Asbestos Thailand Conference 2014 Nov Singapore j takala & lynnette goh

A Great Workforce A Great Workplace
© 2010 Government of Singapore
1
Asbestos – Trends and Action Globally
and in Singapore
Dr Jukka Takala, Ms.Lynnette Goh
Workplace Safety and Health Institute, Ministry of Manpower
17 November 2014

2
Source: ILO and WSH Institute
www.wsh-institute.sg/files/wshi/upload/cms/file/Global%20Estimates%20of%20Occupational%20Accidents%20and%20Work-related%20Illness%202014.pdf

3
Past World Estimates, asbestos deaths:
112,000 every year (ILO estimate)
107,000 every year (WHO estimate)

4

Asbestos consumption in Asia and in the World
5 5

6

Work-related Annual Deaths –
Singapore and EU distribution of fatal injuries and
illnesses, EU in brackets
7
Work-related Annual Deaths – EU-27
Sources: WSH Institute Singapore 2014, Hämäläinen P, Takala J, Saarela KL; TUT, ILO, WHO,
EU-OSHA, WSH Institute Singapore, JOEH May 2014, ref. data: MOH/MOM and WHO WPRO A
region

8
Work-related Annual Deaths –World
Sources: Hämäläinen P, Takala J,
Saarela KL; TUT, ILO, EU-OSHA,
Asbestos: 25-50% of all work-related
cancers
New 102 500

9
Source: Rushton a.o.

10
10
Consumption of Asbestos and Mesothelioma Deaths in the U.K. 2003

11
11
Today

Finland
Singapore:total estimated consumption
1960 -2012 was 136,209 metric tons
Finland: total estimated consumption
1960 -2012 was 311,904 metric tons
* *
12
Year
*
Source: R. Virta, United States Geological Survey , U.S. Department of Interior * Exports bigger than imports in 1985 etc.

Every 170 tons causes 1 mesothelioma case, and 2-10 lung cancers **
•Total consumption in Taiwan 480,000, Singapore 136,000, and
Malaysia 750,000 metric tons in
*
13
Year
Data Source: United States Geological Survey , U.S.
Department of Interior
*
* Exports bigger than imports
** IntJOEH2004;10:22-25 & BJC(2012),106,575-584

Mesothelioma deaths Today U.K
U.K 2005
Singapore scale
100
Singapore expected
* *
14
Year
*
Source: United States Geological Survey , U.S. Department of Interior
Singapore Number of Deaths
50
Singapore index: 2 x 104
*
* Exports bigger than imports in 1985

15
Sources:
Eun-Kee Park , Ken Takahashi (UOEH), Problem Jukka Takala, ILO

= 200,000 tons used/year Mesothelioma deaths
U.K 2005
16
*
* *
Thailand deaths,
estimate
U.K.
Exposure
U.K.
Deaths
Thailand
exposure,
moving
average
1500
Today U.K
Singapore
Finland

Source: http://www.mesotheliomasymptoms.com/mesotheli1o7ma-symptoms
17
Selected data from various
sources, refs included
2-Dec-14 Visiting Expert Week
– Tim Driscoll

Asbestos mortality estimates A based Great Workforce on A Great consumed
Workplace
18
asbestos, FINLAND
Estimates made in 2001 based on 1996 data (Nurminen )
1. 59 mesothelioma deaths, 42 at work, 208 asbestos related lung cancer deaths
estimated, RR = 2.3, AF= 14% (males) for asbestos and synergistic smoking, related to
average asbestos consumption 10 041 tons/year, 1950-70
2. 170 tons of asbestos use causes 1 mesothelioma death, data calculated also for global
estimates (Tossavainen)
3. 48 tons of asbestos consumption caused 1 asbestos related lung cancer, totalling 250
deaths, 312 - 335 deaths at peak level in the year around 2020 of which an expected
62, in reality 85, mesothelioma deaths, see point 7. below.
4. Other cancers known to have been caused by asbestos: stomach, colon, larynx, ovary,
rectum, and asbestosis deaths need to be added
5. Asbestos epidemic will cause 8 785 deaths of which 1 757 mesothelioma deaths.
6. Year 2013: average 85 mesothelioma cases recorded annually in Finland.
Sources: Nurminen, Karjalainen: Scand J Work Environ Health, Vol 27, no.3
Tossavainen A.: IntJOEH 2004; 10:22-25

