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Occupational cancer in Europe – working towards solutions



 

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Conference:

kNOw cancer risks at work, Cockle Bay Sydney, May 2015

 

Presenter:

Professor John Cherrie, Research Director, Institute of Occupational Medicine, Edinburgh UK

 

Title:

Occupational cancer in Europe – working towards solutions

 

Presentation outline:

Professor John Cherrie discusses occupational cancer trends in the UK and Europe and new interventions to help decrease the workplace cancer burden. As well as a perspective on the role of legislation, he highlights new awareness campaigns being used to increase Europeans’ understanding of workplace cancer risks.

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First of all, let me say thank you very much to the Cancer Council of Australia for the invitation to come and speak to you. It is a very interesting opportunity to try and share some of the work that we have been doing in Europe and in the UK to try and kick start things in terms of a new approach to occupational cancer.

I will start off with some general introductory remarks about cancer and the importance of that and I will talk about what we have been doing to try and bench mark the burden of cancer in terms of number of deaths and other impacts, both in the UK and in Europe and some of the figures that I will show you will echo the things that Terry presented already, We will talk a bit about legislation and how you might approach things to try and regulate in terms of occupational cancer, but other things as well and I want to mainline on some of the other initiatives that are going on in the UK in terms of trying to improve people’s understanding of the problem. I will talk a little bit about work that we’ve done also in terms of temporal trends and exposure, I think this is one of the important things that we need to actually get involved with and understand, because it really eases our job in terms of trying to reduce risks in the future. Then I will talk about some of the simple interventions that we might think about in terms of trying to provide solutions.

Before I start that, just one minor correction to what Terry said, I used to be Research Director at IOM, but I stepped down from that role at the end of last year and I work now between the IOM and Heriot-Watt University. You probably understand what a university is, but you may not understand what the Institute of Occupational Medicine is, and so I thought I would explain a little bit about it. We are not for Profit Company, which was originally set up by the coal company in the UK carrying out research into coal workers pneumoconiosis and so we have got a long background in terms of working in industry looking at disease. We no longer do very much work for the coal industry in the UK, but we cover a wide variety of research and consulting interests, both in the UK and elsewhere. We do a lot of work, I mean, thousands upon thousands of pieces of work each year. So, some of that involves occupational cancer and particularly a lot of the research that we have been doing at IOM has been focused on cancer over the years.

Cancer is clearly a very big public health priority and is as big a problem both in Australia as it is in UK. We share a lot common heritage and so on, but you have a lot more land than we do. When I drew the slide I tried to get it to scale, but felt if it went truly to scale, UK might just disappear completely off the radar. But, we have got lot more people and so in terms of number of cases of cancer diagnosed each year, we have a lot more individuals affected, but in general the rate of cancer is similar in both countries and survival is better in Australia. You have a better regimen of identifying cancers and treating cancers than we do in the UK and so for example in terms of cancer survival, 2/3rd will survive to more than 5 years, whereas this is really just about a half in the UK.

There is a wide variety of cancers that are caused, but I want to focus on lung cancer because lung cancer and respiratory cancers as we will see make up a big part of what the priority is in terms of occupational cancer. So, about 13% in the UK of all cancers diagnosed are lung cancers, but when it comes to look at the mortality, the proportion of deaths from cancer is much bigger and that reflects the fact that only about 10% of people who ever get a diagnosis of lung cancer will survive more than 5 years. So, our treatment regimens are very good and as we said in Australia, more than half of people who get that diagnosis will survive. It is still a very much a death sentence for many people if they got a diagnosis of a respiratory cancer. Again, you will see later in the presentation, many of the occupational cancers are respiratory cancers. So, both from exposure to asbestos, but for many other causes as well. That really underlines for me the message that prevention is a very important thing that we need to focus on in terms of occupational cancer, because we can’t rely on the treatment aspects to kind of bail us out and so we are making sure that we have good healthy work environments for individuals is key.

A mention has already been made about the World Health Organisation’s international agency for research on cancer, and I also had a monograph program in place in 1972 where they reviewed the scientific evidences available about the cancer hazards that may exist and they categorised agents in terms of number of groups, Group 1 being carcinogenic to humans, 2A being probably carcinogenic and we have already the glyphosate has been recently put into that category and then there are a number of other categories 2B and so on. It is interesting to look at the rate at which we have been identifying cancer, so these are the proven human carcinogens mapped out in the period since 1972 up-to-date and we have 116 agents or circumstances which have been classified in this way over the years, roughly three per year on average.

