International Job Exposure Matrix for Asbestos IJEMA

International Job Exposure Matrix for Asbestos – IJEMA

Juliana Uribe, Ken Takahashi, Juan Pablo Ramos-Bonilla, Manuela M. Valenzuela, Margarita M. Giraldo,

David S. Infante

ABSTRACT

Introduction: Workers in different occupations have been and are currently exposed to asbestos during asbestos mining, and in the manufacturing, use, and disposal of asbestos containing products. Although some of the occupations and industries in which asbestos exposure occurs have been identified in previous studies for some countries, the results in terms of asbestos exposure by occupation can be radically different between countries. The purpose of this study is to construct an International Job-Exposure Matrix of Asbestos (IJEMA), based on the scientific information available, linking occupation and asbestos exposure at the country level. Methods: Countries were classified by income group, following the country-income classification of the World Bank. Two search cycles were conducted using PubMed as the main search engine. A database was created based on the search cycle. To include an article in the elaboration of the IJEMA, the following criteria were applied: 1. the study had to be fully written in English, 2. the article should have been peer reviewed, and 3. the study clearly mentioned asbestos exposure in an occupation. Occupations identified as having asbestos exposure were classified following the International Standard Classification of Occupations – ISCO-08, to build the International Job Exposure Matrix for Asbestos. Results: The most common occupations identified as having asbestos exposures were: Managers in construction- ISCO 1323, Supply, distribution and related managers- ISCO 1324, Civil engineering-ISCO 2142, Mechanical engineering- ISCO 2144, Chemical engineering-ISCO 2145, Mining engineering, metallurgists and related professionals-ISCO 2146, Power production plant operators-ISCO 3131, Process control technicians-ISCO 3139, Ships' engineers- ISCO 3151, General office clerks- ISCO 4110, Stock clerks-ISCO4321, Fire-fighters-ISCO 5411, Inland and coastal waters fishery workers-ISCO 6222, Insulation workers-ISCO 7124, Plumbers and pipe fitters-ISCO 7126, Welders and flamecutters-ISCO 7212, Sheet-metal workers- ISCO 7213, Motor vehicle mechanics and repairers- ISCO7231, Building and related electricians-ISCO 7411, Miners and quarries- ISCO 8111, Mineral and stone processing plant operators-ISCO 8112, Cement, stone and other mineral products machine operators-ISCO 8114, Steam engine and boiler-ISCO 8182, Mining and quarrying laborers-ISCO 9311, Hand packers-ISCO 9321 and Manufacturing labourers not elsewhere classified-ISCO 9329. Important differences were identified in terms of the amount of scientific information available comparing countries income level groups.

Conclusion: This is an initial effort to understand occupational asbestos exposures at the global level. Since is based on peer-reviewed scientific studies published in English, asbestos occupational exposures in several countries that are current asbestos consumers and producers were not identified. Thus, there is an open invitation to complement this initial effort to identify asbestos occupational exposures in countries that lack adequate scientific information. Key words: asbestos, occupational exposure, IJEMA, occupational code

INTRODUCTION

Asbestos are commercially exploited mineral fibers which are classified in two major groups: serpentines and amphiboles. Amphiboles include five varieties: anthophyllite, amosite, crocidolite, tremolite, and actinolite (U.S. Department of the Interior, 2000). Serpentines include only one variety, called Chrysotile or “white asbestos”. Asbestos have many industrial applications

because of several desirable characteristics such as resistance to almost all types of degradation (biological, chemical and physical), little reactivity to chemicals, high tensile strength, good sound insulation, and high adsorption capacity of heat and electricity (Canadian Centre for Occupational Health and Safety, 2013).

Despite all the industrial applications of the material, asbestos are classified as hazardous materials and exposure to asbestos can have negative consequences for human health. Asbestos exposure can result in the development of different diseases, including asbestosis, mesothelioma, and cancer of the lung, larynx, and ovaries (IARC, 2012). Some of the asbestos containing products that have been manufactured and distributed globally for decades include automobile friction products (e.g., brake and clutch pads), cement and construction products (e.g., cement pipes, roofing products, floor tile, ceiling tiles), a type of protective clothing (e.g. gloves, coats and boots), asbestos containing industrial products (e.g. valve packing material, gaskets), and other products including cigarette filters and gas masks (Cheng, 1986), (Cely-García, 2014), (Burdett G. J., 1994), (Sheehan, 2010), (Lange, 2002), (Keyes, 1991), (Markowitz, 1991), (Millette, 1993), (McKinnery, 1992), (Talcott, 1989), (Acheson, 1982). Workers in different occupations have been and are currently exposed to asbestos during asbestos mining, and in the manufacturing, use, and disposal of asbestos containing products. Some of the occupations that have been identified as being potentially exposed to high asbestos concentrations include miners that work in asbestos extraction, workers in manufacturing facilities of asbestos containing products (e.g., textile industry, cement industry) or stationary and plant machine operators in industries related with the use of asbestos (e.g., paper industry, rubber industry and shipyard industry), maintenance and renovation workers that during repair processes manipulate asbestos containing products installed in buildings (e.g., electricians, carpenters, roofers, floor and tile settlers, plasters, painters, bricklayers, welders, plumbers, insulation and sheet metal workers) and laborers that during the production and post-production process manipulate asbestos waste (e.g. cleaners, chimney sweeps, freight handlers and refuse workers) (Berry, 2012), (Nayebzadeh, 2006), (Sluis-Cremer, 1970), (Menegozzo S. , 2011), (Loomis D. , 2010), (Andersson, 2013), (Straif, 1999), (Tomioka, 2011), (Hodgson, 1988), (García-Closas, 1995), (Pairon, 1994) (Burdett G. , 2007), (Bard, 2007), (Lilis, 1992), (Järvholm,

