PSAC Position papers
PSAC POSITION PAPER 1
INDOOR AIR QUALITY
Over the past fifteen years, there has been increasing concern about "indoor air pollution" and the effects of sealed buildings on workers. Hundreds of buildings in North America and Europe have been studied, invariably as a result of complaints of health problems from the workers.
The Public Service Alliance of Canada has been involved directly in numerous cases, involving thousands of members, which included health studies, building performance assessments and/or air quality assessments. Our studies and those of others have shown, time and again, that the symptoms of sick building syndrome are widespread and that workers' complaints are very real.
Our employers and our government have been very reluctant to recognize our health problems, fighting every step of the way our efforts to get the air in our workplaces cleaned up.
Within the Alliance, we have been pursuing more long-term activities, pressuring the federal government to scrap its energy conservation policies, and to develop national standards for ventilation in buildings which protect the health and safety of the occupants.
Many of our Locals have been engaged in ongoing battles for years. However, the reality is that in too many cases these efforts have not been successful. Thousands of members continue to suffer on a daily basis from the effects of poor indoor air quality in their workplaces.
Workplace Safety and Health Committee members and representatives in these and other Locals across the country continue their efforts to have their ongoing air quality problems remedied, for the most part with little or no success. Endless testing, reports, delays are the common employer response, along with arguments over who is responsible for corrective action.
Recent developments in a few federal buildings may mean that we can finally expect some improvements on that front. Clearly, this shift has been the result of continued pressure from our members. Even the Public Service 2000 reports admitted that air quality is a major problem. In their Report on Workforce Adaptiveness, they recommended "as a matter of urgency" that the government take concrete corrective action. Among other things, they stressed the value of "windows that open".
Over the last few years, there has been a vast amount of research carried out by scientists all over the world which confirms what workers knew all along - there are serious health effects from exposure to polluted indoor air.
The Nordic Committee on Building Regulations (Denmark, Finland, Iceland, Norway and Sweden) recently published a draft of extensive recommendations for indoor air quality and the U.S. Senate has recently introduced a comprehensive bill.
Numerous scientific studies indicate that pollutants in indoor air include radon, asbestos, volatile organic chemicals (including formaldehyde and benzene), combustion by-products such as carbon monoxide and nitrogen oxides, metals and gases (including lead, chlorine and ozone), respirable particles, environmental tobacco smoke, biological contaminants, micro-organisms and other contaminants.
The time has come to press our demands for clean, healthy workplaces, to insist that our government and our employers live up to their legal and moral responsibilities to protect our health and safety.
While there is a continuing debate about many aspects of the "sick building" issue, there is a growing consensus about some measures that can be taken, without great cost, to remedy most problems. These actions can and must be taken without further delay.
Canadian governments must recognize that poor indoor air results in occupational health problems for a significant portion of Canadian workers.
1. General Principles
The following principles must form the basis for government action with regard to poor indoor air quality in our workplaces:
1. The federal government must initiate legislative action (together with the provincial and territorial governments) to ensure effective and coordinated action on the growing problem of poor indoor air quality.
The WHMIS model (of similar legislation spanning all Canadian health and safety jurisdictions) should be considered to ensure that adequate measures are taken to protect the health and safety of all Canadian workers. All new regulations must be flexible enough to incorporate new information and standards as they become available.
2. A new indoor air authority must be created to initiate and coordinate research activity on a larger scale.
To date this has been sorely lacking in Canada. Two particularly important areas of research are:
- the health effects, including reproductive effects and changes to the immune system, of prolonged exposure to low levels of toxic substances found in our workplaces; and
- low polluting building materials, equipment and furnishings.
3. The World Health Organization defines health as: "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".
The introductory clauses of all health and safety legislation in Canada place on employers the duty to "ensure that the safety and health of every person employed by him is protected". Dismissing the health effects of poor indoor air quality as "comfort problems" is not acceptable.
4. The health and comfort of all affected workers must be protected, both healthy individuals and sensitive populations.
A portion of our working population is more sensitive to indoor air pollution than others. Estimates vary between 15 and 30 per cent. It is not acceptable to set building ventilation and thermal comfort standards which deliberately exclude the needs of these individuals. Recent advances with respect to the rights of needs of disabled persons must be extended to incorporate the population of chemically- sensitive individuals. Technology currently exists to identify and resolve the vast majority of such problems.
5. Workers' Compensation Boards and Commissions must recognize "Tight or Sick Building Syndrome" as an occupational disease and compensate its victims in our workplaces.
Since 1982, the World Health Organization has recognized sick building syndrome and some provinces have compensated in a limited way victims of sick building syndrome.
6. The air inside a non-industrial building should not be substantially different from the ambient air in the community in which it is located.
There is no logical justification for allowing concentrations of pollutants to build up inside these buildings, thus forcing the workers to breathe contaminated air for their entire work shift. Nor is it reasonable to set different standards for indoor air in a residential setting than a general occupational environment.
7. There should be no recirculation of:
- any contaminants from one portion of the building to another which does not already contain these contaminants (e.g. tobacco smoke, printing fumes); and
- any substance known or suspected to be a human carcinogen.
Local exhaust must be required for any process likely to introduce pollutants into the building's air.
8. The introduction of new pollutants, via emissions from new furnishings, paints, glues, etc., should be strictly controlled.
Employers must be required to adopt policies for using the lowest polluting building furnishing, materials and equipment available, and taking the necessary measures to prevent the air from being contaminated by such equipment.
