Occupational health services in China occupy a much more central role in public life than they do in North America. The Communist ideology on which the People's Republic was built, and which it almost alone today defends, places an idealized concept of the worker at the centre of the economic, social and political system. The present system in China is a parallel, institutionally separate system of medical care and research on occupational disorders that is in some ways better provided for with resources than the general healthcare system. One of the issues facing China today is how to turn the priorities of this vast, elaborate and incompletely developed system of occupational health care away from the provision of medical care to workers made ill from workplace exposure and towards prevention of the exposures that made them ill in the first place. The prevalence of smoking and the intensity of passive smoke exposure in Chinese workplaces make this exposure one of the most deadly occupational hazards seen. This problem of health promotion can probably only be effectively approached in China by worksite programmes but these are not apparent.