Clearing the Air on Asbestosis Prevention

RESPIRATORY PROTECTIVE EQUIPMENT IS JUST ONE PIECE OF THE PUZZLE

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No matter where you are in the world, asbestos kills. For the more than 60 countries where the use of asbestos is now banned, this deadly substance – once deemed a ‘wonder material’ – now presents a ticking time bomb. For countries still using asbestos, however, which includes the UAE despite its ban, the root of the problem is yet to be contained and so the scale of the final problem is yet to be uncovered.

Asbestos is the biggest occupational cancer killer, claiming more than 200,000 lives a year worldwide, according to the Global Health Data Exchange. In the United Kingdom and the United States alone, in 2017 over 55,000 people died from work-related asbestos-caused diseases.

“despite numerous countries in the region banning asbestos, including the UAE in 2006, there is evidence that asbestos containing materials are still being used”

Comparing prevention and policy from the UK and the US allows us to better understand the scope of risk to mitigate exposure. Although the UK banned asbestos in 1999, the US failed to ban asbestos in 1989 and asbestos imports and use continue today. Meanwhile in the Middle East, despite numerous countries in the region banning asbestos, including the UAE in 2006, there is evidence that asbestos containing materials are still being used in new construction projects in the region.

Asbestos causes mesothelioma as well as a number of other cancers and deadly diseases, including lung, ovarian, laryngeal cancers, and asbestosis to name a few, yet all asbestos-caused diseases are 100 percent preventable if we prevent exposure in the first place.

“despite numerous countries in the region banning asbestos, including the UAE in 2006, there is evidence that asbestos containing materials are still being used”

When asbestos is inhaled, the indestructible fibres lodge themselves in the body where they remain, causing damage for years to come. Asbestoscaused diseases have long latency periods, with symptoms typically not presenting until 10-50 years after the time of exposure. And asbestos is undetectable by sight, smell or taste, so you can be exposed without ever knowing it.

Despite the focus on occupational exposure, the risk doesn’t stop at factory walls. Asbestos has been found in talcum powder, teen makeup, toys, and crayons. After decades of popular use in the construction industry, asbestos-contaminated materials are also commonly found in homes, office buildings, and schools – in fact, according to Parliament, 85 percent of UK schools contain asbestos.

A long, dark history

It can be difficult to fully understand the century-old asbestos tragedy. Commonly, it is described in three waves.

“Wave One” of asbestos diseases and deaths occurred in the early 1900s among workers who mined, milled, or transported raw asbestos. This gave way to “Wave Two” exposures which were concentrated in high-risk industries during the mid-century decades when asbestos was used rampantly in manufacturing. These high-risk industries include construction, automotive, shipbuilding, and the military, all of which had labourers handling or working in direct proximity to raw asbestos and contaminated materials. “Wave Three” refers to the structural, environmental, and secondary exposures – this wave continues in the Middle East, US and beyond today.

Environmental exposure can happen in structures built with materials containing asbestos. When do-it-yourself or commercial repairs and remodels are done to structures containing asbestos, fibres can be released into the environment. The same risk occurs when asbestos-filled structures are demolished. For example, untold amounts of asbestos were released into New York City air during the 9/11 attack on the World Trade Center (WTC). Unfortunately, the firefighters who risked their lives responding to the disaster have seen a 19 percent spike in cancer rates compared to New York firefighters who weren’t at Ground Zero.

Not unlike the WTC, when the UK’s Grenfell Tower fire broke out, it too contained asbestos. Firefighters bravely fought the blaze for more than 24 hours. Tragically, 71 people lost their lives to the fire, but it is expected that others will suffer in the coming years from asbestos exposure.

Both natural disasters and ageing infrastructure can also be a source of environmental exposure. For example, even burst water pipes can cause fibres to become airborne.

“eventually, science and government proved what the asbestos manufacturing companies had known for years: asbestos exposure causes disease”

An especially tragic side of both Wave Two and Wave Three is secondary exposure, sometimes referred to as “deadly hugs and chores.” This kind of exposure happens when workers bring asbestos fibres home on their clothes and expose their families who lovingly greet them with a hug at the door or clean their work clothes. Tragically, people who were exposed this way as children are now dying from mesothelioma and other asbestoscaused diseases in their 20s and 30s.

Eventually, science and government proved what the asbestos manufacturing companies had known for years: asbestos exposure causes disease.

In the 1960s, the American researcher Dr Irving Selikoff pioneered landmark studies of insulation workers that “demonstrated the severity of a modern occupational and public health tragedy.” However, it wasn’t until 1983 that Iceland became the first country to finally heed the science and fully ban asbestos. In slow succession, nearly 70 other countries followed suit and banned asbestos, but it remains legal and lethal in more than two-thirds of countries around the globe.

