Macro-level Governance Environment and Occupational Health: A Comparison of Pneumoconiosis Policies

Under the background of the "Healthy China" initiative and the continuous improvement of the occupational health system, pneumoconiosis still poses a challenge to the health rights and interests of workers and the ability of public governance. This disease has the characteristics of long incubation period, irreversible course, and difficult traceability of responsibility. This article reviews the experience of the United States and other developed countries in the control of pneumoconiosis, and uses the panel data of 31 provincial administrative units in China from 2007 to 2023 to construct a two-way fixed effect model. Given data limitations, the reported incidence rate of tuberculosis is used as a proxy indicator to examine macro-level factors such as industrial structure, industrial pollution, public services, labor protection, and medical resources. The study also analyzes institutional inflection points in China’s governance of pneumoconiosis by combining policy documents with prosecutorial case studies. The study found that the share of the secondary sector and sulfur dioxide emissions is significantly and positively correlated with reported incidence rates, while the share of healthcare expenditure, urbanization rates, and infrastructure are significantly and negatively correlated. The relationship between the number of workers covered by work-related injury insurance, the allocation of healthcare professionals, and human capital lacks stability. Case studies further indicate that the coordination among workplace protection, occupational health records, occupational disease diagnosis, work-related injury determination, and benefit payments is a key institutional condition affecting the prevention of pneumoconiosis and the protection of patients. Based on these findings, this paper proposes that the development of the pneumoconiosis management system for the 15th Five-Year Plan should strengthen dust control at the source, protection for high-risk populations, grassroots occupational health services, cross-regional information coordination, and long-term collaborative care, thereby promoting the coordinated development of occupational health risk prevention and control and the protection of workers’ rights.