Results
Period 4 1996–Present): Shrinkage of Asbestos Industry
Starting in the early 1990s, the asbestos manufacturing facilities started to move from Korea to other countries, most notably China and Indonesia. This change, in turn, reduced the manufacturing of asbestos products in Korea, a trend that became quite evident by the year 2000. This shrinkage in domestic manufacturing was compensated for by an increase in the importation of asbestos products, especially from Southeast Asia (Fig. 6.4).
The importation and use of crocidolite and amosite were banned in 1997, and asbestos factories that exposed workers to asbestos dust were shut down by the Ministry of Labor for the first time in 1998. The interest shown by academia in the asbestos problem was rather belated. Even after the first systematic national survey of asbestos-related diseases in 1993 (Paek 2003), it was near the end of twentieth century before academics paid attention to the need for a mesothelioma registry.
Such a registry, based in this case on pathologists’ reports, was finally established in 2001. It was, and has continued to be, funded by the Korean Occupational Safety and Health Agency (KOSHA) (Paek & Choi 2002). The 1988 exposure limit for asbestos (2 fibers/cc) was lowered to 0.1 fibers/cc in 2001. In 2003, actinolite, anthophylite, and tremolite were added to the list of banned asbestos types.
Public campaigns targeting the dangers of asbestos have been staged by labor unions and non-governmental organizations (NGOs) such as the Green Alliance.
These efforts of the unions and NGOs, along with those of lawyers, have made a positive contribution to public awareness of the asbestos problem and have demanded attention from the public authorities as well as the researchers (Paek 2003). In early the 2000s, these efforts led to the identification of asbestos products in subway stations and trains. A health-effects survey of subway workers, requested by the labor unions, was carried out in 2007. The results revealed pleural plaques in over 30% of those surveyed.
It is noteworthy that in 2003 the scope of the protection measures was finally expanded to include asbestos workers outside the manufacturing sector, especially workers engaged in asbestos abatement. A stipulation was added that required employers to obtain permission before dismantling or removing asbestos materials from industrial facilities and office and residential buildings. The first permit was issued for two sites in 2003, and the number increased to 115 in 2005. The amount
Fig. 6 .4 Import of asbestos products by product category 0
5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000
2000 2001 2002 2003 2004
Year
Tons
brakes and gaskets textiles and their products cement
total
of asbestos waste in Korea fluctuated between 50 and 183 tons per year from 2000 through 20051 (Report of Ministry of Environment 2006). Together with the NGOs’
heightened vigilance over the illegal removal of asbestos products during the renovation of old residential and office buildings, the number of facilities dedicated to asbestos abatement has increased. As the asbestos abatement industry has grown, the major Korean importers of asbestos have become asbestos abatement professionals. Protection from asbestos exposure has also been expanded to include any workplaces where asbestos products are either used or manufac- tured. Finally, it was decided that in 2009 all types of asbestos and asbestos products will be banned from industrial sites in Korea (Report of Ministry of Labor 2007).
Awareness of the asbestos problem in society has increased, resulting in civil lawsuits against those who expose neighborhood residents to airborne asbestos.
Asbestos victims have in fact been found among members of the general population who have never worked at, but lived near, an asbestos manufacturing site.
Up to now, about 34 workers have received compensation for either mesothe- lioma or lung cancer. These cases, however, were mainly those of workers exposed to asbestos products, not those working in asbestos plants. The third study of meso- thelioma patients listed the occupations of 18 mesothelioma victims from 2004 to 2005. Eight of the patients (44%) had positive occupational exposure histories, and 6 (33%) had probable environmental exposure at home (Jung et al. 2006). Even though the number of studies is limited, their results collectively show a clear trend of increasing asbestos exposure among mesothelioma patients compared to the general population in Korea (Kang et al. 2006). The repercussions of these data are beginning to appear. With respect to time differences in the phase changes, Korea is expected to catch up to Japan in 10 to 15 years.
Discussion
By examining the progression of the asbestos problem in Korea over time, we can say that the problem is not just medical, that is, a matter of how many cancer cases can be expected in each period and how many patients can be managed. In many ways, the asbestos problem is rooted in economic and political factors. As a way to conceptualize the stages of the asbestos problem as they have unfolded over time, we propose the Source, Exposure, Effect, and Action (SEEA) model. The model is intended to explain the status of the asbestos industry in different countries and to describe the various strategies these countries have adopted at different times to solve the many aspects of the asbestos problem (Table 6.3) (Fig. 6.5).
1 Asbestos waste in Korea: 148.7 tons in 2000, 164.2 in 2001, 148.6 in 2002, 97.1 in 2003, 50.2 in 2004, 183.0 in 2005.
The SEEA Model as a Way to Explain the Current Status of the Asbestos Problem
The SEEA model explains the changes in the asbestos industry through an analysis of the changes in the major operating principles of the health and safety system across three phases. The model describes this system by answering a four-part question about its operation: Why (the primary purpose), by whom (the role play- ers), with what (the programs), and how (the delivery of services) does the system operate? The phase changes in the system can also be represented as shifts in the primary emphasis of the operating principles from input dominance to process domi- nance, and the stages from process dominance to output dominance.
