Why some, but not all, countries have banned asbestos

Our plain-English summary of Why some, but not all, countries have banned asbestos, by J. Bahk, Y. Choi, S. Lim, et al (International Journal of Occupational and Environmental Health, 2013).

The study

• Authors: J. Bahk, Y. Choi, S. Lim, D. Paek
• Journal: International Journal of Occupational and Environmental Health
• Published: 2013;19(2):127-35
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Out of 143 countries that consumed asbestos between 2003 and 2007, only 44 have banned asbestos. This study tried to explain why some countries have banned asbestos while others have not, based on a synthesis that asbestos ban policy of a country will rely on a process of cognition of threats and exploration of safer alternatives.

Method: As we hypothesized that increased social cost of mesothelioma, capacity of health-related infrastructures, and policy diffusion from adjacent countries were related to asbestos ban adoption, published databases of asbestos ban years, mesothelioma mortality, country rankings in health care and human rights standings, and distribution of banning countries over 14 regions were analyzed accordingly.

Results: The average mesothelioma death rate was significantly higher for countries with asbestos bans than in those with no ban (4·59 versus 1·83/million). No-ban countries had less well-developed health-related infrastructures. Among European countries, there was a tendency toward geographical diffusion of asbestos ban policy from Nordic to Western and then other European countries over the years. Even though aberrant cases were also noted where bans were instituted even without mesothelioma database, these were rather exceptions than rules.

Conclusion: Risk cognition is a complex process, but the presence of well-functioning health infrastructures, as well as the increased social cost of mesothelioma, that can make the plight of asbestos victims visible to the eyes of public and policy makers, may have contributed to this process. Asbestos ban policy from adjacent countries might have facilitated the adoption of alternative solutions.

In plain English

The authors used published databases to examine why some countries have banned asbestos and others have not. They identified 122 countries that had or might have used asbestos from the 1950s through the 1980s, of which 55 had banned it. They compared World Health Organization mesothelioma death data for 1970 to 2008, country rankings for health systems, workplace injury coverage and human rights, and ban timing across 14 world regions. The mean mesothelioma death rate was 4.59 per million in countries with bans, counted up to the ban year, and 1.83 per million in countries without bans. Countries with bans tended to rank higher on health systems. Among banning countries, earlier bans were associated with higher rankings on all three measures. A country's ban status was predicted by bans within its own region and, more weakly, by bans in other regions. In Europe, bans tended to spread from Nordic countries to Western and later Eastern and Southern Europe. The USA, Canada and New Zealand had high death rates but no ban. The authors noted gaps in the mortality data.

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-national analysis of published databases: descriptive comparison of ban and no-ban countries, simple regression of ban timing against country rankings, and a mixed-model analysis of regional ban status
• Who was studied: 122 countries that produced or used, or might have produced or used, asbestos from the 1950s through the 1980s. 55 had banned asbestos according to the International Ban Asbestos Secretariat list revised 6 January 2011. Mesothelioma mortality data covered 1970 to 2008.
• Exposure: National asbestos ban status and ban year, studied against: crude mesothelioma death rates per million from the WHO Mortality Database; rankings of overall health system attainment (1997), legal employment injury coverage (2010) and human rights (2007); and regional ban patterns. No fiber types were studied. Before ICD-10 there was no separate mesothelioma code, so pleural cancer codes were used.
• Main results:
  • For countries with bans, the mean mesothelioma death rate (calculated from 1970 to the ban year) was 4.59 deaths per million (standard deviation 3.60). For countries without bans it was 1.83 deaths per million (standard deviation 2.90).
  • Mesothelioma mortality data were available for 33 of 68 no-ban countries (49%) and for 44 of 55 ban countries (80%).
  • On overall health system attainment, ban countries had a mean rank of 46 and no-ban countries a mean rank of 100. The OCR prints these as 546 and 5100.
  • Among ban countries, the rank of ban year was related to the rank of overall health system attainment in 1997, with an adjusted R-square of 0.38 (p less than 0.0001).
  • Among ban countries, the rank of ban year was related to the rank of legal employment injury coverage in 2010, with an adjusted R-square of 0.27 (p less than 0.0001).
  • Among ban countries, the rank of ban year was related to the rank of human rights in 2007, with an adjusted R-square of 0.24 (p equal to 0.0003).
  • Two-thirds of African countries had not banned asbestos, while most European countries had. Only four countries in the Americas had banned asbestos.
  • Most Nordic countries banned asbestos in the 1980s, while countries in Eastern and Southern Europe did so in the 2000s.
  • For 1983 to 2010, both intra-regional and inter-regional ban status were statistically significant predictors of a country's ban status. Intra-regional status was the stronger predictor.
  • Some developed countries with high mesothelioma death rates, namely the USA, Canada and New Zealand, had not banned asbestos.
• The authors' conclusion: The authors concluded that well-functioning health infrastructures and the increased social cost of mesothelioma may have contributed to risk recognition and bans, and that bans in adjacent countries might have facilitated adoption of alternatives. They said developing countries should be supported to collect their own asbestos-related epidemiological data.
• Limitations the authors state:
  • The mesothelioma mortality databases were not comprehensive, leaving gaps for some countries and time periods. 46 countries did not provide mesothelioma mortality data to the WHO.
  • The three hypotheses may not be sufficient to explain individual asbestos bans.
  • The authors did not propose a unified quantitative model of the ban process.
  • An organizational model of policy diffusion, working through networks and conferences, was beyond the study's scope.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Standing.

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