Thu, 06/24/2021 - 11:32 — lac-admin
2021-06-24
Part One: Introduction
1. Background and research purposes
There are a large number of pneumoconiosis patients in China. Previous studies show that pneumoconiosis prevention work can be traced back to the early days of new China. In late 1950s, a country-wide scale of dust-reduction activities was organized and it had good impacts. In 1955-1959, the average life length of pneumoconiosis patients since their diseases were certified was 9.5 years, but it was extended to 26.2 years in 1985-1986. Rapid economic growth, however, has brought a trend of growth of pneumoconiosis again. From 1998 to 2007, there were 119,948 reported pneumoconiosis cases in China and from 2008 to 2017, 260,601 cases. The growth went up by around 1.5 times.
Recently, both the government and the public have paid more attention to the livings and the rights of the pneumoconiosis group. However, according to the online information, pneumoconiosis patients have suffered from harsh living conditions. This study focuses on the ways how pneumoconiosis patients could face the difficulties of their lives. We try to discuss how possible pneumoconiosis patients could benefit from self-help besides both the aid of the existing policies and the support of the society, especially when both could not afford the livings of the patients.
A comprehensive study should be conducted on the significance, urgency and feasibility of reemployment of pneumoconiosis patients before studying the situation of reemployment of the patients. As there are a large number of studies on the living conditions of pneumoconiosis patients, but little about the urgency and the situation of their reemployment. This study articulates the living conditions of pneumoconiosis patients and then focuses on reemployment of the patients.
2. Research method and sample
This online survey collected 311 valid responses. As the online survey was distributed via WeChat, the geographical range is limited. Most of the participants live in Henan (39%) and Shanxi (36%).
Basic information:
a) Gender ratio: male: female = 99:1
b) Age distribution: most of the participants are young to middle-aged adults. The largest two groups on the year of birth are 1965 to 1974 and 1975 to 1985, 30% and 57% respectively.
c) Locality: most of the participants come from Henan and Shanxi, 39% and 36% respectively. It is distorted by the sample collection method so that it does not represent the actual geographical distribution of pneumoconiosis patients in China.
d) Marital status: 89.1% of the participants are married.
e) Stage of the disease: 14% at pneumoconiosis stage I, 33% at stage II, and 53% at stage III.
The details are listed in Table 1.
Table 1: Background information
|
Types |
Options |
% |
|
Gender |
Male |
99% |
|
Female |
1% |
|
|
Year of birth |
1955-1964 |
8% |
|
1965-1974 |
57% |
|
|
1975-1984 |
30% |
|
|
1985-1998 |
5% |
|
|
Locality |
Henan |
39% |
|
Shanxi |
36% |
|
|
Hubei |
4% |
|
|
Hunan |
3% |
|
|
Others |
18% |
|
|
Education background |
Primary or below |
38% |
|
Junior high |
55% |
|
|
Senior high |
7% |
|
|
Undergraduate or above |
1% |
|
|
Marital status |
Married |
89.1% |
|
Single |
0.6% |
|
|
Divorced |
7.1% |
|
|
Separated |
1.0% |
|
|
Others |
2.3% |
|
|
Year of diagnosis (including the time when the patients are suspected to have contracted the disease) |
1995 |
0.3% |
|
2001 and after |
99.7% |
|
|
The industries in which the patients contracted pneumoconiosis |
Mining |
79% |
|
Jewelry |
2% |
|
|
Construction materials |
3% |
|
|
Ceramic products |
1% |
|
|
Refractory |
2% |
|
|
Others |
13% |
|
|
Types of Pneumoconiosis |
Silicosis |
72% |
|
Coal worker's pneumoconiosis |
14% |
|
|
Graphite pneumoconiosis |
5% |
|
|
Carbon black pneumoconiosis |
1% |
|
|
Asbestosis |
1% |
|
|
Unknown |
3% |
|
|
Others |
4% |
|
|
Stage of Pneumoconiosis (Stage III is the severest) |
Stage I |
14% |
|
Stage II |
33% |
|
|
Stage Ⅲ |
53% |
Part Two: Main body of the report
1. Labor protection and social assistance of pneumoconiosis patients
It is widely recognized that the emergence of pneumoconiosis is closely associated with poor working environment. The environmental standards of workshops in production and their implementation are governed by the existing polices and regulations and monitored by the departments concerned and the public. Under such condition, a worker who suffers from pneumoconiosis should and could find someone held responsible for his/her case. They include the employer and the governing departments concerned.
