asbestos thailand conference 2014 nov singapore j takala & lynnette goh

65
© 2010 Government of Singapore A Great Workforce A Great Workplace 1 Asbestos – Trends and Action Globally and in Singapore Dr Jukka Takala, Ms.Lynnette Goh Workplace Safety and Health Institute, Ministry of Manpower 17 November 2014

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Presentation in the "Expedite Asia Free from Asbestos Hazard" Conference in Bangkok" on 24-25 Nov 2014

TRANSCRIPT

Page 1: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1

Asbestos ndash Trends and Action Globallyand in Singapore

Dr Jukka Takala MsLynnette Goh

Workplace Safety and Health Institute Ministry of Manpower

17 November 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

2Source ILO and WSH Institutewwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

3

Past World Estimates asbestos deaths

112000 every year (ILO estimate)

107000 every year (WHO estimate)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

4

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

Asbestos consumption in Asia and in the World

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

6

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

7

Work-related Annual Deaths ndash EU-27

Sources WSH Institute Singapore 2014 Haumlmaumllaumlinen P Takala J Saarela KL TUT ILO WHO

EU-OSHA WSH Institute Singapore JOEH May 2014 ref data MOHMOM and WHO WPRO A

region

Work-related Annual Deaths ndashSingapore and EU distribution of fatal injuries and illnesses EU in brackets

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

8

Work-related Annual Deaths ndash World

Sources Haumlmaumllaumlinen P Takala J

Saarela KL TUT ILO EU-OSHA

Asbestos 25-50 of all work-

related cancers

New 102 500

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

9Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

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A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

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A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

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A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

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A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 2: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

2Source ILO and WSH Institutewwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

3

Past World Estimates asbestos deaths

112000 every year (ILO estimate)

107000 every year (WHO estimate)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

4

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

Asbestos consumption in Asia and in the World

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

6

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

7

Work-related Annual Deaths ndash EU-27

Sources WSH Institute Singapore 2014 Haumlmaumllaumlinen P Takala J Saarela KL TUT ILO WHO

EU-OSHA WSH Institute Singapore JOEH May 2014 ref data MOHMOM and WHO WPRO A

region

Work-related Annual Deaths ndashSingapore and EU distribution of fatal injuries and illnesses EU in brackets

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

8

Work-related Annual Deaths ndash World

Sources Haumlmaumllaumlinen P Takala J

Saarela KL TUT ILO EU-OSHA

Asbestos 25-50 of all work-

related cancers

New 102 500

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

9Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

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A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

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A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

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A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

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A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

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A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

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A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

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43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

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A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

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A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

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A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

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A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

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A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 3: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

3

Past World Estimates asbestos deaths

112000 every year (ILO estimate)

107000 every year (WHO estimate)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

4

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

Asbestos consumption in Asia and in the World

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

6

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

7

Work-related Annual Deaths ndash EU-27

Sources WSH Institute Singapore 2014 Haumlmaumllaumlinen P Takala J Saarela KL TUT ILO WHO

EU-OSHA WSH Institute Singapore JOEH May 2014 ref data MOHMOM and WHO WPRO A

region

Work-related Annual Deaths ndashSingapore and EU distribution of fatal injuries and illnesses EU in brackets

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

8

Work-related Annual Deaths ndash World

Sources Haumlmaumllaumlinen P Takala J

Saarela KL TUT ILO EU-OSHA

Asbestos 25-50 of all work-

related cancers

New 102 500

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

9Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

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A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

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A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

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A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

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A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

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A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

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A Great Workforce A Great Workplace

35

Conclusion

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36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

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A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

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A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

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A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

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40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

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43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

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A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

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A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

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A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

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A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

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A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

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A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

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A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

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A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

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62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 4: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

4

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

Asbestos consumption in Asia and in the World

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

6

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

7

Work-related Annual Deaths ndash EU-27

Sources WSH Institute Singapore 2014 Haumlmaumllaumlinen P Takala J Saarela KL TUT ILO WHO

