Hellenic Asbestos Conference

As the first public event to address the Greek asbestos legacy, the Hellenic Asbestos Conference attracted wide support and media interest, putting asbestos firmly on the national agenda. The conference was organized by the Hellenic Thoracic Society and the International Ban Asbestos Secretariat (IBAS) in collaboration with the Greek General Confederation of Labor and the Greek Society of Occupational and Environmental Medicine. The participation of delegates from diverse subject disciplines ensured that this was not a run-of-the-mill academic gathering. Greek trade unionists, medical specialists, general practitioners, medical students and others discussed a range of asbestos-related topics with doctors, scientists, lawyers, architects, victim support workers and campaigners from sixteen countries. The difference of opinions and clash of viewpoints that occurred produced a vibrant atmosphere in which constructive discussions took place.

Setting the Scene

At a press briefing on October 29, Professor Panagiotis Behrakis, President of the Hellenic Thoracic Society and President of the Conference, told reporters that the purpose of the forthcoming meetings was to explore the repercussions of occupational and environmental asbestos exposure in Greece and identify ways of minimizing risks. He said that the scientific and medical communities have an obligation to raise asbestos awareness amongst at-risk groups and the public. Laurie Kazan-Allen, the Coordinator of IBAS, pointed out that in the 1990s, Greece was the 7^th largest asbestos producer in the world with the chrysotile (white asbestos) mine in Kozani, Northern Greece producing an average of 70,000 metric tons a year. Although most of the asbestos was exported, some of it was used in asbestos-cement factories in Greece. The fact that Greece was both a producer and user of asbestos might explain why it is one of only two European Union Member States not to have banned asbestos. Mrs. Kazan-Allen hoped that the meeting would stimulate the national debate on asbestos.

Categorizing the legacy of asbestos as an "invisible public health disaster," Dr. Barry Castleman, an eminent U.S. scientist, told reporters that a national asbestos strategy requires:

Information – labeling of asbestos-containing products, government information campaigns and surveillance of exposed workers (including the setting up of cancer registries);
Regulation – control of asbestos exposures experienced by workers, consumers and the public;
Compensation – the pursuit of financial compensation by injured workers is a basic human right and one way of ensuring that employers take precautions; lack of legal redress for the injured results in workers and their families bearing the burden of financial deprivation and failing health caused by asbestos-related diseases; this is often referred to as "the externalization of costs;" when companies are made to foot the bill for loss of earnings and damaged lives, the use of safer alternatives becomes a more attractive commercial proposition.

According to Dr. Castleman, the scale of the asbestos tragedy in the U.S. is huge; one American dies from an asbestos-related disease every hour. In Europe there will be at least 500,000 deaths from asbestos cancer in the current thirty-year period. There is no doubt that people in Greece will die from these diseases. To illustrate this point, Dr. Castleman introduced a young doctor who was assisting Professor Behrakis with the translations during the press conference; one of the doctor’s relatives had recently been diagnosed with mesothelioma, a type of asbestos cancer. It was believed that his exposure to asbestos took place during his years in the merchant navy; he died the day after the press conference.

Opening Ceremony

The opening ceremony of the conference was held during the evening of October 29 and included a short program of speeches, followed by the opening of a photographic exhibition and a gala reception.

Welcoming delegates to the first session of the conference, Professor Behrakis emphasized the need for doctors to be involved in discussions with the Government, the Trade Unions and the injured. He expressed the gratitude of all the delegates when he thanked Dr. Andreas Martinis, the President of the Hellenic Red Cross, for making the splendid conference facilities at the Henry Dunant Hospital available.

Professor Stavros Constantopoulos, one of the key organizers of the conference, expressed his satisfaction at the broad range of support which the conference had received and thanked Laurie Kazan-Allen, the IBAS Coordinator, for her role in this event.

The representative of the Greek General Confederation of Labor, Andreas Kollas, said that too often Greek trade unionists die from asbestos-related diseases just as they retire. Although the Greek asbestos mine in Kozani is now closed, Mr. Kollas confirmed, the asbestos-cement factory in Thessaloniki will stay open until the EU 2005 asbestos deadline. It was unfortunate, the trade unionist said, that Government agencies responsible for protecting workers and the public from exposure to asbestos have not yet acted in an effective and coordinated manner.

Conference delegates were delighted to hear the speech by Professor Evangelos Solinareos, an eminent doctor who has been studying occupational disease in Greece for decades. Professor Solinareos recalled some of his cases and spoke of unsuccessful attempts to conduct X-ray examinations of workers, most of whom were in fear of losing their jobs.

The Global Campaign to Ban Asbestos was the title of the speech made by Ms. Kazan-Allen. Detailing, the growth of the anti-asbestos movement, she said:

"Asbestos has been a global industry for one hundred years. For over fifty years, international asbestos producers have used the considerable resources at their disposal to maximize sales and generate profits despite mounting evidence that exposure to asbestos caused disabling and fatal diseases. Public relations campaigns were mounted to persuade workers, the public, the media, scientists and politicians that asbestos products could be used 'safely' under ‘controlled’ conditions."

