Global Policy Forum

By Erik Eckholm

Like many of his fellow villagers, Zhou Zhihai leapt at the opportunity to work in the tiny, dank shoe factories here in the county seat. Though it meant 10- to 14-hour days swabbing leather with pungent glue, by working fast he could earn as much as $120 a month, enabling him to build one of the two-story brick houses that give this county's overcrowded countryside a facade of prosperity.

His widow and their 12-year-old son still live in that new house, set in their hillside village among gleaming rice paddies. Last September, Mr. Zhou became dizzy and weak from severe anemia, almost certainly caused by inhaling benzene fumes from the factory glue, and stopped work briefly. But he was in debt and returned to shoemaking. In December, at the age of 36, he died of leukemia. "Lots of people here work in the shoe factories, get sick, rest, go back to work, then get sick again," said Chen Yiwen, who runs the rudimentary clinic in Mr. Zhou's home village, Santai. "That's all you can do around here to make a living."

As China applies to join the World Trade Organization, international concern has been directed at the sometimes unpleasant or dangerous working conditions in the country's export industries, especially those owned by foreign companies. But health and safety conditions are generally far worse, Chinese and foreign experts say, in the many smaller factories and mines that have sprung up across the country during the economic reforms of the last two decades, mainly producing goods for the domestic market. These are run by private owners or cash-hungry local governments, often under 19th-century safety conditions.

Mr. Zhou's story is well known in his village and is far from unique. But few people have been deterred from seeking similar work in the thousands of mom-and-pop shoe factories for which Bishan County, about 25 miles west of Chongqing in the central province of Sichuan, is known.

The villagers persist, even though most have heard that the benzene-containing glues still widely used in China can cause life-threatening illness. Some workers, thumping their chests to show their strength, simply assume that they will be spared from the epidemic of blood disorders afflicting this county, where more than 20,000 workers produce millions of pairs of shoes each year for sale throughout China. Others, already weakened, continue working until they cannot continue -- and no follow-up studies have been conducted of the subsequent health of such dropouts.

"I need to eat," said a 46-year-old man in a workshop in Bishan city. "I need to survive." He has had periods of severe anemia and described his job as "slow suicide." As he spoke, the man, who was afraid to give his name, continued gluing soles by himself, working through the lunch break. He was working extra hours, he said, to make up for his slowed pace. He said he could not even think of going to the nearby hospital, because it was too expensive.

Though little factories are scattered across the county, the shoe producers are mainly concentrated in the "shoe town" district in Bishan, where hundreds of dingy garage-like workshops bustle with the cutting and gluing activities of shoe construction. Most of the workers are younger men and women from outlying villages.

Stylish-looking shoes that may retail for $4 are created in these workshops with pre-industrial methods, amid a mess of open glue pots and leather scraps, the rich glue odor pervading the air. Often the workers, and sometimes the owner and his family, too, sleep in the room above the workshop, potentially inhaling toxic fumes through the night. Protective masks are nonexistent, exhaust fans scarce.

Such appalling conditions have stirred the normally compliant government-controlled trade union federation to demand stronger measures from Beijing. Describing the general condition of small-scale industries, the federation's newspaper, Worker's Daily, said in a recent article:

"In some newly established, labor-intensive firms, work conditions are abominable, workshops are small, low and damp, dust and noise seriously exceed standards, and toxic and hazardous tasks are not effectively regulated. After working in these abominable conditions for a long time, workers' health is utterly devastated."

The medical consequences have been magnified by the breakdown of public health care services for the poor in the economic reform era, with many of the country's hospitals simply turning away sick people who cannot pay. And because so many sick villagers do not even try to visit doctors or hospitals they cannot afford, no one has good data on the prevalence of occupational diseases in places like Bishan.

Bishan County's shoemaking boom has enabled many villagers to earn more than $1,000 a year, several times what farming alone can bring from the undersized plots each family has. Families say they need the cash for taxes and school fees and are using what is left to replace their old mud houses. For the villagers it is a calculated risk: in the isolated village of Santai, one of scores like it in the county, 600 of 1,800 residents are making shoes, according to local newspaper reports.