Asbestos mortality estimates A based Great Workforce on A Great consumed
Workplace
19
asbestos, UNITED KINGDOM
Estimates made in 2005 (Rushton )
1. 8 010 occupational cancer deaths in 2005, 1 937 mesothelioma deaths at
work, 2 223 asbestos related lung cancer deaths, total 4160 deaths estimated,
related to annual average asbestos consumption: 140 173 tons in 1950-70,
resulting to 33.7 tons of asbestos causing 1 death either by mesothelioma or
lung cancer
2. Year 2013: 2 535 recorded mesothelioma deaths, with corresponding rate
estimated to have 2 909 lung cancer deaths, totalling 5 444 deaths, (HSE)
3. Maximum recorded consumption in 1960: 163 019 tons of asbestos, this
consumption would produce an expected 4 837 maximum estimate of
expected deaths: the reality is close to above 5 444 deaths/year between
2015-2020
Sources: BJC Rushton: BJC(2012),106,575-584 and
HSE:
http://www.hse.gov.uk/statistics/causdis/mesothelioma/mesothelioma.pdf

2-Dec-14 Visiting 20
Expert Week
20 © 2010 Government of Singapore
– Tim Driscoll

Work-related Asbestos Mortality A Great Workforce estimates A Great Workplace
based
21
on consumed asbestos, WORLD (1 of 2)
Estimates made in Nov 2014 (Takala )
1. Based on RR = 2.3 and AF = 14 % (males), 0.6% (females),
10 041 tons of asbestos exposure cause 208 asbestos related lung cancer, ARLC
(Nurminen), or every used 48 tons cause one lung cancer, and every 170 tons cause one
mesothelioma, every 35.5 tons cause 1 death (Tossavainen).
2. World consumption was 3.5 million tons in 1970 and peak consumption was 4.7 million
tons in 1980.
3. Corresponding ARLC in around 2015-20 will be: 73 200 deaths, and peak mortality in
2025-30: 97 800 deaths. Mesothelioma deaths, peak 27 600 (under reporting expected
here) in 2025-2030.
4. Asbestos caused other cancer deaths ( colon,stomach, larynx, ovary) come to approx. 1.8 % of
mesothelioma and lung cancers (1760), and asbestosis deaths to 3.8% of these cancers
(4765), adding all together at peak period
132 000 deaths
Sources:
1.Rushton L: BJC(2012), 107,53-57
2. HSE: http://www.hse.gov.uk/statistics/causdis/mesothelioma/mesothelioma.pdf
3. Nurminen M, Karjalainen A: Scand J Work Environ Health, Vol 27, no.3
4. Tossavainen A.: Int JOEH 2004; 10:22-25
5. Virta Robert, United States Geol. Survey: Worldwide Asbestos Supply and Consumption
1900-2003, http://pubs.usgs.gov/circ/2006/1298/c1298.pdf
6. Straif K: The Burden of occupational cancer, editorial, DOI: 10.1136/oem.2007.038224 http://oem.bmj.com/

22 2-Dec-14

Work-related Asbestos mortality A Great Workforce estimates A Great Workplace
based
on U.K. consumed asbestos, WORLD cont. (2 of 2)
Estimates made in Nov 2014, (Takala )
1. Based on U.K. Data (Rushton) in 2005 there were 8 010 occupational cancer deaths of which
1 937 mesothelioma deaths and 2 223 ALRC deaths. In 2013 the number of mesothelioma cases
23
was 2 535 and corresponding estimated ARLC deaths 2 909, totalling 5 444 deaths.
2. U.K. Peak consumption was 163 019 tons of asbestos in 1960. Average annual consumption in
1950-70 was 140 173 tons.
3. The average consumption between 1950-70 would be equal to 1 death for every 33.7 tons
covering both ARLC and mesothelioma. For peak consumption and present 2013 deaths, 1
death would be caused by 29.9 tons. Global peak consumption 4.7 million tons in 1980,
outcome in 2025-2030.
4. Corresponding global ARLC and mesothelioma deaths would be 139 500 based on average
consumption 1950-70, and 157 000 based on latest 2013 death numbers and peak consumption
in the U.K. Other asbestos caused cancers and asbestosis deaths need to be added.
Sources:
1.Rushton L: BJC(2012), 107,53-57
5. Virta Robert, United States Geol. Survey: Worldwide Asbestos Supply and Consumption 1900-2003,
http://pubs.usgs.gov/circ/2006/1298/c1298.pdf

