Hazards issue 116, October-December 2011
Dust at work can make you cough, wheeze, choke – and for a large and largely unacknowledged group of thousands each year – croak. This is not disputed. Statistics for 2010/11 published by the Health and Safety Executive (HSE) on 2 November 2011 declared “about 30,000 workers report they currently have breathing/lung problems caused or made worse by their work.”1 HSE says several thousand dust exposed workers die each year as a result.
But when it comes to the real harm caused by workplace dust, HSE is throwing up a smokescreen. There are not tens of thousands but hundreds of thousands of people alive and hacking in the UK with medically-confirmed work-related lung diseases, many receiving compensation from a government fund.2 That’s something HSE omits to mention.
‘Chronic Obstructive Pulmonary Disease (COPD) in Great Britain’3, an HSE background report accompanying its new statistics, notes a review of available studies on this single dust-related condition “suggests there could be several hundred thousand occupational cases” in Great Britain, dwarfing the 30,000 all-causes occupational lung disease figure that makes it into HSE’s public tally.
MISSING FROM THE BODY COUNT
In June 2008, the UK government said 91 per cent of the 591,760 claims to a no fault government-financed scheme to compensate former coal miners suffering from Chronic Obstructive Pulmonary Disease (COPD) had been settled2. Although over half those receiving payouts had subsequently died or were the dependants of deceased miners, this meant over 200,000 were living with work-related COPD in 2008.
But these figures are for just one occupation. The scheme was not extended to the majority of jobs known to be associated with increased risk of COPD, including steel, construction, farming and other dusty industries. HSE acknowledges: “Epidemiological studies have identified associations between a number of other occupational exposures, including cotton dust, grain dusts and endotoxin, flour dust, welding fumes, other minerals - such as silica and man-made vitreous fibres, other chemicals - such as isocyanates, cadmium, vanadium, and polycyclic aromatic hydrocarbons (PAHs) - and wood dust.”3
COPD is just one type of work-related dust disease. Add in the cancers, asthma, extrinsic allergic alveolitis, fibrosing alveolitis, pneumoconioses (like silicosis and asbestosis) and the total number of wheezing and sometime expiring because of workplace dust exposures will be significantly higher. And the lungs are not the only organ targeted by dust. Dust-related heart disease is a major problem. And some dusts can cause immune disease [see graphic].
HSE’s 2011 annual statistics report also puts the healthiest possible gloss on work-related COPD deaths4. It notes: “Around 15 per cent of Chronic Obstructive Pulmonary Disease (COPD – including bronchitis and emphysema) may be work-related. This suggests there could be some 4,000 COPD deaths each year due to past occupational exposures to fumes, chemicals and dusts.”
Only the 15 per cent was the bottom end of the 15 to 20 per cent dusty work contribution suggested by HSE research published in the journal Occupational and Environmental Medicine in 20055, and was calculated from its lower end figure of HSE’s 25,000-30,000 estimate of total COPD deaths each year. The British Lung Foundation (BLF) puts the COPD toll in the UK at 30,000 deaths a year, with an estimated 3.7 million living with the condition. Based on BLF’s mortality and morbidity estimates and HSE’s calculation of the proportion caused by work, work-related COPD causes up to 6,000 deaths each year and affects over half a million people in the UK.
It’s a problem replicated everywhere HSE is the body counter. The safety watchdog typically sources an unrealistically conservative figure for its estimate of occupational lung disease, and publishes it without qualification in its key statistical publications. What goes for COPD goes for cancer, lung scarring, and other conditions caused by dust, including heart and immune diseases. It now seems 15-20 per cent of all cases of asthma are work-related, a proportion of these – certainly running to thousands a year – caused or exacerbated by dust.
This occupational dust toll of many hundreds of thousands affected and an annual death count in five figures is finessed down to a more palatable HSE figure for public consumption of 30,000 cases and a few thousand deaths.
There’s a deadly knock-on from HSE’s statistical sleight of hand. If you deny there is a problem, then you don’t have a problem to solve. And that is precisely what is happening with the majority of dust exposures at work. Nothing.
A dust storm is brewing
TUC’s September 2011 ‘Dust in the workplace’ guide6, which has been sent out to union safety reps, argues there is now “clear scientific evidence” that cancer and lung diseases can result from dust exposures well below the current legal limit. This is no small problem – by HSE’s estimate, 1.8 million construction workers are regularly exposed to dust. Add in farm, metal and other industrial jobs and the at-risk total quickly runs to several millions.
TUC general secretary Brendan Barber commented: “Because disease and death caused by the various types of dust can take many years to develop, both employers and regulators take them far less seriously than deaths caused by injury, yet they are just as tragic for both the workers and their families.
“Each and every one of these thousands of deaths caused by dusts is avoidable. Given the scale of the problem we need an urgent examination of both the current standards and their enforcement.”
