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ILO action towards the elimination of asbestos-related diseases

National Workshop on Strategies for Elimination of ARD 5 August 2008, Bangkok. ILO action towards the elimination of asbestos-related diseases. Igor FEDOTOV, MD, Ph.D Programme on Safety and Health at Work and the Environment International Labour Office (ILO), Geneva www.ilo.org/safework

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ILO action towards the elimination of asbestos-related diseases

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  1. National Workshop on Strategies for Elimination of ARD 5 August 2008, Bangkok ILO action towards the elimination of asbestos-related diseases Igor FEDOTOV, MD, Ph.D Programme on Safety and Health at Work and the Environment International Labour Office (ILO), Geneva www.ilo.org/safework fedotov@ilo.org

  2. 6 MILLION TONS / YEAR 5 4 3 2 1 0 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 WORLD ASBESTOS PRODUCTION 1900-2001(Source: US Geological Survey, 2002)

  3. Asbestos-related diseases Latency period Diseases malignant & non-malignant Exposures Fibre type Fibre size Fibre dose Industrial process Concentration Length of exposure Type of exposure: work, home, environment Lung cancer Mesothelioma Asbestosis Pleural plaques, thickening and effusions Laryngeal cancer Other cancers 10 to 40 years Latency period

  4. Problems in diagnosis & recognition of ARD • Long latency period • Large variety of end users • Difficult assessment of exposure • Residual health risks after cessation of exposure • Chronic illnesses, incurable diseases and deaths • Late detection due to lack of standardized diagnostic criteria • Low level of compensation

  5. asbestos consumption [1,000 tons/year] Germany: asbestos consumption and annually new compensated asbestos-related occupational diseases 1950 - 2001 800 lung cancer 770 700 705 mesothelioma 600 asbestosis 500 407 400 [n/year] 300 GDR 200 FRG 100 0 1940 45 50 55 60 65 70 75 80 85 90 95 2000

  6. Asbestos main occupational exposures • Asbestos mining and milling • Manufacture of asbestos products (asbestos cement, textiles, friction products) • Construction trades (insulators, sheet metal workers, electricians, plumbers, pipefitters, carpenters, demolition workers) • Shipbuilding and shipscrapping workers • Maintenance workers in buildings with ACM • Workers removing insulation and other ACM

  7. Asbestos environmental exposures • Natural sources (erosion of asbestos containing rocks) • Residence in the viciniy of mines or plants manufacturing asbestos products • Release of fibers from public, residential and commercial buildings containing friable asbestos • Contamination of homes by work clothes

  8. Figures on Asbestos Annual deaths UK: 153 in 1968, 1’874 in 2003, increase to 2’450 by 2015 France: 2’000 at present, peak 3’000 by 2020 USA: around 10’000 cases Projected deaths during 1995-2029 200’000 (mesothelioma) in 6 countries of Western Europe (France, Germany, Italy, Netherlands, Switzerland, UK) 500’000 - for the whole Western Europe (mesothelioma and lung cancer)

  9. Compensation costs Germany:€290 million by 2001, several billions Euros by 2020 France:€27-37 billion for the next 20 years United States 600’000 cases filed in courts by 2000 50’000 new complaints lodged every year $21.6 billion paid by insurers by 2000 $32 billion paid by prosecuted enterprises $200-265 billion increase is expected

  10. indicated compensated Suspected and new compensated fibrogenic and malignant asbestos-related diseases in Germany 1968 – 2001 4.000 [n] pulmonary fibrosis (asbestosis) and pleural abnormalities 3.500 3.000 2.500 asbestos-related lung cancer 2.000 diffuse malignant mesothelioma 1.500 1.000 500 0 65 70 75 80 85 90 95 2000 70 75 80 85 90 95 2000 70 75 80 85 90 95 2000

  11. Many countries have completely banned all types of asbestos

  12. Carcinogenicity of Asbestos • IARC evaluations in 1972, 1977, 1987 • Group 1 “ Agent carcinogenic to humans” • 1999 ILO/WHO/UNEP ICSC on Chrysotile • US-EPA, 1988-93, asbestos a human carcinogen • 2004 ACGIH evaluation – chrysotile is carcinogen • National lists of carcinogenic substances • EU ban of chrysotile asbesotos in 2005 • Lifetime risks of 5/1.000 for lung cancer, 2/1.000 for asbestosis at 0.1 f/cc OEL