The important thing to realise is that there is no saying of this trend decreasing, it is just a simple linear trend and the suggestion to my mind is that if we carry on looking, then we will carry on identifying things which cause cancer and if you think about the number of agents which are in 2A category, which is probably carcinogenic, then there is another 73 there, if you look at 2B, which are possibly carcinogenic, that is nearly 300. So, there is a huge number of things out there, which are either known or probably or possibly carcinogenic agents and that this for me is one of the problems we have in terms of trying to prioritise things that we really need to think amongst all these various things where should we take action, how should we address these individual problems. One of the ways to do that is to move beyond hazard, but to think about impact and one of the first attempts to try and assess impact was carried out by two rather famous epidemiologists which are Doll and Peto who really carried out work for the American Government to try and see how much of cancer could be prevented if we were able to design the right type of interventions. This work was done in 1981 and it was really part and parcel of what was one of the early attempts to try and address cancer, it was part of what became known as Richard Nixon’s “War on Cancer”. What they identified was that for whole range of possible exposures that there were perhaps more or less important things, so diet they said they thought was perhaps most important, tobacco, next infections, reproductive risks, and then #5 occupation, where they thought that perhaps it was about 4% of all cancers might be due to work place exposures and they said some sort of uncertainty bounds on that, which said could be as low as 2%, could be as high as 8%, but they are not quite sure.

Since then, a lot has been done to try and improve our understanding of what causes of cancer may be important and if you were to redraw this graph now a days, it would be different. There would be less emphasis on diet, tobacco would be #1 and some of the other things would disappear, so for example medical exposures nowadays account for very few potential cancers. Next was a part of our realisation that things had moved on that the UK Health and Safety executive commissioned an updating of the cancer burden estimates for workplace exposures in UK and this work really was intended to be completely comprehensive to try and to assess all the various possible sources of cancer that might be present in the workplace and to identify all the possible types of cancers that may be caused and we focused on those agents which were identified by IARC, the proven human carcinogens group 1 or probable human carcinogens which were group 2A, so we did not include a lot of things that are possibly carcinogenic. The results of this shows that in terms of the relative proportion of disease for each other different types of cancers, which knows the attributable facts and then mesothelioma we thought was almost always caused in men by work and in women slightly less, so it is something like about 80% of cases in women we thought were work related and the remainder are being due to prior occupational or environmental exposures. Next on the list was sinonasal cancer and then lung cancer. Lung cancer in men we thought might explain 1 in 5 of cancers and that actually has generated a bit of kick back from people who look at it and they say well how can this be, we surely be know that cigarette smoking is the main cause of lung cancer, but you have to accept that workplace and cigarette smoking may be interacting with each other, so there may be this possibility that the risk is bigger among smokers and that the occupational exposures add to the risks that the smokers experience. And then, there is a whole list of other cancers that we have identified, but when we did an assessment, I think somewhat to our surprise came to the conclusion that about 5% of all cancers were work related and if you remember back in the 1980s, that was roughly what Doll and Peto thought was the situation as well. So, although we have made great strides in terms of protecting people in certain industries and industries have changed without recognition over that period of time, still we face with a similar level of disease.

The changes we have made have not really hard to the impact that we would have hoped for. One of the things that motivates me is I don’t want to be sitting the audience in 10 or 20 years' time and somebody stand up and say you know we have done an assessment of the occupational cancer, but then it is 5%. These are all preventable cancers. These are all cancers for which there is no need for them to occur if we get things right in our work places. If you look at the causal agents, then the studies that we have done have shown asbestos is the main cause of cancer registrations and main cause of cancer deaths, both mesothelioma and asbestos-related lung cancers. Second in our list is shift work involving night work, which has been categorised by us as a category 2A carcinogen in terms of breast cancer in women and then mineral oil, solar radiation, silica, diesel engine exhaust, PAHs, working as a painter, and so on. The one thing that often comes back is people wonder where the chemicals are, you know the suspicion that it is lot of chemicals that are causing the burden of disease that we have got, but that is not the case and in fact 85% of the cancer cases that we identify come from just 10 carcinogens and most of these carcinogens are associated with things like constructions, half of the cases that we have benchmarked will come from the construction industry in the UK. This I think is an important sort of check point for us because we remember we have got a 116 category 1 carcinogens from IARC and we have got more than 300 other possible or probable carcinogens, but if you focus and you just look at the top 10 chemical agents, then that will cover most of the cases of occupational cancers that are diagnosed. So, one of the important outputs of this work has been to allow us to prioritise action to try and say where we could have the most benefit.