EU-OSHA WSH Institute Singapore JOEH May 2014 ref data MOHMOM and WHO WPRO A

region

Work-related Annual Deaths ndashSingapore and EU distribution of fatal injuries and illnesses EU in brackets

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

8

Work-related Annual Deaths ndash World

Sources Haumlmaumllaumlinen P Takala J

Saarela KL TUT ILO EU-OSHA

Asbestos 25-50 of all work-

related cancers

New 102 500

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

9Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

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A Great Workforce A Great Workplace

222-Dec-14

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A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

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A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

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A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

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A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

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A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

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A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 5: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

Asbestos consumption in Asia and in the World

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

6

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

7

Work-related Annual Deaths ndash EU-27

Sources WSH Institute Singapore 2014 Haumlmaumllaumlinen P Takala J Saarela KL TUT ILO WHO

EU-OSHA WSH Institute Singapore JOEH May 2014 ref data MOHMOM and WHO WPRO A

region

Work-related Annual Deaths ndashSingapore and EU distribution of fatal injuries and illnesses EU in brackets

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

8

Work-related Annual Deaths ndash World

Sources Haumlmaumllaumlinen P Takala J

Saarela KL TUT ILO EU-OSHA

Asbestos 25-50 of all work-

related cancers

New 102 500

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

9Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

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A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 6: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

6

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

7

Work-related Annual Deaths ndash EU-27

Sources WSH Institute Singapore 2014 Haumlmaumllaumlinen P Takala J Saarela KL TUT ILO WHO

EU-OSHA WSH Institute Singapore JOEH May 2014 ref data MOHMOM and WHO WPRO A

region

Work-related Annual Deaths ndashSingapore and EU distribution of fatal injuries and illnesses EU in brackets

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

8

Work-related Annual Deaths ndash World

Sources Haumlmaumllaumlinen P Takala J

Saarela KL TUT ILO EU-OSHA

Asbestos 25-50 of all work-

related cancers

New 102 500

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

9Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

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A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

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A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

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A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

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A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 7: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

7

Work-related Annual Deaths ndash EU-27

Sources WSH Institute Singapore 2014 Haumlmaumllaumlinen P Takala J Saarela KL TUT ILO WHO

EU-OSHA WSH Institute Singapore JOEH May 2014 ref data MOHMOM and WHO WPRO A

region

Work-related Annual Deaths ndashSingapore and EU distribution of fatal injuries and illnesses EU in brackets

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

8

Work-related Annual Deaths ndash World

Sources Haumlmaumllaumlinen P Takala J

Saarela KL TUT ILO EU-OSHA

Asbestos 25-50 of all work-

related cancers

New 102 500

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

9Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 8: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

8

Work-related Annual Deaths ndash World

Sources Haumlmaumllaumlinen P Takala J

Saarela KL TUT ILO EU-OSHA

Asbestos 25-50 of all work-

related cancers

New 102 500

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

9Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 9: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

9Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

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A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 10: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1010

Consumption of Asbestos and Mesothelioma Deaths in the UK 2003

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 11: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

1111

Today

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 12: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

12

Year

Source R Virta United States Geological Survey US Department of Interior Exports bigger than imports in 1985 etc

Singaporetotal estimated consumption 1960 -2012 was 136209 metric tons

Finland total estimated consumption 1960 -2012 was 311904 metric tons

Finland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 13: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

13

Year

Data Source United States Geological Survey US Department of Interior

Exports bigger than imports

IntJOEH20041022-25 amp BJC(2012)106575-584

bullTotal consumption in Taiwan 480000 Singapore 136000 and Malaysia 750000 metric tons in

Every 170 tons causes 1 mesothelioma case and 2-10 lung cancers

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

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A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 14: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

14

Year

Source United States Geological Survey US Department of Interior

Sin

gap

ore

Nu

mb

er

of

De

ath

s

50

100

Sin

gap

ore

ind

ex 2

x 1

04

Exports bigger than imports in 1985

UK 2005

Singapore expected

Singapore scale

Today UKMesothelioma deaths

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 15: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