2014), (Kishimoto, 2000), (Hogstedt, 2013), (Quinn, 1987), (Breysse, 2005). There are studies that have tried to determine the association between asbestos exposure in specific industries and health consequences in workers. Examples of these type of studies include the risk analysis conducted to determine the incidence of lung cancer in a cohort of workers of an asbestos cement industry in Denmark (Raffn, 1998), the complete analysis of the asbestos consumption, use and occupational exposure related to the development of lung cancer and mesothelioma in Japan (Takahashi, 2013), the analysis of the exposure-response relationship between cancer risk and asbestos in a textile industry in China (Deng, 2012), the cancer incidence analysis made in the Chongqing asbestos plant in China (Zhong, 2007), the Job Exposure Matrix (JEM) developed for a North Carolina textile plant (Dement, 2009), the comparison against this later case and the lung cancer incidence in a South Carolina textile plant (Elliott L. , 2012), and the analysis of the incidence of mesothelioma in a Connecticut friction products plant (Finkelstein, 2010). Because of health risks resulting from asbestos, several initiatives have tried to identify at the country level occupations that can result in asbestos exposure. Thus, specific methods have been developed to link asbestos exposure with industries and occupations. The methods most commonly used are the occupational exposure databases, the job-exposure matrix (JEM), and the task- exposure matrix (TEM). The occupational exposure databases summarize the information available to estimate the number of workers occupationally exposed to a specific agent. Some examples of these databases are the CAREX (International Information System on Occupational Exposure to Carcinogens), that estimates by industry the number of workers occupationally exposed to carcinogens in the EU from 1990 to 1993, and the NOES (National Occupational Exposure Survey) in which carcinogen and not carcinogen substances are taken in to account (Mannetje, 2003). The JEM method links in a matrix the occupations and industry codes (rows) with the occupational hazards (columns). The cells of the matrix represent an estimation of the occupational exposure to each agent in a specific job (Moual,

1995). There are two classes of JEM: the general population job-exposure matrix (GPJEM), and the industry- specific job-exposure matrix (ISJEM). The GPJEM takes into account all possible occupations in which the exposure can occur, and the ISJEM only considers the job and task developed in a specific industry (Mannetje, 2003). An example of the former is the development of a GPJEM to relate the occupational exposure to asbestos in parents of child’s with cancer, and some of the occupations identified in this GPJEM included motor vehicle mechanics, electricians, and carpenters (Feingold, 1991). The TEM relate the job or task with the exposure to an occupational hazard. This method was developed to correct potential misclassification of the jobs that develop multiple tasks called “multitasking jobs” in which each of the tasks has different profiles exposures (Benke, 2000). An example of the use of this method is the development of a TEM to relate 12 common asbestos tasks (rows) with the use of asbestos products (columns) (Hyland, 2010). Although some of the occupations and industries in which asbestos exposure occurs have been identified in previous studies for some countries, the results in terms of asbestos exposure by occupation can be radically different between countries. Furthermore, asbestos regulations vary greatly between countries, which can results in different exposure levels by occupation and important changes over time when countries with different income levels are compared. Most high-income countries in the world have more stringent regulatory standards and even have imposed complete asbestos bans, while most low- and middle-income have lax or nonexistent asbestos standards. As it can be noted in Figure 1, the percentage of high-income countries that have banned asbestos is approximately twice of the percentage of countries from upper-middle income economies that have banned asbestos.

Figure 1. Percentage of countries that have banned

asbestos by income group (IBAS, 2010)

These differences between countries in terms of the scientific information available at the country level could determine that in some countries there are occupations that are currently exposed to asbestos and have not been identified. Furthermore, approaching the problem of occupational exposures to asbestos has been done at the country level only. Therefore, two important questions remain unanswered: 1 – Is there an unbalanced distribution between countries of scientific studies that analyzed occupational exposure to asbestos? And 2- from a global perspective what are the occupations in which asbestos exposure occur in each country? The propose of this study is to construct an International Job-Exposure Matrix of Asbestos (IJEMA), based on the scientific information available, linking occupation and asbestos exposure at the country level. METHODOLOGY Figure 2 presents a flow chart of the methodology followed described. Search strategy The first step in this study was to classify countries by income groups, following the country-income classification of the World Bank (2014): Low income- US$1,035 or less (36 counties), Lower-middle income- between US$1,036 and US$4,085 (48 countries), Upper-middle income-between US$4,086 to US$12,615 (55 countries) and High income- US$12,616 or more (75 countries).

53%

18%

3% 0%High incomeeconomiesUpper incomeeconomiesLow-middle sincomeeconomiesLow income

(75)

(55)

(48)(36)

Once the classification was done, the search began by using PubMed as the main search engine. The search was made using the combinations of key words that are presented below (i.e. identified in Fig. 2 as step 1):

Asbestos [country name]

Asbestos occupational exposure [country name]

Asbestos job exposure matrix [country name]

Asbestos workers [country name]

For countries that resulted in large number of studies using the key words listed previously, additional key words were employed in the search:

Chrysotile asbestos workers [country name]

Amphiboles asbestos workers [country name]

One additional cycle of search was also implemented (i.e. identified in Fig. 2 as step 2). It contains four specific searches, each one with a concrete purpose: 1. A search for articles using the key words “asbestos occupation”, to find identify that have an objective similar to the purpose of this study.

2. A search for the articles mentioned in other articles. This search was conducted to consider articles that were not included in the PubMed database, but that could be relevant for the purposes of the study.

