Introduction

Coal-burning type of endemic fluorosis is only occurred in China and the severely affected areas are mainly distributed in the southwestern mountainous areas.In the past over 40 years when it was epidemic from 1970s until now, with the high attention of the Communist Party of China(CPC)and Government,Chinese researchers of endemic diseases continuously worked on the research and prevention and control of this disease.These 40 years may be roughly divided into five stages.At the first stage, the scientists and technicians of prevention and contol spent ten years investigating on the characters of epidemiology in key areas and the severity of coal-burning fluorosis, and clarifying the etiology and chains of causation of this disease.At the second stage, from 1987 to around 1990, the prevention and control of coal-burning fluorosis was included in the management of key endemic diseases by Chinese Government.National institutions for the prevention and control of endemic disease and the institutions for scientific research as well as some universities and colleges, who integrated the strength and jointly tackled key problems, systematically clarified many scientific problems such as the sources of fluoride intake and the contamination paths, and established the comprehensive measures of prevention and control, giving priority to stove improvement for decreasing fluoride.At the third stage, the state established the surveillance sites of coal-burning fluorosis and began the sentinel surveillance in key endemic areas.Large scale investigations in the endemic areas and basic research were started at the same time from 1991 to 2004 continuously.At the fourth stage, from 2004 to 2012, the state established Project of Endemic Disease Prevention and Control of special Found of Central Financial Subsidy to Local Public Health（PCTL），and input lots of funds focusing on the implementation of the comprehensive measures of prevention and control based on health education, giving priority to stove improvement for decreasing fluoride.A total of 5.32 million stoves had been improved.The rate of improved stoves and the correct usage rate reached to 99.38% and 98.84%, respectively.At this stage, the leader of the CPC Central Committee cared for people’s health in the endemic areas very much and personally inquired about the implementation of the prevention and control measures of coal-burning fluorosis.Mr.Chen Zhu, the former Minister of Health, investigated the endemic areas of Guizhou Province and further included the project of stove improvement of coal-burning fluorosis in the major projects of public health service, and also signed the ministry-province collaborative project with Guizhou Province to promote the complete implementation of the prevention and control measures.At the fifth stage, from 2013 to now, the state has followed the plan to normatively evaluate the effectiveness of the implementation of the prevention and control measures for coal-burning fluorosis in the endemic areas of the whole country according to the Assessment methods for the control and elimination of major endemic diseases(No.79 document issued by the Bureau of Disease Control, National Health and Family Planning Commission in 2014).Results showed that 76 counties have reached the elimination standard, accounting for 44.19%, and 68 counties reached the control standard, accounting for 40.12%.

So far, all the work for the prevention and control of coal-burning fluorosis in China has been completed,from the discovery to the clarification of etiology and epidemic paths, then from the determination of prevention and control measures to the systematic implementation, finally to the comprehensive assessment for the effects of disease prevention and control.It is safe to say that the prevention and control of coalburning fluorosis was the most typical successful case in the field of public health in China and also a miracle for a kind of chronic disease affecting 30 million populations to undergo from seriously widespread prevalence to sustainable control and even the elimination.It actually embodies the superiority of our socialist system which can concentrate resources to do things of significance, moreover it is the consequence of hardships experienced by several generations of personnel engaging in the prevention and control,research and management of endemic diseases.During this period, the head of the Leading Group of CPC Central Committee for the Prevention and Control of Endemic Disease, Li Desheng, Vice Ministers of the former Ministry of Health in charge of Endemic Disease Prevention and Control including Guo Ziheng, He Jiesheng, Yin Dakui, Peng Yu and Wang Longde, the director of the Office of CPC Central Committee for the Prevention and Control of Endemic Disease, Sun Xi, the leaders of the Bureau(Division)of Endemic Disease Prevention and Control, National Office for Prevention and Control of Endemic Disease, and Disease Control Division(Bureau)of former Ministry of Health including Zhang Yifang, Fu Xin, Gao Shufen, Chen Jixiang, Qi Xiaoqiu, Chen Xianyi, Hao Yang, Yu Jingjin, Xiao Donglou, Bai Huqun, Wang Bin, Liu Jiayi,Lei Zhenglong, Wang Liying, Wu Liangyou, Li Quanle, Li Xun, Yan Jun, et al., did a lot of work in policy setting and fund raising.Some research institutes and universities including the National Endemic Disease Control Center, the former Academy of Preventive Medicine, the Chinese Academy of Sciences, Harbin Medical University, Guizhou Medical University, etc.played an important role in determining the strategies for disease prevention and control and carrying out scientific researches.The grassroots personnel for the endemic disease prevention and control, rural cadres and doctors, and the teachers of primary and middle schools, played a vital role in implementing health education and the prevention and control measures.

At the completion of the first-round evaluation on the national control and elimination of coal-burning fluorosis, we organized and compiled this book entitled Coal-burning Type of Fluorosis Control and Practice in China.The main purpose is to fully reflect the national process and achievements, to summary the experiences in different provinces, and to record this unduplicated history for the prevention and control of coal-burning fluorosis.Of course, owing to the certain restriction in the overall recognition and limited capacity of the authors, some shortcomings are surely inevitable.We would appreciate any comments or suggestions from the personnel working for the endemic disease prevention and control.

For the publication of this book, we would like to thank the National Health and Family Planning Commission and People’s Medical Publishing House for their great support and help, and we are appreciative for the full support from Academician Chen Zhu, Vice Chairman of the Standing Committee of the 12th National People’s Congress, President of Chinese Red Cross and Minister of the former Ministry of Health.Thanks again for all the leaders, experts, disease prevention and control personnel, medical personnel of township hospitals, rural doctors and cadres, primary and middle school teachers.We appreciate all their contributions to the prevention and control of coal-burning fluorosis!

Editors

Sep 25th, 2016