China: Injury Prone?

The recent mine flooding in Shanxi province and the subsequent (and ongoing) rescue attempts of the Chinese authorities has received notable attention in the western press. 153 miners were trapped inside a coal pit which flooded on the 28th March. The state media so far has reported that 114 of the 153 missing miners have been rescued and 3000 people have been frantically trying to pump out water and reach the trapped miners for 8 days.

Everyone likes a good rescue story, but it has unfortunately overshadowed a horrendous week for the mining industry in China.

“The Wangjialing disaster was one of five this week in China’s mines, which are considered the most dangerous in the world.

On Wednesday, 19 miners were killed and dozens trapped by a gas explosion at a pit in Yichuan County in Henan province.

Five people were also reported to have been trapped after a flood at a pit in Heilongjiang province on Thursday on the same day that nine died after a fire in Shaanxi province.

Another 10 miners were reported missing after a pit collapsed in western Xinjiang region.”

BBC News (2010)

When one thinks of healthcare, usually hospitals, doctors and disease are some of the first things which spring to mind. This is not surprising; in the developed world the leading causes of morbidity are non-communicable diseases. Years of Life Lost (YoLL) due to non-communicable disease ranges from 73% in the United States to 86% in Germany (WHO, 2004). However, China has a completely different morbidity profile to that of a Western nation. YoLL to non-communicable disease are at 59%, communicable disease at 20% and injuries at 21%. Injury related deaths are often “under-recognized” (Wang et al., 2008), possibly because of the low proportions of such deaths in Western countries.

For example, in the UK and Germany the ‘Age-standardized mortality rate for injuries’ is calculated at 26 and 28 per 100,000 of the population respectively. In China the rate is 73 (down from 79 in 2002) per 100,000. This is over double that of the two European examples and just under 50% more than the rate in the United States (50/100,000). The YoLL to injuries is proportionately high, especially compared to the UK (9%), Germany (10%) and Sweden (11%).

Like most accidents, the Wangjialing flooding was preventable;

“China’s State Administration of Work Safety said the state-run 180-sq-km (70-sq-mile) mine had been overcrowded and managers had ignored reports of water leaking into the tunnels. It said the mine’s operators had “violated regulations and policies during the work process” and failed to follow the rules for preventing water leaks.“

BBC News (2010)

This blatant non-adherence to health and safety regulations and recommendations is not unique to the Wangjialing mine, or the mining industry in general. Injuries are becoming a “Major global public health crisis” (Sharma, 2008) and China is at the forefront of this worrying trend.

Every year, 800,000 lives are lost to injury in China and Wang et al. (2008) attribute this mainly to urbanization and the increase in automobile usage. In their study, Wang et al. (2008), observed a mean average of 273,879 deaths per year from traffic injuries over a 5 year period.

Increases in traffic injuries over the past 20 years cannot be attributed solely to wealthier citizens, as poorer regions like Tibet, Ningxia, Qinghai and Xinjiang (the former 3 in the poorest 10 provinces) have the highest rates – particularly amongst rural males (Ministry of Public Health, 2007). Wang et al. (2008) estimate that reasons include “poor-quality roads, less police supervision on the roads, increased presence of vulnerable road users, insufficient emergency medical services, and higher rates of driving under the influence of alcohol,” however the actual causes are not known.

Completely contrasting with road design in the West, Chinese roads (such as those in Beijing) have shifted from separate lanes for vulnerable users towards bigger roads to accommodate the increase in vehicles. Wang et al. (2008) believe a shift back towards added safety for cyclists would cause improvement in traffic injury statistics.

Furthermore, it is suggested that public information initiatives such as seat-belt and helmet drives should be utilized (and have been proven to be effective in lowering disability costs) (Stevenson et al., 2008). However, Wang et al. (2008) cite 3 studies (Routley et al., 2007; Passmore & Ozanne-Smith, 2006; Liu et al., 2002), concluding that despite the availability of seat belts and regulations mandating their use; rates of use are still very low.

“A government-supported seat belt intervention in the southern city of Guangzhou that included enhanced police training, intensive enforcement, and social marketing to raise public awareness proved that community-based programmes can be cost-effective in China: in the 12 month study, seat-belt use increased from 50% to 62% and the cost per disability-adjusted life year (DALY) saved was only 3246 Renminbi ($US 418).“

Wang et al. (2008)

State social marketing has historically been one of China’s most recognizable traits, from the propaganda posters of the communist years to the current drives to improve social skills for the Shanghai 2010 Expo.

This report has only briefly looked into just a small aspect of public health in China (and it’s very likely that we will take a few more peeks into the area), but it appears to me that perhaps some of the resources spent telling citizens to “stop spitting” and “start queuing” could be put to better use by telling road users to “buckle up” and mining companies to “follow health and safety regulations.”

References

BBC News (2010) China rescue workers ‘hear signs of life’ in flood mine. URL: http://news.bbc.co.uk/2/hi/asia-pacific/8600561.stm. Accessed 06.04.2010.

Liu, N., Yang, G.H., Ma, J.M. & Chen, A.P. (2002) Injury associated health risk factors in Chinese people in 2002. Chinese Journal Epidemiology, 26, pp. 746-750.

Passmore, J., Ozanne-Smith, J. (2006) Seatbelt use amongst taxi drivers in Beijing, People’s Republic of China. International Journal Injury Control & Safety Promotion, 13, pp. 187-189.

Routley, V., Ozanne-Smith, J., Dan, L., Hu, X., Wang, P. & Qin, Y. (2007) Patterns of seat belt wearing in Nanjing, China. Injury Prevention, 13, pp. 388-393.

Sharma, B.A. (2008) Road Traffic Injuries: A major global public health crisis. Public Health, 122, pp. 1399-1406.

Stevenson, M., Yu, J., Hendrie, D., Li, L-P., Ivers, R., Zhou, Y., Su, S. & Norton (2008) Reducing the burden of road traffic injury: translating high-income country interventions to middle-income and low-income countries, Injury Prevention, 13, pp. 284-289.

Wang, S.Y., Li, Y.H., Chi, G.B., Xiao, S.Y., Ozanne-Smith, J., Stevenson, M. & Phillips, M.R. (2008) Injury-related fatalities in China: an under-recognised public-health problem, The Lancet, 372, pp. 1765-1773.

World Health Organization (2004) WHO Statistical Information System. URL: http://www.who.int/whosis/en/. Accessed 06.04.2010.