Needless to say, positive or negative responses of the bodies held responsible to the workers who suffer from pneumoconiosis affect the patients’ lives, their medical treatments, living conditions, and the willingness to reemployment (if we do not consider their health condition) directly and indirectly.
In this part, the research analyzes various kinds of assistance to pneumoconiosis patients and their actual implementation by the parties who hold responsible for the patients under the existing laws and regulations.
Let us see first the labour protection and various kinds of social assistance to pneumoconiosis patients.
a) Work-Related injury assistance
According to the Regulation on Work-Related Injury Insurances, the workers who suffer from pneumoconiosis, a typical occupational-caused disease in the list of occupational diseases in China, are usually assessed as ones who suffer from occupational injury and are entitled to enjoy the work-related injury assistance. The regulations stipulate that pneumoconiosis patients are usually entitled to enjoy the work-related injury assistance and claim for the reimbursement of 90% or above of their medical expenses and to receive various kinds of subsidies upon the level of loss of working ability. For instance, the patients whose disabilities are classified as Level 1-4 are entitled to enjoy disability subsidy after retirement. The work-related injury assistance has been hitherto the most comprehensive and effective way in support of pneumoconiosis patients in China.
b) Civil compensation
According to the Prevention and Control of Occupational Diseases Law of the People's Republic of China (“the Prevention and Control of Occupational Disease Law”) and the laws and regulations related to personal injuries, an occupational disease victim, besides the work-related injury compensation, can charge his/her employer for compensation through civil claims. In fact, some pneumoconiosis patients did succeed in claiming compensations other than the work-related injury compensation. Civil compensation is seen as a supplementary way to the patients or a substitution if the patients fail to enjoy the work-related injury compensation.
c) Other kinds of social assistance
The issue of pneumoconiosis has been centralized to handle and has aroused more public attention, but the compensations to the patients are various from place to place and it is a matter of public knowledge. Medical compensation includes the new rural medical care reimbursement, centralized treatment of critical diseases and some local subsidies to pneumoconiosis patients (e.g., free lung lavage and free medical care). Living subsidies include minimum living standard, children education allowance and social assistance.
After the discussion about various kinds of social assistance to pneumoconiosis patients, we then examine whether the said assistance is good enough to afford the medical and living expenses of pneumoconiosis patients.
(1) Only 10.9% of the interviewed pneumoconiosis patients enjoy the work-related injury insurances and only 15.2% enjoy the work-related injury subsidy. Nearly 85% of the patients fail to enjoy the protection under the Regulation on Work-Related Injury Insurances
As discussed above, the work-related injury subsidy is the most comprehensive and effective way in support of pneumoconiosis patients. This study shows, however, that only 15.2% of the interviewees received the work-related injury subsidy. It means that nearly 85% of the pneumoconiosis patients fail to enjoy the subsidy for their medical and living expenses under the Regulation on Work-Related Injury Insurances.
Among the 303 valid responses to the question, “Have you been assessed as an occupational disease victim by an occupational disease identification body?”, 73.3% replied “yes”. However, in the further question for these 73.3% patients, “the level of the loss of work ability in the last assessment by the work ability assessment committee”, 60% of them replied “not yet assessed”. In other words, among the total 303 valid responses, only 27.4% of the interviewees received the work ability assessment result. It is grounded to guess that part of the 73.3% interviewees who claimed to have been certified as occupational disease victims might assume wrongly the hospitals they stayed as the occupational disease identification bodies.
