tag:theconversation.com,2011:/uk/topics/asbestos-1381/articlesAsbestos – The Conversation2024-02-26T18:59:32Ztag:theconversation.com,2011:article/2239722024-02-26T18:59:32Z2024-02-26T18:59:32ZFrom a ‘magic mineral’ to the stuff of nightmares: a 6,700-year history of asbestos<p>Asbestos is making national news once again after being found in contaminated mulch used in hundreds of locations, including <a href="https://www.theguardian.com/australia-news/2024/feb/24/sydney-asbestos-crisis-epa-following-up-on-whether-second-mulch-supplier-is-involved">schools and hospitals</a>, <a href="https://www.theguardian.com/australia-news/2024/feb/19/asbestos-mulch-locations-sydney-sites-near-me-nsw-map-full-list-when-where-found-schools-parks-epa-news">across Sydney</a> and regional New South Wales. </p>
<p>With headlines featuring terms such as “<a href="https://www.reuters.com/world/asia-pacific/sydney-school-supermarket-tainted-with-asbestos-crisis-widens-2024-02-18/">crisis</a>”, “<a href="https://www.youtube.com/watch?v=v6ewhMFXf08">nightmare</a>” and “<a href="https://www.news.com.au/lifestyle/health/childrens-hospital-at-westmead-among-54-locations-contaminated-with-asbestos/news-story/97aa31383db6f492718d82f099f89d14">deadly</a>”, it’s hard to believe the toxic mineral was once hailed for its supposedly “magical” properties.</p>
<p>In fact, the history of asbestos goes back at least 6,700 years. Its prevalence in our built environment means it’s (unfortunately) here to stay for a long time.</p>
<h2>Before it became a ‘killer dust’</h2>
<p>Asbestos is a naturally occurring mineral found in rock formations across the globe, including in <a href="https://www.australianasbestosnetwork.org.au/asbestos-history/asbestos-wittenoom">some national parks</a> in Australia.</p>
<p>It gets its name from the Greek word for inextinguishable (<em>ásvestos</em>), alluding to its resistance to fire and corrosion. It was these characteristics, along with its insulating properties, that made asbestos seem like a “<a href="https://www.amazon.com.au/Mineral-Killer-Turner-Newall-Asbestos/dp/0199243999">magic mineral</a>” in centuries prior.</p>
<p>Researchers have found ancient clay pottery from East Finland, dated to 2500 BC, with asbestos fibres mixed into it – <a href="https://www.researchgate.net/publication/291349782_Early_Asbestos_Ware">likely added for</a> extra strength and resilience. Some of the <a href="https://www.researchgate.net/publication/357560672_Asbestos_Ceramics_from_Archaeological_Sites_of_Southern_Fennoscandia_Karelia_Mineralogical_and_Geochemical_Aspects">earliest asbestos</a> pottery, also found in Finland, has been dated to 4700 BC. Asbestos use has also been recorded at other neolithic sites, including in Central Russia and Norway.</p>
<p>In (Western) literature, the first known reference to what might have been asbestos comes from Theophrastus (circa 372-287 BC), a student of Greek philosopher Aristotle and his successor at the Lyceum. In his book <a href="https://www.xtal.iqfr.csic.es/Cristalografia/archivos_01/THEOPHRASTUS_CALEY.pdf">On Stones</a>, Theophrastus writes:</p>
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<p>In the mines at Scapte Hyle a stone was once found which was like rotten wood in appearance. Whenever oil was poured on it, it burnt, but when the oil had been used up, the stone stopped burning, as if it were itself unaffected.</p>
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<p>In the 10th century, Christian pilgrims travelling to Jerusalem were <a href="https://www.sciencedirect.com/science/article/abs/pii/S0305440314000399">sold</a> pieces of asbestos as fragments of the True Cross – their divinity supposedly evidenced by their incombustibility. By the medieval ages, trading asbestos-containing items had become common. This fascination continued for millennia.</p>
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<a href="https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">This earthenware pilgrim flask (circa 1585-1600) has an impresa with burning asbestos and the words ‘ardet aeternum’, meaning ‘burn forever’. It’s painted with a medallion showing a nude male (Bacchus) holding two bunches of grapes.</span>
<span class="attribution"><span class="source">British Museum</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
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<p>In 1725, a young Benjamin Franklin found himself broke and living in London. In need of cash to pay his bills, he sold a <a href="https://royalsocietypublishing.org/doi/pdf/10.1098/rsnr.1952.0018">purse</a> made of fibrous mineral asbestos that he’d brought from North America. The recipient was <a href="https://www.britishmuseum.org/about-us/british-museum-story/sir-hans-sloane">Hans Sloane</a>, whose collections would later be used to <a href="https://www.smithsonianmag.com/history/british-museum-was-wonder-its-time-also-product-slavery-180966997/">establish the British Museum</a>.</p>
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<h2>A class I carcinogen</h2>
<p>The carcinogenic effect of asbestos – even at brief, transient and “low” doses (such as bystander exposure) – has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069377/">recognised since</a> at least 1965. Today, it is classified as a class I carcinogen and considered a deadly threat to humans.</p>
<p>Asbestos is the main <a href="https://pubmed.ncbi.nlm.nih.gov/13782506/">cause of mesothelioma</a>, a cancer of the surface of the lung. It can also cause lung cancer and is implicated in other cancers, including throat and stomach cancers. </p>
<p>In Australia, there are more than <a href="https://www.aihw.gov.au/about-our-data/our-data-collections/australian-mesothelioma-registry-database-amr">700 cases</a> of mesothelioma each year. We don’t know how many of the roughly 6,000 yearly cases of lung cancer are caused, wholly or partially, by asbestos. </p>
<p>Although asbestos use has been banned in Australia <a href="https://www.asbestossafety.gov.au/countries-asbestos-bans#:%7E:text=Asbestos%20has%20been%20banned%20in,on%20all%20types%20of%20asbestos.">since 2003</a>, people the world over continue to deal with its harmful effects.</p>
<h2>The spread of ‘fibro houses’</h2>
<p>Australia started using asbestos goods from around the 1880s, largely for steam-driven machines that benefited from its insulating properties. Only small local mines operated at the time. </p>
<p>Eventually, the world wars increased demand and active exploration led to larger-scale mining, <a href="https://theconversation.com/more-than-2-000-people-from-wittenoom-died-of-asbestos-related-diseases-a-powerful-and-compelling-requiem-brings-their-story-to-the-stage-198779">especially at Wittenoom</a> in Western Australia. Even then, local production wasn’t meeting demand.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-2-000-people-from-wittenoom-died-of-asbestos-related-diseases-a-powerful-and-compelling-requiem-brings-their-story-to-the-stage-198779">More than 2,000 people from Wittenoom died of asbestos-related diseases. A powerful and compelling requiem brings their story to the stage</a>
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<p>It was initially miners who presented with the disease, followed by workers in industries manufacturing asbestos-containing products, as well as builders, plumbers and fitters. The Wittenoom miners and their families are still being <a href="https://www.nature.com/articles/bjc201223">followed by researchers</a> to determine the effects of exposure.</p>
<p>The economic boom that followed WWII further drove demand for asbestos. In addition to local production, more than <a href="https://www.researchgate.net/publication/285994368_Asbestos">50,000 tons of asbestos</a> were imported to Australia each year throughout the 1950s and into the late 1970s.</p>
<p>Asbestos afforded many Australians a home. Timber-framed houses clad in flat asbestos cement sheeting (called “fibro houses”) were favoured by people who built or legally supervised the building of their own home.</p>
<p>In <a href="https://www.booktopia.com.au/asbestos-in-australia-lenore-layman/book/9781925835618.html?msclkid=3d5f43a20ad011798598267e19af1c3d&utm_source=bing&utm_medium=cpc&utm_campaign=Booktopia%20-%20AU%20-%20Shopping&utm_term=4585169650599087&utm_content=All%20Custom%20Label">the mid-1960s</a>, nearly 20% of Australia’s housing stock was made up of fibro houses – with the highest uptake (more than 50%) in the Northern Territory. It’s impossible to say exactly what percentage of existing buildings contain asbestos.</p>
<p>When cyclone Tracy swept through Darwin in 1974, the <a href="https://www.miragenews.com/ken-s-journey-with-asbestos-disease-ends/">death and disease</a> that resulted from the uncoordinated cleanup served as a warning of the possible dangers of asbestos removal.</p>
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Read more:
<a href="https://theconversation.com/asbestos-still-haunts-those-exposed-as-kids-in-mining-towns-9487">Asbestos still haunts those exposed as kids in mining towns</a>
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<h2>Asbestos is here to stay</h2>
<p><a href="https://www.researchgate.net/publication/292053877_Dail_and_Hammar's_Pulmonary_Pathology">Asbestos-related cancers</a> have a long lag time between exposure and detectable disease. Although this lag is typically about 30 years, it can range anywhere between 10 and 70 years. As such, it can be difficult to trace exposure retrospectively.</p>
<p>Many buildings constructed before the mid-1980s contain asbestos. It’s often inseparably bound to other materials, such as tiles, vinyl and cement. </p>
<p>Regulations demand <a href="https://www.asbestossafety.gov.au/find-out-about-asbestos/asbestos-safety-information/brochures/asbestos-safety-householders-and-home-renovators">specialist removal</a> for asbestos-affected areas of more than 10 square metres. In reality, whether this happens comes down to how effectively it can be detected, and whether the people affected can afford removals. Without specialised assessment and analysis, asbestos can be difficult to recognise.</p>
<p>Since there is no recognised “safe” dose – a dose below which there’s no risk of developing asbestos-related cancer – <a href="https://www.safeworkaustralia.gov.au/sites/default/files/2023-09/guidance_material_-_asbestos_registers_guide_-_august_2023.pdf">workplace standards</a> can only minimise risk, not eliminate it.</p>
<p>Only time will tell what the long-term outcomes are from the latest exposure in NSW. The risk from asbestos depends on several factors, including the overall amount inhaled, the type of asbestos and the number of years since exposure.</p>
<p>Among the most heavily exposed Wittenoom miners, about 20% have developed mesothelioma so far.</p>
<h2>Documenting cases</h2>
<p>Since July 2010, the <a href="https://www.aihw.gov.au/about-our-data/our-data-collections/australian-mesothelioma-registry-database-amr">Australian Mesothelioma Registry</a> has collected information on new mesothelioma cases diagnosed in Australia. The national <a href="https://www.asbestossafety.gov.au/national-asbestos-exposure-register/online">Asbestos Exposure Register</a> also allows any person to register a documented or suspected case of exposure. </p>
<p>If you’re worried about your neighbourhood, the Asbestos and Silica Eradication Agency has produced a national heat map showing the <a href="https://www.asbestossafety.gov.au/what-we-do/news-and-announcements/national-residential-asbestos-heatmap-2023-update">probability of asbestos</a> presence in buildings by geographic area.</p><img src="https://counter.theconversation.com/content/223972/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sonja Klebe works for SA Pathology and gets called as a paid expert to court. She has received funding from NHMRC, MRFF, AstraZeneca, Roche and Ventana.
</span></em></p>One of the earliest known references to asbestos may come from Theophrastus, a student of Aristotle and his successor at the Lyceum in Athens.Sonja Klebe, Associare Professor, College of Medicine and Public Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2238622024-02-20T05:05:54Z2024-02-20T05:05:54ZDid your dog dig in asbestos-laden mulch? Here are the risks – and what to do next<p>This week, disturbing news emerged about <a href="https://theconversation.com/asbestos-in-mulch-heres-the-risk-if-youve-been-exposed-223729">mulch containing asbestos</a> in parks, schools and homes across New South Wales (<a href="https://www.canberratimes.com.au/story/8527611/test-samples-collected-to-check-act-mulch-asbestos-contamination/">and possibly Canberra</a>). So far, the discussion has focused on the risks to human health. </p>
<p>But the incidents have prompted me to worry about the effects on dogs. Dogs love to sniff, dig, lick and roll on the ground. That means dogs in the vicinity of the mulch may have been exposed to asbestos.</p>
<p>I research the environmental causes of cancer in animals. Animal exposure to asbestos is deeply worrying. Long-term exposure, even to low doses, can cause a type of cancer called mesothelioma. The disease also affects humans.</p>
<p>Here, I outline the risks of asbestos exposure in dogs, and what to do if you’re concerned.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/Rvuizzr4gqA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The experts trained to identify asbestos in mulch | 7.30, ABC, 19 February 2024.</span></figcaption>
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Read more:
<a href="https://theconversation.com/asbestos-in-mulch-heres-the-risk-if-youve-been-exposed-223729">Asbestos in mulch? Here's the risk if you've been exposed</a>
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<h2>What do we know about mesothelioma in dogs?</h2>
<p>Mesothelioma is an aggressive cancer that affects both animals and humans. It’s typically concentrated in the respiratory tract, but can affect all cells lining body cavities. </p>
<p>The illness is <a href="https://vsso.org/mesothelioma">rare in dogs</a>, causing less than 1% of all canine tumours. But it takes years to develop, by which time successful treatment is difficult. </p>
<p>Symptoms in dogs include difficulty breathing, enlarged abdomen and muffled heartbeat. A dog may cough, become lethargic, lose its appetite and become depressed. </p>
<p>In dogs, the incubation time – the period when the cancer is developing, is <a href="https://www.ncbi.nlm.nih.gov/books/NBK234946/">less than eight years</a>, compared with more than 20 years in humans. So studying cancer in pet dogs can provide important <a href="https://pubmed.ncbi.nlm.nih.gov/6641667/">information about similar cancers</a> that might also affect humans. </p>
<p>Dogs can be exposed to asbestos in the same way as humans – for example, during home renovation projects. People can wear protective gear, but animals cannot. Dogs also tend to lick things, which means they may ingest asbestos fibres as well as breathe them in. </p>
<p>Asbestos is more dangerous when it is “friable” or easily crumbled and broken up into smaller pieces, releasing fibres into the air. </p>
<p>One study from the 1980s showed <a href="https://pubmed.ncbi.nlm.nih.gov/6641667/">dogs could be exposed to asbestos</a>, through “secondary contact” or the actions of someone else. This may occur, for example, if a dog inhaled asbestos fibres from the clothes of its owner.</p>
<p>So during house renovations, pets may need to stay mostly outside, or at someone else’s house or a boarding kennel.</p>
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<a href="https://images.theconversation.com/files/576701/original/file-20240220-24-k79how.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A small dog looking up from digging a hole in the garden" src="https://images.theconversation.com/files/576701/original/file-20240220-24-k79how.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576701/original/file-20240220-24-k79how.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576701/original/file-20240220-24-k79how.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576701/original/file-20240220-24-k79how.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576701/original/file-20240220-24-k79how.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576701/original/file-20240220-24-k79how.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576701/original/file-20240220-24-k79how.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Dogs love to dig but this may can expose them to contaminants.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dog-garden-digging-hole-2167039171">jarizPJ, Shutterstock</a></span>
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<h2>What about the mulch issue?</h2>
<p>At latest count, <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240220-asbestos-investigation-updates-20-february">47 sites in NSW</a> have tested positive for asbestos in mulch. In the Australian Capital Territory, environment officials are investigating <a href="https://www.accesscanberra.act.gov.au/city-services/potential-mulch-asbestos-contamination">potentially contaminated “cottage mulch”</a> sold to 24 companies and 27 addresses in and around Canberra.</p>
<p>In <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240220-asbestos-investigation-updates-20-february">all but one Sydney case</a>, the asbestos was considered lower-risk as it was mixed with cement or other hard bonding materials. However, “non-friable” or “bonded” asbestos <a href="https://www.asbestos.nsw.gov.au/identify-asbestos/what-is-asbestos/friable-and-non-friable-asbestos">can become friable if damaged or old</a>. Then, asbestos can be released into the air. </p>
<p>The more dangerous friable asbestos was found at a popular <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240220-asbestos-investigation-updates-20-february">public park in Glebe</a>. This is concerning.</p>
<p>The risk of an animal developing cancer is influenced by duration of exposure and the extent of contamination. We don’t know what level of exposure is required to develop mesothelioma in dogs. But in humans, there is <a href="https://www.health.wa.gov.au/%7E/media/Files/Corporate/general-documents/Asbestos/PDF/AsbestosinandaroundyourhomeOctober2014.pdf">no known safe asbestos exposure level</a>. </p>
<h2>What to do if you’re concerned</h2>
<p>Mesothelioma can progress rapidly in both dogs and humans. Early diagnosis increases the chance of survival. </p>
<p>If you think your dog has been exposed to asbestos, take it to see a vet. The vet may perform an x-ray to check the dog’s lungs and/or abdomen and windpipe. If damage is present, a vet would take samples of tissue and fluids from the thorax or abdomen, for further examination.</p>
<p>So what happens if a dog is diagnosed with mesothelioma?</p>
<p>In some cases, the cancer will be so far progressed that treatment is not an option. In that case, all effort should be made to ensure the dog is as comfortable as possible. </p>
<p>If it’s not too late to start treatment, dogs can undergo chemotherapy, usually in the form of injections. One study suggests chemotherapy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9796774/">increases</a> a dog’s chance of survival.</p>
<p>The duration of treatment and side effects of chemotherapy vary depending on the severity of the dog’s case. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681408/">Deciding whether or not to proceed</a> with chemotherapy can be difficult and requires weighing up the costs and likely benefits. It is expensive, but many dogs cope remarkably well and <a href="https://adelaidevet.com.au/pet-library/chemotherapy-and-your-pet/">rarely lose their hair</a>. </p>
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<h2>A wake-up call</h2>
<p>Cancer in pets doesn’t always develop by chance. It can be caused by the air they breathe, the soil they dig in and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9969847/">water</a> they drink.</p>
<p>The case of asbestos-contaminated mulch should be a wake-up call for regulators and industry. But it should also remind pet owners to carefully consider the substances their animals might be exposed to, both inside and outside the home. </p>
<p>Gathering data on canine exposure to environmental hazards is crucial to understanding the origin of spontaneous cancers. We have just launched a national survey on the topic. You can <a href="https://uniofqueensland.syd1.qualtrics.com/jfe/form/SV_9YqjgniJezB8dym">find it here</a>.</p>
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Read more:
<a href="https://theconversation.com/why-does-my-dog-eat-grass-and-when-is-it-not-safe-for-them-205658">Why does my dog eat grass? And when is it not safe for them?</a>
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<img src="https://counter.theconversation.com/content/223862/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chiara Palmieri receives funding from philanthropic donations, the Australian Research Data Commons, Perpetual trust, canine research foundation, University of Queensland internal grant schemes, Meat & Livestock Australia, and Agrifutures.</span></em></p>Exposure to asbestos can cause the same cancer in dogs as it does in humans. Recent cases of asbestos-contaminated mulch highlight the need to better protect our pets.Chiara Palmieri, Professor, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2237292024-02-19T02:50:03Z2024-02-19T02:50:03ZAsbestos in mulch? Here’s the risk if you’ve been exposed<p>Mulch containing asbestos has now been found at <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240219-asbestos-investigation-updates">41 locations</a> in New South Wales, including Sydney parks, <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240211-asbestos-mulch-found-at-liverpool-west-public-school">schools</a>, <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240216-epa-to-conduct-priority-testing-at-sydney-schools">hospitals</a>, a <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240219-asbestos-investigation-updates">supermarket</a> and at least <a href="https://www.sbs.com.au/news/article/testing-for-asbestos-tainted-mulch-across-sydney-set-to-begin/0d6wo7hx6">one regional site</a>. Tests are under way at <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240219-asbestos-investigation-updates">other sites</a>. </p>
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<p>As a precautionary measure, some parks have been <a href="https://www.reuters.com/world/asia-pacific/sydney-parks-cordoned-off-mardi-gras-event-cancelled-after-asbestos-concerns-2024-02-15/#:%7E:text=SYDNEY%2C%20Feb%2016%20(Reuters),toxic%20material%20from%20public%20spaces.">cordoned off</a> and some schools have <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240219-asbestos-investigation-updates">closed</a> temporarily. Fair Day – a large public event that traditionally marks the start of Mardi Gras – <a href="https://whatson.cityofsydney.nsw.gov.au/events/fair-day">was cancelled</a> after contaminated mulch was found at the site.</p>
<p>The New South Wales government has announced a new <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240215-new-asbestos-taskforce-to-support-investigation-into-mulch">taskforce</a> to help investigate how the asbestos ended up in the mulch.</p>
<p>Here’s what we know about the risk to public health of mulch contaminated with asbestos, including “friable” asbestos, which <a href="https://www.theguardian.com/australia-news/2024/feb/14/nsw-opposition-calls-for-central-register-of-sites-under-investigation-amid-asbestos-crisis#:%7E:text=The%20City%20of%20Sydney%20announced%20on%20Tuesday%20that%20friable%20asbestos,been%20found%20at%20Regatta%20Park.">has been found</a> in one <a href="https://www.epa.nsw.gov.au/news/media-releases/2024/epamedia240216-epa-to-conduct-priority-testing-at-sydney-schools">site</a> (<a href="https://www.smh.com.au/national/nsw/asbestos-found-in-multiple-sydney-parks-20240213-p5f4ep.html">Harmony Park</a> in Surry Hills). </p>
<h2>What are the health risks of asbestos?</h2>
<p>Asbestos is a naturally occurring, heat-resistant fibre that was widely used in building materials from the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/workplace-cancer/asbestos">1940s to the 1980s</a>. It can be found in either a <a href="https://www.safeworkaustralia.gov.au/safety-topic/hazards/asbestos/overview">bonded or friable</a> form. </p>
<p>Bonded asbestos means the fibres are bound in a cement matrix. Asbestos sheeting that was used for walls, fences, roofs and eaves are examples of bonded asbestos. The fibres don’t escape this matrix unless the product is severely damaged or worn. </p>
<p>A lot of asbestos fragments from broken asbestos products are still considered bonded as the fibres are not released as they lay on the ground.</p>
<figure class="align-center ">
<img alt="Bonded asbestos" src="https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=322&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=322&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=322&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=404&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=404&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576359/original/file-20240219-16-54tww8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=404&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Asbestos sheeting was used for walls and roofs.</span>
<span class="attribution"><a class="source" href="https://theconversation.com/diy-renovators-now-most-at-risk-of-asbestos-cancers-3206">Tomas Regina/Shutterstock</a></span>
</figcaption>
</figure>
<p>Friable asbestos, in contrast, can be easily crumbled by touch. It will include raw asbestos fibres and previously bonded products that have worn to the point that they crumble easily.</p>
<p>The risk of disease from asbestos exposure is due to the <a href="https://www.asbestossafety.gov.au/asbestos-health-risks-and-exposure/asbestos-health-risks">inhalation of fibres</a>. It doesn’t matter if those fibres are from friable or bonded sources. </p>
<p>However, fibres can more easily become airborne, and therefore inhalable, if the asbestos is friable. This means there is more of a risk of exposure if you are disturbing friable asbestos than if you disturb fragments of bonded asbestos.</p>
<h2>Who is most at risk from asbestos exposure?</h2>
<p>The most important factor for disease risk is exposure – you actually have to inhale fibres to be at risk of disease. </p>
<p>Just being in the vicinity of asbestos, or material containing asbestos, does not put you at risk of asbestos-related disease. </p>
<p>For those who accessed the contaminated areas, the level of exposure will depend on disturbing the asbestos and how many fibres become airborne due to that disturbance. </p>
<p>However, if you have been exposed to, and inhaled, asbestos fibres it does not mean you will get an asbestos-related disease. Exposure levels from the sites across Sydney will be low and the chance of disease is highly unlikely.</p>
<p>The evidence for disease risk from ingestion remains <a href="https://iris.who.int/bitstream/handle/10665/350932/WHO-HEP-ECH-WSH-2021.4-eng.pdf">highly uncertain</a>, although you are not likely to ingest sufficient fibres from the air, or even the hand to mouth activities that may occur with playing in contaminated mulch, for this to be a concern.</p>
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<p>The risk of disease from exposure depends on the <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1445-5994.2011.02451.x">intensity, frequency and duration of that exposure</a>. That is, the more you are exposed to asbestos, the greater the risk of disease. </p>
<p>Most asbestos-related disease has occurred in people who work with raw asbestos (for example, asbestos miners) or asbestos-containing products (such as building tradespeople). This has been a tragedy and fortunately asbestos is now banned. </p>
<p>There have been cases of asbestos-related disease, most notably mesothelioma – a cancer of the lining of the lung (mostly) or peritoneum – from non-occupational exposures. This has included people who have undertaken DIY home renovations and may have only had <a href="https://www.mja.com.au/journal/2011/195/5/increasing-incidence-malignant-mesothelioma-after-exposure-asbestos-during-home">short-term exposures</a>. The level of exposure in these cases is not known and it is also impossible to determine if those activities have been the only exposure. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/diy-renovators-now-most-at-risk-of-asbestos-cancers-3206">DIY renovators now most at risk of asbestos cancers</a>
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<p>There is no <em>known</em> safe level of exposure – but this <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1445-5994.2011.02451.x">does not mean that one fibre will kill</a>. Asbestos needs to be treated with caution.</p>
<p>As far as we are aware, there have been no cases of mesothelioma, or other asbestos-related disease, that have been caused by <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/resp.14648">exposure from contaminated soils or mulch</a>.</p>
<h2>Has asbestos been found in mulch before?</h2>
<p>Asbestos contamination of mulch is, unfortunately, <a href="https://www.perthnow.com.au/news/wa/asbestos-mulch-fears-in-perth-southern-suburb-aubin-grove-ng-1b39c602956a6588f35f42b90be75e40">not new</a>. Environmental and health agencies have dealt with these situations in the past. All jurisdictions have strict regulations about removing asbestos products from the green waste stream but, as is happening in Sydney now, this does not always happen. </p>
<figure class="align-center ">
<img alt="Mulch" src="https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576363/original/file-20240219-30-nbwq6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Mulch contamination is not new.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/barking-mulch-617198870">gibleho/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What if I’ve been near contaminated mulch?</h2>
<p>Exposure from mulch contamination is generally much lower than from current renovation or construction activities and will be many orders of magnitude lower than past occupational exposures. </p>
<p>Unlike activities such as demolition, construction and mining, the generation of airborne fibres from asbestos fragments in mulch will be very low. The asbestos contamination will be sparsely spread throughout the mulch and it is unlikely there will be sufficient disturbance to generate large quantities of airborne fibres. </p>
<p>Despite the low chance of exposure, if you’re near contaminated mulch, do not disturb it. </p>
<p>If, by chance, you have had an exposure, or think you have had an exposure, it’s highly unlikely you will develop an asbestos-related disease in the future. If you’re worried, the <a href="https://www.asbestossafety.gov.au/asbestos-home">Asbestos Safety and Eradication Agency</a> is a good source of information.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/asbestos-still-haunts-those-exposed-as-kids-in-mining-towns-9487">Asbestos still haunts those exposed as kids in mining towns</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/223729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Franklin is on the board of Reflections, a not-for-profit organisation for the asbestos awareness and support of people with asbestos-related disease. </span></em></p>The most important factor for disease risk is exposure – you actually have to inhale asbestos fibres to be at risk of disease. But asbestos needs to be treated with caution.Peter Franklin, Associate Professor and Director, Occupational Respiratory Epidemiology, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2129322023-09-11T09:08:00Z2023-09-11T09:08:00ZConcrete crisis: officials thought asbestos in schools was safe too – the same mistakes have been made over Raac<p>The decision to close some schools and erect emergency structural supports in others just days before the start of a new term appeared to come about suddenly. The announcement followed three recent failures of reinforced autoclaved aerated concrete (Raac), in particular the <a href="https://www.bbc.co.uk/news/education-66681702">collapse of a beam in late August</a> at a primary school in Leicester. </p>
<p>The schools minister, <a href="https://www.bbc.co.uk/news/uk-england-south-yorkshire-66680856">Nick Gibbs</a>, said: “Raac that had been considered to be a low risk actually turned out to be unsafe.” </p>
<p>This “low risk” status meant that, if these sudden failures had not happened, no immediate remedial action would have been required in the affected schools. These buildings were effectively classified as “safe enough” – until it became clear that Raac even considered “low risk” by officials could collapse at any moment. </p>
<p>Clearly, what is considered safe can change quickly, when there is new evidence (or new interpretations of evidence). </p>
<p>This situation shows that claims about building safety that rely on managing and mitigating known risks – without fixing or removing them – are inadequate for the people who use those buildings. Buildings classified by technicians or officials as “safe enough” are unlikely to be accepted as such by school workers, children and their families.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/J4DNOcuHl1c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<h2>Asbestos and school safety</h2>
<p>The UK saw a similar situation in the 1980s. Concerns then were not about crumbling concrete, but another major danger in thousands of schools: <a href="https://theconversation.com/the-hidden-danger-of-asbestos-in-uk-schools-i-dont-think-they-realise-how-much-risk-it-poses-to-students-203582">asbestos</a>.</p>
<p>For local authorities and officials, as long as it was monitored and managed, the presence of asbestos was not considered a cause for concern. For parents, teachers and children, this wasn’t good enough assurance. </p>
<p>Working with charities and campaigners, parents and teachers launched protests to challenge official declarations of the risks of asbestos in schools, and ensure their voices were heard in debates about what was considered safe. </p>
<p>Children and parents picketed schools, and parents and teachers organised into asbestos action groups. Some parents withheld their children from school, and in at least one case in the 1990s, as I found in archival research, were faced with legal action by the council. </p>
<p>One of the schools subject to these protests was a primary school in the London borough of Enfield. In response to parents’ campaigning and a report by leading <a href="https://www.theguardian.com/society/2009/feb/23/nancy-tait">anti-asbestos campaigner Nancy Tait</a>, the council took air samples to detect asbestos fibres within the school. </p>
<p>The data appeared to show that fibre levels were within <a href="https://www.britsafe.org/publications/safety-management-magazine/safety-management-magazine/2014/asbestos-testing-up-in-the-air/">the limits recommended</a> by the health and safety executive at the time. But Tait challenged the assertion that this meant the school was safe. </p>
<p>She highlighted that these “official” limits were based on scientific reports that focused on asbestos factories, not schools or other public buildings where conditions were quite different. They also ignored the growing international consensus that there was no safe level of exposure to asbestos. </p>
<p>Reports, like the one <a href="https://www.hse.gov.uk/asbestos/assets/docs/exposure.pdf">cited by Enfield Borough Council</a>, used statistical estimates of the likelihood of someone working in a factory for years or decades being diagnosed with an asbestos-related disease. The key assumption was that a certain amount of death and disease in such an industry was, essentially, inevitable. But when this was applied to schools or other non-industrial settings, that argument was far from convincing. </p>
<h2>Raac and risk</h2>
<p>As recently as 2022, the government has <a href="https://publications.parliament.uk/pa/cm5803/cmselect/cmworpen/633/report.html">rejected recommendations</a> by a <a href="https://publications.parliament.uk/pa/cm5802/cmselect/cmworpen/560/report.html">parliamentary committee</a> to commit to a 40-year deadline to remove all asbestos in schools. Central to this reasoning is the idea that there is an “acceptable” level of risk for asbestos exposure in schools. The government said that it “currently has a mature and comprehensive plan to managing legacy asbestos risks”.</p>
<p>The danger of the approach of managing – but not removing – risks can be seen in the rapidly spiralling Raac crisis. Like asbestos, a known problem with potentially devastating consequences was considered to be manageable until it was suddenly proven not to be. </p>
<figure class="align-center ">