This could be achieved by various mechanisms, involving the Workplace Safety and Health Committee/Representative. A possible vehicle could be WHMIS type labels and/or Material Safety Data Sheets. Current developments in the U.S. in measuring emissions from material will assist.
9. Worker input through their Workplace Safety and Health Committee/ Representative must be built into regulations dealing with indoor air quality.
This input must include:
- training in the operations of the ventilation equipment in their building;
- incorporation of the ventilation equipment into their routine workplace inspections;
- provision of all information, records, test reports, etc. about the ventilation system and practices in the building; and
- notification and consultation about any changes planned to or within the building which could affect the ventilation or air quality, such as renovations or new furnishings.
10. A procedure must be established for workers to file complaints with occupational health and safety inspectors about indoor air quality, with specified actions and time limits.
These bodies must be properly equipped to respond to these complaints. Additional inspectors, training, equipment and technical back-up will be required.
11. Labour must be represented on committees such as the National Research Council's Building Code Review Committee and the Standing Committee on Heating, Ventilation and Airconditioning in particular.
Critical decisions are taken at these bodies which affect the health of Canadian workers and they should be represented.
2. Specific Requirements
In addition to the basic principles outlined above, based on research findings from Canada and abroad, the PSAC demands that federal, provincial and territorial health and safety legislation be amended without further delay to meet the following minimum requirements:
- no workplace should be exempt from new indoor air quality legislation;
- ventilation rates must be increased to 17.5 litres of fresh air per second (30 cubic feet per minute) per person, closer to the pre-1970s energy crisis levels, from the present 10 litres (20 cubic feet per minute);
- temperature must be maintained within the target range 20oC and 23oC, with provision for personal adaptation above or below the target range. The Workplace Safety and Health Committee/Representative must be notified immediately where the temperature moves away from the ideal range to determine whether corrective action is required;
- humidity levels must be maintained between 40 and 55 per cent;
- a protocol must be developed for the investigation of outbreaks of health problems suspected to be related to building air quality; and
- maintenance performance standards must be established for building owners and operating staff. Training of maintenance personnel to meet these performance standards must be mandatory. These standards should include reports to be filed on a regular basis with the Workplace Safety and Health Committee/Representative and the Regional Office of Labour Canada or the appropriate provincial or territorial health and safety authorities.
- Federal Government
The Canadian government must take action, through the new Indoor Air Agency to coordinate and direct the activities of the various departments and bodies.
1. Coordination of activity, including research, of the numerous bodies involved in air quality at the federal government level. The most important are the National Research Council, the Department of Public Works, Labour Canada, Consumer and Corporate Affairs, Health and Welfare and the Canadian Centre for Occupational Health and Safety. New initiatives being undertaken and generated and information received by these bodies can assist in protecting Canadian workers if it is shared and their activities coordinated.
2. A governmental or other appropriate body must assess indoor air monitoring and clean-up services provided by private firms and other organizations, including the range of services, their reliability and accuracy. Registration, licensing and certification of these services must be explored. This is critical in order to protect the health of workers and the investment of building owners as these services are proliferating at a great rate.
3. Labour Canada's Education Section should develop materials (manuals, videos, pamphlets, etc.) for workers, employers and building owners on how to investigate and remedy air quality problems. This information should be widely publicized throughout the federal jurisdiction and shared with provincial and territorial health and safety authorities.
We call on the federal government to prepare a comprehensive response plan, as proposed in the U.S. Indoor Air Quality Bill and the Nordic Indoor Climate draft proposals. This plan must involve the affected workers and the provincial/territorial governments.
- Union Action
Indoor air quality has been an ongoing struggle for our union for 15 years. We have made some small gains but a lot more remains to be done. This problem of "sick buildings" has arisen because of political decisions to save money by conserving energy and cutting back on maintenance in our buildings. Requests to have these policies reviewed have fallen on deaf ears.
Very recently, we have begun to see some small indications that improvements, at least at the federal government level, may be forthcoming. We welcome these initiatives. However, until our demands are met for all the changes necessary to safeguard the health of our members, the PSAC will continue our campaign to clean-up the air in our workplaces.
- Health Surveys
We will continue to encourage Locals to conduct health surveys. We will review the requests and make recommendations for specific corrective measures and follow-up action.
We will lobby for expanded powers under our health and safety legislation, for greater involvement of Workplace Safety and Health Committee Representative in monitoring ventilation, selecting building equipment and furnishings, participating in investigations, and ultimately, shutting down unsafe work.
We will also lobby for the creation of one Canadian authority to oversee all aspects of indoor air quality with sufficient funds to ensure that the air we breathe is as healthy as possible.
- Legislative Changes
We will continue to participate through the Canadian Labour Congress in the development of a new federal Building Safety Regulation which will include indoor air quality. Through this bipartite process, we will press for demands outlined above. We will support similar efforts at the provincial and territorial levels.
We will strengthen our collective agreements to ensure that our safety and health is protected and to give us effective redress mechanisms when our employers fail to take proper protective measures.
In addition, we will continue our efforts to expand and strengthen our NJC Health and Safety Standards for those members under Treasury Board.
The PSAC firmly believes that workers' health should not be harmed in any way. The issue of indoor air quality is a serious one which has and is making thousands of our members sick on a daily basis. We will continue to press our employers and governments to take the necessary action to remedy this problem.
It is the sad reality that each year thousands of our members are injured or made ill by their work.
