Introduction: Asbestos has been used for thousands of years but only at a large industrial scale for about 100–150 years. The first identified disease was asbestosis, a type of incurable pneumoconiosis caused by asbestos dust and fibres. The latest estimate of global number of asbestosis deaths from the Global Burden of Disease estimate 2016 is 3495. Asbestos-caused cancer was identified in the late 1930’s but despite today’s overwhelming evidence of the strong carcinogenicity of all asbestos types, including chrysotile, it is still widely used globally. Various estimates have been made over time including those of World Health Organization and International Labour Organization: 107,000–112,000 deaths. Present estimates are much higher. Objective: This article summarizes the special edition of this Journal related to asbestos and key aspects of the past and present of the asbestos problem globally. The objective is to collect and provide the latest evidence of the magnitude of asbestos-related diseases and to provide the present best data for revitalizing the International Labor Organization/World Health Organization Joint Program on Asbestos-related Diseases. Methods: Documentation on asbestos-related diseases, their recognition, reporting, compensation and prevention efforts were examined, in particular from the regulatory and prevention point of view. Estimated global numbers of incidence and mortality of asbestos-related diseases were examined. Results: Asbestos causes an estimated 255,000 deaths (243,223–260,029) annually according to latest knowledge, of which work-related exposures are responsible for 233,000 deaths (222,322–242,802). In the European Union, United States of America and in other high income economies (World Health Organization regional classification) the direct costs for sickness, early retirement and death, including production losses, have been estimated to be very high; in the Western European countries and European Union, and equivalent of 0.70% of the Gross Domestic Product or 114 × 10⁹ United States Dollars. Intangible costs could be much higher. When applying the Value of Statistical Life of 4 million EUR per cancer death used by the European Commission, we arrived at 410 × 10⁹ United States Dollars loss related to occupational cancer and 340 × 10⁹ related to asbestos exposure at work, while the human suffering and loss of life is impossible to quantify. The numbers and costs are increasing practically in every country and region in the world. Asbestos has been banned in 55 countries but is used widely today; some 2,030,000 tons consumed annually according to the latest available consumption data. Every 20 tons of asbestos produced and consumed kills a person somewhere in the world. Buying 1 kg of asbestos powder, e.g., in Asia, costs 0.38 United States Dollars, and 20 tons would cost in such retail market 7600 United States Dollars. Conclusions: Present efforts to eliminate this man-made problem, in fact an epidemiological disaster, and preventing exposures leading to it are insufficient in most countries in the world. Applying programs and policies, such as those for the elimination of all kind of asbestos use—that is banning of new asbestos use and tight control and management of existing structures containing asbestos—need revision and resources. The International Labor Organization/World Health Organization Joint Program for the Elimination of Asbestos-Related Diseases needs to be revitalized. Exposure limits do not protect properly against cancer but for asbestos removal and equivalent exposure elimination work, we propose a limit value of 1000 fibres/m³. Full article

Although some countries have reduced asbestos consumption and instituted bans, other countries continue to produce and consume asbestos even as asbestos-related deaths mount and the associated societal costs are high. Asbestos production and consumption has declined globally; the number of bans has increased; and the speed at which countries have tapered off consumption has increased. Using country-level data, we study the economic impact of historical changes in the production and use of asbestos. We compare changes in gross domestic product (GDP) following the enactment of asbestos bans. We do not find any significant effect on GDP following an asbestos ban. In a regional case study, we compare changes in GDP and employment with changes in asbestos production. Regional-level data revealed a temporary employment decline at the local level that was then reversed. Full article

The most effective way of reducing the global burden of asbestos-related diseases is through the implementation of asbestos bans and minimising occupational and non-occupational exposure to respirable asbestos fibres. Australia’s asbestos consumption peaked in the 1970s with Australia widely thought to have had among the highest per-capita asbestos consumption level of any country. Australia’s discontinuation of all forms of asbestos and asbestos-containing products and materials did not occur at a single point of time. Crocidolite consumption ceased in the late 1960s, followed by amosite consumption stopping in the mid 1980s. Despite significant government reports being published in 1990 and 1999, it was not until the end of 2003 that a complete ban on all forms of asbestos (crocidolite, amosite, and chrysotile) was introduced in Australia. The sustained efforts of trade unions and non-governmental organisations were essential in forcing the Australian government to finally implement the 2003 asbestos ban. Trade unions and non-government organisations continue to play a key role today in monitoring the government’s response to Australian asbestos-related disease epidemic. There are significant challenges that remain in Australia, despite a complete asbestos ban being implemented almost fifteen years ago. The Australian epidemic of asbestos-related disease has only now reached its peak. A total of 16,679 people were newly diagnosed with malignant mesothelioma between 1982 and 2016, with 84% of cases occurring in men. There has been a stabilisation of the age-standardised malignant mesothelioma incidence rate in the last 10 years. In 2016, the incidence rate per 100,000 was 2.5 using the Australian standard population and 1.3 using the Segi world standard population. Despite Australia’s complete asbestos ban being in place since 2003, public health efforts must continue to focus on preventing the devastating effects of avoidable asbestos-related diseases, including occupational and non-occupational groups who are potentially at risk from exposure to respirable asbestos fibres. Full article

