benzene-free glues and paints have long been developed. Yet, com-panies big and small, local and trans-national, are still using benzene with abandon - all out of cost saving calculations. Such reckless acts lead to the continuous creation of tragedies. While the western world is phasing out benzene, the same poisonous substance is enjoying increasing demands from the developing world.

�e widespread occurrence of benzene poisoning is taking its toll on the country. It leads to the loss of many young labour force and hence the driving power of economic development. At the same time it creates a huge burden on the society. Take the example of a benzene-poisoned leukemia patient in Guangdong. He needs to spend over ¥300,000 (about US$50,000) a year on his treatment, and six years on since his diagnosis, he has already spent over ¥2 million. �e number is terrifying when you consider the huge number of benzene-poisoned workers. �e �nancial and emotional burdens in turn a�ect the workers’ family members, and have already led to many broken families.

Workers are not the only group susceptible to benzene poisoning. Benzene containing waste water can cause long-term pollution to underground water. Benzene is also highly volatile, and would adversely a�ect the air quality of the areas surrounding benzene-using factories. Consumers are also at risk by buying benzene-containing solvents or products, which might have a particularly harmful e�ect on children. Members of the public should be aware of the risk benzene posed, and we hope to have your support in calling for a benzene ban.

Ban Benzene Campaign in China

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 17 10/18/2013 4:17:23 AM

Page 18: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

16

�e continuous use of benzene in the face of longstanding evidence of its harm is blatant murder. �is must be stopped!

We call for:A complete ban of benzene-containing solvents!We demand:1. Companies and brands to take immediate action to eliminate the use of benzene in their supply chains;2. Chinese government to legislate against the industrial use of benzene-containing solvents (with only limited exception in the production of benzene compound), and to ratify the Benzene Convention (C136).

We must not merely look on as companies continue to trade the lives of millions for transient pro�ts! From this moment on, say no to benzene!

2. Why Ban Benzene?

Benzene is a highly dangerous carcinogen. As the American Petroleum Institute stated as early as 1948, "...it is generally considered that the only absolutely safe concentration for benzene is zero."[1] As such we consider its current widespread usage as an all-out assault on workers' right to health. Benzene is not irreplaceable; human lives are.

However, you might not know what benzene really is, what its harm e�ects are, or have doubts about the feasibility of a benzene ban. Here we have collected some data, laws and information about the use of benzene, so as to give you clearer rationales of our campaign.

• What is benzene?• Benzene Poisoning in China• Benzene regulations in the world• What are the alternatives to benzene?• Industry Guidelines

[1] American Petroleum Institute, API Toxicological Review, Benzene, September 1948, Agency for Toxic Substances and Disease Registry, Department of Health and Human Services (http://web.archive.org/web/20030310145140/http://hobsonlaw.com/benzene_pages/pd�le.pdf)

3. What is Benzene?

- Chemical Formula: C6H6; Molecular Ring Structure- Organic Chemical Compound with Sweet Smell- Well-known carcinogen- Common solvent, contained in paints, glues, fuels and cleaning agents- Widely used in di�erent industries, such as electronics, toys and shoes manu-facturing- Related to several myeloid abnormalities; such as leukemia and aplastic anemia- Possible cause of birth defects

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 18 10/18/2013 4:17:23 AM

Page 19: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

4. Benzene Poisoning in China

Benzene is the most common cause of industrial poisoning in China. According to o�cial statis-tics, over 60% of all occupational cancers are caused by benzene[1]. In the industrial city of Dongguan, 30% of all diagnosed occupational diseases are caused by benzene poisoning[2]. �ose who have su�ered from chronic benzene poisoning o�en require life-long treatments; many died. Acute benzene poisoning has a fatality rate of 21.7%.[3]

