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The burden of asbestos-related disease in British Columbia : final workshop report, May 14, 2010 - Vancouver,… WorkSafeBC-CHSPR Research Partnership 2011

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The Burden of Asbestos-Related Disease in British ColumbiaFinal Workshop ReportMay 14, 2010  - Vancouver, British ColumbiaT H E  B U R D E N  O F  A S B E S T O S - R E L A T E D  D I S E A S E  I N  B C :  F I N A L  W O R K S H O P  R E P O R T2Th is report was produced by: Centre for Health Services and Policy Research University of British Columbia #201 – 2206 East Mall (LPC) Vancouver, BC   V6T 1Z3 Phone: 604-822-4969 Email: enquire@chspr.ubc.ca You can download this publication from our website, at www.chspr.ubc.ca How to cite this report:  WorkSafeBC-CHSPR Research Partnership. (2011). Th e Burden of Asbestos-Related Disease in BC: Final Workshop Report. Vancouver, Centre for Health Services and Policy Research, University of British Columbia. Photos in this report taken from the Flickr Creative Commons pool.  Th anks to photographers Daryl Mitchell, Th egirlsmoma, and escapevehicle. 4 About the WorkSafeBC-CHSPR Partnership 5 Executive Summary 6 Introduction 7 Goals of the workshop 7 Format of workshop 8 Summary of presentations 10 Priorities for action 13 Evaluation of workshopContents3U B C  C E N T R E  F O R  H E A L T H  S E R V I C E S  A N D  P O L I C Y  R E S E A R C HT H E  B U R D E N  O F  A S B E S T O S - R E L A T E D  D I S E A S E  I N  B C :  F I N A L  W O R K S H O P  R E P O R T4About the WorkSafeBC-CHSPR PartnershipTh is research partnership between WorkSafeBC (the Workers’ Compensation Board of BC) and the UBC Centre for Health Services and Policy Research (CHSPR) aims to address current and emerging issues of work-related health in British Columbia. Th e Partnership conducts research that provides a unique and comprehensive portrait of the health and well being of workers, and helps support evidence-informed decision-making in the area of occupational health.For more information about the WorkSafeBC-CHSPR Partnership, please visit http://www.chspr.ubc.ca/research/worksafebc.Our partnersUBC Centre for Health Services and Policy ResearchAs leaders in independent, policy relevant research and graduate training, CHSPR is dedicated to fostering visionary research within a collaborative and innovative research environment. CHSPR’s work engages and informs health policy and issues that matter to Canadians.For more information about CHSPR, please visit http://www.chspr.ubc.caUBC School of Environmental HealthTh e School of Environmental Health (SOEH) is a multidisciplinary teaching and research unit whose mandate is to study exposures, health eff ects, and control strategies in occupational and community settings.  It off ers masters and doctoral programs, a continuing education program, a seminar series open to the public (& available via webcast), and specialized laboratory and exposure measurement services.  It provides the only graduate program in western Canada that trains “oc-cupational hygienists,” the professionals who aim to reduce work exposures to chemical, physical and biological hazards.For more information on SOEH, please visit http://www.soeh.ubc.ca/Population Data BCPopulation Data BC is a multi-university, nationally active and recognised data and education resource facilitating interdisciplinary research and teaching on the determinants of human health, well-being and development. While respecting and adhering to legislation and protocols governing access to sensitive information and protecting individual privacy, our work strives to ensure that:• Researchers have timely access to data and training.• Researchers have access to data that address research questions on human health, well-being and development.• Research using these data informs policy-making and leads to healthier communities.For more information on Population Data BC, please visit http://www.popdata.bc.caFundingTh is workshop was made possible through a Meetings, Planning, and Dissemination grant from the Canadian Institutes of Health ResearchU B C  C E N T R E  F O R  H E A L T H  S E R V I C E S  A N D  P O L I C Y  R E S E A R C H5Asbestos-related diseases are a serious occupational health issue for workers, compensation boards, and health care providers.  Th is report describes the results of a workshop that brought together a diverse group of stakeholders inter-ested in, or aff ected by, asbestos-related disease to share current research activity on asbestos-related disease, and to discuss ways of improving awareness and prevention of asbestos-related disease in BC.  Researchers shared current research regarding the bur-den, surveillance, and compensation of asbestos-related disease.  Th is was followed by a panel with speakers representing the medical, compensation, and patient communities.  Each speaker shared their unique perspec-tive around prevention and awareness of asbestos-related disease.  Th e workshop concluded with group discussions that developed priorities for action, including goals relat-ing to improving education resources on asbestos-related disease, enhancing aspects of the compensation process, improving the quality and availability of data on asbestos-related disease, and expanding eff orts around prevention and surveillance.  