“Calais Jungle Camp littered with asbestos”; “Buckingham Palace could be vacated to remove asbestos”; “Safety concerns for refugees and workers as Nauru asbestos removal programme kicks off”.
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.
Useful But Deadly
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.
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 single exposures to dust have been linked to cancer. Rates of asbestos-related cancer have recently been on the rise in Europe and Japan and look set to climb in many developing countries where the material is still being widely used, often without safety precautions. According to WHO estimates, asbestos now causes more deaths globally than excessive sun exposure. In the UK it is estimated to cause almost three times as many deaths as road traffic accidents
Yet awareness about the threat it poses is often low, even in high-risk groups such as plumbers.
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.
Real And Present
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 homes, workplaces and schools, and demolitions, renovation and DIY work can lead to significant exposures. In a recent Australian survey, over 60% of DIY home renovators 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.
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It had previously been thought that only workplace exposure was sufficient to cause cancer, but it is now estimated that, in industrialised counties, non-occupational exposure accounts for around 20% of cases of mesothelioma, an especially deadly form of cancer.
Explosion In Developing Countries
More worryingly, the use of asbestos is exploding and is largely unregulated in many developing countries including India, Indonesia and Thailand.
Until as recently as 2011, Canada, historically the largest producer of asbestos, was still mining the substance and exporting it to India, 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.
Correcting The Neglect
Asbestos cannot be set aside as a 20th century problem. So what explains it’s relative neglect as a public health threat?
A powerful asbestos industry 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.
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.
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.
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 taken significant steps in this direction, 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.
About The Author
Tom Douglas, Senior Research Fellow , University of Oxford. He is Principal Investigator on the Wellcome Trust-funded project 'Neurointerventions in Crime Prevention: An Ethical Analysis' and Lead Researcher in the Oxford Martin Programme on Collective Responsibility for Infectious Disease.