As employers do not follow the law to purchase the work-related injury insurances, at least 10.9% of the pneumoconiosis patients fail to enjoy the work-related injury subsidy although they have had the official confirmation of occupational diseases and their loss of work ability has been assessed by the work ability assessment committee. Only 15.2% of the interviewees can enjoy the work-related injury subsidy, but most of them cannot receive the full amount.
(2) Only 3.5% of the patients succeed in the civil compensation: the civil compensation regulations of occupational diseases have created meager impacts to pneumoconiosis patients
In the survey, only 11 of the 311 interviewees have received the three main items of civil claim compensation, “disability compensation (the difference on the compensation amount in comparison with the similar item in the work-related injury compensation)”, “allowance to the dependents” or “mental damage compensation”. Although the Prevention and Control of Occupational Disease Law, the Tort Law and the local judicial interpretation (like No. 147 of the Higher People’s Court of Guangdong Province) stipulate that occupational disease patients are entitled to claim for civil compensation in additional to the work-related injury compensation, only 3.5% of the interviewees could enjoy civil compensation. The laws and regulations concerned do not help much to the patients.
(3) Inadequate social assistance in support of the livings of pneumoconiosis patients
Table 2.1: Medical expense reimbursement of the pneumoconiosis patients
|
Items |
Ratio of the patients who enjoyed the assistance |
|
Social insurance |
10.6% |
|
Cooperative health insurance |
59.8% |
|
Centralized treatment of critical illnesses |
5.8% |
|
Others |
4.5% |
|
None of above |
36% |
Table 2.2: Medical expense reimbursement of the pneumoconiosis patients
|
Items |
Ratio of the patients whose reimbursement were higher than 70% of the amount they had claimed for |
|
Social insurance |
78.8% |
|
Cooperative health insurance |
33.9% |
|
Centralized treatment of critical illnesses |
38.9% |
|
Others |
42.9% |
|
None of above |
0% |
Table 3: Items of the assistance to the pneumoconiosis patients*
|
Items |
Ratio |
|
Work-related injury compensation |
15.2% |
|
Civil compensation |
3.5% |
|
Minimum living standard subsidy |
23.8% |
|
Other governmental subsidies |
4.2% |
|
Children education allowance |
17.7% |
|
Support from NGOs |
13.8% |
|
None of above |
50.5% |
*Among the 311 responses, 15.9% of them enjoyed work-related injury insurance compensation. It was different from the figure (15.2%) calculated in the previous section. For consistency, in this table, the research keeps on using 15.2%. Data used in this table are combined from the data in the questions 14, 24, 27 and 29.
The coverages of medical subsidy and living assistance are not wide enough: nearly 36% of the participants cannot claim for their medical expenses (see Table 2), while 50.5% receive no living assistance (see Table 3).
Except the work-related injury insurance compensation, other kinds of social assistance do not help much to the patients. For the medical expense reimbursement covering more than 70% of the actual expenses, 33.9% of the patients in the new rural medical care can enjoy so, 38.9%, in the centralized treatment of critical illnesses and 42.9%, in others. In terms of living assistance, the responses show that other than the work-related injury insurance compensation and civil compensation, the level of minimum living standards and other social subsidies is 500 RMB per month (about 78.1 USD).
2. Living conditions of pneumoconiosis patients
As discussed above, despite various ways to support pneumoconiosis patients, the overall support is inadequate. We further analyze this issue from the perspective of the living conditions of pneumoconiosis patients to explain why reemployment to the patient is crucial or why the patients are forced to go back to the job market again.
(1) Income cannot afford the living expenses
Table 4: Family expenses of the pneumoconiosis patients
|
Items |
Ratio |
|
Rent and utility |
54.66% |
|
Daily necessities, like food |
77.49% |
|
Expenses for children |
77.17% |
|
Support to parents |
64.31% |
|
Medical expenses |
88.75% |
|
Mortgage and car loans |
10.29% |
|
Others |
9% |
|
Valid responses |
311 |
From the basic information section, we learn that 87% of the participants are 36-55 years old. Like the people of their generation. they need to support both their parents and children. 77% of the participants need to pay for their children and 64% need to support their parents. But unlike the people of their generation, the patients need to afford the medical expenses and 89% of the patients need to do so.