TUC contends that several thousand workers are dying each year as a result of preventable workplace dust exposure. It says although much of the toll is “because of inadequate enforcement of existing standards, a considerable number of deaths are a result of the inadequate maximum exposure levels.” Workers are developing sometimes fatal diseases at exposures at or below the current workplace limit.
Some workplace dusts, like asbestos and silica, have their own tighter - but still inadequate and under-enforced - exposure standards. But most fall under what used to be called the ‘nuisance dust’ standard. The lingo has recently been tweaked, with what was a ‘nuisance’ now dubbed ‘limited toxicity, poorly soluble dust.’ Whatever you call it, TUC says this general dust standard is “totally inadequate.”
The union body points to studies for HSE showing a range of dusts, including silica, coal dust, talc and kaolin, cause lung disease in a significant proportion of workers when exposures are at the current “safe” limit. TUC says health effects have not only been observed at the official limit of 4mg/m³ of respirable dust for “a range of so-called low toxicity dusts”, but for some dusts even a 1mg/m³ limit was not protective.
An internal HSE briefing paper considered at the watchdog’s December 2010 board meeting7 made reference to an HSE commissioned study, which it said used “coalmine dust as a benchmark for low toxicity poorly soluble dust.” This concluded that at the current dust standard “there was a distribution of effects with some individuals being more severely affected. Hence a moderate proportion (around 12 per cent) of workers would develop larger losses in lung function of a magnitude that would raise concern for occupational health.”
Unions set the standard
The push for a lower, more protective, workplace dust limit has received strong backing from the union Unite. Along with the TUC, it is calling for a review of dust exposure levels, in line with recommendations from the trade union side of the Health and Safety Executive’s (HSE) Advisory Committee on Toxic Substances (ACTS). Unions also want a high profile campaign to inform workers of the risks posed by dust exposure.
It is not something HSE is willing to consider. Minutes of HSE’s December 2010 board meeting8 record: “The action of TUC representatives who sit on ACTS in recommending a lower precautionary exposure threshold for dust to their members was noted. However, HSE will not pursue the lowering of current exposure limits on present evidence.” The minutes made no reference to the union call for an awareness campaign, however the HSE briefing considered by board members noted: “With constrained resources also to take into account, HSE cannot make a case for a generic campaign at this time.”
While they wait for HSE to act, unions are promoting their own interim voluntary exposure ceiling. This union 'precautionary standard' of 1mg/m³ for respirable dust, is a quarter the current official standard. Bud Hudspith, Unite national health and safety adviser, commented: “The current dust standards are not good enough and there is strong scientific evidence to prove it.”
It is a view supported in a May 2011 briefing paper from the Edinburgh-based Institute of Occupational Medicine (IOM)9. This warned “the current British occupational exposure limits for airborne dust are unsafe and employers should attempt to reduce exposures to help prevent further cases of respiratory disease amongst their workers. Mirroring the call from unions, IOM added “employers should aim to keep exposure to respiratory dust below 1mg/m³”.
The IOM briefing noted that evidence considered by HSE’s own advisory WATCH committee “suggests exposure to any poorly soluble dust, even at low doses, will affect lung function in a roughly linear fashion, ie. increasing exposure will result in increasing adverse health effects.” IOM concluded that as HSE’s WATCH committee had advised “there is no threshold for the effects of dust the lung then… reducing exposure should pro rata reduce the risk of disease in the future.”
IOM research director Dr John Cherrie told Hazards: “The IOM is concerned about the human costs of chronic lung disease and the role that occupational exposures may have in causing or exacerbating workers symptoms. We thing that HSE’s own figures suggest that several hundred lives could be saved each year if employers can significantly reduce exposures to dust at work.”
This is not news to HSE. The 2005 Occupational and Environmental Medicine paper on COPD prevalence5, authored by experts from HSE’s laboratory wing HSL, noted “the UK Control of Substances Hazardous to Health (COSHH) Regulations state that any dust not otherwise classified as harmful should be regarded as hazardous to health at airborne concentrations of 4 and 10 mg/m³ (respirable and inhalable fractions respectively). These levels almost certainly need to be lowered.
“The financial burden of COPD alone to our country should supply incentive to all those in positions of responsibility, irrespective of the personal and medical costs. Even if one assumes a relatively conservative estimate, 10 per cent of the current approximate costs of the medical treatment of COPD in the UK equates to £100 million, and this does not take into account productivity losses due to working days lost.”
For six years at least HSE has ignored unions, medical authorities, its own experts and the compromised health of thousands of workers and defended a dust standard that is killing and disabling tens of thousands each year.