<img alt="Workers in full body protection removing asbestos from a small structure with a corrugated metal roof" src="https://images.theconversation.com/files/547180/original/file-20230908-29-okjsqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547180/original/file-20230908-29-okjsqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547180/original/file-20230908-29-okjsqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547180/original/file-20230908-29-okjsqi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547180/original/file-20230908-29-okjsqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547180/original/file-20230908-29-okjsqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547180/original/file-20230908-29-okjsqi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">What is considered ‘acceptable’ risk is different for asbestos workers than for schoolchildren.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/professional-asbestos-removal-men-protective-suits-1385432417">Logtnest/Shutterstock</a></span>
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<p>Nancy Tait’s report on the Enfield school included a wealth of evidence, including detailed summaries and reviews of technical literature on asbestos products. It also gave a voice to those directly affected, through the names and stories of 16 people who had died from <a href="https://www.nhs.uk/conditions/mesothelioma/">mesothelioma</a> after brief exposures to asbestos. </p>
<p>Putting names to the numbers is an important way to challenge ideas about managing acceptable risk. Campaigners like Tait, who were often affected by asbestos-related disease themselves (her husband died of mesothelioma), were instrumental in <a href="https://journals.sagepub.com/doi/abs/10.2190/NS.21.4.j">shifting public perceptions</a> of asbestos and the eventual banning of asbestos in the UK in 1999.</p>
<p>The current Raac crisis presents the government with an opportunity to re-evaluate its approach to safety in schools and other public buildings. In addition to technical studies, new understandings of safety should be developed by engaging with affected communities – in this case, the thousands of families whose children are now displaced from their school buildings at short notice.</p>
<p>The Raac scandal lays bare the fallibility of expert evaluations, at significant risk to the public. What is considered safe one day can be considered critically dangerous the next. Continuing to rely on the management of risk only will not result in a safe environment in schools.</p><img src="https://counter.theconversation.com/content/212932/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Page does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Raac and asbestos in schools show that ‘official’ declarations of safety are not acceptable to families.Adam Page, Lecturer in Modern British History, University of LincolnLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2035822023-04-18T16:12:06Z2023-04-18T16:12:06ZThe hidden danger of asbestos in UK schools: ‘I don’t think they realise how much risk it poses to students’<figure><img src="https://images.theconversation.com/files/520743/original/file-20230413-20-dirux3.jpg?ixlib=rb-1.1.0&rect=16%2C101%2C3554%2C2093&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A Department for Education survey suggests more than 80% of state schools in England still have asbestos on their premises.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/canterbury-kent-england-oct-24-2021-2085375118">Lucy M Ryan/Shutterstock</a></span></figcaption></figure><blockquote>
<p>Being diagnosed came as a complete shock. You do not imagine that you are going to go into a school to teach children and come out with an industrial disease.</p>
</blockquote>
<p>Carole Hagedorn had taught foreign languages in schools in south-east England for more than 30 years when she was diagnosed with malignant <a href="https://www.nhs.uk/conditions/mesothelioma/">mesothelioma</a> – a cancer caused almost exclusively by exposure to asbestos fibres in the air.</p>
<p>Mesothelioma develops rapidly and has no cure. Symptoms include chronic productive coughing, breathlessness, chest pain and fatigue. While treatment innovations are progressing, the disease is not curable and about <a href="https://www.rcplondon.ac.uk/projects/outputs/national-mesothelioma-audit-report-2020-audit-period-2016-18">60% of patients</a> die within a year of receiving a diagnosis.</p>
<p>The particular threat posed to teachers and school workers was highlighted in <a href="https://www.theguardian.com/global/2023/jan/15/uk-unions-call-in-cancer-expert-over-fears-of-asbestos-risk-to-female-teachers">a recent analysis</a> which suggested that the risk to women in their late-40s to mid-60s who have worked in schools is statistically significant. This builds on <a href="https://www.fieldfisher.com/en/injury-claims/insights/hse-statistics-show-male-carpenters-and-female-tea">earlier data</a> that had identified a potential elevated risk for female teachers and education professionals.</p>
<p>Hagedorn, who died in 2014, told the <a href="https://www.tes.com/magazine/archive/asbestos-victim-facing-death-heed-my-warning">TES</a> she had been shocked by her diagnosis, which is more usually associated with men who have worked in heavy industries. Having been forced to retire due to ill-health, she said she was angry at being viewed as “some sort of collateral damage or natural wastage in the education game”.</p>
<p>But it is not just teachers and school workers who are of concern – many children may have been exposed while at school. However, since mesothelioma is regarded as an industrial disease and being a child is not an occupation, the Office for National Statistics (ONS) keeps no data on deaths from mesothelioma due to exposure to asbestos as a school pupil.</p>
<p>Following her diagnosis, Hagedorn warned in the <a href="https://www.standard.co.uk/hp/front/dying-teacher-asbestos-in-schools-will-kill-pupils-6771486.html">Evening Standard</a> in 2009:</p>
<blockquote>
<p>Children are thought to be much more susceptible than adults. However, we probably won’t know for another 20 or 30 years how many will already have contracted this cancer from exposure in schools.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520739/original/file-20230413-18-6y9ct8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Asbestos chrysotile fibres." src="https://images.theconversation.com/files/520739/original/file-20230413-18-6y9ct8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520739/original/file-20230413-18-6y9ct8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520739/original/file-20230413-18-6y9ct8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520739/original/file-20230413-18-6y9ct8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520739/original/file-20230413-18-6y9ct8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520739/original/file-20230413-18-6y9ct8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520739/original/file-20230413-18-6y9ct8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chrysotile (white asbestos) fibres.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asbestos-chrysotile-fibers-that-cause-lung-1871676343">Wirestock Creators/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why children are particularly vulnerable</h2>
<p>In March 2011, the UK’s <a href="https://www.supremecourt.uk/cases/uksc-2009-0232.html">supreme court ruled</a> that Dianne Willmore had been exposed to asbestos while she was a pupil at Bowring Comprehensive in Liverpool in the 1970s. As a result, she developed what the court called the “hideous disease” of mesothelioma.</p>
<p>Willmore had died in 2009, aged 49 – just hours after the court of appeal first decided she was entitled to compensation. One of the UK’s leading experts on asbestos-related cancers, <a href="https://royalsociety.org/people/julian-peto-14115/">Julian Peto</a>, later estimated to a parliamentary select committee that <a href="http://www.rbasbestos.co.uk/wp-content/uploads/2015/08/appg-booklet-final-17-mar-14-asbestos-in-schools-2-1-.pdf#:%7E:text=In%202013%20a%20leading%20epidemiologist%20gave%20evidence%20to,the%20exposures%20continue%2C%20then%20so%20will%20the%20deaths.">between 200 and 300 former pupils</a> would die each year as a result of their exposure to asbestos while at school in the 1960s and ’70s.</p>
<p>Today, deaths of former pupils from mesothelioma due to asbestos exposure are still not officially recognised. Instead, they remain hidden among the UK’s unusually high “background rate” of the disease, not included as a specific ONS category. Yet children are particularly vulnerable to asbestos – a point made starkly ten years ago in a <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/315919/vulnerability_of_children_to_asbestos.pdf">report</a> for the Department for Education (DfE):</p>
<blockquote>
<p>[Exposure] of children to asbestos is likely to render them more vulnerable to mesothelioma than exposure of adults to an equivalent asbestos dose.</p>
</blockquote>
<p>Mesothelioma risk from asbestos is unlike lung cancer risk from smoking. If a smoker gives up, the risk of lung cancer declines over time. By contrast, the risk of mesothelioma from an exposure to asbestos <a href="https://link.springer.com/article/10.1007/s00420-019-01433-4">accumulates over time</a>. A five-year-old child who is exposed to asbestos has been estimated to be <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/315919/vulnerability_of_children_to_asbestos.pdf">five times more likely</a> to develop mesothelioma during their lifetime than an adult who is first exposed at the age of 30.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><strong><em>This article is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.</em></p>
<hr>
<p>In the absence of hard data on deaths from mesothelioma due to exposure as a pupil at school, a document from the US Environmental Protection Agency (EPA) is widely <a href="https://nepis.epa.gov/Exe/ZyNET.exe/9100BENP.TXT?ZyActionD=ZyDocument&Client=EPA&Index=1976+Thru+1980&Docs=&Query=&Time=&EndTime=&SearchMethod=1&TocRestrict=n&Toc=&TocEntry=&QField=&QFieldYear=&QFieldMonth=&QFieldDay=&IntQFieldOp=0&ExtQFieldOp=0&XmlQuery=&File=D%3A%5Czyfiles%5CIndex%20Data%5C76thru80%5CTxt%5C00000012%5C9100BENP.txt&User=ANONYMOUS&Password=anonymous&SortMethod=h%7C-&MaximumDocuments=1&FuzzyDegree=0&ImageQuality=r75g8/r75g8/x150y150g16/i425&Display=hpfr&DefSeekPage=x&SearchBack=ZyActionL&Back=ZyActionS&BackDesc=Results%20page&MaximumPages=1&ZyEntry=1&SeekPage=x&ZyPURL">cited</a>. Using US data to develop a model of the risk presented to both workers and pupils in schools, the report concluded that around 90% of premature deaths due to asbestos exposure at school occur in people who were exposed as children.</p>
<p>Putting the Peto and EPA estimates together, the Joint Union Asbestos Committee subsequently reported that over the period 1980-2017, the number of UK mesothelioma deaths as a result of exposure to asbestos as school pupils <a href="https://norac.org.uk/wp-content/uploads/2021/07/Continuing-Government-Failure-leads-to-rise-in-school-mesothelioma-deaths-JUAC-REPORT-02-07-2021-FINAL.pdf">was between 3,890 and 9,000</a>.</p>
<p>In 2021-22, we conducted <a href="https://www.sheffield.ac.uk/media/36602/download?attachment">our own review</a> of media and legal coverage of 84 people who had developed mesothelioma after being exposed to asbestos while working in UK schools. These included heart-rending interviews with patients and relatives who, despite their own suffering, were keen to highlight wider concerns about the threat that asbestos in schools might pose to children.</p>
<p>For example, Mick Adkins, an electrician contracted to work in Birmingham schools and who died of mesothelioma, told the <a href="https://www.thefreelibrary.com/I+got+cancer+from+schools%3B+EXCLUSIVE+THE+ASBESTOS+TIMEBOMB+%27Builders...-a0161338347">Sunday Mercury</a> in 2007:</p>
<blockquote>
<p>How many schools are swamped with asbestos? We literally caked them in it when I was building them, so God only knows how many people, young and old, have been exposed to it over the last 40 years.</p>
</blockquote>
<p>And Freddie Davis – husband of Pearl, a former primary school teacher in Gillingham and Chatham who died of mesothelioma – <a href="https://www.irwinmitchell.com/news-and-insights/newsandmedia/2017/february/husband-appeals-for-help-after-teacher-wife-dies-following-asbestos-cancer-diagnosis-jq-504632">reflected after her death</a>:</p>
<blockquote>
<p>What was also incredibly upsetting to Pearl was the idea that children may have been put at risk on those premises. It doesn’t bear thinking about.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520727/original/file-20230413-20-gqkc7s.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An asbestos enclosure" src="https://images.theconversation.com/files/520727/original/file-20230413-20-gqkc7s.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520727/original/file-20230413-20-gqkc7s.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520727/original/file-20230413-20-gqkc7s.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520727/original/file-20230413-20-gqkc7s.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520727/original/file-20230413-20-gqkc7s.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520727/original/file-20230413-20-gqkc7s.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520727/original/file-20230413-20-gqkc7s.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A protective enclosure for the removal of asbestos.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/2/2a/UK_Asbestos_Removal_Enclosure.jpg">Fevs101/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Why there is so much asbestos in UK schools</h2>
<p>The presence and problem of asbestos in schools has been known about for many years. A 2019 DfE <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/906343/AMAP_Report_2019.pdf">survey</a> suggested that around 81% of primary and secondary state schools in England still have asbestos “present on their estate” – despite the use of asbestos in any form <a href="https://www.gov.uk/government/publications/asbestos-properties-incident-management-and-toxicology/asbestos-general-information">having been banned</a> in the UK since 1999.</p>
<p>Commercial exploitation of asbestos in the UK <a href="https://blogs.imperial.ac.uk/imperial-medicine/2018/02/02/the-asbestos-story-a-tale-of-public-health-and-politics/">began in the 1870s</a>. Its resistance to high temperatures and fire made it valuable in steam-powered industries. The same properties later made it useful as a fire retardant and heat insulator in buildings.</p>
<p>Between 1920 and 1970, the UK was the largest importer of asbestos <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221761/">in Europe</a>. This period includes the massive post-war rebuilding programme which made widespread use of <a href="https://en.wikipedia.org/wiki/Prefabs_in_the_United_Kingdom">prefabrication</a>, or system building, to rapidly erect buildings including many homes and schools, often with asbestos incorporated.</p>
<p>The UK’s relatively cold climate also meant that better insulating – but <a href="https://ec.europa.eu/taxation_customs/dds2/SAMANCTA/EN/Safety/Asbestos_EN.htm">more dangerous</a> – types of asbestos were used. And its links with former colonies, particularly Australia and South Africa, allowed the UK to import asbestos at cheaper rates <a href="https://lucionservices.com/insights/deadly-exposures-uk-misses-the-mark-with-asbestos-controls">than the rest of Europe</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520728/original/file-20230413-18-ix7bwy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Curved asbestos sheeting" src="https://images.theconversation.com/files/520728/original/file-20230413-18-ix7bwy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520728/original/file-20230413-18-ix7bwy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=874&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520728/original/file-20230413-18-ix7bwy.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=874&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520728/original/file-20230413-18-ix7bwy.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=874&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520728/original/file-20230413-18-ix7bwy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1099&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520728/original/file-20230413-18-ix7bwy.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1099&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520728/original/file-20230413-18-ix7bwy.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1099&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Curved asbestos sheets for the construction of temporary houses after the end of the second world war.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/2/2b/Post_War_Planning_and_Reconstruction_in_Britain-_Construction_of_Temporary_Housing_D24195.jpg">Ministry of Information via Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>As a result of this high usage, the UK now has one of the world’s <a href="http://www.ibasecretariat.org/lka-global-mesothelioma-landscape-2015.pdf">highest rates of mesothelioma</a>. In 2020, there were <a href="https://www.globalenvironmental.co.uk/asbestos-related-deaths-in-the-uk-continue-to-rise/#:%7E:text=There%20were%202%2C544%20mesothelioma%20deaths,deaths%2C%20and%20459%20female%20deaths.">2,544 mesothelioma deaths</a> registered. The annual UK total has now been increasing year-on-year for more than 50 years, such that the 2010s saw more than eight times as many deaths from mesothelioma as the 1970s.</p>
<p>The very first UK death from lung fibrosis caused by asbestos was <a href="https://blogs.imperial.ac.uk/imperial-medicine/2018/02/02/the-asbestos-story-a-tale-of-public-health-and-politics/">reported</a> back in 1899. The first UK government regulations aimed at controlling exposure to asbestos were introduced in 1931, and carcinoma due to asbestos exposure was <a href="https://pmj.bmj.com/content/80/940/72">first described in 1935</a>. By 1960, it was known that asbestos exposure at low levels could cause mesothelioma.</p>
<p>Yet three years earlier, the Consortium of Local Authorities Special Programme (<a href="https://www.designingbuildings.co.uk/wiki/CLASP">Clasp</a>) had been introduced in England with the aim of developing prefabricated school buildings using a modular design around a steel framework.</p>
<p>The open and light nature of these structures made them vulnerable to fire – and so, <a href="https://en.wikipedia.org/wiki/Consortium_of_Local_Authorities_Special_Programme#Asbestos_in_CLASP_buildings">asbestos was extensively used</a> within them for its retardant properties. It was embedded in ceiling panels, wall boards, pipe lagging, and to cover any structural gaps. The asbestos used in Clasp buildings included large amounts of the even more dangerous <a href="https://www.pennmedicine.org/cancer/types-of-cancer/mesothelioma/asbestos-cancer/types-of-asbestos#:%7E:text=Amosite%20asbestos%2C%20also%20known%20as,that%20can%20be%20easily%20inhaled.">amosite</a> type, also known as “brown” asbestos.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520801/original/file-20230413-22-z1wqbv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="System-built school premises" src="https://images.theconversation.com/files/520801/original/file-20230413-22-z1wqbv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520801/original/file-20230413-22-z1wqbv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520801/original/file-20230413-22-z1wqbv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520801/original/file-20230413-22-z1wqbv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520801/original/file-20230413-22-z1wqbv.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520801/original/file-20230413-22-z1wqbv.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520801/original/file-20230413-22-z1wqbv.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This Clasp schoolroom built in Derbyshire in the 1970s was demolished in 2018.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/9/91/GlossopdaleCommunityCollegeHadfieldSportsHall.jpg">Fitzyraz via Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>Thousands of Clasp buildings – mainly schools – were constructed, particularly in coal mining areas such as Nottinghamshire and Derbyshire that were likely to be affected by subsidence (the modular design allowed for easier replacement and repair). An <a href="https://greenfieldremovals.com/clasp-buildings-of-the-50s-simple-cost-effective-dangerous/">estimate in 2016</a> suggested that around 3,000 of these buildings were still in use.</p>
<p>While <a href="https://www.innovaresystems.co.uk/2016/07/21/modular-building-can-meet-school-demand-must-look-like-normal-buildings-says-mike-green-director-efa/">further schemes</a> similar to Clasp continued into the 1970s, system building in general fell out of favour. However, up to the UK’s outright ban on asbestos in 1999, it was still being used in specific building features such as radiator panels. Today, system-built schools remain of particular concern to health researchers as they age and deteriorate.</p>
<h2>In-situ management: the problem for schools</h2>
<p>Under the present <a href="https://www.hse.gov.uk/asbestos/regulations.htm">Control of Asbestos Regulations 2012</a>, those responsible for the maintenance and repair of non-domestic premises, such as schools, are required to follow a policy of “<a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/412466/The_management_of_asbestos_in_schools_a_review_of_Department_for_Education_policy.pdf">in-situ management</a>”. This is based on the idea that asbestos presents little risk provided it is in good condition and not disturbed.</p>
<p>The estimated four in every five UK state schools that have asbestos on their estate are required to have an <a href="https://www.hse.gov.uk/asbestos/managing/write.htm">asbestos management plan</a>, designed to ensure its condition is regularly monitored. Should its condition deteriorate, then the asbestos would be removed alongside compulsory monitoring of air quality. Between September 2022 and March 2023, the Health and Safety Executive carried out 400 school inspections to make sure asbestos in schools was being correctly managed.</p>
<p>But our research shows that such management plans can, in some cases, become little more than box-ticking exercises, not necessarily performed well. As Carol Anthony, whose husband Alan, a teacher, died of mesothelioma in 2011, later <a href="https://silo.tips/download/asbestos-incidents-and-failures-of-asbestos-management-in-schools">reflected</a>:</p>
<blockquote>
<p>We cannot be certain of where in schools there is asbestos because inadequate records were kept in the past, and it can be unwittingly disturbed during a building programme. In the case of my husband, the solicitors tried to track down the source of asbestos in the London school where he worked, but there was only a very scanty record – and by that I mean scrappy notes on a sheet of A4 paper.</p>
</blockquote>
<p>And even well-kept management plans run into the problem that schools typically experience high levels of damage and deterioration. Asbestos <a href="https://www.gavinpublishers.com/article/view/the-experiences-of-presentation-diagnosis--treatment-and-care-for-school-based-education-workers-with-mesothelioma-a-scoping-review">can be found</a> in panelling under radiators, within electric storage heaters with blowers, and in music room walls and ceilings, for example. All may be vulnerable to curious or mischievous schoolchildren.</p>
<p>A teacher of 27 years in north Lincolnshire, Elizabeth Belt, who died of mesothelioma in 2015, gave a statement before her death which <a href="https://www.mirror.co.uk/news/uk-news/teacher-dies-after-being-exposed-7225791">outlined</a> many occasions when she believed she had been exposed to asbestos. For example:</p>
<blockquote>
<p>A boy had made a hole in the wall at one time and pupils would kick at the walls. There were holes in the corridor walls.</p>
</blockquote>
<p>Similarly, Joan Henry, a drama teacher in Havering, east London, who died of mesothelioma in 2009, had <a href="https://www.gavinpublishers.com/article/view/the-experiences-of-presentation-diagnosis--treatment-and-care-for-school-based-education-workers-with-mesothelioma-a-scoping-review">noted</a>:</p>
<blockquote>
<p>Frighteningly, the disturbance was what could be described as natural “wear and tear” – pupils disturbing it with bags, rulers etc.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520795/original/file-20230413-18-hlbgcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pipes surrounded by asbestos insulation." src="https://images.theconversation.com/files/520795/original/file-20230413-18-hlbgcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520795/original/file-20230413-18-hlbgcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520795/original/file-20230413-18-hlbgcr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520795/original/file-20230413-18-hlbgcr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520795/original/file-20230413-18-hlbgcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520795/original/file-20230413-18-hlbgcr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520795/original/file-20230413-18-hlbgcr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Old pipes surrounded by asbestos insulation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/picture-pipe-containing-asbestos-insulation-2200176187">James Ebanks/Shutterstock</a></span>
</figcaption>
</figure>
<h2>The behaviour of children – a legal issue</h2>
<p>The “mischievous” nature of children was first established to be of legal significance <a href="https://asbestoslawblog.files.wordpress.com/2020/08/asbestos-in-schools-a-breach-of-absolute-statutory-dutyfinal2.pdf">in 1893</a>, when a case concerning the responsibilities of a schoolmaster acknowledged that:</p>
<blockquote>
<p>Children by their ordinary nature had a tendency “to do mischievous acts and [a] propensity to meddle with anything that came their way”.</p>
</blockquote>
<p>The legal importance of this is that those responsible for health and safety in schools, such as education authorities, are required to allow for how children behave when devising management plans. But there is little evidence that they do this in the asbestos plans kept by schools.</p>
<p>The Willmore <a href="https://www.supremecourt.uk/cases/uksc-2009-0232.html">supreme court hearing</a>, for example, cited several acts of mischief and bullying that may have exposed her to asbestos dust:</p>
<blockquote>
<p>[Willmore] was exposed to asbestos several times. Asbestos insulation ceiling tiles had been taken down and stacked in a busy corridor while electricians worked on cables … Bullies took children’s satchels and blazers and hid them in the ceiling tiles. And there had been vandalism in the girl’s toilets, where asbestos ceiling tiles <a href="https://www.theguardian.com/education/2011/mar/09/asbestos-school-compensation-dianne-willmore">were also stacked</a>.</p>
</blockquote>
<p>And this point is supported by a <a href="https://silo.tips/download/asbestos-incidents-and-failures-of-asbestos-management-in-schools">collated report</a> of 291 failures of asbestos management in schools that resulted in the release of asbestos fibres between September 2000 and March 2014. This report was written by Michael Lees, a founder member of the <a href="http://www.asbestosinschools.org.uk/background-and-cv-of-this-site/">Asbestos in Schools Group</a>, whose wife Gina was a nursery school teacher who died at the age of 51 following exposure to asbestos at work. In a 30-year teaching career, she had worked at 25 schools, most of which contained asbestos.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520753/original/file-20230413-16-ix7bwy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Damaged school building" src="https://images.theconversation.com/files/520753/original/file-20230413-16-ix7bwy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520753/original/file-20230413-16-ix7bwy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520753/original/file-20230413-16-ix7bwy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520753/original/file-20230413-16-ix7bwy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520753/original/file-20230413-16-ix7bwy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520753/original/file-20230413-16-ix7bwy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520753/original/file-20230413-16-ix7bwy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A damaged old school building in Wolverhampton.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/abandoned-building-inside-located-england-wolverhampton-655275790">Sigitas Duoblis/Shutterstock</a></span>
</figcaption>
</figure>
<p>There are also concerns about the level of knowledge among those who work in schools containing asbestos. The Health and Safety Executive’s <a href="https://www.hse.gov.uk/asbestos/managing/tell.htm">guidelines</a> require only fairly minimal interventions – for example, that the employee responsible for the asbestos plan:</p>
<blockquote>
<p>… should stick labels on anything that contains or might contain asbestos if it is located where people are likely to disturb or damage it. Get these from safety sign companies.</p>
</blockquote>
<p>It seems unlikely that this takes adequate heed of the “mischievous” nature of children. In addition, there seems to be little requirement for education or training regarding asbestos.</p>
<p>Elizabeth Bradford worked as an infant school teacher for many years, including in a building prefabricated from asbestos-containing materials on which she pinned children’s work. In a <a href="https://www.youtube.com/watch?v=P6TPkfKAG-A">video</a> recorded in 2011, she said:</p>
<blockquote>
<p>I was asked if I’d ever worked with asbestos and I said no. But then I remembered – going back many, many years – that I had actually worked in a classroom which was, I felt, lined with asbestos. In fact, I had been told it was asbestos, but that it was white asbestos and it was safe, and I’d taken that on trust.</p>
</blockquote>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/P6TPkfKAG-A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Interview with infant teacher Elizabeth Bradford.</span></figcaption>
</figure>
<p>According to the <a href="https://www.ncbi.nlm.nih.gov/books/NBK304374/">International Agency</a> for Research on Cancer and the <a href="https://www.who.int/publications/i/item/9789241564816">World Health Organization</a>, all types of asbestos cause cancer in humans, but the risk increases with type. The ratio of risk for white (chrysotile), brown (amosite) and blue (crocidolite) asbestos has <a href="https://pubmed.ncbi.nlm.nih.gov/11108782/">been estimated</a> at 1:100:500. The danger is related to each material’s “<a href="https://en.wikipedia.org/wiki/Friability#:%7E:text=In%20materials%20science%2C%20friability%20(%2F,or%20contact%2C%20especially%20by%20rubbing.">friability</a>”, as well as to the toxicity of the fibres that are released and inhaled.</p>
<h2>A rare and aggressive cancer</h2>
<p><a href="https://www.nhs.uk/conditions/mesothelioma/">Malignant mesothelioma</a> is a rare and aggressive cancer with a high symptom burden. It most commonly affects the lungs, although it can also affect the abdomen and testes. It causes a range of debilitating symptoms including breathlessness, pain, fatigue and cough – which can often emerge quite suddenly.</p>
<p>According to the <a href="https://www.ukata.org.uk/documents/404/Mesothelioma_mortality_by_occupation_statistics_in_Great_Britain_2022.pdf">ONS</a>, 463 former or current teaching and educational professionals (male and female) died from mesothelioma between 2001 and 2020. However, this is likely to be a significant underestimate – in part because the deaths of people over the age of 75 are not recorded by former occupation. And of those cases that are recorded, only the final occupation is mentioned, so this total also doesn’t include people who moved on from teaching to another career.</p>
<p>Bernard Dawson, a father of five and grandfather of seven, taught maths and science for more than 50 years in Greater Manchester and Lancashire schools. Soon after retirement, he was diagnosed with mesothelioma but died aged 81, so would not have been included in the ONS statistic above.</p>
<p>When teaching, Dawson regularly used asbestos mats for Bunsen burners and recalled seeing asbestos dust in store cupboards. After his death in 2016, his widow Maureen told the <a href="https://www.manchestereveningnews.co.uk/news/greater-manchester-news/exposure-asbestos-classrooms-thought-led-11311320">Manchester Evening News</a>:</p>
<blockquote>
<p>He never smoked, rarely drank and liked to keep fit … but almost overnight he turned into a decrepit old man. He would cough so much that he couldn’t catch his breath. He was so tired and weak and scared because he didn’t want to leave me and the boys.</p>
</blockquote>
<p>One problem for those who have not worked in the recognised high-risk industries, such as construction, is that the “index of suspicion” among health professionals may be low. In other words, symptoms that would trigger immediate suspicion in a former carpenter may not do so in a former nurse or teacher. There is also evidence that women in general may be viewed with a lower index of suspicion regarding possible symptoms of mesothelioma.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/tQXDq6WYGEc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Report featuring an interview with former school teacher Rosie Peters.</span></figcaption>
</figure>
<p>While no statistical research has yet investigated this, qualitative studies of school and hospital workers (including <a href="https://www.sheffield.ac.uk/media/36602/download?attachment">ours</a>), as well as of <a href="https://pubmed.ncbi.nlm.nih.gov/33945895/">women</a>, have identified numerous examples. As retired school teacher <a href="https://www.youtube.com/watch?v=tQXDq6WYGEc&list=WL&index=6">Rosie Peters</a> said in an interview less than a year before her death due to mesothelioma:</p>
<blockquote>
<p>The chest surgeon … couldn’t believe a teacher would have it because I wasn’t in any of the industries known for this disease.</p>
</blockquote>
<p>People outside high-risk industries may also struggle to get compensation for the disease. While lawyers have <a href="https://www.lawgazette.co.uk/news-focus/news-focus-a-white-collar-wave-of-mesothelioma-claims/5113384.article">noticed an increase</a> in “white collar” cases of mesothelioma sufferers seeking compensation, a difficulty in such cases is establishing precisely whether and when any exposure took place that can be pinned to managerial negligence.</p>
<p>Northumberland teacher Patricia Cameron was exposed to asbestos when hanging pupils’ clothes up to dry on asbestos lagging in the school boiler room in the 1970s. She was still working as a teacher when she began to suffer symptoms, including “return[ing] from work complaining of breathlessness”.</p>
<p>Following her death some 25 years after the exposure to asbestos ended, an inquest ruled that Cameron died of industrial disease – yet the subsequent claim for compensation ended <a href="https://www.irwinmitchell.com/news-and-insights/newsandmedia/2008/february/teacher-exposed-to-asbestos-dies-of-mesothelioma">without Northumberland County Council admitting liability</a>. However, in this case, her family was still awarded compensation.</p>
<h2>The risk to caretakers, cleaners and dinner ladies</h2>
<p>A further reason for the persistent underestimation of UK deaths from mesothelioma among school workers is that not all non-teaching staff are included in this <a href="https://www.ukata.org.uk/documents/404/Mesothelioma_mortality_by_occupation_statistics_in_Great_Britain_2022.pdf">data</a>. Nineteen of the 84 cases we found in our <a href="https://www.sheffield.ac.uk/media/36602/download?attachment">review</a> were non-teaching staff, including caretakers, cleaners and dinner ladies.</p>
<p>In fact, the nature of some of these roles may make exposure to asbestos more likely. Caretakers, cleaners and contractors such as electricians have identified exposure during work in boiler rooms, or around insulated heating pipes, as possible sources of exposure.</p>
<p>Margaret James had been a caretaker at a junior school in Llandudno from 1976 until 1992. Unknown to her, she was exposed to asbestos when completing numerous tasks including cleaning up after tradesmen following the building of a second school on the site. A <a href="https://www.rwkgoodman.com/info-hub/mesothelioma-claim-asbestos-school-cleaner-caretaker-within-five-months-instruction/">legal report</a> stated:</p>
<blockquote>
<p>The building had suspended ceilings which were constructed of asbestos ceiling tiles. Once the school was operational, tiles would sometimes fall down and it was Margaret’s job to put them back up. The edges of the tiles were fibrous and dusty to touch when they were handled. In addition, one of the routine tasks Margaret did was to sweep out the boiler room and, in school holidays, dust down pipes throughout the school. These were lagged with asbestos and led to Margaret being exposed unknowingly to toxic dust.</p>