Ms. Kazan-Allen reported that Chile, Argentina, most of Western Europe and much of Brazil have now prohibited the use of chrysotile, other forms of asbestos having been banned previously. This year Australia, Spain, Luxembourg and the Slovak Republic plan to ban it. Most of the Eastern European countries poised to join the EU plan to ban chrysotile by the 2005 EU deadline. In April 2002, a new group called BANI: the Ban Asbestos Network of India was formed. BANI’s primary objective is an immediate ban on the import, use, manufacture and trading of all forms of asbestos and asbestos products. In the United States, proposals to ban asbestos were announced on June 18, 2002 by Senator Patty Murray in the Congressional bill entitled: Ban Asbestos in America Act. In Asia and the Far East, the situation is changing. Singapore’s strict asbestos regulations constitute a de facto ban. The Government of Vietnam has announced plans to ban chrysotile in 2004. High-level discussions about unilateral bans are proceeding in Japan and Malaysia.

Senator Bob Ruers, a founding Member of the Dutch Asbestos Victims’ Group and a lawyer specializing in asbestos litigation, described how asbestos victims, working closely with politicians and legal advisers, revolutionized national procedures. The previous system ensured that asbestos claims were rejected; nowadays compensation claims for workers, their families and the public are routinely paid by negligent corporations and Government agencies. Senator Ruers discussed the concept of double standards; explaining that in Holland, former workers of the multinational corporation Eternit are compensated while in Belgium, they are not. The discrepancy in this treatment of victims is unacceptable and a project is underway to compile data on the worldwide treatment of Eternit asbestos victims with a view to forcing the company to act responsibly in every country in which it’s operations produced asbestos-containing products and asbestos victims.

As delegates entered the conference hall, they passed an exhibition of the work of South African photographer Hein du Plessis. His startling black and white photographs depict the impact of asbestos on people in South African towns that have been decimated by asbestos disease and pollution. For decades, the British multinational, Cape Asbestos Co. Ltd., owned asbestos mines and processing facilities in the towns of Prieska and Koegas. A long-running legal action by 7,000 South African asbestos claimants has been dragging through the UK courts for years. A £21 million (US$31.5 million) settlement agreed in December 2001 has not been honored by the company and the claimants returned to court in October 2002 to recommence proceedings. Hein du Plessis explained his involvement with the case; his use of first person captions on the photographs was a deliberate attempt to give a voice to those no longer able to speak.

Opening the exhibition, Dr. Sophia Kisting, who works with South Africans affected by asbestos, spoke eloquently of their dignity, expressing the hope that their struggle would not be forgotten.

Plenary Sessions - October 30, 2002

During the first session on Wednesday morning, a panel of speakers addressed the situation relating to occupational asbestos exposure in Greece. Several salient facts were revealed during the presentations:

there is no registry of asbestos-related diseases at the Ministry of Health or Ministry of Labor; no independent epidemiological studies have been carried out in Greece;

aside from research relating to "Metsovo Lung," there has been little medical research done on asbestos in Greece with few papers appearing in international journals;
there is no coordination amongst Greek government agencies responsible for various asbestos-related issues, such as occupational health, consumer protection and the environment – "the system does not work;"
there is no government agency responsible for the health of retired workers exposed to asbestos during their careers;
there is no medical follow-up of retired workers;
according to trade union representatives, workers identified asbestos problems decades ago but doctors refused to act; doctors claimed that medical research on asbestos problems was delayed by lack of worker participation and speculated that fear of unemployment, prevented workers from submitting to medical examinations;
Greece has the lowest rate of occupational disease in the European Union! Considering traditional working practices and the almost total absence of preventative measures, it is obvious that this statement does not accurately reflect the true incidence of occupational disease in Greece.

Several interesting points were raised from the floor:

in light of the EU 2005 deadline, some Greek companies have plans to produce fiber-cement with alternative materials; no additional information on this was available;
the results of a proposed study by the Ministry of Labor on the effects of asbestos exposure on fiber-cement workers are compromised by using company doctors to examine workers; occupational physicians cannot be paid by industry if they are to regard workers’ health as the top priority;
the Public Power Corporation in Greece used asbestos as did the railways; although further information is unavailable at this time, it is clear that secondary asbestos use occurred in the textile and building materials industries; the human repercussions of asbestos exposure remain invisible;
a speaker, believed to be a member of a trade union, complained that the purpose of this meeting was to "terrorize people;" he commented that the alternatives to asbestos are not trusted;
Dr. Metoda Dodic-Fikfak from Slovenia said that although her country banned asbestos in 1996, hundreds of people are still being occupationally exposed to asbestos; before 1998, there were no asbestos claims from injured workers; since the national debate on asbestos began, the number of claims has grown; until there is a public debate on these issues, the problems will remain invisible;
random findings and anecdotal evidence collected by Greek experts cannot replace coordinated Government action on asbestos; pressure must be brought to bear on state agencies.

Dr. Ken O’Byrne, Chairman of the British Mesothelioma Interest Group, discussed his experience at the Leicester Royal Infirmary. Many of the mesothelioma patients are retired, but there are a significant number of men in their 40s and 50s. The median survival rate for mesothelioma patients is 6 months. The earlier a diagnosis is made, the greater the chance that surgery could be considered. Dr. O’Byrne outlined the research by his department into the suppression of the immune response by mesothelioma but said that the lack of UK funding for mesothelioma research means that not enough work is being done in this field.

The next presentation – Environmental and Low Dose Exposure to Asbestos and Risk of Mesothelioma – continued the discussion of mesothelioma.