In 1996, the media uncovered a series of benzene poisoning cases in the shoe-making town of Putian, Fujian, some dating back to the 80s. A collective case in 1993 was of particular note; a group of workers got violently sick a�er working for a few months in Jinjiang factory; two pregnant workers subse-quently died from leukemia together with their unborn children. Atmospheric benzene content in the town was also revealed to be 30% above the maximum permissible level, and local residents expressed fear of its health e�ects on them and their next generation.[4] In 2000, another collective case was revealed in a shoe factory in Nanhai, Guangdong. Among its 200 workers, 44 show signs of benzene poisoning. In response the authorities carried out health checks for workers in 17 other shoe factories, uncovering another 67 cases.[5] In 2002, 31 workers from luggage factories in Gaobeidian, Hebei were diagnosed with benzene poisoning; 9 died.[6] �e average age of the workers poisoned was only 17 years old, and have on average worked there for 10.8 months[7]. �eir employers were later found guilty of causing major industrial incidents and sentenced to 6 months to 4 years imprisonment[8]. In 2004, 11 workers in the painting department of a forestry plant in Fujian were sent to hospital due to acute ben-zene poisoning. �e hospitalized workers were foaming at the mouth and su�ering from convulsion. In 2010, 35 workers at a hair products factory in Xuchang, Henan were found to be benzene poisoned. Half of them su�ered from aplastic anemia, a debilitating blood cancer[9].

�e above case show only the tip of the iceberg, consisting of cases that managed to gain media attention and/or state recognition. Yet they are still su�cient to show that benzene poses a substantial and life-threatening risk to workers across the country and across industries, working with paints, glues and other common solvents. �e Ministry of Health has �agged up the issue of benzene poisoning as early as 2002, but has so far been ine�ective in curbing the problem. While there are industrial standards in place for permissible exposure level, it is o�en unenforced. Factory inspections are mostly a sham, and prob-lems are not spotted until people actually get sick.

[1] 卫生部通报2010年职业病防治工作情况和2011年重点工作 (http://www.moh.gov.cn/mohwsjdj/s5854/201105/51676.shtml).[2] 东莞常见4种职业病 三成源自苯中毒 (http://news.qq.com/a/20090611/000446.htm)[3] 卫生部:急性苯中毒死亡率高达21.7%http://www.people.com.cn/GB/shehui/47/20020402/700372.html[4] 妈祖有泪(苯毒危害女工报告之一)http://old.chinacourt.org/public/detail.php?id=7593[5] 毒胶水害苦鞋厂工人 中毒打工仔入院治疗http://news.sina.com.cn/s/159341.html[6] 紧急追查“苯中毒”事件http://www.people.com.cn/GB/shehui/212/7792/[7] 2002年高碑店市箱包业苯中毒事件调查分析http://file.lw23.com/9/94/94c/94c572c7-7ee7-418c-8206-231b7c64a21a.pdf[8] 河北高碑店“苯中毒”事件八名厂主被判有罪http://www.unn.com.cn/GB/channel19/49/117/200207/26/198963.html[9] 福州一工厂发生急性苯中毒事故http://www.chinasafety.gov.cn/wangluocankao/2004-07/13/content_16289.htm[10] 许昌一家企业密封严 十多天发现30名员工苯中毒 http://www.dahe.cn/xwzx/sz/t20100330_1772565.htm

17

5. Benzene Regulations in the World

While benzene has enjoyed wide application early on[1], its use has subsequently been heavily circumscribed due to the discovery of its carcinogenicity.

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 19 10/18/2013 4:17:23 AM

Page 20: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

18

In 1971, ILO passed the Benzene Convention (C136). Article 2(1) states that, “Whenever harm-less or less harmful substitute products are available, they shall be used instead of benzene or products containing benzene.” Article 4 mandates that the use of benzene and of products containing benzene as a solvent or diluent shall be prohibited, except where the process is carried out in an enclosed system or where there are other equally safe methods of work. Regrettably, to date only 38 countries have rati�ed the Benzene Convention[2].

