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22 N E HEALTH OCCUPATIONAL DISEASES: Advertising FeatureThe North-East’s miningandshipbuildingpast arecasting ashadow overmany familiestoday asindustrialdiseasescontinue totake their toll❛ Minershavethe dubioushonour ofclaiming thetop spotwhen itcomes toindustrialdiseaseChemicals and coal dust,fibres and fumesTHE North-East is a regionproud of its industrial heritageand built on a strongwork ethic, where workingmen and women earn an honestday’s wage for a job well done.But along with their pay packetsand pensions, workers past and presenthave for decades been bringinghome something much more sinister.From chemicals to coal dust, fibresto fumes, the conditions to whichworkers have been exposed meanmany have taken their lives in theirhands as they’ve walked through thefactory gates.The mines may be gone but theirlegacy on the pitmen’s health continues,while other conditions related tothe working environment continue toshorten and shackle lives.Industrial or occupational diseasescover a wide range of conditionswhich can be linked to an employee’swork. Unlike workplace accidents,they are usually characterised by atime delay between exposure and illhealth often stretching to years andeven decades.In 2003/04 an estimated 2.2 millionpeople in Great Britain were sufferingfrom an illness which they believedwas caused or made worse by theircurrent or past work.Miners have the dubious honour ofclaiming the top spot when it comesto industrial disease, both in theirnumber and in the difficulty of theconditions they were exposed to underground.Many suffer from severe respiratorydiseases including bronchitis, emphysemaand other chronic chest conditionscaused by exposure toairborne dust.Miners also top the list when itcomes to Vibration White Finger(VWF), a condition linked to repeateduse of vibrating machinery andtools which results in the loss of sensationand a lack of dexterity in thehands.More than 780,000 applications havebeen received from former miners andtheir families in England and Walesunder both the respiratory disease(which closed to new claims on March31, 2004) and vibration white finger(which closed in October 2002) compensationschemes. With £2.6bnawarded so far, it is the world’s biggestpersonal injury compensationscheme, allegedly paying out morethan £2m every working day.Not exclusive to miners, workers inconstruction, engineering, rail andmanufacturing industries and evenhospital cleaners are among others affectedby VWF.Meanwhile, the cloud of mesotheliomaand asbestosis, cancers causedby exposure to asbestos, hangs overmany other sections of the workingpopulation.From those who worked in shipbuildingand on the railways toplumbers and people in the motortrade, the magic mineral continues tokill men and women in increasingnumbers. It’s estimated that in the 30years between 1968 and 1998, 50,000people died in the UK from asbestosrelateddiseases.The long latency period – which canbe anything from ten to 60 years –means fibres breathed in decades agoare only now exerting their fatal hold,especially among men in their 60s, 70sand 80s.In spite of concerns about asbestosbeing raised decades ago it is said toremain the most serious occupationalhealth problem, in terms of fataldisease, that the country faces.The Health and Safety Executive estimatesthat a further 55,000 men willdie from mesothelioma between nowand 2050.Annual deaths due to mesotheliomaare predicted to peak at a lowerlevel than once thought – between1,950 and 2,450 (around 1,650-2,100men; 250-310 women) – and sooner,probably between 2011 and 2015.As well as the pressure on thehealth service, the impact will be seenin an increase in claims for benefit.Meanwhile, other health problemscaused or exacerbated by exposure tosubstances at work continue to affectemployees.Exposure to cancer-causing chemicalsis linked to increased risk of anumber of different cancers includinglung, bladder and kidney cancers,some types of leukaemia, lymphomaand myeloma (bone marrow cancer).Just last month the Redwings horsecharity was ordered to pay £45,000 infines and costs after three workers inhaledfumes from toxic rat poison asthey went into a barn to stack hay.The men, who were left fighting forbreath, suffered medical problemsthat could affect them for life.Skin diseases, occupational asthma,musculoskeletal problems, hearingloss and mental illnesses areamong other disorders connectedwith work.And then there are the effects