based
24
THAILAND
1. Based on estimate of exposure-outcome relation (RR=2.3), and the Thai consumption
of asbestos in 1970, which was 21 272 metric tons, Thai ARLC number would be 441
deaths and mesothelioma 125 deaths totalling 566 and adding other asbestos caused
deaths 599 annually in 2015- 20.
2. Average annual consumption around 2006 was 135 000 tons which would produce
3 800 (3802) peak annual deaths of all asbestos related causes around the year 2050.
3. Peak consumption of 190 205 tons of asbestos in 1996 in Thailand would produce a
figure of 5 400 (5 357) in around the year 2040-50 (less reliable).
Sources:
1.Rushton L: BJC(2012),107,53-5

based
25
SINGAPORE
1. Based on estimate of exposure-outcome relation (RR=2.3), and the Singapore peak
consumption of asbestos in 1975 which was 8 671 metric tons the number of total
peak annual asbestos related number would be 244 deaths in 2025-30.
Mesothelioma may be around 10-25 % of this number depending on the type of
asbestos used.
2. Total consumption until 2006 was 136 209 tons which would produce
an asbestos epidemic of 3 800 (3836) deaths of all asbestos related causes during
some 50 years.
3. Peak of deaths is expected at 2025-30
Sources:
1.Rushton L: BJC(2012),107,53-57
6. McCormack, Peto et al: BJC(2012),106,575-584

Why Mesothelioma Mortality A Great is Workforce low A in Great Asia Workplace
as
compared to Europe, USA, Australia/NZ, Japan
26
1. Asbestos use was started slower in Asian countries and generally later than in
industrialised countries. The peak for Singapore is expected to be 10 years later than
in the U.K. at 2025-30. In Thailand the peak is expected to be 30-35 later in 2040-50.
Latency time from the high country consumption is also longer than earlier thought:
not all imported/produced asbestos is used immediately on the year imported,
rather with some delays, also disease latency period is very long - up to 50+ years.
2. Diagnosing, recording, reporting and compensating mesothelioma is considerably
low and lower in Asian and other developing countries than in best reporting
developed countries.
3. The type of asbestos used e.g. in the U.K. has earlier contained a significant amount
of crocidolite and other amphibole fibers that are known to cause more
mesothelioma and proportionally less ARLC (McCormack et al.)
Sources:
1.Rushton L: BJC(2012),107,53-57

27
Why Asbestos-related Lung Cancer is poorly
identified
1. Lung cancer is caused by many factors and smoking may cover up to 85% of all lung cancers.
The link of the outcome to asbestos is not often identified as asbestos-related and easily
dismissed because many workers exposed to asbestos are also smokers, and most lung cancer
victims are exposed to asbestos and actively smoking.
2. The attributable fraction or the number of “lung cancers eliminated by reducing just asbestos“
is high but, in particular, caused by the multiplicative or super-additive synergistic effects of
both asbestos exposure and smoking (see next slide).
3. Diagnosing, recording, reporting and compensating asbestos related lung cancer is weak
everywhere due to difficulty of individualising the asbestos exposure effect. This effect is seen
in a population but evidence individually is challenging to proof. Many jurisdiction expect
asbestos being as the main cause i.e. the magnitude of causal effect is higher than ½ of all
linked causes (RR=2 or higher, AF= 50%) to record them as compensable.
4. Life expectancy is relatively low in many Asian countries. Lung cancer and mesothelioma
appear late in life.
Sources:
1.Rushton L: BJC(2012),107,53-57
7. Memorandum from the Occupational Cancer Working Group, FIOH
www.ttl.fi/en/publications/Electronic_publications/Documents/Memorandum_Cancer_2013.pdf

28
Asbestos and smoking - synergistic effect
Increased risk of lung cancer when exposed to:
1. Asbestos alone RR = 2 - 5,
2. Smoking alone RR = 8-10
3. Combined RR = up to 50-80 ?