In the EU, benzene has been classi�ed as a category I carcinogen as early as 1967[3]. Its use is restricted in the Marketing and Use Directive (76/769/EEC)[4]. Benzene is not allowed to be placed on the market, or used as a substance, or as a constituent of mixtures in concentration greater than 0.1% by weight. In particular strict restriction is placed on its use in toys. Regulation (EC) 1907/2006, concern-ing the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH), rea�rmed the above rules.

In the US, benzene was withdrawn from consumer products since 1978. �e Occupational Safety and Health Administration has set a permissible exposure limit of 1 ppm in the workplace during an 8-hour workday, 40-hour workweek. UK has the same exposure limit[5], and employers are required to eliminate its use or substitute a safer material where possible. In China, the corresponding limit is 1.878 ppm[6].

However, even when the stricter 1 ppm limit is complied with, exposure for a working lifetime is estimated to cause 5 excess leukemia deaths per 1000 employees exposed[7]. Given the prevalent use of benzene in developing countries, that will still translate into millions of avoidable deaths[8]. �e use of benzene in the workplace should be more strictly circumscribed than that.

6. What are the alternatives to benzene?

�e use of benzene as a solvent has been largely phased out in the West, as safer alternatives can o�en be found. Benzene-free paints are now commercially available, so is benzene-free glues. Cyclohex-ane is o�en used as an alternative to benzene in electroplating, rubber manufacturing and varnish solvents. Heptane is another e�ective replacement for benzene, and is commercially available for use in paints and coating, and as a solvent. Many other non-polar solvents can act as alternatives to benzene. Water-based paints and adhesives can also be used in place of organic-based ones. In fact, apart from the limited needs of manufacturing benzene-derived chemicals, the use of benzene is seldom absolutely necessary. It is just cheaper.[1]

[1] According to a New York Times report, benzene-free glues in China are 30% more expansive than benzene containing ones. “For Want of Safer Glue, Chinese Shoemakers Get Sick“, 6 June 2000 (http://www.nytimes.com/2000/06/06/world/for-want-of-saf-er-glue-chinese-shoemakers-get-sick.html?pagewanted=all&src=pm)

7. Industry Guidelines

Certain brands, mostly in the footwear industry, have laid down guidelines banning the use of benzene, showing that a benzene ban is actually possible. However, most other industries and compa-nies have simply put no thoughts to the matter.

Adidas has a Health and Safety Guidelines which is binding on its suppliers. �e Guidelines

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 20 10/18/2013 4:17:23 AM

Page 21: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

come with a list of banned chemicals, including benzene[1]. Puma has also banned the use of benzene as a solvent[2]. Nike, however, allows the use of benzene in their toys products.[3]

It does seem that the toy industry is lacking behind in its regulation of hazardous chemicals. No guidelines on chemical use can be found in the publicly available codes of conduct of Mattel, Disney or the International Council of Toy Industries.

In the electronic industry, most companies do have chemical guidelines. However those guide-lines focus more on the chemicals contained in the �nal products rather than those employed in the manufacturing process. Most guidelines make no mention of benzene, including Apple’s Regulated Substances Speci�cation[4], HP’s Substances and Materials Requirements[5] and Samsung’s Standards for Control of Substances concerning Product Environment[6]. Nokia does mention benzene in its substance list and mandates a ban, but the restriction applies only to products and not processes[7]. Nor does the Electronic Industry Citizenship Coalition have any policy on chemical use in the work-place.