Tables 5-6 show the monthly family expenses and income respectively of the pneumoconiosis patients. 85% of the families of the patients spend more than 1500 RMB (around 234 USD) per month, but only 34% the families of the patients earn more than 1500 RMB every month. It is pitied that 47% of the patients have no family income.
Table 5: Monthly family expenses of the pneumoconiosis patients
|
Expense (RMB) |
Ratio |
|
300-500 |
7% |
|
1500-3000 |
44% |
|
3000-5000 |
33% |
|
More than 5000 |
8% |
|
Not sure/ Others |
8% |
Table 6: Monthly family income of the pneumoconiosis patients
|
Income (RMB) |
Ratio |
|
0 |
47% |
|
1-1000 |
8% |
|
1000-1500 |
11% |
|
1500-3000 |
27% |
|
3000-5000 |
6% |
|
More than 5000 |
1% |
(2) Nearly 80% of the participants owe their relatives or friends money
Table 7: Debts of the pneumoconiosis patients
|
Items |
Ratio |
|
Mortgage |
12.22% |
|
Car loans |
3.22% |
|
Other bank loans |
28.94% |
|
Loans from relatives and friends |
77.81% |
|
Online loan |
6.11% |
|
No debt |
11.58% |
|
Others |
6.75% |
|
Valid responses |
311 |
Inadequate income causes huge debts among pneumoconiosis patients. 77.8% of the participants owe their family members or friends money and 28.9% have bank loans. Many participants list “medical expenses” in the option of this question, “others” (see Table 7). It shows that the patients either owe hospital medical charges or owe someone for their medical expenses.
Huge debt of the pneumoconiosis patients reflects meagerness of social assistance and the difficulties of the patients’ self-help, and even the survival crisis of the patients' families.
3. Reemployment condition of the pneumoconiosis patients
(1) Low motivation to reemployment: the patients whose diseases are more serious have less motivation to go for reemployment
For the questions about “willingness to reemployment” and “physical and mental conditions”, the survey applies Matrix scale chart, with a range of 1-5 to articulate if the patients agree to the individual statements. 1 stands for “strongly disagree”, 2, “disagree”, 3, “neutral”, 4, “agree” and 5, “strongly agree”.
On the two questions mentioned above, the study adopts the mean value to make general analysis and the proportion rate to make a comparative study on individual statements.
Table 8: The will to reemployment of the pneumoconiosis patients (1)
by the mean value
|
The will to reemployment/ Stage of the disease |
Stage I |
Stage II |
Stage III |
|
I need to work |
3.2 |
3.2 |
2.7 |
|
I was rejected several times when looking for job after having contracted the disease |
3.0 |
3.2 |
3.3 |
|
I have difficulty in finding a job |
3.5 |
3.4 |
3.4 |
|
I want to work in a company |
3.0 |
3.1 |
2.5 |
|
I want to have my own shop or business |
3.3 |
3.0 |
2.6 |
|
I don’t think there are jobs suitable for pneumoconiosis patients |
2.1 |
1.5 |
1.8 |
|
I’m satisfied with the existing job |
3.4 |
2.8 |
3.1 |
|
I cannot work anymore due to my health condition |
2.2 |
1.8 |
1.7 |
|
Job cannot solve my problem |
3.3 |
3.3 |
3.6 |
|
I want to have a part-time job |
3.1 |
2.8 |
2.3 |
In Table 8, the responses to “I need to work”, “I want to work in a company”, “I want to have a part-time job” and “I want to have my own shop or business” are around 3 and not higher than 3.3. Generally, the participants are neutral to reemployment and have no strong will to work again. For the pneumoconiosis patients at stage III, the mean values of the said four items are 2.7, 2.5, 2.3 and 2.6, respectively. The patients at Stage III intend not to work anymore.
Why do pneumoconiosis patients have low motivation to reemployment?
(2) Two major hurdles: lack of work ability, and nobody wants to employ pneumoconiosis patients
Table 9 summarizes the will to reemployment of the patients.
