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WHC4001 SUMMARY Determinants of health and labour participation
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WHC4001 – Determinants of health and labour participationCase 1 – Asbestos (physical environment, mono-causal)
1) What is asbestos? (Characteristics, types, what it is used for)
Prazakova S, Thomas PS, Sandrini A, & Yates DH. (2014). Asbestos and the lung in the 21st century: an update.
The Clinical Respiratory Journal, 8(1), 1-10.
Asbestos is the collective name for a group of fibrous silicates (naturally occurring) with high
durability, tensile strength and heat resistance. Asbestos was extensively used in many
products including thermal insulation, electrical wiring, building materials, friction products
and others.
- e.g. used in carpet linings for fire resistance, in cement of buildings, breaks of cars
Asbestos is a generic term for a group of fibrous
silicates, and can be divided into two groups that differ
in mineralogical and chemical properties: amphiboles
and serpentines. Amphiboles include crocidolite,
amosite, anthophyllite and tremolite. Chrysotile is the
only serpentine and represents 95% of the commercial
asbestos ever used around the world (1). Crocidolite is
recognized to be the most carcinogenic and fibrogenic,
but there has been vigorous debate about the relative
potency of chrysotile in carcinogenesis in the past
30 years. The general consensus currently is that
chrysotile is capable of inducing malignant mesothe-
lioma (MM), although it is less potent in this regard
than other types of asbestos
Asbestos is a generic term for a group of fibrous silicates, and can be divided into two groups
that differ in mineralogical and chemical properties: amphiboles and serpentines.
- Amphiboles include crocidolite, amosite, anthophyllite, tremolite and actinodite.
Crocidolite is recognized to be the most carcinogenic and fibrogenic, but there has
been vigorous debate about the relative potency of chrysotile in carcinogenesis in the
past 30 years.
o Really dangerous, when inhaled fibres make a chemical reaction and get stuck
in the lung veoli (tissue)
o Carcinogenic (potential to cause cancer)
o Prohibited
- Chrysotile is the only serpentine and represents 95% of the commercial asbestos ever
used around the world. The general consensus currently is that chrysotile is capable of
inducing malignant mesothelioma (MM), although it is less potent in this regard than
other types of asbestos
o Really small fibres, body is able to dispose the fibles, easy to breath out
(exhale) from respiration system
o Also dangerous, but less like to occur
o Controlled use is still aloud
o Softer and more flexible
1
,Although the use of asbestos was prohibited in the Netherlands in 1993 (and 2005 in the EU),
people are still being exposed, because asbestos used in the past is still present in many
settings. Occupational exposure can still occur when homes and other buildings are
demolished, when soil purification activities are undertaken, and when ships, drilling.
Asbestos is still used in for example Asia (64% of the world’s asbestos use).
2) What are the health effects of the different types of asbestos?
Health Council of the Netherlands. (2010). Asbestos: Risks of environmental and occupational exposure. The
Hague: Health Council of the Netherlands, publication no. 2010/10E. §2.3 Health effects
Inhaled asbestos fibres can enter the smallest parts of the respiratory tract and the alveoli.
Those that are not too large are then engulfed by macrophages; larger fibres can migrate into
the tissue. Fibres that are coughed up are liable to be swallowed, and then leave the body after
passing through the digestive tract. However, they can also enter the lymphatic system and
thus be transported to parts of the body far from the lungs. The number of asbestos bodies is
indicative of the level of asbestos exposure that a person has suffered. In response to the
accumulation of asbestos fibres in the lung, fibrous tissue formation (pulmonary fibrosis)
occurs; the particular form of diffuse pulmonary fibrosis caused by exposure to asbestos is
referred to as asbestosis. In the surrounding tissue, asbestos can subsequently trigger the
development of malignant growths.
When a worker breaths, asbestos fibres enter the mouth and nose and flow down the air
passages deep into the lungs. The fibres lodge in the delicate lung tissue where oxygen is
absorbed into the blood. Immune system cells try to break down the asbestos fibres and
become damaged and die. Scar tissue forms around the dead cells and spreads as more fibres
embed in the lungs. Asbestos fibres can remain in the lungs for long periods of time and the
scar tissue that results continues to develop for many years after exposure. Eventually, so
much scar tissue develops that the lungs stop working.
Exposure to asbestos can cause cancer in various organs. Because these types of cancer often
do not develop until years after exposure (long latency period), environmental and
occupational exposure to asbestos in the past continues to cause mortality.
Prazakova S, Thomas PS, Sandrini A, & Yates DH. (2014). Asbestos and the lung in the 21st century: an update.
The Clinical Respiratory Journal, 8(1), 1-10.
The Health effects are irreversible.
Asbestos produces the following lung disorders:
asbestosis (diffuse interstitial pulmonary fibrosis due
to asbestos inhalation), pleural plaques (PPs), diffuse
pleural thickening (DPT), benign asbestos pleural effu-
sion (BAPE), rounded atelectasis (RA), lung cancer
(LC) and MM.
