Current activities towards banning asbestos/chrysotile in Thailand for APNARI Nov, 2011

Transcription

1 Current activities towards banning asbestos/chrysotile in Thailand for APNARI Nov, 2011 Pornchai Sithisarankul, MD, MPH, DrPH Faculty of Medicine, Chulalongkorn University Academic affairs, Association of Occupational and Environmental Diseases

2 Asian Asbestos Conference 2006 Some of us attended this conference Bangkok Declaration 2006

3 ACOH 2011

4 ACOH 2011 I served as Chairman of the Scientific Committee

5 ACOH 2011 On 11 March, we held a session on asbestos in the morning, a press conference at 1 pm, and 2 round-table discussion groups in the afternoon. (Professors Takahashi, Kang and Honma kindly joined us)

6 6The Situation of Asbestos in Thailand

7 The Situation of Asbestos in Thailand No asbestos mine in the country Asbestos has been imported for >70 years Thailand is the world top 5 in terms of importer and user of asbestos (>100,000 ton/year) Raw material is used in several manufactures 90% in cement roof tile, & cement pipe manufactures 7% in production of brake & clutch 3% in production of vinyl floor tile, gasket and heat insulating materials Only chrysotile is used (crocidolite was banned in 1995 & amosite was banned in 2001, the other 3 amphiboles were banned in 2009) 7

8 8 Amount of Imported Asbestos in Thailand during 1989 June 2010 Amount of Asbestos imported to Thailand * Year Source: Thai Customs Department: Import & Export Statistics *Data from Jan-Jun 2010 only

9 9 Top 3 countries of (Chrysotile) asbestos importers to Thailand in n Russian Federation n Brazil n Canada Top 4 countries of (Others) asbestos importers n Russian Federation n Canada n Kazakhstan n China

10 10 No. of asbestos factories (by type) in Thailand in Type No. of factories In 2007 Still use asbestos In 2008 Brake & crutch Roof Tile product 11 8 Pipe product 3 2 Glue 1 1 Others 2 - Total 43 24

11 11 Asbestos concentration in working environment Year Factory type Sample No. of sample >0.1 fiber/cc Asbestos conc. (fiber/cc) Roof tile & pipe 12 4 Brake & Clutch (Mean = 0.11) (Mean = 2.63) Source: 1 Data collected by the Department of Labour Protection and Welfare under The Occupational Lung Disease Surveillance in the Workplaces Program 2009 * means > ACGIH TLVs 0.1 fiber/cc

12 Comparison of Asbestos Concentrations in Brake and Clutch Factories between year 2000 and 2008 Asbestos Concentration (fibers/1 cc) 2000 (5 factories) 2008 (13 factories) Jobs Blending and Mixing Sample size Asbestos Mean Asbestos SD Sample size Asbestos Mean Asbestos SD Cold press Hot press Polish Source: Data collected by the Department of Labour Protection and Welfare under The Occupational Lung Disease Surveillance in the Workplaces Program

13 Comparison of Asbestos Concentrations in Roof Tile & Pipe Factories between year 2000 and 2008 Asbestos Concentration (fibers/1 cc) 2000 (3 factories) 2008 (12 factories) Jobs Sample size Asbestos Mean Asbestos SD Sample size Asbestos Mean Asbestos SD Transferring Mixing Producing Press Molding Polishing Source: Data collected by the Department of Labour Protection and Welfare under The Occupational Lung Disease Surveillance in the Workplaces Program

14 ASBESTOS-RELATED DISEASES 14

15 15 Active health surveillance data in asbestos use factories during Year No. of Factories No. of workers No. of abnormal CXR No. of pleural thickening No. of suspected asbestosis ? ? 37 7

16 16 The First Reported Case of Work-related Mesothelioma in Thailand n 75 years old, Male n Work as an engineer in a local roof tile production company for 24 years n Retired in 1985 n First symptoms: August 2007 n Diagnosis: November 2007 n Passed away: January 2008

17 Clinical signs and symptoms and radiological findings were consistent with the diagnosis The pro-asbestos groups and academia argued on the uncertainty of the exposure history (no recorded occupational history and environmental monitoring data) The argument between the pro- and the antiasbestos groups has been made to public since 2010

18 18 Unpublished report of Mesothelioma cases in Thailand n 39 cases of Mesothelioma diagnosed since 1968 n All in a university hospital in Bangkok but never reported to the DDC or the workmen compensation fund n The author commented that these Mesothelioma cases were not caused by asbestos exposure since its fiber could not be found in the lung tissues

19 19 Estimation of death due to Mesothelioma: WHO-Disease Burden Guideline n Assumption: Mesothelioma:Occ. Lung cancer = 0.5:1 n Calculating as follow: n Mesothelioma Death/year = Total LC x AF x 0.5 n Male = 1766 x x 0.5 = 29 deaths/year Total LC deaths in male aged >15 years = 1,766 cases (in 2007) AF for males for lung cancer from occupational asbestos exposure = n Female = 828 x x 0.5 = 10 deaths/year Total LC deaths in female aged >15 years = 828 cases (in 2007) AF for females for lung cancer from occupational asbestos exposure =