Th is report provides a summary of the proceedings of the workshop, along with an itemized list of priorities for future actions.  Executive summaryT H E  B U R D E N  O F  A S B E S T O S - R E L A T E D  D I S E A S E  I N  B C :  F I N A L  W O R K S H O P  R E P O R T6About asbestos-related diseaseAsbestos exposure is one of the most important occupa-tional health issues in Canada and around the world.1   It is associated with a number of deadly diseases, including lung cancer, a form of cancer called mesothelioma, and asbestosis, a progressive fi brotic lung disease.  Although the production and use of asbestos in Canada peaked in the mid-1970s and then declined sharply, the diseases associated with it have a 20-50 year latency period, so the number of cases of asbestos-related disease will continue to increase.2   In addition, workers involved in construc-tion or asbestos remediation are still exposed to asbestos in the course of their work.  It is estimated that at least several thousand people are diagnosed with asbestos-related illnesses every year in Canada, and most will die from their disease.  Th e diseases are devastating for aff ect-ed workers and their families.  Th ey are also associated with high costs to compensation boards, to the Canadian health care system, and to the families.In British Columbia, research has shown that while al-most all asbestos-related diseases are work-related, many aff ected individuals do not seek compensation.  Research shows that less than half of all individuals with meso-thelioma in the province have a workers’ compensation claim.3   For asbestosis, the rate of compensation is even lower, with only a quarter of cases having a compensa-tion claim.4   It appears that both patients and physicians 1 World Health Organization. (2008).  Elimination of asbestos-related diseases. http://www.who.int/occupational_health/publications/asbestosrelateddiseases.pdf (accessed 5 Octo-ber 2008). 2 Selikoff  IJ, Hammond EC, Seidman H. Latency of asbestos disease among insulation workers in the United States and Canada. Cancer 1980;46(12):2736-40.3 Kirkham T, Koehoorn M, McLeod C, Demers P. (2011). Surveillance of mesothelioma and workers’ compensation in British Columbia, Canada.  Occupational and Environ-mental Medicine 2011;68:30-5. Published Online First: 27 Sept 2010 doi: 10.1136/oem.2009.048629. 4 Gan W, Demers P, McLeod C, Koehoorn M.  Population-based asbestosis surveillance in British Columbia.  Occupational and Environmental Medicine 2009;66:766-771. Published Online First: 14 June 2009 doi:10.1136/oem.2008.045211.Introductionmay not be aware that the disease is compensable, or even work related.   Alternatively, workers may be aware but may choose not to participate in workers’ compensation for other reasons such as they wish to proceed with a tort action.  If ill workers do seek compensation, they may fi nd the compensation system diffi  cult to navigate, as the legal and policy framework for compensation of asbestos-related disease is complex.In the face of the clear health and economic consequenc-es of asbestos-related disease, several questions need to be addressed.  Th ey include the following:1.  How can information about BC’s compensation system be improved to ensure that workers and their families can access information and resources ef-fi ciently?2. How can administrative data on health and occupa-tional history be improved to facilitate the surveil-lance of asbestos-related disease?3. How can current training and certifi cation initia-tives promote awareness and prevention of asbestos exposure and compensation?4.  What kinds of educational initiatives are required to improve awareness of asbestos-related disease and compensation among physicians, workers, and fam-ily members?To begin addressing these and other questions, we held a one-day workshop on asbestos-related disease in Vancou-ver, BC.  Th e meeting was organized by the UBC School of Environmental Health and the Centre for Health Ser-vices and Policy Research, an interdisciplinary group of researchers who have been active in researching asbestos-related disease for a number of years.  U B C  C E N T R E  F O R  H E A L T H  S E R V I C E S  A N D  P O L I C Y  R E S E A R C H7Knowledge translation was the focus of the workshop.  It brought together a diverse group of more than 40 indi-viduals representing workers and their families, labour unions, employers, researchers, physicians, legal experts, and the workers’ compensation agency to exchange knowledge and ideas around asbestos-related disease.  Th e objectives of this workshop were to:•  share, and get feedback on, the results of a number of research studies around asbestos-related disease;•  discuss ways of improving awareness, notifi cation and compensation services for workers aff ected by asbestos-related disease in BC;•  spur discussion on how data resources (e.g., disease registries) could be developed to improve asbestos-related disease surveillance and health services; and•  off er a forum for researchers and research users to discuss new research questions that are responsive to the current research literature and to research users’ priorities.Goals of the workshop Format of workshopTh e workshop was designed as a combination of didactic presentations and breakout groups.  