[1] Adidas Group: Health and Safety Guidelines, p.43 (http://www.adidas-group.com/de/sustainability/assets/Guide-lines/2010/Health_and_Safety_Guidelines/Health_Safety_Guidelines_English.pdf)[2] PUMASafe Environment Handbook Volume 2, p.30 (http://about.puma.com/wp-content/themes/aboutPUMA_theme/me-dia/pdf/PUMASafeEnvironmentHandbook-Vol2_�nal.pdf)[3] Nike Restricted Substance List, p.41 (http://www.nikeincchemistry.com/wp-content/uploads/Abbreviated-RSL.pdf)[4] While Apple makes reference to the Speci�cation on its website, it has not made it publicly available.[5] HP’s General Speci�cation for the Environment (http://www.hp.com/hpinfo/globalcitizenship/environment/pdf/gse.pdf)[6] Samsung Electronics: Standards for Control of Substances concerning Product Environment (http://www.sam-sung.com/us/aboutsamsung/sustainability/envi-ronment/chemicalmanagement/download/SEC_Standard_0QA-2049_Rev14_EN.pdf)

19

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 21 10/18/2013 4:17:23 AM

Page 22: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

20

A. Preface

- �e present criteria are formulated in accordance with the Law of the People’s Republic of China on the Prevention and Control of Occupational Diseases. - �e present criteria were dra�ed in accordance with the rules provided in GB/T 1.1-2009. - �e present criteria shall be mandatory, except section 5.1 which shall be recommendatory.- �e present criteria shall replace GBZ 68-2008 Diagnostic Criteria of Benzene Poisoning.- Major amendments of the present criteria from GBZ 68-2008 are: - provisions with regard to “subject under medical surveillance” were removed; - platelet critical counts with respect to chronic mild poisoning and chronic moderate poison ing were modi�ed.- �e present criteria were promulgated by the Expert Committee on Occupational Disease Diagnosis under the Ministry of Health.- �e present criteria were dra�ed by Huashan Hospital, Fudan University. �e following parties have also contributed to the dra�ing process: Shanghai Yangpu District Central Hospital, Shanghai Hospi-tal of Occupational Disease, Shanghai Institute of Occupational Disease for Chemical Industry, Shanghai Municipal Centre for Disease Control and Prevention, Xin Hua Hospital A�liated to Shang-hai Jiao Tong University School of Medicine,Taizhou Hospital of Zhejiang Province, and the First People’s Hospital of Wenling.- �e present criteria were dra�ed collectively by the following individuals: Zou huojian, Lu ling, Wan weiguo, Huang Jianshu, Ni weimin, Sun daoyuan, Li sihui, Wang peili, Cao zhongcing, Zhang kaijing, and Yang yunfang. - �e present criteria shall replace the criteria previously published in the following order: - GB 3230-1982, GB 3230-1997 - GBZ 68-2002, GBZ 68-2008.

B. Diagnosis of Occupational Benzene Poisoning

1. Scope

�e present criteria contain regulations with regard to the diagnosis of occupational benzene poisoning, diagnosis writing formats and treatment principles.

�e present criteria shall apply to the diagnosis and treatment of poisoning due to benzene exposure in occupational activities. �ey may be applied in benzene poisoning cases due to exposure to benzene-containing industrial chemicals, such as toluene and dimethylbenzene.

Diagnostic Criteria of Benzene Poisoning

GBZ 68-2013(As translated from Chinese)

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 22 10/18/2013 4:17:23 AM

Page 23: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

2. Normative References

�e following documents are essential to the application of the present document. For dated refer-ences, only the dated editions shall apply to the present document, For undated references, the most updated editions (including all amendments) shall apply to the present document.

GB/T 16180 Standard for Identifying Work Ability - Gradation of Disability Caused by Work-related Injuries and occupational diseasesGBZ 76 Diagnostic Criteria of Occupational Acute Neurotoxic Diseases Caused by ChemicalsGBZ 78 Diagnostic Criteria of Occupational Chemical-induced Sudden DeathGBZ 94 Diagnostic Criteria of Occupational CancerWS/T 244 Reference Method for Platelet CountingWS/T 245 Reference Method for the Enumeration of Erythrocytes and Leucocytes

3. Diagnostic Principles

3.1 Acute Benzene Poisoning Diagnosis of acute benzene poisoning shall only be made by a comprehensive analysis of the following criteria: an occupational history of short-term, excessive inhalation of benzene vapor, primary clinical �ndings of consciousness disturbance, on-site occupational health investigation, laboratory test indexes, and the exclusion of possible central nervous system damage due to other illnesses.