3. A search of Job Exposure Matrix (JEM) was conducted for specific countries. This search was made to identify potential JEM developed at the country level.

4. A search was made to found the studies of occupations and asbestos exposure produced by international agencies, including CAREX (European Union), NOES (United States), FINJEM (Finland), COLCHIC (France), MEGA (Germany), WAUNC (Netherlands), NEDB (United Kingdom) and ATABAS (Denmark). To verify the previous searches, two members of the group made independent searches to identify potential articles that were not captured in the original search cycle. From each article identified, independently of the approach used to identify them, a database was created including the following information: Country were the study was conducted, key words used in the search, engine of search, date of search,

first author, title of the article, journal, volume and issue, year of publication, pages, URL occupation or industry analyzed, measure of the exposure used, type of asbestos involved identified in the study, and a summary of the article was elaborated with key aspects related to the objective of this study.

Inclusion criteria To be considered for the development of the IJEMA, the following criteria were applied to select articles (i.e. identified in Fig. 2 as step 3): 1. The study was fully written in English. 2. The article was must have been peer reviewed.

3. The study specifically mentioned asbestos exposure in an occupation.

4. The study belonged to one of the following four study designs: Exposure assessment studies, health outcomes studies (e.g., mesothelioma cases), mortality studies, and review studies. Occupational Matrix development process Occupations were classified following the International Standard Classification of Occupations – ISCO-08. (i.e. identified in Fig. 2 as step 4): This code of occupations is part of the international family of economic and social classifications and is one of the international codes that are managed by the International Labour Organization (ILO) (International Labour Organization (ILO), 2010)). This classification allows for a standardized language related to occupations. Thus, for the articles included in this study the specific occupation identified in each article was classified according to the ISCO-08. The code uses the concepts of job, occupation and skill as a basis of the classification structure. A job is understands as the labors or assignments performed by one worker, these definition include both, employer and self-employment, an

occupation refers to a person that develop more than one labors with a high level of similarity and the skill is more related with the aptitudes and competence to performance the job. Under these three concepts, the occupations are organized into Major groups, Sub-major groups, Minor groups and Unit groups according to the level of specialization. For example: Major group 5: Services and Sales workers contains the Sub-major Group 51: Personal Services Workers that contains the Minor Group 511: Travel attendants, Conductors and Guides and is derived in 3 Unit groups 5111: Travel attendants and Travel Stewards, 5112 Transport Conductors and 5113 Travel Guides. (International Labor Office (ILO), 2008). Each of the Major groups involves a skill or educational level. Skill level 1 involves repetitive hand-made tasks and it requires primary educational level, skill level 2 involves the use of machinery and electronic equipment, and it requires post-secondary educational level, upper-secondary educational level or lower-secondary educational level, skill level 3 involves more complex and specialized technical tasks, and it requires first stage of tertiary education (short or medium duration), and skill level 4 involves complex problem-solving and decision making based on the knowledge of specialized fields, and it requires first stage of tertiary education, 1st degree (medium duration) or second take of tertiary education (International Labor Office (ILO), 2008) (See ¡Error! No se encuentra el origen de la referencia.¡Error! No se encuentra el origen de la referencia. (Table 1)). In some cases there was not an exact match between the ISCO-08 code and the occupation described in the study. The following list shows some of these occupations that were described in the literature as exposed to asbestos, and how they were classified in ISCO-08:

1. Lagger: 7124 Insulation workers 2. Boilermaker: 7213 Sheet metal worker 3. Store man: 5221 Shop keepers 4. Walf: 6222 Inland and coastal waters

fishery workers

5. Shipyard workers 723 Machinery mechanics and repairers+ 821 Assemblers+71 construction workers.

6. Skilled worker: This code is divided into skill levels, so in this case this category is related with the minimum skill level (9).

7. Demolition worker: 7119 Building frame and related trades workers not elsewhere+9313 Building construction laborers

8. Drywall construction worker: 7123 Plasterers

9. Material handler: 9333 Freight handlers 10. Cigarette and filter manufacturing :

9629 Elementary workers not elsewhere classified

11. Foundry as workshop// cast: 7211 Metal molders and core makers

12. Warehousing//store house: 9334 Shelf fillers

13. Foremen // supervisor: 312 Mining, manufacturing and construction supervisors

14. Paviour// reinforced concrete workers: 7114 Concrete placers, concrete finishers and related workers

15. Dockyard: 9333 Freight handlers 16. Fitter: 723 Machinery mechanics and

repairers* depending of the context can be electrical fitter or pipe fitter.

17. Turner: 722 Metal working machine tool setters and operators----Metal turner 7523 Woodworking machine tool setters and operators--- wood turner

18. Draftsmen: 4120 Secretaries (general)

19. Smelter//melter : 2146 Mining engineers, metallurgists and related professionals

20. Metal rehearsing: 722 Metal working machine tool setters and operators

21. Recovery of jute sacks: 9611 Garbage and recycling collectors

22. Coating: 7213 Sheet metal workers 23. Producing tatami mat: Handicraft

workers in wood, basketry and related materials

24. Wearing Fireproofing cloths: 5411 Fire-fighters

25. Gas mask: 932 Manufacturing labourers

26. Sailor // seafarers: 3152 Ships' deck officers and pilots

27. Iron worker // metal plater:7221 Blacksmiths, hammer smiths and forging press workers

28. Coast Guard personnel// U.S. Navy personnel: 0310 Armed forces occupations, other ranks

29. Gauge mechanic: 7222 Toolmakers and related workers

30. Maritime trade: 3324 Trade broker 31. General manufacturing process: some

classification of the section 81: Stationary plant and machine operators + 932 Manufacturing laborers. For example: workers from an asbestos textile industry were classified: 815 Textile, fur and leather products machine operators+932 Manufacturing laborers

32. Miners and mil workers: 8111 Miners and Quarriers + 8112 Mineral and stone processing plant operators+ 9311 Mining and quarrying labourers

RESULTS

A total of 1030 articles were reviewed, and 604

contained information relevant for IJEMA, (i.e.,

426 were excluded) (Table. 2). The number of

articles relevant for this study varies considerably

between income level groups: Countries classified

as high income economies had 81.4% of the

articles, countries classified as upper-middle

income economies had 13.0% of the articles,

countries classified low-middle income economies

had 4.8% of the articles, and countries with low

income economies had 0.9% of the articles.