In terms of protecting people’s health, we often think that legislation is the key way to do this and in Europe, we have a Pan-European system of regulating health and safety where the European Union sets the agenda and then each country implements the legislation in its own situation. We have a carcinogen and mutagens directive which has done that in Europe and that it was first introduced in 1990, but it is a very cumbersome system you know that to do this and to do this in a way that actually has any effect is very difficult. So, over that period since 1990, we have really only had one substantive amendment of the directive, which was to revise the binding limit for benzene exposure. We only have three exposure limits within the directive in terms of binding limits, so we really do not have legislation, which is on view is fit for purpose and actually in the commission‘s view is not fit for purpose either and in 2004, they started a process by which they wanted to update the legislation. It may surprise you know that we still in 2015 haven’t updated the legislation and the whole process has become mired in process and discussions and politics and that is really a big problem for us. In 2012, because the legal requirements of the commission is that they have to have an impact assessment, we carried out an impact assessment for them in relation to 25 carcinogenic agents and we showed them that there was benefit in terms of reducing limit values for many of these agents, but not all and we in fact recommended a prioritisation to them as well.

But, my argument is that the legislation we have in Europe hasn’t worked. We still have an attributable fraction of cancer, which is around 5%. The carcinogens and mutagens directive does not cover many of the main causes of occupational cancer; for example, it does not cover crystalline silica, does not cover shift working, and so on. So, it is not really focused on the problem. It is focused on chemicals and that is not really perhaps what it should be and it truly is focused on chemicals and not things like diesel engine exhaust and crystalline silica where there is perhaps a bigger need to have some legislation. In any case, legislation does not seem to be something that is easy to update and as we have seen, things are really reaching a very perilous position and then finally, for legislation to be effective, it has to be taken up by people in the work place and as part of some recent work that I have been doing with the safety and health professionals in UK, we kind of survey the members to ask them about their understanding of occupational cancer risks and we got the most ill-informed response back, because they really haven’t been focused on and this as a problem. Their focus is mainly on safety issues and not so much on health.

People now in Europe are getting to the stage of saying well, you know, something has to happen to improve the situation and on International Worker’s Memorial Day recently the European Trade Unions Confederation put out some publicity saying that this was completely unacceptable and that the commission and governments really needed to get their act together and take steps.

One of the reasons I think why this process is rather laboured, this comes out from actually the impact assessment work that we did. The graph you can see shows on the horizontal axis the baseline health cost in millions of Euros and on the vertical axis, the number of cancer deaths that we predicted occurring between 2010 and 2069 in Europe and you can see that on the top right hand corner of the graph, there are two other outlying lines. They are for diesel engine exhaust and respirable crystalline silica and there we estimate that there will be more than 100,000 deaths in each case from lung cancer occurring from these exposures in Europe over the next 50 years. The health cost associated with that mortality is something in the order of a 100 billion Euros or more over that period of time. It is an enormous cost. You know, it is a measurable fraction of the GDP of Europe over that period of time. It is not insignificant and so recognising the fact that these are the health costs monetised, but actually in a burden estimation, we also looked at the costs of preventing these by implementing controlled measures and to put cost against these, you end up with figures which are even larger. So in essence what we found was that there was not a cost benefit in the way that these things are done in actually intervening. My problem with cost benefit analysis is that it is slanted against action, it is a political tool which is designed to allow you to judge investments to-date, but what they do is they discount benefits which occur in the future, so they say if we spend money today to prevent health, but those benefits don’t accrue for another 40-50 years, then the benefits should not really count for very much, so we don’t pay completely the health costs in that process and we argued that with the Commission and said that you shouldn’t take this seriously as it may be implies and you should focus perhaps on the human toll rather than on the financial costs and they were listening to that as an argument.

