Attempts to regulate and even ban asbestos were thwarted for decades by industry; but lawsuits and labor leaders have helped enact rules to limit the devastating risks of asbestos exposure.

For much of the 20th century, asbestos was hailed for its versatility—fire resistance, insulation, and strength—leading to its incorporation into thousands of products, from building materials and automotive parts to textiles and even some consumer goods. 

But the microscopic, needle-like fibers that made asbestos so useful also made it profoundly dangerous when inhaled. The ensuing public health crisis has prompted decades of regulatory action worldwide. But with a foe as insidious and persistent as asbestos, the crucial question remains: what aspects of these regulations have genuinely worked to protect human health?

A recent resource provides a valuable lens through which to examine this question, particularly within the context of ongoing workplace exposures. While focused on the Turkish regulatory landscape, its findings and discussion points resonate with the global challenge of managing this enduring threat: latency and legacy.

The Twin Specters: Latency and Legacy

Understanding the nature of asbestos-related diseases (ARDs) is critical to appreciating the regulatory challenge. Conditions like asbestosis (a scarring of lung tissue), lung cancer, and mesothelioma (an aggressive cancer of the lining of the lungs or abdomen) have long latency periods. This means that individuals exposed to asbestos fibers may not develop symptoms or be diagnosed for 10, 20, 30, or even 40+ years after their initial exposure. This long delay often means that by the time a disease is identified, the exposure responsible occurred in a less-regulated past, and the damage is already done.

Compounding the issue of latency is the vast legacy of asbestos. Decades of widespread use mean that countless tons of asbestos-containing materials (ACMs) remain embedded within our built environment – in older homes, schools, public buildings, industrial facilities, and ships. This “locked-in” asbestos is generally considered safe if undisturbed and in good condition. However, when these buildings are renovated, demolished, or simply deteriorate over time, the fibers can be released into the air, creating new exposure risks for workers and, potentially, the public.

The treatment-resistant nature of many ARDs, particularly mesothelioma, further elevates the urgency of prevention. Once inhaled, asbestos fibers, due to their physical structure, can become deeply lodged in lung tissue. The body’s attempts to dislodge or break them down are often futile and can trigger chronic inflammation and cellular changes leading to cancer. There is no known way to effectively remove asbestos fibers from the lungs once they are embedded. Mesothelioma, in particular, has a grim prognosis, with limited effective treatment options, making prevention the only truly viable strategy.

Regulatory Strides: What Has Made a Difference?

Despite these formidable challenges, regulatory efforts over the past few decades have undeniably made a significant impact, especially in reducing new large-scale occupational exposures. Key approaches that have proven effective include:

  1. Bans and Prohibitions: 

The most decisive regulatory action has been the outright ban on the mining, importation, manufacture, and use of asbestos. Many developed countries, including those in the European Union and Australia, implemented comprehensive bans starting in the late 1990s and early 2000s. Turkey, as noted in the İksad paper, officially banned all types of asbestos in 2010. These bans are crucial in stopping the introduction of new asbestos into the market and environment, thereby preventing future primary exposures. 

  1. Strict Controls on Handling Existing Asbestos: 

Recognizing the legacy problem, regulations have been established to manage ACMs in situ and during disturbance. This includes:

  • Licensing and Certification: Requiring specialized training and licensing for asbestos abatement contractors and workers ensures that those handling and removing ACMs have the knowledge and equipment to do so safely.
  • Safe Work Practices: Mandating specific procedures for asbestos removal, such as wet methods to suppress dust, enclosure of work areas, use of negative air pressure units, and proper personal protective equipment (PPE) like respirators and disposable coveralls. The Turkish study highlights the importance of such “technical and hygienic measures.”
  • Risk Assessment and Management Plans: Requiring building owners and employers to identify ACMs, assess their condition, and develop management plans to either safely maintain them or schedule their removal.
  1. Worker Training and Education: 

Regulations mandating comprehensive asbestos awareness and task-specific training for workers who may encounter ACMs have increased understanding of the risks and safe handling procedures. The İksad paper emphasizes that “employees should be informed and trained about all risks…and protection methods.”

  1. Air Monitoring and Exposure Limits:

 Establishing permissible exposure limits (PELs) for airborne asbestos fibers and requiring regular air monitoring during abatement activities helps ensure that control measures are effective and workers are not being overexposed. The Turkish study notes the legal obligation for employers to “ensure that the asbestos concentration in the air…does not exceed the limit value.”

  1. Health Surveillance:

Implementing medical surveillance programs for workers historically or currently exposed to asbestos allows for early detection of ARDs, though it doesn’t prevent them. This can include regular lung function tests and chest X-rays. The Turkish paper points to “health surveillance” as a key element of their OHS regulations.

  1. Waste Disposal Regulations: 

Strict rules for the packaging, transportation, and disposal of asbestos waste in designated landfills prevent the re-release of fibers into the environment.

Improvements Over the Past Two Decades

The cumulative effect of these regulatory approaches over the past two decades has led to tangible improvements:

  • Reduced New Occupational Exposures in Regulated Industries: While ARD statistics still reflect past exposures due to latency, the incidence of new high-level exposures in industries that historically used asbestos (e.g., manufacturing, shipbuilding with new asbestos) has dramatically fallen in countries with strong regulations.
  • Professionalization of Abatement: The “cowboy” era of uncontrolled asbestos removal has largely given way to a more professionalized abatement industry, at least in well-regulated regions.
  • Shift in Building Practices: New construction largely avoids asbestos, and there’s a greater focus on identifying and managing asbestos during renovations of older buildings.

Ongoing Challenges Highlighted by the Turkish Study and Beyond

The İksad study, while acknowledging Turkey’s legal framework, implicitly and explicitly points to areas where challenges persist – challenges mirrored globally:

  1. Legacy Asbestos in Demolition and Renovation: This remains the primary source of ongoing exposure. As the paper notes, exposure risk is high in “repair, maintenance, demolition of buildings, facilities, and ships containing asbestos.” Ensuring compliance with safe work practices in these often fragmented and smaller-scale operations is difficult.
  2. Naturally Occurring Asbestos (NOA): Some regions have naturally occurring asbestos in soil and rock. Construction, road building, or even recreational activities in these areas can release fibers if not properly managed, a risk often less regulated than industrial asbestos.
  3. Enforcement and Compliance: Regulations are only as effective as their enforcement. Inadequate inspection resources, lack of awareness among smaller contractors or DIY renovators, and deliberate non-compliance can undermine even the best rules. The Turkish paper’s call for “necessary inspections” underscores this.
  4. Global Disparities: While many developed nations have strong regulations, some countries still use asbestos or have weaker enforcement, leading to ongoing exposures and the potential for ACMs to enter the global supply chain.
  5. The “Invisible” Threat: Because asbestos fibers are microscopic and have no smell or taste, workers or homeowners may be unaware of their presence or the risks they face during activities that disturb ACMs.

The Turkish study’s recommendations – emphasizing comprehensive risk assessment, adherence to exposure limits, provision and correct use of PPE, continuous training, health surveillance, and proper waste management – are not new. They reflect established best practices. The fact that an academic paper is reiterating these points in 2024 (publication year on PDF) indicates that consistent implementation and vigilance remain crucial, even in countries with established bans.

Progress Made, Vigilance Required

So, what asbestos regulations have worked? Bans on new asbestos use have been the most impactful long-term strategy, stemming the tide of new material entering our environment. Coupled with stringent controls on handling existing asbestos, robust worker training, and health surveillance, these measures have significantly reduced the risk of high-level occupational exposures compared to the mid-20th century. The improvements over the past two decades are real.