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Asbestos: The Worst Industrial Killer

The medical profession, construction employers and architects got it badly, dangerously wrong. Asbestos is killing thousands more people today than they ever predicted possible and the numbers, particularly among construction workers, are rising.

In the first part of the next century at least 30 people will die each day of an asbestos related disease. We are facing a massive and totally preventable epidemic of early, painful death and suffering. In the next 30 years at least 150,000 UK citizens will die of lung cancer, mesothelioma and asbestosis, yet the "evil" effects of asbestos were first documented by HM Factory Inspectors nearly 100 years ago.

Current official estimates announced in March 1995, by Professor Julian Peto of the Institute of Cancer Research and the Health and Safety Executive, HSE, are that asbestos now kills between 3,000 and 3,500 people in Britain every year and that this death rate will increase to between 5,000 and 10,000 in the first quarter of the 21st century.

This recognition of the scale of the epidemic comes 10 years too late. Many people warned that Peto's previous work grossly underestimated the extent of the risk from asbestos.

In 1982 both Nancy Tait of SPAID (Society for the Prevention of Asbestosis and Industrial Diseases), and David Gee, National Health and Safety Officer, GMB, had letters printed in the New Statesman arguing that Richard (brother of Julian) Peto's prediction of 50,000 deaths from asbestos, which he knew could be lower or higher, was an underestimate and argued the total would be nearer to 70,000-75,000. Richard Peto had predicted a peak of 2,000-3,000 deaths per year occurring sometime in the 1990s. Nancy Tait said of the impending controls, "SPAID does not accept that to halve the amount of dust which workers are allowed to inhale will halve the number of cancer deaths......cancer, especially mesothelioma, attacks those with slight, short and/or intermittent exposure to asbestos, and non-smokers and the very fit do not escape." Gee said: "Whatever the figure (of deaths) it represents a public health disaster which was predictable and preventable...Most readers will be more interested in the politics...whereby known preventive measures were not adopted, than in the exact size of the tragedy."

In 1984 Hazards Bulletin was sued and made bankrupt after the publication in 1979 of Asbestos Killer Dust - a worker/community guide. This book warned of the impending disaster. The dedication reads, "This booklet is dedicated to the many working class people who have been murdered by the asbestos industry and to those beginning to fight back for the right to a healthy and safe workplace."

Alan Dalton, the author, now National Health and Safety Co-ordinator of the TGWU, was also sued for libel and made bankrupt by a doctor. He defended himself, but lost the case. The jury awarded the doctor just £500 after a 10-day High Court trial, but his court costs were £13,000. Alan says, "It gives no pleasure that history proved Hazards right."

In 1985 Richard Doll and Julian Peto produced a report for the Health and Safety Commission (HSC) that confirmed no safe limit exists for exposure to asbestos. They believed the then permitted levels of exposure to asbestos dust would kill one in 100 workers. They then went on to make a series of speculative assumptions and produce a dangerously misleading estimate that the risk of dying from asbestos would be "only" one in 100,000 or one death per year in the UK.

At the time, this speculation lead to headlines like Asbestos Panic Can Stop (Sunday Times, 21 April 1985) and sighs of relief from cost-conscious/about to be rate capped local authorities faced with a relatively militant and organised tenants' movement demanding asbestos be removed safely from council estates and other public buildings.

Asbestos panic starts now

The muted headline of the HSE's press release, announcing the new estimates, "HSE Campaign warns plumbers, carpenters and electricians of fatal asbestos danger", should read, "Asbestos Panic Can Start Again - Now."

For men born in the 1940s, one in a 100 will die of mesothelioma. They will die of a condition that the medical textbooks describe as an extremely rare cancer. The current mesothelioma mortality levels can be directly attributed to inadequate worker protection in the past. The long latency period for the development of the disease, anything between 10 and 50 years, means that the death rates for these cancers will not be affected by subsequent improvements in working conditions. The new figures show increases in the number of cases under 45, a trend Peto describes as "extraordinary and very worrying".

Mesothelioma has been the largest cause of occupationally induced cancer among males for many years. The numbers are rising at a time when many other industrially induced cancers are in decline. The highest rates are in the North, Scotland, London and the South East. Peto and other experts say that the natural background levels were less than two per million, or 100 cases a year.