20 20 Estimation of Mesothelioma cases: Ro-Ting Len et al Lancet 2007; 369: n Ro-Ting Len using Annual consumption of asbestos in Kg/capita/year (ACKCP) = Import + Production - Export n Calculating as follow: n All mesothelioma in male (M) = x ACKCP n All mesothelioma in female (F) = x ACKCP Where: Amount of consumption = 3.0 Kg/capita/year n M = x = cases/million/year n F = x = cases/million/year n Mesothelioma in male = x 63 = 64 cases/year n Mesothelioma in female = x 63 = 18 cases/year

21 21 Estimation of Mesothelioma new case: Int J Occ Env Hlth, 2004, 10:22-25 n Tossavainen indicated a significant linear correlation between consumption of asbestos and the number of mesothelioma cases n Calculating as follow: n Y = 6.82 x amount of consumption (25-30 years ago) Where: Y = No. of cases/million/year Amount of consumption = No. of Kg/capita/year (3.0 Kg/capita/year) n Y = (6.82 x 3.0) = 20.9 cases/million/year n Total new case/year = 20.9 x 63 = 1,317 cases

22 Estimation of Mesothelioma case 22 n Using Global Trade Unions on Occupational Health and Safety profiling of countries ( n Calculating as follow: n 170 tons of asbestos use = 1.6 lung cancer, 1case of mesothelioma, and 0.7 cases of asbestosis Where: Amount of Asbestos imported in 2009 = 102,739 tons n Mesothelioma = 1 x 102,739/170 = 605 cases/year

23 Regardless of methods of estimation, we found/diagnosed much fewer cases

24 24 National strategy for prevention & control of asbestos-related diseases

25 Organizations and Legislation 25 n Ministry of Industry: Control of import, use, and storage Hazardous Substance Act 1992 n Ministry of Labour: Regulation of an occupational exposure limit Labour Protection Act 1998 n Ministry of Public Health: Provision of Occupational health and safety guidelines and services

26 26 The National Strategic plan after BKK Declaration in 2006 n Protection of workers and the public n Control, and Ban of Asbestos use in the industries n Increasing the awareness of asbestos-related health risks to the public n Improvement of diagnosis and surveillance of asbestos-related diseases n Collaboration among relevant organization at all levels

27 Aims of National Strategic Plan 27 n To control, reduce, and finally ban the use of asbestos within 5 years ( ) n To prevent and control of asbestos-related diseases

28 Some current activities (1) Activity toward the control and ban of asbestos use: n In the past, asbestos ban activities have been run by the government and academia only. However, recently, the NGOs have been involved in activities toward the banning of asbestos n In November 2009, the Foundation of Consumer has launched a meeting which included ~100 representatives of non-governmental consumer organizations from all over the country to set up a work plan to ban asbestos-containing product

29 Some current activities (1) (Cont.) 1. Activity toward the control and ban of asbestos use: n Measures to make Thai society free from asbestos agenda has been proposed by the technical working group to the 3rd National Health Assembly in December 2010 n In 2010, Strategic Road Map toward the ban of Asbestos use has also been proposed by NGOs to the National Economic and Social Advisory Council to take it into action 29

30 Summary of Measures to make Thai society free from asbestos Resolution 1) Request the NHCO to submit the strategy to the cabinet for approval and further work assignment 2) Request the Ministry of Industry to ban Chrysotile (raw material) within ) Request the Office of the Consumer Protection Board to issue the regulations governing ACPs within ) Request the Ministry of Finance to reduce the import tariff for alternative substances 5) Request the Ministry of Interior to develop measures to control the dismantling, repair, and extension of buildings with ACM, and set the 30 measures for disposal asbestos waste

31 Some current activities (2) Increasing of the awareness in industries and the public and strengthening capacity building: 2.1 Releasing of information to medias 2.2 Supporting the labeling of warning sign on asbestos containing products 2.3 Setting up of training courses for workers and safety officers

32 Training courses for workers and safety officers 32 n In 2009, project entitled Mobilization stakeholder supports and willingness to response to the development of the coalition for prevention and control of asbestos-related diseases has been conducted under the funding support by WHO: n Aims: 1) to strengthen occupational health service providers and 2) to increase workers and public awareness n Results: Target participants included n ~1,000 workers and safety officers n ~500 factories/companies (especially SMEs) n 154 governmental officers n 9 provinces adopted the program

33 Some current activities (3) Proposed Policy and Strategic Plan for reduction of asbestos use and promotion of substitution: 3.1 The Office of Consumer Protection Board: - Enforce the enactment of the legislation on the labeling policy require the company to label a warning sign on asbestos-containing products