  13. International Program on Chemical Safety IPCS evaluation of the health effects of chrysotile asbestos 1998 (EHC 203) Exposure to chrysotile asbestos poses risks for asbestosis, lung cancer and mesothelioma in a dose-dependent manner No threshold has been identified for carcinogenic risks Where safer substitute materials for chrysotile are available, they should be considered for use

  14. 13th Session of the Joint ILO/WHO Joint Committee on Occupational Health, 2003

  15. ILO Asbestos Efforts EU/ILO Asbestos Conference 2003 Dresden Declaration: - Asbestos remains the primary carcinogenic substance in the workplace - Asbestos-related diseases are amongst the most serious and costly occupational illnesses - In transition and developing countries asbestos will be a “time bomb” in 20-30 years

  16. ILO Asbestos Efforts 10th International Conference on Occupational Respiratory Diseases (China, 2005) “…concluded that on medical, scientific, ethical and equity grounds it is justified to call for an ultimate elimination of production and use of asbestos, that is a global ban of asbestos, to be implemented everywhere in the world.”

  17. ILO instruments: Convention 139 on Occupational Cancer Convention 162 on Asbestos Convention 170 on Chemicals Resolution on Asbestos (2006) WHO recommendations Resolution WHA58.22 Cancer Prevention and Control Resolution WHA60.26 Workers' Health: Global Plan of Action Elimination of Asbestos-related Diseases Cancer Control: WHO Guide for Effective Programmes, Module Cancer Prevention Multilateral environmental agreements Rotterdam Convention on Prior Informed Consent Basel Convention on Hazardous Waste International instruments

  18. ILO Asbestos Convention No. 162 • Safety in the use ≠ safe use • “Safe use” is not in Conv.162 • “Controlled use” is not in Conv.162 • “Responsible use” is not in Conv.162 • Ratified by 32 countries

  19. “The elimination of the future use of asbestos and the identification and proper management of asbestos currently in place are the most effective means to protect workers from asbestos exposure and to prevent future asbestos-related diseases and deaths.” “The Asbestos Convention, 1986 (No. 162), should not be used to provide a justification for, or endorsement of, the continued use of asbestos.” http://www.ilo.org/public/english/protection/safework/health/resolution_on_asbestos.pdf ILO Resolution on Asbestos, 2006

  20. http://www.ilo.org/public/english/protection/safework/health/outline_npead.pdfhttp://www.ilo.org/public/english/protection/safework/health/outline_npead.pdf http://whqlibdoc.who.int/hq/2007/WHO_SDE_PHE_07.02_eng.pdf

  21. Introduction and purpose Health aspects Magnitude of the problem Economic and social aspects Political and legal background National legislation International commitments Strategy for elimination of asbestos-related diseases Preventive strategies Strategic actions – national, provincial and enterprise levels Knowledge management information about substitutes registry of exposed workers capacities and resources National programmes for elimination of asbestos-related diseases - ILO/WHO model

  22. National programmes for elimination of asbestos-related diseases - cont'd • Implementation • Preparatory phase – building up political commitment • First phase – reducing exposure to chrysotile • Second phase – stopping the use of chrysotile asbestos • Monitoring and evaluation • outcome • process • administration • National asbestos profile • first profile • periodic update

  23. Elimination of asbestos-related diseases The elimination of conditions inevitably leading to ARD means not only the elimination of exposure conditions, but also requires the changes of the Economic, commercial, legal, social and political conditions that permit persistence of the working conditions leading to these diseases

  24. Concluding remarks • The continuous use of asbestos represents serious health risks to individuals and is damaging to the economy and society in general • The use of asbestos in the developing world is still high; it even continues to grow in some countries • In many developing countries preventative capacities, legal systems and compensation mechanisms are inadequate to respond to the forthcoming peak of asbestos-related diseases

  25. Future action The ILO will continue to implement its international instruments in order to successfully prevent health risks posed by harmful exposures to asbestos. It will use its available means of action to support activities at national and enterprise levels with the aim of eliminating asbestos-related diseases worldwide.

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