A Study Of Tuberculosis Control In The Coal-mining Industry Of PRC(1949-2002)

Since the founding of PRC,the prevention and control of tuberculosis in the coal industry is generally divided into three stages in 1978 and 1992.Before the reform and opening up,the decline of TB prevalence rate was slow,not only lower than the national average,but lower than the natural degradation rate in developed countries;at the beginning of reform and opening up,TB prevalence rate decreased substantially;after 1992,the TB epidemic rebounded in some coal mine enterprises.The characteristics of this stage is due to the differences caused by the mining area environment and the anti tuberculosis work performance in different historical periods.The mining environment improved effectively or not and the quality of tuberculosis control is closely related to macro economic strategy,economic system and social management system.In the planned economy period,energy supply of China's industrialization mainly depended on coal.As a result,the government attached great importance to coal production and took various actions(for example,constantly increasing the development and utilization of new and old coal mines,expanding scale of production,vigorously advocating labor competitions)to increase coal output.However,these measures virtually increased the coal mine enterprise staff's physical energy consumption.More importantly,the economic development ideas of 'high accumulation,low consumption" and 'produce first,life second' negatively influenced the investment of the country and enterprises in non-productive facilities,resulting in serious dust hazard and environmental pollution in coal-mining industry,leaving the living and working conditions of employees unimproved over a long period.Meanwhile,tuberculosis control in mining areas was unsatisfied.According to the labor medical insurance system built up in early 1950s,it was the enterprise that was responsible for the staff's health care work.However,the industrial health management system transplanted from the Soviet Union later required unified management of industrial hygiene by the local health department.The tangled management system caused continuous conflicts between the health department and industrial and mining enterprises,further leading to lack of overall effective management of tuberculosis control in mining areas.The health department often came up with plans and policies related to tuberculosis control while being unable to provide necessary human,financial and material resources.Under the heavy burden of production,coal mining enterprises also took passive and perfunctory attitudes towards the policies.In this case,tuberculosis control in mining area was impossible to be fully implemented and the epidemic situation was not well controlled.In the initial stages of reform and opening up,the government reflected and adjusted the national economic development strategy of "high accumulation,low consumption","first production,after life",and increased investment in the people's life.At the same time,the coal mine industry implemented the general contracting system of input and output,and expanded the enterprise autonomy,so that it could have a certain financial resources to non production facilities.In this context,through the environmental pollution control,improve the level of mechanization,dust hazard governance,improve the living standards of workers and improve the living conditions and so on,the coal mining enterprises let the mining environment get some improvement.More than this,with the state starting to take active tuberculosis control policy,the coal industry finally established hygiene vertical management and tuberculosis control collaboration group.The collaboration group got support from the health department of the coal ministry and generated certain social capital,thus played a central and active role in anti tuberculosis management.The collaboration group initially set up a tuberculosis control system in the coal industry by promoting coal mine enterprises to establish anti tuberculosis organizations and conducting training and academic exchange activities.Under the unit system,coal mine personnel relied on this system and conducted strict monitoring to patients to supervise and urge them to obey the medical arrangements,controlling the epidemic situation of tuberculosis to an extent.After 1992,the market economic system reform in the coal industry began.Because the government drew on coal enterprises financial subsidies,liberalization of coal prices was slow,the user arrears coal mine,the market downturn and other reasons,the economic pressure of coal mining enterprises increased.This situation influenced the mining environment improvement process in a large extent,and broke the good momentum of development of TB prevention work.As a result of the economic difficulties of coal mining enterprises,on the one hand,the air pollution,dust hazard couldnot be cured,workers living in poverty;on the other hand,the reform of labor medical insurance system accelerated,and gradually established a state,enterprises and individuals sharing the medical security system.In addition,companies slashed investment in health,anti tuberculosis organizations were required to pursue new income-earning activities or even directly abolished,so anti tuberculosis work went steadily downhill.Because of the function adjustment of administrative department in charge of the coal industry,vertical management system of coal industry health and cooperative group tended to collapse.It was unable to save the landslide situation.In sum,actual performance of tuberculosis prevention and control in coal industry varied in different historical periods because of various constraints.To improve tuberculosis control,a tuberculosis control management system that fits the current economic system has to be built.Meanwhile,necessary funding must be guaranteed and medical technologies must be promoted.On another hand,only if we raise the awareness of 'Extensive Prevention' and 'Extensive Health' and place as much emphasis on disease control as on enhancing living standards,bettering working and living environments and curbing environmental pollution can we ensure public health as much as possible.