And even though asbestos has killed millions upon millions in the past century, the dark legacy and continuing risk remain a mystery to most.

Education is the first step

The health illiteracy around asbestoscaused disease is one of our biggest challenges in ending the epidemic of preventable deaths surrounding the fibre.

“asbestos remains legal and lethal in more than two-thirds of countries around the globe”

In America, where asbestos is still legal, nine in 10 people mistakenly believe the substance is banned and therefore poses no risk. In the UK, where asbestos was banned in 1999, many believe that asbestos danger is a thing of the past, but thousands of residents continue to fall ill and die from mesothelioma and other asbestos-caused diseases.

Misconceptions about asbestos must be corrected, because although promising research continues, exposure prevention is currently the only cure for asbestoscaused diseases.

While trade unions, safety and health professionals, and anti-asbestos advocates work hard to bring the truth to light, we fight an uphill battle against the spin and propaganda peddled by asbestos producers and users. Despite the longstanding scientific consensus that there is no safe level of exposure to asbestos, companies that still use it in manufacturing claim their method of use is safe. And chemical lobbyists and asbestos exporters, especially those in Russia, would have us believe that a risk-free version of asbestos – chrysotile – exists, though the World Health Organization is very clear in stating that “all forms of asbestos including chrysotile are carcinogenic to humans.”

Employers, regulators and governments alike need to take time to reflect on the tsunami of evidence linked to asbestosrelated disease and to understand the burden this deadly product places on people, their families and society as a whole to stem the tide of suffering and death.

“asbestos fibres can get trapped in the facial hair to be inhaled later if the worker does not properly decontaminate at the end of their shift”

Practices in prevention

While the regulatory picture varies widely, nearly all of the laws are insufficient to fully prevent asbestos exposure. Because inhalation of asbestos fibres is the major pathway of causing disease, many protective measures rely on using respiratory protective equipment (RPE) when working around asbestos and contaminated materials.

RPE protects the wearer from hazardous substances in the air before they can breathe them in. In the UK, RPE must be used where it is not possible to achieve adequate exposure control by other measures alone, for example, the use of local exhaust ventilation.

But preventing exposure with RPE takes much more than just throwing a mask at employees and telling them to wear it. First, it is important to select the correct RPE for the type of contamination you’re working to protect against. Proper storage, maintenance, and repair of RPE must also be followed, including changing the filter in accordance with supplier recommendations. And, crucially, the workers relying on RPE must be educated and empowered as partners in prevention.

Much of the RPE used at work is incorrectly selected, used, maintained or stored. Although RPE can greatly reduce exposure risk, these failures reduce the effectiveness of the equipment and can cause workers to breathe in the toxin they’re trying to avoid.

Wearing RPE, but still at risk

One of the most common problems that occurs with RPE is determining and maintaining the proper fit. Fit testing must occur when the RPE is initially distributed, and it must be redone annually and whenever a physical change has occurred that would affect the fit, like a change in facial hair. A worker’s moustache, beard, or even sideburns can prevent the RPE from properly fitting and protecting that person. Moreover, asbestos fibres can get trapped in the facial hair to be inhaled later if the worker does not properly decontaminate at the end of their shift.

In the underbelly of the US Capitol building, workers learned this the hard way.

In 2012, workers were sent down to remove asbestos from the steam tunnels that run underneath the Capitol, the home of the United States Congress and the seat of the legislative branch of the US federal government. They were warned of the asbestos risk and provided with RPE to protect themselves, but the crucial fit tests never took place. One of those workers, John T, wore the mask thinking it would keep him safe, but he had facial hair that prevented the respirator from working properly. He has since developed pleural disease, a thickening of the lining around the lungs and heart caused by asbestos exposure. This disease is incurable, and John will have to remain on an aggressive barrage of medications for the rest of his life to manage it as best he can.

“if workers aren’t fully trained on using the masks and aware of the real risk level, all the protective equipment in the world won’t help”

And even if an employer goes through all of the necessary steps to ensure the RPE provided to their employees are in good condition and properly fitted, if workers aren’t fully trained on using the masks and aware of the real risk level, all the protective equipment in the world won’t help.

Les Skramstad provides a heartbreaking example of this problem. Les was an employee of the W.B. Grace asbestos mine in Libby, Montana – often considered the epicentre of the asbestos tragedy in America. W.B. Grace provided their miners with paper masks, but failed to educate them around the dangers of asbestos.

Because they didn’t know the dangers they were up against, Les and his fellow miners didn’t realise the lifesaving importance of the protective equipment they were asked to wear. Working down in those mines in the summer, they faced suffocating heat, and Les couldn’t breathe with the mask on, so he took it off – not realising doing so would leave him fighting for breath decades down the line. Les ultimately developed asbestosis and later mesothelioma. Tragically, Les died in 2007. Before his death, he became a fierce advocate for the asbestos victim community, fighting for honest communication about workplace dangers between companies and their employees.

