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The WHO was late in recognizing the epidemic and failed to act decisively after it was well under way. The WHO and the ILO continue to fail to address the problem of asbestos mining, manufacturing, and use and world trade of a known human carcinogen. Part of the problem is that the WHO and the ILO have allowed organizations such as the International Commission on Occupational Health (ICOH) and other asbestos industry advocates to manipulate them and to distort scientific evidence. The global asbestos cancer epidemic is a story of monumental failure to protect the public health. Key words: amosite, asbestos, asbestos cancer epidemic, chrysotile, crocidolite, ICOH, ILO, international occupational health, lung cancer, mesothelioma, WHO. Environ Health Perspect 112:285-290 (2004

The Cost of Failure to Act
Occupational exposures to asbestos constitute a major health hazard in all industrialized countries of the world. Peto et al. (1999) predicted that deaths from mesothelioma among men in Western Europe would increase from just over 5,000 per year in 1998 to about 9,000 by the year 2018. In Western Europe alone, past asbestos exposure will cause a quarter of a million deaths from mesothelioma over the next 35 years.

The number of lung cancer deaths caused by asbestos is at least equal to the number of deaths from mesothelioma. The ratio may be much higher than 1 to 1, with some reports suggesting up to 7 to 1 (Howie 2001), so there may be more than a half million asbestos cancer deaths in Western Europe over the next 35 years (Peto et al. 1999). In Sweden, Jarvholm et al. (1999) have reported that the number of deaths caused each year by malignant mesothelioma is greater than the number of deaths caused in that country by all workplace injuries.

Worldwide, many millions of workers have been exposed to asbestos in the workplace. About 20-40% of adult men report some past occupations and jobs that may have entailed asbestos exposures at work (Goldberg et al. 2000; Tossavainen 1997). In the most affected age groups, mesothelioma may account for 1% of all deaths (Peto et al. 1995). In addition to mesotheliomas, 5-7% of all lung cancers can be attributable to occupational exposures to asbestos (Tossavainen 2004). A number of studies have projected the premature deaths that will result from the asbestos cancer epidemic (Goldberg et al. 2000; Howie 2001; Jarvholm et al. 1999; Peto et al. 1999; Tossavainen 1997, 2000, 2004; Tossavainen and Takahashi 2000). The ILO has taken the incidence of asbestos-related cancer in Finland and extrapolated it to the world worker population, resulting in an estimate that at least 100,000 and maybe as many as 140,000 workers die each year from asbestos exposures resulting in cancer (ILO 2003). When the various estimates from this and other studies are extrapolated to include the world population, they project that the asbestos cancer epidemic will cause 5-10 million deaths, past and present (Leigh 2001).

 In this conservative estimate, it is assumed that asbestos exposures are going to cease and that the epidemic will run itself out, but the world's production of asbestos, which went down by half in the 1990s, seems to have stabilized at around 2 million tons/year in 2001-2002, and further progress is far from assured. There is no indication at this time that a global ban on asbestos is likely to be accepted by all countries, and international enforcement of a ban on asbestos is unlikely to occur. In developing countries, where little or no protection of workers and communities is taking place, the asbestos cancer epidemic may be even more devastating and may continue indefinitely.

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