Breakout groups contained members from each key stakeholder group (labour, employer, clinician, and academic), in order to facilitate knowledge exchange.  Each breakout group was facilitated by a member of the workshop organizing com-mittee, and the proceedings were recorded by a student volunteer.  Aft er each breakout session, breakout groups prioritized key recommendations to bring forward to the larger group, to help develop a list of priorities for action.  Th ese were discussed and further prioritized during the closing panel. T H E  B U R D E N  O F  A S B E S T O S - R E L A T E D  D I S E A S E  I N  B C :  F I N A L  W O R K S H O P  R E P O R T8Summary of PresentationsAssessing the full burden of asbestos-related disease in BCPaul Demers, Professor at the UBC School of Environ-mental Health (now Director, Occupational Cancer Research Centre), presented an overview of the historical use of asbestos in BC, and the resulting toll on health.  He described the types of occupations in which workers were exposed to asbestos, and described the recognition of asbestos-related diseases by the scientifi c and medical community in the early to mid twentieth century.  Prof. Demers showed that due to the long latency associated with asbestos-related disease, cases of these diseases continue to increase, and he provided some insight into the diff ering trends of the diseases, which vary signifi -cantly by region and by sex.  Th e presentation ended with an explanation of how the excess risk of other cancers attributable to asbestos exposure, such as lung cancer, can be calculated.Find out more about this study on the CHSPR website: http://www.chspr.ubc.ca/research/worksafebc/asbestosisSurveillance of asbestos-related disease: challenges and opportunities in BCMieke Koehoorn, Associate Professor at the UBC School of Population and Public Health and faculty lead of the WorkSafeBC-CHSPR Partnership, presented an overview of an evaluation of a notifi cation system for physicians of newly diagnosed mesothelioma patients in British Columbia.  Previous research showed that less than half of all mesothelioma cases sought compensa-tion from WorkSafeBC, despite the large majority of cases being work-related.   In order to increase awareness of compensation services, the researchers worked with the BC Cancer Agency to send a letter to all physicians of newly-diagnosed mesothelioma patients. Th is letter campaign, which began in November 2004, has increased compensation rates by 15% for those patients whose phy-sicians received a letter.  An evaluation of the campaign has uncovered some areas in which the letter could be improved, and UBC researchers are actively collaborating with the BC Cancer Agency and WorkSafeBC to make these improvements.  Find out more about this study on the CHSPR website: http://www.chspr.ubc.ca/research/worksafebc/mesothe-liomaWorkers’ compensation for asbestos-related disease in five Canadian provincesKatherine Lippel, Canada Research Chair in Occupation-al Health and Safety Law at the University of Ottawa, de-livered the workshop’s keynote presentation, which com-pared workers’ compensation for asbestos-related disease in Alberta, BC, Newfoundland, Quebec, and Ontario.  Her talk addressed the legal and policy frameworks for compensation of asbestos-related occupational disease, describing and comparing criteria applied by compensa-tion boards in each province to allocate workers’ compen-sation.  Th e presentation showed that there is signifi cant variation between provinces with respect to the legislative presumptions that govern compensation.  For example, criteria relating to the availability of evidence, the dura-tion and location of exposure, and evidence of disability vary signifi cantly between the fi ve provinces studied.  Dr. Lippel raised a number of issues specifi c to compensation in British Columbia; including both barriers and facilita-tors to accessing compensation. Download the full report: ‘Workers’ Compensation for asbestos related disease in fi ve Canadian provinces’,  http://www.partnershipagainstcancer.ca/wp-content/up-loads/Katherine_Lippel_-FINAL-_report_April_20.pdfU B C  C E N T R E  F O R  H E A L T H  S E R V I C E S  A N D  P O L I C Y  R E S E A R C H9Panel: Current issues around asbestos – prevention and awarenessTh e workshop’s fi nal presentation was a panel presenta-tion that addressed questions around asbestos-related disease from a number of diff erent perspectives: a family member aff ected by asbestos-related disease, a medical oncologist, and a policy maker from WorkSafeBC.  Each speaker provided their perspective on challenges and current eff orts/needs to raise awareness about asbestos-related disease, and to help prevent future disease.  Tracy Ford lost her father, Dave, to mesothelioma in 2008.  Her presentation outlined her family’s personal experience with asbestos-related disease, and she dis-cussed some of the key diffi  culties they faced with both the medical and compensation systems.  