Evolving Risk in Occupational Lung Disease
World Asthma Day (1 May) is an annual event organised by the Global Initiative for Asthma to improve asthma awareness and care around the world.
The risks to the lungs from inhaling foreign substances while at work have been known since the Romans recognised baker’s asthma. Today the range of recognised occupational lung disease is far more extensive and growing. Some problems, such as asthma, develop soon after exposure. Other conditions only develop years later - for example, mesothelioma from exposure to asbestos - and can be life threatening and shortening.
The UK’s Health and Safety Executive (HSE) estimates that occupational lung disease is responsible for 12,000 deaths each year and approximately 18,000 new cases that cause 400,000 lost working days.1 These numbers have remained roughly stable over the past 10 years.
More recently, the blog on Keeping Workers Safe From Cancer raised important questions on the impact and effectiveness of proposed EU regulations in this regard. For the UK, preparing to exit from the EU leaves regulations like these hanging in the balance. Despite the uncertainty of Brexit, the HSE Workplace Healthy Lungs Summit 2017 helped keep the issue on the radar.2
The Summit celebrated the success in reducing respiratory risk achieved in large organisations where hazards - such as flour dust, welding fumes and crystalline silica exposure - are all being increasingly controlled by new and effective technological solutions.
Despite these gains, two major concerns remain. The first concern regards small and medium-sized companies where awareness and understanding of the risks, and potential fixes, is not so well developed. Businesses like these are particularly difficult to engage as hazard exposure may be intermittent rather than fundamental to particular job roles.
Secondly, rapid technological developments bring with them exposure to new substances: for example, powdered metal for additive manufacturing or in 3D printing.3,4 Their effects are not well characterised and have the potential to be harmful. Less familiar risks are presented by working with new materials, such as the carbon nanotubes used in aerospace, electronics, biotechnology and biomedicine.5,6 Nanotubes are made up of tough fibres similar in size, shape and inert nature to asbestos, which may be a risk when inhaled and are known to cause cancer in rodents.
The response to new occupational risks like these can depend on how importantly they are regarded by workers themselves, or even how visible any contaminants are when in the air. The interventions required to address these perceptions is a focus of research and debate. Behavioural initiatives are important but so is the legislative framework to ensure the enforcement of safe exposure levels. Ensuring control by law is as important as ensuring that health and safety inspectors do not have a mindset that normalises a degree of risk.7
The health problems associated with diesel emissions are well known, but the exposure of workers most at risk (e.g., drivers or warehouse operatives) is rarely adequately monitored.8 It’s in conventional industries - such as stone working, construction, baking, steel work and welding, roadworks and quarrying - that occupational lung diseases have traditionally been concentrated, and it’s also where most risk reduction effort has been made.
Achieving some progress means that short and long-term health risks have been reduced, and this is positive for insurers seeking to provide cover for those actively at work. To fully understand the occupational risk to which some applicants are exposed, insurers will need to be aware of new work sectors and job roles that have emerging exposure to health harms. The potential for claims many years after exposure is a reality wherever in the world these technologies develop.
- Op. cit. see note 4.