A time bomb

For men born in the 1940s deaths from mesothelioma will account for almost 1% of all male deaths. This represents a real increase in mesotheliomas, not just an artefact of improved diagnosis. Peto is "surprised" by the fact that the worst effects of asbestos exposure are to be experienced by men (mainly), who started work in the 1960s, after the carcinogenic effects of asbestos became widely known.

Previous HSE studies looked at samples of workers covered by the 1969 Asbestos Regulations and the 1986 Asbestos Licensing Regulations, which required some workers to have medical examinations. In this sample 183 mesothelioma deaths occurred between 1971 and 1991 among this group. However, in the same period there were 10,985 mesothelioma deaths nationally. This figure comes from the HSE's Mesothelioma Register. Since 1968, the UK Health and Safety Executive has maintained a register of deaths in England, Wales and Scotland for which mesothelioma is mentioned in the death certificate. In other words for 20 years the HSE has only been looking closely at 1% of those at risk. They did not study the vast majority of workers dying from asbestos. According to Peto, "The vast majority of workers actually at risk from asbestos were not employed in occupations were this risk was recognised."

At least a quarter of those dying are construction workers though the true proportion of deaths due to exposure in construction may be much higher. The mesothelioma register records occupation as it appears on the death certificate. Men leaving the building industry, through sickness, accidents or inability to find a construction job, will often be classified under other occupations.

A year earlier, speaking at a British Occupational Hygiene Society conference, Peto referred to another study: SWORD - Surveillance and Work-Related Occupational Disease. This shows that among younger men about half the mesotheliomas occur in workers in the construction industry.

Peto's new statistical analysis is straightforward. He looks at male death rates from mesothelioma. The rates of mesothelioma form a clear pattern related to the date of birth of the dead men and their age at death. There is a long period of time between exposure to asbestos and onset of mesothelioma, therefore the death rates are highest for men aged in their 70s. Because the use of asbestos in Britain increased dramatically through the twentieth century, peaking in the 1970s, there are higher death rates for people born later in the century - there was (and is) so much more asbestos around during their lifetime. The curve plotting death rates against age is the same shape for all "age cohorts" (group of men born in the same decade). It is just a lot higher for more recent age cohorts. The full curve for death rates can be seen in the statistics for men born in the 1890s and 1900s - with rising numbers of deaths in ages 50s and 60s reaching a peak in their 70s and dropping off again for 80-90 year olds. Peto expects the pattern to be the same for all age cohorts. The death rates now amongst workers in their 30s and 40s gives early warning of what the overall death rate is going to be amongst workers born in any given year. You can look at the death rates of men aged under 50 now and predict death rates in their 60s and 70s for people born in the same decade. This is what Peto has done - the predictions are horrendous. The relatively new phenomenon of large numbers of people dying in their 30s and 40s from mesothelioma is only half the story - they foreshadow even greater carnage amongst the same age cohort when they reach their 60s and 70s.

The building workers' plague

Why did the government, the HSE, or medical experts like Peto, not realise that thousands of carpenters, plumbers, gas fitters, electricians, and other workers involved in building renovation, maintenance and demolition would soon die of asbestos exposure in such numbers? Why did they not realise that other workers and members of the community would have their lives put at risk by living and working in buildings riddled with asbestos that could never be guaranteed to remain intact?

One in 40 building workers now in their 50s may die of the cancer mesothelioma. One in 10 building workers in this age group are at risk of dying of asbestos-related disease. This is using the HSE estimate that there is, on average, at least two asbestos-related lung cancers for every case of mesothelioma, a conservative assumption.

According to Peto, "most exposures (not the most intense, but affecting large numbers) occurred in occupational settings, particularly in the building industry, which were and are still unmonitored." When asked how this medical disaster had come about, in a recent discussion on BBC Radio 4, he said, "This is a mistake that I'm as guilty of as everybody else and I've been involved in asbestos research for some time."

Construction trade union UCATT called for a ban

Not everyone is guilty. In 1976 the building workers' trade union, UCATT, passed an emergency resolution that called for a complete ban on asbestos use. The resolution was moved by Vic Heath, then convenor of Camden Direct Labour Organisation (DLO) Shop Stewards Committee now an active campaigner with the Construction Safety Campaign (CSC). It was prompted by information about the deaths of South African asbestos miners. It was not well received by the UCATT Executive at that time. They brought in a speaker from the Health and Safety Executive who trotted out the official myths of the day: some asbestos is not so dangerous; there is only about 2% in most construction products; it is sealed in. Despite this obvious pressure from the Executive, there was uproar at the conference and the resolution was passed overwhelmingly.