Table 9: The will to reemployment of the pneumoconiosis patients (2)
|
Question/option |
Strongly disagree |
Disagree |
Neutral |
Agree |
Strongly agree |
|
I was rejected several times when looking for job after having contracted the disease |
26.37% |
8.68% |
18.01% |
11.58% |
35.37% |
|
I have difficulty in finding a job |
25.08% |
6.11% |
13.83% |
10.61% |
44.37% |
|
I don’t think there are jobs suitable for pneumoconiosis patients |
22.83% |
12.86% |
26.69% |
11.25% |
26.37% |
|
I cannot work anymore due to my health condition |
18.97% |
7.72% |
19.61% |
13.18% |
40.51% |
|
Job cannot solve my problem |
26.05% |
11.25% |
21.86% |
11.25% |
29.58% |
From Table 9, 46.9% of the pneumoconiosis patients have experienced of being rejected when looking for job. At least 53.7% of the patients think that their health condition due to the disease makes them unable to work and at least 47.6% think that no job is suitable for a pneumoconiosis patient. Moreover, more than 55% of the patients find it difficult to have a job and 40.8% think that job cannot solve their problems. From the responses, about half of the patients take negative attitude towards reemployment. The negative attitude comes from both the weak ability to work and the experience of being rejected.
(3) Reemployment rate is 30% only. Most workers find hourly-counted works and more than half of the reemployed face occupational hazards
Table 10: Job search by the pneumoconiosis patients
|
Have you found a job after having contracted the disease? |
Ratio |
|
Yes |
21% |
|
No |
53% |
|
Others |
26% |
Although around half of the participants take negative attitude to employment, 47% of the participants have thought of reemployment. Though 53% of the participants have not tried to get a job after having contracted the disease, 21% have looked for jobs and 26% have thought of works in other ways (see Table 10).
What happens to the participants (47%) who have thought of reemployment? Their experiences are summarized as follows.
a) Only 30% of them can get jobs and 54.2% of the job offer are casual job or hourly-paid job
Table 11: Types of the jobs of the reemployed pneumoconiosis patients
|
Types of jobs |
Ratio |
|
Causal/Hourly-paid work |
54% |
|
Work in factory |
14% |
|
Taxi-driver/hawker |
8% |
|
Security guard |
6% |
|
Free-lanced driver |
4% |
|
Work in construction site |
3% |
|
Others |
11% |
Despite the low reemployment rate of the patients, half of the 47% of the participants wish to get employed again. Among the 146 participants who have tried to find jobs, only 31.5% are hired, and 54% of them work as casual or hourly-paid workers (see Table 11).
b) Low income: more than half of them earn less than 2000 RMB per month
The wages of the reemployed pneumoconiosis patients are low. 51.4% of them earn less than 2000 RMB (about 312 USD) per month, and 27.8% of them earn 2001 to 3000 RMB (about 468 USD) per month (see Table 12).
Table 12: Monthly income of the reemployed pneumoconiosis patients
|
Monthly income (RMB) |
Ratio |
|
2000 or less |
51.4% |
|
2001-3000 |
27.8% |
|
3001-4000 |
9.7% |
|
4001-5000 |
5.6% |
|
Uncertain |
5.6% |
c) Exposure to occupational hazards again: 40% of the reemployed are exposed to the hazards of dust or noise
From the survey, 9.7% of the reemployed participants are exposed to a large amount of dust, 20.8% to a small amount of dust and 11.1% to the hazard of noise.
(4) Health is the biggest hurdle to reemployment
Table 13: Hurdles to reemployment from the view of the pneumoconiosis patients
|
Option |
Ratio |
|
Health problem makes us unable to work |
82.64% |
|
Can’t find a job |
30.87% |
|
Have reached the age of retirement |
3.22% |
|
Take care of family members (the elderly, children or other patients) |
9.97% |
|
No need to work– good social assistance |
0% |
|
No need to work – good family support |
0% |
|
Don’t want to work |
0.32% |
|
Can’t pass the health examination |
40.19% |
|
Others |
8.04% |
|
Valid responses |
311 |
About 82.6% of the participants who is unemployed think that the health problem makes them unable to work, while 40.2% of them cannot pass the health examination and 30.9% cannot find a job. In summary, “unable to work” and “nobody hires” are the two biggest hurdles to reemployment of the patients, but “unable to work” comes dominantly.
