Asbestos and Health WHO recommendations on elimination of asbestos-related diseases Dr Ivan D. Ivanov Public Health and Environment World Health Organization Thai National Asbestos Workshop, 6-8 March 2007, Bangkok

Background World Health Assembly Resolution 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 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 alternatives Example: 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 aluminum 12.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

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