In 1999 the French authorities established a specific early retirement scheme for persons having worked with asbestos (CAATA) further to the health crisis surrounding exposure of workers to asbestos. This scheme is applicable both to individual workers suffering from occupational diseases related to asbestos and to employees of establishments in which the activities performed were considered by policymakers to involve the highest risk of exposure to this substance. In this second scenario, actual application of the scheme raises significant problems, given that it is a collective scheme made accessible to all staff employed by establishments registered on inter-ministerial lists. As a result, it is socially inequitable since it may benefit workers who had a low level of exposure or no exposure, while others who were highly exposed derived no benefit because they were exposed while working in an unregistered establishment.
One of the avenues of reform of this scheme that was proposed by the authorities in 2009 consisted in changing the CAATA’s scope of application based on combining a list of establishments whose activities lead to particularly high exposure with a list of occupations entailing particularly high exposure.
The work of the Agency
As part of the reform of this scheme, in May 2009 the Agency received a formal request to prepare a summary of scientific and technical data on occupational exposure to asbestos. The ultimate aim was to identify occupations with a high level of exposure to asbestos and those for which exposure leads to the development of occupational diseases.
To this end, the Agency examined the available national and international scientific literature, and the main databases in this field. A survey was also conducted in six European countries (Germany, Spain, Finland, Italy, Norway, and the United Kingdom) in order to collect information on regulations, applicable medical follow-up procedures, occupations and sectors involving exposure, and the particulars of the compensation schemes for workers exposed to asbestos.
On the basis of all the available data and studies from expert and research bodies, ANSES produced a report which was submitted for critical appraisal to independent specialists recognised for their expertise in the assessment of occupations exposed to asbestos.
Details of the work of the Agency
Regarding the collection of data for research on the occupations involving heavy exposure to asbestos in France, the Asbestos-related diseases cohort (ARDCO) study and two French post-occupational surveillance programmes of workers exposed to asbestos—SPIRALE and ESPRI (were chosen since they use a classification of exposure to asbestos based on individualised assessments, conforming to the criteria selected during the Consensus Conference of 1999.
The performance and value of two metrological databases, EVALUTIL of the French Institute for Public Health Surveillance (InVS) and FIBREX of the National Research and Safety Institute (INRS), were also examined.
Research on the occupations responsible for the development of occupational diseases was based on data from the French National Mesothelioma Surveillance Programme (PNSM) and data on the recognition of occupational diseases derived from the French national healthcare benefits system. ANSES also benefitted from early results from ARDCO aimed at associating certain occupations with an excess risk of developing pleural plaques.
Although the available databases were constructed using fairly different protocols, a comparison of the data clearly shows that a consistent and comprehensive body of information has been produced, highlighting the occupations and sectors of activity considered to involve the highest exposure to asbestos.
Levels of exposure to asbestos and their apparent relationship with diseases such as pleural plaques and mesothelioma classify certain occupations as being clearly exposed to asbestos (sheet-metal workers, welders and flame-cutters, etc.). For other more “general” occupations (electricians, pipefitters, etc.), further examination is needed in order to take the activity sector into account. Finally, for some special cases of occupations in which there is only occasional exposure to high concentrations of asbestos fibres, evaluation of the fact, frequency and levels of exposure requires an individual approach.
The European international survey conducted as part of this report showed, qualitatively, that the activity sectors and occupations exposed differ only slightly from what can be observed from the French data. In addition, examination of these databases has made it possible to identify the practices relating to damages and compensation for workers in each country who are victims of asbestos, and to rank the French system for recognising asbestos-related diseases compared to its European neighbours. Finally, special attention was paid to Italy’s experience with establishing a scheme related to retirement benefits for workers exposed to asbestos, the sole system comparable to the French CAATA Fund in Europe.
ANSES’s expert appraisal showed that as of 2009, there was no database providing a definitive and exhaustive list of the occupations involving the highest exposure applicable to all situations. Each database has its own characteristics and limitations. Nonetheless, examination of these databases made it possible to identify several major issues to be taken into account when establishing a fair compensation system:
- specific features of different occupations: certain non-specific occupations have a prevalence of exposure to asbestos that varies widely depending on the sector of activity in which the work was performed (manual labourers, stevedores, electricians, etc.). If not specified in the survey, the assessment needs to be more detailed in order to identify the activity sector in which the work was performed;
- absence of certain activity sectors: not all of the databases in the report take into account all of the existing employment situations. For example, jobs in public administration that could lead to direct or indirect exposure, have not been considered (facilities management staff, for example);
- failure to take certain occupations into consideration: not all of the occupations that could lead to high exposure over a short period of time are necessarily represented in all the epidemiological studies, either for sampling reasons specific to the study itself, or because they only take into account work that was performed for long periods (recall bias);
- period of activity during which the work was performed: the 1996 ban on asbestos had a simultaneous impact on levels of exposure to asbestos fibres, types of occupation and the sectors exposed. It could be observed that the reduction in exposure to asbestos was not the same across all sectors or occupations, and that certain activities, particularly in the areas of decommissioning and demolition, faced greater exposure to asbestos after 1996;
- specific case of the building trades: the report clearly shows exposure in the building and public works trades, with heterogeneous levels being explained by the study protocols on which they were based. In addition, the PNSM indicates a significant risk of developing pleural mesothelioma in the building trades;
- problems reconstructing exposure scenarios over the course of the working career: these concern workers who, for various reasons, have been faced with situations that could result in sufficient exposure to contract an asbestos-related disease even though the work they performed is not necessarily included among the occupations exposed to asbestos. This last point demonstrates that greater precision in characterising exposure can be gained from a detailed analysis of the employee’s working life that includes the tasks performed;
- in cases of multiple occupational exposures: some people have had several different occupations that exposed them to asbestos. In general, it is difficult or impossible in these cases to link asbestos exposure to a particular job, given the latency of certain diseases.
Various elements of this report also show the need to facilitate access to post-occupational monitoring in France for people who have been exposed to asbestos in the workplace.