15

ProblemSources Eun-Kee Park Ken Takahashi (UOEH) Jukka Takala ILO

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 16: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

16

Thailand deaths estimate

UKExposure

UKDeaths

Thailandexposuremoving average

UK 2005

Mesothelioma deaths= 200000 tons usedyear

1500

Today UK

SingaporeFinland

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 17: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

17

Selected data from various

sources refs included

2-Dec-14 Visiting Expert Week ndash Tim Driscoll17Source httpwwwmesotheliomasymptomscommesothelioma-symptoms

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 18: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

18

Asbestos mortality estimates based on consumed asbestos FINLAND

Estimates made in 2001 based on 1996 data (Nurminen )

1 59 mesothelioma deaths 42 at work 208 asbestos related lung cancer deaths estimated RR = 23 AF= 14 (males) for asbestos and synergistic smoking related to average asbestos consumption 10 041 tonsyear 1950-70

2 170 tons of asbestos use causes 1 mesothelioma death data calculated also for global estimates (Tossavainen)

3 48 tons of asbestos consumption caused 1 asbestos related lung cancer totalling 250

deaths 312 - 335 deaths at peak level in the year around 2020 of which an expected

62 in reality 85 mesothelioma deaths see point 7 below4 Other cancers known to have been caused by asbestos stomach colon larynx ovary

rectum and asbestosis deaths need to be added 5 Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths6 Year 2013 average 85 mesothelioma cases recorded annually in Finland

Sources Nurminen Karjalainen Scand J Work Environ Health Vol 27 no3 Tossavainen A IntJOEH 2004 1022-25

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

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A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

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A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 19: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

19

Asbestos mortality estimates based on consumed asbestos UNITED KINGDOM

Estimates made in 2005 (Rushton )

1 8 010 occupational cancer deaths in 2005 1 937 mesothelioma deaths at work 2 223 asbestos related lung cancer deaths total 4160 deaths estimated related to annual average asbestos consumption 140 173 tons in 1950-70 resulting to 337 tons of asbestos causing 1 death either by mesothelioma or lung cancer

2 Year 2013 2 535 recorded mesothelioma deaths with corresponding rate estimated to have 2 909 lung cancer deaths totalling 5 444 deaths (HSE)

3 Maximum recorded consumption in 1960 163 019 tons of asbestos this consumption would produce an expected 4 837 maximum estimate of expected deaths the reality is close to above 5 444 deathsyear between 2015-2020

Sources BJC Rushton BJC(2012)106575-584 andHSE

httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 20: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

202-Dec-14 Visiting Expert Week

ndash Tim Driscoll20

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 21: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

21

Work-related Asbestos Mortality estimates based on consumed asbestos WORLD (1 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on RR = 23 and AF = 14 (males) 06 (females) 10 041 tons of asbestos exposure cause 208 asbestos related lung cancer ARLC (Nurminen) or every used 48 tons cause one lung cancer and every 170 tons cause one mesothelioma every 355 tons cause 1 death (Tossavainen)

2 World consumption was 35 million tons in 1970 and peak consumption was 47 million tons in 1980

3 Corresponding ARLC in around 2015-20 will be 73 200 deaths and peak mortality in 2025-30 97 800 deaths Mesothelioma deaths peak 27 600 (under reporting expected here) in 2025-2030

4 Asbestos caused other cancer deaths ( colonstomach larynx ovary) come to approx 18 of mesothelioma and lung cancers (1760) and asbestosis deaths to 38 of these cancers (4765) adding all together at peak period

132 000 deathsSources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003 httppubsusgsgovcirc20061298c1298pdf6 Straif K The Burden of occupational cancer editorial DOI 101136oem2007038224 httpoembmjcom

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 22: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

222-Dec-14

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 23: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

23

Work-related Asbestos mortality estimates based on UK consumed asbestos WORLD cont (2 of 2)

Estimates made in Nov 2014 (Takala )

1 Based on UK Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which 1 937 mesothelioma deaths and 2 223 ALRC deaths In 2013 the number of mesothelioma cases

was 2 535 and corresponding estimated ARLC deaths 2 909 totalling 5 444 deaths2 UK Peak consumption was 163 019 tons of asbestos in 1960 Average annual consumption in