"I see two or three new cases involving shoemakers every day," said Dr. Chen Wanhui, one of the internal medicine specialists at Bishan County Hospital. "They come in complaining of dizziness, lethargy and poor appetite and say they find it difficult to work.

"Some need blood transfusions, while some only need medicines and they gradually get better. Some have no money and they just go away." Dr. Chen said that recovery from severe anemia, caused by benzene's damage to the bone marrow, usually takes at least three months and costs $350 to $600, mainly for medications, but that returning to the workshops afterward is extremely dangerous.

Chen Yiwen, the medical worker in the village of Santai, said: "It's just a small minority of workers who get the most serious form of anemia. You can usually get treated and get better -- if you have the money." When Mr. Zhou, the leukemia victim, first felt dizzy and weak last fall, he went to a city hospital for treatment, Mr. Chen said. But he never gave himself a chance to recover fully.

Mr. Zhou had taken out a loan to cover medical costs that approached $1,000, Mr. Chen said, and he still owed money on his house. So after a few weeks he returned to work in a shoe factory, and within three months he was dead.

In China's shoe and other domestic industries, worker exposures to toxic chemicals have often worsened during the last two decades of economic reform and rise of private enterprise, according to Meei-shia Chen, a Taiwanese expert on public health, and Anita Chan, an Australian sociologist. Their study of the health risks in Chinese shoe factories appeared in the International Journal of Health Services last year.

Whatever their other faults, larger state-run companies were subject to national rules and standards and usually provided regular medical checkups for their workers. Because of the extreme danger, the use of glues containing benzene has stopped in most developed countries, and allowable worker exposures to the chemical have been drastically reduced. Newer benzene-free glues that cost about 30 percent more are used in much of the world and are in theory available in China, usually as imports from Taiwan.

But a recent visit to Bishan's shoe district showed that virtually all of the glue sold by supply shops there is Chinese-made and contains benzene. Several factory owners said they could not afford to pay more, in part because of the taxes they must pay the local government. They also voiced a belief -- disputed by experts -- that substitute glues do not stick as well.

Local governments themselves have emerged as an obstacle to cleaning up the small factories. Throughout much of China today, the county and township governments, far from imposing worker protections, are increasingly reliant on local private companies for revenue, said Dai Jianzhong, a sociologist at the Beijing Academy of Social Sciences who has studied the shoe and other industries.

"That means that no matter how serious the problems with workers' conditions or pollution, the local governments are willing to put up with them," Mr. Dai said. "The present system makes local government place the bosses' interests before workers' welfare," said Mr. Dai, who added that only strong regulation could improve the situation.

Opinions vary on the potential effects of China's World Trade Organization entry on small, hazardous industries like these. Over time, many economists predict, the influx of foreign companies and products will mean more modern and safer factories. Still, the recent study by Ms. Chen and Ms. Chan found persistent examples of dangerous exposure to benzene and other toxic chemicals in larger, export-oriented factories, mainly Taiwanese-run, in the coastal province of Fujian.

Of foreign companies operating in China now, Mr. Dai said, "the European and American firms, especially the bigger ones, often play a model role in worker safety." ''But among firms from Hong Kong, Taiwan and South Korea, conditions can be much worse," he said. "For much of Chinese industry, W.T.O. might even worsen conditions by making markets here even more competitive, though I can't imagine how much worse they could be than they are now."

Zhao Jiazhu, 36, a Santai resident who worked in factories before starting his own four-person workshop in the village under the label Good Luck Comes, laughed when asked about his prospects after China joins the world trade group. ''It's not going to have any effect here at all," he said. "The ordinary people are not millionaires and they can't afford all those imported shoes."

Zhou Weiqiang, 26, whose factory in the nearby town of Liutang employs 10 to 20 workers depending on the season, produces shoes under the label Hundred Beauties and boasts, "You can buy my shoes all over the country."

His entire family has left farming for the shoemaking trade and they are not seriously worried about the health hazards, for themselves or their workers, Mr. Zhou insisted. "There's some risk, but it's not too great," he said. As for the looming impact of the World Trade Organization, he said, "The new competition is going to bring down prices, even for shoes. ''But I'm not too worried. I just have to get on with my business."

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