[Australia's engineered stone ban. A sound decision]

Australia se convirtió en diciembre de 2023 en el primer país en prohibir el uso de los aglomerados de cuarzo. El consumo de estos materiales sintéticos, que contienen más del 80% de sílice cristalina y que desde los años 90 se han empleado para la fabricación de encimeras de cocina y baños, ha contribuido al resurgimiento en numerosos países de formas aceleradas de silicosis y a una notable incidencia de enfermedades sistémicas. El objeto de este trabajo es analizar los fundamentos que sustentan la decisión australiana. Dichos fundamentos están principalmente recogidos en el informe elaborado en 2023 por la agencia gubernamental Safe Work Australia (SWA), que recomendó la prohibición del producto. SWA llevó a cabo una consulta pública entre todos los actores sociales y científicos interesados en el problema. El informe de SWA señaló la ausencia de evidencia científica sobre un umbral de sílice toxicológicamente seguro cuestionando la estrategia de los fabricantes del material de presentar como productos seguros a los aglomerados con menos del 40% de contenido de sílice. La recomendación de SWA tomó en consideración la evaluación del nivel de cumplimiento de las estrictas medidas de prevención implementadas entre 2019 y 2023, constatando que el incumplimiento siguió siendo generalizado en el sector. Además se realizó un análisis coste-beneficio para valorar el número de casos de silicosis que sería necesario evitar para “compensar” los costes económicos asociados a cada opción de prohibición. Para ello empleó el Valor Estadístico de la Vida (VEV) actualizado en 2023 en Australia y estimó en 4,9 millones de dólares australianos cada vida salvada y silicosis evitada. En nuestra opinión, la prohibición australiana es modélica por la forma en que se ha gestado la decisión, por su sólida fundamentación científica y socio-laboral, y por la aplicación del principio de precaución.

[Analysis of Hospital Care Registers due to Silicosis in Spain, 1997-2020]

OBJECTIVE

The re-emergence of silicosis in Spain since 2007 has been identified by the increase in the number of occupational disease reports. The aim of our study was to analyse the silicosis care processes attended by the National Health System between 1997 and 2020 to better understand the epidemiological dimension of the problem.

METHODS

Processes were obtained from the Registro de Actividad Sanitaria Especializada (RAE-CMBD), with ICD-9-CM codes 500 and 502 (1997-2016) and ICD-10-CM J60, J62.0 and J62.8 (2017-2020). Descriptive statistical methods and modelling by logistic regression and Joinpoint regression methodology were applied.

RESULTS

A total of 111,325 records were obtained (ages twenty-one hundred years), 4.3% for silicosis as the main diagnosis (PD) and 95.7% as a secondary diagnosis (SD). Men accounted for 98% and women for 2%. The mean age for SD processes was 75.1, and 68.7 for PD processes. The median age increased by eight years for SD and decreased by three years for PD. Although the overall burden of care decreased, under-fifty PD procedures between 2006 and 2009 showed an upward trend (APC=27.01%). SD processes showed a non-significant upward trend (APC=1.92%) between 2005 and 2020.

CONCLUSIONS

The upward trend in silicosis care processes in people under fifty years of age since 2005 confirms the healthcare impact of the re-emergence of silicosis in Spain. The associated burden of care constitutes a present and future public health problem given the decreasing age of those affected.

Current global perspectives on silicosis-Convergence of old and newly emergent hazards

Silicosis not a disease of the past. It is an irreversible, fibrotic lung disease specifically caused by exposure to respirable crystalline silica (RCS) dust. Over 20,000 incident cases of silicosis were identified in 2017 and millions of workers continue to be exposed to RCS. Identified case numbers are however a substantial underestimation due to deficiencies in reporting systems and occupational respiratory health surveillance programmes in many countries. Insecure workers, immigrants and workers in small businesses are at particular risk of more intense RCS exposure. Much of the focus of research and prevention activities has been on the mining sector. Hazardous RCS exposure however occurs in a wide range of occupational setting which receive less attention, in particular the construction industry. Recent outbreaks of silicosis associated with the fabrication of domestic kitchen benchtops from high‐silica content artificial stone have been particularly notable because of the young age of affected workers, short duration of RCS exposure and often rapid disease progression. Developments in nanotechnology and hydraulic fracking provide further examples of how rapid changes in technology and industrial processes require governments to maintain constant vigilance to identify and control potential sources of RCS exposure. Despite countries around the world dealing with similar issues related to RCS exposure, there is an absence of sustained global public health response including lack of consensus of an occupational exposure limit that would provide protection to workers. Although there are complex challenges, global elimination of silicosis must remain the goal.

