National Programmes for Elimination of Asbestos-Related Diseases

1. Thai National Workshop on Strategies for Elimination of Asbestos-Related Diseases, Bangkok, 5 August 2008 National Programmes for Elimination of Asbestos-Related Diseases Ivan D. Ivanov Department for Public Health and Environment,

2. Summary of the conclusions from international assessments • All types of asbestos cause asbestosis, mesothelioma and lung cancer • No safe threshold level of exposure has been identified • Safer substitutes exist • Exposure of workers and other users of asbestos containing products is extremely difficult to control • Asbestos abatement is very costly and hard be carried out in a completely safe way

3. Recommendations for elimination of asbestos-related diseases • Elimination of the exposure • recognize that stopping the use of asbestos is the most effective preventive measure • provide information about safer substitutes • develop economic and technological mechanisms to stimulate substitution • Asbestos abatement • avoid exposure during asbestos removal • develop regulatory and workplace control measures for asbestos abatement • Medical surveillance • improve early diagnosis, treatment, rehabilitation and compensation of asbestos-related diseases • establish registries of people with current and past exposures

4. National instruments for elimination of asbestos-related diseases • National programme for elimination of asbestos-related diseases (NPEAD) • Long term objectives and targets • Strategy • Priorities • Political commitment • National asbestos profile • Baseline situation – current and historical use • indicators • National asbestos workplan • Time sensitive objectives • Accountability, monitoring and evaluation • Intersectoral mechanism for management of NPEAD

5. National asbestos profile • Regulations • Import, domestic production and consumption • Number of workers exposed • List of industrial users, including high risk • Estimate of the burden of asbestos/related disease • Incidence and prevalence of asbestos/related diseases • Percentage of house stock and vehicles containing asbestos • Workers eligible for compensation • National standards • Inspection system • Economic loss • Epidemiological studies

6. Registered diseases – the tip of the iceberg Registered diseases

7. WHO methodology for estimating the burden of occupational cancer • Health outcomes – lung cancer and mesothelioma • Relative risk • Estimation of exposure • Workforce exposed • Levels of exposure • Estimating disease burden • Attributable fraction • DALYs • Deaths • Evidence for relative risks – lung cancer and mesothelioma

8. Many countries have completely banned all types of asbestos

13. Further steps • Assisting countries to develop health arguments for regulation of chrysotile asbestos • Estimates of the national burden of asbestos-related diseases • Developing a set of preventive interventions, incl. substitution • Upgrading legislation • Economic and social measures • Awareness raising - workers, employers, general public • Political commitment • Dialogue with users

14. Further information WHO 2006. Elimination of asbestos-related diseases http://whqlibdoc.who.int/hq/2006/WHO_SDE_OEH_06.03_eng.pdf ILO & WHO, 2007 Outline for the development of national programmes for elimination of asbestos-related diseases http://whqlibdoc.who.int/hq/2007/WHO_SDE_PHE_07.02_eng.pdf WHO 2007, Cancer Control: WHO Guide for Effective Programmes, Module Cancer Prevention http://www.who.int/cancer/modules/Prevention%20Module.pdf workershealth@who.int safework@ilo.org