1950-70 was 140 173 tons3 The average consumption between 1950-70 would be equal to 1 death for every 337 tons

covering both ARLC and mesothelioma For peak consumption and present 2013 deaths 1 death would be caused by 299 tons Global peak consumption 47 million tons in 1980 outcome in 2025-2030

4 Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average consumption 1950-70 and 157 000 based on latest 2013 death numbers and peak consumption in the UK Other asbestos caused cancers and asbestosis deaths need to be added

Sources 1Rushton L BJC(2012) 10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 24: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

24

Work-related Asbestos Mortality estimates based THAILAND

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Thai consumption of asbestos in 1970 which was 21 272 metric tons Thai ARLC number would be 441 deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused

deaths 599 annually in 2015- 20

2 Average annual consumption around 2006 was 135 000 tons which would produce

3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050

3 Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a figure of 5 400 (5 357) in around the year 2040-50 (less reliable)

Sources 1Rushton L BJC(2012)10753-5 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 25: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

25

Work-related Asbestos Mortality estimates based SINGAPORE

Estimates made in Nov 2014 (Takala )

1 Based on estimate of exposure-outcome relation (RR=23) and the Singapore peak consumption of asbestos in 1975 which was 8 671 metric tons the number of total peak annual asbestos related number would be 244 deaths in 2025-30 Mesothelioma may be around 10-25 of this number depending on the type of asbestos used

2 Total consumption until 2006 was 136 209 tons which would produce

an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during

some 50 years3 Peak of deaths is expected at 2025-30

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 26: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

26

Why Mesothelioma Mortality is low in Asia as compared to Europe USA AustraliaNZ Japan

1 Asbestos use was started slower in Asian countries and generally later than in industrialised countries The peak for Singapore is expected to be 10 years later than in the UK at 2025-30 In Thailand the peak is expected to be 30-35 later in 2040-50 Latency time from the high country consumption is also longer than earlier thought not all importedproduced asbestos is used immediately on the year imported rather with some delays also disease latency period is very long - up to 50+ years

2 Diagnosing recording reporting and compensating mesothelioma is considerably low and lower in Asian and other developing countries than in best reporting developed countries

3 The type of asbestos used eg in the UK has earlier contained a significant amount of crocidolite and other amphibole fibers that are known to cause more mesothelioma and proportionally less ARLC (McCormack et al)

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-584

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 27: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

27

Why Asbestos-related Lung Cancer is poorly identified

1 Lung cancer is caused by many factors and smoking may cover up to 85 of all lung cancers The link of the outcome to asbestos is not often identified as asbestos-related and easily dismissed because many workers exposed to asbestos are also smokers and most lung cancer victims are exposed to asbestos and actively smoking

2 The attributable fraction or the number of ldquolung cancers eliminated by reducing just asbestosldquo is high but in particular caused by the multiplicative or super-additive synergistic effects of both asbestos exposure and smoking (see next slide)

3 Diagnosing recording reporting and compensating asbestos related lung cancer is weak everywhere due to difficulty of individualising the asbestos exposure effect This effect is seen in a population but evidence individually is challenging to proof Many jurisdiction expect asbestos being as the main cause ie the magnitude of causal effect is higher than frac12 of all linked causes (RR=2 or higher AF= 50) to record them as compensable

4 Life expectancy is relatively low in many Asian countries Lung cancer and mesothelioma appear late in life

Sources 1Rushton L BJC(2012)10753-57 2 HSE httpwwwhsegovukstatisticscausdismesotheliomamesotheliomapdf3 Nurminen M Karjalainen A Scand J Work Environ Health Vol 27 no3 4 Tossavainen A Int JOEH 2004 1022-25 5 Virta Robert United States Geol Survey Worldwide Asbestos Supply and Consumption 1900-2003

httppubsusgsgovcirc20061298c1298pdf6 McCormack Peto et al BJC(2012)106575-5847 Memorandum from the Occupational Cancer Working Group FIOHwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 28: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