</blockquote>
<p>She became ill with shortness of breath and a chesty cough in 2019. Scans revealed a build-up of fluid on her lung, and a biopsy confirmed she had mesothelioma. The report concluded:</p>
<blockquote>
<p>An offer to settle was made in April 2020 and the council’s insurers made a counter offer in early May 2020, which was accepted by Margaret. The claim settled within five months for in excess of £120,000 and damages were also recovered for the hospice. Sadly, Margaret passed away only a few days later.</p>
</blockquote>
<h2>A recommendation to remove all asbestos</h2>
<p>In April 2022, a UK Work & Pensions <a href="https://publications.parliament.uk/pa/cm5802/cmselect/cmworpen/560/summary.html">select committee report</a> recommended the gradual removal of all asbestos from UK buildings over the next 40 years – with priority placed on the most hazardous types of asbestos, and also those buildings at particular risk, including schools.</p>
<p>The UK government rejected <a href="https://publications.parliament.uk/pa/cm5803/cmselect/cmworpen/633/report.html#heading-1">this recommendation</a>, pointing to the very low risk of exposure where in-situ management is effectively implemented. The Health and Safety Executive suggests that a “rush to remove asbestos” would pose a more significant risk in terms of asbestos exposure. However, our analysis suggests this does not take full account of the condition, and day-to-day use, of many UK schools. </p>
<p>There are grounds to believe that the current policy of in-situ management is inadequate and, as buildings deteriorate, likely to become increasingly so. The policy came under further pressure in November 2022, when the first annual data analysis report into <a href="https://issuu.com/stevesadley/docs/atac_asbestos_report_nov2022?fr=sMDVkZTIwNzQwNjQ">asbestos in UK buildings</a> highlighted that:</p>
<blockquote>
<p>Of the 710,433 items of asbestos found, 507,612 (71%) were recorded as having some level of damage.</p>
</blockquote>
<p>The chair of the select committee, Stephen Timms MP, <a href="https://www.politics.co.uk/opinion-former/press-release/2022/07/25/the-government-and-hse-reject-recommendations-for-reform-of-the-uks-asbestos-management-system/">expressed extreme disappointment</a> at the government’s decision, commenting:</p>
<blockquote>
<p>To put it bluntly, the UK has one of the worst asbestos legacies in the world – and our current lack of an informed strategy for dealing with this is shocking. For any project involving old buildings it will mean increased costs, delays, and even untimely deaths. Industry, campaigners, patient organisations and unions are united in their disappointment of this missed opportunity.</p>
</blockquote>
<p>A <a href="https://commonslibrary.parliament.uk/research-briefings/cdp-2023-0079/">parliamentary debate</a> led by Loughborough MP <a href="https://www.janehunt.uk/news/member-parliament-loughborough-visits-national-charity-asbestos-related-cancer">Jane Hunt</a> again addressed concerns about asbestos in the workplace on April 19, 2023. Trade unions whose members work in the education sector have long sought changes in the current policies of management and monitoring. As well as calling for the removal of asbestos from these environments, they also seek better monitoring of air quality in the meantime, and greater education of those who work and are schooled within them.</p>
<p>The permitted level of exposure to asbestos fibres in the air, set by the HSE, is currently in accordance with EU rules. However, these levels were based on what was technically feasible to monitor when the rules were set. This has now changed and many countries, including France, Holland and Germany, have much stricter levels.</p>
<p><a href="https://ec.europa.eu/commission/presscorner/detail/en/ip_22_5679">The EU is proposing</a> to lower its current maximum level, and is also encouraging the removal of asbestos from all buildings. No such proposals have been approved in the UK.</p>
<p>A spokesperson for HSE said:</p>
<blockquote>
<p>Asbestos was banned in Great Britain by 1999 and stringent regulatory controls are now in place to prevent people being exposed today. We understand the concern about asbestos in school buildings. Risk of exposure is low as long as schools follow the regulations and have the right measures in place. We provide clear <a href="https://www.hse.gov.uk/services/education/asbestos.htm?utm_source=govdelivery&utm_medium=email&utm_campaign=school-inspections-22&utm_term=resources-1&utm_content=education-13-jul-22">guidance</a> and <a href="https://www.hse.gov.uk/services/education/asbestos-faqs.htm?utm_source=govdelivery&utm_medium=email&utm_campaign=school-inspections-22&utm_term=resources-1&utm_content=education-13-jul-22">advice</a> to those who manage buildings that contain asbestos, and our recent inspection campaign checked whether schools had the right steps in place and were following the law.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520724/original/file-20230413-16-gkx2e5.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two young workers mixing asbestos insulation" src="https://images.theconversation.com/files/520724/original/file-20230413-16-gkx2e5.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520724/original/file-20230413-16-gkx2e5.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=620&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520724/original/file-20230413-16-gkx2e5.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=620&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520724/original/file-20230413-16-gkx2e5.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=620&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520724/original/file-20230413-16-gkx2e5.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=779&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520724/original/file-20230413-16-gkx2e5.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=779&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520724/original/file-20230413-16-gkx2e5.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=779&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Two young workers mixing asbestos insulation in a Tyneside shipyard, 1943.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/8/8a/Cecil_Beaton_Photographs-_Tyneside_Shipyards%2C_1943_DB126.jpg">Cecil Beaton via Wikimedia Commons</a></span>
</figcaption>
</figure>
<h2>‘You don’t expect to go to school and come out with what I’ve got’</h2>
<p>HSE predicts that the total number of mesothelioma deaths across England, Scotland and Wales will <a href="https://www.hse.gov.uk/statistics/causdis/mesothelioma/mesothelioma.pdf">decline steadily</a> over the next three decades, with the rate falling faster among men than women. As asbestos is no longer used in new buildings, the number of people diagnosed after manufacturing or using asbestos products, such as (mostly male) construction workers, should tail off significantly.</p>
<p>However, the anticipated decline in mesothelioma cases may yet stall unless the issue of background exposure to asbestos in public buildings, including schools, is tackled. Despite the ongoing work of the parliamentary committee, there has been a striking lack of intervention and research in this area.</p>
<p>Peto has <a href="https://www.theguardian.com/global/2023/jan/15/uk-unions-call-in-cancer-expert-over-fears-of-asbestos-risk-to-female-teachers">proposed</a> new research to build on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280925/">The Inhaled Particulates Study (Tips)</a>. This would involve taking tissue samples from teachers without a mesothelioma diagnosis during lung surgery for other conditions, and analysing them for asbestos fibres as an indication of exposure in schools.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/asbestos-in-schools-what-you-need-to-know-120042">Asbestos in schools: what you need to know</a>
</strong>
</em>
</p>
<hr>
<p>While there is no cure for mesothelioma, treatment innovations are progressing, including surgery trials such as <a href="https://bmjopen.bmj.com/content/10/9/e038892">Mars 2</a> and targeted therapies including the <a href="https://clinicaltrials.gov/ct2/show/NCT05455424">Nero</a>, <a href="https://www.mesothelioma.uk.com/mitope-clinical-trial-brings-a-new-treatment-to-patients-suffering-from-malignant-pleural-effusion-and-malignant-mesothelioma/">Mitope</a> and <a href="https://crukradnet.colcc.ac.uk/2022/08/11/new-clinical-trial-hemithoracic-irradiation-with-proton-therapy-in-malignant-pleural-mesothelioma-hit-meso/#:%7E:text=The%20new%20study%20will%20be%20focusing%20on%20HIT-MESO%3A,are%20limited%20treatments%20and%20survival%20rates%20are%20low.">HIT-Meso</a> trials. Carole Hagedorn, the teacher quoted at the start of this article, is <a href="https://www.express.co.uk/news/uk/505275/Pioneering-treatment-gives-dying-wife-five-more-years">reported</a> to have undergone a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741797/">radical pleurectomy</a> in 2011 – a treatment which included having her lung lining removed in an attempt to eliminate much of the cancer. </p>
<p>But as she <a href="https://www.standard.co.uk/hp/front/dying-teacher-asbestos-in-schools-will-kill-pupils-6771486.html">highlighted</a> before her death, the most important issue is to stop more young people becoming victims in later life. It is unacceptable that the level of exposure of pupils in UK schools is still unknown – and imperative that the public are made aware of the risks of asbestos exposure in all working, living and educational environments, past and present.</p>
<p>Without a programme of safe removal of asbestos, there are likely to be many more experiences like that of Chris Willis. He was diagnosed with mesothelioma aged 29, and claimed this was from being exposed to asbestos while at school. He died in 2022, leaving behind a young family. Following his diagnosis, Willis had told the <a href="https://www.chroniclelive.co.uk/news/north-east-news/kenton-terminal-cancer-school-asbestos-20718127">Newcastle Chronicle</a>:</p>
<blockquote>
<p>You don’t expect to go to school, get an education, and come out with what I’ve got. I don’t think schools realise how much asbestos is still dormant in buildings, and how much risk it poses to students.</p>
</blockquote>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>For you: more from our <a href="https://theconversation.com/uk/topics/insights-series-71218?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insights series</a>:</em></p>
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<li><p><em><a href="https://theconversation.com/a-toxic-policy-with-little-returns-lessons-for-the-uk-rwanda-deal-from-australia-and-the-us-201790?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">‘A toxic policy with little returns’ – lessons for the UK-Rwanda deal from Australia and the US</a></em></p></li>
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<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While evidence grows about the impact of asbestos exposure on teachers and other school workers, the risk to schoolchildren remains worryingly under-reported and under-researched.Bethany Taylor, Research Fellow Mesothelioma UK Research Centre, University of SheffieldAngela Tod, Professor of Older People and Care, University of SheffieldPeter Allmark, Researcher, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1987792023-02-02T23:51:56Z2023-02-02T23:51:56ZMore than 2,000 people from Wittenoom died of asbestos-related diseases. A powerful and compelling requiem brings their story to the stage<figure><img src="https://images.theconversation.com/files/507988/original/file-20230202-19611-hi8om7.jpg?ixlib=rb-1.1.0&rect=33%2C11%2C7315%2C5233&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Jodie Hutchinson/Red Stitch</span></span></figcaption></figure><p><em>Review: Wittenoom, directed by Susie Dee, Red Stitch</em></p>
<p>Deep in the remote Pilbara region of Western Australia, the town of Wittenoom lies empty, desolate … and contaminated.</p>
<p><a href="https://en.wikipedia.org/wiki/Wittenoom,_Western_Australia">Wittenoom</a> is on Banjima country. It was officially established in 1947 as a company town to house those working on the blue asbestos mine in the nearby Wittenoom Gorge. In the 1950s, Wittenoom became Australia’s sole supplier of asbestos. The reported health risks of asbestos led to the shutting down of the mine in 1966 and permanent closure of the town in 2022. </p>
<p>To date, <a href="https://asbestosdiseases.org.au/the-wittenoom-tragedy/">more than 2,000</a> miners, residents and family members have died from asbestos-related diseases. </p>
<p>Wittenoom, a new play by Mary Anne Butler, is the story of Pearl (Emily Goddard) and her mother Dot (Caroline Lee), who live and work in the town in its functioning heyday of the 1940s. </p>
<p>The pair face a tragic outcome borne of corporate greed and denial. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/asbestos-still-haunts-those-exposed-as-kids-in-mining-towns-9487">Asbestos still haunts those exposed as kids in mining towns</a>
</strong>
</em>
</p>
<hr>
<h2>Dark and spare</h2>
<p>As the play opens, Dot and Pearl are perched on the small stage underneath a faded and broken “Welcome to Wittenoom” sign with most of the letters missing. It’s a junky wooden scaffold, propped up with ladders and broken trusses, panels gaping, covered in a fine dust. Pearl begins with a breathy and apocalyptic opening monologue – a lyrical portent that foreshadows the disturbing story to come.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/507990/original/file-20230202-9745-crv8gi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two women on stage" src="https://images.theconversation.com/files/507990/original/file-20230202-9745-crv8gi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/507990/original/file-20230202-9745-crv8gi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507990/original/file-20230202-9745-crv8gi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507990/original/file-20230202-9745-crv8gi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507990/original/file-20230202-9745-crv8gi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507990/original/file-20230202-9745-crv8gi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507990/original/file-20230202-9745-crv8gi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The play shifts from hardscrabble domestic moments to more poetic interludes.</span>
<span class="attribution"><span class="source">Jodie Hutchinson/Red Stitch</span></span>
</figcaption>
</figure>
<p>The writing is dark and spare, and the play skips between present and past, shifting from hardscrabble domestic moments to more poetic interludes. Capable, affable Dot opens her house to some of the Greek and Italian mine workers to help them feel at home, even as, over time, the residents of the town begin to question the safety of the mine and the place where they live. </p>
<p>Young Pearl loves her mum, struggles to fit in at school, and grows more and more disturbed by the threat of the mine. These recollections are countered with the horror of a <a href="https://en.wikipedia.org/wiki/Mesothelioma">mesothelioma</a> diagnosis and the hard facelessness of the medical fraternity. </p>
<p>As Dot, Lee is confident and centred. Goddard’s performance as Pearl is similarly accomplished, although there is a slightly alarming moment early on when Goddard resorts to that artificial convention of an adult playing a child. This is a brief interlude, fortunately, and for the most part both actors own the space. Together, they are terrific. It is so satisfying to see two performers who match each other’s energy and presence so well. </p>
<p>This presence is complemented by vocally strong delivery and an integrated and embodied physical expression – with each other, with the audience and with the space. </p>
<p>Despite the constrained playing area, there’s plenty of room for the audience to imagine into the world of the play, such is Susie Dee’s specific and attentive direction. Choreographed unison moments of long-recalled gestures and ghostly dances work to hold the piece in a kind of netherworld of memory and sadness. </p>
<p>The sound design by Ian Moorehead is variously heavy and swelling or dark and thunderous, sustained throughout the piece. At times a little tinny, it feels as if there is too much sound in this work, but the long and deep tones at the top of the show establish a suitably ominous feel.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/507991/original/file-20230202-7117-lm012v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman in a pink shirt" src="https://images.theconversation.com/files/507991/original/file-20230202-7117-lm012v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507991/original/file-20230202-7117-lm012v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507991/original/file-20230202-7117-lm012v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507991/original/file-20230202-7117-lm012v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507991/original/file-20230202-7117-lm012v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507991/original/file-20230202-7117-lm012v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507991/original/file-20230202-7117-lm012v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The cast are terrific.</span>
<span class="attribution"><span class="source">Jodie Hutchinson/Red Stitch</span></span>
</figcaption>
</figure>
<p>The writing does not shy away from the ghastly medical detail of someone suffering from mesothelioma or the harsh reality that characterises its progression. This grounds the play in an authentic space in which the vulnerability of the human body is laid bare. </p>
<p>The theme of contamination is writ large. The inexorable advance of the disease is manifest as Pearl describes the gobbets of blood coughed up on the floor, the shadows on the lungs, the tumours like tap roots, the tiny poisonous fibres – all while a pale, fine ash gradually settles over the actors’ bodies like bone dust. </p>
<h2>Human costs</h2>
<p>Wittenoom does have its difficult moments, but Butler’s writing provides enough space and silence to give us time to breathe and Dee’s direction keeps the energetic arc dynamic. </p>
<p>The show is hard and sad, as is the real-life story of many who lived in the town, but it is also necessary. It reminds us of the personal, messy, human cost of such tragedies.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/507992/original/file-20230202-19291-85lvkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two women on stage" src="https://images.theconversation.com/files/507992/original/file-20230202-19291-85lvkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/507992/original/file-20230202-19291-85lvkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=840&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507992/original/file-20230202-19291-85lvkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=840&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507992/original/file-20230202-19291-85lvkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=840&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507992/original/file-20230202-19291-85lvkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1056&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507992/original/file-20230202-19291-85lvkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1056&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507992/original/file-20230202-19291-85lvkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1056&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There is space and silence for the audience to breathe.</span>
<span class="attribution"><span class="source">Jodie Hutchinson/Red Stitch</span></span>
</figcaption>
</figure>
<p>The story of Wittenoom is a stark reminder of the deceptive and immoral practices large corporations maintain in the name of profit. The implications continue to manifest in contemporary Australian life. Asbestos mining was the cornerstone of the housing boom in the 1950s and ‘60s, and many of us grew up – or are still living – in houses built from asbestos sheeting, while companies continue to avoid admission of liability.</p>
<p>The show draws themes of grief, memory and injustice together in an undeniably moving way. It is a powerful and compelling requiem for the people whose lives have been destroyed. </p>
<p><em>Wittenoom is at Red Stitch, Melbourne, until February 19.</em></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-why-the-james-hardie-asbestos-victim-compensation-fund-is-running-out-of-money-31633">Explainer: why the James Hardie asbestos victim compensation fund is running out of money</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/198779/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Hunter does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Susie Dee directs this dark and spare new play by Mary Anne Butler for Red Stitch.Kate Hunter, Lecturer in Art and Performance, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1862722022-07-14T12:34:20Z2022-07-14T12:34:20ZAn expert panel has recommended against taking vitamin E or beta carotene supplements for the prevention of cancer and cardiovascular disease – here’s why<figure><img src="https://images.theconversation.com/files/473088/original/file-20220707-16-ngb99k.jpg?ixlib=rb-1.1.0&rect=151%2C0%2C7083%2C4303&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Consuming an ample supply of fresh fruits and vegetables is still a tried and true way of getting vitamins and minerals and achieving lasting health benefits.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cropped-shot-of-an-unrecognisable-woman-standing-royalty-free-image/1357662733?adppopup=true">PeopleImages/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>The U.S. Preventive Services Task Force <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/vitamin-supplementation-to-prevent-cvd-and-cancer-preventive-medication#fullrecommendationstart">issued a recommendation statement</a> in June 2022 on the use of over-the-counter vitamin supplements. Based on its independent panel of experts’ review of existing scientific evidence, the task force recommended against using beta carotene or vitamin E supplements for the prevention of cancer and cardiovascular disease, the two leading causes of mortality in the U.S.</em> </p>
<p><em>The task force’s new statement is an update to its 2014 recommendation, which drew the same conclusion. In the most recent analysis, the expert panel looked at an additional six randomized control trials for beta carotene and nine for vitamin E.</em> </p>
<p><em>The Conversation asked Katherine Basbaum, a clinical dietitian specializing in cardiovascular disease, to explain what this recommendation means for the general public, particularly those who are currently or considering taking dietary supplements for the prevention of cancer and cardiovascular disease. In our Q&A with Basbaum, she interprets the data behind the task force’s conclusion.</em> </p>
<h2>1. What was the basis of the task force’s recommendation?</h2>
<p>The U.S. Preventive Services Task Force evaluated and averaged the results of multiple studies looking at health outcomes associated with beta carotene and vitamin E supplements. Beta carotene is a phytonutrient – or plant chemical – with a red-orange pigment; both beta carotene and vitamin E are found in many fruits and vegetables such as carrots, sweet potatoes, kale, spinach, Swiss chard and avocados, to name a few.</p>
<p>The panel of experts concluded that with regard to the prevention of cardiovascular disease or cancer, the harms of beta carotene supplementation outweigh the benefits and that there is no net benefit of supplementation with vitamin E for those purposes. Their recommendation applies to adults who are not pregnant and excludes those who are chronically ill, are hospitalized or have a known nutritional deficiency. </p>
<p>Beta carotene and vitamin E are powerful <a href="https://www.nccih.nih.gov/health/antioxidants-in-depth">antioxidants, substances that may prevent or delay cell damage</a>. They are commonly taken as dietary supplements for their potential health and anti-aging benefits, such as to combat age-related vision loss and the inflammation associated with chronic disease. Vitamin E has also been shown to <a href="https://doi.org/10.1002%2Fiub.1976">help support the immune system</a>. </p>
<p>Our bodies do require <a href="https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/">beta carotene and various nutrients for a variety of processes</a>, such as cell growth, vision, immune function, reproduction and the normal formation and maintenance of organs. But it is important to point out that more than 95% of the U.S. population receives <a href="https://www.cdc.gov/nutritionreport/pdf/nr_ch2a.pdf">adequate levels of vitamin A, vitamin E and beta carotene</a> through the foods they consume. Therefore the average healthy adult likely does not need additional supplementation to support the processes mentioned above. </p>
<p>The task force did not focus on other potential benefits of vitamin supplementation. It noted that “there may be other benefits of some supplements that were not covered in this review owing to its focus on cardiovascular disease and cancer prevention.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A bunch of freshly-picked carrots in a container." src="https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472871/original/file-20220706-14-la3uyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Consumption of foods high in beta carotene and Vitamin E is considered preferable to taking supplements.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/carrots-in-bowl-royalty-free-image/522241828?adppopup=true">Roy Morsch/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<h2>2. What risks did the task force point to?</h2>
<p>Based on its review of the evidence, the expert panel concluded that beta carotene supplementation likely increases <a href="https://doi.org/10.1056/nejm199404143301501">the risk of lung cancer incidence</a>, particularly in those at high risk for lung cancer, such as people who smoke or who have occupational exposure to asbestos. It also found a statistically significant <a href="https://doi.org/10.1056/nejm199605023341802">increased risk of death from cardiovascular disease</a> associated with beta carotene supplementation.</p>
<p>In one of the clinical trials reviewed by the task force for their recommendation statement, people who smoked or had workplace asbestos exposure were at <a href="https://doi.org/10.1001/jama.2022.8970">increased risk of lung cancer or death from heart disease</a> at doses of 20 and 30 milligrams per day of beta carotene. This dosage is higher than the standard recommendation for beta carotene supplementation, <a href="https://www.drugs.com/cons/beta-carotene.html#dosage">which ranges from 6 to 15 milligrams per day</a>. </p>
<h2>3. Why were these supplements historically considered beneficial?</h2>
<p>Antioxidants like beta carotene and vitamin E may help fight inflammation and oxidative stress, two of the primary contributors to the development of cancers and heart disease. Oxidative stress can trigger cell damage; when this happens, cells can become cancerous. </p>
<p>Since cancer and cardiovascular disease are the two leading causes of death in the U.S., it’s natural that so many people would choose to seek out dietary supplements to potentially add a boost of prevention. Additionally, since only <a href="https://www.cdc.gov/media/releases/2017/p1116-fruit-vegetable-consumption.html">1 in 10 Americans meet the federal recommendation</a> for fruit and vegetable intake – 1.5 to 2 cups of fruit and 2-3 cups of vegetables per day – people often turn to dietary supplements to make up for that deficiency.</p>
<p>There is strong evidence that a diet <a href="https://doi.org/10.1093/ije/dyw319">rich in fruits and vegetables is beneficial</a> to overall health and disease prevention. Researchers also suggest that this may be due in large part to their high antioxidant content. The antioxidant dose received by eating an abundance of foods rich in beta carotene and vitamin E are not nearly as high as the doses available in supplement form. </p>
<h2>4. Should people be concerned about taking any kind of dietary supplement?</h2>
<p>Rigorous testing is required before a drug is approved by the Food and Drug Administration. However, that is not the case with dietary supplements, which are regulated as a food, not a drug. The FDA therefore does <a href="https://www.fda.gov/consumers/consumer-updates/fda-101-dietary-supplements">not have the authority</a> to approve dietary supplements for safety and effectiveness – or to approve their labeling – before the supplements are sold to the public.</p>
<p>The global dietary supplements market size was <a href="https://www.grandviewresearch.com/industry-analysis/dietary-supplements-market">valued at US$151.9 billion in 2021</a>. According to data from the 2017-2018 National Health and Nutrition Examination Survey, an estimated 60% of U.S. adults were taking some form of dietary supplement, including vitamins, minerals, multivitamins, botanicals and herbs, probiotics, nutritional powders and more.</p>
<p>Consumers should <a href="https://theconversation.com/the-dietary-supplement-youre-taking-could-be-tainted-with-prescription-medications-and-dangerous-hidden-ingredients-according-to-a-new-study-181418">be cautious when buying and consuming dietary supplements</a>, as they may contain ingredients that could negatively interact with a prescribed medication or medical condition. It is also worth noting that products containing hidden drugs are also sometimes falsely marketed as “dietary supplements,” which can further put consumers at risk. </p>
<p>This year, the FDA began working to strengthen the regulation of dietary supplements and has <a href="https://www.fda.gov/regulatory-information/search-fda-guidance-documents/draft-guidance-industry-policy-regarding-certain-new-dietary-ingredients-and-dietary-supplements">drafted a proposal</a> to amend its current policies.</p><img src="https://counter.theconversation.com/content/186272/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Basbaum does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite the popular belief that vitamin E and beta carotene supplements help prevent heart disease and cancer, the latest research suggests they do not – but the supplements do have potential risks.Katherine Basbaum, Clinical Dietitian, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722172022-03-09T13:15:55Z2022-03-09T13:15:55ZHow pet cancer data sheds light on human cancers – and speeds the development of new treatments<figure><img src="https://images.theconversation.com/files/445202/original/file-20220208-25-bkvy80.jpg?ixlib=rb-1.1.0&rect=18%2C0%2C4075%2C2729&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dogs are pets in nearly 50 million U.S. homes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/zhao-hui-royalty-free-image/990972040">zhao hui/500Px Plus via Getty Images</a></span></figcaption></figure><p>Stunning advances have happened in medicine since President Richard Nixon declared the “<a href="https://www.npr.org/sections/health-shots/2021/12/23/1058107864/50-years-ago-nixon-gave-the-u-s-a-christmas-gift-it-launched-the-war-on-cancer">war on cancer</a>” just over a half-century ago. </p>
<p>But that progress is only the beginning. More is expected in the coming years and decades, particularly following President Biden’s recent announcement of a <a href="https://www.npr.org/2022/02/02/1077620199/cancer-moonshot-biden">new “cancer moonshot” initiative</a>, coupled with a pledge to “<a href="https://www.webmd.com/cancer/news/20220203/biden-cancer-moon-shot-relaunched">end cancer as we know it</a>.”</p>
<p>One way to help make that happen is through the study of cats and dogs. As a <a href="https://vetmedbiosci.colostate.edu/directory/member/?id=3874">professor of oncology and doctor of veterinary medicine</a> who has been researching cancer in dogs for more than 40 years, I learned long ago that companion animals can teach us an enormous amount about how to prevent and treat cancer in people. </p>
<p>There are many reasons why this is true. <a href="https://www.smithsonianmag.com/smart-news/human-genomes-are-surprisingly-cat-like-180978332/">Domesticated cats</a> <a href="https://doi.org/10.1038/nrg1492">and dogs</a> share approximately 85% of the same DNA as humans. And because both <a href="https://theconversation.com/ancient-dna-reveals-how-cats-conquered-the-world-79584">have been intimately associated</a> with people for <a href="https://www.bbc.com/news/science-environment-54690458#">more than 10,000 years</a>, they have become <a href="https://doi.org/10.1146/annurev-animal-051021-080937">susceptible to some of the same diseases</a>. </p>
<figure class="align-center ">
<img alt="A tabby cat with a brown nose and green eyes looks at the camera." src="https://images.theconversation.com/files/445208/original/file-20220208-24-10sx1vj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445208/original/file-20220208-24-10sx1vj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445208/original/file-20220208-24-10sx1vj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445208/original/file-20220208-24-10sx1vj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445208/original/file-20220208-24-10sx1vj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445208/original/file-20220208-24-10sx1vj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445208/original/file-20220208-24-10sx1vj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Exposure to tobacco smoke can cause cancer in cats and dogs.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/tabby-cat-with-green-eyes-looking-at-camera-royalty-free-image/89781261?adppopup=true">Lysandra Cook/Moment via Getty Images</a></span>
</figcaption>
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<h2>Remarkable similarities in cats, dogs and people</h2>
<p>Over decades, researchers have accumulated what is now a treasure trove of <a href="https://ccr.cancer.gov/comparative-oncology-program">cancer data on companion animals</a>. This data holds clues – and perhaps, answers – to how and why pets can get cancer, and how to keep it in check or get rid of it. </p>
<p>But because of the remarkable similarities in the biology and habitats of cats, dogs and people, it’s possible researchers can also extract this data on pets and extrapolate it to humans. Therein lies the opportunity to discover biomedical innovations that benefit not only your pet, but you as well. </p>
<p>This approach <a href="http://www.nap.edu/catalog/21830/the-role-of-clinical-studies-for-pets-with-naturally-occurring-tumors-in-translational-cancer-research">cuts by decades</a> the amount of time it takes for data to come in. Consider that veterinarians observe and care for cats and dogs as they age and die over a life span of roughly 10 to 15 years. In comparison, gathering similar data from humans over a lifetime takes from 60 to 100 years. </p>
<p>You may wonder if the same information could be gleaned from laboratory animals. After all, scientists have been obtaining important data from them for decades to develop new products. But cancer is induced in lab animals artificially, primarily through surgeries or injections; companion animals “naturally” develop disease, and data from them <a href="https://doi.org/10.1158/1078-0432.CCR-15-2347">reflect more realistic estimates</a> when serving as precursors to investigations in humans.</p>
<h2>Dogs and cats as canaries in the coal mine</h2>
<p>Cancer is a <a href="https://doi.org/10.1111/j.1748-5827.2010.00974.x">leading cause of death</a> for cats and dogs. As with people, the disease develops over a long period of time, and the same conditions that create cancer in humans also apply to them.</p>
<p>Here are some examples: Scientists have long noted the <a href="https://dx.doi.org/10.1371%2Fjournal.pcbi.1009450">similarities in mutations and biological changes</a> in dogs and people with melanoma, lymphoma and lung cancers. A growing segment of veterinarians, human medical doctors and cancer scientists are using these shared characteristics <a href="https://doi.org/10.1038/s41568-020-0297-3">to develop improved therapeutics</a> for pet dogs with cancer. Many researchers believe this will help them develop <a href="https://doi.org/10.1038/s41568-020-0297-3">effective treatments for humans as well</a>. </p>
<p>Studies show that <a href="https://doi.org/10.1016/0013-9351(83)90114-7">asbestos exposure</a> can lead to mesothelioma, a malignant tumor that forms on the lining of tissues throughout the body in both dogs and humans. Tobacco smoke can cause lung cancer in humans, <a href="https://doi.org/10.1093/aje/kwf044">lymphoma in cats</a> and <a href="https://doi.org/10.1093/oxfordjournals.aje.a009475">nasal cancers in dogs</a>. Learning how to lessen toxin exposure in companion animals could speed up the use of similar strategies to keep humans healthy. </p>