In spite of our successful Black Paper campaign to obtain health and safety legislation for our members working for the federal government, our Gross Injustices report documenting the problems of our members hurt on the job, and our ongoing activities to achieve clean and safe workplaces, our members in all jurisdictions still suffer injury, illness and death as a result of their work.
Tens of thousands of PSAC members are routinely exposed to substances and working conditions that place their health at serious risk. The widespread use of cancer causing chemicals in worksites from offices to airplanes means that all workers are potentially exposed. Other substances commonly found in many of our workplaces can permanently damage the respiratory, nervous and reproductive systems. In fact, every part of our bodies can be harmed by a variety of conditions in our workplaces.
It is the firm belief of the PSAC that no aspect of any person's health or well-being should be damaged in any way by his/her work.
But we have a long way to go. Our employers are often reluctant to live up to their legal and moral responsibilities, to eliminate hazards at the source, and to create healthy and safe workplaces. In the interim, we must press for measures to assist our members who are harmed by their work and those who are exposed to conditions that could cause damage to their health in the future.
Medical monitoring is one measure employers and some workers propose as an essential health and safety activity. They argue that it is necessary to prevent disease and to study the effects of various substances and activities on workers' health.
Since such surveillance is too often misused and abused to the detriment of workers, the PSAC National Board of Directors moved that a Position Paper be prepared to ensure the full protection of our members' rights and a consistent union approach to this controversial issue.
WHAT IS MEDICAL MONITORING?
Part of the controversy around medical monitoring arises out of the confusion over what the term actually means. There are several different views of what medical monitoring (also known as medical surveillance) is.
According to Dr. Gordon Atherly, former President of the Canadian Centre for Occupational Health and Safety, medical monitoring includes:
"Clinical tests, laboratory tests, physical examinations and questionnaires applied prior to employment, at its start, or during its course".
Medical monitoring can include:
1. Medical examinations which may be full physical examinations or examinations of selected aspects of the person's health and well-being - e.g. lower back, respiratory function, psychological, etc.
- Pre-employment examinations try to identify people who are more likely to become ill on a particular job due to higher susceptibility or disability, or who may be unable to perform the job duties for some health reason.
- Pre-placement examinations are carried out after a person has been hired to try to match the worker's capabilities to the job requirements.
- Periodic examinations are medical examinations carried out on a periodic basis to detect impairment to one or more aspect of a worker's health.
2. Tests of strength, stamina or fitness.
3. Tests of the faculties and senses, e.g. balance, hearing, eyesight, motor ability.
Tests of strength, fitness and the faculties can be used as pre-employment screening or to establish "baseline" information. Later examinations are then compared against the baseline. This information is often used to protect the employer against compensation claims.
4. Biological tests such as examination of blood, urine, sputum, chest and back X-rays.
A biological test may be carried out to measure how much of a workplace pollutant an individual has absorbed. This can be an indicator of early signs of disease. It may also be used to identify workers whose body levels of a substance are too high. Ideally, the tests would serve to indicate that environmental control measures must be improved, but more often they simply result in the worker being removed from the work environment until the levels (e.g. of lead in the blood) drop to "acceptable" levels.
5. Genetic screening
Genetic screening is based on the premise that certain individuals are more likely than others to succumb to diseases such as cancer. It also assumes that tests can detect who these individuals are. The Atomic Energy Control Board is currently investigating genetic screening for cancer susceptibility.
Obviously, any of the above tests may be requested by a worker from his/her family doctor for his/her own information. This is not what we mean by medical monitoring which is usually required by the employer or government regulation. This is not the same as a visit to your family doctor. In many cases, workers are not permitted to choose the doctor or nurse who will carry out the testing, nor do they control what tests are done or what happens to the results.
Weaknesses and Bogus Claims
Medical monitoring is often presented as a valuable method of protecting workers from the harmful effects of substances at work. This can be seductive given the appalling toll in workers' lives and health from working in unsafe conditions. But the fact is that few tests do more than demonstrate that damage has already occurred. Most are far less precise. To quote Dr. Linda Murray, former director of the Manitoba Federation of Labour's Occupational Health Clinic,
"Medical Monitoring is a tool, a very crude tool. Like any other tool, it can be used for us or against us".
All too often, by the time tests indicate a problem, irreversible damage has been done and nothing can be done to alter the outcome.
Medical monitoring presents a number of serious drawbacks, technical, legal and moral, all of which are often compounded by workers' lack of control over such surveillance programs.
Moreover, a number of claims are made regarding benefits of medical monitoring which we reject. They include:
1. Prevention of illness in present workers
Medical tests cannot prevent illness, they can only detect damage once it has occurred. In some cases, adverse effects can be reversed or treatment given to delay the course of the disease. This is not prevention.
2. Prevention of illness in workers of the future
It is sometimes argued that knowledge gained from studying the effects on workers of workplace exposures to hazardous substances can be used to protect future generations of workers. This does not constitute prevention of disease. This justification of medical monitoring uses workers as guinea pigs. It does not prevent disease. This is clearly unacceptable.
3. Identification of vulnerable workers, thus preventing them from being at risk
Research has shown that tests for hypersensitivity and vulnerability to disease have a very poor predictive value. Genetic screening is both scientifically imprecise and a very serious threat to human rights of workers. Finally, when "vulnerable" workers, such as pregnant women or women who might become pregnant, are removed from a high risk workplace, the rest of the workers are left behind to be exposed. Workplaces must be safe for all workers.