This paper was presented by Dr. Gunnar Hillerdal from the Department of Lung Medicine at the Karolinksa Hospital in Stockholm and analyzed the risk to the general public. Dr. Hillerdal said that because even low exposure can cause mesothelioma, it is important to continue phasing out asbestos in our surroundings: "Any source of asbestos releasing fibers in the environment should be identified and eliminated in a safe way. Correct handling is essential in reconstruction or destruction of asbestos-containing buildings." Dr. Hillerdal’s assertion that pleural plaques are symptomless was hotly disputed by Dr. Dodic-Fikfak and others who cited examples of pleural plaque patients with pain and breathing difficulties. The discussion on this topic continued in the medical workshop.

A paper entitled The Global Use of Asbestos and Incidence of Mesothelioma showed the correlation between past asbestos consumption and the incidence of mesothelioma in industrialized nations. Dr. Antti Tossavainen, from the Finnish Institute of Occupational Health, said: "The results (of the research) indicate that the national use of 2.8 kg per capita will induce about 18 mesothelioma cases/million people, i.e. 170 tons of produced and consumed asbestos will cause one death from pleural or peritoneal mesothelioma." Although less than 0.1 kg/capita/year of asbestos is now used in Western Europe and North America, 3.4 kg/capita/year is consumed in Russia. Nowadays, 70% of the asbestos produced worldwide is used in Eastern Europe and Asia; the vast majority is used for low cost asbestos-cement building materials. While the disease rate could peak in Western countries around 2010-2020, Dr. Tossavainen says "no reliable incidence data are available for the developing countries in Asia, Africa and South America."

Occupational Hygienist Robin Howie from Edinburgh, Scotland addressed: Asbestos Issues in the Eastern Mediterranean.

Asbestos was mined in Cyprus, Greece, Bosnia, Herzegovina, Bulgaria, Serbia and Montenegro. According to the United States Geological Survey, the processing of 64 tonnes of Greek ore was required per tonne of asbestos fiber produced. During the 1990s, average production at the Kozani chrysotile mine in Northern Greece was 70,000 tonnes a year; this means that over seven years, 32 million tonnes of ore were processed to produce 490,000 tonnes of asbestos. Given the long latency period of mesothelioma and the fact that production at the mine did not commence until the early 1980s, the results of this exposure may not yet have become apparent. Howie asked what steps have been taken to control fiber release from the mine tailings in Kozani?

The younger the age at which someone is exposed to asbestos, the greater the risk that the disease will occur. Howie’s calculations show the following mesothelioma risk:

Relative risk of developing mesothelioma by age 70 due to 5 year exposure starting at various ages.

Starting Age	55	35	20	0
Risk	1	17	53	152
From Doll and Peto (1985)

Unlike occupational asbestos exposure, the risk from environmental exposure is continuous; individuals may be exposed for 24 hours per day, 365 days per year therefore "environmental fiber exposures must be stringently controlled to minimize risk."

Laurent Vogel from the European Trades Union Council (ETUC) performed a semi-miracle by making the legislative process of the European Union (EU) understandable in his talk on Asbestos Developments in Europe: A Trade Union Perspective:

"The ban of asbestos has been at the same time a fight of trade unions and a fight within trade unions for an independent working class perspective against a certain type of social partnership with employers which is based on pure blackmail."

Having taken us through the genesis of the EU asbestos ban, Mr. Vogel focused on recent developments. In September, 2002, the Council of Ministers adopted a working text that revises aspects of EU asbestos regulations. Although the trade and import of asbestos and asbestos-containing products are banned within the EU (all EU member states must comply by 2005 with the 1999 Directive which banned asbestos), there is ambiguity on whether the mining and export of asbestos from the EU to external countries is permitted. The ETUC is pushing for clarification on this and other points such as the EU position on sending asbestos-contaminated ships to Asia for stripping, the sub-contracting of skilled asbestos removal work to unqualified companies, proposed revisions in the notification procedure which mean that whereas previously companies had to name the people who would be exposed before asbestos work began, now companies only need provide an estimate of the number of people likely to be exposed. The speaker called for:

national public health registers of mesothelioma;
registers of exposed people;
the addition of asbestos-related lung cancer and larynx cancer to the EU list of proscribed occupational diseases (this move, vigorously resisted by employers, is currently only being supported by the French).

Due to unforeseen circumstances, the timetable was altered so that the next speaker was Dr. Sophia Kisting. Discussing South Africa’s Asbestos Legacy from the Perspective of Sick Workers, Dr. Kisting said that her country’s asbestos problems were a microcosm of other national challenges. In 1999, the South African Government convened The Asbestos Summit in Johannesburg, bringing together a range of stakeholders including workers, trade unions, government officials, community groups, mining and asbestos companies. While discussions at these meetings were productive, progress has been slow due to a lack of resources. The negotiated settlement reached in December, 2001 in the case brought by South African asbestos claimants against the British company, Cape plc had given hope to thousands of people in asbestos-contaminated communities. Four months after the money was due and ten months after the settlement had been agreed, no payment has been received leaving impoverished and ill workers in great difficulty.

The choice of topic by Asbestos Consultant Andy Oberta was particularly relevant to Greece - a country in which asbestos-cement products are still being manufactured. The case study An Asbestos-Cement Plant in Israel: Contamination, Clean-up and Dismantling detailed Mr. Oberta’s involvement with a project in the City of Nahariya, Northern Israel.