29
Asbestos and smoking - synergistic effect
Increased risk of lung cancer when exposed to:
1. Asbestos alone RR = 2 - 5,
2. Smoking alone RR = 8-10
3. Combined RR = 50-80
Source: T. Driscoll

Background or “non-exposed” reference mortality
30
1. Relative risk and attributable fractions are calculated against the background mortality for
“non-exposed“ population. Exposure limit today for airborne asbestos vary from 0.1 fiber/ml
to 0.01 f/ml (or 100 000 to 10 000 fibres/m3)
2. In countryside Europe background is about 100-500 fibres/m3. In cities – e.g. in Geneva in
between the ILO and WHO buildings (Avenue Appia): 900 fibres/m3 and inside the ILO office
building 600 fibres/m3.
3. 25 fibres/ml – years is considered as a criteria for ARLC/mesothelioma recognition for workers‘
compensation based on daily 8 hours exposure. This may be easily reached in a population of
1 000 people if exposure is continuous for 24h/day:
900 fibres/m3 * 3 * 1000 = 2.7 f/ml – yrs in a yaer and in 10 years: 27 f/ml – yrs.
1 death in a population of 1000 for every 10 years for “non exposed“ - acceptable?
4. Passive smoking and, in particular, active smoking radically increase the risk of ARLC.
5. Health-based OEL should be 0.001 f/ml or 1000 f/ml, and for general population life-time risk
(24/7 exposure, 80years, 1% of OEL) limit should be 0.0000001 f/ml or 0.1 fibres/m3 (Cherrie) .
Sources:
Cherrie John http://venus.unive.it/fall/presentazioni/Cherrie_op.pdf

31
Slide of Sugio Furuya

U.K.: ̴ 2909 a-r lung cancers, 48.5/mill.
2535 meso.,42.2 in 2013, HSE
Source:Fazzo et.al
32
Slide of Sugio Furuya, modified by JT:
Singapore, other Asia
Finland 42/mill.a-r lung cancer
Finland 11.8/mill.meso.
Finland 16/mill.

Table 1. Asbestos-Related Disease and All Cancer Deaths at Work
33
Year & Area/
Deaths
Finland
2001
(Nurminen et al.)
(selected countries)
Finland
2014 est.
U.K.
2005
(Rushton et al.)
U.K .
2013 est.
Thailand
2015
Thailand
2050 est.
World
Peak value
Asbestos related
lung cancer, ARLC 208 243 2223 2909 441 6 3093 6 97800 3
Mesothelioma 42 - 59 68–85 5 1937 2535 125 6 507 6 27600 3
ARLC +
Mesothelioma 250 311 4160 5444 566 3600 125400 3
Other asbestos
cancers and
asbestosis added
264 328 4234 4 5541 4 598 3800 132000 3
All cancer deaths
at work
839 1135 1 8010 13300 1 4825 1 n/a 666 000 2
1. Based on a proportional value derived from ILO estimate for High income economies and SEARO countries (WHO data 2011)
2. Based on ILO Estimate 2014 (WHO data from 2011):
https://www.wsh-institute.sg/files/wshi/upload/cms/file/Global%20Estimates%20of%20Occupational%20Accidents%20and%20Work-related%20Illness%202014.pdf
3. Around the years 2025-2030
4. Without asbestosis
5. Estimated at 68 but recorded annual average at 2010 was 85
6. Rate between ARLC and Mesothelioma considered 4:1 , in 2050 used McCormack et.al ratio 2-10 : 1 , average 6.1:1

34
Conclusions borrowed from Kurt Straif:

35
Conclusion

Singapore’s Experience in Asbestos
Management and Control
36

History of Asbestos Control in Singapore
Licensing of all raw
asbestos and ACM
(excluding
chrysotile) imports
in 1989
1950 1980 1990 2000 2014
37
Use of asbestos
building
materials
banned in 1988
Banning of
asbestos brake
pads and clutch
linings in 1995
Inclusion of
chrysotile
containing ACM
for licensing
control in 2008
Decreasing
use of ACM
Wide usage of asbestos as
building materials, fireproofing
and heat insulators
Enactment of
Factories (Asbestos)
Regulations in 1980
Gazette of WSH
(Asbestos)
Regulations in
2014

38
National Asbestos Control Programme
Targeted intervention
Standard setting
Compliance assistance
Capability building
Engagement

