A case study in avoiding a deadly legacy in developing countries

Our plain-English summary of A case study in avoiding a deadly legacy in developing countries, by R.A. Lemen, E. Bingham (Toxicology and Industrial Health, 1994).

The study

• Authors: R.A. Lemen, E. Bingham
• Journal: Toxicology and Industrial Health
• Published: 1994;10(1-2):59-87
• Type of article: Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

The authors asked what the history of asbestos in the industrialized world could teach developing countries that were importing asbestos for domestic use. They reviewed asbestos mining, production and uses; the numbers and types of exposed workers and their exposure levels; early knowledge of health effects; animal and epidemiological evidence; risk to workers; and regulation. They described asbestos exports to developing countries, citing reports about Canadian exports to Thailand. One author had surveyed a refugee camp at Phanat Nikhom, Thailand, where workers and refugees building housing from asbestos wallboard and roofing were unaware of the dangers and had no exposure controls or protective gear. The authors reported that asbestos cement products made up 70% of commercial use and that amphiboles made up less than 3% of asbestos in use. They cited an OSHA risk assessment of 6.7 deaths per 1,000 at 0.2 fiber/cc, and 3.4 per 1,000 at the NIOSH recommendation of 0.1 fiber/cc. They argued against regulating chrysotile less strictly than amphiboles. They identified four factors behind the asbestos epidemic: slow action by key policy makers, late use of mechanisms for policy change, fragile support infrastructures, and inadequate surveillance. They contrasted this with the response to vinyl chloride in 1974. They concluded that the lessons learned by the industrialized world could help avert similar experiences in developing countries.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a review and commentary, not a new study. The authors traced the history of asbestos mining, use, health knowledge and regulation, mainly in the industrialized world. Their question was how a similar toll could be prevented in developing countries now importing asbestos, where it is used mostly as a building material and in drinking-water pipe. One of the authors had surveyed a Thai-United Nations refugee camp at Phanat Nikhom, Thailand. There, workers building housing from asbestos wall board and roofing shingle were unaware of the dangers, had no exposure controls or protective gear, and wore contaminated clothing home. The authors argued that human evidence on pure chrysotile did not show it to be less hazardous than the amphiboles, and they argued against less stringent limits for chrysotile. They concluded that four factors drove the asbestos epidemic in industrialized countries: slow action by key policy makers, late use of mechanisms for policy change, fragile support infrastructures, and inadequate surveillance. They contrasted this with the response to vinyl chloride and concluded that these lessons could help avert similar experiences in the developing world.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review and historical commentary (a 'case study' of the history of asbestos), not an original study
• Who was studied: No study population. The article reviewed the history of asbestos in the industrialized world and discussed developing countries importing asbestos, especially Thailand, including one author's earlier survey of a refugee camp at Phanat Nikhom, Chonburi Province, Thailand.
• Exposure: Asbestos in general (chrysotile and the amphiboles, including amosite, crocidolite, tremolite and anthophyllite). The focus was on uses in developing countries as a building material for dwellings and in potable water pipe.
• Main results:
  • At the Thai-United Nations refugee camp surveyed by one of the authors, workers building housing from asbestos wall board and roofing shingle were unaware of the dangers, had no exposure controls, had no protective clothing or gear, and wore their contaminated clothing home.
  • The authors argued that existing human evidence on pure chrysotile exposure does not lead to the conclusion that chrysotile is less hazardous than the amphiboles. They added that most chrysotile deposits are contaminated with tremolite.
  • The authors stated that the reviewed animal and epidemiologic literature, together with the Ontario Royal Commission and WHO (1989) reports, supports an argument against less stringent exposure limits for chrysotile than for the amphiboles.
  • Citing others' historical work, the authors described asbestos research as largely funded and controlled by the industry, with findings of adverse health effects left unpublished.
  • The authors described a hierarchy of controls (exposure limits, engineering controls, work practices, protective equipment, training, and medical and environmental surveillance). They pointed to the U.S. asbestos standard as a model.
• The authors' conclusion: The authors concluded that four factors led to the epidemic of asbestos-related disease in the industrialized world: lethargic action by key policy makers, use of mechanisms for policy change that came too late, fragile support infrastructures, and lack of adequate surveillance. They contrasted this with the response to vinyl chloride after 1974 and concluded that the lessons learned could be critical in averting similar experiences in developing countries.
• Limitations the authors state:
  • The authors stated that why policy makers did nothing or chose non-preventive actions was beyond the scope of their article.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos-Cement, Amphibole Group, OSHA, NIOSH, Chrysotile.

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