ASIA: Asbestos Stop In Asia Key words: asbestos, environmental and occupational health and epidemiology, mesothelioma, lung cancer. Abbreviations: MPM, malignant pleural mesothelioma; WWII, World War II.

In this issue of Respirology, an extensive paper on asbestos is presented. It is a special paper because it combines the medical and socio-legal aspects of asbestos handling. Asbestos was discovered in ancient Greece and appraised for its special properties. In the 19th century, emaciation and certain pulmonary problems related with asbestos handling were reported, although at this time the mineral was not mined in large quantities. The industrial revolution and the World War II (WWII) stimulated the manufacture of asbestos containing products on a very large scale.1 It was not until the early ‘60s of the last century that the relationship between (blue) asbestos exposure and malignant pleural mesothelioma (MPM) became apparent. Since this discovery, better insight in the biology and mutagenic potential of these classes of fibres has become apparent. All groups of asbestos fibres (serpentines and amphiboles) carry a risk, albeit the different physical properties lead to different grades of risk.2 All processes involved in the life cycle of asbestos products contain a health risk. In this issue of Respirology, Leong et al. present a comprehensive overview of the risks of the asbestos products for mankind.3 Although these risks are well known, it is of great importance to present these data together with the worldwide changes occurring in asbestos exports. The Western world has taken measures against the handling and import of asbestos in the last century— most countries having banned the use and import of asbestos completely in the early 20th century. People who have contracted asbestos-related diseases are today reimbursed for their suffering by many Western countries. These patients have been entitled to financial reimbursements of 20 000–200 000 euros per case. With a total number of inhabitants of 731 billion and an estimated incidence of 1.3/100 000 for MPM alone, already 200 million to 2 billion euros will probably need to be spent in compensation. Despite the European measures to control asbestos import, the global production of asbestos has not decreased. In 2013, it measured 1.94 million tons. The top asbestos-producing countries are Russia, China and Kazakhstan, and have no published plans to close their excavation sites.

© 2015 Asian Pacific Society of Respirology

There are many similarities between Asia nowadays and the Western world at the end of the first half of the 20th century. Rebuilding Europe after WWII with a high unemployment rate and limited funds made us choose cheaper products. The asbestos industry was welcomed in the struggle to get people to work. The level of development of different Asian countries varies. Countries like China and India with high population densities are trying to improve the primary health-care level by developing water distribution and sewer systems and housing. In addition, they are dealing with high unemployment rates. The low costs and the worrisome lack of affordable alternatives lead many people to use of asbestos. There is however a significant difference between the Western world after WWII and Asia now. Specifically, we are now aware of the huge risks associated with asbestos exposure. How can we solve this asbestos time bomb that Asia is facing?4 Should we continue with the mining and export of asbestos? Should we go for short-term profit and accept the occupational hazards? Short-sightedness is not acceptable anymore. Asbestos is a major health threat; it has already ruined too many lives. Therefore, we must help the developing world by finding suitable alternatives for asbestos as soon as possible or we will face an immense loss of quality of life and working potential in these countries. The asbestos problem represents the beginning of a showdown between the World Trade Organization and World Health Organization. Paul Baas, MD, PhD and Sjaak Burgers, MD, PhD Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

REFERENCES 1 Vita RL. Worldwide asbestos supply and consumption trends from 1900 through 2003. US Geological Survey Reston, VA. 2006. [Accessed 15 Jan 2014.] Available from URL: circ/2006/1298/ 2 Landrigan PJ, Nicholson WJ, Suzuki Y, Ladou J. The hazards of chrysotile asbestos: a critical review. Ind. Health 1999; 37: 271–80. 3 Leong SL, Zainudin R, Kazan-Allen L, Robinson BW. Asbestos in Asia. Respirology 2015; 20. 4 Allen D, Kazan-Allen L (eds). India’s Asbestos Time Bomb. International Ban Asbestos Secretatiat (IBAS), London, 2008. [Accessed 2 Jan 2015.] Available from URL: _asb_time_bomb.pdf

Respirology (2015) 20, 521 doi: 10.1111/resp.12533

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