<p>Work is underway to make this happen. In one study, researchers strapped silicon sensors to people and their pets to measure their exposure levels to pesticides and herbicides in the home and yard. The exposure levels between humans and their pets <a href="https://doi.org/10.1021/acs.est.9b06605">were strikingly similar</a>. This study suggests our pets may serve as harbingers of harmful environmental exposures – the so-called canary in the coal mine.</p>
<p><a href="https://datacommons.cancer.gov/repository/integrated-canine-data-commons">Scientists are now starting to integrate</a> the millions of human and canine datasets now available and compare them across species. The rapid and recent development of genetic sequencing technologies, along with the proliferation of electronic medical records, has also been tremendously helpful. </p>
<p>These factors will greatly accelerate significant insights into cancer risk factors for both companion animals and people. Already, <a href="https://doi.org/10.1098/rstb.2014.0230">large population studies of dogs</a> have begun, with researchers collecting the animal’s <a href="https://doi.org/10.1007/s00335-016-9638-7">genetic, environmental, lifestyle and nutritional information</a>. </p>
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<figcaption><span class="caption">By watching your pet closely, you may be able to detect signs of cancer in its early stages.</span></figcaption>
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<h2>The bone cancer connection</h2>
<p>As previously noted, traditional lab animals don’t always make the best subjects for cancer research. The immune systems of mice and rats, for instance, <a href="https://doi.org/10.3389/fimmu.2019.02935">are not as complex as that of humans</a>; those of dogs and cats are far more like our own. </p>
<p>One example: Researchers combined a blood pressure medication, already generically available for humans and dogs, with a chemotherapeutic agent, also approved by the Food and Drug Administration for humans and dogs. Then they studied the repurposed product on pet dogs with bone cancer. The results were so positive that doctors <a href="https://doi.org/10.1158/1078-0432.ccr-21-2105">initiated the same protocol in children</a> with bone cancer. That clinical study is not yet far enough along to draw any conclusions. </p>
<p>But the proposition makes sense. Bone cancer in humans and dogs is <a href="https://dx.doi.org/10.1186%2F1471-2164-10-625">genetically indistinguishable</a>. If this approach works, it could cut by years, and with far less cost, the time it takes to develop a pharmaceutical product to treat children with bone cancer. </p>
<p>A rule of thumb: The <a href="http://csdd.tufts.edu/">traditional pipeline for a new cancer drug</a> is at least 10 years at a cost of billions of dollars. But the bone cancer clinical trial on children began within five years – and cost US$2 million. </p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p>
<h2>What’s next</h2>
<p>The people-pet connection is more than just the similarity in species. An extensive veterinary medical infrastructure now exists to support cats and dogs during cancer management. An ever-burgeoning technology and an abundance of data that crosses disciplines are there for the taking. </p>
<p>However, gaps still exist in our knowledge, particularly regarding our understanding of the immune system of companion animals. Additionally, the funding available to conduct clinical studies in companion animals is severely limited. Support from the National Institutes of Health, however, has been <a href="https://dctd.cancer.gov/NewsEvents/20190327_canine_immunotherapy.htm">earmaked to overcome at least some of these obstacles</a>.</p>
<p>When science learns more about how to prevent and treat cancer in our pets, it’s likely that we will minimize the burden of cancer for all species.</p><img src="https://counter.theconversation.com/content/172217/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Lee Page previously received consulting funding from The Morris Animal Foundation as Principal Investigator of the Golden Retriever Lifetime Study. He has not received funding for 3 years. He is affiliated with The Dog Aging Project, Vaika Inc, and Embark Inc as a volunteer member of the scientific advisory board. </span></em></p>New research on cat and dog health may provide clues on how to prevent and treat cancer in humans.Rodney Lee Page, Professor of Oncology, Colorado State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1665372021-09-10T12:28:29Z2021-09-10T12:28:29Z9/11 survivors’ exposure to toxic dust and the chronic health conditions that followed offer lessons that are still too often unheeded<figure><img src="https://images.theconversation.com/files/420128/original/file-20210908-22-728gm5.jpg?ixlib=rb-1.1.0&rect=0%2C125%2C2775%2C1859&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Toxic dust hung in the air around ground zero for more than three months following the 9/11 terrorist attacks.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-unidentified-new-york-city-firefighter-walks-away-from-news-photo/1372804?adppopup=true">Anthony Correia/Getty Images</a></span></figcaption></figure><p>The 9/11 terrorist attack on the World Trade Center in New York resulted in the loss of <a href="https://www.cnn.com/2013/07/27/us/september-11-anniversary-fast-facts/index.html">2,753 people in the Twin Towers and surrounding area</a>. After the attack, more than 100,000 responders and recovery workers from every U.S. state – along with <a href="https://www.cdc.gov/wtc/history.html">some 400,000 residents</a> and other workers around ground zero – were exposed to a <a href="https://abcnews.go.com/Health/september-11-toxic-world-trade-center-dust-cloud/story?id=14466933">toxic cloud of dust</a> that fell as a ghostly, thick layer of ash and then hung in the air for more than three months. </p>
<p>The World Trade Center dust plume, or <a href="https://doi.org/10.3109/10408444.2015.1044601">WTC dust</a>, consisted of a dangerous mixture of cement dust and particles, asbestos and a class of chemicals called <a href="https://www.epa.gov/international-cooperation/persistent-organic-pollutants-global-issue-global-response">persistent organic pollutants</a>. These include <a href="https://www.epa.gov/dioxin/learn-about-dioxin">cancer-causing dioxins</a> and <a href="https://www.cdc.gov/biomonitoring/PAHs_FactSheet.html">polyaromatic hydrocarbons, or PAHs</a>, which are byproducts of fuel combustion. </p>
<p>The dust also contained heavy metals that are known <a href="https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health">to be poisonous to the human body and brain</a>, such as lead – used in the manufacturing of flexible electrical cables – and mercury, which is found in float valves, switches and fluorescent lamps. The dust also contained cadmium, a carcinogen <a href="https://doi.org/10.1007/s10534-010-9328-y">toxic to the kidneys</a> that is used in the manufacturing of electric batteries and pigments for paints.</p>
<figure class="align-center ">
<img alt="Smoke pours from the Twin Towers of the World Trade Center in New York City on September 11, 2001." src="https://images.theconversation.com/files/420341/original/file-20210909-27-p4t2aq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420341/original/file-20210909-27-p4t2aq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420341/original/file-20210909-27-p4t2aq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420341/original/file-20210909-27-p4t2aq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420341/original/file-20210909-27-p4t2aq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420341/original/file-20210909-27-p4t2aq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420341/original/file-20210909-27-p4t2aq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One of the haunting images from 9/11: Smoke pours from the twin towers of the World Trade Center in New York after they were hit by two hijacked airliners.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/smoke-pours-from-the-twin-towers-of-the-world-trade-center-news-photo/1339505?adppopup=true">Robert Giroux via Getty Images</a></span>
</figcaption>
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<p><a href="http://www.idph.state.il.us/envhealth/factsheets/polychlorinatedbiphenyls.htm#:%7E:text=Polychlorinated%20biphenyls%20(PCBs)%20are%20a,equipment%20like%20capacitors%20and%20transformers.">Polychlorinated biphenyls</a>, human-made chemicals used in electrical transformers, were also part of the toxic stew. PCBs are <a href="https://www.epa.gov/pcbs/learn-about-polychlorinated-biphenyls-pcbs#healtheffects">known to be carcinogenic</a>, toxic to the nervous system and disruptive to the reproductive system. But they became even more harmful when incinerated at high heat from the jets’ fuel combustion and then carried by very fine particles. </p>
<p><a href="https://doi.org/10.3109/10408444.2015.1044601">WTC dust</a> was made up of both “large” particulate matter and very small, fine and ultrafine ones. These particularly small particles are known to be <a href="https://doi.org/10.1038/s41598-018-35398-0">highly toxic</a>, especially to the nervous system since they can travel directly through the <a href="https://doi.org/10.1016/j.neuro.2011.12.001">nasal cavity to the brain</a>. </p>
<p>Many first responders and others who were directly exposed to the dust developed a <a href="https://doi.org/10.3109/10408444.2015.1044601">severe and persistent cough</a> that lasted for a month, on average. They were treated at Mount Sinai Hospital and received care at the Clinic of Occupational Medicine, a well-known center for work-related diseases.</p>
<p>I am a physician specializing in occupational medicine who began working directly with 9/11 survivors in my role as director of the <a href="https://www.cdc.gov/wtc/">WTC Health Program</a> <a href="https://icahn.mssm.edu/about/departments/environmental-public-health/research/wtc-data-center">Data Center</a> at Mount Sinai beginning in 2012. That program collects data, as well as monitors and oversees the public health of WTC rescue and recovery workers. After eight years in that role, I <a href="https://stempel.fiu.edu/faculty/roberto-lucchini/">moved to Florida International University</a> in Miami, where I am planning to continue working with 9/11 responders who are moving to Florida as they reach retirement age.</p>
<figure class="align-center ">
<img alt="In lower Manhattan near Ground Zero, people run away as the North Tower of the World Trade Center collapses." src="https://images.theconversation.com/files/420343/original/file-20210909-23-1bc9fnj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420343/original/file-20210909-23-1bc9fnj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420343/original/file-20210909-23-1bc9fnj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420343/original/file-20210909-23-1bc9fnj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420343/original/file-20210909-23-1bc9fnj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420343/original/file-20210909-23-1bc9fnj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420343/original/file-20210909-23-1bc9fnj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Remembering 9/11: As the north tower of the World Trade Center collapses, a cloud of toxic gas chases terrified residents and tourists.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-run-away-as-the-north-tower-of-world-trade-center-news-photo/1339533?adppopup=true">Jose Jimenez/Primera Hora via Getty Images</a></span>
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<h2>From acute to chronic conditions</h2>
<p>After the initial “acute” health problems that 9/11 responders faced, they soon began experiencing a wave of chronic diseases that <a href="https://doi.org/10.3390/ijerph18126383">continue to affect them</a> 20 years later. The persistent cough gave way to <a href="https://doi.org/10.1001/dmp.2011.58">respiratory diseases</a> such as asthma, chronic obstructive pulmonary disease (COPD) and upper airway diseases such as <a href="https://doi.org/10.1136/oemed-2015-103094">chronic rhinosinusitis</a>, laryngitis and nasopharyngitis. </p>
<p>The litany of respiratory diseases also put many of them at risk for <a href="https://doi.org/10.1038/ajg.2011.357">gastroesophageal reflux disease</a> (GERD), which occurs at a <a href="https://doi.org/10.1097/JOM.0b013e3181845f9b">higher rate in WTC survivors</a> than in the general population. This condition occurs when stomach acids reenter the esophagus, or food pipe, that connects the stomach to the throat. As a consequence of either the airway or the digestive disorders, many of these survivors also <a href="https://doi.org/10.1097/JOM.0b013e3182305282">struggle with sleep apnea</a>, which requires additional treatments.</p>
<p>Further compounding the tragedy, about eight years after the attacks, <a href="https://doi.org/10.1093/jncics/pkz090">cancers began to turn up</a> in 9/11 survivors. These include tumors of the blood and lymphoid tissues such as lymphoma, myeloma and leukemia, which are well known to <a href="https://doi.org/10.1186/1745-6673-8-14">affect workers exposed to carcinogens</a> in the workplace. But survivors also suffer from other cancers, including breast, head and neck, prostate, lung and thyroid cancers. </p>
<p>Some have also developed mesothelioma, an aggressive form of cancer related to <a href="http://dx.doi.org/10.1136/thoraxjnl-2013-204161">exposure to asbestos</a>. <a href="https://www.9news.com.au/9stories/september-11-death-toll-from-terror-attack-could-rise-by-millions-due-to-toxic-asbestos-dust/8bc90677-0032-42a2-82f9-4b9baad753d9">Asbestos</a> was used in the early construction of the north tower until public advocacy and broader awareness of its health dangers <a href="https://www.mesothelioma.com/states/new-york/world-trade-center/">brought its use to a halt</a>.</p>
<p>And the psychological trauma that 9/11 survivors experienced has left many suffering from persistent mental health challenges. One <a href="https://doi.org/10.1007/s10488-019-00998-z">study</a> published in 2020 found that of more than 16,000 WTC responders for whom data was collected, nearly half reported a need for mental health care, and 20% of those who were directly affected developed <a href="https://doi.org/10.1016/j.dadm.2016.08.001">post-traumatic stress disorder</a>. </p>
<p>Many have told me that the contact they had with parts of human bodies or with the deadly scene and the tragic days afterward left a permanent mark on their lives. They are unable to forget the images, and many of them suffer from mood disorders as well as <a href="https://doi.org/10.1186/s12940-019-0449-7">cognitive impairments and other behavioral issues</a>, including substance use disorder. </p>
<figure class="align-center ">
<img alt="On 9/11, shortly after the terrorist attack in New York City, a distraught survivor sits outside the World Trade Center." src="https://images.theconversation.com/files/420347/original/file-20210909-23-do7s5e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420347/original/file-20210909-23-do7s5e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420347/original/file-20210909-23-do7s5e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420347/original/file-20210909-23-do7s5e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420347/original/file-20210909-23-do7s5e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420347/original/file-20210909-23-do7s5e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420347/original/file-20210909-23-do7s5e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Remembering 9/11: A distraught survivor sits outside the World Trade Center after the terrorist attack.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/survivor-sits-outside-the-world-trade-center-after-two-news-photo/50833029?adppopup=true">Jose Jimenez/Primera Hora via Getty Images</a></span>
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</figure>
<h2>An aging generation of survivors</h2>
<p>Now, 20 years on, these survivors face a new challenge as they age and move toward retirement – a <a href="https://doi.org/10.3386/w12123">difficult life transition</a> that can sometimes lead to mental health decline. Prior to retirement, the daily drumbeat of work activity and a steady schedule often helps keep the mind busy. But retirement can sometimes leave a void – one that for 9/11 survivors is too often filled with unwanted memories of the noises, smells, fear and despair of that terrible day and the days that followed. Many survivors have told me they do not want to return to Manhattan and certainly not to the WTC. </p>
<p>Aging can also bring with it forgetfulness and other cognitive challenges. But studies show that these natural processes are <a href="https://doi.org/10.1186/s12940-019-0449-7">accelerated and more severe</a> in 9/11 survivors, similar to the experience of veterans from war zones. This is a concerning trend, but all the more so because a growing body of research, including <a href="https://doi.org/10.21203/rs.3.rs-846359/v1">our own preliminary study</a>, is finding links between <a href="https://doi.org/10.1192/bjp.bp.105.014779">cognitive impairment in 9/11 responders and dementia</a>. A recent <a href="https://www.washingtonpost.com/magazine/2021/08/30/911-first-responders-dementia/">Washington Post piece detailed</a> how 9/11 survivors are experiencing these dementia-like conditions in their 50s – far earlier than is typical. </p>
<p>The COVID-19 pandemic, too, has taken a toll on those who have already suffered from 9/11. People with <a href="https://doi.org/10.1016/j.eclinm.2020.100515">preexisting conditions</a> have been at far higher risk during the pandemic. Not surprisingly, a recent study found a <a href="https://doi.org/10.1371/journal.pone.0254713">higher incidence of COVID-19</a> in WTC responders from January through August 2020.</p>
<h2>Honoring the 9/11 survivors</h2>
<p>The health risks posed by direct exposure to the acrid dust was underestimated at the time, and poorly understood. Appropriate personal protective equipment, such as P100 half-face respirators, was not available at that time. </p>
<p>But now, over 20 years on, we know much more about the risks – and we have much greater access to protective equipment that can keep responders and recovery workers safe following disasters. Yet, too often, I see that we have not learned and applied these lessons. </p>
<p>For instance, in the immediate aftermath of the <a href="https://www.nytimes.com/live/2021/07/06/us/miami-building-collapse-updates">condominium collapse</a> near Miami Beach last June, it took days before P100 half-face respirators were fully available and made mandatory for the responders. Other examples around the world are even worse: One year after the <a href="https://www.npr.org/2021/08/04/1024275186/a-year-after-the-beirut-explosion-victims-families-continue-to-push-for-justice">Beirut explosion</a> in August 2020, very little action had been taken to investigate and manage the physical and <a href="https://timep.org/commentary/analysis/the-beirut-explosions-impact-on-mental-health/">mental health consequences </a> among responders and the impacted community.</p>
<p>Applying the lessons learned from 9/11 is a critically important way to honor the victims and the brave men and women who took part in the desperate rescue and recovery efforts back on those terrible days.</p><img src="https://counter.theconversation.com/content/166537/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roberto Lucchini receives funding from CDC/NIOSH to study the cognitive impacts associated to the WTC exposure to neurotoxins and to intense psychological trauma. </span></em></p>Those directly exposed to toxic dust and trauma on and after 9/11 carry with them a generation of chronic health conditions, which are placing them at higher risk during the pandemic and as they age.Roberto Lucchini, Professor of Occupational and Environmental Health Sciences, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1660332021-09-08T20:12:17Z2021-09-08T20:12:17Z20 years on, 9/11 responders are still sick and dying<figure><img src="https://images.theconversation.com/files/419188/original/file-20210903-23797-akqghk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2396%2C1595&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos.aap.com.au/search/world%20trade%20center%20attack">Shawn Baldwin/AP/AAP Image</a></span></figcaption></figure><p>Emergency workers and clean-up crew are among 9/11 responders still suffering significant health issues 20 years after the <a href="https://www.history.com/topics/21st-century/9-11-attacks">terrorist attacks</a>.</p>
<p>More than <a href="https://pubmed.ncbi.nlm.nih.gov/18500709/">91,000 workers and volunteers</a> <a href="https://www1.nyc.gov/site/911health/enrollees/rescue-recovery-workers.page">were exposed</a> to a range of hazards during the rescue, recovery and clean-up operations.</p>
<p>By March 2021, some 80,785 of these responders had enrolled in the <a href="https://www.cdc.gov/wtc/">World Trade Center Health Program</a>, which was set up after the attacks to monitor their health and treat them.</p>
<p>Now our <a href="https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/abs/health-trends-among-911-responders-from-20112021-a-review-of-world-trade-center-health-program-statistics/09B87521287B943402782DAADB47E0B9">published research</a>, which is based on examining these health records, shows the range of physical and mental health issues responders still face.</p>
<h2>Breathing problems, cancer, mental illness</h2>
<p>We found 45% of responders in the health program have aerodigestive illness (conditions that affect the airways and upper digestive tract). A total of 16% have cancer and another 16% have mental health illness. Just under 40% of responders with health issues are aged 45-64; 83% are male.</p>
<p>Our analysis shows 3,439 of responders in the health program are now dead — far more than the <a href="https://parade.com/1248604/jessicasager/9-11-facts/">412 first responders who died on the day</a> of the attacks.</p>
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<p>Respiratory and upper digestive tract disorders are the number one cause of death (34%), ahead of cancer (30%) and mental health issues (15%). </p>
<p>Deaths attributed to these three factors, as well as musculoskeletal and acute traumatic injuries, have increased six-fold since the start of 2016. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-pain-of-9-11-still-stays-with-a-generation-64725">How the pain of 9/11 still stays with a generation</a>
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</em>
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<h2>An ongoing battle</h2>
<p>The number of responders enrolling in the health program with emerging health issues rises each year. More than 16,000 responders have enrolled in the past five years. </p>
<p>Cancer is up 185% over the past five years, with leukaemia emerging as particularly common, overtaking colon and bladder cancer in the rankings.</p>
<p>This equates to an increase of 175% in leukaemia cases over a five-year period, which is not surprising. There is a <a href="https://pubmed.ncbi.nlm.nih.gov/32771228/">proven link</a> between benzene exposure and acute myeloid leukaemia. Benzene is found in jet fuel, one of the toxic exposures at the World Trade Center. And acute myeloid leukaemia is one of the main types of leukaemia reported not only by responders, but by <a href="https://www.wtc-illness.com/cancers/leukemia-blood-cancer">residents of lower Manhattan</a>, who also have higher-than-normal rates. </p>
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<p>Prostate cancer is also common, increasing 181% since 2016. Although this fits with the age profile of many of the health program’s participants, some responders are developing an <a href="https://pubmed.ncbi.nlm.nih.gov/31221798/">aggressive, fast-growing form</a> of prostate cancer. </p>
<p>Inhaling the toxic dust at the World Trade Center site may trigger a cascading series of cellular events, increasing the number of inflammatory T-cells (a type of immune cell) in some of the responders. This increased inflammation <a href="https://pubmed.ncbi.nlm.nih.gov/26816843/">may eventually lead to prostate cancer</a>.</p>
<p>There may also be a <a href="https://pubmed.ncbi.nlm.nih.gov/31490535/">significant link between</a> greater exposure at the World Trade Center and a higher risk of long-term cardiovascular disease (disease affecting the heart and blood vessels). Firefighters who responded to the World Trade Center on the morning of the attacks were 44% more likely to develop cardiovascular disease than those who arrived the next day.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/air-pollution-causes-cancer-so-lets-do-something-about-it-19380">Air pollution causes cancer, so let's do something about it </a>
</strong>
</em>
</p>
<hr>
<h2>The mental health effects</h2>
<p>About <a href="https://pubmed.ncbi.nlm.nih.gov/31625489/">15-20%</a> of responders are estimated to be living with <a href="https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/ptsd">post-traumatic stress disorder</a> (PTSD) symptoms — roughly <a href="https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd">four times</a> the rate of the general population. </p>
<p>Despite 20 years having passed, PTSD <a href="https://pubmed.ncbi.nlm.nih.gov/28805168/">is a growing problem</a> for responders. Almost half of all responders <a href="https://pubmed.ncbi.nlm.nih.gov/31776767/">report</a> they need ongoing mental health care for a range of mental health issues including PTSD, anxiety, depression and <a href="https://www.medicalnewstoday.com/articles/325578">survivor guilt</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-11-anniversary-a-watershed-for-psychological-response-to-disasters-2975">9/11 anniversary: a watershed for psychological response to disasters</a>
</strong>
</em>
</p>
<hr>
<p>Researchers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364857/">have also found</a> brain scans of some responders indicate the onset of early-stage dementia. This is consistent with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364857/">previous work</a> noting cognitive impairment among responders occurs at about twice the rate of people 10-20 years older.</p>
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<h2>COVID-19 and other emerging threats</h2>
<p>Responders’ underlying health conditions, such as cancer and respiratory ailments, have also left them <a href="https://www.usatoday.com/in-depth/news/nation/2021/05/05/covid-risk-911-september-2001-ground-zero-responders-causes-concern/4961779001/">vulnerable to COVID-19</a>. By the end of August 2020, <a href="https://www.newsweek.com/how-many-people-died-911-thousands-perishing-september-11-related-illnesses-1531058">some 1,172 responders</a> had confirmed COVID-19.</p>
<p>Even among responders who have not been infected, the pandemic <a href="https://www.thecity.nyc/2020/9/10/21431746/how-many-9-11-survivors-have-died-of-covid-19">has exacerbated</a> one of the key conditions caused by search and rescue, and recovery after terrorist attacks — PTSD.</p>
<p><a href="https://www.nbcnews.com/news/us-news/covid-19-has-killed-dozens-9-11-first-responders-n1239885">More than 100 responders have died</a> due to complications from the virus, which has also exacerbated other responders’ PTSD symptoms.</p>
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<p>The number of responders with cancers associated with asbestos exposure at the World Trade Center is expected to rise in coming years. This is because mesothelioma (a type of cancer caused by asbestos) usually takes <a href="https://www.canceraustralia.gov.au/cancer-types/mesothelioma-cancer/awareness#:%7E:text=It%20usually%20takes%20a%20very,and%20roofing%2C%20and%20in%20insulation.">20-50 years to develop</a>. </p>
<p>As of 2016, at least 352 responders had been diagnosed with the lung condition <a href="https://www.mayoclinic.org/diseases-conditions/asbestosis/symptoms-causes/syc-20354637">asbestosis</a>, and at least 444 had been diagnosed with another lung condition, <a href="https://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/symptoms-causes/syc-20353690">pulmonary fibrosis</a>. Exposure to asbestos and other fibres in the toxic dust <a href="https://www.asbestos.com/world-trade-center/">may have contributed</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-harms-of-asbestos-wont-be-known-for-decades-14845">Health harms of asbestos won't be known for decades </a>
</strong>
</em>
</p>
<hr>
<h2>Lessons learned</h2>
<p>Our research involved analysing data from existing databases. So we cannot make direct links between exposure at the World Trade Center site, length of time there, and the risk of illness. </p>
<p>Differences in age, sex, ethnicity, smoking status and other factors between responders and non-responders should also be considered. </p>
<p>Increased rates of some cancers in some responders may also be associated with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2764101">heightened surveillance</a> rather than an increase in disease.</p>
<p>Nevertheless, we are now beginning to understand the long-term effects of responding to the 9/11 terrorist attacks. Exposure is still having both a physical and mental health impact and it’s likely responders are still developing illnesses related to their exposures.</p>
<p>Ongoing monitoring of responders’ health remains a priority, especially considering the looming threat of new asbestos-related cancers.</p><img src="https://counter.theconversation.com/content/166033/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More 9/11 responders died from physical and mental health issues after the terrorist attacks than on the day itself. And survivors are still suffering 20 years later.Erin Smith, Associate Professor in Disaster and Emergency Response, School of Medical and Health Sciences, Edith Cowan UniversityBrigid Larkin, PhD candidate, Edith Cowan UniversityLisa Holmes, Lecturer, Paramedical Science, School of Medical and Health Sciences, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1374652020-05-29T12:30:58Z2020-05-29T12:30:58ZWith the coronavirus, where government stumbles, litigation will step in<figure><img src="https://images.theconversation.com/files/338061/original/file-20200527-20233-rtiusp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Workers leave Ford's Chicago Assembly Plant on May 20, 2020 in Chicago, Illinois. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/workers-leave-fords-chicago-assembly-plant-on-may-20-2020-news-photo/1226082592?adppopup=true">Scott Olson/Getty </a></span></figcaption></figure><p>Republican Senate Majority Leader Mitch McConnell has issued a demand: Any further coronavirus aid legislation must <a href="https://www.rollcall.com/2020/05/21/corporations-and-consumer-groups-battle-over-covid-19-liability/">protect businesses from coronavirus-related lawsuits</a>.</p>
<p>Democrats have balked, with House Speaker Nancy Pelosi saying they “<a href="https://www.law360.com/health/articles/1267837/mcconnell-wants-broad-liability-shield-in-next-covid-19-bill">have no interest in diminishing protections for employees and customers</a>.” </p>
<p>Superficially, this standoff seems like another example of Washington’s toxic politics, where hope for any legislation rests on crass political trades among bickering partisan factions. </p>
<p><a href="https://global.oup.com/academic/product/how-policy-shapes-politics-9780199756117?cc=ca&lang=en&">Our research</a>, though, indicates there’s more to this struggle than just partisan politics. American ambivalence about government has left litigation to play an outsized role in responding to crises like this one. Including protections for businesses against lawsuits alongside a new aid package might make sense. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/338063/original/file-20200527-20264-1n65kyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/338063/original/file-20200527-20264-1n65kyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338063/original/file-20200527-20264-1n65kyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338063/original/file-20200527-20264-1n65kyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338063/original/file-20200527-20264-1n65kyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338063/original/file-20200527-20264-1n65kyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338063/original/file-20200527-20264-1n65kyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338063/original/file-20200527-20264-1n65kyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some passengers on the cruise ship Grand Princess, seen here, sued the ship’s owner for negligence for exposing them to the coronavirus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-coronavirus-stricken-grand-princess-cruise-ship-is-news-photo/1218105547?adppopup=true">Jane Tyska/Digital First Media/East Bay Times/Getty Images</a></span>
</figcaption>
</figure>
<h2>Disasters lead to court</h2>
<p>Health disasters in the United States – the <a href="https://pubmed.ncbi.nlm.nih.gov/30146985/">opioid epidemic</a>, the diseases caused by <a href="https://us.sagepub.com/en-us/nam/up-in-smoke/book237268">tobacco use</a>, <a href="https://www.press.umich.edu/291047/suing_the_tobacco_and_lead_pigment_industries">lead paint</a>, <a href="http://press.georgetown.edu/book/georgetown/dust">asbestos</a>, <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674010260">Agent Orange</a> and <a href="https://press.uchicago.edu/ucp/books/book/chicago/M/bo5378458.html">many others</a> – often generate a surge of court cases.</p>
<p>But research shows that litigation is an expensive, haphazard way to handle injury claims. Legal action can drive some businesses into bankruptcy while leaving many victims without the money and damages they sought. Studies of the personal injury system suggest that for <a href="https://www.rand.org/pubs/reports/R3391.html">every dollar the injured recover, another dollar is spent on lawyers and lawyering</a>. </p>
<p>Although only a small number of cases have been filed so far, the coronavirus pandemic seems likely to replicate this pattern.</p>
<p>At this early stage, class action lawsuits are pending against <a href="https://www.npr.org/sections/coronavirus-live-updates/2020/04/22/840525310/even-with-covid-19-cases-suing-cruise-lines-is-extraordinarily-difficult">cruise ships</a> on the grounds that they negligently exposed passengers to the virus and, in some cases, prevented them from seeking treatment. <a href="https://www.latimes.com/california/story/2020-05-17/officials-mishandled-lompoc-terminal-island-prison-outbreaks-lawsuit">Prisons</a> and <a href="https://www.law.com/newyorklawjournal/2020/04/23/trapped-in-litigation-lawsuit-warned-of-staffing-shortfalls-at-bronx-nursing-home-before-covid-19-wave/">nursing homes</a>, where many have died as a result of COVID-19, face similar suits. </p>
<p>And personal injury lawsuits are only one type of litigation related to COVID-19. Employers are concerned about <a href="https://www.chicagotribune.com/coronavirus/ct-coronavirus-employer-liability-workplace-exposure-20200501-dye6husnszchpnpaadiensn2ja-story.html">potential liability for bringing workers back too soon</a>, while others are already facing suits over <a href="https://www.natlawreview.com/article/class-action-litigation-related-to-covid-19-filed-and-anticipated-cases">wages, worker safety protections, pensions, privacy, and disability accommodations and discrimination claims</a>. </p>
<p>Consumers are suing airlines, colleges and universities, ticketing agencies and others for <a href="https://www.natlawreview.com/article/class-action-litigation-related-to-covid-19-filed-and-anticipated-cases">refunds</a>. Bankruptcies – another kind of litigation – are <a href="https://www.usnews.com/news/best-states/wisconsin/articles/2020-04-14/more-wisconsin-farmers-filing-for-bankruptcy">reportedly on the rise</a>, and <a href="https://www.brookings.edu/research/bankruptcy-and-the-coronavirus/">many more will surely follow</a>, as businesses collapse under the weight of stay-at-home orders and people with no or limited insurance face crushing medical bills. </p>
<p>While conservatives like McConnell and his fellow party members have legitimate concerns about the potential costs of litigation, they’re wrong about why litigation happens in the first place. They tend to attribute surges of litigation to a kind of character defect: Americans, they contend, have become whiny victims who, <a href="https://www.washingtonexaminer.com/opinion/stop-the-lawsuits-related-to-the-coronavirus-pandemic">urged on by greedy lawyers, sue at every opportunity</a>. </p>