For example, pa-tients and their families may be frustrated and confused by diff erent treatment options off ered in diff erent juris-dictions, and about the complexities and consequences of applying for workers’ compensation.  Th e Ford family has set up the Asbestos-related Research, Education, and Advocacy (AREA) Fund (http://www.areafund.ca) in order to support asbestos-related research, education and advocacy initiatives.Chris Lee is a medical oncologist at the BC Cancer Agen-cy.  He spoke to a number of issues faced by physicians who treat individuals with asbestos-related diseases.  He noted that physicians struggle to get information about work history from their patients, because even those with asbestos-related diseases, which are almost always associ-ated with work exposures, do not oft en volunteer infor-mation about their work histories.  He also explained that many patients do not apply for compensation because it is perceived as too complex, and that physicians are not trained to help their patients navigate the compensation system.  Dr. Lee also explained that the treatment regimes for asbestos-related disease in British Columbia are evidence-based, and that some of the more controversial options (e.g., surgery for mesothelioma) cannot be done in our province. Susan Hynes, Director of the Compensation and Assess-ment Policy Department with the Policy and Research Division of WorkSafeBC, talked about WorkSafeBC’s commitment to preventing future cases of asbestos-related disease.  Most current exposure to asbestos occurs in the construction industry, which is large and diverse.  Th us, WorkSafeBC is undertaking a range of prevention-related activities including identifying and inspecting demolition and renovation projects, developing educa-tional materials to raise awareness of where asbestos can be found in existing structures, and training programs for asbestos-related remediation companies.  Ms. Hynes also addressed some of the issues raised by Tracy Ford, regarding the complexities of the compensation system.  She noted that a new website will be launched in summer 2011, providing a comprehensive information resource for those aff ected by asbestos-related disease.  Th e new website will be accompanied with a full media campaign, and information will be available in multiple languages.    T H E  B U R D E N  O F  A S B E S T O S - R E L A T E D  D I S E A S E  I N  B C :  F I N A L  W O R K S H O P  R E P O R T1 0Th e presentations given at this workshop were followed by small group discussion, where the workshop participants developed a number of key ideas and priorities for action.  Priorities for action are listed below, and divided into four categories.  Items that the group identifi ed as short- to mid-term goals are highlighted.  In addition, work by various stakeholders to address issues raised during the workshop are listed.EducationGoals Stakeholder actions planned/proposed Achievable in short- to mid-termImprove physician education around occupational disease (perhaps through a CME-eligible course)In the future (pending funding and collaboration from other organiza-tions), the WorkSafeBC-CHSPR Partnership at UBC aims to organize a CME-accredited course to raise awareness of occupational cancers among physicians.  Th is will require additional funding and support from other stakeholders.WorkSafeBC sponsors a page in the monthly BC Medical Journal where  clinical based articles are submitted.  Th e Director of Clinical Services submitted an article on asbestosis in the November 2010 issue (available at http://www.bcmj.org/worksafebc/asbestosis-persistent-nemesis).√Mesothelioma letter-writing campaign should be im-proved and be extended to family members of deceased individuals diagnosed with mesothelioma. WorkSafeBC-CHSPR partnership is pursuing this in collaboration with the BC Cancer Agency and WorkSafeBC√Increase education regard-ing asbestos-related disease (via WorkSafe, unions, etc), perhaps by using a multipar-tite group (with representa-tion from labour, academia, health care providers, compensation).Require asbestos education as part of OHS requirements √Provide information on where past asbestos expo-sures may have occurredRequire asbestos education as part of OHS requirementsTh is requirement does exist in WorkSafeBC’s Occupational Health and Safety Regulation.Priorities for actionU B C  C E N T R E  F O R  H E A L T H  S E R V I C E S  A N D  P O L I C Y  R E S E A R C H1 1Goals Stakeholder actions planned/proposed Achievable in short- to mid-termStart education early (high school and trade schools)Get information to workers and families on the benefi ts of applying for workers com-pensation (and diff erences between compensation and lawsuits)Th is information will be included when WorkSafeBC’s asbestos web site is launched in summer 2011.In addition, WorkSafeBC’s Occupational Disease Services Department has been given approval to hire a designated resource to help workers and their families with their workers’ compensation questions.  √Families need information before they fi le a claimWorkSafeBC initiatives as discussed above will help provide this type of information.CompensationGoals Stakeholder actions planned/proposed Achievable in short- to mid-termImprove WorkSafe re-sources for special claims (live, trained person on the phone)WorkSafeBC’s Occupational Disease Services Department has been given approval to hire a dedicated resource.  