Don’t hold your breath
Dusty industries don’t want tighter controls, and so far they have had the ear of HSE. So, while the safety watchdog ignores compelling health evidence and refuses to either raise awareness through a dust dangers campaign or tighten the workplace exposure standard, TUC is urging union safety reps to put their own dust control strategy into motion.
TUC wants safety reps to:
• Check risk assessments include the dangers of dust and that the employer has proper procedures in place to control it
• ensure all parts of the workplace are regularly monitored for levels of workplace exposure to both general dust and any specific types of dust that may have their own specific standards. Safety reps have the right to see the results of any monitoring exercise
• where the level of dust is above the limits for inhalable and respirable dust of 10 mg/m³ and 4 mg/m³ respectively, then make sure the employer is taking the legally required action to reduce exposures. If the employer refuses, then contact the official safety enforcer (See: Where's the watchdog?)
• where the level of dust is still above the TUC’s recommended precautionary dust standard of 2.5 mg/m³ inhalable dust and 1 mg/m³ respirable dust, try to ensure action is taken to reduce it to that limit. Seek an agreement with the employer that they will not exceed the TUC limit
• make sure that members are aware of the possible dangers from dust. This can be done jointly with the employer if they agree, without them if they don’t
• where there could be a dust problem, check the health of the exposed workforce is being monitored and make sure you know if any problems are identified
• ensure the employer is following the Control of Substances Hazardous to Health (COSHH) prevention hierarchy, by first seeking to first to eliminate the use of the harmful substance, then trying control and if that fails, as a last resort, opting for the use of personal protective equipment (PPE)
• ensure union health and safety reps are involved in the choice of breathing masks or other PPE and ensure it is suitable for all workers
• make sure any PPE is properly maintained.
How does dust hurt you?
Chronic Obstructive Pulmonary Disease (COPD) - also called Chronic Obstructive Airways Disease (COAD), a blanket term for ‘obstructive’ lung conditions like bronchitis and emphysema, reduces airflow out of the lungs. HSE has estimated 15-20 per cent could be work-related.
Asthma – another obstructive lung disease, which can be caused by exposure to irritants or allergens (‘sensitisers’) at work and causes aeversible shortness of breath. Studies are typically showing between 15 and 20 per cent of all cases are work-related.
Extrinsic allergic alveolitis (EAA) – an allergic condition, which affects workers exposed to biological dusts, causing conditions including farmers’ lung and pigeon fanciers’ lung.
Fibrosing alveolitis - also known as pulmonary fibrosis, can be caused by some occupational dust exposures, for example work with cobalt or ‘hard metals’ in cutting tools. Related conditions, for example ‘flock workers’ lung’ and ‘popcorn lung’ (Hazards 104), have been discovered relatively recently.
Pneumoconiosis – a group of ‘restrictive’ lung diseases like silicosis, talcosis and asbestosis, where dust exposure causes debilitating lung scarring.
Cancers – tumours, particularly of the lung and nose, are related to substances commonly encountered at work including asbestos, silica, chrome VI, nickel, cadmium and wood dust. These account for thousands of work-related deaths each year.
Heart disease - Dust-affected lungs put extra strain on the heart, which can lead to right-sided heart failure. Some occupational exposures, like hard metal dust, can cause potentially fatal conditions like cardiomyopathy. Very fine dust particles cause inflammation of the heart and a higher risk of heart attacks.
Other problems – Exposure levels half the level allowable for most workplace dusts overwhelm the body’s first line of defence, the ‘mucociliary clearance’ that filters out dust in the upper respiratory tract. This can leave the worker more vulnerable to infections and more susceptible to occupational lung disease. Lots of other dust-related conditions occur, some specific to particular exposures; beryllium is linked to sarcoidosis, chrome dust to chrome ulcers.
1. Annual statistics report 2010/11, Health and Safety Executive, November 2011.
2. No fault liability scheme, House of Commons debate, Hansard, 2 March 2010. Compensation for miners: Three years on. Coal health claims, newsletter 15, BERR, June 2008 . Background on the scheme in the National Archive.
3. Chronic Obstructive Pulmonary Disease (COPD) in Great Britain, HSE background report to its 2010/11 statistic report, November 2011.
4. HSE COPD webpage, accessed 20 November 2011.
5. M Meldrum and others. The role of occupation in the development of chronic obstructive pulmonary disease (COPD). Occupational and Environmental Medicine, volume 62, pages 212-214, 2005. [Extract] [Full text].
6. Dust in the workplace, TUC, September 2011.
7. Delivering for health: HSE action on occupational respiratory disease, paper to the HSE board meeting, 15 December 2010.
8. Minutes of the HSE board meeting, 15 December 2010.
9. The IOM’s position on occupational exposure limits for dust, Institute of Medicine (IOM), May 2011.
Thousands each year cough, wheeze, choke and then croak as a result of dust exposures at work. If the authorities won’t act, unions will.