(Figure. 3)

Table 2. Number of articles identified by country

income level group

Figure 3. Percentage of articles included by

country income

Among the high-income group, the top ten

countries in terms of articles with documented

occupational asbestos exposures were the United

States (N =127), United Kingdom (N=44), Italy

(N=39), Canada (N=30), Sweden (N=29), Australia

(N=25), Japan (N=23), France (N=19), Finland

(N=18), and Germany (N=16). Among the upper-

middle income group, the top five countries in

terms of articles with documented occupational

asbestos exposures were China (N=26), South

Africa (N=22), Brazil (N=9), Iran (N=9), and

Turkey (N=5). In the lower-middle income

economies, India (N=15), Egypt (N=6), Kosovo (3),

and Nigeria (2) had the largest number of articles,

and in the low income group only two countries

had articles: Zimbabwe (2) and Bangladesh (1).

Table 3 show the number of articles included and

excluded by country and income group in the

elaboration of IJEMA. Since some articles

identified occupational exposures in more than

one country, a column was included in Table 3

display the number of multiple country articles

that were reviewed, since this could create

81%

14%

4% 1%High income

Upper-middleincome

Lower-middleincome

Low income

Income Total of

countries Articles

included Articles

excluded High income 75 482 352

Upper-middle income

55 88 46

Lower-middle income

50 31 18

Low income 34 3 6

Total 214 604 426

discrepancies regarding the total number of

articles included.

Figure. 2, Methodology used in the elaboration of the International Job-Exposure Matrix for Asbestos.

Use PubMed as the main search engine.

Search words: Asbestos [country name],

Asbestos occupational exposure [country

name], Asbestos job exposure matrix

[country name], Asbestos workers

[country name].

Classify countries by

income groups, following

the World country-income

classification Bank

Exposure assessment studies.

Health outcomes studies (e.g.,

mesothelioma cases) studies

The article complied criteria 1?

What type

of article

is?

Mortality studies

Review

Yes

No

Identification of the

relevant information for

the elaboration of IJEMA.

The occupation of

the article is

exactly related in

the ISCO-08 code?

Yes

No

Relate the occupations in the

context of the article with

the definition of the

occupations listed in the

Draft definitions of the ISCO-

08 code.

Classification of information

by country and occupation

and create the Occupational

exposure matrix.



The article complied criteria 4??

Yes

Yes or discussed

No

No

No

Not included in the IJEMA

Additional cycle of search (4

specific searches on PubMed)

The country had a large

number of publications

Additional search in PubMed with

the following key-words: Chrysotile

asbestos workers [country name],

Amphiboles asbestos workers

[country name].

No

Included in the IJEMA

Yes

Bibliography of Review

articles was also used to

identify new articles

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Table 3. Number of articles by country

Country Articles by

country Multiple country article

Included in the IJEMA Articles

included Articles not

included High Income economies

Australia 32 0 25 7 Austria 3 0 3 0 Belgium 5 0 4 1 Canada 49 9 30 19 Channel island 0 0 0 0 Croatia 7 0 3 4 Czech Republic 3 1 0 3 Denmark 11 11 7 4 Estonia 3 0 2 1 Finland 31 8 18 13 France 43 9 19 24 Germany 33 9 16 17 Greece 8 1 7 1 Guam 0 1 0 0 Hong Kong 5 1 3 2 Iceland 4 0 2 2 Ireland 1 0 1 0 Israel 18 2 10 8 Italy 70 6 39 31 Japan 34 3 23 11 Korea Rep 5 6 4 1 Kuwait 1 0 1 0 Latvia 0 1 0 0 Lithuania 5 1 2 3 The Netherlands 17 5 4 13 New Caledonia 2 0 1 1 New Zealand 6 0 1 5 Norway 26 9 13 13 Poland 16 3 9 7 Russia 7 1 4 3 Singapore 6 2 3 3 Slovak rep 2 1 2 0 Slovenia 3 0 1 2 Spain 16 4 4 12 Sweden 47 10 29 18 Switzerland 3 3 2 1 United Kingdom 76 4 44 32 United States 208 7 127 81 Uruguay 3 0 2 1

Total 838 17 482 356

Middle-Upper income economies

Argentina 4 1 0 4 Botswana 1 0 1 0 Brazil 14 1 9 5 Bulgaria 1 0 1 0 China 33 3 26 7 Colombia 2 0 2 0 Hungary 2 1 2 0 Iran 9 1 9 0 Jamaica 2 0 2 0 Jordan 0 1 0 0 Lebanon 2 0 2 0

Low -middle income economies

Egypt 10 0 6 4 Indonesia 0 2 0 0 India 25 1 15 10 Kosovo 3 0 3 0 Micronesia 0 1 0 0 Nigeria 2 0 2 0 Pakistan 1 0 0 1 Phillipines 0 2 0 0 Senegal 1 0 0 1 Swaziland 2 1 1 1 Vietnam 1 1 1 0 Total 49 3 31 18

Low income economies

Bangladesh 2 0 1 1

Korea, Dem 0 1 0 0

Zimbabwe 6 1 2 4

Total 9 0 3 6

Final total 1030 20 604 426

Occupations with asbestos exposure by income

level groups

Following the ISCO occupational groups

classification and the World Bank income level

classification, the major occupational groups that

have asbestos exposure were identified at the

country level (Tables 5 - 8).