But, I must admit I have given up rather on the regulators and politicians in terms of getting action and we have for a while been saying to professionals in the UK that really if we are going to get something done, then we as the professionals need to take ownership of this problem and try to persuade our employers to try and persuade trade unions to do something. So, I am really delighted that the Institute of Occupational Health and Safety and the British Occupational Hygiene Society have both started campaigns to try and address cancer and the other problems that are associated with work place exposure. So, the main focus of these campaigns is really to raise awareness and as I said, also awareness of the problem is quite abysmal amongst the professionals, but they have done this in a very sensitive way, they looked at the evidence that was available and they decided to prioritise their action, not to try and address everything, but to say let us focus. So, both campaigns will be concerned with the construction sector where we think that the majority of the problem lies and they will deal with a number of carcinogenic agents or other exposures in the work place. In fact, the No Time to Lose campaign and I have brought some of the materials, which you can have a look at or take away from these campaigns. The No Time to Lose campaign will focus on just five carcinogenic agents, diesel engine exhaust particulate, solar radiation, crystalline silica, shift work involving night work, and asbestos and the program is set to run over a two-year period and it will progressively cover these top five agents as we go. This is an important first step I think to get people to recognise the problem. As part of the whole program, they have set an action plan to challenge government to try and highlight the cost to society to improve the intelligence network that we have in terms of exposures in the work place and to fund more research and they have also challenged the regulator to get more efficient in the process and an action plan challenging the professionals and the industry as well. Very much they are trying to get industry to sign up to this, so they are asking industry representatives to sort of take a pledge or public declaration that they are going to implement some form of program.

Okay, so there is a challenge here as to what is to be done. There is some good news as well that comes out of the research that we have been doing and the good news is that we can do something about this problem, it is not an intractable problem. Back in the 1970s, we identified that exposure to vinyl chloride monomers, the building blocks of PVC caused a rather rare liver tumour and industry and governments really were quite shocked and startled at that time and I remember having a conversation with one of the people who is in the production side of the process at this time and he said that ICI, which was then one of the biggest producers of PVC in Europe had decided that if they did not solve the problem, they would close down all their PVC plants and they would just retrench from the industry. So, it was clearly seen as a major problem, but as you can see, although it appeared just over a year, the industry was able to drop the exposure to vinyl chloride by more than an order of magnitude and that is a pretty impressive achievement. How were they were able to do that? Well actually all they did was accelerate technological changes that were in place, so they had already been working on cleaning systems inside the reactive vessels using high pressure water jets and so they just accelerated that research implementation. They carried out other technical improvements, improved the ventilation, paid attention to leaks in the processing plant, and then provided workers with breathing apparatus when it was appropriate. I mean, these are sort of standard approaches in terms of occupational hygiene practice, nothing special was being done, they did not completely redesign the process. They retrofitted changes and solved the problem virtually overnight. Looking at similar data for whole host of other industries from a review that we carried out in 2007, you can see these are fitted lines, but in general, over time, the exposure seems to go down and what we see is that on average, there is about a 5-10% reduction in exposure year on year as time progresses. Ahead of all these studies that we reviewed for aerosols, there was only one study which showed an increase in exposure over time, and we did the same for gases and vapours and for fibers, dust, and the pattern is remarkably similar for all of these different types of agents. And that suggests, science is a wonderful thing, but occupational health science and occupational exposure science, is really not an exact science. So, to find such an almost universal truth implies that there is something very important behind it and for me the thing that is behind it is the capitalist process. It is about if you want to be in business, you got to improve your process, you have got to continuously be trying to improve the way you do things to get financial benefit out of things. As I say benefit to that, we end up seeing exposures going down and it is a very useful side benefit, because we do not have to do anything to get that benefit; that just happens in most industries. So, we could do something to just tweak that a little bit to try encourage a little bit better performance and if we could do that, that will be a major achievement instead of getting 5% to 10% reduction every year, if you get 10% to 20% reduction, which would not require a lot of extra effort, but that would be a major achievement. So, the kinds of interventions that we can conceive after trying and working towards a solution would be things that were just to improve the technology a little bit better, for example with diesel to look at the fuel formulations could we get a better fuel formulation that gave less emission of diesel particulates or simple solutions like providing local exhaust ventilation or providing appropriate personal protective equipment. Hygienists have this kind of unremitting mantra which says your personal protective equipment is the last resort, but actually, you know, it is more dogma than truth and if you look at things realistically, personal protective equipment is a very effective way of controlling exposures and is something that nowadays is much more acceptable to workers than it was 20-30 years ago when the dogma was at its height.

