Implementation of national policies for a total asbestos ban: a global comparison

Our plain-English summary of Implementation of national policies for a total asbestos ban: a global comparison, by R.T. Lin, L.C. Chien, M. Jimba, et al (The Lancet. Planetary Health, 2019).

The study

• Authors: R.T. Lin, L.C. Chien, M. Jimba, S. Furuya, K. Takahashi
• Journal: The Lancet. Planetary Health
• Published: 2019;3(8):e341-e348
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Two international Conventions from the International Labor Organization (ILO; C162 Asbestos Convention) and the UN (Basel Convention) offer governments guidelines for achieving a total asbestos ban policy, but the long-term effect of these Conventions on policy implementation, and the role of government effectiveness, remains unknown. We aimed to investigate associations between government ratification of the ILO and UN international Conventions, government effectiveness, and implementation of a national total asbestos ban.

Methods: We obtained data for year of a national asbestos ban, year of ratification of one or both international Conventions, and World Bank government effectiveness scores for 108 countries that ever used asbestos. We did a survival analysis for countries with data in the follow-up period (March 22, 1989, to Feb 2, 2018) to assess whether ratification of the international Conventions and greater government effectiveness were associated with time of implementation of a national total asbestos ban.

Findings: Of 108 countries with data for asbestos consumption, nine were excluded because they implemented an asbestos ban before 1989. Therefore, 99 countries were included in the survival analysis. 26 countries ratified both international Conventions and 73 ratified either one or no Convention. Countries that ratified both Conventions had a shorter time to adoption of a total asbestos ban (mean 8·9 [SD 6·4] years) than did countries that ratified one or no Conventions (16·9 [6·1] years). After controlling for government effectiveness, countries that ratified both Conventions had a significantly higher conditional probability of banning asbestos than did those ratifying one or no Convention (hazard ratio [HR] 41·8, 95% CI 4·5-383·3; p=0·0010). For every 1 point increment in government effectiveness, the percentage change in HR for persistent asbestos consumption significantly increased by 127% (95% CI 13-354; p=0·021).

Interpretation: This study confirms that adoption of both the C162 Asbestos Convention and the Basel Convention facilitates countries in moving towards a total asbestos ban. The effect was reinforced by government effectiveness. Both international programmes and new agreements towards total asbestos bans and government commitments are needed.

Funding: China Medical University, and the Ministry of Science and Technology (Taiwan).

Copyright © 2019 The Authors(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

In plain English

This study compared national asbestos policies across countries. It did not study people's health. The authors looked at 108 countries that had used raw asbestos since 1978. They asked whether two things were linked with how soon a country adopted a total ban on chrysotile, crocidolite and amosite: ratifying two international agreements (the ILO C162 Asbestos Convention and the UN Basel Convention), and a higher World Bank government effectiveness score. Of 34 countries that ratified both Conventions, 22 (65%) had a total ban by 2018. Of 74 countries that ratified one or none, 30 (41%) did. The survival analysis covered 99 countries from 1989 to 2018. Among countries that went on to ban asbestos, those that ratified both Conventions took a mean of 8.9 years, compared with 16.9 years for the others. After accounting for government effectiveness, ratifying both was associated with a hazard ratio of 41.8 (95% CI 4.5 to 383.3) for banning asbestos. Higher government effectiveness was also associated with banning. The authors concluded that adopting both Conventions helps countries move towards a total ban, and that effective government reinforces this. They noted that they used only English-language sources and had to estimate effectiveness scores for years before 1996.

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-country comparison using survival analysis (Kaplan-Meier and Cox proportional hazards models) of national policy data
• Who was studied: 108 countries (from 195 UN Member States plus Taiwan and Hong Kong) with data for raw asbestos consumption since 1978; 99 countries in the survival analysis (26 that ratified both Conventions, 73 that ratified one or none), followed from March 22, 1989, to Feb 2, 2018
• Exposure: Ratification of the ILO C162 Asbestos Convention and the UN Basel Convention, and World Bank government effectiveness scores. The outcome was a national ban on chrysotile, crocidolite and amosite (or all asbestos types).
• Main results:
  • Of 34 countries that ratified both Conventions, 22 (65%) had a total asbestos ban by 2018, compared with 30 (41%) of 74 countries that ratified one or no Convention (p=0.020)
  • Among countries in the survival analysis that achieved a total ban, mean time to a ban was 8.9 years (SD 6.4) for those that ratified both Conventions (14 countries) and 16.9 years (SD 6.1) for those that ratified one or none (29 countries)
  • By Feb 2, 2018, the estimated probability of persistent asbestos consumption was 60% (95% CI 48 to 70) among countries that did not ratify both Conventions and 46% (27 to 64) among those that ratified both (p=0.011 for the difference between the survival curves)
  • After controlling for government effectiveness, countries that ratified both Conventions had a higher conditional probability of banning asbestos than those ratifying one or none: HR 41.8 (95% CI 4.5 to 383.3; p=0.0010)
  • For every 1-point increase in government effectiveness score, the hazard ratio (as described by the authors, for persistent asbestos consumption) increased by 127% (95% CI 13 to 354; p=0.021). The authors interpreted this as meaning that the more effective the government, the more likely the country was to adopt a total ban.
  • For every additional year a country took to ratify both Conventions, the hazard ratio decreased by 3% (95% CI –6 to –1; p=0.022). The authors stated that asbestos is more likely to persist in countries that lagged in ratifying.
• The authors' conclusion: The authors concluded that adopting the international Conventions helps countries progress towards a total asbestos ban, that this effect is reinforced by government effectiveness, and that both international programmes and national government commitments are required.
• Limitations the authors state:
  • Data sources were restricted to those published in English, and findings should be interpreted carefully outside the studied countries
  • Pioneer countries and non-members such as Hong Kong and Taiwan could not officially ratify the Conventions, so the effect of ratification might be underestimated
  • No government effectiveness data existed before 1996, so earlier scores were estimated by extrapolation
  • Economic indicators could not be added to the model because they were collinear with government effectiveness
  • The Cox model was not compared with parametric survival models
  • Other unmeasured variables probably contribute, and the causal mechanism was beyond the scope of the study

Topics

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

Medical terms in this study, explained in our Lexicon: Hazard Ratio.

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