3.2 Chronic Benzene Poisoning Diagnosis of chronic benzene poisoning shall only be made by a comprehensive analysis of the following criteria: an occupational history of prolonged close exposure to benzene, primary clinical �ndings of damage in the hematopoietic system, on-site occupational health investigation, laboratory test indexes, and the exclusion of possible blood or bone marrow changes due to other illnesses or reasons.

4. Diagnostic Classi�cations

4.1 Acute Benzene Poisoning

4.1.1 Mild Poisoning Symptoms of dizziness, headache, nausea, vomiting and mucosal irritation, accompanied by mild consciousness disturbance, a�er short-term and excessive inhalation of benzene vapor. (See GBZ 76)

4.1.2 Severe Poisoning Clinical manifestation of one of the following symptoms, a�er excessive inhalation of Benzene vapor: a) Moderate to severe consciousness disturbance (See GBZ 76); b) Respiratory and circulatory failure; c) Sudden death (See GBZ 78).

4.2 Chronic Benzene Poisoning

4.2.1 Mild Poisoning An occupational history of prolonged close exposure to benzene, accompanied by symptoms such as dizziness, headache, fatigue, insomnia, memory loss, and susceptibility to infections. Biweekly exam-

21

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 23 10/18/2013 4:17:23 AM

Page 24: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

ination of Complete Blood Count (CBC) in three months, the result of which satisfy one of the follow-ing criteria: a) Leukocyte count mostly lower than 4x10^9/L, or neutrophilic granulocyte count lower than 2x10^9/L; b) Platelet count mostly lower than 80x10^9/L.

4.2.2 Moderate Poisoning Symptoms of chronic mild poisoning are usual. In addition, there shall be susceptibility to infec-tions and (or) haemorrhages. One of the following criteria shall be satis�ed: a) Leukocyte count lower than 4x10^9/L or neutrophilic granulocyte count lower than 2x10^9/L, accompanied by a platelet count lower than 80x10^9/L; b) Leukocyte count lower than 3x10^9/L or neutrophilic granulocyte count lower than 1.5x10^9/L; c) Platelet count lower than 60x10^9/L.

4.2.3 Severe Poisoning In addition to a diagnosis of moderate poisoning, one of the following criteria shall be satis�ed: a) Pancytopenia; b) Aplastic Anemia; c) Myelodysplastic Syndromes; d) Leukemia.

5. Treatment Principles

5.1 Remedies

5.1.1 Acute Poisoning Transfer the poisoned patient to a place with fresh air immediately. Remove the benzene-contam-inated clothing and wash the contaminated skin parts with soap and water, during which the patient must be kept warm. First-aid shall conform with general medicine principles, and adrenaline treatment shall be refrained from.

5.1.2 Chronic Poisoning �ere are no speci�c antidotes. Treatment shall be prescribed according to the type of blood disorder caused by hematopoietic system damage.

5.2 Other Treatments

5,2.1 Acute Poisoning Mildly-poisoned patients shall return to their original job positions a�er recovery; severely-poi-soned patients shall be removed from their original job positions in principle. GB/T 16180 shall be referenced if work ability assessments are necessary.

5.2.2 Chronic Poisoning Patients shall be removed immediately from all types of work involving benzene and other harm-ful substances a�er diagnosis is con�rmed. GB/T 16180 shall be referenced if work ability assessments are necessary.

6. Proper use of the present criteria

Please refer to Appendix A.

22

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 24 10/18/2013 4:17:23 AM

Page 25: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

C. Appendix A

Appendix A(Informative Appendix)

Proper Use of the Present Criteria

A.1 Operations and works causing benzene poisoning Benzene is used mainly as solvents, diluents and industrial chemical during productions. Opera-tions and works involving benzene as solvents or diluents, or as a raw material, may lead to the case of benzene poisoning.