For nearly fifty years, amosite, crocidolite and chrysotile had been used at this site during the manufacture of asbestos-cement pipes and sheet products. The factory owners distributed asbestos waste to local people for use on their driveways, paths and farms throughout western Galilee. Although the plant shut in 1997, friable and non-friable waste material was still lying on the beach and by the roads which bordered the factory site. Town councilors thought a good use for the area would be a children’s amusement park and plans were developed to build this tourist attraction. A series of photographs illustrated the hazards of such a plan and Mr. Oberta explained the process by which negotiations with the Israeli Ministry of the Environment and local people resulted in the rejection of this idea.

Occupational Health and Safety Officer Lars Vedsmand has worked on asbestos issues since 1978. In his presentation – Asbestos Training Program of Danish Trade Union – Mr. Vedsmand explained that although a Danish professor wrote a book about asbestos in 1948, no one warned the insulation workers of the hazards for another twenty years. An autopsy conducted in 1952 on an insulator who had worked with sprayed asbestos in the shipyards found asbestos in his lungs. By 1954, a program had been set up to clinically examine insulators. The union campaigned for insulators to receive compensation for their asbestos injuries. There have been asbestos lawsuits in Denmark; one case against an asbestos-cement company went all the way to the Supreme Court. The company was found liable for failing to inform the worker of the hazards of asbestos.

Despite the fact that all forms of asbestos have been banned in Denmark for more than a decade, people are still dying and will continue to die from these diseases. To prevent more needless deaths, the union works with international groups such as the International Federation of Building and Woodworkers, which coordinates the efforts of 283 trade unions with 11 million members in 124 countries, and the International Confederation of Free Trade Unions to lobby for a global ban on asbestos. Within Denmark, the union promotes awareness of the risks through its training courses. In Denmark, anyone whose work involves the risk of contact with asbestos is required to take a 4 day training course which covers information on the history and health risks of exposure to asbestos and practical guidelines on the recognition of asbestos-containing building materials and asbestos management techniques.

Argentinean Architect Susana Mühlmann has been involved in a high-profile asbestos project in Buenos Aires for nearly two years. The derelict asbestos-contaminated twenty-one story building which used to be the Caseros Jail is located close to several hospitals, one of which, Hospital Garrahan, is the country’s top children’s hospital. The army’s plans to demolish the building through a controlled implosion were stopped after objections from the Ministry of Health and asbestos experts who were concerned at the levels of environmental pollution which would be caused. Subsequently, the Government of Buenos Aires began an asbestos removal project. Photographs from the first site visit to the jail show inspectors wearing ordinary street clothes; by the second visit, all the inspectors were in protective clothing and masks.

This year, Architect Mühlmann has taken asbestos training courses in Germany and the U.S. The photographs of the equipment and explanation of the procedures used in both places were informative. Ms. Mühlmann said the asbestos removal procedures were tiring, heavy, hot and uncomfortable. In Germany, work is done in two-hour shifts; although the German system is more expensive, it is quick to assemble and the use of alarmed doors provides workers with an additional safeguard. The U.S. system used airlocks and triple doors made of plastic; Ms. Mühlmann found walking through the plastic surprisingly arduous and tiring. Having compared these two systems, the Government of the City of Buenos Aires has decided to adopt elements from both.

Conference Dinner

The conference dinner was held at the Dionysus Restaurant facing the Acropolis. The delicious food and wine gave delegates an opportunity to experience Greek cuisine whilst enjoying a panoramic view of one of the world’s most famous sites. As one delegate said, it looked too good to be true! As you can see from the background in the photograph taken by Hein du Plessis, it really was breathtaking!

Workshop Sessions - October 31, 2002

Medical Workshop

Professor Stavros Constantopoulos discussed the identification and spread of the condition known as "Metsovo lung." Clusters of mesotheliomas found in the town of Metsovo, Northern Greece were traced to the bi-annual custom of using crushed rock, imported from an area 20 kilometers from Metsovo, to make a whitewash for application to domestic interiors. The crushing produced 200 asbestos fibers/cm³; the rock contained chrysotile (white asbestos) heavily contaminated by tremolite. This lethal practice was widely used until the 1950s. After a big public health campaign, this practice has ceased. In Central and Southeastern Anatolia, Turkey whitewash containing tremolite also produced a mesothelioma epidemic amongst the local population.

Greek researchers have identified a peculiar phenomena amongst people from Metsovo. Examinations by CT scan showed that hardly any mesothelioma patients had calcifications; patients with calcifications did not have mesothelioma. Professor Constantopoulos said that the division of the Metsovites into two groups, those with mesothelioma and those with calcifications, led medical researchers to wonder whether patients with calcifications produced more killer cells thereby enjoying greater protection against neoplasia. Attempting to explain this discrepancy, researchers are now investigating the role of macrophages.

Dr. Ken O’Byrne discussed the diagnosis and treatment of mesothelioma in the UK. Currently there are 1600 mesothelioma deaths every year; epidemiologists predict this figure will rise to 3,000 in the next twenty years. This is three times the number of UK deaths from cervical cancer. Mesothelioma diagnosis is essentially a diagnosis of exclusion of other tumors. Symptoms include dyspnoea, chest wall pain, weight loss, night sweats and loss of appetite. Patients often experience pleural effusions. The median survival rate is 5-10 months. Dr. O’Byrne’s team does surgical biopsies in the majority of cases. UK drug trials for the treatment of mesothelioma were discussed; the lack of Government funding for research has been constant.

Dr. Metoda Dodic-Fikfak, from the Institute of Occupational Medicine in Ljubljana, Slovenia, presented: The Amphibole Theory - A Nested Case Control Study of Workers Exposed to Asbestos in Salonit Anhovo.