28

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = up to 50-80

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 29: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

29

Asbestos and smoking - synergistic effect

Increased risk of lung cancer when exposed to

1 Asbestos alone RR = 2 - 5

2 Smoking alone RR = 8-10

3 Combined RR = 50-80Source T Driscoll

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 30: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

30

Background or ldquonon-exposedrdquo reference mortality

1 Relative risk and attributable fractions are calculated against the background mortality for ldquonon-exposedldquo population Exposure limit today for airborne asbestos vary from 01 fiberml to 001 fml (or 100 000 to 10 000 fibresm3)

2 In countryside Europe background is about 100-500 fibresm3 In cities ndash eg in Geneva in between the ILO and WHO buildings (Avenue Appia) 900 fibresm3 and inside the ILO office building 600 fibresm3

3 25 fibresml ndash years is considered as a criteria for ARLCmesothelioma recognition for workerslsquo compensation based on daily 8 hours exposure This may be easily reached in a population of 1 000 people if exposure is continuous for 24hday

900 fibresm3 3 1000 = 27 fml ndash yrs in a yaer and in 10 years 27 fml ndash yrs 1 death in a population of 1000 for every 10 years for ldquonon exposedldquo - acceptable

4 Passive smoking and in particular active smoking radically increase the risk of ARLC5 Health-based OEL should be 0001 fml or 1000 fml and for general population life-time risk

(247 exposure 80years 1 of OEL) limit should be 00000001 fml or 01 fibresm3 (Cherrie)

SourcesCherrie John httpvenusuniveitfallpresentazioniCherrie_oppdf

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 31: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

31

Slide of Sugio Furuya

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 32: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

32

Slide of Sugio Furuya modified by JT

Singapore other Asia

UK 2909 a-r lung cancers 485mill

2535 meso422 in 2013 HSE

SourceFazzo etal

Finland 42milla-r lung cancer

Finland 118millmeso

Finland 16mill

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 33: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

33

Year amp Area

Deaths

Finland

2001 (Nurminen et al)

Finland

2014 est

UK

2005 (Rushton et al)

UK

2013 est

Thailand

2015

Thailand

2050 est

World

Peak value

Asbestos related

lung cancer ARLC 208 243 2223 2909 441 6 3093 6 97800 3

Mesothelioma 42 - 59 68ndash85 5 1937 2535 125 6 507 6 27600 3

ARLC +

Mesothelioma 250 311 4160 5444 566 3600 125400 3

Other asbestos

cancers and

asbestosis added264 328 4234 4 5541 4 598 3800 132000 3

All cancer deaths

at work839 1135 1 8010 13300 1 4825 1 na 666 000 2

1 Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)2 Based on ILO Estimate 2014 (WHO data from 2011) httpswwwwsh-institutesgfileswshiuploadcmsfileGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdf

3 Around the years 2025-20304 Without asbestosis5 Estimated at 68 but recorded annual average at 2010 was 856 Rate between ARLC and Mesothelioma considered 41 in 2050 used McCormack etal ratio 2-10 1 average 611

Table 1 Asbestos-Related Disease and All Cancer Deaths at Work (selected countries)

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 34: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

34

Conclusions borrowed from Kurt Straif

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 35: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

35

Conclusion

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 36: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

36

A Great Workforce A Great Workplace

Singaporersquos Experience in Asbestos Management and Control

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 37: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

37

1950 1980 1990 2000 2014

Use of asbestos building materials banned in 1988

Licensing of all raw asbestos and ACM (excluding chrysotile) imports in 1989

Banning of asbestos brake pads and clutch linings in 1995

Inclusion of chrysotile containing ACM for licensing control in 2008

Decreasing use of ACM

Wide usage of asbestos as building materials fireproofing and heat insulators

Enactment of Factories (Asbestos) Regulations in 1980

History of Asbestos Control in Singapore

Gazette of WSH (Asbestos)

Regulations in 2014

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 38: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

