Development of the "National Asbestos Profile" to Eliminate Asbestos-Related Diseases in 195 Countries

Our plain-English summary of Development of the "National Asbestos Profile" to Eliminate Asbestos-Related Diseases in 195 Countries, by D. Arachi, S. Furuya, A. David, et al (International Journal of Environmental Research and Public Health, 2021).

The study

• Authors: D. Arachi, S. Furuya, A. David, A. Mangwiro, O. Chimed-Ochir, K. Lee, P. Tighe, J. Takala, T. Driscoll, K. Takahashi
• Journal: International Journal of Environmental Research and Public Health
• Published: 2021;18(4)
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Worldwide, 230,000+ people die annually from asbestos-related diseases (ARDs). The World Health Organization (WHO) recommends that countries develop a National Asbestos Profile (NAP) to eliminate ARDs. For 195 countries, we assessed the global status of NAPs (A: bona fide NAP, B: proxy NAP, C: relevant published information, D: no relevant information) by national income (HI: high, UMI: upper-middle, LMI: lower-middle, LI: low), asbestos bans (banned, no-ban) and public data availability. Fourteen (7% of 195) countries were category A (having a bona fide NAP), while 98, 51 and 32 countries were categories B, C and D, respectively. Of the 14 category-A countries, 8, 3 and 3 were LMI, UMI and HI, respectively. Development of a bona fide NAP showed no gradient by national income. The proportions of countries having a bona fide NAP were similar between asbestos-banned and no-ban countries. Public databases useful for developing NAPs contained data for most countries. Irrespective of the status of national income or asbestos ban, most countries have not developed a NAP despite having the potential. The global status of NAP is suboptimal. Country-level data on asbestos and ARDs in public databases can be better utilized to develop NAPs for globally eliminating ARDs.

In plain English

This study checked whether countries had written a National Asbestos Profile (NAP), a standard country report on asbestos and asbestos-related diseases built on a WHO and ILO template. The authors searched the internet in four languages and asked contacts about 195 countries (193 UN member states plus Taiwan and Hong Kong). Fourteen countries (7%) had a true ("bona fide") NAP, 98 (50%) had a substitute ("proxy") NAP, 51 (26%) had only other relevant published information, and 32 (16%) had no relevant published information. Of the 14, 8 were lower-middle income, 3 upper-middle and 3 high income. No low-income country had one. Bona fide NAPs were found in 8% (5/65) of countries with asbestos bans and 7% (9/130) of countries without. Public databases held asbestos-use data and estimated mesothelioma figures for most countries, but reported mesothelioma or asbestosis deaths for only 49% (96/195). The authors concluded the global status of NAPs is suboptimal. They noted they may have missed some NAPs and, having helped write several, may have been biased in judging them.

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: Cross-sectional review of national documents and public international databases (a policy survey of countries, not a study of patients). The authors searched the web and asked co-authors' contacts, then two authors rated each country into one of four categories.
• Who was studied: 195 countries: 193 United Nations member states plus Taiwan and Hong Kong.
• Exposure: No exposure of people was measured. Countries were compared by World Bank income group, by asbestos ban status taken from the International Ban Asbestos Secretariat list, and by whether public databases held data on raw asbestos consumption, imports of asbestos-containing material, and mesothelioma or asbestosis.
• Main results:
  • Of the 195 countries, 14 (7%) had a bona fide NAP (category A) and 98 (50%) had a proxy NAP but no bona fide NAP (category B).
  • 51 countries (26%) had only other relevant published information (category C), and 32 (16%) had no relevant published information (category D).
  • Of the 14 countries with a bona fide NAP, 8 were lower-middle income, 3 upper-middle income and 3 high income.
  • A bona fide NAP was published by 16% of lower-middle income, 6% of upper-middle income and 5% of high-income countries. No low-income country had developed one.
  • Among the 32 countries with no relevant published information, low-income countries made up the greatest proportion, followed by lower-middle, upper-middle and high-income countries.
  • A bona fide NAP was found in 8% (5 of 65) of countries with asbestos bans and 7% (9 of 130) of countries without bans.
  • Every country with an asbestos ban had at least some relevant published information.
  • Of the 14 countries with a bona fide NAP, seven were in the Western Pacific, four in South East Asia and three in Europe.
  • Asbestos data were available for 85% (165/195) of countries from the US Geological Survey (raw asbestos consumption) and for 92% (179/195) from UN Comtrade (asbestos-containing materials).
  • Disease data availability was: reported mesothelioma or asbestosis deaths (WHO Mortality Database) 49% (96/195); estimated mesothelioma incidence (Global Burden of Disease) 95% (186/195); estimated mesothelioma deaths (WHO Global Health Estimates) 91% (178/195); reported or estimated mesothelioma deaths (WHO Global Cancer Observatory) 69% (134/195).
  • Reported mesothelioma or asbestosis death data from the WHO Mortality Database were available for 50% (7/14), 64% (63/98), 37% (19/51) and 22% (7/32) of countries in categories A, B, C and D, respectively.
  • The 14 bona fide NAPs were most often written by multiple stakeholders (9), then by government (8) and by non-government (6) organizations. Some NAPs were counted in more than one group.
• The authors' conclusion: The authors concluded that the global status of NAPs is suboptimal. In their view, most countries have not developed a NAP despite having the resources and information to do so, regardless of national income or asbestos ban status.
• Limitations the authors state:
  • The study assessed whether NAPs were developed, not how they were used.
  • The authors may have missed an existing bona fide NAP.
  • Some authors helped develop NAPs for Japan, Vietnam and Australia, so bias in judging whether a NAP was bona fide may not have been eliminated.
  • The scope was limited to mesothelioma and asbestosis and to databases using reported and/or estimated mortality.
  • Databases that rely on estimates or country-level proxy data have limitations.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

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