Research conducted at the asbestos-cement plant Salonit Anhovo was the basis for the comparison of lung cancer risk from exposure to chrysotile and amphiboles. The researchers utilized historical exposure data from the factory’s files to analyze the lifetime exposures to chrysotile and amphiboles of fifty-eight workers who contracted primary lung cancer from 1964 -1994 and nearly 300 controls. It was concluded that: "Workers who were exposed only to chrysotile had (a) two fold risk of getting lung cancer after 35 years of latency…. The smoking effect was as expected: workers from the cohort who had smoked had 3 times higher risk of getting lung cancer than non-smokers…" The investigations will continue for another 10-15 years in order to study "cases relevant to the period of heaviest exposure in the 1970s and 1980s."

Dr. Antti Tossavainen of the Finnish Institute of Occupational Health discussed The Helsinki Criteria: guidelines for diagnosing asbestos-related diseases which were agreed in 1997 by nineteen experts from eight countries not producing asbestos. The deliberations took place during The International Expert Meeting on Asbestos, Asbestosis, and Cancer convened in Helsinki on January 20-22, 1997. According to the Consensus Report published after this meeting: "In general, reliable work histories provide the most practical and useful measure of occupational asbestos exposure… The clinical diagnosis of asbestos-related diseases is based on a detailed interview of the patient and occupational data on asbestos exposure and appropriate latency, signs and symptoms, radiological and lung physiology findings, and selected cytological, histological and other laboratory studies." Using structured questionnaires and checklists, trained interviewers can identify people whose working histories are compatible with a two-fold risk of lung cancer. Since 1987, it has been possible to obtain compensation for asbestos diseases from the insurance system without going to court in Finland. Furthermore, the habit of smoking, which bars asbestos claims in many countries has, with the adoption of The Helsinki Criteria, become irrelevant for compensation purposes in Finland.

The Finnish Institute of Occupational Health² has published reports on the global use of asbestos including a 1997 paper on the Asbestos Symposium held in Hungary for Central and Eastern European Countries; the proceedings of the Asbestos Symposium for Asian Countries, held in Japan in September, 2002, will be published soon.

Dr. Tushar Kant Joshi, Director of The Center for Occupational and Environmental Health at Lok Nayak Hospital, New Delhi and a Fellow of the Collegium Ramazzini, presented his paper: Medical Issues Relating to Asbestos Diseases in India. The 110,000 workers in India being exposed to asbestos currently are part of an international trend: the transfer of asbestos manufacture from the West to developing countries. The current annual consumption of asbestos in India is 125,000 tonnes, the majority of which is imported from Canada and Russia to make asbestos-cement products such as pipes and sheets. In Morocco, about 150 firms import 8,500 tonnes of Canadian asbestos annually. In India, locally produced tremolite is still being used. Government plans to restrict its use are likely to be abandoned. The use of asbestos in India is "virtually out of control."

Trade Unionists and Asbestos Victims’ Workshop³

This session was chaired by Dr. Evangelos Alexopoulos, occupational health physician and consultant of the Greek General Confederation of Labor, who was one of the key facilitators of this conference.

Dr. E. Galanopoulou and Mrs. Stratigaki, from the Center of Occupational Health and Safety at the Ministry of Labor, began the workshop by explaining that the prevention of occupational exposure to asbestos is the responsibility of the Ministry of Labor; the supervision of asbestos disposal procedures comes under the Ministry of Environment. There is an overall lack of coordination between Greek agencies regulating asbestos matters. Precautionary measures for minimizing exposure to asbestos have come from EU regulation and have not been Greek initiatives. By Presidential Decree, the following are required:

written risk assessments based on airborne fiber levels;
adherence to EU limit values and action levels for chrysotile and the amphiboles;
written strategies by employers for preventing illegal exposures;
specified follow-up measures if these levels are exceeded including notification procedures;
pre-employment physical examinations and medicals for workers every three years;
companies involved in refurbishment and demolition work must train employees in the use of precautions, notify the authorities and remove asbestos-containing materials prior to the commencement of building work.

Some research on occupational asbestos exposure was done in Greece in the 1990s and there has been some improvement. Although the Greek asbestos mine has ceased operations, there are still two asbestos-cement factories employing 250 workers. These plants will close when the EU 2005 deadline comes into force. The lack of qualified laboratories in Greece for analyzing dust counts is a significant bar to the introduction of techniques for identifying asbestos materials within the Greek infrastructure.

Occupational Hygienist Robin Howie addressed the subject of Work with Asbestos Board - Estimate of Risk. Asbestos boards used in buildings include:

millboard: 25-50% crocidolite, generally very friable; in the UK mainly used for electrical work;
asbestos insulating board (AIB): 25-40% amosite, may contain chrysotile; used for fire protection of internal walls, ceiling tiles and soffits;

Using a battery powered drill to make twelve 4 mm diameter holes 10 mm deep, Mr. Howie produced 850,000 respirable amosite fibers. Breaking up one 1.2m x 2.4m AIB board and sweeping up the debris generated 5 billion respirable fibers.

AIB was often used in schools where teachers would pin students’ work on to the boards with drawing pins. The insertion and removal of 100 drawing pins into AIB produced 660,000 respirable fibers.