A.2 Sudden death due to benzene poisoning Sudden deaths may occur to individual workers exposed to highly concentrated Benzene. Please refer to GBZ 78 for their diagnosis.

A.3 Complete Blood Count (CBC) Test Method �e methods of testing complete blood count may vary for di�erent medical institutions, such as by direct microscopic count or using an automatic hematology analyzer. �e present criteria stipulate that automatic hematology analyzer (WS/T 244 and WS/T 245) shall be used for testing complete blood count a�er a phlebotomy. Di�erences with respect to the above method shall be regarded when other methods are used for testing and analysis.

A.4 Peripheral Blood Cell Morphology Examination Due to the use of automatic hematology analyzer in occupational health examinations, morpho-logical change of peripheral blood cells cannot be observed. When peripheral blood cells count is unusual, a microscopic morphology examination shall be conducted. Certain patients su�ering from leukemia or potential leukemia may show an increased count of peripheral blood leukocytes. �is may be accompanied by leukocyte abnormalities, such as undeveloped cells, irregular nuclei, or vacuolar and nuclear degeneration; if the toxicity of benzene a�ects the red blood cells, hemoglobin synthesis di�-culty or irregular cells may result. Otherwise, if myelodysplastic syndromes occur, peripheral blood cells would mainly show irregularity in size and nucleoplasmic irregularities. Morphology examination may be helpful in diagnosing and classifying chronic benzene poisoning.

A.5 Bone Marrow Examination Bone marrow examination may help assess the situation of hematopoietic damage. For patients su�ering from chronic poisoning, discovery of signs such as speci�c blood cell irregularities, pancyto-penia, aplastic Anemia, myelodysplastic syndromes and leukemia would be helpful in diagnosing and classifying the poison. As a single bone marrow smear examination may not accurately re�ect the conditions, multiple puncturing or biopsies at di�erent parts of the body may be necessary in cases of uncertainty.

A.6 Occupational Time Frame for Chronic Benzene Poisoning For the most part, chronic benzene poisoning results from benzene exposure of more than three months. However, certain patients with a consecutive occupational history of less than three months, but with a high daily exposure to concentrated benzene, would show signs of lower peripheral blood cell count, or even aplastic anemia. �is type of aplastic anemia, however, recovers better a�er positive

23

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 25 10/18/2013 4:17:23 AM

Page 26: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

treatments. �ese cases shall be di�erentiated from traditional chronic poisoning; time-wise they are classi�ed as “subacute”, but they share clinical symptoms with chronic benzene poisoning. �us they di�er from the regular notion that subacute poisonings would show similar clinical symptoms with acute poisonings. �e present criteria have classi�ed these cases as chronic benzene poisoning; how-ever, the above type of patients shall be given extra care for data collection and later modi�cation of these criteria.

A.7 Benzene-induced Leukemia Benzene-induced leukemia has been included in GBZ 94, which has stipulated that with respect to the diagnosis of Benzene-induced leukemia, the consecutive occupational history shall be one year or above, and the latent period shall be the same. GBZ 94 shall apply when diagnosing “Occupational Chronic Severe Poisoning (Leukemia)”.

A.8 Naming and Writing Format of Benzene-Poisoning Diagnosis �e formulation of o�cial naming and writing format of diagnosis is bene�cial to diagnostic work, clinical data collection, guided treatments and future research.

Acute benzene poisoning shall be named and written as:“ Acute Mild Benzene Poisoning” or “Acute Severe Benzene Poisoning”.