Part Three: Conclusion
1. About 22% of the pneumoconiosis patients are in deadly despair
After the studies of the labour protection of and social assistance to the pneumoconiosis patients, the living conditions and the reemployment condition of the patients, we now study both physical and psychological status of the patients (see Table 14-15).
Table 14: Physical and psychological status of the pneumoconiosis patients
by the mean value*
|
Health status |
Stage I |
Stage II |
Stage III |
|
I seldom have coughing and chest pain |
2.8 |
2.6 |
2.3 |
|
I had good appetite |
2.3 |
2.6 |
2.4 |
|
The disease does not affect my daily life much |
2.1 |
2.2 |
2 |
|
I think disciplined smoking and alcohol drinking are good to release the disease |
2.1 |
1.5 |
1.5 |
|
I often suffer from shortness of breath when walking in a plain path |
3.5 |
3.6 |
4.0 |
|
I often suffer from insomnia |
3.3 |
3.5 |
3.8 |
|
I can’t take care of myself (e.g., taking food, dressing clothes) |
2.2 |
2.2 |
2.8 |
|
I’m often depressed |
3.8 |
3.6 |
3.8 |
|
I often have had temper |
3.8 |
3.3 |
3.6 |
|
I’m worried about my disease |
3.9 |
4.0 |
4.0 |
|
I have no confidence of the medical treatment |
3.7 |
3.4 |
3.5 |
|
I can’t accept the fact that I have contracted the disease |
3.8 |
3.5 |
3.6 |
|
I don’t have hope for the future |
3.6 |
3.6 |
3.4 |
*Matrix scale chart of individual statements with a range of 1-5. 1 stands for “strongly disagree”, 2, “disagree”, 3, “neutral”, 4, “agree” and 5, “strongly agree”.
Coughing, chest pain, bad appetite and being hard to do physical labouring (like shortness of breath when walking) are common among pneumoconiosis patients. Moreover, the patients psychologically suffer from insomnia, feeling down, bad temper, denial of the disease, lack of confidence and loss of hope (see Table 14). But physical and mental symptoms are not corresponding directly to the severity of the disease.
Table 15: How do the pneumoconiosis patients think of the pressure due to family financial problems?
|
Option |
Ratio |
|
No pressure |
0% |
|
Bearable |
1.29% |
|
Wish but unable to solve |
29.26% |
|
Muddle along |
5.14% |
|
Huge pressure |
39.55% |
|
Despair |
21.86% |
|
Others |
2.89% |
|
Valid responses |
311 |
For the pressure from family financial condition (see Table 15), except 1.3% of the participants who find “bearable”, the responses are all negative, while about 21.9% of them feel despaired severely.
2. Reemployment is not a solution
As pneumoconiosis is completely caused by the working environment, the bodies who hold responsible for the disease should take the main role in giving aids to the patients. Although the labour protection and the social assistance system can provide significant support to pneumoconiosis patients, their coverage are small, so they can create limited impacts to most pneumoconiosis patients. Most patients stay in a very poor living condition with severe medical and financial pressure.
Loss of working ability and lack of motivation to work caused by health deterioration make most pneumoconiosis patients unemployed. But some patients still try hard to get employed again because of living difficulties. However, reemployment is also harsh to the patients. On the one hand, there are hurdles to their reemployment, “unable to work” and “nobody hires”. On the other hand, they suffer from low wages and further exposures to occupational hazards.
This research aims to explore the reemployment condition of pneumoconiosis patients and study how much the patients could help themselves in face of their difficulties. Unfortunately, we cannot but make such a conclusion that reemployment is not yet a good option for the survival of pneumoconiosis patients today.
* The author owns the copyright. It is prohibited to reprint this article without the author's permission.
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