Fiber emission from AIB can be controlled with the use of wetting agents, sharp tools, good ventilation and shadow vacuuming during removal. Mr. Howie recommends high levels of personal protection such as the use of TMP³ when working with AIB⁴. The Protection Factor (PF) of 2000 quoted for TMP³ respirators is based on performance under laboratory conditions; the efficiency of these respirators is much lower in the workplace (PF 40!). This discrepancy emphasizes the need to suppress fiber production at source.

Dr. Christian Schepers, from the University of Dortmund, presented a case study entitled Handling Asbestos-Cement Products - Technical Rules and Removal Practices. In the construction of Dortmund University between 1968 and 1985 crocidolite and chrysotile-containing materials were used. The university’s asbestos strategy includes a protocol for asbestos-cement materials; once removed, the reuse of asbestos-cement products is prohibited. A long-term remedial program is underway based on German regulations: The Technical Rules for Hazardous Substances, available in English, which specify:

practices for renovation, demolition and maintenance work;
who can undertake asbestos work;
how airborne concentrations should be measured;
notification procedures to be followed and protective equipment to be used;
the provision of medical exams to at-risk workers.

As the author of the forthcoming ASTM⁵ Standard on Asbestos Control⁶, Asbestos Consultant Andy Oberta was well qualified to speak on The Development of Standard Practices for Work on Asbestos-Cement Products. Mr. Oberta discussed the uses of asbestos-cement in pipes and other products. Expressing concern about hazardous practices such as cutting, sanding and grinding during maintenance, renovation and demolition, he said that the dry cutting of a 1/8" sheet with a power saw created more than 10f/ml. The new ASTM Standard avoids a reliance on overly sophisticated equipment and stresses the need for training and the use of wet methods. Consultant Oberta invited conference delegates to participate in the international effort to develop standard practices for use with asbestos-cement products; his email address is: AndyObe@aol.com

Andreas Kollas, representing the Greek General Confederation of Labor, told of a long struggle by the trade union movement, especially in the shipyards, to obtain recognition of asbestos problems. The EU Asbestos Directive has been pivotal in forcing the Government to begin addressing union concerns. Mr. Kollas urged the country to adopt a policy of "Just Transition," so that new jobs are created to replace those lost through the banning of asbestos. He said that although the Greek Institute for Hygiene and Safety has begun an asbestos study in Northern Greece, more scientific research is needed; the Hellenic Asbestos Conference was a positive step towards raising awareness of asbestos problems in Greece.

Praising the asbestos study in Northern Greece, Occupational Physician Spiros Drivas offered to work with Mr. Kollas on this project.

Dr. Drivas said that in 1906 a journalist was dragged before the courts for criticizing asbestos practices in Greece; fortunately, he was absolved by the judge. For decades, mine workers, asbestos employees, shipyard workers and others were occupationally exposed to asbestos; the health of 150,000 workers was put at risk. When they got ill, many were fired; the lucky ones got disability pensions. All became unemployable. Questions about health problems arising from the use of asbestos began to surface in the 1970s; little was done. Dr. Drivas found only nine papers on mesothelioma in Greek medical literature. One exception to this information vacuum was a study of transport workers exposed to asbestos during repairs on brakes; clinical examinations confirmed that 30% of them had respiratory problems. Acting on these findings, their employer converted to non-asbestos brakes. Generally speaking, however, the trade unions did not have the support of the scientific community and, from comments made during the conference, it seems that there has been a serious lack of communication between doctors and trade unionists.

Acknowledging the widespread failure to diagnose asbestos-related diseases in Greece, Occupational Health Physician Stelios Papadopoulos called on doctors to take into account occupational asbestos exposure when making diagnoses. At-risk workers require medical examinations every three years, shipyard workers every two years. Physicians should inform their patients of all findings. Although a medical is required prior to retirement there is a poor follow-up of cases. Employers must accept the responsibility for assessing occupational health risks and the Government must ensure that risks are monitored and compensation is paid. The absence of qualified laboratories is a problem that needs remedying.

Danish trade unionist Lars Vedsmand warned that employers will seek cheap solutions to asbestos problems. He said that the gap between scientific knowledge and workers’ knowledge could be exploited by the employers; cooperation between physicians and trade unionists is crucial in the campaign to raise awareness. Epidemiological studies are essential to locate clusters of asbestos-related disease. Unions need to campaign for the adoption of a policy of "Just Transition;" experience in Germany, Denmark and France has shown that the shift to non-asbestos technology does not cost jobs. A global ban on asbestos is required to prevent multinational companies exporting dirty technology to less developed countries.

Due to a shortage of time, Laurent Vogel condensed his presentation Lessons from the WTO: The Defence of Health and Safety Standards at the International Level, pointing out that additional information on this case can be found on the ETUC website. Summing up the World Trade Organization (WTO) legal action brought by Canada against the French ban on chrysotile, Mr. Vogel said that:

Despite the victory (the asbestos ban was upheld), legal arguments were accepted which made national health legislation subservient to free trade rules.
This case emphasized that access to the WTO process is restricted to nation states; NGO involvement is discouraged by a series of barricades.
WTO procedures are shrouded in secrecy; WTO personnel are trade specialists with no scientific training.
National policy on occupational health should be decided by political democratic institutions not the world’s foremost bastion of free trade.