Of course, these are the ways that you try to intervene, but if you are a legislator, then the kind of interventions that you perceive of are more about compliance with the law or tightening up exposure limits and I have got a little example that might bring things home to you in terms of the benefits of these kind of approaches as we go. This is for crystalline silica and it really looks up for the UK, the benefits of moving from where we were and are, which was having a limit value of 0.1 mg/m3 and very poor compliance with the law, only about a third of the work places is complied with this limit value and the options that we investigated were introducing new limit values at lower figures, half or quarter of the existing limit or just improving the compliance moving to 90% compliance.

This is a rather busy graph and I will go through it step by step, but basically the red bars are to do with the baseline, so that is point one and 33%, the orange lower limit value, but still poor compliance. The next one is an even lower limit, but still poor compliance and then we step through with the original limit again, but better compliance than lower limit better compliance and so on. If we move on to the next slide, it will be a little bit clearer, so these bars just ones that are colored in know that they are to do with reducing the limit value and the first thing to note is that if we do nothing, such as in a red bars, then the number of registrations from exposure to crystalline silica, stays broadly the same, somewhere about 800 cases of cancer every year occurring in the UK because of these exposures, but if we were to reduce the limit, then we got some benefit, so by 2080, we can get down to almost half the number of cases in this projection, that would be something beneficial, but the real benefit comes actually if you improve compliance. So, the next set of bars show you the situations where we have got 90% compliance with the law in the UK and these are the original figure or the lower exposure limits and here you can see that if we get 90% compliance with the law, then we could get down to 100 registrations over the period of time that we are looking out and if we could do that with a lower limit, we could almost eliminate the problem of occupational cancer from silica exposure. It will take some time because there is a long lag between intervening and actually seeing the benefit, but that something that we need to be aware of that we need to invest in this whole area for the future.

So, the solutions that are available are very simple. You do not have to look very far to find the solution. So there are websites, there are guidance documents, there are best practice documents available that tell you how you should deal with the exposures to crystalline silica, diesel engine exhaust, and so on and some of these figures are taken from the national web site in the USA where you can see on the left hand side, the situation with no control while they are doing this cutting with a power tool and the situation with just local exhaust ventilation on the tool. It drops the exposure during this work by a factor of a 100. Then why don’t people do this? You know if I had to do this at home, hey I will be going for the situation on the right hand side rather than the left hand side, but people do not do it because it costs a little bit more. If you are a construction company, you either have to buy the equipment or you rent it and the cost will be slightly more, would not be a lot more, but will be slightly more to buy the better tools and in a harsh financial environment people often choose the lower cost situations. This is not about the technology, the technology exists, it is about shifting people’s mindset to say what we have been doing over the years is not good enough, we need to do something which is better. We need to think more about respiratory protective equipment as a possible means of controlling exposure and this is something we need to think about for diesel engine exhaust where there are many people who are not in conventional workplaces who are exposed the diesel engine exhaust and we will need to think about how we could provide adequate protection for them and in many cases that will be respiratory protection. We need to think, is it acceptable as it is going to be acceptable for us to wish our traffic cops or other workers in the public sphere with respiratory protection to try and reduce their risks? I am not advocating it; I am challenging you to think about it.

So, my main message is that the status quo is not good enough that we cannot carry on as we are doing. If we do that, then we will end up within 20, 30, 40 years’ time, 5% of all cancers being due to workplace exposures or maybe worse, who knows. We need to do something to try and address the problem, but the whole thing is that it is not difficult to do. We just need to accelerate this natural process of improving things in the workplace, to get exposures down a little bit faster than they are at the moment and the tools to do that are there, we do not have to invent new things, we just have to use our ingenuity to apply existing kinds of controls, but apply them in situations where in the past we would not really have thought that was necessary. It is all about changing people’s mindsets. It is all about telling them if you do not do something, then hundreds of thousands of people are going to lose their lives, but if you do a little bit, you can go a long way to preventing these deaths.