Although there were asbestos studies in upper-

middle, lower-middle, and low income countries,

overall the evidence in these income groups is

scarce in comparison to the high-income group.

The high-income group has a total of 75 countries,

and 35 of these countries had studies reporting

asbestos exposures in at least one major

occupational group. On the contrary, in the upper-

middle income group there are 55 countries, and

only 15 had studies, in lower-middle income there

are 48 countries, and only 5 had studies, and in the

low income group there are 34 countries and only

2 had studies. For the major occupational groups

of 0-Armed Forces, 1-Managers, 2-Professionals,

3-Technicians, 5-Service and Sales Workers, and

6- Skilled agricultural, forestry and fishery

workers, asbestos exposures were identified only

in high-income and upper-middle income

countries, and no studies were found for these

occupations in low-middle and low-income

countries. Additionally to the major occupational

groups, the ISCO classification has more specific

occupations (i.e., designated unit groups) within

each major group. Table 6 shows the unit groups

within each major occupational groups in which

Libya 1 0 1 0 Malaysia 4 1 3 1

Country Articles by

country Multiple country article Included in the IJEMA

Articles included Articles not

included Middle-Upper income economies

Mexico 3 0 1 2 Romania 2 1 0 2 South Africa 38 1 22 16 Thailand 5 0 2 3 Turkey 8 0 5 3 Total 134 0 88 46

asbestos exposures were commonly identified in

the development of IJEMA (Table 4).

Table 4. Common unit group occupations identified to be exposed to asbestos Major group ISCO Unit group

1.Managers 1323 Managers of construction

1324 Supply, distribution and related

managers

2. Professionals

2142 Civil engineering

2144 Mechanical engineering 2145 Chemical engineering

2146 Mining engineering, metallurgists

and related professionals

3-Technicians

3131 Power production plant operators

3139 Process control technicians

3151 Ships' engineers

4.Clerical support workers 4110 General office clerks 4321 Stock clerks

5. Service and Sales Workers 5411 Fire-fighters

6. Skilled Agricultural, Forestry, and Fishery Workers

6222 Inland and coastal waters fishery workers

7. Craft workers

7124 Insulation workers

7126 Plumbers and pipe fitters 7212 Welders and flamecutters

7213 Sheet-metal workers

7231 Motor vehicle mechanics and repairers

7411 Building and related electricians

8.Stationary Plant Operarors

8111 Miners and quarries

8112 Mineral and stone processing plant operators

8114 Cement, stone and other mineral products machine operators

8182 Steam engine and boiler

9.Elementary occupations

9311 Mining and quarrying laborers

9321 Hand packers 9329 Manufacturing labourers not

elsewhere classified

Table 5 shows the occupations identified for eahc

country for 0- Armed Forces, 1- Managers, and 2-

Professionals. The table also includes the unit

groups within each major occupational group

were asbestos exposure was identified. In these

three major occupational groups, no asbestos

exposures were identified in lower-middle and

low-income countries.

Table 5. Occupations identified in major groups: 0,1,2

0-Armed forces

1-Managers 2-Professionals

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High income countries

Australia * * * * Canada * * * * Denmark * * Finland * * * Germany * * * Greece * * Iceland * * Ireland * Italy * * * * Japan * * * * Korea Rep * * * * Lithuania * The Netherlands

*

Norway * * Spain * * Sweden * * * * * * United Kingdom

* *

United States

* * *

Uruguay * Upper-middle income countries

Hungary * * * Iran * South Africa

* * * *

Table 6 displays which countries had asbestos

exposures for the major occupational groups of 3-

Technicians, 4-Clerical support workers, and 5-

Service and sales workers. Egypt was the only

country with a lower-middle income economy in

which asbestos exposures were identified among

these major occupational groups, and no asbestos

exposures were identified in low-income

countries.


3- Technicians 4- Clerical support workers 5- Service and sales workers

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5)

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rs (

51

)

Sa

les

wo

rke

rs (

52

)

Pe

rso

na

l ca

re w

ork

ers

(5

3)

Pro

tect

ive

se

rvic

es

wo

rke

rs (

54

)


Australia * * * * * *

Belgium * Canada * * * *

Croatia * *

Denmark * * Finland * * * * France * * * Germany * * * * * * Greece * Hong Kong * * Iceland * Israel * * Italy * * * * * * * Japan * * * Korea Rep * Lithuania * The Netherlands

*

Norway * * * * Poland * Singapore * Spain * * * Sweden * * * * * * United Kingdom

* * * * * *

United States * * * * * *

Upper-middle income countries

China * * Colombia * Hungary * * * * Iran * South Africa * * * * Thailand * Turkey *

Lower-middle income countries Egypt *


exposures for the major occupational groups of 6-

Skilled agricultural, forestry and fishery workers,

7-Craft and related trades workers, and 8-Plant

and machine operators, and assemblers. Countries

from all four income groups were identified with

asbestos exposures among these occupational

groups, including five countries from the lower-

middle income group and two countries from the

low-income group.


