Comprehensive workplace intervention for cancer prevention in China

在全球范围内，癌症是第二大死因，约70%的癌症死亡发生在低收入和中等收入国家。死亡人数继续增加，这给中低收入国家的个人和医疗保健系统带来了巨大的负担。工作场所是癌症防治的重要渠道。一些高收入国家，如美国和英国，已经建立了工作场所健康促进计划，以解决癌症的行为风险因素。这些方案已经成功实施，不仅在雇员的行为改变方面，而且在与工作相关的成果方面，包括雇主的经济回报方面，都取得了显著的改善。基于国际经验和本地评估，我们的研究将适应现有的循证策略，建立一个可扩展的癌症预防模型，可广泛应用于中国的工作场所。在量身定制的智能手机应用程序的支持下，将通过一系列涉及个人方案、组织政策和支持性环境的多层次参与战略，制定、实施和评估一套全面的工作场所干预方案，以解决雇员患癌症的主要行为风险，如吸烟和饮酒、不健康饮食、肥胖和缺乏体育活动。在本研究中，我们将测试干预包在不同地区不同饮食和生活方式的不同工作场所的适应性。我们将分别从中国北部、中部和南部三个省份的三个城市选择15个工作场所，约1500名员工，这些城市主要位于经济不发达地区。本研究通过雇主和雇员充分参与的交错设计，干预时间分别为1年、1.5年和2年，旨在实现癌症可改变危险因素的个人行为改变。从长远来看，研究成果还将体现在减少员工的癌症和其他主要非传染性疾病（如中风和心脏病发作）的发生率、员工的生产力和工作绩效以及雇主的经济效益等方面。全面的工作场所干预将为中国数百万的工作场所人口带来巨大的利益，此外，将有很大的潜力被许多具有类似癌症负担沉重情况的其他中低收入国家所适应。这项研究将提供证据和解决方案，以解决这些国家面临的共同挑战，特别是克服干预措施实施中的障碍。最终，研究成果将有助于实现联合国可持续发展目标3.4，减少大量癌症导致的过早死亡。在一个由癌症造成巨大健康和经济负担的世界上，这项研究的成功将对全球健康产生重大影响。

Globally, cancer is the second leading cause of death and approximately 70% of the cancer deaths occur in low- and middle-income countries (LMICs). The death numbers are continuing to increase, which puts a tremendous burden on individuals and the healthcare system in LMICs. Workplace is an important channel for cancer prevention and control. Several high-income countries, such as the US and the UK, have established workplace health promotion programmes to address behaviour risk factors of cancer. These programmes have been successfully implemented, resulting in a significant improvement not only in behaviour changes of the employees, but also in the work-related outcomes, including economic returns of the employers. Based on the international experience and local assessment, our research will adapt existing evidence-based strategies and establish a scalable model for cancer prevention that can be widely applied in Chinese workplaces. A comprehensive workplace intervention package, which will address major behaviour risks of cancer for the employees, such as tobacco and alcohol use, unhealthy diet, obesity and lack of physical activity, will be developed, implemented and evaluated through a series of multilevel involvement strategies covering individual programmes, organizational policies and supportive environment and with the support of a tailored smartphone application. In this research, we will test the adaptability of the intervention package across various workplaces in diverse regions with different diets and lifestyles. We will select 15 workplaces with approximately 1500 employees from three cities located in the northern, central and southern provinces of China respectively - mostly in the economically underdeveloped areas. By full engagement of employers and employees in a staggered design with the intervention duration lasting for 1 year, 1.5 years and 2 years respectively, the research aims to achieve the individual behaviour changes in modifiable risk factors of cancer. In the long term, the research outcome will also be demonstrated by the reduction of occurrence of cancer and other major non-communicable diseases, such as stroke and heart attacks of employees, the productivities of the employees and their work performance, as well as the economic benefits of the employers. The comprehensive workplace intervention will bring enormous benefits to millions of Chinese workplace population and furthermore, will have a great potential to be adapted by many other LMICs with a similar situation of heavy cancer burden. The research will provide evidence and solutions to address the common challenges of these countries, particularly to overcome the barriers in intervention implementation. Ultimately, the research outcome will contribute to the attainment of the United Nations' Sustainable Development Goal 3.4 by reducing a great deal of premature mortality from cancers. The success of this research will lead to significant global health impact in a world with huge health and economic burden caused by cancer.