In 2009, asbestos was finally banned in Korea, about 70 years after the first opening of asbestos mines under Japanese control. After having presented the history of asbestos industry, together with its regulations and health effects over time, we constructed narrative analyses of how the asbestos issue under the prevailing risk system was managed by whom and for what purpose, to provide context for the change. We could identify five different phases: laissez-faire, politico-technical, economic–managerial, health-oriented cultural, and human rights-based post-cultural risk systems. The changes leading to the asbestos ban evolved over different phases, and each phase change was necessary to reach the final ban, in that, without resolving the previous issues by examining different categories of potential alternatives, either the final ban was not possible or, even if instituted, could not be sustained. An asbestos ban could be introduced when all the alternatives to these issues, including legitimate political windows, economic rationalizations, health risk protections, and human rights sensitivities, were available. We think the alternatives that we had were not in perfect shape, but in more or less loosely connected forms, and hence we had to know how to build solidarities between different stakeholders to compensate for the imperfections. Full article

The banning by the New Zealand Government of the import and export of asbestos-containing products resulted from the interplay of a number of factors. At a personal level, there were the actions of the asbestos sufferers, their families and support groups. At the political level, there were the activities of progressive trade union groups representing the hazardous trades, such as labourers, construction workers and demolition workers, and at a Government level, there was a positive response to these public health pressures. The Prohibition Order 2016 concerning Imports and Exports (asbestos-containing products) was the outcome of this 80-year long saga. Full article

This paper provides a narrative of the national intervention strategy in Sweden aimed to restrict the industrial use of asbestos. For many years, asbestos was imported for widespread industrial use, resulting in large amounts throughout Swedish society. In 1972, the whistle was blown in a Communist Party parliamentary motion describing asbestos as a health hazard and requesting action to prohibit its use. Although the motion was rejected, it initiated the extensive charting of asbestos sources on a tripartite basis, involving government agencies, and employer and trade-union organizations. Restrictive asbestos management practices were enforced from July 1982. The year 1985 saw the Government Asbestos Commission review, covering use-determining factors, international regulations, and assessments of cancer risks. The relative risks of chrysotile and amphibole were considered internationally (by the IARC), since chrysotile (a Canadian export) was regarded as unharmful in Canada at that time. Prohibiting asbestos use resulted in its virtual disappearance as an import to Sweden from the early 1980s. However, asbestos has undergone a transition from an occupational to a public-health hazard (although some work-related hazards, such as handling and disposal, remain). The transition reflects the public’s exposure to existing stocks, in homes, workplaces, etc. Mesothelioma incidence has come to be regarded as an indicator of prevention effectiveness. Full article

Background and history: Italy was the main asbestos producer and one of the greatest consumers in 20th century Europe until the asbestos ban was introduced in 1992. Asbestos exposure affected the population in a wide range of working environments, namely mining and marketing of asbestos, asbestos cement production, shipyards and textile industries. This also determined a widespread environmental asbestos exposure affecting the surrounding communities. Methods: To investigate the drivers and difficulties of the process leading to the asbestos ban and its subsequent implementation, we focused on stakeholder involvement, environmental health policies, capacity building and communication. Results: In the past three decades, stakeholder involvement has been instrumental in advancing the industrial asbestos replacement process, prevention and remediation interventions. Furthermore, involvement also contributed to the integration of environmental and health policies at national, regional and local levels, including capacity building and communication. In a global public health perspective, international scientific cooperation has been established with countries using and producing asbestos. Discussion and Conclusions: Key factors and lessons learnt in Italy from both successful and ineffective asbestos policies are described to support the relevant stakeholders in countries still using asbestos contributing to the termination of its use. Full article