So, my conclusions then are that we need to do something better in terms of understanding the problem and in fact the work that we have done has been done by almost pulling things out of this sort of atmosphere, the evidence is slim and puts together to be a coherent picture, but is not as robust as it could be. We need to have better information systems available to us. Legislation is necessary. I am not advocating that we do away with the legislation, but I am saying it is not sufficient to solve the problem. We need to do more and we can do this by building coalitions to get safety professionals, occupational health professionals, trade unions, management, workers, industry organisations to come together in a communal way to try and focus on dealing with the problem. As time goes on, occupational exposures go down and that is really a very important point. It is not that we will be pushing against a trend. We just need to try and accelerate that trend.

Thank you very much.

Thank you John that is fabulous because that mainly gives us some time for some questions and we have actually got a good chunk of time for that which is a very good piece of news. I want to call for questions from the floor.

Why does shift work of any job present a higher risk than day shift work? I think the answer is, we do not really properly understand it but the epidemiological evidence suggests that for women who work nightshifts, there is an increased risk of breast cancer and the hypothesis is that this may be somehow hormonally related. If you work on nightshifts, really it disrupts your normal biological rhythms and so it will disrupt the hormone system as well. Breast cancers are hormonally mediated cancer. So, you can see that is a plausible argument that says it is something to do with the biology of the process. Breast cancer again it surprises a lot people that the breast cancer pops up as such a high priority in the rankings here and it surprised the IOSH to the point where there is really something we need to get more people aware of, so they put it into their five priority areas for the campaign.

Thanks very much John that was really tremendous. My name is Peggy Trompf, I am an Occupational Hygienist and I particularly work and I am interested in the construction industry. I was interested to hear your comments about exposure reductions of course in terms of silica exposure, which I totally agree with, but in my experience here even at the very top level companies which the ones I mainly work with, you would never see a hygienist around it to do any measurements. One has just recently employed a hygienist, but that was because of a whole set of peculiar circumstances and mainly at my instigation. So I am just interested in Europe, is it more common for measurements to be able to be taken so that you can actually get a picture of what is going on there?

I would say in general not, I think we as I said at the beginning we share a lot and one of the things we shared is a lack of hygiene resource, but very interestingly for crystalline silica in Europe there is a social partnership on crystalline silica and it is formally been set up under the European commission’s umbrella and the purpose of this program is really to get labour unions and employers in the same place and to agree some sort of priorities for this and as part of that, the employers have agreed to measure exposure regularly in the workplaces, so there is a commitment in each workplace to measure exposure each year and then in addition to that to offer health surveillance to the work force. So, that has been a major step forward and what is has actually allowed the industry to demonstrate is that they see the kind of temporal trends that I have being talking about, that exposures in the industry have been falling over the 5 or so years that the program has been in place. So, I am an advocate of the fact that if you measure exposure, it will help you understand whether or not you are seeing a real improvement and it will allow you to see the rate of improvement, but you don’t need to do that on a sort of employer by employer basis and keep the information secret. If you are going to have benefit from this, you have to do it on an industry wide basis and share the information.

I am Susan Tapioni, I am the associate professor of Occupational Health and Safety at RMIT University and we have grappled with how you teach all these things for a very long time, but I will just make a couple of observations. One of the things that you were saying was that you know the issue that I am concerned about is that your statistics at the beginning are all about the outcomes. The things that people were able to be compensated for and all of our focus is on numbers of these incidences and their outcomes, but the things that you talked about in terms of making progress are about measuring exposure and so there is no legislation in Australia that strongly encourages assessment of exposure. There is a move toward doing it if you are a good person, but there, you know, the focus is still very much on the outcome. So until we can actually get some focus further upstream, it will never happen and that is very similar to my previous comment or my other comment is that you are very concerned about there being just a natural reduction in exposures. To me that is just a really stronger reminder that OHS professionals have to get in at that design phase and working with industries and organisations to make sure you get a voice at the table at that point.

Thank you.

I agree with everything you said. Occupational Health and Safety professionals need to challenge themselves. So, I think there is a lot of complacency almost in the way we deal with things. We do need to strive for things to be a lot better than they are today and that means doing things very differently from today and so we need to think, okay, as I said about respiratory protection, we need to challenge ourselves, you know, is the dogma that we have had all these years, the right thing to be saying or should we be saying, now look, respirators have actually been very useful and we should be using them more.