4. Ensure "fitness to be exposed"
No worker should be forced to be exposed to hazardous substances in their workplaces. Employers should control the hazards at their source instead of looking for "superworkers" who can endure working in unhealthy environments. In addition, as noted in no. 3 above, predicting who will be adversely affected by certain levels of exposure is an inexact science, rejected by most reputable occupational health experts.
5. Tests are safe
Simply because medical tests are carried out by nurses and doctors does not mean they are safe.
For years, routine chest X-rays were administered to workers, though they were known to increase the risk of cancer. Chest X-rays, then, add to the hazards faced by these workers. Other tests which on the surface may appear harmless, such as sputum cytology, may, if positive, lead to more invasive and potentially hazardous tests. Further, the psychological damage done by a wrong diagnosis should not be underestimated.
6. Results are confidential
Too often, company doctors (doctors employed by management) have done the medical monitoring. The results have been used to further the objectives of the employer rather than improve the working conditions or benefit the workers themselves.
There have been examples in the past where the results of medical tests have been passed along to the employer, but not to the workers on whom the tests were carried out. The most notorious example of this is, of course, asbestos. Any disclosure of information without consent of the worker is against the law.
Further, the worker should be free to choose the doctor who will carry out the tests/examinations. Confidentiality and security of workers' rights must be ensured.
As long as medical monitoring is primarily for the benefit of employers - for minimizing future compensation costs, eliminating "susceptible" workers, detecting affected workers early - it will violate the rights of workers. Therefore, we must be sure that if our members participate in medical monitoring, it must be under stringent conditions which meet their needs and safeguard their health and rights.
Conditions For Medical Monitoring
Medical monitoring can be beneficial to workers provided very strictly-controlled conditions are met. Any medical tests carried out must meet the following criteria. They must:
- be scientifically valid. They must accurately and reliably identify exposure to the hazard or the expected consequence of exposure.
- provide real benefits to workers in terms of improved health, longer life or relief from physical, emotional or social damage.
- be carried out with workers' participation in determining what tests will be done, what will happen to the results and who will do the testing.
- be part of a larger prevention program which focuses primarily on monitoring the workplace and eliminating hazards at their source.
- not introduce a new hazard to the worker.
If the above conditions are met, medical monitoring can provide some benefits to some workers; for example, laboratory workers who are constantly in contact with hazardous substances that pose known danger if any exposure occurs. However, medical monitoring is no substitute for primary prevention of the hazards at the source. In the worst event, test results can assist with workers' compensation claims for health damage.
If carried out according to the preceding criteria, medical monitoring can:
1. provide a baseline assessment of a worker's health at the time of hiring;
2. document changes which occur in the course of employment;
3. determine whether any health damage has occurred as a result of an accident or workplace exposure to known hazardous chemicals or biological hazards (if reliable tests for the hazards exist);
4. in some cases, detect disease early enough that action can be taken to reverse the effects and/or to prolong the life of the worker. Few, if any tests, however, can satisfy this condition;
5. advise a worker about any condition that might be made worse by a particular type of work, thus allowing the worker to choose whether or not to accept the risk;
6. determine that environmental control measures are inadequate, leading to necessary improvements;
7. ensure that a worker is fit for a high hazard job and/or for public safety. However, the tests must relate to bona fide job requirements, and not simply be used to weed out "undesirable" candidates. For example, in firefighting, a strong heart is necessary to withstand high heat and a healthy respiratory system to wear breathing apparatus;
8. detect an undiagnosed medical condition among groups of workers, such as ships' crews, who will be far away from medical help for periods of time; and
9. provide records and data to public authorities and unions for use in documenting some adverse health effects of exposure to workplace hazards. It cannot prevent the adverse health effects.
Despite labour's misgivings, medical monitoring is now a part of the field of health and safety. For this reason, it is critical that the Public Service Alliance of Canada set out clearly circumstances and conditions under which medical monitoring is acceptable.
The following guidelines, produced by the Canadian Centre for Occupational Health and Safety (CCOHS), form the basis for the PSAC's position on medical monitoring.
CCOHS GUIDELINES FOR MEDICAL MONITORING IN CONNECTION WITH WORK
Medical monitoring means the periodic conduct of specific manoeuvres or tests on a population of exposed workers. It does not include case-finding where heavily-exposed workers are sought out for special testing.
The following guidelines only apply where medical monitoring meets certain ethical pre-conditions. These exist where:
* all efforts have been made to eliminate related workplace contaminants or to protect workers through environmental controls; and
* the specific medical monitoring procedures are valid, sensitive measures of individual or collective risk.
1. The right to know. The worker has the right to a full explanation of the risks and benefits of medical monitoring procedures prior to their conduct. The worker should have the right to copies of test results, to a full explanation of the tests, to their interpretations and to knowledge of the uses to which the data will be put. The risks of medical monitoring must include those related to the phenomenon of labelling, where a stigma may result from testing or its results.
2. The right to competent medical advice in all aspects of the work-health relation.
3. The right to be monitored by the physician of his/her choice.
4. The right to refuse medical monitoring carried out in connection with work. That is, no medical monitoring is to be carried out without the worker's specific and informed consent.
5. The right to confidentiality in the handling of medical monitoring information and to withhold the results of monitoring from third parties. When the results of medical monitoring are to be collected for research or compliance with regulations, this should be done in a way which guarantees the confidentiality of the individual's records.
