What do we need to do to stop the silicosis crisis in Australia?

With every passing year we learn more about a serious and widespread lung disease affecting workers, caused by silica, which has been dubbed “the new asbestos”. A recent study suggests over 100,000 Australian workers will suffer from silicosis due to current workplace conditions.

This devastating lung disease is caused by breathing in tiny bits of silica, which injures and scars the lungs causing irreversible damage. Australian workers in construction, engineering, mining, demolition, and in particular the manufactured stone industries, are at highest risk. There is no cure and in serious instances it leads to death. However, unlike with asbestos-related lung damage, the serious impacts of silicosis can be seen relatively quickly, with people aged in their twenties suffering from the disease.

Safe Work Australia are calling for public submissions on how to best manage this issue in Australian workplaces right now. In this article I’m going to outline what some of the main issues are, from my perspective. The scientists who are experts in this topic have told us what is actually happening in Australian workplaces. I’m one of those scientists. As an occupational hygienist who has worked to prevent silicosis for a long time in some of our highest-risk industries, I've been involved in many consultative forums, taskforces and committees on this very topic. There's a lot to be done, but I'm going to focus on just four key steps that Australian state and federal governments must take. These steps are just the beginning and by no means do they represent an exhaustive list of all that we must do.

1. The first thing we must do is progress the necessary work to ban high-quartz manufactured stone. The majority of cases of silicosis in recent years have been in workers who cut into engineered stone that form our shiny kitchen benchtops. As a result, many stakeholders have called for engineered stone to be banned and for safer alternatives to be used. But this won’t address the entire problem. Almost half of workers who were diagnosed with silicosis in 2020/2021 in NSW, for example, worked in industries other than engineered stone. That’s because crystalline silica, the chemical that’s the origin of toxic silica dust, is found in concrete, bricks, sandstone, tiles… and a seemingly endless list of other building products.
2. The second key step, therefore, is to increase funding to ensure worksite safety inspections and compliance with basic safety measures occurs across all at-risk industries. Many work sites are not able to be inspected by state regulators due to a shortage of specialist resources. We are failing our workers due to poor standards and underfunding and failing to support employers to understand and meet their obligations to provide safe workplaces for all. Not all people affected by silicosis have been the ones involved in directly generating the dust. Some work downstream of the dust or in administrative roles at worksites. When airborne dust affects people well away from the source of the dust it shows a lack of knowledge, care and understanding in how to keep all workers safe. Medical and health professionals, worker representatives, and legal representatives support the need for more effective compliance and enforcement by regulators across the country.
3. The third key thing we must do is improve national standards, which means better and more targeted regulation across all at-risk industries and the introduction of licensing schemes nationally for manufactured stone companies. This was a recent recommendation of a NSW Parliament Upper House Inquiry looking at the Review of the NSW Dust Diseases Scheme at which I gave evidence.
4. The fourth, and perhaps most important, step is that governments must resist the aggressive lobbying of some industry stakeholders. For example, recent attempts to improve regulation and standards in the ACT were pushed back due to ‘consultation with industry stakeholders’. This just does a disservice to the employers who do put systems & controls in place to keep workers safe and who are doing the right thing. The "good guys" get penalised because their products and services cost more. We must ensure that the protection and safety of workers always comes first & that those that scrimp on safety measures, and are arguably cheaper, are not given an advantage.

Australia faces a serious choice about how it can respond to this evolving public health crisis. It can respond to the threat quickly and forcefully, protecting workers’ lives and livelihoods, or it can bow to the pressures of industry lobbying. The end result of doing nothing is that workers continue to get sick. We have the opportunity to do what is right, and to avoid a repeat of the mistakes made with asbestos. It is up to all of us to make sure that happens.

I’ve taken some time to summarise some key points that may help you with your own submission to Safe Work Australia in response to the many questions in the Consultation Regulation Impact Statement (CRIS). Take what you like, make your own independent enquiries on areas of interest, but most importantly, put in a submission and make your voice heard. Because it is possible to protect workers and address this unfolding public health crisis.

Submissions close on the 15th of August and can be uploaded here.

Information to support submissions to Safe Work Australia

Statement of the problem (Chapter 2)

In my view, the problem definition appropriately identifies that: a) Workers in a broad range of industries are at risk of silicosis and silica-related diseases, b)?Worker exposure to silica dust comes from a lack of understanding of the risks and the current regulatory requirements to ensure the health and safety of those working with silica-containing materials, and c)?There are inadequate levels of compliance and enforcement with the current model Work Health and Safety laws.