To enhance protection of workers against asbestos exposure
39
WSH (Asbestos) Regulations 2014
Effective from 30 May 2014

40
WSH (Asbestos) Regulations 2014
Key changes:
1. Asbestos Survey to be carried out by a
competent person to ascertain the presence of
asbestos
2. Licensing of contractors carrying out asbestos
removal work
3. Written plan of work to ensure asbestos removal
work is carried out safely
4. Removal of ACMs before demolition of building
5. Technical requirements on asbestos work
6. Training for persons carrying out work involving
asbestos
Source: http://www.mom.gov.sg/legislation/occupational-safety-health/Pages/default.aspx

200
Notifications
per year
41
Are there building
works carried out for
building built before
1 Jan 1991?
Is there any work,
operation or process
involving a specified
material?
Conduct an asbestos
survey to ascertain
the presence of
asbestos
Engage an approved
asbestos –removal
contractor
Submit asbestos
work notification to
Ministry of
Manpower
Conduct asbestos-removal
work with
measures taken to
minimise the release
or spread of
asbestos during work
Engage a licensed
waste disposal to
dispose asbestos
waste
YES YES
Presence of asbestos
68
Competent
persons
trained
14 AARC
licensed by
MOM
Cable penetration insulation, fire
protection board, panel, wall and
door, gasket, refractory lining,
sprayed insulation, thermal
insulation of pipe, boiler, pressure
vessel and process vessel
2 licensed
companies
by NEA

42
Illegal removal of asbestos-containing materials

43
Illegal removal of asbestos-containing materials
Any person who contravenes the WSH(Asbestos) Regulations shall be liable
on conviction to a fine not exceeding $20,000 or to imprisonment for a term
not exceeding 2 years or to both
Any person guilty of an offence under the WSH Act shall be liable on
conviction to a fine not exceeding $200,000 or to imprisonment for a term
not exceeding 2 years or to both for persons
Any person guilty of an offence under the WSH Act shall be liable on
conviction to a fine not exceeding $500, 000 to companies

44
Other Relevant Regulations
1. WSH (Medical Examinations) Regulations 2014
Persons who carry out work involving asbestos to
undergo pre-employment and periodic medical
examinations to screen for symptoms of
asbestos-related diseases.
2. Work Injury Compensation Act
Asbestosis and Mesothelioma are reportable
occupational diseases and workers who have
contracted these diseases arising out of their
work can claim compensation.

Common ACMs found in Singapore (Buildings)
45
Corrugated asbestos sheets
Roof
Wall Cladding

Asbestos ceiling
46
Common ACMs found in Singapore (Buildings)
Asbestos
cemented
wall panels
board
Asbestos ceiling board Asbestos
Vinyl Sheet

47
Common ACMs found in Singapore (Plants /vessels)
Pipe lagging Gasket
Pipe insulation Cable Penetration

48
• Notification of asbestos-removal work
•
2011 2012 2013 2014 (till date)
194 205 251 202
Total Permits Demolition
work
Structural work
Average
(Jun-Oct 2014)
519 79 440

49
“Not-so-common” ACMs
Rubbish
chute
insulation
lining
Ventilation
panels

50
Technical requirements on asbestos work
Designated
work area
Negative
pressure units
Proper
decontamination
facilities
Industrial
vacuum
cleaner
Measures to minimise the release or spread of asbestos
during work

51
Designated work area
Decontamination facilities
Industrial vacuum cleaner
Clean Shower Dirty

52
Compliance Assistance
WSH Guidelines
Management and
Removal of Asbestos
-Good practices in managing exposure to ACM
-Removal of ACM
•Plan of work
•Site preparation
•Decontamination facilities
•PPE
•Air monitoring etc.