RPE: just one piece of the puzzle

Since the risks of asbestos are so poorly understood, in a way, RPE can provide a false sense of security. Workers dealing with asbestos feel protected by the masks and too often fail to realise the other exposure pathways that they may not be addressing.

The asbestos risk doesn’t just go away once the dust of the worksite settles. The invisible fibres cling to clothes, boots, hair, and skin. This necessitates using RPE in conjunction with other protective equipment and practices to most fully prevent exposure, as well as putting into place and following careful post-shift decontamination protocols.

When these measures aren’t taken, workers take the asbestos risk home with them, exposing their spouses and children. This was the case with Mavis and Ray Nye.

Mavis and Ray are active anti-asbestos advocates in the UK. They got married in 1960 while Ray was working around asbestos at the Chatham dockyards. When Mavis would wash his work clothes, she would shake them out first, sending plumes of dust into the air around her.

Forty years later, Mavis was diagnosed with mesothelioma as a result of this “deadly chore.” Mavis continues to battle the incurable disease, and the Nyes have since founded the Mavis Nye Foundation in hopes of educating others in Britain and around the world of this risk.

Ensure the correct use of RPE and decontamination methods help to prevent cases of second-hand exposure like Mavis’s.

Getting RPE right

What John, Les, and Mavis’s stories all have in common is that they show us why it takes so much more than equipment to truly protect against asbestos exposure.

In addition to the RPE itself, we need a stronger emphasis on training, enforcement, and education to ensure full compliance while using RPE as well as the implementation of other protective equipment and prevention protocols.

Careful risk assessments by employers – including educating workers of their risk – is the necessary first step and one required by federal health and safety authorities in both the UK and the US. This should include installing visual cues in the areas where RPE and other protective equipment should be worn, as well as setting up a system by which workers can request new RPE when theirs becomes dirty or they require a refitting.

Once a full exposure prevention plan is developed, it is key to empower workers with knowledge and leadership and to make them partners in the plan. When we’re all at risk, we’re all responsible for prevention; and, the more people we have who are focused on enforcement and sharing knowledge, the higher chance we have of full compliance.

Acting as a prevention plan steward doesn’t have to be difficult. One of the best ways to encourage your workers to use RPE correctly is to focus on positive reinforcement.

For example, when a prevention plan steward sees someone correctly using RPE and following other protocols, they should take a moment to praise that person by pointing out their success to fellow workers and reinforcing why it’s so commendable.

Making it clear what proper prevention looks like through this method – especially when it becomes a common refrain made by multiple stewards – ensures that workers will have a clear understanding of how to do their job “the right way.”

Building a culture of prevention

Mesothelioma and other asbestoscaused cancers and diseases are incurable. While doctors and scientists search for solutions every day, for now, prevention remains the only cure. That makes each of us responsible for the effort to end the onslaught of needless asbestos-caused deaths.

We are fortunate that we have RPE and decades of research to guide us in how to best protect ourselves, but we must take advantage of these resources and make sure we do so properly. With invisible risks like asbestos, sharing knowledge and making oneself accountable for the safety of those around us is paramount.

As we push forward in the fight for an asbestos-free globe, we will have to mitigate the risk of the deadly legacy caused by the asbestos used in years past. We must continue to band together with our health and safety allies in governments, the public sector, trade unions, and nonprofits – as the US and the UK have done for many years – to keep asbestos awareness at the forefront of people’s minds and make exposure-prevention a normal part of our wellness routines.

As the Asbestos Disease Awareness Organization (ADAO), says and practices:

“Hear Asbestos. Think Prevention.”

Brought to you by

Linda Reinstein and Dr Karen McDonnell

Linda Reinstein, President/CEO, Asbestos Disease Awareness Organization (ADAO) Linda Reinstein is the Co-Founder and President of the Asbestos Disease Awareness Organization (ADAO), which was created in 2004 after her late husband Alan was diagnosed with mesothelioma, an asbestos-caused cancer. Reinstein has been a strong political voice for major local, national, and international asbestos-related issues and frequently serves as a Congressional witness on asbestos-related issues. Recognised as a top public health influencer, Reinstein has shaped public policy, delivered over 100 national and international speeches, and built and sustained a diverse community to protect public health. As a strategic storyteller, Reinstein’s prevention and political campaigns have reached global audiences and affective change. Karen McDonnell, CFIOSH, Chartered FCIPD, PIEMA, MRSB, MSP, is a highly motivated advocate for occupational health and safety, skilled in partnership working with a track record of working with and through stakeholders across the UK, Europe and wider world. A broad range of personal and operational experience gained working for RoSPA promoting the importance of a whole person whole life approach to preventing accidents and work related ill health.

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