Asbestos and HealthWHO recommendations on

elimination of asbestos-related diseases

Dr Ivan D. IvanovPublic Health and Environment

World Health Organizationivanovi@who.int

Thai National Asbestos Workshop, 6-8 March 2007, BangkokThai National Asbestos Workshop, 6-8 March 2007, Bangkok

Background

• World Health Assembly Resolution 58.22 from 2005 on Cancer Prevention and Control– Countries should pay special attention to cancers for which avoidable

exposure is a factor

• Thirteenth Session of ILO/WHO Joint Committee on Occupational Health (2003)– Special efforts to elimination of asbestos-related diseases

• Asbestos is the most important occupational carcinogen– Half of the deaths from occupational cancer are caused by asbestos

Asbestos-related diseases

• Lung cancer

• Mesothelioma

• Asbestosis

• Pleural plaques, thickening and effusions

• Laryngeal cancer

• Other cancers

Worldwide 125 million people are exposed to asbestos

900

1'976

2'842

4'462

4'683

5'084

5'678

6'155

6'222

6'233

6'312

7'057

26'651

39'655

0 10'000 20'000 30'000 40'000

AMRO D

EMRO B

WPRO A

EURO B

AMRO A

AFRO D

EMRO D

SEARO B

AMRO B

AFRO E

EURO A

EURO C

SEARO D

WPRO B

Population exposed to asbestos by WHO region and mortality stratum (thousands)

Every year at least 90,000 people die from asbestos-related diseases

• Annual deaths attributable to asbestos

– at least 90,000 from lung cancer, mesothelioma and asbestosis due to occupational exposure

– Additionally at least several thousands deaths can be attributed to other asbestos-related cancers and to non-occupational exposure

Asbestos is the most important occupational carcinogen causing 54% of all deaths from occupational cancer

The death toll will increase in the future

One third of the WHO Member States still use asbestos

• 23% have banned or intend to ban chrysotile

• 41% have not banned but show no record of trading in

• 36% still use, import and export asbestos and asbestos-containing products

• Largest use (90%) is in asbestos-cement industry in developing countries

• World production and use remains stable between 2,050,000 and 2,400,000 metric tonnes.

All types of asbestos are hazardous to health

• Increased risk of lung cancer

• Mesothelioma – both occupational and non-occupational (environmental, take-home) exposures

• No threshold has been identified for carcinogenic risk of all asbestos types, incl. chrysotile

• Both active and passive smoking increase the risk of lung cancer from asbestos

Mesothelioma

There are safer substitutes to asbestos

• Fibre substitutes, e.g.:– short fibre attapulgite

– carbon fibres

– non-respirable cellulose fibres

– non-biopersistent sythetic vitreous fibres

– natural wollastonite

– xonolite

WHO Workshop on Mechanisms of Fibre Carcinogenesis and Assessment of Chrysotile Asbestos Substitutes, 8-12 November 2005, Lyon

There are many alternativesExample: Substitutes for Asbestos-Cement Corrugated Roofing

1. Fiber-cement roofing using: synthetic fibers (polyvinyl alcohol, polypropylene) and vegetable/cellulose fibers (softwood kraft pulp, bamboo, sisal, coir, rattan shavings and tobacco stalks, etc.); with optional silica fume, flyash, or rice husk ash.

2. Microconcrete (Parry) tiles 3. Galvanized metal sheets 4. Clay tiles 5. Vegetable fibers in asphalt 6. Slate 7. Coated metal tiles (Harveytile) 8. Aluminum roof tiles (Dekra Tile) 9. Extruded uPVC roofing sheets 10.Recycled polypropylene and high-density

polyethylene and crushed stone (Worldroof) 11.Plastic coated aluminum12.Plastic coated galvanized steel.

Source: B. Castleman, 2006, personal communication

Roofing Sheets (picture BWWI)

Summary of the conclusions from WHO assessments

1. All types of asbestos cause asbestosis, mesothelioma and lung cancer

2. No safe threshold level of exposure has been identified

3. Safer substitutes exist

4. Exposure of workers and other users of asbestos containing products is extremely difficult to control

5. Asbestos abatement is very costly and hard be carried out in a completely safe way

Working with asbestos-containing materials requires enormous measures

for protection

WHO recommendations for elimination of asbestos-related diseases

• Elimination of the asbestos– Stop using asbestos

– Provide information about safer substitutes

– Develop economic and technological mechanisms to stimulate substitution

• Asbestos abatement– Avoid exposure during asbestos removal

– Develop regulatory and workplace control measures for asbestos abatement

• Medical surveillance– Improve early diagnosis, treatment, rehabilitation and compensation of

asbestos-related diseases

– establish registries of people with current and past exposures

National approaches for elimination of asbestos-related diseases

• National profiles– Use of asbestos– Asbestos-related diseases

(statistics and estimates)– Exposed populations

• Awareness raising– Framing health arguments for

stopping the use of asbestos– Targeting industry, entrepreneurs,

workers, policy makers

• Capacity building– Recognition of asbestos exposure– Detecting asbestos-related

diseases– Engineering control

• institutional framework– Ministries of health, labour,

environment– Ministries of industry, trade,

construction

• National plan of action– Step by step– Priority setting– Intersectoral coordination– Involving civil and business

society– Monitoring, accountability– Evaluation

Future steps by WHO

• Launch global campaign on elimination of asbestos-related diseases (jointly with ILO, other UN agencies, civil and business society, trade unions)

• Endorse Global Plan of Action on Workers Health, WHA 2007

• Implement WHO Module for Cancer Prevention

• Pilot jointly with ILO comprehensive national approaches for elimination of asbestos-related diseases

http://www.who.int/occupational_health/publications/asbestosrelateddiseases.pdf

Further information

Available also in Arabic, Chinese, French, Russian and Spanish

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