Debby Glass, Monash University, I wanted to reflect little bit of about how we get better compliance because you suggested that is one way in which we are really going to reduce the burden and yet my experience is that small and medium size enterprises which employ a very large number of people have vanishingly small knowledge of exposure to make some control measures. So, given that they don’t know about it, they are not going to comply with the limits, the only way we are going to get compliance is by having some effective enforcement I would suggest. Do you have any other ideas?

I agree, we need to have somebody promoting change and that might be the regulator, but it could equally be the industry itself taking ownership of the problem and for small companies, they don’t need to know my exposure is this and I need be there. What they need to know is that to do this job, I need to use this kind of equipment, I was quite struck when I was in the UK in the city center and there were these guys were cutting up paving stones and in the past, you would see clouds and clouds of dust, but actually there was nothing like that. It was very noisy still, but there was no dust and I kind of looked more carefully to see what was going on and there were two of them there and the one guy was cutting and the other one was spraying water onto the saw and you know, that is a very simple change and that change has taken place because someone has said to them you can’t do it the way you did it before, you need to do it like this, see there in the specifications or some other… So you can make changes by you know improving practice in a direct way like that.

John, if I can on exercise chairman’s privilege and ask question myself and that is how is it fascinated by your five top priorities and I am sure there was lots of debate about what was in and what was out and I suspect you were involved in that, so I have got a two prong question. One is diesel exhaust was in, clearly there have been changes in terms of the formulation of diesel and those things are coming in progressively over time, so that is clearly going to help over the longer term. What other strategies are you recommending with regard to diesel and the second prong question is what are things you may think should have been in there or do you think there is anything else that might go close to joining that list of five?

I wasn’t involved in the choice of that five, but yeah, I don’t disagree with the choices that they made. I think there is a lot of ways you can spin things if you want and there are several other priorities that could be there in terms of other risks in the workplace, PAHs for example would be another possibility, wood dust may be another priority and they made their choices for various reasons.

Practical management for diesel?

That is a big challenge. Respirators, I think I have a role to play and respirators are a very efficient ways of protecting people and they are flexible, so that is one and especially we have got workers who are like postmen or you know other people who very sort of widely dispersed in terms of where they got exposed, but that is a possibility. There are a lot of other simple things. It strikes me that if you had more efficient filtration in to cabs, that would be one possible way of improving the situation and so, you know, simple things like that can, if we can get people start thinking well if I buy a truck that I need to make sure it has got the right kind of air handling system into the cab to ensure that people get some protection.

One down the front here, which might have to be last one… Alan Rogers, I am the President of the Australian Institute of Occupational Hygienists and I would just like to set the situation is that our legislation actually requires risk assessment and you run the risk assessment against exposure standards and those exposure standards are written into the legislation. As John has quite rightly said, we have known each for many many decades, the main problem is implementation and trying to get people to measure exposure and go against an actual standard, and I will be addressing many more at a presentation later on. Some of you may be quite surprised to find that the regulators in Australia are currently considering whether they remove mandatory exposure standards from regulations. Your comments please, John.

I think that legislation has two purposes in my view. One, it is there to encourage people to do the right thing. So, in the UK, we introduced seat belts many many years ago and having the law actually stimulated the people to use the seat belts. It wasn’t the fact that there was heavy enforcement of the law, it is in fact that the law set the tone for what people should do, so that is one thing. I think it helps people see the right direction, but the other is that the law is there to act as a way of avoiding people being completely irresponsible in what they do. So I think it is necessary to have some means of prosecuting people who do outrageous things and so, you know, in the UK, again we have had circumstances where people have been put in a room with a rather nasty vapour and being given a tube and told put that in your mouth and we will put the other end out of the window and that will be okay. You know, the law is there to ensure that things like that don’t happen, whether you need exposure limits to be able to enforce those kind of laws, I’m not sure, but that is the other perspective I have on legislation. But legislation alone won’t solve the problem of occupational cancer, because it doesn’t drive people in the right direction all the time and it does not force you to continuously improve. If I meet the limit, that is all I need to do.


This page was last updated on: Thursday, January 28, 2016

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