The President of the Union representing the asbestos mine workers, Mr. Evangelos Michos, and the President of the Union representing the asbestos-cement workers at Ellenit, Mr. Alekos Manousos, expressed anxiety over the loss of employment that the asbestos ban could produce; this needs to be addressed. There should be a provision for early retirement for Greek asbestos workers; unemployed asbestos workers should be retrained. Asbestos workers can obtain a pension at 50 years old but only if they have worked for the industry for fifteen years. Although there is now medical surveillance, examining doctors are asbestos company employees. The gap between theory and practice is exacerbated by low standards amongst some asbestos "professionals;" protective measures and asbestos legislation must be strictly implemented.

In the debate from the floor which followed, several interesting points were raised:

asbestos products hidden within the Greek infrastructure are a time bomb;
workers are reluctant to accept the advice of occupational health physicians, dismissing their warnings as interference;
Greek workers were the first group to identify the effects of occupational asbestos exposure; they paid for scientific investigations and held the first meetings on asbestos in the 1970s; they received no support from the medical community or the Government.

Plenary Sessions - October 31, 2002

Time and again, asbestos industry representatives have repeated the mantra of "controlled use," to justify the industry’s continued existence in the face of safer alternatives. Chrysotile can be used safely, they say; it is an irreplaceable and cheap material needed for providing clean water and public housing in developing countries. Scientist Barry Castleman explored The Fallacy of Controlled Use: "Really well-controlled use of asbestos has never existed anywhere in the world, and it isn’t being invented anywhere today." Paying particular attention to asbestos-cement (A-C) products which now account for over 90% of asbestos used worldwide, Dr. Castleman demonstrated the futility of attempts to control the hazards posed by these materials once they are in housing, schools, commercial, public and industrial structures:

"(In 1992) Japanese scientists reported quite high exposures… from field cutting of A-C pipe. Exposures from repair work on A-C pipes using high-speed disc cutters inside and outside of holes dug in the ground to gain access to the pipes were recorded as: 49-170 f/cc (mean value 92) inside the hole, and 1.7-15 f/cc outside. If this kind of extreme exposure has continued until so recently in Japan, it is reasonable to expect that it is widely prevalent in Asia and other parts of the world where A-C pipes are still widely used and there are little or no product stewardship efforts by manufacturers."

In his paper The Public Health Observatory for Asbestos-Related Disease: The Role of the Regional Health Systems in Greece, Dr. Christos Lionis described a pioneering scheme for data collection and dissemination of information on Crete. The objectives of the Public Health Observatory are to:

monitor public health and the incidence of certain diseases, highlighting problem areas;
draw together information from different sources;
identify the needs of the population and advise local health bodies;
develop a cancer registry using information resources such as death registries, hospital records, pathology reports, etc;
design and administer a website to disseminate health guidelines to physicians, public health workers and community health care workers;
make recommendations to doctors.

Preliminary research has found a very low incidence of asbestos-related disease amongst the island’s 700,000 population. Between 1992-1997, only 8 cases of mesothelioma have been identified.

Throughout the 20^th century, Australia mined and imported asbestos; in many areas, people lived in asbestos-cement houses. It is not surprising therefore that many Australians have contracted mesothelioma and asbestos-related lung cancer.

Solicitor Vincent Goldrick from Sydney discussed: Compensation for Australian Asbestos Claimants. Six sovereign States and two self-governing Territories make up the Federation of Australia; legislative control over workplace health and safety, workers’ compensation and the administration of the Courts remain with individual States: "The result is that the six Australian States all have different Court systems and compensation schemes with which to deal with the tragedy of Australia’s asbestos history."

Mr. Goldrick explained the unique system in New South Wales (NSW) which includes a specialist Court, the Dust Diseases Tribunal of NSW, to adjudicate and expedite asbestos claims. The Tribunal also hears claims for recovery between employers and asbestos suppliers, building occupiers, power station designers and others. In NSW, an asbestos case can come before the Court for directions within 1-2 hours of issue; usually, a hearing will take place in Court, at home or in the hospital within two days. It is routine for asbestos cases to be concluded within three months. In the past, defendants were able to delay court hearings by various means; these delays are no longer tolerated by judges. Measures which speed-up proceedings include: the use of evidence from previous cases, the adoption of the Helsinki criteria for diagnosing asbestos diseases and a standard date of knowledge, set at 1956, for big companies. NSW also has a compensation authority: the Workers Compensation Dust Diseases Board of NSW; this no-fault scheme pays pensions, medical expenses and death benefits and also funds medical research into dust diseases.

Dr. Annie Thebaud-Mony, a French sociologist and a founding member of the French Asbestos Victims’ Group (ANDEVA), spoke about improvements in the treatment of French asbestos victims since the setting up of ANDEVA in the mid-1990s.

Although support for this association came from a range of groups and institutions, the spark which lit the fire came from two sources: asbestos textile workers, mostly women, campaigning for asbestos compensation and teachers and students demonstrating against the presence of sprayed asbestos fireproofing throughout their university.

The success of ANDEVA is based on its roots as a social movement; there are 8,000 members of ANDEVA at 20 local branches. Acting as an umbrella group, ANDEVA:

supports victims, individually and collectively, in claims before social security panels and the courts;
exerts pressure on politicians to improve and enforce asbestos legislation;
cooperates with trade unions;
develops initiatives to further ANDEVA’s influence as a counter-power in dealings with the medical establishment, social security institutions, the civil service, employers and others;
lobbies domestically for the adoption of measures to prevent asbestos exposure and for improvements in the treatment of French asbestos victims (such as early retirement packages) and globally for an asbestos ban;
campaigns for an end to double standards such as the switch to non-asbestos technology in France (which followed the national asbestos ban) while French multinationals export dirty technology to developing countries.