The input-dominant stage of the industry phase can be described as bureaucrats delivering primarily technical programs using code-based dictates for mainly politi- cal aims. This stage is called input-dominant because the operation of the system is
Fig. 6 .5 Source, Exposure, Effect, and Action (SEEA) Model of asbestos industry Source
Exposure
Effect
Action Administrative Asbestos Ban
Regulation Expansion
Phase
Plateau Phase
Shrinkage Phase Repercussions Foreign
Investment
Table 6.3 The SEEA Model: the phases of the asbestos industry, safety policy, and politics
Phases Industry Exposure Effect
Stages Input-dominant Process-dominant Output-dominant
Objectives (why) Politics-based Fragmented initiatives Economy, workforce
Economy-based Issue development Need for control
Health-based Repercussions Feedback Participants (who) Bureaucrats, employers Professionals, unions Victims, NGOs Programs (what) Technical
Recommendations Guidelines
Managerial Inspection Research and info Compensation
Cultural
Building of capacity Education
and training Delivery (how) Code-based
Legislation National policy
Labor-based H&S committee OSH management
System-based Social institutions Campaigns
often regulated by the amount of input, regardless of the rationale of the process or its results. Next, the process-dominant stage of the exposure phase can be described as professionals taking advantage of the dynamics of labor relations to coordinate primarily managerial programs with the major aim of economic rationalization.
This stage is called process-dominant because the final (health) outcome is not yet appreciated (also not realized) even though the emphasis is on the rationalization of the process. Finally, the output-dominant stage of the effect phase can be described as victims systematically carrying out programs geared to changes in socio-cultural attitudes and with the aim of achieving a healthy and safe society.
In the SEEA model, the components of the various problem-solving approaches, programs, or strategies employed by a particular player are addressed across technical, managerial, and socio-cultural categories. The components of the strategy are as follows: (1) Technical intervention: to provide the opportunity to observe and recognize hazards; (2) Managerial intervention: to enable a search of alternatives for actions and protective measures; and (3) Social-cultural interven- tion: to compare and change the value systems regarding the relative importance of different health hazards.
The phase transitions between these three stages do not occur automatically unless source (S), exposure (E), and effect (E) are linked with one another sequen- tially through certain actions (A). The actions that lead to the input-dominant stage (source phase) are often organized by political initiatives, and politicians and bureaucrats play the major role in the shifts to this stage. Then the actions that lead to the process-dominant stage (exposure phase) are usually organized by demands from the professionals who are in charge of the preexisting technical programs intended to make the regulatory measures more efficient and effective, and stream- line the institutional measures. Further actions linking the process-dominant stage to the output-dominant stage (effect phase) are organized by victims reacting to the repercussions of previous exposures. The last actions of this round (which are also the actions leading to the next round of the system-building cycle) are fueled by the feedback provided by all of the participants, but political maneuvering is still important in creating new initiatives.
In the SEEA model, the most important determinant of phase shifts between the three different stages is the presence of key role players. However, the mere pres- ence of a key player in a stage is not sufficient for change to occur; the players must be matched to the appropriate stage. These stage-specific determinants of phase change in the system differ from the conventional health and safety profiles in individual countries, in which some profile components can be redundant or even counterproductive in effecting phase changes, depending on the situation.
Industry Phases and Choice of Regulatory Measures
A few Asian countries are nowadays trying to ban the use of asbestos and its products, and the other Asian countries are experiencing an increase in asbestos
consumption. Overall, the manufacture and consumption of asbestos products has been shifting to Asia (International Social Security Association 2005). One-by-one comparisons of countries that are at different stages of the process may not be appropriate and feasible, because the situation in each country is different.
However, some overall patterns can be detected. They could be observed also in the industrialized countries.
In general, the countries that are experiencing an increase in asbestos consump- tion are trying to expand their overall economy by stimulating the manufacturing and construction sectors. These countries, which are most likely in the input- dominant or process-dominant stage, have yet to experience a single case of asbestos-related cancer. Meanwhile, in the countries that are trying to ban or restrict asbestos use, asbestos-related health problems have become a major social issue.
These countries are either in the output-dominant stage or starting the next round of system building.
Although all these countries have instituted regulatory measures, the effectiveness and meaning (real social functions) of the regulation vary between countries. Each country’s regulations should be crafted, reflecting the experiences of that particular country in solving the occupational and environmental problem, by moving through the action sequence of source, exposure, effect, and feedback. In this sense, the mea- sures aimed at curbing asbestos exposure and its effects vary across stages in their concreteness and comprehensiveness. The different societal stages seem to reflect the historical experiences of problem solving in that particular country.
The controlled use of asbestos, which is advocated by Canada, is not viable in developing countries because it ignores the socio-cultural conditions there.
The countries that employ the controlled-use strategy limit themselves to engineering/
technical solutions that are totally dysfunctional in developing countries.
Paradoxically, controlled use is attractive to developing countries because it ignores the socio-cultural conditions that such countries are ill-equipped to tackle (Pandita 2006; Virta 2006).
However, if we continue to ignore these conditions, we will never be able to solve the asbestos problem successfully. To be successful, a strategy must be focused on how to eventually engage all the key role players in a network consisting of politicians, bureaucrats, workers, and victims. Each of these constituencies must play a positive and fully active role in facilitating the needed sequence of changes.
Of course, there will always be some skeptics on the periphery, and it is important to turn these peripheral players into friendly activists. This approach must proceed incrementally as the situation changes. However, even in the face of such changes, priorities must be set, and the overall direction of change should be driven by sympathy and consideration of human rights. Those who seek to insert such values into the system should be recognized and their roles actively promoted. In most countries, activist researchers should become key role players.
We need an asbestos industry that fights other industries rather than victims groups. We need victims groups that fight ignorance, bias, and discrimination in the general population. But first of all we need, not engineering or managerial solutions, but sympathetic attitudes and changes in traditional or contemporary
values. The roadmap for this problem-solving approach requires that the problem solvers have consciousness-raising experiences. The methods through which ethical imperatives will eventually come to override economic justifications must be devised strategically, instead of by an exclusive reliance on medical and pub- lic-health approaches.
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