34 The enactment of labeling policy 34 n legislation on the labeling of asbestos-containing products has been proposed in 2008 and enacted by the Consumer Protection Agency on September 2009: n This labeling law requires asbestos-containing products including brake, clutch, every construction materials that contained asbestos e.g., roof tile, floor tile, siding tile, and cement pipe n Must include the details of safety handling instruction and PPE information on the product n Must label a warning sign on the products as this product contains asbestos which may cause lung cancer and diseases

35 35 A warn sign logo used for labeling small asbestos-containing products May Cause Lung cancer and Diseases

36 Some current activities (4) Improvement of diagnosis of asbestos-related diseases: 4.1 Training for Chest X-ray reading on pneumoconiosis according to the ILO classification 4.2 AIR Pneumo Project (Prof. Yukinori Kusaka and his colleagues)

37 37 Improvement of Diagnosis of Asbestos-related Disease n Training for Chest X-ray reading on pneumoconiosis according to the ILO classification: n 3 training courses supported by ILO has been arranged in 1995, 2000, and 2004 with a total of 70 participants n 2 training courses in Thai were arranged by local core group with approx. 50 participants n Air Pneumo Project: n The 1 st Air Pneumo examination has been conducted in There were 29 examinees including n 24 physicians from Thailand 23 Passes n 5 from International countries 4 Passes

38 No. of reported cases of Pneumoconiosis and years of training courses No. of reported cases of pneumoconiosis and years of training courses Source: Bureau of Epidemiology

39 Some current activities (5) Surveillance of asbestos-related diseases: 5.1 Workers health surveillance (26 factories in 2009) 5.2 Mesothelioma surveillance in hospitals

40 Obstacles 40 n Ministry of Public Health is not the main responsible authority n No systematic health data to convince policy makers and public n Continuous interruption of the process by proasbestos agencies

41 So 41 n Thailand will face asbestos-related health problems in the near future n The concern becomes national public health issue n The national work plan and strategy has already been developed n The improvement of asbestos-related diseases management is urgently needed

42 Current academia s activities The Federation of Occupational Health, Safety, and Environment at Work (joined by the Association of Occupational and Environmental Diseases of Thailand, the Association of Occupational Health Nurse, and the Association of Occupational Safety and Health) was initiated in 2009 On 11 March PressConference.docx

43 April 2011 We were successful to have the resolution of the Council of Ministers on legal actions of several government organizations towards banning asbestos/chrysotile Then came the general election in July, and new cabinet in August Then the pro-asbestos group tried to postpone the ban

44 So we (The Federation, The National Health Assembly, and The Network of Consumers Protection, etc.) resume our move towards asbestos/chrysotile banning.

45 On 26 Sep, we sent an official letter to the Minister of Industry asking the progress of the April s cabinet agreement on banning asbestos On 5 Oct, we met together to plan for our next On 5 Oct, we met together to plan for our next move Meeting5Oct.doc

46 The Federation of Occupational Health, Safety, and Environment at Work (joined by the Association of Occupational and Environmental Diseases of Thailand, the Association of Occupational Health Nurse, and the Association of Occupational Safety and Health) propose Strategies towards solving and preventing asbestos-related diseases (ARDs) problems

47 1. Raise awareness among employers and employees 1.1 bring into consideration of The National Safety Promotion Committee 1.2 publicize this issue and educate all stake holders via relevant websites and social network (Facebook, Twitter, etc) 1.3 register high-risk industries and occupations (with the Bureau of Occupational and Environmental Diseases) and put them under long term surveillance

48 1.4 co-operate with the Federation of Thai Industry making the list of asbestos-containing materials (ACMs), publicize and made into product label 1.5 educate public via mass media 1.6 publicize symptoms and signs of ARDs This strategy requires co-operation with the Bureau of OED, Regional Offices of Diseases Control, mass media, etc.

49 2. Raise awareness among physicians seeing employees 2.1 occupations at risk 2.2 symptoms and signs of ARDs 2.3 training in diagnosis, referral system/channel, treatment and reporting

50 3. Initiate pathway/channel for physicians to report the suspected ARD cases 3.1 initiate Thai Asbestos Surveillance System (TAS) with a format available from website 3.2 in the future, integrate TAS into the existing system of the Bureau of Epidemiology or the Department of Medical Services

51 3.3 regularly disseminate the surveillance data periodically 3.4 refer suspected cases to experts 3.5 generate asbestos website for physicians 3.5 generate asbestos website for physicians (ABtox) collecting updated related documents, with Q&A responded by Web master

52 4. Capacity building of experts Chest physicians, radiologists, pathologists, and occupational medicine physicians as a group/network - aim to improve diagnosis and treatment of ARDs Work with tertiary hospitals in diagnosis, treatment and rehabilitation to take care of increasing referred suspected cases (from primary and secondary hospitals)

53 5. Improve safe working procedure with ACMs The Federation of Occupational Health, Safety, and Environment at work (led by the Association of Occupational Safety and Health) set up a safe working procedure with ACMs (construction, demolition, etc.) and educate/force relevant stakeholders to comply

54 We plan to expand from ARDs to all pneumoconioses in the future

55 Thank you APNARI & for your attention