53
Compliance Assistance
WSH Guidelines
Management and
Removal of Asbestos
Video
Working Safely with
Asbestos
WSHC Website
Asbestos
www.wshc.sg

54
Conclusion
• Asbestos-related diseases have killed a large number of
people worldwide
• Most effective way to prevent asbestos-related diseases is
to eliminate or prohibit the use of asbestos
• A multi-pronged approach involving legislation,
enforcement and engagement is necessary
• Joint effort by regulators and stakeholders is needed to
prevent exposure to asbestos and manage asbestos at
workplaces

55
THANK YOU

57

58
Additional selected data from
various sources, refs included

59

60

61

EUROSTAT numbers referred by the Health and Safety Executive, U.K. web page: http://www.hse.gov.uk/statistics/pdf/fatalinjuries.pdf (accessed 2014 09 11)
Takala J, Hämäläinen P, Saarela KL, Loke YY, Manickam K, Tan WJ, Heng P, Tjong C, Lim GK, Lim S, Gan SL: Global Estimates of the Burden of Injury and Illness at Work in 2012.
JOEH 11: 326-337, May/2014, Taylor & Francis, open access, http://www.tandfonline.com/doi/pdf/10.1080/15459624.2013.863131
ILO Report Contribution by Nenonen N, Hämäläinen P, Takala J, Saarela KL, Lim SL, Lim GK, Manickam K: GLOBAL ESTIMATES OF OCCUPATIONAL ACCIDENTS AND FATAL
WORK-RELATED DISEASES IN 2014, based on 2010 and 2011 DATA, Report to the ILO, Tampere, Singapore, Geneva 2014, DOI: 10.13140/2.1.2864.0647, web page:
http://www.wshi.gov.sg/files/Global%20Estimates%20of%20Occupational%20Accidents%20and%20Work-related%20Illness%202014.pdf
Stephen S Lim, Theo Vos, Abraham D Flaxman, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters I 21
regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224-60, Institute of Health Metrics and Evaluation web site:
http://vizhub.healthdata.org/gbd-cause-patterns/
Hämäläinen P. Global Estimates of Occupational Accidents and Fatal Work-Related Diseases. Doctoral dissertation, Publication 917, Tampere University of Technology,
Finland, 2010. Accessed on 11 Sep 2014 and available at http://dspace.cc.tut.fi/dpub/bitstream/handle/123456789/6818/hamalainen.pdf?sequence=1
Nurminen M & Karjalainen A (2001). Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland. Scandinavian Journal of Work,
Environment & Health 27, 161–213. http://www.sjweh.fi/show_abstract.php?abstract_id=605(accessed 26 March 2014)
Steenland K, Rollins School Public Health, Emory University, Atlanta, Ga. USA. 2004 http://www.occupationalcancer.ca/wp-content/uploads/2011/03/Steenland.pdf
(Accessed on 2014 09 14)
Ana M García, Rafael Gadena Merino, Vicente López Martínez: Estimación de la mortalidad atribuible a enfermedades laborales en España, 2004. Rev Esp Salud Pública 2007;
81 :261-270, N.°3 Mayo-Junio 2007. Accessible from: http://scielo.isciii.es/scielo.php?pid=S1135-57272007000300003&script=sci_arttext (accessed 2014 09 15)
Andrea ‘t Mannetje, Neil Pearce: Quantitative estimates of work-related deaths, diseases and injury in New Zealand. Scand J Work Environ Health 2005;31(4):266-276;
doi:10.5271/sjweh.882. Accessible from www.sjweh.fi/download.php?abstract_id=882&file_nro=1 (accessed 2014 0915)
Murray CJL, Lopez AD (ed.) The Global Burden of Disease – A comprehensive assessment of mortality and disability from diseases, injuries, and risk fraction in 1990 and
projected to 2020. Volume I. The Harvard School of Public Health, World Health Organisation, and World Bank. 990 p., 1996.
Santonen T, Oksa P. (eds.): Memorandum from the Occupational Cancer Working Group. Finnish Institute of Occupational Health. ISBN 978-952-261-369-1. See:
http://www.ttl.fi/en/publications/Electronic_publications/Documents/Memorandum_Cancer_2013.pdf (accessed 2014 09 15)
V McCormack, J Peto, G Byrnes, K Straif, P Boffetta. Estimating the asbestos-related lung cancer burden from mesothelioma mortality. Accessed on 16 May 2013 at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273352/ (accessed 17 March 2014)
WHO: Asbestos: elimination of asbestos related diseases. See: http://www.who.int/mediacentre/factsheets/fs343/en/ (accessed 2014 09 15)
Singapore WSH Statistics, WSH Institute, available at http://www.wshi-institute.sg/Observatory-WSH-Landscape/WSH-Statistics.html
Labour Force Survey 2013, Ministry of Manpower available at http://stats.mom.gov.sg/Pages/Employment-Tables2013.aspx
Lesley Rushton, Sally J Hutchings, Lea Fortunato, Charlotte Young, Gareth S Evans, Terry Brown, Ruth Bevan, Rebecca Slack, Phillip Holmes, Sanjeev Bagga, John W Cherrie
and Martie Van Tongeren. Occupational cancer burden in Great Britain Br J Cancer 107: S3-S7; doi:10.1038/bjc.2012.112. Accessed on 16 May 2013 and available at
http://www.nature.com/bjc/journal/v107/n1s/index.html
Communicable Disease Report 2012, MOH: accessed on 16.09.2014
http://www.moh.gov.sg/content/moh_web/home/Publications/Reports/2013/Communicable_Diseases_Surveillance_in_Singapore_2012.html
62
Selected sources, not comprehensive:

Cancer site: Attributable Fraction(%) Attrib Deaths (2005) Attrib. Registrations (2004)
Male Female Total Male Female Total Male Female Total
Bladder 7.1 1.9 5.3 215 30 245 496 54 550
Bone 0.0 0.0 0.0 0 0 0 0 0 0
Brain 0.5 0.1 0.3 10 1 11 12 2 14
Breast 4.6 4.6 555 555 1,969 1,969
Cervix 0.7 0.7 7 7 18 18
Kidney 0.04 0.04 0.04 1 1 1 2 1 3
Larynx 2.9 1.6 2.6 17 3 20 50 6 56
Leukaemia 0.9 0.5 0.7 18 5 23 30 9 38
Liver 0.2 0.1 0.2 4 2 5 4 1 5
Lung 21.1 5.3 14.5 4,020 725 4,745 4,627 815 5,442
Lympho-haematopoietic 0.004 0.002 0.003 0 0 0 0 0 0
Melanoma (eye) 2.9 0.4 1.6 1 0 1 6 1 6
Mesothelioma 97.0 82.5 94.9 1,699 238 1,937 1,699 238 1,937
Multiple Myeloma 0.4 0.1 0.3 5 1 6 8 2 10
Nasopharynx 10.8 2.4 8.0 7 1 8 14 1 15
NHL 2.1 1.1 1.7 43 14 57 102 39 140
NMSC 6.9 1.1 4.5 20 2 23 2,513 349 2,862
Oesophagus 3.3 1.1 2.5 156 28 184 159 29 188
Ovary 0.5 0.5 23 23 33 33
Pancreas 0.02 0.01 0.01 1 0 1 1 0 1
Sinonasal 43.3 19.8 32.7 27 10 38 95 31 126
Soft Tissue Sarcoma 3.4 1.1 2.4 11 3 13 22 4 27
Stomach 3.0 0.3 1.9 101 6 108 149 9 157
Thyroid 0.12 0.02 0.05 0 0 0 1 0 1
Total 8.2 2.3 5.3 6,355 1,655 8,010 9,988 3,611 13,598
Total GB cancers 15+yrs Source: Rushton a.o.
77,912 72,212 150,124 © 2010 Government 175,399 of 168,184 Singapore
343,583 63

64
Cancer Site Asbestos Shift
work
Min.
oils
Solar
n
rad
Silica DEE PAHs
(Tars)
Painters Dioxins ETS RadonWelders All
Bladder 296 106 71 550
Brain 14
Breast 1,957 1,969
Cervix 18
Kidney 3
Larynx 8 56
Leukaemia 38
Liver 5
Lung 2,223 470 907 695 282 215 284 209 175 5,442
LH cancers 1
Melanoma eye 6
Mesothelioma 1,937 1,937
Multiple
Myeloma 10
Nasopharynx 15
NHL 74 140
NMSC 902 1,541 475 2,862
Oesophagus 188
Ovary 33
Pancreas 1
Sinonasal 55 126
STS 27 27
Stomach 47 83 157
Thyroid 1
Total Attrib.
Registrations
4,216 1,957 1,722 1,541 907 801 475 437 316 284 209 175 13,598
Source: Rushton a.o.

http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
65
10 leading causes of Deaths in East Asia
Murray et al. Lancet 2012,

http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
66
10 leading causes of Deaths in East Asia
Murray et al. Lancet 2012,
WORK-related

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