<p>Scholars, however, <a href="https://www.academia.edu/884211/Reading_the_landscape_of_disputes_What_we_know_and_dont_know_and_think_we_know_about_our_allegedly_contentious_and_litigious_society">question whether Americans are more innately litigious than citizens of other affluent countries</a>. They point instead to a <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674238367">fundamental tension in American politics that gives courts an unusually prominent role in public policy</a>. </p>
<p>On one hand, <a href="https://www.pewresearch.org/fact-tank/2017/05/26/few-americans-support-cuts-to-most-government-programs-including-medicaid/">Americans want protections against pervasive social problems</a>, such as environmental harms, unsafe products and sudden economic downturns. </p>
<p>On the other hand, <a href="https://www.ucpress.edu/book/9780520243231/lawyers-lawsuits-and-legal-rights">many Americans are skeptical of the typical response of most nations to such problems</a>: a larger welfare and regulatory state.</p>
<p>And even when a majority of Americans favor expanding government, our fragmented lawmaking process, in which bills must pass through multiple committees and two chambers of Congress and be signed by the president, provide repeated opportunities for special interest groups to block sweeping reforms.</p>
<p>This leaves those in distress to pursue help where they can find it, in the legal system.</p>
<h2>Asbestos cases: 730,000 claims in US, only 10 in Netherlands</h2>
<p>Consider the <a href="http://press.georgetown.edu/book/georgetown/dust">asbestos crisis</a>. Asbestos is a “<a href="https://global.oup.com/academic/product/magic-mineral-to-killer-dust-9780198296904?cc=ca&lang=en&">magic mineral</a>,” which is flexible enough to be woven into cloth yet stronger than steel. After World War II, manufacturers used it in everything from hair driers to automobile brakes to ship boilers. </p>
<p>The problem is that exposure to asbestos can be deadly, causing fatal diseases such as asbestosis, a progressive scarring of the lungs that slowly strangulates its victims, and mesothelioma, a fast-acting cancer of the linings of the lungs.</p>
<p>Contrary to the myth of litigiousness, American workers exposed to asbestos did not immediately sue when they starting falling ill in growing numbers in the late 1960s. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/338067/original/file-20200527-20264-18jweul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/338067/original/file-20200527-20264-18jweul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338067/original/file-20200527-20264-18jweul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338067/original/file-20200527-20264-18jweul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338067/original/file-20200527-20264-18jweul.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338067/original/file-20200527-20264-18jweul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338067/original/file-20200527-20264-18jweul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338067/original/file-20200527-20264-18jweul.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">GOP leader Sen. Mitch McConnell says any further coronavirus aid legislation must protect businesses from coronavirus-related lawsuits.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/senate-majority-leader-mitch-mcconnell-republican-of-news-photo/1214038033?adppopup=true">Saul Loeb/AFP/Getty</a></span>
</figcaption>
</figure>
<p>Instead, they filed claims with state workers’ compensation programs for lost wages and help with their medical bills. When these programs provided very limited relief, they turned to lawyers, who found new ways to hold companies liable for the failure to warn their workers about the dangers of their products. </p>
<p>Over the next few decades, asbestos litigation skyrocketed. By the early 2000s, Americans had filed an estimated 730,000 claims for damages associated with their illnesses and to punish companies for their reckless conduct. Those claims have bankrupted scores of businesses while providing victims slow and erratic payments. The final price tag could reach an estimated <a href="http://press.georgetown.edu/book/georgetown/dust">US$325 billion in today’s dollars</a>.</p>
<p>The Netherlands offers an instructive contrast. Dutch workers suffered from asbestos-related diseases at five to 10 times the rate of <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674238367">American workers</a>. </p>
<p>Yet Dutch workers had filed a total of 10 – 10! – <a href="http://press.georgetown.edu/book/georgetown/dust">lawsuits against businesses by the early 1990s</a>.</p>
<p>Dutch workers had little incentive to sue, because they were guaranteed relatively generous health and unemployment benefits from the government that would be deducted from any recovery in the courts.</p>
<h2>Less government; more litigation</h2>
<p>The asbestos example underscores an implicit trade in the American approach to social problems that leaves both Republicans and Democrats unsatisfied: less “government” but more litigation. </p>
<p>It is the same trade that leaves <a href="https://www.nytimes.com/2017/04/15/us/politics/republicans-health-care-bill-medical-malpractice-suits.html">Republicans railing against medical malpractice lawsuits</a> while <a href="https://democrats.org/where-we-stand/the-issues/health-care/">Democrats decry the lack of universal health insurance</a>. </p>
<p>The coronavirus pandemic, like other health disasters, has revealed the downsides of this trade for both businesses and households. Businesses, already under financial strain from the pandemic, worry that the trickle of lawsuits that has already begun will turn into a torrent. Displaced workers lack adequate health care insurance and have no guarantee they will be protected from poverty when their unemployment benefits run out.</p>
<p>This brings us back to the congressional standoff. Congress could clarify the responsibilities of businesses, creating a safe harbor from lawsuits: If businesses adopt model sanitation and social distancing measures and provide workers with protective equipment, they could not be sued on the grounds that these procedures were inadequate. In exchange, the aid package should ensure that workers’ lost wages and medical costs associated with the pandemic are fully covered. </p>
<p>This would not be a cynical partisan deal. It would be an exchange of remedies, replacing some forms of litigation, which have often proved expensive and unreliable mechanisms for protecting workers and consumers, with direct support for those whose health and livelihoods have been devastated. </p>
<p>If properly structured, such a deal would offer more aid for victims of the coronavirus and more legal certainty for businesses seeking to reopen. That would be a win for both sides – and a step away from depending so much on courts to respond to disasters like this pandemic.</p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/137465/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>American ambivalence about government has left the courts to play an outsized role responding to public health crises like lead poisoning, asbestos-related illnesses and now, the coronavirus pandemic.Jeb Barnes, Professor of Political Science, USC Dornsife College of Letters, Arts and SciencesThomas F. Burke, Ralph Emerson and Alice Freeman Palmer Professor of Political Science, Wellesley CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1264892019-11-07T19:03:31Z2019-11-07T19:03:31ZEngineered stone benchtops are killing our tradies. Here’s why a ban’s the only answer<figure><img src="https://images.theconversation.com/files/300381/original/file-20191106-88403-1i4frk7.jpg?ixlib=rb-1.1.0&rect=6%2C7%2C1016%2C674&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If we can't afford natural stone, like marble, it's tempting to choose engineered or artificial stone instead. But at what cost to those who breathe in the silica dust when cutting it?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-smiling-caucasian-family-kitchen-preparing-347647706">from www.shutterstock.com</a></span></figcaption></figure><p>The <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-nat-dust-disease-taskforce.htm">National Dust Disease Taskforce</a> is preparing to read submissions next week on how best to handle the resurgence of the fatal lung disease silicosis. This can develop after breathing in silica dust when cutting artificial stone — also known as engineered, composite or manufactured stone — the type used for kitchen benchtops.</p>
<p>But this is not the first time we’ve been alerted to the long-term effects of exposure to hazardous dust. Think asbestos.</p>
<p>So what lessons can Australia learn from tackling asbestos to manage this latest preventable occupational hazard?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-silicosis-and-why-is-this-old-lung-disease-making-a-comeback-80465">Explainer: what is silicosis and why is this old lung disease making a comeback?</a>
</strong>
</em>
</p>
<hr>
<h2>We’ve known about hazardous dust at work for centuries</h2>
<p>Centuries ago, we recognised dust in mines badly damaged workers’ lungs. In 1713, Italian physician Bernardino Ramazzini <a href="https://www.ajconline.org/article/0002-9149(59)90174-2/pdf">wrote</a> how miners’ bodies:</p>
<blockquote>
<p>[…] are badly affected, the lungs especially since they take in with the air mineral spirits.</p>
</blockquote>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/ajim.22528">More evidence</a> led to a 1930 conference in South Africa agreeing the lung disease silicosis was caused by silica dust. A few years later, the International Labour Organisation included silicosis in a list of diseases workers could be compensated for.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/black-lungs-back-how-we-became-complacent-with-coal-miners-pneumoconiosis-57718">Black lung's back? How we became complacent with coal miners' pneumoconiosis</a>
</strong>
</em>
</p>
<hr>
<p>Control measures to reduce the risk of silicosis were well-recognised even in the mid-1930s; <a href="https://www.amazon.com/Hawks-Nest-Incident-Americas-Industrial/dp/0300035225">lawsuits were filed</a> against the Union Carbide company for not protecting construction workers. </p>
<p>At that time, breathing protection was fairly basic. But in the decades since then, <a href="https://www.safeworkaustralia.gov.au/silica">we established</a> that any activity generating silica dust (such as cutting, blasting or grinding concrete or rock) needed water spray systems, extraction fans and respirators.</p>
<h2>The dangers of cutting engineered stone</h2>
<p>So how, in a country like Australia, do we suddenly see young workers dying of this completely preventable disease? </p>
<p>The cases seem to be arising from cutting artificial stone. This can contain up to 95% silica, <a href="https://www.worksafe.qld.gov.au/injury-prevention-safety/alerts/whsq/2018/prevent-exposure-to-silica-for-engineered-stone-benchtop-workers">compared with</a> less than 40% silica in natural stone.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300387/original/file-20191106-88382-15fxzpd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cutting engineered stone exposes workers to higher levels of silica dust than cutting natural stone.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stone-cutting-tool-evening-1232151553">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Cutting artificial stone has emerged as a major hazard. <a href="https://www.abc.net.au/news/2019-09-16/silicosis-surge-prompts-call-for-ban-on-engineered-stone-product/11516138">The ABC reports</a> there have been 260 cases of silicosis in Australia, mostly in Queensland. </p>
<p>And there are likely to be more cases developing. <a href="https://www.commerce.wa.gov.au/announcements/spotlight-silica-proactive-inspection-program">Regulators’</a> <a href="https://www.finance.nsw.gov.au/about-us/media-releases/nation-leading-program-fight-silicosis-0">responses</a> — proactively inspecting workplaces to see if they comply with safe work practices and issuing prohibition notices and fines to individual workplaces if not — are very welcome.</p>
<p>But these responses come too late for those hundreds of young workers who have lost their health, some of whom may die without a lung transplant.</p>
<h2>What can we learn from asbestos?</h2>
<p>We have been here before. Asbestos mining and manufacturing and the importation of asbestos products into Australia started in the 1880s. Over the next century, it developed into a major industry, peaking in the decades after the second world war.</p>
<p>Over the same time, medical knowledge about the diseases caused by asbestos was growing. The first recorded case of asbestosis (a progressive lung disease) was <a href="https://catalog.hathitrust.org/Record/100760626">described in London in 1906</a> (although, reports of ill health in asbestos workers had been reported <a href="https://catalog.hathitrust.org/Record/002130771">from as early as 1899</a>). </p>
<p>In 1928 the Journal of the American Medical Association <a href="https://jamanetwork.com/journals/jama/article-abstract/253232">published an editorial</a> on asbestosis. And, in Australia from 1945, standards for exposure to asbestos <a href="https://publishing.monash.edu/books/aa-9781925835618.html">were introduced</a> as controlling dust levels was thought the best way to prevent disease. </p>
<p>If Australia had stopped the use of asbestos in 1928, the ill health and death associated with asbestos would not be at levels we’ve seen since.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-harms-of-asbestos-wont-be-known-for-decades-14845">Health harms of asbestos won't be known for decades </a>
</strong>
</em>
</p>
<hr>
<p>Instead, <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1702/literaturereview_airborneasbestosfibres_2008_pdf.pdf">Australia only stopped using</a> blue asbestos (the most carcinogenic form) in the late 1960s, brown asbestos (the next most carcinogenic) in the 1980s, and all asbestos in 2003.</p>
<p>By 2020, there will have been an estimated <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/ajim.10047">18,000 cases of mesothelioma</a>, <a href="https://www.nature.com/articles/bjc2011563">108,000 cases of lung cancer</a> and <a href="https://www.safeworkaustralia.gov.au/doc/asbestos-related-disease-indicators-2014">an unknown</a> but substantial number of cases of asbestosis in Australia.</p>
<h2>How best to protect workers?</h2>
<p>The standard response to the silicosis epidemic is that workers should use control measures and personal protection. However, there is <a href="https://academic.oup.com/annweh/article/59/1/122/2464381">increasing</a> <a href="https://oeh.tandfonline.com/doi/abs/10.1080/15459624.2013.789706">evidence</a> dust control measures do not reduce the levels of silica to non-hazardous levels. </p>
<p>Many companies also use a mixture of dry and wet cutting, particularly when installing the products. As with asbestos, there simply is no way to safely use this material.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dying-for-work-the-changing-face-of-work-related-injuries-40328">Dying for work: the changing face of work-related injuries</a>
</strong>
</em>
</p>
<hr>
<p>We need to go back to the basics of occupational health — <a href="https://en.wikipedia.org/wiki/Hierarchy_of_hazard_controls">the hierarchy of control</a>. This means, if there is a hazard, we first see if we can eliminate it by banning the dangerous product.</p>
<p>This basic principle, taught to all occupational health and safety professionals, seems to have been forgotten for silica. For example, SafeWork Australia does not mention elimination in its online information on controlling <a href="https://www.safeworkaustralia.gov.au/silica">silica</a>, although it does mention substitution with products containing lower levels of silica.</p>
<p>The <a href="https://www.breathefreelyaustralia.org.au/">Breathe Freely Australia</a> public health campaign, <a href="https://www.breathefreelyaustralia.org.au/wp-content/uploads/2019/10/bf-cmt-Hiearchy-of-Control.pdf">notes</a> elimination:</p>
<blockquote>
<p>[…] is the preferred method of control as it completely eliminates the hazard, but unfortunately it is not often feasible. </p>
</blockquote>
<h2>Yes, a ban is feasible</h2>
<p>We argue it is feasible to ban artificial stone, which is not made in Australia but imported. There are many alternatives, such as natural stone, or <a href="https://www.bettastone.com.au/">Betta Stone</a> made from recycled glass.</p>
<p>The National Dust Disease Taskforce is <a href="https://consultations.health.gov.au/ohp-regulatory-policy-branch/national-dust-disease-taskforce/">taking submissions</a> until November 11, 2019.</p>
<p>We suggest:</p>
<ul>
<li><p>a total ban on importing, making and using engineered stone with a crystalline silica content of more than 80%</p></li>
<li><p>immediate regulation (in every jurisdiction) banning dry cutting, grinding or polishing of all artificial stone</p></li>
<li><p>a reduction of the workplace exposure standard for respiratory crystalline silica to half current levels by January 2020 (from 0.10mg/m³ to 0.05mg/m³). Disappointingly, a recent SafeWork Australia meeting rejected the opportunity to reduce the level to 0.02mg/m³.</p></li>
</ul>
<p>It took 70 years for Australia to ban all forms of asbestos. We need to learn from that disaster and immediately ban artificial stone. We just can’t continue to let young Australian workers die just so we can have cheap, fashionable kitchens.</p><img src="https://counter.theconversation.com/content/126489/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lin Fritschi is a member of the Occupational and Environmental Cancer Subcommittee for Cancer Council Australia. She is also an expert member on the Western Australian Commission for Occupational Safety and Health. She has made a submission to the National Dust Disease Taskforce. The opinions expressed are her own.</span></em></p><p class="fine-print"><em><span>Alison Reid will be making a submission to the National Dust Disease Taskforce.
</span></em></p>What lessons can Australia learn from tackling asbestos to manage this latest preventable occupational hazard?Lin Fritschi, Professor of Epidemiology, Curtin UniversityAlison Reid, Associate Professor, Epidemiology and Biostatistics, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1200422019-07-10T11:16:24Z2019-07-10T11:16:24ZAsbestos in schools: what you need to know<figure><img src="https://images.theconversation.com/files/283275/original/file-20190709-44479-1l7pwql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/595873274?src=Ep4RrTQAsyBYWXE7o7lM8g-1-6&studio=1&size=medium_jpg">AndrewHeffernan/Shutterstock</a></span></figcaption></figure><p>The Department for Education referred <a href="https://www.theguardian.com/education/2019/jul/04/700-english-schools-reported-over-asbestos-safety-concerns">nearly 700 schools</a> in England to the Health and Safety Executive (HSE) as they did not provide evidence that they were managing asbestos in line with regulatory requirements. Of the 29,000 schools in Britain, more than 75% contain asbestos. </p>
<p>Asbestos, the so-called magic mineral, was introduced into building materials over 100 years ago because of its insulation and fire-retardant properties. Its use in buildings peaked in 1975. It was used to lag pipes and boilers, and it was used in walls and ceilings. But the mineral turned out to be a killer. Blue and brown asbestos were banned in the UK in 1984, and white asbestos was banned in 1999. </p>
<p>When asbestos is damaged or disturbed, tiny fibres are released into the air, and these fibres cause disease. About 5,000 people die each year in the UK from asbestos-related diseases, according to <a href="http://www.hse.gov.uk/asbestos/faq.htm">official reports</a>. </p>
<p>Since 2001, the Office for National Statistics revealed at least 305 teaching and education professionals have died of <a href="https://www.nhs.uk/conditions/mesothelioma/">mesothelioma</a>, a cancer almost exclusively caused by asbestos. But no mortality figures are available for children exposed to asbestos at school, although one estimate suggests there have been <a href="https://www.teachers.org.uk/files/appg-booklet-final-17-mar-14-asbestos-in-schools--2-1-.pdf">300 asbestos-related deaths</a> of children who were at school in the 1960s and 70s. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/283298/original/file-20190709-44437-1wd7f3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/283298/original/file-20190709-44437-1wd7f3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/283298/original/file-20190709-44437-1wd7f3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/283298/original/file-20190709-44437-1wd7f3e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/283298/original/file-20190709-44437-1wd7f3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/283298/original/file-20190709-44437-1wd7f3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/283298/original/file-20190709-44437-1wd7f3e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Asbestos fibres can cause a range of diseases, including cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/691857409?src=6QCpYiY1FXgGGp8l3A875Q-1-2&studio=1&size=medium_jpg">farbled/Shutterstock</a></span>
</figcaption>
</figure>
<p>There are five times more deaths from mesothelioma among teachers than there are in the general population. HSE also <a href="http://www.euro.who.int/__data/assets/pdf_file/0003/194133/RB-Asbestos-Mtg-Report-Bonn-2012.pdf">estimates</a> that there is the same number of asbestos-related lung cancer deaths as there are mesothelioma deaths. Others <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273352/">estimate</a> that there are at least two asbestos-related lung cancer deaths for every mesothelioma death. </p>
<p>Non-governmental organisations, such as the European Work Hazards Network, the Hazards Campaign, and trade unions, believe that many asbestos risks have been <a href="http://www.asbestosinschools.org.uk/">under-estimated</a>. In continental Europe, it is <a href="https://www.eurogip.fr/images/publications/EUROGIP-24E-AsbestosOccDiseases.pdf">recognised</a> that asbestos can cause cancer of the larynx, pharynx, trachea, sinus, oesophagus, stomach, colon and rectum – something that is not recognised in the UK. </p>
<p>Asbestos-related diseases can take from <a href="http://www.hse.gov.uk/asbestos/faq.htm">15 to 60 years</a> to develop. Children exposed at school could develop asbestos-related cancers decades later. And it is highly unlikely that the original exposure would be recorded or recognised. </p>
<p>There are no safe levels for exposure to carcinogens and working out what asbestos exposures, at what level and over what period occur in school children is exceptionally difficult. </p>
<p>Children are more <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/315919/vulnerability_of_children_to_asbestos.pdf">vulnerable</a> to the effects of asbestos. There are respiratory and immunological differences between adults and children. Children have an increased life expectancy compared with adults, so there is also an increased lifetime risk of mesothelioma because of the long latency period of the disease. Some estimates suggest children may be five times more likely to develop mesothelioma than adults in the same environment.</p>
<h2>Where does responsibility lie?</h2>
<p>School managers need to carry out asbestos risk assessments. They should ensure risks are managed by checking on the presence and state of asbestos in their schools. Where necessary, they should remove asbestos according to the regulations. And this should be backed up by HSE inspection. </p>
<p>Sealing in asbestos can be a temporary solution to dealing with the hazardous substance in schools, but it’s not a permanent fix as there will be wear and tear and general deterioration of buildings over time. The only viable long-term solution is to remove all asbestos from all schools. </p>
<p>The All Party Parliamentary Group on occupational safety and health in 2012-14 <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/412466/The_management_of_asbestos_in_schools_a_review_of_Department_for_Education_policy.pdf">recommended</a> that the government establish a programme for the phased removal of asbestos from all schools prioritising those schools where the asbestos is considered to be in the most dangerous or damaged condition. </p>
<p>Asbestos fibres have been released at very high levels, even when panels and surfaces look well maintained, as studies revealed in the 1980s. </p>
<p>Removing asbestos is very expensive for local authorities and other school owners, running into millions of pounds, and requires careful planning. However, the human and economic costs of asbestos-related diseases are <a href="https://www.ncbi.nlm.nih.gov/pubmed/17208886">even higher</a>.</p>
<h2>High-quality removal</h2>
<p>If asbestos removal is done professionally by approved and reputable contractors, then the risk of exposure to children will be low. Properly containing and inspecting asbestos in schools will certainly produce fewer risks than inadequate asbestos removals. </p>
<p>Unfortunately, if those removing the asbestos are not competent, then risks of exposure to children <a href="https://www.nasuwt.org.uk/article-listing/proactive-approach-protect-pupils-staff-asbestos.html">may be significant</a> and greater than those from sealed-in materials.</p>
<p>Managing and maintaining asbestos in schools looks likely to continue being a problem, so the commitment to high-quality asbestos removal as the best solution to such a serious health hazard seems the best precautionary approach.</p><img src="https://counter.theconversation.com/content/120042/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Watterson receives funding from WHO to research economic costs of asbestos-related diseases</span></em></p>All asbestos should be removed from all schools.Andrew Watterson, Chair in Health Effectiveness, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1100852019-02-22T11:41:48Z2019-02-22T11:41:48ZWhy asbestos litigation won’t go away: Because asbestos won’t go away<figure><img src="https://images.theconversation.com/files/259805/original/file-20190219-43284-10aoiuv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Johnson & Johnson was ordered to pay US$.4.69 billion in July, 2018 because it failed to warn customers that its baby powder contains asbestos. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Baby-Powder-Cancer-Things-to-Know/cd58ac45db894f56ba473d6d1510ea7a/7/0">Matt Rourke/AP Photo</a></span></figcaption></figure><p>It is tempting to dismiss asbestos as a problem of the past. The <a href="http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199756117.001.0001/acprof-9780199756117">height of its consumption</a> was in the 1970s, and asbestos litigation began over a half century ago. Many of its leading manufacturers and mining companies are long gone.</p>
<p>Yet asbestos litigation is back in the news. </p>
<p>A <a href="https://www.reuters.com/article/us-johnson-johnson-cancer-lawsuit/jury-orders-jj-to-pay-4-7-billion-in-missouri-asbestos-cancer-case-idUSKBN1K234U">trial court ordered Johnson & Johnson</a> in July, 2018, to pay US$4.69 billion for failing to warn customers that its baby powder contained asbestos, which naturally occurs in talc. The company <a href="https://www.nytimes.com/2018/12/14/business/baby-powder-asbestos-johnson-johnson.html">now faces thousands of these suits</a>, and its stock took a nosedive in December 2018 on a report that it <a href="https://www.marketwatch.com/story/johnson-johnson-stock-slammed-by-report-it-knew-of-asbestos-in-baby-powder-2018-12-14">knew its talc was contaminated</a>. The company plans to appeal and continue to fight these cases, but, even if it eventually wins, their emergence raises the question: Why does asbestos litigation persist?</p>
<p>I have studied asbestos for decades and written books about its dangers and public policy around it. The issues surrounding asbestos or the material itself will not go away.</p>
<h2>Stronger than steel, and potentially lethal</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/259806/original/file-20190219-43255-ra3bwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/259806/original/file-20190219-43255-ra3bwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259806/original/file-20190219-43255-ra3bwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259806/original/file-20190219-43255-ra3bwh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259806/original/file-20190219-43255-ra3bwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259806/original/file-20190219-43255-ra3bwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259806/original/file-20190219-43255-ra3bwh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Workers remove asbestos-containing roofing material. Asbestos is used in many industries because of its strength and physical properties.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/removal-fiber-cement-containing-asbestos-1055723846?src=XpaUfZuonFHxq3zjh_5mSQ-1-1">Andre Quinou/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>One reason for the persistence of the problem is that tons of asbestos remain in our communities, a legacy from when <a href="http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199756117.001.0001/acprof-9780199756117">asbestos was prized for its remarkable commercial properties</a>. It is a fiber made of rock that is <a href="https://www.health.state.mn.us/communities/environment/asbestos/">stronger than steel</a>, yet flexible enough to be woven into cloth. It is waterproof, corrosion proof and fireproof, as well as abundant and easy to mine. </p>
<p>Manufacturers found ways to add asbestos to everything from hair driers to battleships, roof shingles to children’s modeling clay, car parts to missile silos. Asbestos is still used legally in the U. S. <a href="https://www.epa.gov/asbestos/us-federal-bans-asbestos">for some purposes</a>, despite efforts to ban it completely, <a href="https://www.asbestossafety.gov.au/importing-advice/countries-asbestos-bans">like many other countries,</a> including those in the <a href="https://www.asbestos.com/mesothelioma/worldwide/">European Union</a>, Australia and dozens more. </p>
<p>Scientists now know that exposure to <a href="https://www.nap.edu/catalog/11665/asbestos-selected-cancers">asbestos’ fibers can be lethal</a>, causing a number of fatal diseases including mesothelioma, an aggressive cancer of the lining of organs, and asbestosis, a progressive scarring of the lungs. Asbestos exposure can also cause <a href="https://www.asbestos.com/mesothelioma/pleural-plaques/">pleural plaques</a>, fibrous thickenings of the membrane around the lung. This condition is asymptomatic and may not develop into serious diseases. But those who have been exposed face years of uncertainty because many of the worst asbestos-related diseases can take decades to appear.</p>
<p>And, yesterday’s asbestos can be today’s health hazard. Because it is a mineral, asbestos does not evaporate, and its dangers do not diminish over time. If anything, some asbestos products can become more dangerous as they become brittle and likely to release fibers into the environment. </p>
<p>Asbestos fibers can also be released when disturbed, a fact tragically illustrated by the Sept. 11 terrorists attacks when the collapse of the World Trade Center towers released a <a href="https://www.simonandschuster.com/books/Fatal-Deception/Michael-Bowker/9780743251433">cloud of dust containing asbestos</a>. </p>
<p>Finally, asbestos is part of the landscape of some communities, and epidemiologists have found <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2718408/">higher rates of asbestos-related cancers</a> in areas that are known to have deposits of asbestos-containing rock. </p>
<p>Accordingly, even if the U.S. followed the lead of other countries and prohibited its use, health risks from asbestos would continue. Consistent with this assessment, the World Health Organization reported that <a href="https://www.who.int/news-room/fact-sheets/detail/asbestos-elimination-of-asbestos-related-diseases">asbestos-related deaths have persisted</a> worldwide, including in countries that banned it in the early 1990s. </p>
<h2>Lawsuits, a result of politics?</h2>
<p>A final reason for continued litigation is political. Asbestos is a global problem, but the American response has been distinct. Whereas other countries have addressed asbestos injuries through centralized benefit programs that pool costs and risks, the <a href="https://www.crcpress.com/Compensating-Asbestos-Victims-Law-and-the-Dark-Side-of-Industrialization/Boggio/p/book/9781409419075">U.S. has relied much more heavily on litigation</a>. </p>
<p>Consider the Netherlands. During the 1970s and 1980s, Dutch workers suffered <a href="http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199756117.001.0001/acprof-9780199756117">five to 10 times the incidence</a> of asbestos-related diseases compared to American workers. Dutch law allows workers to sue their employers for workplace injuries, yet there were only 10 asbestos-related lawsuits in the Netherlands in the 1990s. During the same period, one in three of all civil cases filed in the Eastern District of Texas were asbestos-related. </p>
<p>Dutch workers did not file lawsuits because they did not need to. They enjoyed much more comprehensive health and unemployment benefits, which were deducted from any recovery in the courts. </p>
<p>American workers also <a href="http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199756117.001.0001/acprof-9780199756117">did not sue</a> at first. Instead, they sought relief from state workers’ compensation programs. But these programs were designed to compensate workers for traumatic injuries, like broken arms and legs, and not slowly manifesting occupational diseases, like <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/mesothelioma">mesothelioma</a> and <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/asbestosis">asbestosis</a>. As a result, these programs offered very limited relief. </p>
<h2>With no relief, lawyers moved in</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/260048/original/file-20190220-148523-lni52q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/260048/original/file-20190220-148523-lni52q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/260048/original/file-20190220-148523-lni52q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/260048/original/file-20190220-148523-lni52q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/260048/original/file-20190220-148523-lni52q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/260048/original/file-20190220-148523-lni52q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/260048/original/file-20190220-148523-lni52q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Roofing material that shows small asbestos fibers. When these indestructible fibers enter the lung, they can cause serious disease.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/detailed-photography-roof-covering-material-asbestos-1086447584?src=XpaUfZuonFHxq3zjh_5mSQ-1-11">tunatura/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Entrepreneurial lawyers stepped into the breach. Aided by favorable rulings and the discovery of decades of corporate efforts to conceal the risks of their products, asbestos litigation took hold and ramped up. By the early 2000s, an estimated <a href="https://www.rand.org/pubs/monographs/MG162.html">730,000 claims</a> had been filed targeting over 8,400 companies in 75 of 83 categories of economic activity within the U.S. economy. Building on their early successes, <a href="http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199756117.001.0001/acprof-9780199756117">lawyers created an extensive infrastructure</a> to support these claims, giving rise to a cottage industry complete with extensive marketing campaigns and sophisticated strategies for finding new claims. The final price tag has been <a href="http://press.georgetown.edu/book/georgetown/dust">estimated at over $325 billion</a> in today’s dollars.</p>
<p>Initially, this litigation illustrated the heroic side of the American legal system: its flexibility, innovativeness and ability to take on powerful interests. Over time, however, serious concerns emerged from lawyers, policy experts and judges about its costs and fairness. <a href="https://www.rand.org/pubs/reports/R3324.html">Numerous studies</a> demonstrated that administrative costs of asbestos litigation gobble up over half of all compensation paid. These costs might be tolerable if asbestos litigation has delivered consistent and timely compensation to victims, but payments have been erratic and slow.</p>
