Why tracking risk of disease in the workplace is a national issue

It can be challenging to prove a disease is linked to workplace exposure, says Paul Demers:

“We’re talking about events that happened long ago. You have to pull together the evidence of where somebody worked, what the exposures might have been in the past.”

Demers became interested in workplace exposures about 40 years ago. At the start of his career he was an activist on environmental issues and through this he became interested in workplace issues. He started researching the topic and eventually shifted more to occupational health as his primary area of interest.

To further his education he went to graduate school and got a Master’s degree in occupational hygiene and then a PhD in epidemiology. During his PhD he developed an interest around cancer and eventually went to work at the International Agency for Research on Cancer (IARC). After this he got a faculty position at the University of British Columbia with the School of Occupational Health.

Demers is currently, among other things, the Director at the Occupational Cancer Research Centre in Toronto. He explains that harmful exposures are not limited to one industry, though some sectors are more obvious candidates. For example, “there are issues around construction, where there are a lot of hazardous exposures,” says Demers.

And working conditions are constantly changing, he says, so it can be hard to keep track of which hazards to address.

“Mining is a particularly challenging industry, notably underground mining. There are a lot of respiratory hazards, both causing cancer and lung disease,” says Demers. “And we have these exposures occurring in confined spaces, so very challenging in its own way.”

There are also concerns in other industries, for example nail salons or businesses handling electronic waste.

“It’s actually much more widespread, I think, than people would think about because there are many things that are either known to be related to increased risk of cancer – or suspected to be,” says Demers.

Compensation

Demers says that we need to rely on more extensive research to identify the full impact of harmful exposures.

The more data is found, the more those pushing for change can drive change with hard numbers.

Speaking about the banning of asbestos for example, be said: “The numbers we generated about the number of cancers developed every year in Canada due to workplace exposures really helped be one of the components that supported a ban on asbestos.”

“These numbers can carry weight going forward. The other things that we need to know is where these exposures are occurring so that we can target our prevention efforts on those industries.”

Speaking about numbers, Demers says that “there is a tendency for people to look for workplace disease [statistics] by going to workers’ compensation statistics. But these diseases that develop over decades, only a tiny proportion of them are actually compensated.”

“The more we develop systems to say where those exposures in the past, I think the more we can facilitate the compensation of cases,” he says.

“Worker’s compensation is a social justice issue for people who develop diseases, but it’s also a broader issue of pushing prevention and keeping people aware of the actual risks in order to make sure that we prevent these diseases from happening in the future.

"There is a lot of interest in developing systems to better track the risk of disease in the workplace, and to try to better understand where exposures are occurring. It has, I believe, really become a national issue,” says Demers.

Limited data

There is still limited data on exposures – notably in Canada as statistics are reported on a provincial level.

“By pooling the data that we have, we can develop a better understanding of what is going on,” says Demers.

One way to track exposure numbers is through the CAREX project, which was initially a European project with the IARC and other agencies and experts across Western Europe.

The idea was to “generate estimates of the numbers of people who were exposed to cancer-causing agents in the workplace. The idea was to raise awareness about the importance of this, but also identify where these exposures occur in order to promote prevention.”

Around 2003, Demers received funding from the Workers’ Compensation Board of British Columbia to do a pilot project in B.C. to set up a similar CAREX database in Canada.

Eventually the project received major funding from the Canadian Partnership Against Cancer to create CAREX Canada.

“When you actually put numbers to the problem […] it turns people’s heads. It makes people think about the fact that this isn’t a marginal problem, this is a major issue – not just for small groups of people but for the country as a whole.”

Workplace awareness

Demers says that regulations themselves are never going to be the full answer to prevention in the workplace, there are not enough inspectors for that. Awareness has to happen in the workplace. In addition, says Demers, we have to continue to push to keep up to date with the latest science:

“Things aren’t the same as they were 20 years ago, we continue to learn more about what causes disease. And the more we learn about these different toxic exposures, the more we understand that their effects happen at lower levels than we previously thought.”

Over the last 10 years, Demers says that in Ontario and around Canada occupational disease prevention is becoming more and more of a priority:

“There’s been momentum in some organizations here, there are a number of us in the scientific community that have joined together to try to make this a broader issue.”