Preventive measures to eliminate asbestos-related diseases in singapore

Our plain-English summary of Preventive measures to eliminate asbestos-related diseases in singapore, by J.W. Lim, D. Koh, J.S. Khim, et al (Safety and Health at Work, 2011).

The study

• Authors: J.W. Lim, D. Koh, J.S. Khim, G.V. Le, K. Takahashi
• Journal: Safety and Health at Work
• Published: 2011;2(3):201-9
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The incidence of asbestos-related diseases (ARD) has increased in the last four decades. In view of the historical use of asbestos in Singapore since the country started banning it in phases in 1989 and the long latency of the disease, the incidence of ARD can be expected to increase further. As occupational exposure to asbestos still occurs, preventive measures to eliminate ARD continue to be required to protect the health of both workers and the public from asbestos exposure. The majority of occupational exposures to asbestos at present occur during the removal of old buildings. Preventive measures have been utilized by different government ministries and agencies in eliminating ARD in Singapore over the past 40 years. These measures have included the enforcement of legislation, substitution with safer materials, and engineering controls during asbestos removal as well as improvements in personal hygiene and the use of personal protective equipment. The existing Workman's Compensation System for ARD should be further refined, given that is currently stipulates that claims for asbestosis and malignant mesothelioma be made within 36 and 12 months after ceasing employment.

In plain English

This article reviewed asbestos use, asbestos-related diseases and prevention measures in Singapore over about four decades. Citing other sources, the authors reported that 108,545 metric tons of asbestos were used in Singapore in 1970-2007, 65.8% of it in 1970-1980, and that 49 mesothelioma deaths were recorded in 1990-2006. The mesothelioma death rate was below a background level of 1 per million until 2000 and had since doubled. No raw asbestos users had been known since 2001, but exposure still occurred, mainly during demolition or renovation of pre-1989 buildings. The authors described laws, guidelines, training, removal methods, protective equipment, medical checks, compensation and waste disposal. Gaps they identified included no required retraining for registered asbestos removal competent persons and underreporting by doctors. Another gap was that the Work Injury Compensation Act covered only malignant mesothelioma contracted within 12 months, or asbestosis within 36 months, after leaving employment and causing incapacity or death. A limited, means-tested Worker's Fund could help some who did not qualify. The authors concluded that these gaps needed to be overcome to eliminate asbestos-related diseases in the long term.

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 (descriptive review of asbestos use, disease data and preventive measures in one country)
• Who was studied: Singapore: national asbestos use data for 1970-2007 and mesothelioma deaths for 1990-2006, drawn from cited sources. The review also covers workers exposed to asbestos and Singapore's laws and guidelines.
• Exposure: Asbestos in general. Historically it was used mostly in a single large asbestos cement factory, and also in shipyard, building and power station insulation, friction materials and building products. Current exposure comes mainly from demolition or renovation of buildings constructed before 1989, maintenance of old refinery installations, and brake stripping.
• Main results:
  • A total of 108,545 metric tons of asbestos was used in Singapore during 1970-2007, an annual mean of 1.06 kg per capita per year (figures from cited sources).
  • Most asbestos use (65.8%) occurred during 1970-1980, at 2.89 kg per capita per year.
  • The mesothelioma mortality rate in Singapore was below the background level of 1 per million population until 2000. Since then it has doubled.
  • Since 2001 there have been no known users of raw asbestos in Singapore.
  • Since 1999, importing products containing crocidolite, amosite and other amphiboles, and building materials containing chrysotile, has been prohibited. Chrysotile for gaskets and seals can still be imported with a license. In 2002, actinolite, anthophyllite and tremolite were added to the prohibited list.
  • Singapore's permissible exposure limit for all forms of asbestos dust is less than 0.1 fibres/cc.
  • Asbestos-exposed workers must have medical examinations. These were annual until 1997, when periodic examinations were reduced to every 3 years.
  • No retraining is required once a person registers as a competent person for asbestos removal work.
  • Malignant mesothelioma and asbestosis, the only two notifiable asbestos-related diseases, have been underreported by doctors.
  • Under the Work Injury Compensation Act, compensation covers only workers who contract malignant mesothelioma within 12 months, or asbestosis within 36 months, after ceasing employment. The authors said this does not fit the long latency of these diseases.
  • Under the Act, compensation is payable only if incapacity or the death of the workman results from the disease.
  • Workers who do not meet the Act's criteria can apply to the Worker's Fund. Because this fund is limited, payments are means-tested, and the authors said many affected workers may not qualify.
• The authors' conclusion: The authors concluded that gaps remain in Singapore's preventive measures that need to be overcome to eliminate asbestos-related diseases in the long term. The gaps they named were underreporting by doctors, the criterion for suspending workers, and compensation timelines. They suggested educating physicians, revising the suspension criterion, and considering compensation systems from other countries.
• Limitations the authors state:
  • Asbestosis deaths were recorded together with a group of other diseases, so asbestosis death data could not be separated out.
  • Occupational lung cancers due to asbestos are not reflected in the Ministry of Manpower database.

Topics

Medical terms in this study, explained in our Lexicon: Latency, Occupational Exposure, Asbestos Exposure, Engineering Controls, Malignant Mesothelioma.

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