6. The right not to be discriminated against on the grounds of ill-health or disability.
7. The right to procedural protection and full compensation if medical monitoring leads to loss of job or benefits.
The worker should have the basic responsibility for deciding whether to accept a particular job. The essential limitations on the worker's freedom of choice are whether the worker can actually carry out the job and the degree of risk to others which acceptance of the job would entail. In order to determine whether a worker is capable of doing a particular job, a practical assessment rather than medical tests or questionnaires should be used.
In addition to these basic principles, the PSAC further demands that:
The union must play a critical role in any workplace health and safety program. This includes the development, implementation and evaluation of any monitoring program.
The union must have access to the results of the monitoring. In order to assess the effectiveness of the workplace health and safety program, the union must have the composite results (not individual worker's) of the testing.
The medical monitoring must be limited to specific, identified hazards in the workplace, hazards which are being monitored environmentally as well as medically, and must not be used to collect more general health information (such as alcohol and drug abuse).
The increasingly popular employer approach of using genetic screening to identify "susceptible" workers and refusing to hire them must be firmly resisted.
Firstly, this discrimination violates the human rights of the individual denied employment; and secondly, it violates the rights of all the other workers by exposing them to the hazard.
Where health services are to be provided at work, the conditions must be set out in a written agreement with the Employer. They must be administered by the union or by a joint committee at least half the members of which are workers. Such union involvement will ensure that medical monitoring undertaken by the health services meets the basic needs and protects the rights of our members.
Too often, medical monitoring is used against workers rather than for their benefit as a cheaper alternative to cleaning up unhealthy workplaces. This is not acceptable.
The PSAC will continue to press for collective agreement language and legislative changes that forces employers to take all the necessary measures needed to make our workplaces healthy and safe.
As one part of an overall prevention program, we will support medical monitoring of workers provided that we are sure it is for our benefit, and that we have full participation in all aspects of its implementation. We insist on full protection of our health and our human rights at work.
Cancer is one of the most feared words in our modern world. This is not surprising in that each year about 50,000 Canadians die from it, and new cases are diagnosed at the rate of close to 100,000 per year. The number of new cases has risen steadily in the last 25 years, 40 per cent in the last ten years alone. The probability of developing cancer is now almost one in three.
For many thousands of PSAC members, exposure to known or suspected cancer causing substances at work occurs daily. Our members in laboratories, repair shops, printing shops, agricultural work, heating plants, hospitals are all forced to work under these fearful conditions. This is by no means a complete list. The Alliance has estimated that approximately 40,000 members work directly with substances known or suspected to cause cancer. In addition, we are becoming increasingly aware of the extent of carcinogens, for example, asbestos and formaldehyde, in our general work environments, including office buildings.
These workplace carcinogens affect not only the workers exposed. Families are also affected. Most obvious is the trauma of illness and death of a loved one. In addition, spouses and children can be exposed to hazardous materials brought home on work clothes. And it is becoming tragically apparent that some forms of cancer in children, for example leukemia, can be linked to chemicals, a parent was exposed to before or during pregnancy.
It has long been the position of the PSAC that our health and safety should not be damaged in any way by our work. The union movement has fought long and hard to improve health and safety conditions in our workplaces, and we have achieved many successes. However, when it comes to the growing epidemic of occupationally-related cancer, we still have a long way to go.
It is clear that, as a union, we must take action to protect the health of ourselves, our fellow workers and our families. This position paper confirms and extends our commitment in this area.
WHAT IS CANCER?
Cancer itself is not a single disease. The word defines a broad range of diseases of the cell which share two common factors: 1) the uncontrolled growth of cells, and 2) the fact that it is usually incurable.
The mechanism which causes cells to go out of control is not fully understood. It is known that the genetic material in the cell is damaged in some way that changes its normal growth and functioning. However, the damage may occur years before any cancer develops.
This "latency period" can be anywhere from five to fifty years. It is one of the major factors which makes it so hard to determine what causes cancer.
Another important factor is that scientists are not certain about the exact mechanism, but believe that some substances act together to cause cancer where individually they would not. In some cases, one will prod the other into action.
WHAT CAUSES CANCER?
While it is usually thought of as a disease of heredity, bad luck and lifestyle (the latter pushed strongly by public health authorities and cancer organizations), there is mounting scientific evidence that the major causes of cancer are environmental. Estimates vary between 75 and 85 per cent. Our food, air, water and soil are polluted by thousands of chemicals and other toxic contaminants, usually by-products of industrial processes. This makes it virtually impossible to separate environmental causes from workplace causes. However, workers are exposed directly to these substances on a continuous basis, in large amounts and much more concentrated forms. To date, hundreds of these chemicals have been discovered to cause cancer in animals and/or humans.
Workplace carcinogens can be removed and controlled more easily than environmental hazards and lifestyle factors. Yet, our public health policies continue to focus on "lifestyle" causes of cancer, implying that people can choose to lower their own risk factors. This emphasis on "blaming victims" of cancer is highly misleading because, as individuals, we have very little control over our environment.
As a union, we encourage our members to adopt healthy lifestyles. However, we must not lose sight of the fact that exposure to hazards at work is far too often an INVOLUNTARY condition of employment, not at all comparable to lifestyle risk factors. Few of us can choose not to work and, in times of high unemployment, alternative "safer" jobs may be hard to find.
There are literally hundreds of thousands of chemicals, more than 60,000 of which are in use in North American workplaces. One thousand new ones are introduced every year. However, a U.S. study of 48,523 chemicals revealed that for almost 80 per cent of these, no information was available on the toxic effects, and for the remaining 20 per cent, data was partial at best. In spite of this lack of information, close to 200 chemicals and industrial substances are now linked to cancer. Further research will likely reveal more than 1,000.