Asbestos produces the following lung disorders:
- Asbestosis = scar tissue on the lungs (diffuse interstitial pulmonary fibrosis) due to
asbestos fibres inhalation. The more the exposure, the higher the risk. The latency
period for disease development is usually 15 years or more, and is influenced by
duration and intensity of exposure. Relatively high levels of asbestos inhalation are
required to produce asbestosis (cumulative exposure ≥25 fibres/mL-years),
o You need asbestos exposure mono-causal
2
, - pleural plaques (PPs) = (kind of the same as asbestosis, but there are more forms of
PPs). The thickening of pleural (lining of the lungs) that will compress part of the
lung. PPs are the commonest manifestation of asbestos exposure affecting up to 58%
of asbestos-exposed workers and up to 8% of general environmentally exposed
populations, with a latency period of 20–30 years.
- benign asbestos pleural effusion (BAPE) = excess fluid in pleural space. Latency
period is 10 years, not that deadly, asymptomatic.
- diffuse pleural thickening (DPT) = characterized by extensive thickening of the
visceral pleura. It can develop within a year of exposure but can also take up 40 years.
- malignant mesothelioma (MM) (worst)= MM is an aggressive and incurable tumour
arising from mesothelial cells of the pleura, peritoneum and rarely elsewhere. Can
develop even after short and low exposure. Latency period 40 years. Survival depends
on the stage of the disease when diagnosed. Overall poor prognosis with median
survival of 8-14 months.
o No MM without asbestos exposure mono-causal
- lung cancer (LC) = heavy asbestos exposure produces an increased risk of LC, with a
latency period of approximately 15–20 years. Asbestos-related LCs account for about
3–8% of all LCs. The risk of developing LC is linearly related to cumulative asbestos
exposure.
- Stomach cancer = since you can also swallow asbestos fibres after you cough them up.
3) Is asbestos actively used? (actual use worldwide – Global perspective)
Prazakova S, Thomas PS, Sandrini A, & Yates DH. (2014). Asbestos and the lung in the 21st century: an update.
The Clinical Respiratory Journal, 8(1), 1-10.
All forms of asbestos are now banned in 52 countries, and safer materials have replaced many
products that once contained it. However, asbestos mining still continues. Nowadays, asbestos
is used mainly in developing countries, while in many countries where most types of asbestos
have been banned, the controlled use of chrysotile asbestos is still allowed. Annual world
production remains at over 2 million tons with Russia as a leading producer of asbestos
worldwide, followed by China, which is also the largest consumer. As a consequence, an
epidemic of asbestos-related disorders (ARDs) is expected in next decades in these countries.
- China/India big consumers
- Banned in Netherlands since 1993, in Europe 2005, rest of the world no ban yet.
Exposure ways to asbestos
Asbestos usage peaked in 1950s, 1960s and 1970s in
most developed countries. World Health Organisation
officials estimate that 125 million people worldwide
are annually exposed to asbestos in occupational set-
tings, and more than 107 000 people die annually of
diseases associated with asbestos exposure
Asbestos usage peaked in 1950s, 1960s and 1970s in most developed countries. World Health
Organization officials estimate that 125 million people worldwide are annually exposed to
asbestos in occupational settings, and more than 107 000 people die annually of diseases
associated with asbestos exposure.
The phenomenon of para-occupational or ‘take
home’ asbestos exposure has been recognised for over
50 years and can be described as exposure to asbestos
3
, that occurs in the worker’s home generally because of
dust that has accumulated on the worker’s clothing or
hair. Many studies have described cases of ARDs
caused by para-occupational exposure (12–14).
However, the vast majority of the cases occurred
among family members of workers in industries char-
acterized by high exposures and nearly always to
amphibole fibres.
Direct occupational exposure to raw asbestos or
asbestos products remains the predominant cause of
ARDs. However, recently attention has been focused
on the potential dangers of non-occupational expo-
sure associated with home renovation of asbestos-
containing building products and car maintenance (7).
Asbestos-containing materials are present in many
residential and commercial buildings built after World
War II and may create an exposure hazard to the occu-
pants or to the renovators. One study in Western
Australia showed a marked increase of MM cases asso-
ciated with home maintenance and renovation over
the previous 10 years (15). It is expected that MM cases
as a result of non-occupational exposure to asbestos
will continue to increase over next decades.
The phenomenon of para-occupational or ‘take home’ asbestos exposure has been recognized
for over 50 years and can be described as exposure to asbestos that occurs in the worker’s
home generally because of dust that has accumulated on the worker’s clothing or hair. Direct
occupational exposure to raw asbestos or asbestos products remains the predominant cause of
ARDs. However, recently attention has been focused on the potential dangers of
non-occupational exposure associated with home renovation of asbestos-containing building
products and car maintenance. Asbestos-containing materials are present in many residential
and commercial buildings built after World War II and may create an exposure hazard to the
occupants or to the renovators. It is expected that MM cases as a result of non-occupational
exposure to asbestos will continue to increase over next decades.
Article Rice – the global reorganization and revitalization of the asbestos industry
The asbestos industry is going to developing countries because of:
- Low wages in African countries for instance
- Cost of pollution
- The demand for a clean environment falls as wealth decreases.
So there is a risk transfer from the developed countries to the developing (low developed)
countries.
Asbestos consumption in the industrialized countries declined over this period, in
juxtaposition to a notable increase in consumption in the developing countries. In 2007,
asbestos consumption in the developing countries was more than two million metric tons but
negligible elsewhere in the world economy. The author argues that as asbestos increasingly
became the focus of government oversight in the industrialized countries, continued capital
accumulation efforts necessitated displacement of risk to the developing countries.
the death of a African worker is less costly than the death of a worker in an industrialized
worker.
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