ofbeing exposed to cigarette smoke atwork. An advertising campaign currentlybeing run by the Fresh campaignfor a smoke free North-Eastclaims 35 workers in the region dieevery year from second-hand smoke.A likely ban for smoking at leastwhere food is being served will protectsome of those in the hospitality industry.However, health officials arepushing for a wider ban to includesmoking in any enclosed public placeto protect every worker in the country.Of course safety at work regulationsare much improved and morestringently imposed, while breachingthe rules carries heavy fines underprosecutions brought by the Healthand Safety Executive. Yet 20,000 newcases a year are severe enough occupationaldisorders to be seen by specialistdoctors. In 2003/04, thatamounted to 30 million working dayslost due to work-related ill health.Past and present, the legacycontinues.VIBRATION WHITE FINGEROF the 8,000 cases assessedeach year under the IndustrialInjuries Scheme, which compensatesemployees who have beendisabled by prescribed occupational diseases,almost a third are for sufferersof Vibration White Finger.The amount of compensation paid tovictims of VWF – £1bn so far – is a clearindication of the scale of the problem.The majority of those affected are exminerswho used pneumatic picks underground.A court ruling in 1996 foundthat British Coal had not adequately protectedmen from the effects of the machines.Two compensation schemes, coveringlung disease and VWF, were set upin January 1999 after the Governmentagreed to take on British Coal’s liabilities.These schemes closed to newclaims in early 2003.However, VWF is not exclusive to industriesof the past. It can affect anyonewho uses vibrating hand-held toolsfor sustained periods over time andworkers in certain industries today areno less at risk.Workers in the extraction, energy andwater supply seem to be especially atrisk of VWF (489.3 new assessmentsper 100,000 employees), while construction(13.6 cases per 100,000 employees),manufacturing (7.4) and agricultureforestry and fishing (3.3) arealso danger zones, according to theHealth and Safety Executive.Workers using machines like concretebreakers, riveting hammers, grindersand drills on a regular basis in foundries,mines and quarries and in concrete productionmay also be at risk.VWF is a disorder of the blood supplyto the fingers and hand caused by regularvibration. It manifests itself in a permanentloss of sensation in the fingers,causing problems for picking up andmanipulating small objects. It’s alsoknown as hand arm vibration syndrome(HAVS) with similar symptoms causedby the same type of exposure.The good news is that the number ofnew cases annually appears to be falling– 1,775 in 2002/03 (1,765 men andten women) down from 2,425 in2001/02, and lower than in the precedingseven years – based on assessmentsfor benefit.However, it’s still unclear how manysufferers do not claim any financial assistance.Advice for sufferers of hand arm vibrationsyndrome usually focuses onpreventing it from occurring or at leaston recognising the condition in the earlystages so that something can be done.The TUC advises workers to:● Ask the employer if a job can be donein a different way without using vibratingtools● Use low-vibration tools● Always use the right tool for the job● Ensure tools have been maintainedand repaired to avoid vibrationcaused by faults and generalwear● Keep cutting tools sharp● Rotate tasks to reduce the useof vibration equipment and thereforelessen exposure● Avoid gripping or forcing the toolsmore than necessary● Store tools correctly so that theydo not have very cold handles whennext used● Maintain good blood circulation bykeeping warm, giving up or reducingsmoking, and massaging and exercisingfingers during breaks.Other disorders may also be causedby vibration, such as carpal tunnel syndrome(CTS) where symptoms arethought to arise in part from entrapmentor compression of nerves in the wrist.CTS caused by hand-held vibratingtools was made a prescribed diseaseto qualify for compensation in April1993. Since then annual numbers ofnew assessed cases have increasedfrom 267 in 1993/94 to 797 in2001/02 and 1,035 in 2002/03.CTS may have other occupationalcauses, such as repetitive twisting orgripping movements of the hand.