<p>Meanwhile, claims now are often herded into massive settlements or bankruptcy compensation trusts, where compensation varies and claimants are offered <a href="https://www.rand.org/pubs/monographs/MG162.html">little, if any, individual due process</a>. Even worse, asbestos litigation has reportedly become plagued by <a href="https://reference.findlaw.com/lawandeconomics/7600-class-actions.pdf">questionable practices</a> and <a href="https://www.americanbar.org/content/dam/aba/administrative/tips/asbestos_tf/AsAsbestosClaimsRiseSodoWorriesAboutFraud.pdf">accusations of fraudulent practices</a> that displace consideration of those suffering the most and unfairly burden the courts and businesses.</p>
<p>Given these problems, judges, interest groups and members of both political parties have repeatedly begged Congress to create a national asbestos injury compensation fund along the lines of other economically advanced democracies. These <a href="http://press.georgetown.edu/book/georgetown/dust">efforts have all failed at the federal level</a> for a variety of complex political reasons, which have thwarted compromises over who pays, how much and to whom. </p>
<p>As a result, the erratic beat of asbestos litigation will continue, as the problem of asbestos will not go away on its own. People without adequate health insurance and social benefits will continue to suffer, and lawyers will continue to find ways to bring claims. Just ask Johnson & Johnson.</p><img src="https://counter.theconversation.com/content/110085/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeb Barnes receives funding from National Science Foundation. </span></em></p>Asbestos litigation is the number one source of tort claims in the US, with many people decrying the filing of so many claims. But there’s a reason the claims persist. Asbestos isn’t going anywhere.Jeb Barnes, Professor of Political Science, USC Dornsife College of Letters, Arts and SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/896732018-01-08T22:47:34Z2018-01-08T22:47:34ZMeat is not the ‘new tobacco,’ and shouldn’t be taxed<figure><img src="https://images.theconversation.com/files/200826/original/file-20180104-26169-xpun6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is meat the new tobacco? Some are suggesting it is, and urging a "sin tax" on beef, pork and other meats.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The idea of having to pay a sin tax for environmentally detrimental foods is gaining more support. For some, eating meat is a sin, and therefore meat products should be taxed like alcohol and tobacco. </p>
<p><a href="http://www.fairr.org/resource/livestock-levy-regulators-considering-meat-taxes/">A new report published recently by a British group called Farm Animal Investment Risk and Return Initiative (FAIRR)</a> argues that a tax on meat is inevitable.</p>
<p>The meat industry, particularly beef producers, has been facing relentless criticism over the last decade. Very rarely have we seen reports encouraging consumers to eat more meat. </p>
<p>For one thing, science-based findings linking climate change and meat have been accumulating. The United Nations Food and Agriculture Organization <a href="http://www.fao.org/ag/againfo/resources/en/publications/tackling_climate_change/index.htm">has reported that livestock account for about 14.5 per cent</a> of the world’s greenhouse gas emissions. Other surveys have suggested the sector may represent up to 18 per cent. </p>
<p>Greenhouse gas emissions produced by the livestock industry will only increase as the middle class in both India and China expand, and, as such, <a href="http://www.ibtimes.co.uk/global-meat-consumption-increasing-driven-china-india-527128">demand for animal protein is exploding.</a></p>
<p>And then there’s health.</p>
<p>In 2015, the World Health Organization <a href="https://www.cancer.org/latest-news/world-health-organization-says-processed-meat-causes-cancer.html">linked meat consumption to cancer.</a> The report indicated that eating processed meat products increases the risk of developing cancer. </p>
<p><a href="http://www.straitstimes.com/asia/australianz/australia-says-who-study-linking-processed-meat-to-cancer-is-a-farce">Several meat-producing countries</a>, including <a href="http://nationalpost.com/news/canada/agriculture-canada-challenged-whos-cancer-warnings-on-meat-according-to-newly-released-documents">Canada</a>, the U.S., Brazil and Australia, ridiculed the report because processed meats were added to the same category as asbestos. </p>
<h2>Meat-eating discouraged in some countries</h2>
<p>But several other governments, <a href="https://www.theguardian.com/world/2016/jun/20/chinas-meat-consumption-climate-change">including China</a> and some European countries, have actively discouraged their citizens from consuming an unreasonable amount of meat. That’s not a signal the meat industry needs.</p>
<p>The other major headwind the industry faces is related to the ethical treatment of animals. Some believe livestock production is unethical and that the industrial production of meat <a href="http://www.debatingeurope.eu/2016/09/20/intensive-animal-farming-banned/#.Wk5ZIbQ-cW8">should be outlawed</a>, period. </p>
<p>The ethics narrative around meat has been gaining traction over the last decade or so.</p>
<p>Now, if you think the FAIRR initiative is some minor, under-resourced group desperately trying to seek attention, think again. It includes a portfolio of 57 investors with more than US$2.3 trillion under management.</p>
<p>This alliance clearly wants to influence the plant-based protein agenda, and has had its fair share of success in doing so. Already, agri-food giants like Tyson Foods and Cargill <a href="https://www.fastcompany.com/40508181/get-ready-for-a-meatless-meat-explosion-as-big-food-gets-on-board">are looking at “beyond-meat” solutions.</a></p>
<p>Demand-focused companies are seeing the writing on the wall. Many consumers are <a href="https://theconversation.com/less-meat-more-choice-a-look-at-key-food-issues-in-2018-89489">re-evaluating their relationship with animal proteins</a>, although in cattle country, a large number remain in deep denial and blame interest groups for fear-mongering.</p>
<h2>Canadians still love their meat</h2>
<p>Statistics show that demand for meat in Canada is still stubbornly robust. The average Canadian typically consumes <a href="http://www.agr.gc.ca/eng/industry-markets-and-trade/market-information-by-sector/red-meat-and-livestock/red-meat-and-livestock-market-information/protein-disappearance-and-demand-by-species/?id=1415860000022">about 87 kilograms of meat products</a> in one year, which is just slightly lower than the amount from five years ago. </p>
<p>This year, beef consumption in our country reached 25.4 kilograms per capita, and some expect demand for the product to increase to 25.5 kilograms next year. Surprising, perhaps, but beef prices have come down, making the product more attractive for the consumer on a budget. </p>
<p>Some <a href="https://caes.usask.ca/members/_pdf/2017%20Canadian%20Agricultural%20Outlook.pdf">significant variations among provinces</a> should be noted, though. Alberta is by far the largest consumer of beef; the average adult Albertan male will eat 83 grams a day. That’s 53 per cent more than the average in Newfoundland, and 18 per cent more than in neighbouring British Columbia. Affordability and lifestyle are probable reasons for such a difference. </p>
<p>Canadian consumers have stayed on the side of our livestock industry, but numbers are showing signs of a change in consumer habits. </p>
<p>Demand for pork is <a href="https://www.discoverwestman.com/ag-news/39921-canadian-pork-council-discusses-strategic-planning-at-fall-meeting">expected to fall to unprecedented levels in 2018,</a> dropping 13 per cent from its 2015 level. Demand for chicken, one of the cheapest types of animal protein out there, plateaued in 2016 and has since softened.</p>
<p>Although beef could experience a rebound in 2018, expected increases aren’t spectacular given how low retail prices are these days. Canadians are not giving up on meats, but they are willing to spend more time away from the meat counter. Animal protein still has market currency, but plant-based alternatives to meat are increasingly attractive.</p>
<p>But little can be accomplished by taxing meat. Taxing food in general — any food product — is morally questionable. A retail tax on food is regressive and can potentially penalize the underprivileged who need affordable sources of protein. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some have floated the idea of taxing meat as a type of sin tax.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<h2>Meat the new tobacco?</h2>
<p>Some have argued that <a href="https://www.huffingtonpost.com/kathy-freston/animal-products-cancer_b_1316222.html">meat is the new tobacco</a>. This sensationalist parallel is unwise, since tobacco is not essential to life and food is. </p>
<p>The implementation of such a tax would also be challenging. </p>
<p>If federal or provincial governments were to tax meat, funds would likely be used to support other relevant public programs. But as with any tax, transparency on how funds are dispersed within the massive, bureaucratic governmental machinery is weak. </p>
<p>What’s more, many small businesses around the country have offered high-quality meat products to local markets. Many of them are family businesses. Taxing sausages and steaks would compromise the viability of many stores valued by communities across the country.</p>
<p>Meat has played a significant part in consumers’ lives in the Western world for centuries. Penalizing consumers for continuing a culinary tradition is unfair.</p>
<p>Taxing a food product that’s been entrenched in our culture for so long is idealistically silly. We should let the market evolve and allow consumers to make their own choices. </p>
<p>That said, the livestock industry must pore over market data and start listening to consumers in order to better appreciate their concerns. Given that they are <a href="https://www.producer.com/2017/10/who-do-consumers-trust-farmers-favoured-for-reliable-info/">one of the most trusted groups in our economy</a>, livestock producers are ideally positioned to renew their social contract with the public.</p><img src="https://counter.theconversation.com/content/89673/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sylvain Charlebois does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Taxing a food product like meat, which has been entrenched in our culture for so long, is silly. We should let the market evolve and allow consumers to make their own choices.Sylvain Charlebois, Professor in Food Distribution and Policy, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/520602015-12-21T06:23:58Z2015-12-21T06:23:58ZWhy the health threat from asbestos is not a thing of the past<p>“<a href="http://www.channel4.com/news/calais-jungle-camp-littered-with-asbestos">Calais Jungle Camp littered with asbestos</a>”; “<a href="http://www.cityam.com/218700/buckingham-palace-could-be-vacated-remove-asbestos-upkeep-presents-significant-financial">Buckingham Palace could be vacated to remove asbestos</a>”; “<a href="http://www.abc.net.au/news/2015-11-30/refugees-removing-nauru-asbestos-without-proper-protection/6985292">Safety concerns for refugees and workers as Nauru asbestos removal programme kicks off</a>”.</p>
<p>Such headlines occur with monotonous regularity. Widespread asbestos use throughout much of the 20th century has ensured that the next contamination scandal is never far off. Despite this, asbestos has not captured the public imagination as a public health threat – at least, not in comparison with other threats such as excessive sun exposure and drink driving.</p>
<h2>Useful but deadly</h2>
<p>Asbestos is a versatile, fibrous mineral that can be cheaply mined and has unusual fire resistance and durability. Use exploded in the 20th century and it was included in such diverse products as automobile brake linings, pipe insulation, ceiling and floor tiles, textured paints, concrete, mattresses, electric blankets, heaters, ironing boards and even piano felts. </p>
<p>However, it has long been known that inhaling asbestos dust can cause cancer and other lung diseases. There is no safe threshold for exposure, and even <a href="https://www.mja.com.au/journal/2011/195/5/increasing-incidence-malignant-mesothelioma-after-exposure-asbestos-during-home">single exposures to dust</a> have been linked to cancer. Rates of asbestos-related cancer <a href="http://www.scielosp.org/scielo.php?script=sci_abstract&pid=S0042-96862011001000010&lng=en&nrm=iso&tlng=en">have recently been on the rise</a> in Europe and Japan and look set to climb in many developing countries where <a href="http://mosaicscience.com/story/killer-dust">the material is still being widely used, often without safety precautions</a>. According to WHO estimates, <a href="http://www.who.int/ipcs/assessment/public_health/asbestos/en/">asbestos now causes more deaths globally</a> than <a href="http://www.who.int/mediacentre/news/notes/2006/np16/en/">excessive sun exposure</a>. In the UK it is estimated to <a href="http://www.britishasbestosnewsletter.org/ban93.htm">cause almost three times as many deaths</a> as road traffic accidents. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/105132/original/image-20151209-15564-f95tu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/105132/original/image-20151209-15564-f95tu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/105132/original/image-20151209-15564-f95tu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/105132/original/image-20151209-15564-f95tu4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/105132/original/image-20151209-15564-f95tu4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/105132/original/image-20151209-15564-f95tu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/105132/original/image-20151209-15564-f95tu4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/105132/original/image-20151209-15564-f95tu4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Take heed.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/orinrobertjohn/3058328612/in/photolist-eezi5q-9K6jS8-dHiZtd-pxqcRQ-6imjsj-6imjmE-jESpP-3VS1qA-5EfJxE-zj2QvH-6GVGdA-dsZwe1-bFioD4-789bHr-9K9kb5-9drEEL">OrinZebest/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Yet awareness about the threat it poses is often low, even in high-risk groups <a href="http://annhyg.oxfordjournals.org/content/51/2/113">such as plumbers</a>. </p>
<p>Huge efforts have been made in recent decades to educate the public on many other health threats, such as those from UV radiation, unsafe sex and drink driving. Asbestos has, relatively speaking, been neglected.</p>
<h2>Real and present</h2>
<p>One factor in the lack of public education and understanding may be the perception that asbestos is a disease of the past: many current asbestos-related deaths are due to exposure that occurred before the 1980s, when strict regulations in developed countries began to bite. However, asbestos remains a pervasive presence in <a href="https://www.mja.com.au/journal/2011/195/5/increasing-incidence-malignant-mesothelioma-after-exposure-asbestos-during-home">homes</a>, <a href="http://www.hsa.ie/eng/Publications_and_Forms/Publications/Chemical_and_Hazardous_Substances/asbestos_guidelines.pdf">workplaces</a> and <a href="http://iopscience.iop.org/article/10.1088/1742-6596/151/1/012023/pdf">schools</a>, and demolitions, <a href="https://www.mja.com.au/journal/2011/195/5/increasing-incidence-malignant-mesothelioma-after-exposure-asbestos-during-home">renovation and DIY work can lead to significant exposures</a>. In a recent Australian survey, <a href="https://www.mja.com.au/journal/2013/199/6/asbestos-exposure-during-home-renovation-new-south-wales">over 60% of DIY home renovators</a> reported having been exposed to asbestos during renovation work, and this may underestimate true exposure, given low awareness of the range of applications in which asbestos has been used. </p>
<p><a href="https://global.oup.com/academic/product/defending-the-indefensible-9780199534852?cc=gb&lang=en&">It had previously been thought</a> that only workplace exposure was sufficient to cause cancer, but it is now estimated that, in industrialised counties, non-occupational exposure <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499908/">accounts for around 20% of cases of mesothelioma</a>, <a href="http://www.sciencedirect.com/science/article/pii/S014067369590462X">an especially deadly form of cancer</a>. </p>
<h2>Explosion in developing countries</h2>
<p>More worryingly, the <a href="http://ibasecretariat.org/lka-latest-global-asbestos-data.php">use of asbestos is exploding and is largely unregulated</a> in many developing countries including <a href="http://www.ctvnews.ca/business/banned-in-much-of-the-developed-world-asbestos-going-strong-in-india-1.1955931">India</a>, Indonesia and Thailand. </p>
<p>Until as recently as 2011, Canada, historically the largest producer of asbestos, was still mining the substance and <a href="http://www.abc.net.au/am/content/2012/s3548789.htm">exporting it to India</a>, even though its use was all but banned at home. Russia, Kazakhstan and Brazil continue to mine and export chrysotile (white) asbestos, the only type of asbestos still being commercially used. There is a risk that the asbestos-related cancer epidemic currently affecting much of Europe and Australasia will be repeated elsewhere, and perhaps on a larger scale.</p>
<h2>Correcting the neglect</h2>
<p>Asbestos cannot be set aside as a 20th century problem. So what explains it’s relative neglect as a public health threat?</p>
<p><a href="https://global.oup.com/academic/product/defending-the-indefensible-9780199534852?cc=gb&lang=en&">A powerful asbestos industry</a> that has consistently cast doubt on the health risks posed by the substance has surely played a role, particularly in countries with significant asbestos industries such as the US, UK, Australia, Italy, Belgium and Canada. The association of asbestos with “boring” workplace health and safety measures may have also helped to prevent the risk capturing the public imagination. And the perception of asbestos-related disease as a problem for the working classes may also have contributed to a lack of attention from predominantly middle-class politicians and officials. </p>
<p>Yet though these factors might explain the relative neglect of asbestos, they do nothing to justify it. Asbestos should get the attention that its devastating health costs warrant. </p>
<p>The developing world should be the top priority here. All countries must promote good practice in the handling of asbestos and lend their support to a worldwide ban on its use. </p>
<p>But more should be done in rich countries too. There is a strong case for widely-publicised home testing services that are made freely available to all tradespeople and home renovators. There is also a need for broad public health campaigns of the sort that have been used to fight road deaths, melanoma and sexually transmitted infections. Australia has recently <a href="http://ibasecretariat.org/lka-blogzxa104.php">taken significant steps in this direction</a>, introducing an asbestos awareness month and creating resources to help homeowners identify asbestos. Other countries should follow suit, and go further. Asbestos has proven itself dangerous enough to warrant a place in the public eye.</p><img src="https://counter.theconversation.com/content/52060/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tom Douglas is a Senior Research Fellow in the Uehiro Centre for Practical Ethics, a Lead Research in the Oxford Martin School, and a Golding Fellow at Brasenose College, University of Oxford. He gratefully acknowledges the financial support of the Uehiro Foundation on Ethics and Education and the Wellcome Trust, and the assistance of Laura Van den Borre and Laurie Kazan-Allen in researching this post. All deficiencies remain attributable to the author. </span></em></p>Asbestos is not a thing of the past, far from it – it’s use is exploding in the developing world and many others are still at risk.Tom Douglas, Senior Research Fellow , University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/466832015-09-24T05:21:25Z2015-09-24T05:21:25ZInquiries into migrant worker rights show same old problems – but we already have solutions<p>A <a href="http://www.abc.net.au/am/content/2015/s4318702.htm">Senate inquiry</a> into exploitation and underpayment of foreign workers at 7-Eleven stores began in Melbourne today. The inquiry is likely to raise questions about the health and safety impacts of workplace practices that target vulnerable workers for profit.</p>
<p>We know that while migrant workers are being underpaid, there’s a lot more at stake here than their pay cheques. <a href="http://www.sjweh.fi/download.php?abstract_id=1112&file_nro=1">Studies show</a> financial insecurity has a strong impact on migrant worker health. There’s also an established relationship between poor working conditions and chronic health issues.</p>
<h2>A recurring problem</h2>
<p>7-Eleven isn’t the only company guilty of bad employment practices. Both the <a href="https://www.parliament.sa.gov.au/Committees/Pages/Committees.aspx?CTId=5&CId=292">South Australian</a> and <a href="http://www.premier.vic.gov.au/chair-of-labour-hire-inquiry-announced">Victorian</a> governments are holding parliamentary inquiries in response to <a href="http://www.abc.net.au/news/2015-05-06/parliamentary-inquiry-into-labour-hire-industry/6449714">reports</a> about widespread worker exploitation in the fresh food industries. And Australia Post <a href="http://www.smh.com.au/national/australia-post-link-to-visa-crime-racket-claim-20150804-girbiw.html">recently fired</a> one of its contractors for similar tactics. </p>
<p>This isn’t a new problem.</p>
<p>The world’s largest blue asbestos mine, which operated in Wittenoom, Western Australia, in the 1960s, had a workforce of both Australian and migrant workers. <a href="http://www.iscrr.com.au/news/events/alison-reid-presentation.pdf">Studies show</a> Wittenoom’s Italian-born workers were placed in the least desirable jobs and exposed to asbestos fibre levels twice as high as their local counterparts experienced. They had a 16 times greater risk of developing mesothelioma, an aggressive cancer affecting the lungs. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1002/ajim.22428/abstract;jsessionid=A693AABAE9DE69A1A06534FC77E07865.f03t03">And a recent study comparing</a> the workplace hazard exposure of ethnic and Australian-born workers across a range of occupations and industries found the former were more likely to be exposed to occupational hazards. </p>
<p>We don’t know the full extent of the problem. Workplace health and safety regulators focus prevention activities on known risks, identified through <a href="http://www.safeworkaustralia.gov.au/sites/swa/statistics/workers-compensation-data/pages/wc-data">workers’ compensation claims data</a>. But this underestimates the total burden of work-related injury, as many workers are ineligible to make claims, or don’t lodge them. </p>
<p>Other datasets reveal a different picture. In the 2013-14 financial year, for instance, 531,800 Australia workers experienced a work-related injury or illness but only 34% <a href="http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/77A34962A3E3DAEACA257D94000BE318/$File/63240_jul%202013%20to%20jun%202014.pdf">received workers’ compensation</a>. Nearly 20% of those who didn’t claim compensation were either unaware of workers’ compensation or felt that making a claim would have a negative impact on their relationship with their employer. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/96008/original/image-20150924-2447-kh6ojn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96008/original/image-20150924-2447-kh6ojn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96008/original/image-20150924-2447-kh6ojn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96008/original/image-20150924-2447-kh6ojn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96008/original/image-20150924-2447-kh6ojn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96008/original/image-20150924-2447-kh6ojn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96008/original/image-20150924-2447-kh6ojn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Italian-born workers at the Wittenoom mine in the 1960s were exposed to twice the level of asbestos that those born in Australia experienced.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/pschube/5399825228/in/photolist-9eavUY-9eaWh5-cMMgjo-8EYteq-cMMe5E-cJCHi1-cJCHKJ-cJCJdd-9eazMJ-9e7sCV-cM94bL-JAwQh-cKbW33-8EVh9R-dk4dB8-cLrXou-cKbWQf-cMMeC9-cKbWzd-cLrYjm-cw54d5-cKbX2o-8EVhnv-cLrZfj-cM92m5-8EYttw-cC31ME-cDgTNy-cAg9HA-cCFV8S-cM91Sq-cM8YsJ-cKbWnj-cALfKf-WxXo-WAFC-cJ4iLq-Wy22-WAFG-cM92Sy-cCFW9A-WxZX-WAER-WxVk-cCFVHU-WADZ-WAFY-WAHA-WAHp-WAHf">Philip Schubert/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>While we don’t know how many of these employees were migrants, we do know that migrant workers in Australia have a <a href="http://www.iscrr.com.au/news/events/monica-odwyer-presentation.pdf">limited understanding</a> of occupational health and safety systems. That puts them at greater risk of workplace injury. </p>
<p>These workers find themselves at the nexus of a complex system encompassing immigration, employment, and health and safety policy. At best, this complexity creates an environment that results in some workers falling through the cracks. At worst, it enables some employers to exploit the gaps. </p>
<h2>Complex system</h2>
<p>Migrant workers and international students, who also work part-time, need employers to provide references to maintain their visa status. Some rogue employers take advantage of this. <a href="http://www.theage.com.au/business/7eleven-workers-pay-up-to-70000-for-visa-in-indentured-labour-scheme-20150923-gjsxzh.html">News reports claim</a> 7-Eleven franchisees coerced staff into working longer hours than their visa requirements allow. They then threatened to report them to immigration authorities if they complained of their conditions.</p>
<p>But migrants aren’t the only ones vulnerable at work; other groups at increased risk of work injury and illness include young and inexperienced workers, older workers and those who struggle with English literacy. </p>
<p>A recently developed <a href="http://www.sciencedirect.com/science/article/pii/S0001457515002286">survey</a> identifies four conditions that affect workers’ risk of work injury: </p>
<ul>
<li> exposure to hazards</li>
<li> workplace policies and procedures to protect workers</li>
<li> occupational health and safety awareness</li>
<li> empowerment and participation of workers in injury prevention.</li>
</ul>
<p>Clearly, vulnerability is not exclusive to age, nationality, culture or language, but the interplay between employer and employee factors renders some workers more vulnerable than others. </p>
<p>We have evidence-based <a href="http://www.safeworkaustralia.gov.au/sites/swa/about/publications/Documents/633/How_to_Manage_Work_Health_and_Safety_Risks.pdf">national protocols</a> in place to help employers identify and minimise risks to health and safety. The protocols define an approach to injury control that begins, where possible, with the elimination of a hazard, progresses to substitution or isolation of the hazard, and finally to reducing worker exposure to the hazard. </p>
<p>These protocols are as relevant to employers of migrant workers as they are to employers of Australian-born workers. But migrants’ lack of knowledge of their rights and the potential for visa-related blackmail expose them to different risks including employer exploitation.</p>
<p>The national and state inquiries are unlikely to discover anything new. But the findings may provide a catalyst to implement solutions that have already been identified. Governments can improve migrant education about their rights at work, establish better occupational injury surveillance systems, and remove policy “gaps” that some employers exploit at a cost to worker health.</p><img src="https://counter.theconversation.com/content/46683/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alex Collie receives funding from WorkSafe Victoria, Comcare, SafeWork Australia, the Transport Accident Commission, the Australian Research Council, the National Health and Medical Research Council of Australia and the Canadian Institutes of Health Research. </span></em></p><p class="fine-print"><em><span>Amanda Sampson is employed by the Institute of Safety, Compensation and Recovery Research which is a joint initiative of WorkSafe, TAC and Monash University.</span></em></p>We already know the solutions to stem the exploitation of migrant workers, and they involve changes at both the employer and government level.Alex Collie, Chief Executive Officer, Institute for Safety, Compensation and Recovery Research, Monash UniversityAmanda Sampson, Research Officer , Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/396122015-04-01T05:35:55Z2015-04-01T05:35:55ZFor most work-related cancers, you have a 1% chance of state compensation<figure><img src="https://images.theconversation.com/files/76650/original/image-20150331-1263-1y17dgw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Welding: source of one of the HSE's top ten priority occupational cancers</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=gsZgeLCmZy3a2Eb-5rV7jA&searchterm=welder&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=218715772">OliverSved</a></span></figcaption></figure><p>While both main political parties come under pressure over how they will cut the UK deficit, the Conservatives <a href="http://www.theguardian.com/politics/2015/mar/27/potential-conservative-welfare-cuts-revealed-in-leaked-emails">reportedly see</a> one possible target as the benefits scheme for industrial injuries. They would pass the costs on to private companies, requiring them either to take out insurance or become members of a default scheme that they would have to pay for. The saving is being touted at £1bn. </p>
<p>But if you were thinking this suggests that the existing system is some lavish benefit asking to be hacked back, think again. In the UK, workers suffering from many occupational cancers and other potentially lethal work-related diseases in a range of occupations can forget about government compensation. </p>
<h2>Deadly statistics and missing bodies</h2>
<p>Occupational diseases are the biggest killers of workers both <a href="http://www.hse.gov.uk/statistics/">in the UK</a> and <a href="http://www.who.int/quantifying_ehimpacts/global/en/">worldwide</a>, far exceeding deaths from safety failures, traffic crashes and murders combined. Yet they receive minimal attention. </p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/18085056">hardest hit are</a> the most vulnerable, the most exposed and the poorest employees with the weakest voices in society. They get the least information about the threats and often the worst support, oversight, inspection and advice on compensation. <a href="http://www.justlabour.yorku.ca/volume22/pdfs/04_lewchuk_lafleche_press.pdf">All too often</a>, occupational ill-health is not looked for, not diagnosed and not recorded. The victims are rendered invisible and there is then no need for governments and their agencies to act. </p>
<p>For example UK government data <a href="http://www.hse.gov.uk/cancer/research.htm">conservatively indicates</a> almost 13,600 new cases of occupational cancer each year. Workers can in theory get Industrial Injuries Disablement Benefit (IIDB) to compensate them, but in 2012 the IIDB <a href="http://www.hse.gov.uk/research/rrpdf/rr858.pdf">compensated only</a> 2,600 cases. Remove asbestos-related cancers and just 90 payments were made: a 1% chance of compensation. </p>
<p>As well as asbestos, the UK’s <a href="http://www.hse.gov.uk/aboutus/meetings/hseboard/2012/220812/paugb1264.pdf">top ten</a> official occupational cancer priorities include lung cancer from welding, lung and bladder cancer from diesel exhaust emissions and breast cancer from shift work. Only three of the ten are recognised for compensation – lung cancer and mesothelioma for asbestos and lung cancer for silica through working with the likes of concrete, bricks, plaster and industrial sand. That leaves seven not recognised, even though millions of workers are exposed. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/76654/original/image-20150331-1249-in07b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/76654/original/image-20150331-1249-in07b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/76654/original/image-20150331-1249-in07b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=896&fit=crop&dpr=1 600w, https://images.theconversation.com/files/76654/original/image-20150331-1249-in07b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=896&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/76654/original/image-20150331-1249-in07b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=896&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/76654/original/image-20150331-1249-in07b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1126&fit=crop&dpr=1 754w, https://images.theconversation.com/files/76654/original/image-20150331-1249-in07b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1126&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/76654/original/image-20150331-1249-in07b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1126&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">High risk: building work.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=KNT3zO3YV32QhDcHpdNh3g&searchterm=cement%20mixer&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=150963926">Scott Latham</a></span>
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<p>For instance diesel exhaust or painting-related lung or bladder cancer are not on the prescribed disease list at all, nor are cancers related to welding and some solvents. Breast cancer caused by shiftwork is estimated by the Health and Safety Executive (HSE) to affect around 2,000 women each year, including around 500 deaths. It is not on the list of prescribed industrial diseases list either. Asbestos-related ovarian cancer is also missing, <a href="http://monographs.iarc.fr/ENG/Monographs/vol100C/mono100C-11.pdf">despite having</a> the top International Agency for Research on Cancer risk rating. </p>
<p>As for the cancers that do receive compensation, the pay-outs are often heavily restricted. The HSE estimates, <a href="http://www.hse.gov.uk/research/rrpdf/rr858.pdf">for example</a>, that nearly 1,000 workers develop lung cancer from silica. Of these, only about 30 get prescribed disease payments. Others who may only have been exposed to silica and no other lung carcinogens still have problems getting medics to accept the cause of the illness. </p>
<h2>Policy shortcomings</h2>
<p>The agency responsible for recommending to the Department of Work and Pensions which occupational diseases should be eligible for compensation is the UK <a href="https://www.gov.uk/government/organisations/industrial-injuries-advisory-council">Industrial Injuries Advisory Council</a> (IIAC). The IIAC mostly imposes an arbitrary “relative risk” test, requiring the condition to be twice as common in the affected group as in the general population. </p>
<p>Even uncontentious causes of occupational cancer will often not overcome this test, which is neither a legal or scientific requirement. This is why fewer occupational diseases are officially recognised in the UK. The same goes for the civil courts, who often apply the same test when workers claim for life-threatening and life-limiting occupational diseases. </p>
<p>The upshot is that workers and their families frequently do not obtain vital compensation when their health and lives have been damaged, frequently irreversibly. It means that citizens and communities too often pay the costs of health treatments and social support when those employers who exposed them to the risks escape with little or no economic damage. It also means that if occupational diseases are not recorded and compensated, the government is less likely to spend resources and time preventing them through things like monitoring and inspection. </p>
<p>There are few perfect state occupational disease compensation schemes, but several avoid UK flaws such as the double relative risk test. In Canada, Australia and parts of the US and Europe, especially Denmark, more occupational diseases are listed based on scientific evidence and recognition by the likes of the International Labour Organisation. </p>
<p>In these countries, there is a burden on employers to rebut such a listing. Where a fire fighter in the province of Alberta in Canada could be entitled to claim for 14 different work-related cancers, in the UK they could claim for none of them. And where the obstacles to claiming are frequently daunting in the UK, this is not the case in many of these other jurisdictions. </p>
<p>It is time for the UK to move in the same direction. This is certainly not the time to demolish industrial injury benefits by moving to employer-led schemes. Historically they have never worked elsewhere, and both these and insurance schemes are open to greater abuse. Compensation can be delayed easily and the schemes are not necessarily applied to independently or rigorously. It would also be even harder to get new diseases recognised.</p>
