Summary The May 2008 earthquake in Wenchuan drew attention to the important but largely unrecognised public-health problem of injury-related mortality and morbidity in China. Injuries account for more than 10% of all deaths and more than 30% of all potentially productive years of life lost due to premature mortality in China. Traffic-related injuries (mainly among cyclists and pedestrians), suicide, drowning, and falls account for 79% of all injury deaths. Rural injury death rates are double those of urban rates and male rates are double those of female rates. Despite an 81% increase in the traffic-related mortality from 1987 to 2006—associated with rapid motorisation—the overall injury mortality decreased by 17%, largely due to a surprising (and unexplained) 57% reduction in the suicide rate. Low-cost prevention measures that are most likely to produce large reductions in injury deaths include enforcement of laws for drinking and driving and for seat belt and helmet use, restriction of access to the most potent pesticides, and teaching children to swim. China needs to improve monitoring of fatal and non-fatal injuries, promote intersectoral collaboration, build institutional capacities, and, most importantly, mobilise community support and political will for investment in prevention.