See relatedEditorial

[The re-emergence of silicosis as an occupational disease in Spain, 1990-2019.]

OBJECTIVE

The presence of new sources of occupational exposure to crystalline silica has contributed to an increased incidence of silicosis. Spain was one of the first countries to identify new occupational risk sectors such as quartz agglomerates. The objective of this work was to describe the incidence of silicosis in Spain between 1990 and 2019 and to determine the main occupational sectors affected.

METHODS

Data on occupational disease cases were obtained from the Spanish Ministry of Inclusion, Social Security and Migration. Disease rates were computed by occupational sector, and analyses were conducted of their time course and their geographical, sex and age distributions.

RESULTS

Data were available on 4,418 cases (96.1% male). The mean annual number of cases was 1,223% higher between 2015 and 2019 than between 1990 and 1995. By occupational sector, 50% were in "Fabrication of other mineral non-metallic products", 18.5% in "Extraction of non-metallic non-energetic minerals", 10.2% in "Construction", 6.1% in "Metallurgy", 3.1% in "Coal mining" and 12% in other sectors. Galicia registered the greatest number of cases (32.9%), followed by Castile and León (14%), Andalusia (10%) and the Basque Country (9.1%). The greatest increase in its incidence was in coal mining, possibly due to the dismantling of this sector and drastic reduction in the workforce.

CONCLUSIONS

Our results suggest the importance of the manufacturing, machining and installation of quartz agglomerates in the re-emergence of silicosis in Spain.

Asbestos-related occupational cancers compensated under the Spanish National Insurance System, 1978-2011

BACKGROUND

In 1978, asbestos-related occupational cancers were added to the Spanish list of occupational diseases. However, there are no full accounts of compensated cases since their inclusion.

OBJECTIVE

To analyze the cases of asbestos-related cancer recognized as occupational in Spain between 1978 and 2011.

METHODS

Cases were obtained from the Spanish Employment Ministry. Specific incidence rates by year, economic activity, and occupation were obtained. We compared mortality rates of mesothelioma and bronchus and lung cancer mortality in Spain and the European Union.

RESULTS

Between 1978 and 2011, 164 asbestos-related occupational cancers were recognized in Spain, with a mean annual rate of 0·08 per 10(5) employees (0·13 in males, 0·002 in females). Under-recognition rates were an estimated 93·6% (males) and 99·7% (females) for pleural mesothelioma and 98·8% (males) and 100% (females) for bronchus and lung cancer. In Europe for the year 2000, asbestos-related occupational cancer rates ranged from 0·04 per 10(5) employees in Spain to 7·32 per 10(5) employees in Norway.

CONCLUSIONS

These findings provide evidence of gross under-recognition of asbestos-related occupational cancers in Spain. Future work should investigate cases treated in the National Healthcare System to better establish the impact of asbestos on health in Spain.

Pleural cancer mortality in Spain: time-trends and updating of predictions up to 2020

BACKGROUND

A total of 2,514,346 metric tons (Mt) of asbestos were imported into Spain from 1906 until the ban on asbestos in 2002. Our objective was to study pleural cancer mortality trends as an indicator of mesothelioma mortality and update mortality predictions for the periods 2011-2015 and 2016-2020 in Spain.

METHODS

Log-linear Poisson models were fitted to study the effect of age, period of death and birth cohort (APC) on mortality trends. Change points in cohort- and period-effect curvatures were assessed using segmented regression. Fractional power-link APC models were used to predict mortality until 2020. In addition, an alternative model based on national asbestos consumption figures was also used to perform long-term predictions.

RESULTS

Pleural cancer deaths increased across the study period, rising from 491 in 1976-1980 to 1,249 in 2006-2010. Predictions for the five-year period 2016-2020 indicated a total of 1,319 pleural cancer deaths (264 deaths/year). Forecasts up to 2020 indicated that this increase would continue, though the age-adjusted rates showed a levelling-off in male mortality from 2001 to 2005, corresponding to the lower risk in post-1960 generations. Among women, rates were lower and the mortality trend was also different, indicating that occupational exposure was possibly the single factor having most influence on pleural cancer mortality.

CONCLUSION

The cancer mortality-related consequences of human exposure to asbestos are set to persist and remain in evidence until the last surviving members of the exposed cohorts have disappeared. It can thus be assumed that occupationally-related deaths due to pleural mesothelioma will continue to occur in Spain until at least 2040.

[Incidence of asbestosis and other benign lung diseases: Spain, 1962-2010]

BACKGROUND

We lack in Spain of a full description of the diseases caused by asbestos since its inclusion in the list of occupational diseases 1961. The aim of this study is to know the incidence of asbestosis and other asbestos-related benign lung diseases, which were recognized as occupational diseases by the Spanish Social Security system between 1962 and 2010.