<p>Instead of going down this blind alley, it is time to improve and strengthen the existing scheme. This would mean that workers could rest assured that the state will provide for them if they are one of the unlucky ones.</p><img src="https://counter.theconversation.com/content/39612/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Watterson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Tories stand to save £1bn from shifting responsibility for occupational illness benefits on to employers. But even now, the system is failing.Andrew Watterson, Chair in Health Effectiveness, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/316332014-09-15T20:30:10Z2014-09-15T20:30:10ZExplainer: why the James Hardie asbestos victim compensation fund is running out of money<p>After a week of media <a href="http://www.smh.com.au/business/is-the-james-hardie-asbestos-compensation-fund-operating-fairly-20140909-10e4pt.html">speculation</a> on the issue, building materials company James Hardie yesterday confirmed the fund for compensating asbestos victims could run short of money as soon as 2017.</p>
<p>Generally, when investigating corporate affairs the golden rule is to “follow the money”. However, in the saga of James Hardie’s involvement with asbestos victims, it may be wiser to follow the numbers. </p>
<p>Since the company’s highly public and controversial corporate restructure in 2001, the guarantee of payments to sufferers from asbestos-related disease has been under constant scrutiny from analysts, journalists and asbestos disease advocacy groups. </p>
<p>The directors of the Asbestos Injuries Compensation Fund (ACIF) are now seeking discussions with James Hardie and the NSW government about the establishment of a payment scheme, to avoid paying lump sums, from July next year. </p>
<p>This is not the first time a payment scheme has been mooted. In the aftermath of the global financial crisis, the NSW government (in agreement with the federal government) established a cash advance facility to stop the need to go to “trickle” payments for claimants and their families through a payment scheme. Media reports at the time highlighted the inability of a financially distressed James Hardie to ensure peace of mind for asbestos victims. </p>
<h2>A complicated history</h2>
<p>The current arrangement is a result of an extended period of “to-ing and fro-ing” over asbestos compensation funding beginning with the restructure and re-domiciling of the parent company in the Netherlands (and later Ireland). The potential insolvency of the Medical Research and Compensation Fund led to the establishment of a more independent arrangement through the AICF. </p>
<p>The AICF is a separate legal entity that is responsible for asbestos-related claims in the past and into the future. The separation of legal responsibility and the arrangements to fund asbestos claims from current operations is covered by the Amended Final Funding Agreement (AFFA) which spells out the terms of the fiduciary relationship. </p>
<p>In this agreement James Hardie is required to contribute to the AICF annually through an “Annual Payment” that is the lesser of actuarial estimates of claims payments and fund running costs known as the “Annual Contribution Amount” (ACA), and a complex bespoke accounting-based formulation of “free cash flows”. This ensures that James Hardie is never required to contribute more than the estimate of future claims. </p>
<h2>Will James Hardie do the right thing?</h2>
<p>The current concerns focus on James Hardie’s moral obligation, rather than mere compliance with the funding agreement. Some have <a href="http://www.smh.com.au/business/james-hardie-asbestos-compensation-scheme-millions-short-after-big-dividends-20140908-10duod.html">asked</a> why James Hardie was able to pay out US$556 million to investors via dividends during the last two years and millions of dollars in staff pay rises, with the risk of a compensation fund shortfall looming.</p>
<p>Compliance with the funding agreement allows for the payment of ordinary dividends (albeit capped at 75% of net income) as these do not form part of the calculation of free cash flow. The free cash flow amount consists of operating cash flows plus or minus such transactions as those relating to interest (normally a financing cash flow) and payments made to the compensation fund during the year (not a component of operations). </p>
<p>The primary reason for the projected shortfall is that the annual contribution amount and the 35% of free cash flows are independent calculations based on different criteria. </p>
<p>The contribution amount is basically an accounting provision or balance sheet item for the compensation fund, whereas the free cash flow relates to the income statement or profitable operations of James Hardie and relies on its ability to generate cash flows from operations. The further into the future cash flows are expected, the less they become in present value terms. </p>
<p>Therefore, in essence the estimates of the annual contribution amount will only affect James Hardie’s annual payment to the AICF at such a time as the projection of future claims diminishes or James Hardie operations generate extraordinary cash flows. </p>
<p>The drafting of the funding agreement was complicated by the long-tail nature of asbestos-related diseases and the need to project so far into the future. The need to provide funding without compromising the viability of James Hardie required a model that controlled and limited the way payments were made resulting in a mismatch between payments to the fund and asbestos claims.</p>
<p>As it stands, claims in recent years have been higher than expected, with a spike in expensive mesothelioma-related claims.</p>
<h2>Should the NSW government step in?</h2>
<p>James Hardie is not required to “catch up” or top up the fund next year when the annual contribution amount - the amount required to appropriately fund future asbestos claims - outstrips the free cash flow calculation. While the disconnect between the numbers and the money creates uncertainty for the AICF, which is responsible for compensation payouts, and a PR nightmare for James Hardie, spare a thought for the victims and their families who justifiably feel outraged and confused. </p>
<p>Given this scenario, Monday’s <a href="http://www.aicf.org.au/docs/Press%20Release%20150914%20Final.pdf">media release</a> from the AICF is a cry for help to the government for further assistance due to the restrictive conditions of the funding agreement, albeit potentially at the expense of asbestos victims. </p>
<p>Bearing in mind that the forward projections of compensation payments from the AICF are just that – estimates – what does the change from a lump sum to an instalment payment scheme achieve? </p>
<p>It will likely only achieve some comfort with numbers reported for directors attenuating the risks around the fund trading while insolvent. However, it will not affect the money that changes hands. That is, it will not change the annual payment amount required from James Hardie, nor the availability of a government-sponsored loan facility, nor the amount of compensation awarded to asbestos victims. </p>
<p>While there are a plethora of potential solutions to increasing asbestos compensation claims, such as removing asbestos from the environment, statutory limits on payouts and disease prevention and cure initiatives, resolving the shortfall of the compensation fund under current arrangements will require James Hardie to accept responsibilities beyond the scope of the funding agreement by paying the fund amounts that more closely match asbestos claims.</p><img src="https://counter.theconversation.com/content/31633/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>After a week of media speculation on the issue, building materials company James Hardie yesterday confirmed the fund for compensating asbestos victims could run short of money as soon as 2017. Generally…Sandra van der Laan, Associate Professor of Accounting, University of SydneyLee Moerman, Associate Professor, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/246232014-03-21T03:32:25Z2014-03-21T03:32:25ZExplainer: what are cancer clusters?<figure><img src="https://images.theconversation.com/files/44373/original/wvpmy38n-1395296855.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A cancer cluster generally features an unusually high number of the same type of cancer occurring in a group of people with a common exposure.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-174876020/stock-photo-interior-of-busy-modern-open-plan-office.html?src=geQShaL-RVH61pCEbfiqjg-1-46">Shutterstock</a></span></figcaption></figure><p>Most of us are <a href="http://demographics.treasury.gov.au/content/_download/australias_demographic_challenges/australias_demographic_challenges.pdf">living longer</a> and we are all expected to be <a href="http://www.smh.com.au/federal-politics/political-news/working-longer-retiring-stronger-20120208-1rf0g.html">working longer</a>. Because the likelihood of cancer increases as we age, we’re more likely to be diagnosed with cancer while still a member of the paid workforce. </p>
<p>That is equally true of our ageing workmates. An increasingly common phenomenon is that of a group of people – who might have been working in the same organisation for decades – will see their peers diagnosed with cancer around the same time.</p>
<p>Concerns that there may be a “cancer cluster” are sometimes raised when there is something unusual about the workplace: its location, the use of a certain types of equipment, old buildings that may contain known carcinogens such as asbestos, and so on.</p>
<p>Some of these factors seem to be at play in the most recent <a href="http://www.theaustralian.com.au/national-affairs/state-politics/mps-chook-house-cancer-fears/story-e6frgczx-1226858502405#mm-premium">suspected cancer cluster</a> at what is known as “the chook house” at the Victorian state Parliament. </p>
<p>Without knowing all the details it’s important to avoid making any specific comment on that case. But it raises an important issue: how do you differentiate between a “cancer cluster” and a normal pattern of cancer diagnoses?</p>
<p>A cancer cluster generally features an unusually high number of the same type of cancer occurring in a group of people with a common exposure – be it where they live, where they work or some other usually long-term exposure to an agent that has brought about the cancer.</p>
<p>The cancer cluster that attracted the most recent attention was the 2006 <a href="https://www.mja.com.au/journal/2007/187/3/there-will-be-no-more-legacy-toowong-breast-cancer-cluster">Brisbane ABC</a> case. Of the 550 female staff, ten women were diagnosed with invasive breast cancer between 1994 and 2006 – a six-fold increase over the number of cases that might have been expected. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/44375/original/n8yzty6t-1395297523.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/44375/original/n8yzty6t-1395297523.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/44375/original/n8yzty6t-1395297523.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/44375/original/n8yzty6t-1395297523.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/44375/original/n8yzty6t-1395297523.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/44375/original/n8yzty6t-1395297523.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/44375/original/n8yzty6t-1395297523.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Governments are still working out how to deal with the enormous (but as yet unquantified) amount of asbestos in our workplaces, homes and public buildings.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-44275543/stock-photo-danger-asbestos-sign.html?src=pp-photo-97385540-UqQ5g9xEQJG7CQyVkm3h8Q-8">Shutterstock</a></span>
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</figure>
<p>The precise cause of those cancers remain uncertain, and the result being due to “chance” is still considered likely. The investigation did, however, lead to the building of a new ABC complex in Brisbane.</p>
<p>An earlier and now famous case was the <a href="http://www.safetyline.wa.gov.au/PDF/Transcripts/Wittenoom_Transcript.pdf">Wittenoom asbestos miners</a> and their families who have been diagnosed with a range of asbestos-related diseases, including <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Mesothelioma">mesothelioma</a>, since the mine closed in the 1960s. This case helped confirm the now well-accepted link between exposure to asbestos and a number of respiratory diseases.</p>
<p>Uncertainty remains the most common outcome of cancer cluster investigations. A group in the United States examined the outcome of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408895/">428 cancer clusters</a> investigations over two decades in that country and found no real increase in cancer cases above what might have been expected in 87% of “clusters”. </p>
<p>The study found one cluster investigation where the genuine increase in cancer cases had an identifiable cause: ship builders living in South Carolina who were exposed to asbestos through their work at a naval shipyard. </p>
<p>Of the other 69 suspected clusters where a substantial increase in cancer rates were observed, the cause remained unclear. In the two remaining cases, there was some indication of an (inconclusive) association between an identified exposure – contaminated water and/or air due to industrial pollution – to leukaemia. </p>
<p>In Australia, potential <a href="http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ps0006_statement_cancer_clusters.pdf">cancer cluster investigations</a> are conducted by epidemiologists, with involvement from occupational hygienists, statisticians and occupational physicians who are independent of the employer, and are often government employees or consulting academics.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/44376/original/hb3twspy-1395298116.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/44376/original/hb3twspy-1395298116.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/44376/original/hb3twspy-1395298116.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/44376/original/hb3twspy-1395298116.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/44376/original/hb3twspy-1395298116.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/44376/original/hb3twspy-1395298116.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/44376/original/hb3twspy-1395298116.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cancer risk increases dramatically with age.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-90609373/stock-photo-elderly-couple-posing-at-park.html?src=Toom37WZC8MCCnEsoDTKgw-1-124">Shutterstock</a></span>
</figcaption>
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<p>Half of all men and a third of all women in Australia are likely to have a <a href="http://www.cancer.org.au/about-cancer/what-is-cancer/facts-and-figures.html">cancer diagnosis by the age of 85</a>. </p>
<p>While common, cancer it is also <a href="http://www.ncbi.nlm.nih.gov/pubmed/7718649">the most feared</a> illness. It’s therefore important that an appropriate expert takes the time to listen carefully to the employees’ or residents’ concerns and any theories that might explain the phenomenon. </p>
<p>Cancer is not one disease but a category of disease that is made up of <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cancer_explained?open">over 200 different illnesses</a> with different causes, pathways and treatments. So if the suspected cluster involves lots of different types of cancer – some people effected by breast cancer, some by lung cancer, some bowel cancer and some leukaemias, for instance – then the workplace (or suburb or other exposure) is an unlikely culprit. </p>
<p>Likewise, if some of the people with cancer have been at that workplace or lived in that street (or had that exposure) for a short period, or had previous disease or risk factors that might explain the cancer, its unlikely to be a cluster.</p>
<p>After looking at the situation systematically, the employees’ or residents’ concerns may be allayed and the initial assessment concluded. </p>
<p>Of course, there may be <a href="http://www.ncbi.nlm.nih.gov/pubmed/24158310">legitimate grounds for concern</a>. For example, exposure to pesticides, solvents, wood dust, diesel exhaust and radiation are established carcinogens that occur in some workplaces. </p>
<p>In Australia, around <a href="http://www.ncbi.nlm.nih.gov/pubmed/16800196">5,000 cases of cancer a year</a> are a result of occupational exposures to things such as environmental tobacco smoke, UV radiation in addition to those mentioned above.</p>
<p>If health authorities have cause to proceed with a formal investigation and a known carcinogen is identified, employers or landlords should act immediately to remove or reduce exposure – waiting for the final results before taking action makes no sense. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/44377/original/b5tstfg9-1395298189.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/44377/original/b5tstfg9-1395298189.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/44377/original/b5tstfg9-1395298189.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/44377/original/b5tstfg9-1395298189.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/44377/original/b5tstfg9-1395298189.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/44377/original/b5tstfg9-1395298189.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/44377/original/b5tstfg9-1395298189.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Wood dust is a cancer-causing agent.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-156981053/stock-photo-saw-mill-with-stack-of-wood.html?src=VKKwWlhbDHPsZoybVvJGLQ-1-15">Shutterstock</a></span>
</figcaption>
</figure>
<p>Finally, it’s important to keep things in perspective. While we don’t know for sure what causes about half of all cancers, lifestyle factors are probably far more likely to be contributing to <a href="http://www.cancer.org.au/preventing-cancer/">cancer risk</a> than where we work or where we live.</p>
<p>We can all reduce our <a href="http://www.iarc.fr/en/publications/books/wcr/wcr-order.php">cancer risk</a> by quitting or not taking up smoking, establishing and maintaining a healthy body weight, avoiding <a href="https://theconversation.com/sunscreen-skin-cancer-and-the-australian-summer-11633">excessive UV exposure</a> and excessive <a href="https://theconversation.com/health-check-does-alcohol-cause-cancer-22959">alcohol consumption</a>, being more physically active and <a href="http://www.dietandcancerreport.org/">eating healthy food</a>.</p>
<p>In broad terms Australia has a safe, well-managed environment with low levels of pollution by world standards. Constant effort is required to maintain and improve on that status. </p>
<p>And there is room for improvement. Like everything we do - even if we are doing okay, it makes sense to try and do even better. It’s a balancing act. But one that we will be increasingly required to face.</p><img src="https://counter.theconversation.com/content/24623/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Terry Slevin has been part of research grant proposals that have received grants form Cancer Australia, NHMRC and Healthway. He is an employee of Cancer Council Western Australia.</span></em></p>Most of us are living longer and we are all expected to be working longer. Because the likelihood of cancer increases as we age, we’re more likely to be diagnosed with cancer while still a member of the…Terry Slevin, Honorary Senior Lecturer in Public Health at Curtin University; Education & Research Director, Cancer Council WA; Chair of the Occupational and Environmental Cancer Committee, Cancer Council AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/150832013-06-13T04:47:27Z2013-06-13T04:47:27ZMind the gap: company disclosure discrepancies not sustainable<figure><img src="https://images.theconversation.com/files/25393/original/bj73f8n9-1371016239.jpg?ixlib=rb-1.1.0&rect=19%2C11%2C967%2C619&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Civilians rescue an injured worker after the eight-storey Rana Plaza garment factory collapsed in Dhaka, Bangladesh, on April 24.</span> <span class="attribution"><span class="source">AAP</span></span></figcaption></figure><p>The recent decision by two Australian retailers to sign an accord protecting suppliers in Bangladesh has highlighted discrepancies in company disclosure of sustainability issues and the need for clearer reporting guidance. </p>
<p><a href="http://www.abc.net.au/news/2013-06-07/kmart-target-sign-up-to-safety-accord-for-bangaldeshi-workers/4739436">Kmart and Target</a> became the first Australian companies to sign the Global Union Federations’ building and safety <a href="http://www.uniglobalunion.org/Apps/UNINews.nsf/vwLkpById/EC90FA91A0DB11C0C1257B6B0028A4DE/$FILE/2013-05-13%20-%20Accord%20on%20Fire%20and%20Building%20Safety%20in%20Bangladesh.pdf">accord</a>, following the collapse of the Rana Plaza garment factory in Bangladesh. According to Oxfam Australia, Big W and Cotton On are also making moves to sign the accord; however, a lack of information on which companies have suppliers in Bangladesh means a potential lack of other Australian signatories. </p>
<p>Recent research by <a href="http://www.catalyst.org.au/">Catalyst Australia</a>, a collaborative policy network, shows that this lack of supply-chain information is not an isolated incident and that significant gaps exist in sustainability reporting by Australian companies.</p>
<h2>Sustainability reporting</h2>
<p>Many ASX-listed companies are increasingly reporting on sustainability alongside financial matters. In a 2012 report, the Australian Council for Superannuation Investors (ACSI) found that 83% of companies listed on the ASX 200 to some extent <a href="http://www.acsi.org.au/images/stories/ACSIDocuments/generalresearchpublic/Sustainability%20Reporting%20Journey%202012.pdf">reported on sustainability matters</a>.</p>
<p>Sustainability, a term often interchangeably used with corporate social responsibility, represents a commitment to operate in an economically, socially and environmentally sustainable manner. The <a href="https://www.globalreporting.org/">Global Reporting Initiative</a> (GRI) provides the most well-known reporting frameworks. However, previous research has shown that <a href="http://cfmeu.com.au/sites/default/files/downloads/%5Bfield_download_state-raw%5D/%5Bfield_download_type-raw%5D/banarracfmeu2010labourpracticesreviewreport29mar2011.pdf">significant gaps</a> exist between claimed levels of GRI reporting and the information found in company reports. </p>
<p>Catalyst Australia developed a <a href="http://csr.catalyst.org.au">CSR dashboard</a> to gauge the quality of sustainability reporting by Australian companies. It analysed 32 companies across six topics - gender equality, environmental impact, labour standards, supply chains, community engagement and community investment - and found great variation in how they reported on their social and environmental activities. </p>
<p>Some of these differences can be attributed to the tendency of companies to concentrate on those areas that affect their performance, while meeting stakeholder demands for transparency and disclosure. At the same time, discretionary reporting can lead to highlighting achievements that reflect well on companies while overlooking other important areas.</p>
<h2>Clear expectations</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/25447/original/99ky4yxr-1371081046.jpg?ixlib=rb-1.1.0&rect=7%2C8%2C992%2C1462&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/25447/original/99ky4yxr-1371081046.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=901&fit=crop&dpr=1 600w, https://images.theconversation.com/files/25447/original/99ky4yxr-1371081046.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=901&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/25447/original/99ky4yxr-1371081046.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=901&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/25447/original/99ky4yxr-1371081046.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1133&fit=crop&dpr=1 754w, https://images.theconversation.com/files/25447/original/99ky4yxr-1371081046.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1133&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/25447/original/99ky4yxr-1371081046.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1133&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Workers layout cable as part of the NBN roll-out, which has caused controversy with recent revelations of asbestos mismanagement.</span>
<span class="attribution"><span class="source">AAP</span></span>
</figcaption>
</figure>
<p>However, Catalyst also found that clearly defined reporting expectations lifted reporting and performance. Gender equality, carbon emissions, energy efficiency, and worker health and safety were well-covered topics, compared to other areas. The majority of companies addressed these topics in their public reports, even when disclosures revealed negative performance outcomes. </p>
<p>It is significant that these areas have strong external reporting guidance. For example, disclosures around gender diversity have recently benefited from the increased guidance of a <a href="http://www.asxgroup.com.au/media/asx_diversity_report.pdf">new reporting regime</a>, established through Australian Securities Exchange (ASX) Corporate Governance Principles. Doubtless, the CSR diversity reporting results reflect the clear guidance provided by the ASX Principles, along with a more activist approach by the federal government in spearheading the new <a href="http://www.wgea.gov.au/">Workplace Gender Equality Agency</a>.</p>
<p>External policy underpinning environment topics also helps steer public disclosures. In addition to a growing number of companies voluntarily reporting to the <a href="https://www.cdproject.net/">Carbon Disclosure Project</a>, corporations registered under the commonwealth government’s <a href="http://www.cleanenergyregulator.gov.au/National-Greenhouse-and-Energy-Reporting/Pages/default.aspx">National Greenhouse and Energy Reporting Act 2007</a> are required to report carbon emissions and energy consumption. This has focused attention on reporting in these areas, particularly when compared with other environmental indicators such as waste production and water consumption.</p>
<p>Worker health and safety disclosures are stimulated by the impact of legislation and by bodies such as <a href="http://www.safeworkaustralia.gov.au/">Safe Work Australia</a>, which encourages companies to collect and analyse detailed data, report targets and compare performance against industry peers and benchmarks. Union focus on workplace safety is also critical, as seen in the recent crisis surrounding asbestos in the <a href="http://www.abc.net.au/7.30/content/2013/s3775579.htm">National Broadband Network roll-out</a>.</p>
<h2>Overlooked areas</h2>
<p>But Catalyst found that supply chains and labour standards were the most under-reported topics, with the majority of companies providing no or very limited information about their policy, management and approach. This lack of focus confirms other <a href="http://www.acsi.org.au/board-composition-and-non-executive-director-pay-in-the-top-100-companies72/700-supply-chain-labour-and-human-rights.html">research</a> findings about Australian firms’ comparatively poor standard of reporting about human rights issues. </p>
<p>The absence of clear reporting guidance in these areas is notable. Unlike their global peers, few Australian companies reference the <a href="http://www.ilo.org/global/standards/introduction-to-international-labour-standards/conventions-and-recommendations/lang--en/index.htm">International Labour Organisation (ILO) Core Conventions</a>. This suggests a need to better contextualise the intent and purpose of the ILO Conventions by developing proxies that can be applied in the Australian context.</p>
<h2>Improving standards</h2>
<p>Disclosure inconsistencies can be avoided by introducing clear, persuasive minimum reporting standards, which should be mandated in areas where there are significant gaps in social and environmental reporting.</p>
<p>There is evidence that companies will embrace common standards for sustainability reporting when mandatory guidelines exist, or when expectations concerning disclosure are well defined and understood. In short: clear guidance contributes to greater transparency around social and environmental matters, and it encourages improved monitoring and performance.</p>
<p>Regulatory agencies, investors and industry bodies should consider minimum content guidelines for sustainability reporting. The ASX can play a pivotal role by spearheading improvements in disclosures that are particularly weak, through select amendments to the ASX Corporate Governance Principles.</p>
<p>Trade unions, civil society organisations and others with an interest in the human rights performance of companies have a vital role to play in creating decent and secure work standards by developing Australian proxies that reflect global sustainability principles. </p><img src="https://counter.theconversation.com/content/15083/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Martijn Boersma works for Catalyst Australia.</span></em></p>The recent decision by two Australian retailers to sign an accord protecting suppliers in Bangladesh has highlighted discrepancies in company disclosure of sustainability issues and the need for clearer…Martijn Boersma, Researcher in Corporate Governance, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/148452013-06-03T04:29:41Z2013-06-03T04:29:41ZHealth harms of asbestos won’t be known for decades<figure><img src="https://images.theconversation.com/files/24844/original/d47w7zv9-1370222683.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exposure to even a single fibre of asbestos dust can cause significant health problems.</span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p>The digital age crashed into the bronze age when the roll out of Australia’s high-speed broadband network was disrupted by the discovery of <a href="http://www.abc.net.au/news/2013-06-03/government-fund-nbn-rollout-asbestos/4728316">asbestos in Telstra pits</a> in recent weeks. </p>
<p>Workplace relations minister Bill Shorten is <a href="http://www.abc.net.au/news/2013-06-03/government-fund-nbn-rollout-asbestos/4728316">expected to introduce</a> a bill to parliament later today to set up national registry for residents and contractors exposed to asbestos as a result of this work. In light of the strong link between asbestos exposure and lung cancer, the register is a sensible first step in managing the health risks associated with exposure to asbestos. </p>
<h2>What is asbestos?</h2>
<p>Asbestos is a naturally occurring mineral which humans have been mining for more than <a href="http://cat.inist.fr/?aModele=afficheN&cpsidt=15374478">4,000 years</a>, principally for its fire-retardant properties. </p>
<p>Mining and production of asbestos increased substantially from the end of the industrial revolution in the middle of the 19th century, eventually peaking in the middle to late 20th century. By then asbestos was being used as a component in hundreds of everyday products such as building materials, brake linings, fuse-boxes, and pipe insulation.</p>
<h2>Health harms</h2>
<p>Exposure to even a single fibre of asbestos dust can cause <a href="http://www.nhmrc.gov.au/your-health/asbestos-related-diseases">significant health problems</a>. Every one of the six variations of the fibrous silicate minerals known collectively as asbestos have the potential to cause malignant lung cancers, <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Mesothelioma">mesothelioma</a>, <a href="http://www.asbestos.com/mesothelioma/pleural-plaques.php">pleural plaques</a> (calcification of the lungs), or asbestosis (pneumoconiosis, a type of lung disease). </p>
<p>Already in Australia asbestos diseases <a href="http://www.nhmrc.gov.au/your-health/asbestos-related-diseases">account for</a> at least 3,500 deaths every year. That rate is predicted to rise until about 2020, with <a href="http://www.nhmrc.gov.au/your-health/asbestos-related-diseases">current estimates</a> suggesting 40,000 Australians eventually will die. And it’s likely these statistics will be an under estimate.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australia has no systematic procedure for recording who has or may have been exposed to asbestos.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Asbestos diseases often take decades to manifest following exposure and many individuals may not even know they have been exposed. Once manufactured, asbestos can be difficult to recognise. It can be shaped and painted and so it often looks like other types of building materials. </p>
<p>Most problematic is that unlike, say, nuclear waste, asbestos does not have a half-life. It can be left alone for a few decades or for 30 generations and when it is disturbed it represents exactly the same health threat as it did when it was originally mined.</p>
<h2>Changing demographics</h2>
<p>Those characteristics are now having impact. Asbestos diseases were once a blue-collar affliction, affecting mainly men, often decades after exposure. Increasingly, younger DIY builders and women are presenting after, often unknowingly, they’ve encountered asbestos during home renovations, or after it’s been dumped on the footpath or in a skip. </p>
<p>While <a href="http://www.adfa.org.au/news2012.html#reno">television renovators</a> lustily knock down walls to rebuild a whole house in a day or a week might have had their own work sites checked for risk, drilling a hole to hang a picture at home, or having the kids build a cubby out of waste from the vacant block next door can be a risky proposition.</p>
<p>Not a home renovator? Even <a href="http://www.abc.net.au/news/2011-11-15/disaster-clean-up-sparks-asbestos-fears/3666512">disaster zones pose potential threats</a> after bush fires, floods and storms.</p>
<p>The best way to handle asbestos is <em>not</em> to handle it. There are experts who can inspect buildings and homes for asbestos and manage its removal. Various government agencies both state and <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-enhealth-asbestos-may2012.htm">federal</a> have been equipped to manage the issues associated with the discovery of asbestos. </p>
<p>A good place to start is the <a href="http://www.goldcoast.qld.gov.au/community/environmental-health-officers-3591.html">environmental health officer</a> at your local municipal council. Safe Work Australia also has <a href="http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/641/How_to_Safely_Remove_Asbestos.pdf">published guidelines</a> about who can remove asbestos and how that must be done. It might seem excessive but if asbestos could be in your home or neighbourhood, call an expert.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Experts can inspect your home for asbestos and manage its removal.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Time for a national registry</h2>
<p>Anyone exposed to asbestos in their workplace, home, or within the community is at risk of developing an asbestos-related disease. By the time the illness manifests, up to 50 years later, the world will have changed: buildings will have been demolished and businesses closed; the names of former colleagues, neighbours and witnesses long forgotten. </p>
<p>Australia has no systematic procedure for recording who has or may have been exposed, how exposure took place, or for monitoring their health.</p>
<p>Compensation depends on where and how exposure occurred. For those exposed in the workplace, compensation in the form of weekly payments is governed by the state workers’ compensation scheme. Injured workers can also <a href="http://www.asbestos.com/mesothelioma/australia/legislation.php">use the common law to seek damages</a> from former employers thanks to the legal actions of former James Hardie employees. </p>
<p>For the increasing numbers of people exposed to asbestos in the home or within the community there is no home- or community-based equivalent of workers’ compensation. Common law damages are also problematic with issues of causation and knowledge of risk providing significant obstacles.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The national registry would record the details of residents and contractors exposed to asbestos during the NBN roll out.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>We are starting to build the big picture. Buildings posing potential asbestos-related health risks can now be tracked via the <a href="http://www.nar.asn.au/">National Asbestos Register</a>. <a href="http://www.mesothelioma-australia.com/">The Australian Mesothelioma Registry</a> collects data on all new cases of mesothelioma and information on past exposure. <a href="http://www.awu.net.au/campaigns/national-asbestos-register">The Australian Workers Union’s National Asbestos Register</a> contains details of more than 6,000 people previously exposed to asbestos in the workplace. </p>