OCCUPATIONAL DISEASES: Advertising FeatureN E HEALTH23The dangers of asbestos are welldocumented, but the one-timewonder material wasn’t banneduntil relatively recently. SARAHFRENCH documents the historyof its use and its deadly legacyIT is said that in the 1st Century AD, theRoman historian Pliny the Elder warnedhis friends not to buy slaves from asbestosmines because “so many of themdie young”.Whether this is true or not lies within theannals of history, but it carries added poignancytoday when so many people have alreadydied from the effects of exposure to asbestosand countless more are storing up fatal healthproblems for the future.Most recently, widower Dr Julian Little won£175,000 damages from the Department ofHealth after his wife Becky died frommesothelioma which developed decades aftershe was exposed to asbestos as a trainee nursein the late 1960s. Mrs Little was one of thousandsof people to have lived with a killer intheir midst.The use of asbestos in the UK is relativelynew, yet there is ancient evidence that suggestsits many benefits were recognised in Finlandas far back as 3,000 years BC.The term asbestos applies to a group of naturallyoccurring, fibrous silicates – chrysotile(white asbestos), crocidolite (blue asbestos)and grunerite or amosite (brown asbestos).Strong yet flexible, resistant to chemicals,non-conductive, with great thermal andacoustic qualities and fire resistant, asbestoswas given its name by the Ancient Greeks becausethe word means “inextinguishable”.It’s little wonder that asbestos, processedinto sheets, blocks and powder, became sucha widely used material following its introductionto the UK in 1857.Industry quickly realised its properties andput it to use in floor and roof tiles, insulation,sealants, cement pipes, turbines, kilns, fire retardantclothing and even in Second WorldWar gas masks.Shipbuilders used it as fire-proof laggingand to insulate hot water pipes; railwaymensprayed it into the cavity between the innerand outer shell of coaches; construction firmsused it in schools and other public buildingsas insulation and sound absorption; mechanicshandled it in vehicle brakeshoes and clutchpads.BUT by the early part of last centuryfears were already being raised aboutthe dangers of asbestos.In 1918 the Prudential in New York refusedto sell life insurance to people working in asbestosmanufacturing. By the 1930s and 1940sthere was widespread concern about the risksof cancer due to exposure to asbestos yet theuse of protective equipment remained inadequate.Its continued use bizarrely included thebroomstick ridden by the Wicked Witch of theWest in the 1939 film The Wizard of Oz.By 1960, asbestos was also related tomesothelioma.Nonetheless, as the post-war building boomcontinued, the use of asbestos materials continuedto grow, finally reaching its peak in themid-1970s.Ten years later the Asbestos Licensing Regulationswere established to control the mosthazardous asbestos removal operations.In 1987, further tightening of the rules camein with the Control of Asbestos at Work Regulations.Meanwhile, in America asbestos wasused as insulation for the solid fuel boostersof the Space Shuttle.By 1992, the import, supply and use of themore carcinogenic brown and blue asbestoswas banned, but the import of white asbestoswasn’t stopped until November 1999.It was too late for many workers in theNorth-East. The Tees and Tyne ports anddockyards were breeding grounds formesothelioma. Geographical tracking ofdeaths also highlights Yorkshire as sufferingVictims: Val Stiles, who breathed in the fibres her aunt Edna, centre, brought home.Above right: Becky Little and, right, her widowed husband Dr Julian LittleAsbestosthe killer inour midstAsbestos fibres under the microscopefor its success in railway engineering and Sunderlandfor its factories that used raw asbestosin production.While deaths due to asbestos are muchlower among females, they are significantlyhigher for women in the North-East than inother parts of the country.Fatal disease is not confined to those whoworked with asbestos.The widower of Val Stiles, formerly of Darlington,received £95,000 in compensation in2002 after his wife died from mesothelioma,aged 52. Val never worked with asbestos. Infact, she was just a schoolgirl when shebreathed in the fibres that would cause herearly death. Her aunt Edna Dean worked atthe Darlington Chemical and Insulation Companyand would often collect Val from schoolcovered like “a snowman” in the deadly whitedust.Other victims have included a hairdresserand chemist’s shop assistant, both exposed viatheir work to asbestos on the clothes and inthe hair of men who worked in nearby factories.Nonetheless, men who worked with asbestosremain