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Why China matters
  1. Brian D Johnston
  1. Correspondence to Dr Brian D Johnston, Department of Pediatries, University of Washington, Seattle, WA 98104, USA; ipeditor{at}

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In the 21st century, injury control specialists – along with those in almost every other discipline – would do well to keep an eye on China. The development of injury prevention as an academic and political entity in that country could do more to reduce the global burden of injury than any other single advancement we can envision.

Domestically, China represents a huge and underserved market for injury control policy and programming. With 1.4 billion people and an economy that will soon become the world's largest, it is self-evident that successful injury control in China will have a significant effect on global totals. The global burden of road traffic injury, in particular, will be impacted by the Chinese experience. Investments in transportation infrastructure have been an engine of economic development in China, with a national highway system that added over 70 000 km of new roadway in 2013 alone.1 And there are vehicles to use those roads: 137 million civilian owned vehicles in 2013, 64 million of which were privately owned cars, an annual increase of over 20%.1

But it is not just the domestic impact of China's motorisation that will shape global injury trends. China is an influential actor across the developing world. The website AidData ( provides a fascinating glimpse into the reach of China's development aid to sub-Saharan Africa. In recent decades Western aid to Africa has gone primarily to social and health sectors whereas the Chinese seem to favour infrastructure and transport projects.2 Among these, a 2000 km coastal highway from Dakar to Lagos, passing through nine West African countries.

The Zambian economist Dambisa Moyo has argued that the Chinese are eclipsing Western democracies as models of economic development in broad swaths of the global south, where the Chinese emphasis on economic rights and state-involvement in the market has been welcomed.3 If this is correct, it implies that the Chinese will wield increasing influence over infrastructure development around the world. If road construction were coupled with engineering to reduce injury and policy incentives to promote mass transit and make roadways safer for motorists, pedestrians and bicyclists alike, today's developing countries could leapfrog over the West's painful and costly experience with uncurtailed motor vehicle carnage.

Our experience at Injury Prevention suggests that our colleagues in China are beginning to find their feet in injury control science. The number of submissions from Chinese authors to the journal increases year over year. Since 2011 we've received 72 submissions from China and published 13%, a figure just under our acceptance rate for North America, Europe and Australasia. Papers have ranged from surveillance studies and descriptive epidemiology,4 ,5 to consideration of important, but particularly Chinese issues: injuries among internal migrant workers6 and their children7 ,8 and the rising toll of injury due to electric bicycles.9

In this issue, Tan and colleagues report a survey of public health practitioners in Changsha, China.10 Unfortunately, many do not see injury as preventable nor do they perceive injury prevention as within the realm of public health practice. It will take a concerted effort to change this mindset, perhaps with input from other sectors, such as health, transport and economic development, where the impact of injury is most acutely felt. But the public health sector also needs clear guidance from applied injury research about what works, in which contexts and with which populations.

Qiong He and colleagues, also in this issue, have looked at randomised controlled trials of injury prevention intervention in China over the decade 2001–2010.11 The 25 studies identified focused primarily on educational interventions with knowledge or behaviour as an outcome. There were no papers that looked at policy, engineering or enforcement as interventions. The authors suggest that there is room for improvement in both the quality of reporting and the scope of injury prevention interventions studied. We couldn't agree more. The journal is most eager to see randomised trials of engineering, product modification or policy intervention from our colleagues in China. Their work could make a world of difference.


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  • Competing interests None.

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