<p>All three initiatives are important but are not enough. A national register of everyone exposed to asbestos, whether at home, in the community, or at work is needed to inform the state and federal policies required to deal with the legacy of asbestos in Australia.</p><img src="https://counter.theconversation.com/content/14845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ricky van der Zwan receives funding from the Asbestos Innovation Fund for a project investigating the psychological impacts of a diagnosis of an asbestos disease for sufferers, their carers, and their families.</span></em></p><p class="fine-print"><em><span>SCU has received funding from Comcare to undertake research into the psychological, social and economic impact of asbestos-related disease on persons with a diagnosis and their carers.</span></em></p>The digital age crashed into the bronze age when the roll out of Australia’s high-speed broadband network was disrupted by the discovery of asbestos in Telstra pits in recent weeks. Workplace relations…Ricky van der Zwan, Associate Professor in Neuroscience and Psychology, Southern Cross UniversityJulie Tucker, Partnership Facilitator, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/94872012-10-09T19:39:45Z2012-10-09T19:39:45ZAsbestos still haunts those exposed as kids in mining towns<figure><img src="https://images.theconversation.com/files/16324/original/hf3ftfjp-1349757112.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Growing evidence suggests asbestos exposure may cause many more diseases than we thought.</span> <span class="attribution"><span class="source">Natalie Blackburn</span></span></figcaption></figure><p>The relationship between asbestos exposure and diseases such as malignant mesothelioma and lung cancer is well established. But now other diseases not typically associated with asbestos may possibly be linked to occupational and non-occupational forms of exposure.</p>
<p>Asbestos refers to a number of naturally occurring minerals that have crystallised to form long thin fibres and fibre bundles. There are three main types that have been used commercially – crocidolite (blue asbestos), amosite (brown asbestos) and chrysotile (white asbestos).</p>
<p>The difference between these types has to do with the shape and size of their fibres. Crocidolite and amosite have long, straight fibres, while chrysotile fibres are short and curly. The shape of these fibres is thought to be central to the damage they do to human health. The long straight fibres, in particular, are thought to easily penetrate into the lungs. </p>
<p>So although all types of asbestos have been found to cause asbestos-related diseases, some types lead to more of these diseases than others. Blue asbestos (the type that was mined at Wittenoom, Western Australia) is the worst for human health, followed by amosite, and then chrysotile. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/16321/original/vwgvm697-1349755680.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/16321/original/vwgvm697-1349755680.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/16321/original/vwgvm697-1349755680.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/16321/original/vwgvm697-1349755680.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/16321/original/vwgvm697-1349755680.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/16321/original/vwgvm697-1349755680.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/16321/original/vwgvm697-1349755680.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">White chrysotile asbestos fibres are thought to cause certain diseases.</span>
<span class="attribution"><span class="source">Asbestorama/Flickr</span></span>
</figcaption>
</figure>
<h2>Asbestos and health</h2>
<p>Diseases most commonly attributed to asbestos exposure are malignant mesothelioma, asbestosis and lung cancer. There’s a clear relationship between the amount of asbestos exposure and the risk of developing mesothelioma and asbestosis, with the risk increasing as the level of exposure increases. </p>
<p><a href="http://www.iom-world.org/pubs/malignant_mesothelioma.PDF">Malignant mesothelioma</a> is a diffuse cancer that spreads over the lining of the lung or stomach. It has a long latency period, rarely developing within 15 years of first exposure. And it is universally fatal – the average survival rate, after diagnosis, is nine months.</p>
<p>Malignant mesothelioma is very rare in people who haven’t been exposed to asbestos. In England, cases were established from autopsy reports between 1910 and 1940, and the disease became more frequently diagnosed in the 1950s. The link between asbestos (crocidolite) exposure and mesothelioma was formally <a href="http://oem.bmj.com/content/17/4/260.full.pdf+html">established in 1960</a>.</p>
<p><a href="http://www.hse.gov.uk/ASBESTOS/exposure.pdf">Asbestosis</a> is defined as “fibrosis of the lungs caused by asbestos dust”. Patients with well-established asbestosis usually <a href="http://ajrccm.atsjournals.org/content/157/5/1666.full.pdf+html">present with symptoms</a> of shortness of breath and a dry cough. It’s a progressive disease but it’s not necessarily fatal. The <a href="http://books.google.com.au/books?hl=en&lr=&id=47qAj5oTFOcC&oi=fnd&pg=PA201&dq=Epidemiology+of+Asbestos-%20Related+Diseases+and+the+Knowledge+that+Led+to+What+is+Known+Today&ots=JW_vMAHq76&sig=CTFCXI7MM9-7kuyBMBDwHcQtpJY#v=onepage&q=Epidemiology%20of%20Asbestos-Related%20Diseases%20and%20the%20Knowledge%20that%20Led%20to%20What%20is%20Known%20Today&f=true">first case of asbestosis</a> was described in medical literature in 1906, in a 33-year-old man who had worked in an asbestos textile factory for 14 years.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/16322/original/t5pgz8fj-1349755863.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/16322/original/t5pgz8fj-1349755863.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/16322/original/t5pgz8fj-1349755863.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/16322/original/t5pgz8fj-1349755863.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/16322/original/t5pgz8fj-1349755863.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/16322/original/t5pgz8fj-1349755863.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/16322/original/t5pgz8fj-1349755863.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children who grew up in Wittenoom, Western Australia between 1943-66 are dying of asbestos-related diseases in adulthood.</span>
<span class="attribution"><span class="source">Five Years/Wikipedia Commons</span></span>
</figcaption>
</figure>
<p>Other kinds of cancers are also more prevalent among workers exposed to occupational levels of asbestos than the general population. These include brain cancers, blood-related disorders (such as leukaemia), kidney cancer, cancer of the larynx, stomach and colorectal cancer. But the evidence that asbestos causes these other diseases is limited, mainly due to a lack of proof for an exposure-response relationship. </p>
<p>The <a href="http://www.iarc.fr/">International Agency for Research in Cancer</a> has recently <a href="http://monographs.iarc.fr/ENG/Monographs/suppl7/Suppl7-20.pdf">stated</a> that asbestos exposure causes <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3230399/pdf/ehp.1003283.pdf">ovarian cancer</a>. But there’s still some <a href="http://cebp.aacrjournals.org/content/20/7/1287.full.pdf+html.">debate</a> about this link in the scientific literature.</p>
<p>Few studies have found an excessive risk of these other cancers developing in people exposed to asbestos. Fewer still have found or reported a causal link.</p>
<h2>Will we ever know for sure?</h2>
<p>Former workers and residents of the blue asbestos mining and milling town of Wittenoom, Western Australia have been followed up through cancer and death registries and by regular questionnaires for over 30 years. Our <a href="http://onlinelibrary.wiley.com/doi/10.1002/ajim.22103/abstract">latest study</a> has revealed a relationship between cancers other than mesothelioma among people who, as children, lived in Wittenoom.</p>
<p>Now adults, this group were exposed to blue asbestos before the age of 15. We have found an increased risk of brain cancer among both the males and females of this group. </p>
<p>We also found higher rates of leukaemia, prostate and colorectal cancer among males, and ovarian cancer among females, compared with the general Western Australian population. These are very rare cancers, so it’s very difficult to state with absolute certainty that they’re caused by exposure to asbestos. Despite the significantly increased rates of cancer within this group, we may never know for sure whether asbestos is implicated.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/16323/original/bdhshgrp-1349756614.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/16323/original/bdhshgrp-1349756614.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/16323/original/bdhshgrp-1349756614.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/16323/original/bdhshgrp-1349756614.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/16323/original/bdhshgrp-1349756614.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/16323/original/bdhshgrp-1349756614.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/16323/original/bdhshgrp-1349756614.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Blue asbestos in Wittenoon, Western Australia still circulates in the air well after the town’s closure.</span>
<span class="attribution"><span class="source">oemebame/Flickr</span></span>
</figcaption>
</figure>
<p>The Wittenoom group also have a high rate of heart disease compared with the Western Australian population. Again, the evidence proving that exposure to asbestos causes heart disease is limited. Although we found an increased risk of heart disease in this group, we didn’t find that the risk increased as the level of asbestos exposure increased. </p>
<p>The Wittenoom children are still young and heart disease is not a major cause of death among them. Perhaps a link between heart disease and asbestos exposure will become apparent as they age. Recent work from the United Kingdom has shown that ischaemic heart disease and cerebrovascular disease were more prevalent among a large group of British workers exposed to occupational levels of asbestos. <a href="http://oem.bmj.com/content/69/6/417.full.pdf+html">In that study</a>, longer exposure was associated with a greater risk of ischaemic heart disease.</p>
<p>One of the ways we can prove that a disease is caused by asbestos is to find that the risk of disease increases with the amount of asbestos exposure. Where we do not find that relationship, we have to concede that the disease may be caused by other factors the group have in common. We may not have looked for such factors or perhaps were unable to look for them in our studies. </p>
<p>Following up the former Wittenoom children may reveal links between asbestos exposure and these other diseases. The longer they are followed up, the more information we will learn about the diseases they develop, and whether asbestos exposure is the cause. </p>
<p>This knowledge may help those still being exposed to asbestos, because we would be able to correctly identify diseases they may present with. But the best way of preventing asbestos-related diseases is to avoid exposure altogether. </p><img src="https://counter.theconversation.com/content/9487/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Reid receives funding from the National Health and Medical Research Council and the Australian Research Council.</span></em></p>The relationship between asbestos exposure and diseases such as malignant mesothelioma and lung cancer is well established. But now other diseases not typically associated with asbestos may possibly be…Alison Reid, Research Associate Professor , The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/68402012-05-03T20:10:59Z2012-05-03T20:10:59ZThe Hardie judgement: Muscling up ASIC<figure><img src="https://images.theconversation.com/files/10335/original/nf8pn2sp-1336051194.jpg?ixlib=rb-1.1.0&rect=20%2C17%2C1940%2C1272&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">ASIC has scored a major victory with a High Court decision against James Hardie non-executive directors.</span> <span class="attribution"><span class="source">AAP</span></span></figcaption></figure><p>The Australian Securities and Investments Commission (ASIC) has secured a major victory in its ongoing battle to enforce the efficacy of the continuous disclosure regime here as well as its standing as a model litigant.</p>
<p>The High Court of Australia overturned a New South Wales Court of Appeal ruling which had voided a lower court’s adjudication that the non-executive directors of the cement manufacturer James Hardie Industries Limited (JHIL) failed to exercise the degree of care and diligence that a reasonable person would exercise if they were a director of a corporation in JHIL’s circumstance. The High Court found that the New South Wales Court of Appeal had erred in discounting the factual evidence that the non-directors had approved the release of erroneous and misleading information to the market because ASIC had declined to call a senior external legal advisor who had minuted the board’s deliberation to give evidence. </p>
<p>At initial trial and appeal the James Hardie Industries case centred on whether, how and why the directors authorised a release to the ASX in February 2001 that a fund established to compensate victims of asbestos poisoning linked to the operation of James Hardie subsidiaries had sufficient resources to meet its liabilities. </p>
<p>The establishment of the Medical Research and Compensation Foundation was pivotal in facilitating the parent company to change its domicile to The Netherlands. The move transferred the liabilities of the subsidiary entities from the parent company to the foundation through a mechanism that saw the foundation indemnify James Hardie in return for a cash investment. </p>
<p>The move to The Netherlands was justified at the time as a mechanism to maximise tax incentives. Two years later, with James Hardie Industries NV then legally incorporated in another jurisdiction (it is now incorporated in Ireland), it emerged that the fund was severely under-reserved, raising the suspicion that the move offshore had more to do with minimising liability. </p>
<p>In 2007 ASIC took action against the non-executive directors. The market conduct regulator alleged that the 2001 statement was approved at a board meeting the day before the formal release. </p>
<p>It claimed that the directors knew or ought to have known that the Medical Research and Compensation Fund did not have sufficient reserves at time of legal separation from JHL to meet its likely obligations from asbestos claimants. </p>
<p>The Supreme Court of New South Wales found in 2009 that the directors had contravened the civil penalty provisions of the Corporations Act by not exercising appropriate duties of care and diligence. It banned them from serving on company boards, a decision that the directors successfully appealed the following year. </p>
<p>While the New South Wales Court of Appeal noted that the draft release was in fact misleading and that if the non-executives had approved the release it would constitute a breach, the Chief Justice, James Spigelman, held the decision not to call David Robb, then a senior partner at the legal firm Allen Arthur Robinson, had undermined the cogency of ASIC’s case to such an extent that the regulator had failed to discharge the burden of proof in terms of the culpability of the non-executive directors. </p>
<p>In a statement at the time of the Court of Appeal ruling, the Australian Institute of Company Directors heralded the decision, saying it <a href="http://www.companydirectors.com.au/General/Header/Media/Media-Releases/2010/James-Hardie-judgement-highlights-strength-of-judicial-system">“highlights the strength of Australia’s legal system and the value of having an independent judiciary and system of appeals.”</a> In a short across the bows of the regulator, the AICD also noted that the decision called into question the ‘procedural fairness’ of the strategy used by ASIC in failing to call a witness with relevant knowledge. </p>
<p>The unmistakable inference from both the ruling and the subsequent commentary was that ASIC had overstepped its authority. It was primarily on these grounds that ASIC lodged its appeal (although it also sought to uphold the ruling of the initial trial that the directors had, in fact, breached their duties by approving an erroneous release). As the then <a href="http://www.asic.gov.au/asic/asic.nsf/byheadline/11-07MR+ASIC+applies+for+special+leave+to+appeal+James+Hardie+decision?openDocument">Chairman of ASIC, Tony D'Aloisio</a>, put it, “clarification [of the scope and extent of obligation as a litigant] is in the public interest, as it will be of considerable significance for how regulatory agencies such as ASIC conduct civil enforcement proceedings.” He argued that the application of the principle that failing to call a witness breached a “middle ground” obligation of fairness involved an extension of principle “<a href="http://www.asic.gov.au/asic/pdflib.nsf/LookupByFileName/James-hardie-dec-10.pdf/$file/James-hardie-dec-10.pdf">not applicable at the time of the trial.”</a> </p>
<p>The High Court upheld both aspects of the appeal. It noted, however, that the court was not asked to adjudicate on whether the directors ought to have known about the lack of provisioning for future claims. The core issue for the Court was whether the Court of Appeal was correct in setting aside the contravention on the grounds that the ASIC had failed to call the legal adviser, notwithstanding the fact that the minutes of the February board meeting and its subsequent ratification in April 2001 provided evidence that the draft announcement was indeed tabled and approved. The critical issue for the High Court was whether ASIC had discharged its duties. The Court of Appeal had argued that: </p>
<p><em>“A body in the position of ASIC, owing the obligation of fairness to which it was subject, was obliged to call a witness of such central significance to critical issues that had arisen in the proceedings.</em></p>
<p><em>"The scope of its powers and the public interest dimensions of its functions, most relevantly with respect to ensuring proper internal governance of corporations and that the market for securities in shares was fully informed, was such that resolution of the civil penalty proceedings required it to call, if only with a view to showing (if it were the case) that he could not in fact recall anything on the factual issues and for cross examination by the [defendants], a witness of such potential importance….</em></p>
<p><em>"The public interest can only be served if the case advanced on behalf of [a] regulatory agency does in fact represent the truth, in the sense that the facts relied upon as primary facts actually occurred.”</em></p>
<p>The High Court recognised the enormity of the challenge this posed to the standing and legitimacy of ASIC as a litigant. It viewed the reasoning as flawed on as two grounds. First, there is the question of the purpose of the trial and the role of participants within it. </p>
<p>It is the responsibility of the court, not an executive agency pleading its case, to determine the facts. Second, it is the obligation of the agency to present the best possible interpretation of the e<a href="http://www.austlii.edu.au/au/cases/cth/HCA/2012/17.html">vidence proffered</a> and “ASIC not calling Mr Robb as a witness in its case occasioned no unfairness to the respondents or other defendants at the trial.”</p>
<p>In a crucial passage, the High Court calls into question the Court of Appeal rationale for questioning agency discretion in bringing cases to trial: “Disputed questions of fact must be decided by a court according to the evidence that the parties adduce, not according to some speculation about what other evidence might possibly have been led. Principles governing the onus and standard of proof must faithfully be applied. And there are cases where demonstration that other evidence could have been, but was not, called may properly be taken to account in determining whether a party has proved its case to the requisite standard. But both the circumstances in which that may be done and the way in which the absence of evidence may be taken to account are confined by known and accepted principles which do not permit the course taken by the Court of Appeal of discounting the cogency of the evidence tendered by ASIC.” </p>
<p>As a consequence, the Court of Appeals was wrong to set aside the primary judge’s ruling. </p>
<p>Not surprisingly, ASIC has <a href="http://www.asic.gov.au/asic/asic.nsf/byHeadline/12-85MR%20Decision%20in%20ASIC%E2%80%99s%20appeals%20in%20James%20Hardie%20matter?opendocument">expressed satisfaction</a> in the outcome. “We made it clear when launching these proceedings that the action was in the public interest as it would involve the responsibility of executives and non-executives when boards of public companies make important or ‘bet the farm’ type decisions,” said the current chairman, Greg Medcraft. “ASIC took this case to the highest court in the land and I am certain this case has and will be studied in boardrooms across Australia and in legal circles, and I know that it is already shaping corporate behaviour and is having a positive deterrent effect,” he continued. </p>
<p>In much the same way as the judicial scepticism expressed in the Court of Appeal ruling sent a signal that privileged regulatory restraint, the victory in the High Court, coupled with the expansion of the use of enforceable undertakings, signal that ASIC is now exceptionally well-placed to use the threat of enforcement to ensure compliance. As with others in the legal community and in corporate boardrooms, I await the next press release from the Australian Institute of Directors on ASIC’s enforcement agenda with much interest. </p>
<p><em><strong>Justin writes a column for The Conversation, <a href="https://theconversation.com/the-hardie-case-muscling-up-asic-6838">The ethical deal</a> and is director of the U<a href="http://www.clmr.unsw.edu.au/">NSW Centre for Law, Markets and Regulation portal</a>, where this story also appears</strong>.</em></p><img src="https://counter.theconversation.com/content/6840/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justin O'Brien receives funding from the Australian Research Council for three grants related to corporate governance, financial regulation and accountable governance. This opinion is simultaneously published on an online portal that maps and tracks regulatory reform in the aftermath of the GFC - <a href="http://www.clmr.unsw.edu.au">www.clmr.unsw.edu.au</a></span></em></p>The Australian Securities and Investments Commission (ASIC) has secured a major victory in its ongoing battle to enforce the efficacy of the continuous disclosure regime here as well as its standing as…Justin O'Brien, Professor of Law, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/32062011-09-04T20:41:04Z2011-09-04T20:41:04ZDIY renovators now most at risk of asbestos cancers<figure><img src="https://images.theconversation.com/files/3311/original/OregonDOT.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many DIYers are not aware of the strict regulations about how asbestos should be removed.</span> <span class="attribution"><span class="source">OregonDOT/Flickr</span></span></figcaption></figure><p><em>A study published in the <a href="http://www.mja.com.au/">Medical Journal of Australia</a> todays says the increase in the number of malignant mesothelioma cases in Western Australia over the past decade is the result of home renovation and do-it-yourself (DIY) projects involving building products containing asbestos.</em> </p>
<p><em>This domestic exposure has been described as part of the “third wave” of asbestos-related diseases, the first being in miners, millers and transport workers, and the second in workers who used asbestos products.</em> </p>
<p><em>Clinical Professor of Respiratory Medicine and senior author of the paper, Bill Musk, discusses the risks to human health posed by asbestos.</em></p>
<p><strong><em>When did we first find out about the harmful effect asbestos has on health?</em></strong></p>
<p>We’ve known about it all for quite a while but it took a painfully long time for action to be taken. Asbestos was finally banned in Australia in 2003. The problem is the stuff that’s still out there.</p>
<p><strong><em>Tell me about the study you’ve published today.</em></strong></p>
<p>The <a href="http://www.australianasbestosnetwork.org.au/Medical+Information/Asbestos+Research/Epidemiological+Research/WA+Mesothelioma+Register/default.aspx">West Australian Mesothelioma Registry</a> has recorded every case of mesothelioma that has occurred in the state ever since the start of the epidemic in the early 1960s.</p>
<p>What we’ve been looking at is where asbestos exposure comes from. In the early period, the greatest proportion of the cases was people who were mining asbestos in the Wittenoom Gorge in Western Australia’s Pilbara Region. </p>
<p>With time, the number of cases from Wittenoom has stayed fairly level because the mines in Wittenoom were closed in 1966. They‘re still happening but the number of people at risk is reducing. </p>
<p>The second wave of cases of mesothelioma was in people who’d been using asbestos, such as carpenters and mechanics. Anybody who used asbestos as part of their trade was at risk and those cases have been getting proportionally greater.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/3312/original/Qole_Pejorian.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/3312/original/Qole_Pejorian.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=426&fit=crop&dpr=1 600w, https://images.theconversation.com/files/3312/original/Qole_Pejorian.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=426&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/3312/original/Qole_Pejorian.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=426&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/3312/original/Qole_Pejorian.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/3312/original/Qole_Pejorian.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/3312/original/Qole_Pejorian.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Renovators are being exposed to asbestos.</span>
<span class="attribution"><span class="source">Qole Perojian</span></span>
</figcaption>
</figure>
<p>Now we’ve got a growing number of people who’ve been exposed through doing-it-yourself jobs at home. Like the others, the risk for people renovating or undertaking DIY projects is proportional to the amount of asbestos they’re exposed to.</p>
<p>But it’s very important to remember there’s no level of exposure at which there’s no risk. </p>
<p>There are lots of people out there who do their own little jobs at home and their individual risks are small but because of the large number of people doing this kind of thing, the number of cases has been increasing.</p>
<p><strong><em>The study reports that the proportion of women developing mesothelioma is much higher than men – a rise from 5% of all cases in the 1990s to 35% for the period 2005 to 2008. Why is this?</em></strong></p>
<p>Mesothelioma is very uncommon in women because their exposure to asbestos in occupational settings is so much less than men. So, as a proportion of all new cases, the percentage of women getting mesothelioma is higher but the number of cases overall is smaller.</p>
<p><strong><em>Where is this exposure coming from?</em></strong></p>
<p>Asbestos was used a lot in the 1950s and 1960s as building material. And there’s nothing wrong with it as a building material, it’s just the health problems that we’re worried about. </p>
<p>So there were lots of asbestos roofs on houses, especially during this time but it reduced soon after because better materials came on board and the health risks started to be recognized. It’s those older houses that are most likely to contain asbestos. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/3306/original/2617099880_e9888e33dc_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/3306/original/2617099880_e9888e33dc_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/3306/original/2617099880_e9888e33dc_o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/3306/original/2617099880_e9888e33dc_o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/3306/original/2617099880_e9888e33dc_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/3306/original/2617099880_e9888e33dc_o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/3306/original/2617099880_e9888e33dc_o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Asbestos should be carefully removed.</span>
<span class="attribution"><span class="source">katsniffen</span></span>
</figcaption>
</figure>
<p>If people think there’s asbestos in their house, they shouldn’t touch it, they should get it identified and if there’re going to remove it, they should take all the recommended precautions for removal.</p>
<p>This is a preventable disease and avoiding exposure to asbestos is the best way to avoid it. </p>
<p><strong><em>How can we avoid exposure?</em></strong></p>
<p>There are regulations about how asbestos should be handled at home or anywhere else for that matter. People doing home renovations often don’t abide by those sort of rules – wearing protection, closing the job they’re doing, wetting it down and preventing exposure to the airborne fibres. </p>
<p>Really you shouldn’t be removing asbestos without observing proper precautions and there’s no great rush to remove asbestos – it’s often safer being left where it is than it is being disturbed.</p>
<p>There’s a degree of ignorance in the general community about the risk and the fact that asbestos might be present in various places and we’re hoping this study will increase people’s awareness of the risk and their care in handling it.</p>
<p><strong><em>How else can we be exposed to asbestos?</em></strong></p>
<p>Asbestos is around us all the time and it has been for years as a result of people using it. There’s asbestos in brake lining, for instance, which may get released into the atmosphere. </p>
<p>Motor mechanics and people working on engines where the exhaust had been covered by asbestos were a significant part of the second wave of people to be diagnosed with mesothelioma. </p>
<p>Between all these sorts of activities, there’s asbestos being released into the atmosphere in urban environments so we all have a few asbestos fibres in our lungs. The risk is related to how <em>much</em> there is. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/3303/original/3728691787_b0c7e8cddd_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/3303/original/3728691787_b0c7e8cddd_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/3303/original/3728691787_b0c7e8cddd_o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/3303/original/3728691787_b0c7e8cddd_o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/3303/original/3728691787_b0c7e8cddd_o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/3303/original/3728691787_b0c7e8cddd_o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/3303/original/3728691787_b0c7e8cddd_o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not all asbestos is equally hazardous.</span>
<span class="attribution"><span class="source">nicksarebi</span></span>
</figcaption>
</figure>
<p>This sort of environmental exposure doesn’t have a big impact on the individual’s risk but over the whole of the population, a few people getting mesothelioma mounts up and that’s the effect we’re seeing. </p>
<p><strong><em>What exactly is meosthelioma?</em></strong></p>
<p>Mesothelioma is a form of cancer arising in the tissue that covers the surface of the lung and lines the inside of the chest wall. It also covers the surface of the bowel and lines the abdominal cavity. The same sort of the tissue covers the heart and lines the pericardial cavity.</p>
<p>It’s a cancer of those cells and the main problem that it gives people initially is where it arose, either around the lung or around the bowel. </p>
<p><strong><em>What are the treatment options for people who develop this illness?</em></strong></p>
<p>That’s the problem with mesothelioma – we don’t have a treatment for it. Because it’s a surface cancer, it already involves all the tissues around the lung, including the lung surface itself. So it’s not really feasible to surgically remove it. It’s been tried but it doesn’t appear, at least at this stage, to have any useful effect. </p>
<p>And again because it’s distributed over the whole surface, it makes it impossible to give adequate amount of radiotherapy to the cancer. It’s also very resistant to chemotherapy, which is the other form of treatment for cancer. There’s one regime of chemotherapy that shrinks the tumour and may keep people alive for a little longer but this cancer is 100% fatal.</p>
<p><strong><em>What is its progression?</em></strong></p>
<p>Mesothelioma doesn’t occur within ten years of first exposure to asbestos, it’s very uncommon within the first 15 years but after that period the rate rises exponentially. Half of the people die within nine and 12 months</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/3310/original/5926330470_20ef648989_b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/3310/original/5926330470_20ef648989_b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/3310/original/5926330470_20ef648989_b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/3310/original/5926330470_20ef648989_b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/3310/original/5926330470_20ef648989_b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/3310/original/5926330470_20ef648989_b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/3310/original/5926330470_20ef648989_b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Asbestos bodies in lung tissue.</span>
<span class="attribution"><span class="source">Pulmonary Pathology</span></span>
</figcaption>
</figure>
<p>There’s no level of exposure below which there’s no risk but the risk is also related to what sort of asbestos the exposure was to. But the more exposure a person has, the greater the risk of getting mesothelioma.</p>
<p>Blue asbestos is the worst while white asbestos is the least potent – we don’t know if pure white asbestos exposure has ever actually caused mesothelioma. </p>
<p><strong><em>So some asbestos is worse than others – could you elaborate?</em></strong></p>
<p>The most commonly used asbestos around the world has been white asbestos and that’s relatively innocuous in causing mesothelioma – it can cause chrysotile cancer and asbestosis but it’s a much less potent cause of mesothelioma. </p>
<p>But amosite or brown asbestos, which is what we got from South Africa, is a different variety of asbestos and it’s much more likely to cause mesothelioma. </p>
<p>Blue asbestos, or crocidolite, is the most potent cause of mesothelioma. And that’s why we believe Western Australia has more mesothelioma per head of population than pretty much elsewhere in the world. </p>
<p><strong><em>We’ve been taking mainly about malignant mesothelioma but asbestos causes a number of other illnesses. What other diseases result from asbestos exposure?</em></strong></p>
<p>Asbestos can cause a number of diseases but one doesn’t cause another – they’re all pretty much independent effects of asbestos. If you’ve been exposed to it, you can get plural plaques and mesothelioma, or plural plaques and lung cancer or plural plaques and asbestosis. Plural plaques are benign so they tend to be around for a long time. </p>
<p>Asbestosis is an inflammation of the lung tissues that causes fibrosis in the walls and the air spaces of the lungs. It impairs their function but its not cancer while mesothelioma and lung cancer are forms of cancer. </p>
<p>Asbestosis was the first asbestos-related disease to be described and that was early last century. Lung cancer was described as an effect of asbestos exposure in the 1950s and mesothelioma as described as a result of blue asbestos exposure in South Africa in 1960.</p><img src="https://counter.theconversation.com/content/3206/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Musk receives funding from the NHMRC and other organisations to look at the effect of asbestos on health. He gives evidence in litigation for asbestos-related cases as an expert witness.</span></em></p>A study published in the Medical Journal of Australia todays says the increase in the number of malignant mesothelioma cases in Western Australia over the past decade is the result of home renovation and…Bill Musk, Clinical Professor of Medicine and Population Health, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.