38

National Asbestos Control Programme

Targeted intervention

Standard setting

Compliance assistance

Capability building

Engagement

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 39: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

39

WSH (Asbestos) Regulations 2014

Effective from 30 May 2014

To enhance protection of workers against asbestos exposure

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 40: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

40

WSH (Asbestos) Regulations 2014

1 Asbestos Survey to be carried out by a competent person to ascertain the presence of asbestos

2 Licensing of contractors carrying out asbestos removal work

3 Written plan of work to ensure asbestos removal work is carried out safely

4 Removal of ACMs before demolition of building

5 Technical requirements on asbestos work

6 Training for persons carrying out work involving asbestos

Key changes

Source httpwwwmomgovsglegislationoccupational-safety-healthPagesdefaultaspx

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 41: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

41

Are there building works carried out for building built before

1 Jan 1991

Is there any work operation or process involving a specified

material

Conduct an asbestos survey to ascertain

the presence of asbestos

Engage an approved asbestos ndashremoval

contractor

Submit asbestos work notification to

Ministry of Manpower

Conduct asbestos-removal work with measures taken to

minimise the release or spread of

asbestos during work

Engage a licensed waste disposal to dispose asbestos

waste

YES YES

Presence of asbestos

14 AARC licensed by

MOM

68 Competent

persons trained

Cable penetration insulation fire protection board panel wall and

door gasket refractory lining sprayed insulation thermal

insulation of pipe boiler pressure vessel and process vessel

2 licensed companies

by NEA

200Notifications

per year

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 42: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

42

Illegal removal of asbestos-containing materials

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 43: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

43

Illegal removal of asbestos-containing materials

Any person who contravenes the WSH(Asbestos) Regulations shall be liable on conviction to a fine not exceeding $20000 or to imprisonment for a term

not exceeding 2 years or to both

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $200000 or to imprisonment for a term

not exceeding 2 years or to both for persons

Any person guilty of an offence under the WSH Act shall be liable on conviction to a fine not exceeding $500 000 to companies

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 44: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

44

Other Relevant Regulations

1 WSH (Medical Examinations) Regulations 2014

Persons who carry out work involving asbestos to undergo pre-employment and periodic medical examinations to screen for symptoms of asbestos-related diseases

2 Work Injury Compensation Act

Asbestosis and Mesothelioma are reportable occupational diseases and workers who have contracted these diseases arising out of their work can claim compensation

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 45: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

45

Corrugated asbestos sheets

Common ACMs found in Singapore (Buildings)

Roof

Wall Cladding

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 46: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

46

Common ACMs found in Singapore (Buildings)

Asbestos cemented

wall panels

Asbestos ceiling board

Asbestos ceiling board Asbestos Vinyl Sheet

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 47: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

47

Common ACMs found in Singapore (Plants vessels)

Pipe lagging Gasket

Pipe insulation Cable Penetration

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 48: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

48

bull Notification of asbestos-removal work

bull

2011 2012 2013 2014 (till date)

194 205 251 202

Total Permits Demolition work

Structural work

Average(Jun-Oct 2014)

519 79 440

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 49: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

49

ldquoNot-so-commonrdquo ACMs

Rubbish chute

insulation lining

Ventilation panels

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 50: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

50

Technical requirements on asbestos work

Designated work area

Negative pressure units

Proper decontamination

facilities

Industrial vacuum cleaner

Measures to minimise the release or spread of asbestos during work

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 51: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

51

Designated work area

Decontamination facilities

Industrial vacuum cleaner

DirtyShowerClean

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 52: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

52

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

-Good practices in managing exposure to ACM-Removal of ACMbullPlan of workbullSite preparationbullDecontamination facilitiesbullPPEbullAir monitoring etc

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 53: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

53

Compliance Assistance

WSH Guidelines Management and

Removal of Asbestos

Video Working Safely with

Asbestos

WSHC WebsiteAsbestos

wwwwshcsg

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 54: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