6- Skilled agricultural, forestry and fishery workers

7- Craft and related trades workers 8- Plant and machine

operators, and assemblers

Co

un

try

/O

ccu

pa

tio

na

l g

rou

p

Sk

ille

d a

gri

cult

ura

l,

fore

stry

an

d f

ish

ery

w

ork

ers

(6

)

Ma

rke

t-o

rie

nte

d s

kil

led

a

gri

cult

ura

l w

ork

ers

(6

1)

Ma

rke

t-o

rie

nte

d s

kil

led

fo

rest

ry, f

ish

ery

an

d

hu

nti

ng

wo

rke

rs (

62

)

Su

bsi

ste

nce

fa

rme

rs,

fish

ers

, hu

nte

rs a

nd

g

ath

ere

rs (

63

)

Cra

ft a

nd

re

late

d t

rad

es

wo

rke

rs (

7)

Bu

ild

ing

an

d r

ela

ted

tr

ad

es

wo

rke

rs, e

*clu

din

g

ele

ctri

cia

ns

(71

)

Me

tal,

ma

chin

ery

an

d

rela

ted

tra

de

s w

ork

ers

(7

2)

Ha

nd

icra

ft a

nd

pri

nti

ng

w

ork

ers

(7

3)

Ele

ctri

cal

an

d e

lect

ron

ic

tra

de

s w

ork

ers

(7

4)

Fo

od

pro

cess

ing

, wo

od

w

ork

ing

, ga

rme

nt

an

d

oth

er

cra

ft a

nd

re

late

d

tra

de

s w

ork

ers

(7

5)

Pla

nt

an

d m

ach

ine

o

pe

rato

rs, a

nd

ass

em

ble

rs

(8)

Sta

tio

na

ry p

lan

t a

nd

m

ach

ine

op

era

tors

(8

1)

Ass

em

ble

rs (

82

)

Dri

ve

rs a

nd

mo

bil

e p

lan

t o

pe

rato

rs (

83

)


Australia * * * * * * * * Austria * Belgium * * * Canada * * * * * * * Croatia * * * * * Denmark * * * * * * * Estonia * * * * Finland * * * * * * * France * * * * * * * Germany * * * * * * * * * * * Greece * * * * * * Hong Kong * * * * * * Iceland * * Ireland * * * * Israel * * * Italy * * * * * * * * * * Japan * * * * * * * * Korea Rep * * * * * * Lithuania * * * * * The Netherlands

* * * * * *

New Caledonia

*

New Zealand

*

Norway * * * * * * * Poland * * * Russia *

Singapore * * * * *

Slovak rep * Slovenia *

Spain * * * * * * * * * *

Sweden * * * * * * * * * * * * Switzerland

* *

6- Skilled agricultural, forestry and fishery workers

7- Craft and related trades workers 8- Plant and machine

operators, and assemblers C

ou

ntr

y/

Occ

up

ati

on

al

gro

up

Sk

ille

d a

gri

cult

ura

l,

fore

stry

an

d f

ish

ery

w

ork

ers

(6

)

Ma

rke

t-o

rie

nte

d s

kil

led

a

gri

cult

ura

l w

ork

ers

(6

1)

Ma

rke

t-o

rie

nte

d s

kil

led

fo

rest

ry, f

ish

ery

an

d

hu

nti

ng

wo

rke

rs (

62

)

Su

bsi

ste

nce

fa

rme

rs,

fish

ers

, hu

nte

rs a

nd

g

ath

ere

rs (

63

)

Cra

ft a

nd

re

late

d t

rad

es

wo

rke

rs (

7)

Bu

ild

ing

an

d r

ela

ted

tr

ad

es

wo

rke

rs, e

*clu

din

g

ele

ctri

cia

ns

(71

)

Me

tal,

ma

chin

ery

an

d

rela

ted

tra

de

s w

ork

ers

(7

2)

Ha

nd

icra

ft a

nd

pri

nti

ng

w

ork

ers

(7

3)

Ele

ctri

cal

an

d e

lect

ron

ic

tra

de

s w

ork

ers

(7

4)

Fo

od

pro

cess

ing

, wo

od

w

ork

ing

, ga

rme

nt

an

d

oth

er

cra

ft a

nd

re

late

d

tra

de

s w

ork

ers

(7

5)

Pla

nt

an

d m

ach

ine

o

pe

rato

rs, a

nd

ass

em

ble

rs

(8)

Sta

tio

na

ry p

lan

t a

nd

m

ach

ine

op

era

tors

(8

1)

Ass

em

ble

rs (

82

)

Dri

ve

rs a

nd

mo

bil

e p

lan

t o

pe

rato

rs (

83

)

United Kingdom

* * * * * * *

United States

* * * * * * *

Uruguay * * * * * * * * *

Upper-middle income countries

Botswana * Brazil * Bulgaria * China * * * * * Colombia * Hungary * * * * * * * * Iran * * * * * * * Jamaica * * Lebanon * * * * Libya * Malaysia * * Mexico * South Africa

* * * * * * * * *

Thailand * * * Turkey * * * *

Lower-middle income countries Egypt * * India * * Kosovo * Nigeria * Vietnam *

Low income countries

Bangladesh * Zimbabwe *


exposures for the major occupational group 9-

Elementary occupations. Countries from all four

income groups were identified with asbestos

exposures among these occupational groups,

including five countries from the lower-middle

income group and one country from the low-

income groups.