METHODS

Cases were obtained from Reports of the National Insurance Institute (1962 to 1975), from Employment Ministry Statistics and Reports of the Work Health and Safety Department (1976 to 1981), and from the Employment Statistics Yearbooks (from 1982). Specific rates were obtained by economic activity and occupation. We represent temporal trends in the number of the diseases under study and described their geographic distribution by provinces.

RESULTS

Between 1963 and 2010, 815 cases of asbestosis and 46 cases of fibrous pleural or pericardial disease were recognized. Since 1990 until 2001 Fiber-cement sector accumulated 189 cases of asbestosis, Shipbuilding sector 173, Construction sector 49 and Metallurgy 35. By occupation, fixed machinery operators had 114 cases; in molders, welders, sheet metal workers and fitters 88 cases; and painters, plumbers and pipe fitters 59 cases. The autonomous communities with the highest number of cases were Valencia (106), Galicia (86), Andalusia (82), Catalonia (75), Madrid (58), and the Basque Country (41).

CONCLUSIONS

Incidence rates and the time trend of professional asbestosis in Spain may be demonstrating the underreporting of the occupational origin of these diseases in our country. The most affected sectors were that of the fiber-cement and the naval one and the highest incidence was given in the Valencian Community.

Radiological protection in the Spanish nuclear industry under Franco, 1939-1975

In debates about nuclear controversy, the issue of occupational safety in radioactive facilities is rarely foregrounded; it has historically been relegated to second place compared to the attention given to potential harm to the general population. Aiming for, at least, partially filling this historiographical gap, this article deals with the development of occupational radiological protection in Spain under the dictatorship of General Franco (1939-1975). It covers the rise of radiological protection measures on an international level and the subsequent development of legislation in the case of Spain, a process that paralleled the growth of the nation's nuclear program. Finally, it explores the main evidence of the impact of ionizing radiation on Spain's working population.

A camel through the eye of a needle: expertise and the late recognition of asbestos-related diseases

The aim of this study is to provide new insights into the late recognition of asbestos-related diseases in contemporary societies. It addresses the role of expert culture in the identification, management, and control of asbestos risks, and examines the contribution of these processes to the late recognition and minimization of risks. After focusing first on Spain, the article presents three historical case studies to illustrate some shortcomings of the expert explanatory model. First, the narrow definition of asbestosis forged by medical experts in interwar Britain helped shape a public perception of the asbestos issue as finite and controllable. Second, the alternative approach to asbestos hazard management proposed by the Spanish trade union Comisiones Obreras in the early 1980s, inspired by the so-called Italian workers' model, prioritized locally produced knowledge. Finally, in the changing public view of asbestos risks in France during the last third of the 20th century, cultural and social factors played a crucial role in broadening the issue beyond its conception as just an occupational health problem. The author argues that expertise itself becomes a deproblematizing agent for industrial health issues, paving the way for their social invisibility.

The politics of silicosis in interwar Spain: Republican and Francoist approaches to occupational health

This article explores the emergence and recognition of silicosis as an occupational disease in interwar Spain. Following International Labour Office guidelines, growing international concerns and local medical evidence, Republican administrators provided the first health care facilities to silicosis sufferers, who eventually became entitled to compensation under the Law of Occupational Diseases (1936), poorly implemented due to the outbreak of the Civil War (1936-39). Silicosis became a priority issue on the political agenda of the new dictatorial regime because it affected lead and coalmining, key sectors for autarchic policies. The Silicosis Scheme (1941) provided compensation for sufferers, although benefits were minimised by its narrow coverage and the application of tight criteria.

Cinematic representations of medical technologies in the Spanish official newsreel, 1943-1970

NO-DO, the Spanish official newsreel produced by Franco's dictatorship (1939-1975), held a 30-year monopoly over audio-visual information in Spain from 1943 to 1975. This paper reports on an analysis of coverage of medical technologies by the Spanish Cinematic Newsreel Service, NO-DO, from 1943 to 1970. The study focuses on the changing roles played by cultural representations of medical technologies deployed in NO-DO. Our analysis shows how these representations offered a new space for the legitimization of the regime, and, more importantly, played a key role in the attempts to construct and enforce a hegemonic national identity after the Spanish Civil War (1936-1939). During the period of isolationist autocracy that ended in the mid-1950s, the images of medical technologies reinforced the idea of a self-sufficient "national space" and deepened the break with the historical past. Once the international isolation of the regime was overcome in the late 1950s and the 1960s, the representation of medical technologies contributed to establishing a Spanish national identity that mirrored the outside world, the foreign space. Finally, gender representations in NO-DO are also explored.