The presentation How Dutch Asbestos Victims Changed National Laws by Solicitor Bob Ruers, a member of the Upper House of the Dutch Parliament and an asbestos specialist, began with the announcement of a revolutionary Dutch scheme that will start in January, 2003. After years of lobbying by victims, their lawyers and the Dutch Socialist Party, the Government has agreed to make interim lump sum payments of 15,000 Euros to mesothelioma claimants who were occupationally exposed to asbestos in professions deemed to be at-risk. As far as Mr. Ruers knows, this is the first such scheme in the world.

Much of the asbestos illness in the Netherlands is due to Eternit, a multinational company that has traditionally had a strong presence in Holland. Mr. Ruers gave details of successful asbestos cases brought by:

the wife of an Eternit worker who contracted mesothelioma from domestic exposure to the fibers brought home on his work clothes;
a 32 year old man whose Father worked for Eternit;
a 46 year old woman who died of mesothelioma; for six years, she washed the work clothes of her Father, an Eternit employee from 1953-84;
a 55 year old woman whose Father worked at Eternit;
a 48 year old woman who has just been diagnosed with mesothelioma; her Father worked at Eternit from 1946-1982.

Asbestos campaigner Laurie Kazan-Allen’s talk National Problems, Global Solutions compared the UK and Greek asbestos experience.

The cumulative UK asbestos death toll between 1926 and 1996 was put at 22,295 by the Government; an independent scientist calculated that the true figure is five times as high: 125,000 deaths. While there are no epidemiological data for Greece, it is undeniable that people will have died from asbestos-related disease in a country that has both mined asbestos and manufactured asbestos products.

Ms. Kazan-Allen said that as she arrived in Athens, she passed the Hilton Hotel which is, like many hotels in Greece, being refurbished in preparation for the 2004 Olympics. In 1963, when the hotel was built, 2,500 m² of a British fireproofing product, Sprayed Limpet Asbestos (SLA), was used in the main lobby, foyer, night club and Pan bar. The composition of SLA was 60% amosite (brown asbestos), water and cement. Was this material safely removed from the hotel? If not, is it still there; what effect is the building work having on the fiber levels at the hotel? SLA was used on railways in Greece and ships operated by the Niarchos Group including the World Glade, the World Glen, the World Dale and the World Mead; it was also used on the Eugenia Niarchos and the Spyros Niarchos, ships owned by the Neptune Tanker Corporation.

Ms. Kazan-Allen urged delegates to put pressure on the Government for an immediate ban on the use of asbestos in Greece. She proposed that a resolution be composed by delegates and sent to the Government, the International Labor Organization, the World Health Organization, the United Nations and the EU.

Conclusion

The Hellenic Asbestos Conference was a success on every level. The coverage of the event on TV, radio and in most of the quality newspapers came as a huge surprise. When taxi drivers begin to discuss a subject you know you have reached the mainstream. Tina Mosidis, an Australian Solicitor of Greek descent, was quizzed on asbestos by the taxi driver taking her to the conference who had heard about the meeting on the morning news. There was a real buzz of excitement amongst delegates and speakers. Among the questions raised in plenary sessions, in workshops, and during continual exchanges in coffee and lunch breaks were:

How can we make changes in a national system which is not meeting the needs of the Greek people?
How can Greek doctors access successful medical protocols which have been developed in other countries?
What can be done to foster cooperation amongst diverse Greek Ministries which cover asbestos-related issues such as the environment, public health and consumer protection?
How can public, trade union and professional awareness of the hazards of asbestos be raised?
What national remedies exist for compensation; what can be done to encourage the Greek legal community to act on this issue?

A proposal was made for an Italian asbestos conference by the Greek Consul to Torino who came to the Henry Dunant Hospital specifically to discuss this idea with the organizers of the Athens event. Discussions also took place about holding a meeting in the Far East, setting up a Greek Mesothelioma Interest Group, assembling a multinational asbestos photographic exhibition, and assisting Greek trade unions and occupational physicians to develop medical surveillance programs. Email addresses were exchanged and plans were made. A working party was designated to draft a resolution of the Hellenic Asbestos Meeting which will, when approved, be circulated at national and international levels. The hospitality of our hosts and the eagerness with which delegates engaged with their international colleagues made a lasting impression on all the participants. The Greek debate on asbestos has begun!

November 18, 2002

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¹This report has been compiled by Laurie Kazan-Allen; her omission of particular speakers is not a reflection on the quality of their presentations but due to the fact that, as one of the conference organizers, Ms. Kazan-Allen could not attend all the sessions. All of the conference speakers have been requested to submit copies of their presentations for inclusion on the conference CD. The pictures used in this report were selected from a large set of conference photographs taken by Hein du Plessis.
²The address of the Finnish Institute of Occupational Health website is: http://www.occuphealth.fi/e/
³As I attended the Medical Workshop and as both workshops were run simultaneously, I have based the following extract on notes kindly provided to me by Andy Oberta and Andy Higgison.
⁴TMP³: Turbo mask particulate (high efficiency); a power-assisted tight-fitting mask fitted with high efficiency particulate filter.
⁵ASTM International was formerly known as the American Society for Testing of Materials. A list of ASTM Asbestos Guidelines is on the website: http://www.normas.com/ASTM/BOOKS/MNL23.html
⁶ASTM Standard Practice for Maintenance, Renovation and Repair of Installed Asbestos-Cement Products.

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