54

Conclusion

bull Asbestos-related diseases have killed a large number of people worldwide

bull Most effective way to prevent asbestos-related diseases is to eliminate or prohibit the use of asbestos

bull A multi-pronged approach involving legislation enforcement and engagement is necessary

bull Joint effort by regulators and stakeholders is needed to prevent exposure to asbestos and manage asbestos at workplaces

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 55: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

55

THANK YOU

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 56: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

57

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 57: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

58

Additional selected data from

various sources refs included

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 58: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

59

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 59: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

60

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 60: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

61

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 61: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

62

EUROSTAT numbers referred by the Health and Safety Executive UK web page httpwwwhsegovukstatisticspdffatalinjuriespdf (accessed 2014 09 11)

Takala J Haumlmaumllaumlinen P Saarela KL Loke YY Manickam K Tan WJ Heng P Tjong C Lim GK Lim S Gan SL Global Estimates of the Burden of Injury and Illness at Work in 2012 JOEH 11 326-337 May2014 Taylor amp Francis open access httpwwwtandfonlinecomdoipdf101080154596242013863131ILO Report Contribution by Nenonen N Haumlmaumllaumlinen P Takala J Saarela KL Lim SL Lim GK Manickam K GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL WORK-RELATED DISEASES IN 2014 based on 2010 and 2011 DATA Report to the ILO Tampere Singapore Geneva 2014 DOI 10131402128640647 web page httpwwwwshigovsgfilesGlobal20Estimates20of20Occupational20Accidents20and20Work-related20Illness202014pdfStephen S Lim Theo Vos Abraham D Flaxman et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21 regions 1990-2010 a systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012 380 2224-60 Institute of Health Metrics and Evaluation web site httpvizhubhealthdataorggbd-cause-patternsHaumlmaumllaumlinen P Global Estimates of Occupational Accidents and Fatal Work-Related Diseases Doctoral dissertation Publication 917 Tampere University of Technology Finland 2010 Accessed on 11 Sep 2014 and available at httpdspacecctutfidpubbitstreamhandle1234567896818hamalainenpdfsequence=1Nurminen M amp Karjalainen A (2001) Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland Scandinavian Journal of Work Environment amp Health 27 161ndash213 httpwwwsjwehfishow_abstractphpabstract_id=605(accessed 26 March 2014)Steenland K Rollins School Public Health Emory University Atlanta Ga USA 2004 httpwwwoccupationalcancercawp-contentuploads201103Steenlandpdf

(Accessed on 2014 09 14)Ana M Garciacutea Rafael Gadena Merino Vicente Loacutepez Martiacutenez Estimacioacuten de la mortalidad atribuible a enfermedades laborales en Espantildea 2004 Rev Esp Salud Puacuteblica 2007 81 261-270 Ndeg3 Mayo-Junio 2007 Accessible from httpscieloisciiiesscielophppid=S1135-57272007000300003ampscript=sci_arttext (accessed 2014 09 15)

Andrea lsquot Mannetje Neil Pearce Quantitative estimates of work-related deaths diseases and injury in New Zealand Scand J Work Environ Health 200531(4)266-276 doi105271sjweh882 Accessible from wwwsjwehfidownloadphpabstract_id=882ampfile_nro=1 (accessed 2014 0915)Murray CJL Lopez AD (ed) The Global Burden of Disease ndash A comprehensive assessment of mortality and disability from diseases injuries and risk fraction in 1990 and projected to 2020 Volume I The Harvard School of Public Health World Health Organisation and World Bank 990 p 1996Santonen T Oksa P (eds) Memorandum from the Occupational Cancer Working Group Finnish Institute of Occupational Health ISBN 978-952-261-369-1 See httpwwwttlfienpublicationsElectronic_publicationsDocumentsMemorandum_Cancer_2013pdf (accessed 2014 09 15)V McCormack J Peto G Byrnes K Straif P Boffetta Estimating the asbestos-related lung cancer burden from mesothelioma mortality Accessed on 16 May 2013 at httpwwwncbinlmnihgovpmcarticlesPMC3273352 (accessed 17 March 2014)WHO Asbestos elimination of asbestos related diseases See httpwwwwhointmediacentrefactsheetsfs343en (accessed 2014 09 15) Singapore WSH Statistics WSH Institute available at httpwwwwshi-institutesgObservatory-WSH-LandscapeWSH-StatisticshtmlLabour Force Survey 2013 Ministry of Manpower available at httpstatsmomgovsgPagesEmployment-Tables2013aspxLesley Rushton Sally J Hutchings Lea Fortunato Charlotte Young Gareth S Evans Terry Brown Ruth Bevan Rebecca Slack Phillip Holmes Sanjeev Bagga John W Cherrie and Martie Van Tongeren Occupational cancer burden in Great Britain Br J Cancer 107 S3-S7 doi101038bjc2012112 Accessed on 16 May 2013 and available at httpwwwnaturecombjcjournalv107n1sindexhtmlCommunicable Disease Report 2012 MOH accessed on 16092014 httpwwwmohgovsgcontentmoh_webhomePublicationsReports2013Communicable_Diseases_Surveillance_in_Singapore_2012html