Table 8. Occupations identified in major group: 9

9- Elementary occupations

Co

un

try

/O

ccu

pa

tio

na

l g

rou

p

Ele

me

nta

ry o

ccu

pa

tio

ns

(9)

Cle

an

ers

an

d h

elp

ers

(9

1)

Ag

ricu

ltu

ral,

fo

rest

ry a

nd

fi

she

ry l

ab

ore

rs (

92

)

La

bo

rers

in

min

ing

, co

nst

ruct

ion

, ma

nu

fact

uri

ng

a

nd

tra

nsp

ort

(9

3)

Re

fuse

wo

rke

rs a

nd

oth

er

ele

me

nta

ry w

ork

ers

(9

6)

High income countries Australia * * * Austria * Belgium * Canada * * * Croatia * Denmark * * * Estonia * Finland * * * France * * * Germany * * * * Greece * Hong Kong * Iceland * * Ireland * Israel * Italy * * * * * Japan * * * Korea Rep * * * Kuwait * Lithuania * The Netherlands

* * *

Norway * * Poland * Russia * Singapore * Slovak rep * Slovenia * Spain * * Sweden * * Switzerland * United Kingdom

* * * *

United States * * * * Uruguay *

Upper-middle income countries Brazil * Bulgaria *

9- Elementary occupations

Co

un

try

/O

ccu

pa

tio

na

l g

rou

p

Ele

me

nta

ry o

ccu

pa

tio

ns

(9)

Cle

an

ers

an

d h

elp

ers

(9

1)

Ag

ricu

ltu

ral,

fo

rest

ry a

nd

fi

she

ry l

ab

ore

rs (

92

)

La

bo

rers

in

min

ing

, co

nst

ruct

ion

, ma

nu

fact

uri

ng

a

nd

tra

nsp

ort

(9

3)

Re

fuse

wo

rke

rs a

nd

oth

er

ele

me

nta

ry w

ork

ers

(9

6)

China * * Hungary * Iran * * Libya * Malaysia * Mexico * South Africa * * * Thailand * Turkey * *

Lower-middle income countries Egypt * * Indonesia India * Nigeria * Vietnam *

Low income countries Zimbabwe *

Asbestos consumption and production by

income level group

Since there were major differences in terms of the

scientific information available based on income

group, asbestos consumption and production was

also determined by income level, identifying

countries that either produce or consume asbestos

that do not have studies to establish occupational

exposures.

Figure 4 shows that during the 2009-2012 period,

the majority of the countries that consume

asbestos belong to the upper-middle and lower-

middle income groups. Only two countries

classified in the high-income group (Russia and

Uzbekistan) are among the countries with the

highest asbestos consumption. In upper-middle

group China had the largest consumption of

asbestos followed by Brazil. In the case of lower-

middle income group India figured as one of the

highest asbestos consumers. (U.S Department of

Interior, 2013). Among the top 20 asbestos

consuming countries, Uzbekistan, Sri Lanka,

Ukraine, Belarus, Cuba, Pakistan, Kyrgyzstan,

Turkmenistan, Bolivia, Kazakhstan and Ecuador

had no studies to determine occupational

exposures to the material.

Figure. 4 The first 20 countries leaders in asbestos

consumption during 2009-2012

As Figure 5 shows, during the 2009-2013 period

the majority of the countries that produce

asbestos belong to the high income and upper-

middle income economies. Only two countries that

are classified in the high-income group (Russia

and Canada) are listed in the group of countries

with the highest asbestos production. In the

upper-middle group, the pattern of production are

similar to the ones observed for consumption.

China leads the world production in this group

followed by Brazil, Kazakhstan and Argentina. In

the case of lower-middle income group and low

income groups, the patterns of production are also

similar to the patterns of consumption. (U.S

Department of Interior, 2013). Among the top 7

asbestos producing countries, Argentina and

Kazakhstan had no scientific studies to determine

occupational exposures to the material.

Figure. 5 The first 7countries leaders in asbestos

production during 2009-2013

DISCUSSION

We want to highlight what we consider are some of the most important contributions of this work:

The IJEMA synthesizes, based on the peer reviewed literature, what we know regarding occupational exposures to asbestos at the global level

The IJEMA also identifies knowledge gaps

regarding occupational asbestos

exposures, determining what seems to be

a reduced amount or lack of scientific

evidence in countries that currently

consume and produce asbestos.

The IJEMA could also be a useful tool for

those countries that have weak

institutions and research communities to

conduct proper surveillance regarding

asbestos use and consumption, to

prioritize their efforts in understanding

the asbestos problem within their

borders.

Results of this study clearly indicate that there are a large number of countries that belong mostly to low, low-middle, and upper-middle income

0

500

00

01

00

00

00

150

00

00

2009 2010 2011 2012

High income Upper-middle income

Lower-middle income Low income

Year

Metr

ic T

ons

0

500

00

01

00

00

00

150

00

00

2009 2010 2011 2012 2013

High income Upper-middle income

Lower-middle income Low incomeM

etr

ic T

ons

Year

economies that have insufficient scientific studies analyzing the potential risks resulting from asbestos production and consumption. Thus, it is possible that the absence of asbestos exposures in IJEMA in certain occupations and countries is the result of the lack of scientific studies, when in reality workers are in fact exposed to asbestos in these occupations and countries. Furthermore, most of the scientific evidence used to construct the matrix comes from high-income countries, and this could bias the results. For this reason, although the process followed in the construction of this International Job Exposure Matrix for Asbestos has been rigorous, as authors we recognize that this is an initial effort. We invite other scientists to complement and improve this work as more peer-reviewed information is identified or developed. We also acknowledge that by including articles only written in English could have missed scientific information valuable in the construction of IJEMA. Nevertheless, the inclusion of articles could have resulted in bias (i.e., as authors we could have included articles written in Spanish and Japanese, but no other languages), and it could also become a barrier in the peer review process of this initial effort. Again, as authors we invite other researchers to complement the information displayed in this initial effort, maintaining the rigorous process we have followed. For example, in countries that belong to the high- income group, the most common occupations that have asbestos exposures belong to the major occupational group 7th - craft and related trade workers. In fact, a total of 16 unit occupations in 28 high income countries were identified in major occupational group 7th. However, in countries that belong to upper-middle, low-middle, and low income economies, the scientific information available for occupations belonging to major occupational group 7th was scarce. As authors we know that construction products that contain asbestos are produced and widely distributed in Colombia (High-middle income economy), but we could not identify one single article analyzing asbestos exposure and use in the occupational

