Written by Tom Douglas
Headlines such as these occur with monotonous regularity. Widespread asbestos use throughout much of the 20th century has ensured that the next contamination scandal is never far off, and asbestos-related legal decisions and personal tragedies often make the news as well. But despite the ongoing media attention, asbestos has not captured the public imagination as a public health threat, at least, not in comparison to other comparable threats like excessive sun exposure and drink driving.
Asbestos is a versatile fibrous mineral that can be cheaply mined and has unusual fire resistance and durability. Its use exploded in the twentieth century, when 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. There is no safe threshold for exposure to asbestos dust, with even single exposures having 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 asbestos 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 posed by asbestos is often low, even in high-risk groups. A recent UK survey found that only a third of at-risk tradespeople were able to identify all of the measures required to work safely with asbestos. An earlier study found that British plumbers recognized only one third of their actual exposures to asbestos. By contrast, a number of comparable public health threats have been the subject of major health promotion campaigns and now enjoy a high profile.
Consider road safety. Speeding and drink driving have been the subject of extensive education programmes and police interventions in many countries, and few could claim ignorance of the risks that they pose. The terms ‘sober driver’ and ‘breathalyzer’ are now part of popular culture in many parts of the world.
A similar story can be told for sun exposure. In recent decades, huge efforts have been made to draw the risks of UV radiation to the attention of the public. In many countries, awareness of the risks of sunburn is now high, and parents who allow their children to burn are widely regarded as negligent. In Australia and New Zealand, which have the highest rates of melanoma, wide-brimmed hats are now commonplace on school playgrounds, as are near full-body swimsuits at the beach.
Nothing similar is true of asbestos. Health campaigns have been largely limited to particular at-risk professionals such as plumbers and demolition workers, and even in those groups, have often been ineffective. Asbestos enjoys a high profile only among workplace health and safety officers, public health experts and the subset of tradespeople who have received extensive training in handling the substance.
What explains the relative lack of public education and understanding regarding asbestos? One factor may be the perception that asbestos is a disease of the past: many current asbestos-related deaths are due to exposures before the 1980s, when strict regulations on the use of asbestos were started to bite. However, asbestos remains a pervasive presence in homes and workplaces, and renovation, demolitions or natural disintegration of building materials can lead to significant exposures. Moreover, asbestos continues to be mined and used in many parts of Asia and South America, often without safety precautions.
A second factor may be the perception that asbestos is a concern only for those in specific high risk occupations. This view is difficult to sustain: home renovators and to some extent inhabitants are also at risk. 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. It had previously been thought that only workplace exposures were sufficient to cause cancer, but Australian national data now indicates that around 40% of people diagnosed with mesothelioma, an especially deadly cancer thought to be caused almost solely by asbestos, report no workplace exposure to the substance.
So the question remains: what explains the lack of public education and understanding about asbestos? 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. Perhaps the perception of asbestos-related disease as a problem for the working classes has also contributed to a lack of attention from predominantly middle-class politicians and officials. (Melanoma is, by contrast, disproportionately a disease of the middle classes.) The association of asbestos with ‘boring’ workplace health and safety measures may have also have helped to prevent asbestos risks from capturing the public imagination as have health risks from sun exposure, smoking, drink driving and unprotected sex.
Yet though these factors might explain the relative neglect of asbestos, they do nothing to justify it. They provide no reason to give asbestos anything other than the attention that its devastating health costs warrant.
The greatest need for attention is in developing countries. While levels of public awareness in the developed world leave much to be desired, most developed countries have at least adopted strict regulations on the importation, sale, use and disposal of asbestos-containing products. By contrast, use of asbestos is exploding, and is largely unregulated, in many developing countries, including India, Indonesia and Thailand. Until recently, Canada, historically the largest producer of asbestos, was still mining the substance and exporting it to India and elsewhere, 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. Unless asbestos rapidly becomes a ‘big issue’ in global health, 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.
More should be done in the richest countries too. Much exposure to asbestos can be attributed to lack of public knowledge and difficulties in identifying the substance, which frequently looks similar to safe alternative products. There is a strong case for widely-publicized home testing services, which should be made freely available to all tradespeople and home renovators. Risks could be significantly reduced by information campaigns, which should extend beyond the highest risk professions. 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, ideally, go further. Asbestos has proven itself more than dangerous enough to warrant public health campaigns of the sort that have been used to fight road deaths, melanoma and sexually transmitted infections.
Acknowledgments: Thanks to Laura Van den Borre and Laurie Kazan-Allen for assisting with my research for this post.