Th e hiring process is cur-rently underway.√Initiate research on claims process from the family/vic-tim point of viewTh is will be pursued as part of the grant ‘Seeking compensation for mesothelioma:  Investigating why individuals do or do not seek work-ers’ compensation benefi ts in British Columbia’ (funded by WorkSafeBC January 2011; PI Koehoorn)√Consider broader presump-tions for asbestos-related disease, and learn from other jurisdictions .   Th e Association of Workers’ Compensation Boards of Canada has instituted a new Occupational Disease Working Committee comprised of representatives from each jurisdiction.  Th rough this committee WorkSafeBC will be able to gain and share information on occupational disease adjudication and trends.  Th e model for compensation is established in legislation. WorkSafeBC will continue to monitor the science and other jurisdictions to ensure that we are at the forefront in terms of compensation and recognition of asbestos related occupational diseases.Provide resources to worker advisor at Ministry of La-bour to help people navigate the compensation processTh is can be achieved as part of the training which follows the introduc-tion of the new web site.  WorkSafeBC can contact the Worker and Employer Advisors Offi  ces.T H E  B U R D E N  O F  A S B E S T O S - R E L A T E D  D I S E A S E  I N  B C :  F I N A L  W O R K S H O P  R E P O R T1 2Improving data quality/accessGoals Stakeholder actions planned/proposed Achievable in short- to mid-termCertain tumors should trig-ger the taking of detailed occupational history (this needs to be resourced)√Make asbestosis a reportable disease √Include occupation in BC databases / e-health recordsTh e WorkSafeBC- CHSPR partnership is currently seeking funding look at the use of occupational and industry codes in the entire claim database applied back to population level health data for surveillance purposes.Better access to histori-cal data for research (e.g. through Mine Act)Require employers to report highly-exposed workers to the province (data should survive aft er industry folds)Use data from lawsuits in surveillanceSurveillance/preventionGoals Stakeholder actions planned/proposed Achievable in short- to mid-termTraining and certifi cation for industries where there is current exposureRequirements currently exist in WorkSafeBC’s Occupational Health and Safety Regulations regarding training.√U B C  C E N T R E  F O R  H E A L T H  S E R V I C E S  A N D  P O L I C Y  R E S E A R C H1 3Goals Stakeholder actions planned/proposed Achievable in short- to mid-termUse exposure data for pre-vention eff ortsWorkSafeBC’s Policy and Research Division took a proposal to the Se-nior Executive Committee of WorkSafeBC regarding the development of an Exposure Registry Program to track exposures in BC.Th e Senior Executive Committee gave approval for the Policy and Re-search Division to proceed with the development of a business case on the creation of an online tool that workers and employers can complete to document exposures to harmful substances.Th e aim is to take the business case back to the Senior Executive Com-mittee for consideration by winter 2011.Develop a disease registry to enable follow up over timeWorkSafeBC initiatives as discussed above.Evaluation of workshopParticipants reported, via workshop evaluations, that they were pleased with the content, format, and achievements of the workshop.  Th e most common comment was an appreciation for the diverse group of people represented in the room, and the opportunity to dialogue and network with individuals from outside their day-to-day network who were inter-ested in asbestos-related disease.  Results from the participant evaluations are summarized below:Question Average response (n=18)1 = strongly disagree | 2 = disagree | 3 = agree | 4 = strongly agreeTh e meeting provided a good overview of the burden of asbestos-related disease in BC 3.6Th e meeting provided an overview of current asbestos-related disease surveillance initiatives in BC 3.4Th e meeting provided an overview of existing compensation policies in Canada 3.6Th e meeting provided information about current eff orts to increase awareness and prevention of asbestos-related disease3.3Th e breakout group discussions increased my awareness and understanding of issues relating to asbestos-related disease3.5Th e meeting provided a forum for networking with a diverse group of people interested in asbestos exposure and disease compensation policy for asbestos-related disease3.7Th e meeting was well organized 3.8T H E  B U R D E N  O F  A S B E S T O S - R E L A T E D  D I S E A S E  I N  B C :  F I N A L  W O R K S H O P  R E P O R T1 4UBC Centre for Health Services and Policy ResearchThe University of British Columbia201-2206 East MallVancouver, B.C. Canada  V6T 1Z3Tel:  604.822.4969Fax:  604.822.5690Email: enquire@chspr.ubc.cawww.chspr.ubc.caAdvancing world-class health services and policy research, training and data resources on issues that matter to Canadians

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