There is more information available now that helps us know the impact of this problem. For example, a recent study by Curtin University predicted that 100,000 workers would be diagnosed with silicosis and up to 10,000 workers would develop lung cancer from exposure to silica dust.

Why is Government action needed? (Chapter 3)

Without government action, the cost burden of work-related disease will move from employers under their existing obligations under Work Health and Safety legislation and onto the affected individuals and the public health system.

The primary objective of government intervention is stated to “reduce workplace exposure to [respirable crystalline silica] RCS and the number of cases of silicosis and silica related diseases, and premature invalidity or death of workers”. But that is inconsistent with the objective in the response to the National Dust Disease Taskforce (NDDT) by the Australian Government which stated that their shared objective was the “elimination of silicosis amongst workers and increased quality of life for those already impacted and their families”.

The difference between “reduction” and “elimination” is significant. The objectives of government intervention must include the elimination of silicosis.

What policy options are being considered? (Chapter 4)

Some of the policy options are anticipated to reduce workplace exposures to silica dust and therefore reduce the number of silica-related diseases. However, these policy options only partially address the wider problem facing Australian employers and workers. The additional complementary options that are missing are: a)?Progressing a ban on the import and use of high-quartz containing engineered stone; and b)?The need for a Centre for Disease Prevention and Control, with a multi-disciplinary Institute of Occupational Health.

The National Dust Disease Taskforce Final Report recommended that a regulatory impact analysis be conducted to identify and decide implementation of measures that provide the highest level of protection to workers from the risks associated with respirable crystalline silica generating activities in the engineered stone industry. The Whole of Government’s Response to the National Dust Disease Taskforce stated that “joint deliberate action is required from all levels of government, industry, unions and workers to drive change”. The stated objective was the “elimination of silicosis amongst workers and increased quality of life for those already impacted and their families”.

The highest level of protection to workers in the hierarchy of control is elimination of the hazard. The consultation regulatory impact statement discounts this option stating that a ban on engineered stone as infeasible. The reasons for not including a ban, in my opinion, are poor. We know from the Curtin University study that banning engineered stone is estimated to result in a reduction of 100 cases of lung cancer and approximately 1,000 cases of silicosis. That is significant.

High-quartz containing engineered stone has toxicological properties that are distinctly and qualitatively different to that found in natural stone. Aside from the toxicological data, it is cause for concern with the current limits of liability available by manufacturers. As one example, Caesarstone Annual Reports for 2020 and 2021 include declarations that their Australian product liability insurance coverage ceased, and it would not provide for any newly diagnosed silicosis related claims, therefore confirming that one of the largest manufacturers of engineered stone globally has not been able to obtain insurance for their product based on continuing liability associated with its use. It is also significant to see Caesarstone declare in their annual report that they have pending lawsuits with 38 people in Australia suffering from silicosis. That same report states that they have “elected to negotiate and/or agree to settlements in most Australian cases”.

In addition, at least one major insurance company has begun to implement policy exclusions to some exposed trades and industries in response to rising costs associated with claims. This reinforces the concern of the recognition of the level of risk by the business sector. Compliance with basic safety standards and correct use of personal protective equipment in the engineered stone sector has been reported to be low and continuing to use this product across our country puts workers at risk. A ban should be performed as a complementary activity to other policy options such as the additional regulation of high-risk crystalline silica processes for all materials.??

Australia doesn't have an independent body that provides leadership in the coordination of work between Safe Work Australia, the Department of Health, and other agencies such as the Australian Industrial Chemicals Introduction Scheme (AICIS) or the Australian Border Force for example, to enable the protection of workers from occupational health hazards. Safe Work Australia note in the consultation regulatory impact statement that the “scope of the model WHS laws…could not prevent the importation of engineered stone into Australia”. We need structural reform in this area.

A multi-disciplinary Institute of Occupational Health could draw on the diverse expertise and knowledge of specialists, people who have worked in Australian workplaces, understand work practices, industry standards, engineering and other control measures and workplace exposure standards. There are many international examples to draw from, including the National Institute of Occupational Health (NIOSH) in the USA.

When it comes to other options that should be considered to address the problem, there are at least two of note.

The first is the need to increase the extent of specialist resources in our health and safety regulators. In my experience, the quality of specialist occupational hygiene inspectors in our regulators is great. These are experienced and passionate people working to prevent occupational illness and disease. The problem is though, there's just not enough of them. We can see the scale of the problem in the consultation regulatory impact statement where the number of workplace visits and associated action with regards to notices issued is provided. There is a wide disparity of the frequency of visits to workplaces in each state.

