Clearly the scale of this public health threat has necessitated an unprecedented response to save human life. There will be a long tail to this crisis with hard lessons to come. Our Prime Minister, Boris Johnson, has rightly pledged to put public health first as we emerge from this phase and begin to meet the ‘five tests’ for recovery. But as we do so we must not let other threats to public health and safety simply fade into the background of public concern.
For decades, the UK has to all intents and purposes ignored the public health impact of asbestos, another silent killer that is the leading cause of the terminal lung disease mesothelioma, and the UKs number one cause of occupational death. Asbestos related diseases account for around 10,000 deaths per year, if we include the fatalities of those aged over 75, which are inexplicably omitted from official figures. A statistical practice that would be unimaginable in accounting for Covid-19 deaths.
The fact that asbestos related deaths receive so little attention highlights the difference between a fast and slow epidemic and the double standards in how we respond to the dangers they present. Yes, contagion plays into the fear factor, but both are a real and present threat to life.
Like the coronavirus, asbestos related disease can take time to manifest symptoms. But unlike the coronavirus, this can typically take between 20 and 40 years to emerge. The difference here is not just temporal, but political. COVID-19 can take effect within as little as 24 hours. Because it carries a risk of imminent fatality to the patient, and rapid transmission to others. The only cogent health and safety response is to stop the spread of contagion.
A disease that takes decades to develop after first contact with a source, does not frighten us into the same call to action. In such cases, health and safety policy slackens and precautions often enacted lackadaisically if at all, lack any proper means of oversight or enforcement. The biggest single asbestos related disease is mesothelioma, and this is incurable. This should make its prevention more important to us as its consequence is fatal.
A slow silent killer that spares no-one is considered less lethal than one which acts swiftly yet is survived in the vast majority of cases. It is an added shame then that those most at risk of developing mesothelioma, whose condition we ignore, happen to be society’s most essential workers.
Over the last two months, school across the UK have emptied while its hospitals have filled to capacity. Around 80 percent of these schools and 94 percent of these hospitals contain asbestos. Teachers and nurses are subsequently 3 to 5 times more likely to develop mesothelioma. When the country’s schools reopen, teachers and schoolchildren will wander right back into the line of fire. Asbestos kills teaching staff at a rate of around 20 per year, which doesn’t even begin to cover caretakers and administrative staff. NHS workers currently moving at breakneck speed around packed wards up and down the UK are largely unaware that absent the Coronavirus they are risking their health just by being in their place of work.
The Health and Safety Executive’s management regime around asbestos has consistently failed to act on this rising death toll among teachers and nurses, taking comfort from (or hiding behind) the fall in deaths caused decades before asbestos was banned. The UK currently lags far behind international standards for sensitive air monitoring, which many developed nations use to test buildings for ambient exposure. Germany not only exceeds UK testing for COVID-19 by a full 140,000 tests per week but has also managed for years to detect airborne asbestos levels with 10 times greater accuracy than in the UK. Its secret has been to invest in the right preventative measures from the get-go.
What then should Government do to eradicate the silent killer we’ve ignored for so long?
One idea articulated in a recent letter to the Chancellor by the think tank ResPublica is that some of the £1 billion allocated by the Treasury for the removal of unsafe materials from Britain’s public estate be used to give a full cost-benefit analysis of the phased removal of asbestos from schools. Detecting and removing the most dangerous material from schools first.
This provision in the budget is primarily aimed at fire prevention. However, as ResPublica points out, fire-safety measures have already started to reduce annual fire-related death rates (268 fire-related fatalities in the year ending June 2019, with death rates falling over the last decade). Comparatively little is being done meanwhile to protect ever younger generations of teachers and pupils from developing mesothelioma.
To accomplish this the UK should roll out a comprehensive sensitive air monitoring test of its public estate, using the best international standards to reveal the true extent of exposure to airborne asbestos and the health risks it presents.
Finally, let’s make the eminently sensible decision of introducing a national asbestos database, one that is centralised in the hands of the HSE so that we can see where and in what condition this material lurks in our public estate. It’s astonishing that no such database for Britain’s biggest occupational killer currently exists. What we measure today can be removed tomorrow.
COVID-19 has already revealed some difficult home truths about our public health policy. We have ignored and continue to ignore clear and present dangers to public health. Between 2001 and 2017 mesothelioma has killed nearly 77,000 people under the age of 74. The total number of asbestos related deaths over the same period could be up to four times higher. It’s time to take action.
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