Establishing a Policy Framework for the Primary Prevention of Occupational Cancer: A Proposal Based on a Prospective Health Policy Analysis

Our plain-English summary of Establishing a Policy Framework for the Primary Prevention of Occupational Cancer: A Proposal Based on a Prospective Health Policy Analysis, by A. Veglia, M. Pahwa, P.A. Demers (Safety and Health at Work, 2017).

The study

• Authors: A. Veglia, M. Pahwa, P.A. Demers
• Journal: Safety and Health at Work
• Published: 2017;8(1):29-35
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Despite our knowledge of the causes of cancer, millions of workers are involuntarily exposed to a wide range of known and suspected carcinogens in the workplace. To address this issue from a policy perspective, we developed a policy framework based on a prospective health policy analysis. Use of the framework was demonstrated for developing policies to prevent cancers associated with diesel engine exhaust (DEE), asbestos, and shift work, three occupational carcinogens with global reach and large cancer impact.

Methods: An environmental scan of existing prospective health policy analyses was conducted to select and describe our framework parameters. These parameters were augmented by considerations unique to occupational cancer. Policy-related resources, predominantly from Canada, were used to demonstrate how the framework can be applied to cancers associated with DEE, asbestos, and shift work.

Results: The parameters of the framework were: problem statement, context, jurisdictional evidence, primary prevention policy options, and key policy players and their attributes. Applying the framework to the three selected carcinogens illustrated multiple avenues for primary prevention, including establishing an occupational exposure limit for DEE, banning asbestos, and improving shift schedules. The framework emphasized the need for leadership by employers and government.

Conclusion: To our knowledge, this is the first proposal for a comprehensive policy framework dedicated to the primary prevention of occupational cancer. The framework can be adapted and applied by key policy players in Canada and other countries as a guide of what parameters to consider when developing policies to protect workers' health.

In plain English

This article was a policy analysis, not a study of workers or patients. The authors searched existing prospective health policy analyses to choose the parts of a framework for planning policies that prevent work-related cancer before it occurs. The framework had five parts: problem statement, context, evidence from other jurisdictions, prevention policy options, and key policy players and their attributes. The authors applied it, using mostly Canadian sources, to diesel engine exhaust, asbestos and shift work. For asbestos, the analysis found that an asbestos ban was the most appropriate option. A national registry of buildings containing asbestos, substitution with safer alternatives, and stricter, enforced exposure limits were also judged feasible for Canada. Complete elimination of diesel engines was judged less feasible at present, and shift work produced fewer options. The authors noted that they did not consult policy players and did not evaluate the options' effects or costs. They concluded that the framework is a useful starting point for those developing policies to protect workers' health.

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: Prospective health policy analysis proposing a policy framework, built from an environmental scan (targeted literature search) of existing prospective health policy analyses and demonstrated on three example carcinogens
• Who was studied: No human subjects. The material was published prospective health policy analyses plus policy-related resources, mainly from Canadian federal and provincial government agencies, advocacy organizations, academic research organizations and occupational health and safety groups.
• Exposure: Occupational exposure to diesel engine exhaust, asbestos and shift work, used as examples. Citing CAREX Canada, the article states that 152,000 workers are currently exposed to asbestos in Canada and that past exposures were much greater. This is an outside estimate, not a finding of this study.
• Main results:
  • The final framework had five parameters: problem statement, context, jurisdictional evidence, primary prevention policy options, and key policy players and their attributes.
  • For asbestos, the analysis found that an asbestos ban was the most appropriate policy option.
  • For asbestos, a national public building registry, substitution with safer alternatives, and more rigorous, enforced occupational exposure limits were judged feasible policy options for Canada.
  • For diesel engine exhaust, complete elimination of diesel engines was judged less feasible at present than other options, such as an occupational exposure limit and stricter emission regulations.
  • Shift work yielded fewer policy options than diesel engine exhaust and asbestos, which the authors attributed to a research gap.
  • Among key policy players, Health Canada was reported to acknowledge that all forms of asbestos are carcinogenic.
• The authors' conclusion: The authors concluded that the proposed framework gives key policy players a useful starting point for deciding which parameters to consider when developing policies to protect workers' health.
• Limitations the authors state:
  • Policy formulation is not always the step-by-step process the framework suggests.
  • The authors did not engage key policy players to understand their resources, interests, perceptions and positions.
  • The framework does not include all possible parameters of a prospective health policy analysis.
  • The framework does not evaluate the policy options, including their unintended effects, outcomes, equity considerations, effectiveness or financial costs.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure.

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