Exact exposure figures are impossible to obtain in this country. To date, no agency or employer is required to record known exposures to toxic substances, and workers are totally unaware of many, if not most, exposures. (The Finnish government, which has legislation and a national agency to register worker exposure to carcinogens, has recorded 20,000 exposed workers, among their 2.3 million workforce in the first six years of their program).
To make matters worse, standards governing exposure of workers to the small proportion of chemicals for which such information does exist are grossly inadequate. Though most reputable scientists strongly question whether there is any "safe" level of exposure to a carcinogen, standards such as the American Conference of Governmental and Industrial Hygienists (ACGIH) "Threshold Limit Values" (TLVs) permit such exposures. Since our federal and most provincial regulations governing hazardous substances incorporate these TLVs, this means that our members are legally exposed to materials known to cause cancer in humans or animals.
In addition, recent research has exposed as unscientific, biased, even fraudulent, the process by which this private U.S. group sets the levels they recommend. The TLV Committee has (as documented by a highly-regarded research team) for years ignored masses of published scientific evidence on adverse health effects, cancer among them, of substances at even lower levels than they recommend.
Various groups, including labour organizations, have been highly critical of this group and its practices for years. More than ten years ago, the Swedish government abandoned ACGIH TLVs as unsatisfactory, and set up their own system. Yet, our Canadian regulators and many occupational health professionals have continued to rely on these questionable exposure levels. It is labour's position that this dangerous practice must be STOPPED.
An equally repugnant aspect of the discussion about what causes concern is the concept of "acceptable risk". This is a cost-benefit approach applied by regulators, employers and some scientists which determines whether and how much "excess cancer" is acceptable versus the cost to employers of taking stronger preventive measures. For example, in setting the exposure level of vinyl chloride in Ontario, it was considered acceptable to allow 50 "excess tumors" per 100,000 workers exposed to this potent carcinogen. Thus, fifty workers are literally sentenced to suffer the risk of getting cancer (in this case, a highly fatal cancer of the liver, or "angiosarcoma"). The sad irony here is that many Canadian and U.S. firms using vinyl chloride had already achieved lower exposure levels through engineering controls! This short illustration is graphic proof that some cases of occupational cancer are caused not only by exposure to toxic substances, but also by economic decisions. Technical solutions to these unacceptable exposure levels have been found where employers saw fit to do so. There is no excuse for exposing workers to carcinogens in their workplaces.
PREVENTION vs CURE
Though cancer is one of the most rapidly growing life-threatening health problems facing workers and the general public, it is treated by health officials as an individual problem for which a cure must be found. Vast amounts of money are spent on diagnosis, treatment, patient care, and on research to find the "magic" cure. However, the treatment of many forms of cancer is marginally effective, and a definitive cure is still elusive. Relatively, little attention is paid to PREVENTION which, from a health and safety point of view, is the best approach - eliminate the hazard at the source. Even from a public health standpoint, prevention is the most effective cure. In fact, the death toll from killer diseases such as cholera and tuberculosis was reduced long before a cure was found, primarily by reducing the hazard through better sewage and water treatment measures.
In the case of AIDS, which shares with cancer the factor of being incurable, governments have decided to respond to the pressure to use current knowledge to prevent the spread of AIDS, while scientists search for a cure. Large campaigns are being financed, all in the few short years since the AIDS virus was identified. Yet, these same bodies refuse to act on the mounting evidence that much of the cancer death toll is also preventable, particularly, cancer related to chemicals and other hazardous substances. Much of this knowledge has been available for decades, even centuries.
WORKERS ARE GUINEA PIGS
For hundreds of years, workers have been the guinea pigs who have tested toxic substances for the rest of society. Scientists, physicians and workers themselves have collected evidence of cancer being strongly related to working with substances like asbestos, benzene, vinyl chloride, formaldehyde and others. This information has been made available to governments, employers, scientists and others such as the ACGIH. Yet, these groups have repeatedly ignored and often suppressed this information. It took the ACGIH, for example, over 30 years to lower the standard for asbestos, lagging behind the U.S. and British governments, and far behind the scientific evidence which showed asbestos to be a potent carcinogen as early as 1930. The Canadian government is currently involved in a campaign to convince the world that asbestos can be used safely, despite volumes of evidence to the contrary.
Ten years ago, a noted American cancer specialist, Dr. Samuel Epstein, argued in his book, "The Politics of Cancer", that testing and regulating environmental pollutants could prevent the majority of cancer deaths, if governments were committed to do so. He wrote:
"While much is known about the science of cancer, its prevention depends largely, if not exclusively, on political action."
This concept of "acceptable risk", that so many workers' lives are expendable, is no longer acceptable. As a union, we must take up the fight for strong and swift action from government and employers to reverse this spectre of death and disability.
PRESSURE FOR CHANGE
We have a toe in the door with the new Workplace Hazardous Materials Information System (WHMIS/SIMDUT) which gives all Canadian workers the "Right to Know" about some of the potentially-toxic substances they work with. We must equip our members to use their rights through Workplace Safety and Health Committees. We will also pursue the improvement of this legislation to overcome the trade secret exemption, thereby extending our "Right to Know" about all potential hazards in our workplaces without exception. Pressure from industry must not be allowed to jeopardize our health and safety. Pressure from labour must be built until the changes needed to truly protect workers are made.