The structure of the respective State and Territory WHS Regulators, in terms of the number of specialist resources engaged at present, is insufficient to adequately intervene. Keep in mind that more than 80% of manufactured stone sites are small to medium sized businesses and the average number of workers at a manufactured stone workplace is 4. This is a very different structure to other at-risk sectors such as construction and mining which have large organisations employing hundreds, and sometimes thousands, of workers likely with better understanding and application of health regulations and control measures. The level of effort involved in visiting hundreds of smaller workplaces in comparison to fewer larger workplaces is very different. While there have been increases to allocated funding to the inspectorate in some jurisdictions, these increases are still insufficient to enable effective intervention for all at-risk industries.

Another issue of importance is that without the implementation of a ban of high-quartz containing engineered stone, there is an urgent need to improve the availability and visibility of product labelling (e.g. label / Safety Data Sheets) across the supply chain to make sure that data on hazardous silica content is available. Businesses use the Safety Data Sheet (SDS) to provide important information pertaining to composition, health risks and control measures. In the case of a complex mixture such as engineered stone, recent studies have shown that SDSs may provide inadequate information on overall health risks and that they are not always available in the engineered stone sector. This was discussed at length during the 2021 review of the NSW Dust Diseases scheme which resulted in a recommendation by the Legislative Council that, “the Minister for Small Business and Fair Trading advocate at the national level for a mandated, consistent format for product labels and safety data sheets for manufactured stone products”.?Mandatory communication through multi-lingual product labels and SDSs for manufactured stone products must be provided. A national compliance campaign targeting towards chemical suppliers and SDSs for all silica-containing products is also urgently needed.

What is the likely impact of each option? (Chapter 6)

The cost modelling methodology doesn't consider other diseases that are known to result in over-exposure to silica dust in addition to silicosis. Exposure to silica dust is associated with a range of other respiratory and non-respiratory conditions including Chronic Obstructive Pulmonary Disease (COPD), pulmonary fibrosis, sarcoidosis, rheumatoid arthritis, systemic lupus, chronic renal disease and lung cancer...just to name a few. Therefore the value for the average of life saved and illness avoided per person is an under-estimate.

Discussion of options (Chapter 7)

In my opinion, the combination of options needed to address the problem are:

1. Progressing a ban on high quartz containing engineered stone; and
2. The establishment of a Centre for Disease Prevention and Control, with a multi-disciplinary Institute of Occupational Health; and
3. Option 4 Implementation of a national licensing framework for PCBUs working with engineered stone; and
4. Option 5a Additional regulation of high risk crystalline silica processes for all materials including engineered stone - which of course needs to be coupled with increased specialist resources in the inspectorate.

Why Option 4? Well a significant barrier to protecting worker health is the varied behaviour of engineered stone fabricators. Some companies consider the costs associated with air monitoring, health surveillance and use of effective controls to be unacceptable and therefore avoid making changes that would cost money. This has led to ongoing problems in those workplaces. Companies that have done the right thing and manage dust exposures though implementing controls, workplace monitoring and health surveillance, have to pass on the cost to the consumer, which in turn makes their product less competitive. The marketplace for engineered stone benchtops should be a level playing field supplied by fabricators complying with regulations. When you have licensing, you have transparency with a list of registered fabricators for both the inspectorate to monitor and builders to engage for supply of fabricated stone bench tops from reputable companies. A ban on its use would be an even simpler way of levelling the playing field.

Why Option 5a? Apart from improvements to require companies to perform a risk assessment for crystalline-silica containing materials, one of the important items in this option is that it includes the need for companies to provide the results of air monitoring to the WHS Regulator. Right now if air monitoring is done, and the results show that workers are being over-exposed to silica dust and at risk of developing silicosis, those results are not submitted anywhere. This was also discussed during the 2021 review of the NSW Dust Diseases scheme and resulted in a recommendation by the Legislative Council that..."the results of air monitoring are reported to SafeWork NSW when the workplace exposure standard is exceeded and immediate regulatory action is taken in response". At present, the Regulator is only informed of a problem once a worker already has silicosis...which is when the damage has been done and it's too late. The NSW Dust Diseases Annual Report 2020-2021 reported that more than 77% of workers diagnosed with silicosis were classified as having ‘chronic’ silicosis. The time between exposure and disease diagnosis for chronic silicosis can be more than 10-years. Many construction projects, and indeed companies, that existed 10-years ago are no longer in business. A better tool to use for regulatory intervention is to create a formal system to capture data on air monitoring so that there can be follow up.

I hope this information helps shine a light on this important issue and helps you with your own submission.