Workplace violence against healthcare workers in China: a systematic legal analysis with reference to international labour standards

BACKGROUND: Workplace violence against healthcare workers (HCWPV) is a global public health and occupational hazard, endangering staff physical/psychological well-being and public health security. China faces strained doctor-patient relations and frequent HCWPV yet its legal framework lacks occupational safety and health (OSH) oriented regulations. The International Labour Organization (ILO)'s Violence and Harassment Convention (C190) and Recommendation (R206) provide an internationally recognized normative benchmark, structured around a three-pillar approach: defining and prohibiting violence, establishing enforcement and remedies, and mandating preventive measures. This study conducted a systematic legal analysis of legally binding national-level documents to examine how HCWPV is addressed in China. By comparing China's national legal framework with the ILO three-pillar model, this study aims to identify regulatory gaps and inform improvements in the governance of HCWPV. METHODS: This study conducted a systematic legal analysis of legally binding national-level legal and policy instruments in China to examine how HCWPV is addressed. Documents were identified through comprehensive database searches and supplementary legal screening, and analyzed using a structured analytical framework informed by international standards. RESULTS: China's relevant legal framework includes the Constitution, 10 laws, 3 administrative regulations, 3 departmental rules, and 33 other normative documents. Provisions are scattered and focusing on post-incident punishment and public order maintenance, while excluding psychological violence and failing to define HCWPV as an occupational hazard. When mapped against the C190& R206 framework, substantial gaps were observed across all 3 pillars, including narrow and incident-based definitions of violence, reliance on post-incident punitive enforcement, and limited preventive obligations for healthcare institutions. CONCLUSION: China's "public order-first" legislative paradigm prioritizes punishment over prevention, creating systemic gaps in HCWPV governance. These findings suggest that reframing HCWPV as a psychosocial occupational hazard and aligning national legislation with the preventive, worker-centered principles of C190&R206 may strengthen the coherence and public health effectiveness of China's regulatory framework.