group ISCO 71 - building and related trades workers. Moreover, in countries that have low-income economies, only two unit occupations were identified as having asbestos exposure among the major occupational group 7th,: ISCO 7113 - stonemasons, stone cutters, splitters and carvers, and ISCO 7219 - blacksmiths, hammer smiths and forging press worker. No countries belonging to the low-income group had studies identifying asbestos exposure in the major occupational group 7th. Therefore, it is expected that in this countries the most common occupations exposed to asbestos (identified in Table 4) as: Insulation workers- ISCO 7124 and plumbers and pipe fitters- ISCO 7126, Welders and flamecutters-ISCO7212, Sheet-metal workers-ISCO 7213 and Building and related electricians-ISCO 7411, had been currently exposed to asbestos and the scientific community have not identified jet. What was previously described for the major occupational group 7th occurs in all the other major occupational groups. In the high-income group asbestos exposure were identified in at least one unit occupation of all the major occupational groups. However, in the upper-middle, lower-middle and low income groups, the few countries that have scientific information showed that most of the asbestos exposure occur in the industrial sector (occupational major groups 8 th and 9th ).

In the United States for example, the US Occupational Safety and Health Administration (US OSHA) estimates that 1.3 million workers can be experiencing significant asbestos exposure at the workplace (OSHA, 2008).In Europe, it is estimated that 1.2 million workers are expose to asbestos in 41 industries. Most of these workers (aprox. 96%) are employed in the following 15 industries (International Agency of Reseach on Cancer (IARC), 2012):

Table 9. Number of workers exposed by industry

Industries Number of workers exposed to asbestos

Construction 574000

Personal and household services

99000

Other mining 85000 Agriculture 81000 Wholesale and retail trade and restaurants and hotels

70000

Food manufacturing 45000 Land transport 39000 Manufacture of industrial chemicals

33000

Fishing 25000 Electricity, gas and steam’

23000

Water transport 21000 Manufacture of other chemical products

19000

Manufacture of transport equipment

17000

Sanitary and similar services

16000

Manufacture of machinery, except electrical

12000

The type and quality of information available regarding asbestos occupational exposures for the US and Europe, described above, should be also available for all countries and regions of the world.

Patterns of consumption and production

In several cases, countries with the largest asbestos consumption and production of asbestos are also the countries that lack scientific information to identify asbestos occupational exposures. From the upper-middle income group, China and Brazil lead the group of asbestos consumers in 2012 with 531000 and 168000 metric tons, respectively. In the same year and among lower-middle income economies, India lead asbestos consumption with 473000 metric tons, followed by Indonesia with 162000 metric (U.S Department of Interior, 2013). From this income group, Uzbekistan, Sri Lanka, Ukraine, Belarus, Cuba, Pakistan, Kyrgyzstan, Turkmenistan, Bolivia, Kazakhstan, and Ecuador, which are countries with asbestos consumption,

have no scientific studies to determine occupational exposures to the material. Analyzing the situation in asbestos producing countries, in the upper-middle income economies China, Brazil and Kazakhstan lead asbestos production in 2013 with 420,000, 307,000, and 242,000 metric tons, respectively. In the lower-middle income group, India had the highest production in 2013 240 metric tons (U.S Department of Interior, 2013). From this group, Kazakhstan is a major asbestos producer with no scientific studies to determine occupational exposures to the material. These two patterns were commonly observed in the development of this study: Countries with high asbestos consumption or production lacking scientific information regarding asbestos occupational exposures.

Asbestos in Latin American countries

The leaders of the banning process of asbestos in Latin American countries are Chile and Argentina. Although asbestos consuming countries from the region like Brazil, Colombia and Mexico have scientific information, this information seems insufficient to fully understand the occupational risks derived from asbestos use. Cuba, Bolivia, and Ecuador are cases of great concern, because asbestos consumption and productions is still legal in these countries (i.e., the three were reported as consumers between 2009-2012 (U.S Department of Interior, 2013)), and there are no scientific studies assessing the risk resulting from asbestos. There is an urgent need to improve the quality health and environmental data associated with asbestos (Pasetto, 2014) CONCLUSIONS Many countries that belong to the upper-middle,

lower-middle and low income groups lack

scientific information for the identification of

occupational exposures to asbestos. Countries that

are the leaders in consumption and production of

asbestos in recent years lack sufficient scientific

information to assess occupational asbestos

exposures.

The lack of scientific information regarding asbestos occupational exposures, combined with the absence of strict regulations for the use of asbestos, becomes a major barrier for the identification of occupations and workers at risk, and for the design and implementation of adequate control strategies. The international scientific community should work on the development of scientific evidence to properly understand the occupational risks resulting form the use of asbestos worldwide. This is especially important for those countries with weak health and environmental institutions, and weak scientific communities. Tools like IJEMA can aid the identification of countries and occupations that are at risk because of asbestos exposure, and can also aid the identification of countries and occupations that require more scientific studies. IJEMA can also aid the decisions making process to address the asbestos problem at the country level.

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