Chronic benzene poisoning shall be named and written as:a) Chronic Mild Benzene Poisoning: 1) Chronic Mild Benzene Poisoning ( Leukopenia); 2) Chronic Mild Benzene Poisoning (Neutrophilic Granuloaytopenia); 3) Chronic Mild Benzene Poisoning (�rombocytopenia);b) Chronic Moderate Benzene Poisoning; 1) Chronic Moderate Benzene Poisoning (Leukopenia, with �rombocytopenia) 2) Chronic Moderate Benzene Poisoning (Neutrophilic Granuloaytopenia, with �rombocyto-penia) 3) Chronic Moderate Benzene Poisoning (Leukopenia) 4) Chronic Moderate Benzene Poisoning (Neutrophilic Granuloaytopenia) 5) Chronic Moderate Benzene Poisoning (�rombocytopenia)c) Chronic Severe Benzene Poisoning 1) Chronic Severe Benzene Poisoning (Pancytopenia); 2) Chronic Severe Benzene Poisoning (Aplastic Anemia); 3) Chronic Severe Benzene Poisoning (Myelodysplastic Syndromes); 4) Chronic Severe Benzene Poisoning (Leukemia).

24

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 26 10/18/2013 4:17:23 AM

Page 27: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

O�ce: (852) 2332 1346Email: [email protected] : www.amrc.org.hkAddress: Flat 7, 9th Floor, Block A, Fuk Keung Industrial Building, 66-68 Tong Mi Road, Kowloon, Hong Kong

Published By:

Asia Monitor Resource Centre

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 27 10/18/2013 4:17:25 AM

Page 28: Occupational Poisoning in China Eng copiable... · 2014. 12. 10. · 6 2.2.2 Occupational poisoning in small and medium-size enterprises were accountable for a high share of occupational

treatments. �ese cases shall be di�erentiated from traditional chronic poisoning; time-wise they are classi�ed as “subacute”, but they share clinical symptoms with chronic benzene poisoning. �us they di�er from the regular notion that subacute poisonings would show similar clinical symptoms with acute poisonings. �e present criteria have classi�ed these cases as chronic benzene poisoning; how-ever, the above type of patients shall be given extra care for data collection and later modi�cation of these criteria.

A.7 Benzene-induced Leukemia Benzene-induced leukemia has been included in GBZ 94, which has stipulated that with respect to the diagnosis of Benzene-induced leukemia, the consecutive occupational history shall be one year or above, and the latent period shall be the same. GBZ 94 shall apply when diagnosing “Occupational Chronic Severe Poisoning (Leukemia)”.

A.8 Naming and Writing Format of Benzene-Poisoning Diagnosis �e formulation of o�cial naming and writing format of diagnosis is bene�cial to diagnostic work, clinical data collection, guided treatments and future research.

Acute benzene poisoning shall be named and written as:“ Acute Mild Benzene Poisoning” or “Acute Severe Benzene Poisoning”.

Chronic benzene poisoning shall be named and written as:a) Chronic Mild Benzene Poisoning: 1) Chronic Mild Benzene Poisoning ( Leukopenia); 2) Chronic Mild Benzene Poisoning (Neutrophilic Granuloaytopenia); 3) Chronic Mild Benzene Poisoning (�rombocytopenia);b) Chronic Moderate Benzene Poisoning; 1) Chronic Moderate Benzene Poisoning (Leukopenia, with �rombocytopenia) 2) Chronic Moderate Benzene Poisoning (Neutrophilic Granuloaytopenia, with �rombocyto-penia) 3) Chronic Moderate Benzene Poisoning (Leukopenia) 4) Chronic Moderate Benzene Poisoning (Neutrophilic Granuloaytopenia) 5) Chronic Moderate Benzene Poisoning (�rombocytopenia)c) Chronic Severe Benzene Poisoning 1) Chronic Severe Benzene Poisoning (Pancytopenia); 2) Chronic Severe Benzene Poisoning (Aplastic Anemia); 3) Chronic Severe Benzene Poisoning (Myelodysplastic Syndromes); 4) Chronic Severe Benzene Poisoning (Leukemia).

C

M

Y

CM

MY

CY

CMY

K

AMRC English.pdf 28 10/18/2013 4:17:27 AM