We must move beyond the "Right to Know" to the "Right to a Truly Safe and Healthy Workplace" which is sorely lacking for our members and all Canadian workers. We must stop the indiscriminate use of substances about which so little is known regarding the potential to harm workers' health. These substances must be assumed to be "guilty until proven innocent", not the reverse as is currently the practice. We have too much experience in the form of dead and disabled workers showing that substances once thought to be harmless turn out to be killers.
Today's occupational cancer deaths are the result of exposures to asbestos, vinyl chloride, benzene and others, twenty or thirty years ago. Substances must be thoroughly tested before they enter the workplace. In the interim, substances scientifically proven to be safe can be substituted or workers can be fully protected from exposure through engineering controls. The technology to achieve the full protection of workers through such measures is readily available.
Standards which permit any exposure to known or suspected carcinogens must be replaced. Zero exposure is the only acceptable level for substances which can cause cancer. In addition, the ACGIH TLVs, which are currently referenced as standards by federal and most provincial jurisdictions, must be abandoned immediately, and replaced by protective standards based on accurate scientific information. The Alliance will continue its efforts to improve standards through involvement on the Labour Canada Regulatory Review Committee on Hazardous Substances.
In the absence of such protection, we must assist our members to use their "Right to Refuse" to work with carcinogens against which they are not fully protected.
The fact that these toxins are inherent in their regular work environment or are a normal condition of employment must not be accepted as legal justification to deny workers the right to refuse.
In the PSAC 1985 position paper on workers' compensation, we stated as our number one principle that all workers who suffer occupational illness or injuries must be guaranteed compensation. To date, there has been no improvement in this area, and workplace cancers are probably the least compensated of all occupational diseases. Again, there are no statistics kept to determine accurate figures. Professor Weiler, in his 1983 Review of Compensation in Ontario, estimated that of at least 700 cancer deaths attributable to occupation in that province annually (using a very conservative formula), in a one-year period only 95 compensation claims were filed. Of these, only 44 were allowed by the Board. Thus, the occupational cancer victims and their families are being punished twice, losing their health and/or a loved one, as well as losing their livelihood.
In 1974, the International Labour Organization adopted Convention #139, "Concerning Prevention and Control of Occupational Hazards Caused by Carcinogenic Substances and Agents". The Canadian Labour Congress called for an "organized national campaign ... to eliminate cancer at work" in 1981. Unions and Federations of Labour in every province have addressed this issue in a variety of ways.
Even the Law Reform Commission, in its 1986 report on "Workplace Pollutants" concluded that present Canadian laws and regulations do not adequately protect workers' health. They made a series of tough recommendations to improve the situation, including a public review of standards and the standard setting process. They also called for significant strengthening of the Canada Labour Code, including the use of the criminal law where actions or omissions of employers result in workers being placed at increased risk of death or irreversible illness.
None of these recommendations has resulted in action to decrease workers' exposure to workplace carcinogens. At least 40,000 of our members are still at risk of contracting occupational cancer. Clearly the time has come to add our strength and commitment to the struggle to overcome workplace cancer.
The PSAC believes that workers come to their jobs with health intact, and the employer has no right to damage that health in any way. Employers must be held accountable for the unnecessary illness and death suffered by victims of workplace cancer. We will continue the struggle to protect our members' health.
In order to reverse the current deplorable situation, the Alliance believes the following concerns must be addressed:
1. There must be an organized national campaign to prevent occupational cancer, coordinated by the federal government, involving labour, employers, the health professions and the scientific community.
2. Exposure standards must reflect the fact that there is no safe level of exposure to a carcinogen.
Current standards, in particular the TLVs, do not protect workers.
3. New standards must specify the means by which employers must comply, such as substitution by a non-carcinogen and engineering controls if substitution is not possible.
These new standards must cover all Canadian workplaces similar to the WHMIS agreement, to prevent some jurisdictions from adopting lower standards.
4. A national body must be established to set standards for occupational exposure to hazardous substances.
These standards must be based on available scientific information and designed to be as protective of workers' health as possible.
A national program of chemical testing must be developed, which requires by law that substances be assumed to be carcinogenic until proven otherwise. In the meantime, no new substances should be permitted into workplaces until they have been fully tested. Substances currently in use must be priorized and evaluated, in consultation with the international scientific community. Those found to be potential carcinogens must be eliminated where possible, and otherwise subject to strict controls.
Since almost all substances found to cause cancer in animals eventually prove to be carcinogenic in humans, results of animal testing must be considered as enough evidence to label a substance as cancer-causing.
5. Enforcement of laws and regulations regarding exposure to carcinogens must be improved.
In many Canadian jurisdictions, there are twice as many wildlife protection officers as there are occupational health and safety inspectors.
The number of inspection personnel must be increased. Their training must equip them to understand the impact of enforcing life and death legislation. The discretionary power of health and safety inspectors must be replaced with clear requirements to enforce the law. For example, an inspector "shall" instead of "may" issue a stop-work order until the hazard is controlled.
Violators must be prosecuted swiftly. Labour Canada's current policy of "voluntary compliance" puts workers at continuing unnecessary risk.
6. Penalties must be designed to ensure compliance with the law and to punish violators effectively.
The current situation of low fines and few prosecutions means that it is often cheaper for an employer to pay the fine than to clean-up the workplace. A system of administrative penalties (such as in B.C. and in the U.S.) must be created with stiff fines levied on the spot by labour inspectors. Research has shown this approach both increases the numbers punished and the amount of fines levied.