The Executive, however, did not at this point issue a statement to all UCATT members saying, "Ban Asbestos." Back at Camden DLO they banned asbestos once it was UCATT policy. Everybody stood by the decision. After about six months a substitute was introduced, Superlux. This has caused health problems as well but not so grave as those of asbestos. Some other local authority DLOs followed.

Says Vic, "We could have enforced a ban in those days. The industry was 50% organised, 100% in local authorities who were still building. Imagine the difference and the lives that would have been saved."

Another UCATT member Tony O'Brien, CSC secretary and ex-convenor of Southwark DLO, adds, "In the mid-1970s there were numerous disputes throughout London over asbestos. One was the Barbican Arts Centre dispute described in Asbestos Killer Dust, Jim Franklin who went on to found the CSC was involved in that. Another big dispute over asbestos was at a hotel opposite Russell Square. They happened all over London, it was common".

By the early 80s UCATT did issue a letter to all branches calling for asbestos to be banned and inserted a statement into UCATT diaries which clearly states that all asbestos is dangerous and that there are no safe levels. George Brumwell the current UCATT General Secretary says that over the years UCATT members have often stopped work over asbestos. Usually the matter has been resolved very quickly, and often the dispute has not been recorded.

If in doubt - stop the job

In 1994, labourers working for sub-contractor Bomac Construction on the refurbishment of St John's Hospital in south London refused to work with the substance they thought was asbestos. A BOMAC foreman told the men: "If you don't work, you're sacked." They refused and were sacked. Only swift action by UCATT got the men reinstated. The building workers union UCATT saw to this. They threatened to take BOMAC to an industrial tribunal using the new rights under the Trade Union Reform and Employment Rights Act 1993 which allow workers to claim damages for unfair dismissal if sacked for health and safety offences.

There are important lessons to learn from this case. Your employer may be responsible, but you can't rely on it. And not all employers will react kindly to you following the HSE's advice and avoiding contact with asbestos materials. In situations like that you need protection - and membership of UCATT provides that better than a mask ever could.

Early warnings of the public HEALTH DISASTER

Nancy Tait undertook a study at Hackney Hospital 13 years ago. She recalls: "SPAID identified and then reported to Parliament in 1982 that young electricians, carpenters, and roofers using asbestos cement were suffering from mesothelioma."

She has copies of some 1982 correspondence between S. Marks of TBA Industrial Products, representing the asbestos industry, and the epidemiologists Doll and Peto. Their debates about future deaths missed the mark now irrelevant: their predictions were wrong: actual deaths are now far higher. Some of their comments are interesting in the light of the current debate:

S. Marks to Doll 13.10.1982

"SPAID, in pursuit of their laudable objectives frequently appear to adopt an uncompromising and extremist stance without taking into account current conditions in the asbestos industry today, nor the overall balance of risk in a modern industrial society."

"Far from being 'more up to date' or 'more accurate and detailed', SPAID's information is so biased and selective that it is worthless for the purpose of assessing the magnitude of the risk in particular occupations.

Because so many "experts" dismissed her findings, a new generation of building workers and those who live and work in the buildings have been condemned to preventable asbestos diseases because an asbestos awareness campaign and tough enforcement were not launched at the right time.

On 30th April 1982 Nancy Tait wrote to Doll at the Cancer Epidemiology

Unit at Oxford, "SPAID has been saying for some time that... asbestos kills more people using it or exposed indirectly to it, than workers who profit by being employed in the primary asbestos industry. SPAID's study of all the mesothelioma patients seen so far at Hackney Hospital shows that not one patient has worked in an asbestos factory and that when investigated adequately, the association with asbestos can be established in mesotheliomas previously reported as unconnected with asbestos.

...We find in many instances that our patients report relatively short periods of employment in secondary asbestos using industries, those industries which would generally be considered to have low or insignificant exposures. These findings support my contention that asbestos users are at greater risk than workers producing the asbestos products they use, yet the major studies on which safety regulations are based, refer to asbestos manufacturing companies.

One of our Hackney cases was responsible for the amendment to DHSS Booklet NI226. (cutting and sawing asbestos, especially with high speed power tools, previously said to be 'little risk')." As a result of SPAID's work to help the Hackney patient, local DHSS offices are accepting more claims from carpenters, roofers, and joiners and this will in time remove some of the bias from PMP (Pneumoconiosis Medical Panels) statistics...