Selected sources not comprehensive

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 62: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

63

Cancer site Attributable Fraction() Attrib Deaths (2005) Attrib Registrations (2004)

Male Female Total Male Female Total Male Female Total

Bladder 71 19 53 215 30 245 496 54 550

Bone 00 00 00 0 0 0 0 0 0

Brain 05 01 03 10 1 11 12 2 14

Breast 46 46 555 555 1969 1969

Cervix 07 07 7 7 18 18

Kidney 004 004 004 1 1 1 2 1 3

Larynx 29 16 26 17 3 20 50 6 56

Leukaemia 09 05 07 18 5 23 30 9 38

Liver 02 01 02 4 2 5 4 1 5

Lung 211 53 145 4020 725 4745 4627 815 5442

Lympho-haematopoietic 0004 0002 0003 0 0 0 0 0 0

Melanoma (eye) 29 04 16 1 0 1 6 1 6

Mesothelioma 970 825 949 1699 238 1937 1699 238 1937

Multiple Myeloma 04 01 03 5 1 6 8 2 10

Nasopharynx 108 24 80 7 1 8 14 1 15

NHL 21 11 17 43 14 57 102 39 140

NMSC 69 11 45 20 2 23 2513 349 2862

Oesophagus 33 11 25 156 28 184 159 29 188

Ovary 05 05 23 23 33 33

Pancreas 002 001 001 1 0 1 1 0 1

Sinonasal 433 198 327 27 10 38 95 31 126

Soft Tissue Sarcoma 34 11 24 11 3 13 22 4 27

Stomach 30 03 19 101 6 108 149 9 157

Thyroid 012 002 005 0 0 0 1 0 1

Total 82 23 53 6355 1655 8010 9988 3611 13598

Total GB cancers 15+yrs 77912 72212 150124 175399 168184 343583Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 63: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

64

Cancer Site Asbestos Shift

work

Min

oils

Solar

radn

Silica DEE PAHs

(Tars)

Painters Dioxins ETS Radon Welders All

Bladder 296 106 71 550Brain 14Breast 1957 1969Cervix 18Kidney 3Larynx 8 56Leukaemia 38Liver 5Lung 2223 470 907 695 282 215 284 209 175 5442LH cancers 1Melanoma eye 6Mesothelioma 1937 1937Multiple

Myeloma 10Nasopharynx 15NHL 74 140NMSC 902 1541 475 2862Oesophagus 188Ovary 33Pancreas 1Sinonasal 55 126STS 27 27Stomach 47 83 157

Thyroid 1Total Attrib

Registrations

4216 1957 1722 1541 907 801 475 437 316 284 209 175 13598

Source Rushton ao

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 64: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

65

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related

Page 65: Asbestos Thailand  Conference 2014 Nov Singapore j takala & lynnette goh

copy 2010 Government of Singapore

A Great Workforce A Great Workplace

66

10 leading causes of Deaths in East Asia

Murray et al Lancet 2012

httpwwwhealthmetricsandevaluationorggbdvisualizationsregional

WORK-related