Flagrant violations of health and safety laws must be prosecuted to the same degree as any other serious crime. Criminals' negligence is criminal negligence whether it occurs in a workplace or outside. Though the Canada Labour Code provides for a two-year jail term, no employer has ever been handed this sentence, even for serious violations resulting in a worker's death.
As well, the procedure to initiate prosecution must be changed so that potential political interference is eliminated. Workers and their representatives must be given the power to initiate action where orders are not issued or enforced by inspectors. This right must be backed up by a Board, similar to a labour board, to which appeals can be directed, and which has remedial powers. Approval of the Minister of Labour should not be required to prosecute offenders.
7. Workers' rights under the law must also be expanded.
Workers must have the clear right to refuse to work with known or suspected carcinogens if their health and safety is not adequately protected. To strengthen workers' rights, Workplace Safety and Health Committees must be given more authority to take action to protect workers - for example, to develop and implement prevention programs, to shut down unsafe work, to review plans for changes in the working environment, and to instruct the employer to make changes necessary to protect the life or health of workers. They must also be able to order tests and to call in inspectors where employers refuse to comply with their instructions.
8. The increasingly popular employer approach of using genetic screening to identify "susceptible" workers and refusing to hire them must be firmly resisted.
Firstly, this discrimination violates the human rights of the individual denied employment; and secondly, it violates the rights of all the other workers by exposing them to the hazard.
9. WHMIS must be strengthened to cover all potentially hazardous substances.
The Trade Secrets exemption, for example, violates the ILO Convention which requires that information shall be provided on "all" hazardous substances used in the workplace. A National Institute of Occupational Safety and Health (NIOSH) study of 4600 common workplace substances found 70 per cent of them to be trade name products which could, according to the current WHMIS requirement, be granted exemption from full disclosure of information. Employers must be forced to take measures to ensure protection of their employees against exposure to carcinogens. Current health and safety legislation requires them to do so.
10. Victims of occupational cancer must be guaranteed workers' compensation.
The onus must be removed from the worker and his/her family to prove the causal relationship between work and the disease. Proof of exposure to a known or suspected carcinogen, and proof of the disease should be sufficient. As set out in the workers' compensation agreement, benefit of the doubt must be given to the worker.
In addition, lists of recognized occupational diseases must be expanded to take into account the growing list of occupational cancers linked to workplace exposures. Finally, workers must be informed of their right to compensation for occupational disease.
The vast majority of workplace cancers go uncompensated because victims, their families and their doctors do not link cancer with work and do not file a claim. The result is that in addition to loss of health, even life, the victims suffer a loss of income.
11. The National Cancer Registry must be directed to document the true incidence of cancer at work in Canada.
Currently, there is no screening required for any relationship with work once cancer has been diagnosed. Physicians must be trained and required by law to do in-depth work and exposure histories to determine if the person was exposed to possible carcinogenic substances and to report this information, on a confidential basis, to the Registry.
Analysis of this data can provide early warning signals of association between occupation and higher risks of cancer of various types. This is done routinely in Scandinavian countries where, for example, an association was established for the first time between asbestos-related cancers and work in the pulp and paper industry. Thus, research can be directed to areas of high risk and appropriate preventive measures put into place.
12. A national system for recording exposures to carcinogens must be established as an essential element of a coordinated attack on occupational cancer.
This is required by the ILO Convention, and has been in place in Finland, for example, for almost ten years. Such a system requires employers to document individual exposures, which can be used to establish compensation claims in future years. It can also direct authorities to individual jobs and workplaces with high exposures, leading to substitutions and/or other preventive measures. Analysis of such exposure data can also identify hazardous occupations. For example, in the first six years of operation in Finland, the top three groups for exposure to carcinogens were mechanics, welders and laboratory assistants (all of which are largely represented among our PSAC membership).
13. Cancer research must be redirected to place far more emphasis on work exposures and cancer.
We know that these can be prevented. Government research councils, as well as groups such as the Canadian Cancer Society, must be strongly encouraged to promote and fund such research. Individual union members can play a role here by requesting that their charitable donations be used for this purpose.
14. Medical education must be improved to ensure that all doctors are taught how to take a proper occupational history.
Much more emphasis must be placed on workplace hazards and their effects on the human body. At present, medical students are taught more about bookkeeping! Practising physicians must be induced to improve their knowledge in this area, and programs established for upgrading. One such incentive would be provided by the requirement to provide a detailed work and exposure history with each new cancer case reported to the National Cancer Registry.
It is also essential that more post-graduate programs in occupational medicine be developed through medical schools and teaching hospitals. These programs should emphasize prevention, not simply diagnosis, treatment and rehabilitation of victims of occupational disease.
15. Medical programs must be established to assist workers who have been exposed and/or are victims of occupational disease.
The Quebec model of giving the Workplace Safety and Health Committee the responsibility for appointing the physician for their workplace and for approving the health program developed by the physician is one way to overcome the "company doctor" phenomenon. Another option being pursued increasingly by labour groups across the country is the worker-controlled occupational health clinic.
Funding for such clinics should be provided by the federal and provincial governments.
Compulsory "medical monitoring" conducted by employers to determine whether workers have been "over exposed" to toxic substances must not be part of these medical programs.
16. Our final recommendation is the establishment of an inquiry into health and safety practices in the federal public service including carcinogens.
The mandate of the inquiry must be broad enough to allow an assessment of the extent of the problem, and provide solutions. Piecemeal efforts at reform have not been adequate. The problem is too complex, with many variables and too many vested interests.
Date Modified : 2010/01/31