As millions of immigrants moved to Hong Kong (HK) from China in the recent decades, large amount of residential housings were built in the early years and a substantial proportion of those buildings used asbestos-containing materials (ACMs). Since the number of new cases of ARDs diagnosed has increased year by year since 1990’s, the remarkable increase of incidences had drawn the attention of the public and most importantly the HK government. It became one of the trigger points leading to asbestos ban in HK history. Comparatively, non-governmental organizations (NGOs), labor unions and patients’ self-help organizations demonstrated a more aggressive and proactive attitude than the HK government and have played a key role in the development of asbestos banning policy in HK. After numerous petitions and meetings with the government representatives by those parties in the past decade, the HK government eventually changed its attitude and started to consider terminating the endless threat from asbestos by amending the policy, and the new clause of legislation for banning of all forms of asbestos was enacted on 4 April 2014. Other than the restriction of asbestos use, the compensation system about ARDs has also made some great moves by the effort of those parties as well. Based on the experience we learnt through the years, efforts from different stakeholders including patients’ self-help organizations, NGOs, legislative councilors, and media power are absolutely essential to the success of progression and development in today’s asbestos banning in HK. Full article

This paper aims to examine the process through which a total ban on asbestos was achieved in Japan. We reconstructed the process, analyzed the roles of involved parties/events, and drew lessons from the Japanese experience of achieving the ban. In Japan, a bill to phase out asbestos was proposed in 1992 but rejected without deliberation. Wide support for such a ban subsequently grew, however, largely due to the actions of trade unions and civil societies in establishing a coalition, raising awareness, organizing asbestos victims and their families, and propagating information on international developments. A governmental decision towards a ban was made in 2002 based on several national and international factors. A huge asbestos scandal in 2005 preponed the achievement of a total ban and led to the establishment of comprehensive measures to tackle asbestos issues. However, challenges remain for the elimination of asbestos-related diseases. Full article

This article describes the history of the asbestos use regulation process in Taiwan and the associated factors leading to its total ban in 2018. Despite the long history of asbestos mining and manufacturing since the Japanese colonial period, attempts to understand the impact of asbestos on the health of the population and to control its use did not emerge until the early 1980s. We attempted to investigate the driving forces and obstructions involved in asbestos regulations by reviewing available public sources and scientific journal articles and conducting interviews with key propagators of the asbestos regulation and ban. Correlation between asbestos exposure and asbestos-related diseases has already been established; however, authorities have been unable to effectively regulate the extensive application of asbestos in various light industries that support economic growth since the 1960s. More stringent regulations on asbestos use in industries and an eventual ban were caused indirectly by appeals made by visionary scholars and healthcare professionals but also due to the subsidence of asbestos-related industries. With the elucidation of factors that affect asbestos regulation and ban, a thorough long-term healthcare plan for the neglected victims of asbestos-related diseases and upstream measures for policy change must be developed. Full article

Less than ten years ago, the asbestos industry enjoyed the support of every Quebec and Canadian political party. The Chrysotile Institute and the International Chrysotile Association, both located in Quebec, aggressively marketed asbestos around the world, claiming scientific evidence showed that chrysotile asbestos could be safely used. The industry created a climate of intimidation. Consequently, no groups advocating for victims of asbestos or campaigning for its outright ban existed in Quebec to challenge the industry. A campaign was launched to mobilize the scientific community to speak out. Working with scientists, activists, and asbestos victims around the world, a small group of Quebec scientists exposed the false arguments of the asbestos industry. They publicly and repeatedly challenged the unscientific and unethical asbestos policy of the government. By appealing to Quebec values and holding those in power accountable, the campaign won public support and succeeded against all odds in defeating the asbestos industry. Full article

There was some limited use of asbestos at end of the 19th century in industrialized countries including Germany, but its consumption dramatically increased after World War II. The increase in use and exposure was followed by the discovery of high numbers of asbestos-related diseases with a mean latency period of about 38 years in Germany. The strong socio-political pressure from the asbestos industry, its affiliated scientists and physicians has successfully hindered regulatory measures and an asbestos ban for many years; a restrictive stance that is still being unravelled in compensation litigation. This national experience is compared with the situation in other industrialized countries and against the backdrop of the constant efforts of the WHO to eliminate asbestos-related diseases worldwide. Full article

Many developed countries have banned the use of asbestos, but not the United States. There have, however, been multiple efforts in the US to establish strict exposure standards, to limit asbestos use, and to seek compensation through the courts for asbestos-injured workers’ In consequence of these efforts, asbestos use has declined dramatically, despite the absence of a legally mandated ban. This manuscript presents a historical review of these efforts. Full article