the greater victims – 85 per centof the 1,860 deaths due to mesothelioma in2001 were men.Meanwhile, the annual number of deathsdue to asbestos exposure in Great Britainrecorded by the Health and Safety Executivecontinues to rise. In 1968 (the first completeyear of data recorded) there were 153; this roseto 1,633 in 2000 and again to 1,862 in 2002.Only this summer a new group waslaunched in the North-East in readiness forthe rising numbers of asbestos-related deathspredicted in the region in the next decade.The Tyne and Wear Asbestos SupportGroup (TWASG) advises sufferers and theirfamilies, co-ordinates access to benefits andcampaigns on health and safety issues to ensureemployers manage asbestos properly.Nancy Tait, director of the charity Occupationaland Environmental Diseases Association,claims mortality figures would be evenhigher if there was standardised diagnosis.She says it’s impossible to estimate howmany deaths have not been diagnosed as beingdue to asbestos following occupational exposuresimply because of the arbitrary measurementof fibres found on victims’ lungs.She is delighted that in a report to the Departmentfor Work and Pensions in July theIndustrial Injuries Advisory Council recommendedthat a lack of fibres “should not beused to exclude a diagnosis of asbestosis”.The report went on: “The occupational historyshould be the primary consideration in allcases.”MRS Tait, whose Darlington-born husbandBill died in 1968 of mesothelioma,fears a whole new generationof workers may be at risk of asbestos relateddiseases.Those considered to be at risk includeplumbers, gas fitters, carpenters, electricians,building and maintenance workers, and demolitionworkers, as well as ordinary peopledoing DIY in older homes.Asbestos removal did not develop as a specialised,licensed industry until 1980.The latency period also makes it impossibleto measure the effectiveness of asbestoscontrols; it is “still too short for the developmentof mesothelioma amongst these workersto be measured” acknowledges an HSE report“Estimating the Future Burden”.The report goes on to say that, while regulationshave controlled the presence of asbestos,it is “unreasonable” to assume that exposureto it in the UK is now zero.As long as asbestos still exists and peopleare exposed to it at work, or at home, the riskto health continues.ASBESTOS-RELATED CONDITIONSMalignant mesotheliomaALTHOUGH a rare form of cancer, mesothelioma isthe disease most commonly connected withasbestos because it’s almost always caused byexposure to the substance, the body’s normaldefences being unable to expel its small, sharpfibres. It’s a malignant and aggressive tumour thatgenerally affects the thin surface membrane of thelungs (pleura) although it can also affect theabdomen (peritoneum) or the heart (pericardium). Itcan be caused by only a few months exposure tolow levels of asbestos – even one fibre can kill.Onset is usually longer than ten years from thedate of exposure (the ‘latency’ period) but deathusually occurs within 12-18 months from diagnosis.There is no cure.Symptoms: pain in the lower back or side of thechest, a persistent cough, shortness of breath, ahoarse or husky voice, weight loss, sweating andfevers and difficulty swallowing.AsbestosisFIBROSIS scarring of the lungs from substantialexposure to asbestos resulting in reduced oxygenuptake to the bloodstream. Asbestosis can take 20years or more to develop following exposure toasbestos. It may damage the function of the lungsso much that the condition progresses to respiratoryfailure.Symptoms: increased breathlessness, especiallywhen exercising, coughing, chest pain and tightnessin the chest; sometimes nail abnormalities andclubbing of the fingers.Asbestos-related lung cancerIT is officially recognised that asbestos exposure cancause lung and other cancers becauseepidemiological studies of asbestos worker deathsshow a high lung cancer rate. However, it’s verydifficult to say whether a specific cancer, other thanmesothelioma, was caused by asbestos exposure.This is complicated further if the sufferer was asmoker at any time in their life.Diffuse pleural thickeningA BENIGN lung condition that occurs when the liningof the lung, the pleura, hardens as a reaction toasbestos fibres. It can develop on one or both of thelungs. In severe cases it can restrict breathing.There is no cure and it can reduce the quality of lifewith extreme cases being life threatening.
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