Men are still working asbestos cement products without protection. We are beginning to document cases of mesothelioma amongst carpenters, joiners and similar workers.

Our paper reports mesothelioma in four dockers.....

Whilst asbestos is now imported in containers, so that the risk to dockers will have been reduced, similar protection is not yet afforded to other workers and the general public. I know of no means of controlling the exposure of the vast majority of the population. 'Control Limits' are of little use. It is not possible to prevent the careless use of asbestos outside the asbestos manufacturing industry, and SPAID has shown very clearly that it is the careless use of asbestos that kills. "

Enfield council fined

The type of exposure to asbestos dust which occurs in construction and maintenance work was brought out in a recent case. Those who work near such workers are also potentially at risk of exposure.

On 25 July 1995, Enfield Council was found guilty of exposing two sub-contracted employees to asbestos. The Council was fined £12,500 plus almost £11,500 in costs after the Court determined that the Council violated two important regulations requiring employers to protect non-employees from exposure to asbestos and risks to their health and safety. "No one ever mentioned any asbestos. No one told us to use precautions or gave us any safety instructions," said one of the exposed workers who had been given the job of drilling holes in the amosite (brown asbestos)-laden walls of the Enfield Civic Centre in December 1993.

Less than a year before the incident, Enfield Council had no legally acceptable policy and plan for managing asbestos. It was only in March 1993 after the expiry of an enforcement notice that a plan was produced. HSE inspector Rosalind Roberts says she considered prosecuting the Council and the Chief Executive personally at the time, but the Council quickly produced an implementation plan and the HSE "trusted them to implement it."

Then, on 3rd December, Civic Centre workers walked in to find a snow storm of dust containing asbestos on their desks and papers. Following an HSE investigation, the Council shut down the Civic Centre air conditioning system, evacuated part of the building and brought in a licensed contractor to clean-up the asbestos dust. The HSE says "they just don't know" if anyone else in addition to these two workers was exposed to asbestos dust at dangerous levels.

Although Civic Centre employees feel that the Council now has a good safety policy, they have doubts on whether it will be fully implemented. "We're concerned that the same thing could happen again," said Paul Bishop, UNISON Enfield Branch Secretary. Bishop says that their demand for comprehensive asbestos labelling was agreed by the Council years ago, but it still hasn't happened. UNISON is aware of another incident of a contractor drilling and releasing asbestos in an Enfield Council sheltered housing property. "If these accidental releases are going to continue to happen, we've got a serious problem."

'Important and frightening'

Alan Dalton, has recently criticised the medical profession for ignoring earlier warnings in the medical literature that an epidemic was on the horizon but says, "Do not get me wrong. This latest Peto report is both very important and very frightening; as much for what it does not say as for what it does".

The report draws out the risks to building workers and effectively launches an official, although low key, awareness campaign. It highlights the fact that inadequate regulation of the asbestos removal industry has contributed to the burden of future occupational disease. It implies this was just an initial problem. The Asbestos Removal Contractors Association have said, however, that bad removal jobs generate much of their work.

Also, it does not address the realities of life on construction sites. Tony O'Brien of the CSC said at the HSE launch of this latest Peto report, "Workers who complain about asbestos do not get controls or masks - they get the sack."

Peto has said that, "the asbestos industry regulations were not really enforced at all in the groups at greatest risk. It's quite clear that the exposures were in occupations that were not monitored." He does not base his predictions on exposure to asbestos during removal operations. This began on a large scale during the 1980s and he is unable to say how much exposure occurs now.

Keith Morris, HM Principal Inspector of Factories at the HSE's Field Operations Division (FOD), with particular responsibility for asbestos, has admitted that the "standards we were applying in the 1970s were not as good as they could have been."

Other high risk groups

Metal-plate workers which includes shipyard workers continue to be the group with the highest current death rate for mesothelioma. This is why campaigners in Glasgow, Tyneside and Liverpool have seen so many deaths and got involved at an early stage with asbestos victim support work. The next highest category is vehicle body builders which includes those who built railway wagons. Most other high risk groups in the Mesothelioma Register are building trade workers, including plumbers and gas fitters and construction managers and other professionals. Other groups which figure are chemical and electrical engineers and scientists; welders; dockers; draughtsmen; laboratory technicians.

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