Occupational cancer: a ticking timebomb in construction

Although construction is the second largest industry in India, employing over 74 million people and contributing more than nine per cent of India’s GDP, it is also a high hazard sector.

Construction labourers undertake many tasks that expose them to serious hazards, such as falling from roofs, being struck by heavy construction equipment and plant, electrocution and exposure to harmful substances, such as diesel exhaust, asphalt fumes, solvents, silica dust and asbestos, a cheap, heat-resistant mineral used in a variety of construction materials, especially roofing, pipes and insulation.

Construction workers frequently develop cancer due to significant exposure to known carcinogens like asbestos, silica dust and various chemicals found on construction sites.

In 2021, the Union Government’s Labour Ministry informed Parliament that at least 6,500 employees had died while working at factories, ports, mines and construction sites in the preceding five years, although commentators say these figures are likely to be a major underestimate due in part to the way work fatalities are recorded by the authorities and police.

However, there is limited information on the scale and extent of occupational cancer among construction workers due to past exposure to hazardous substances and other carcinogens.

“There is limited research on occupational cancers related to construction work in India,” notes Abha Rao, a research scientist and assistant professor at the Ramalingaswami Centre on Equity and Social Determinants of Health, at the Public Health Foundation of India in Bangalore, in an article for the environmental and science news site, Down to Earth.

“Those that do exist tend to focus on how the behaviour of construction workers contributes to cancer risk rather than the dangers inherent in construction work itself.”

It is estimated that between two and eight per cent of all cancers globally can be attributed to exposure to carcinogens – substances recognised for their cancer-causing potential – within occupational settings.

India tops the table for asbestos imports
Asbestos, which was once used widely in building materials, is now banned in 70 countries. These nations have deemed the material a ‘silent killer’ due to the carcinogenic nature of its fibres, once disturbed or damaged and released into the air.

Although India banned asbestos mining in 1993, when the government stopped re-issuing licences, the country imports more of the toxic mineral than any other nation. In 2021, India accounted for 44 per cent of global imports of asbestos, a 29 per cent increase on 2020. Russia and Brazil are its key suppliers.

The construction sector has the highest occupational exposure to asbestos compared to other sectors.

Although best practice involves taking suitable precautions to prevent occupational exposure to the substance – such as the use of adequate personal protective equipment that complies with international standards, the presence of health inspectors and conducting routine checks on workers’ health for the early indications of asbestos-related disease – in reality the practice of labourers merely using bits of cloth as rudimentary face masks is a common sight at construction sites across India.

However, commentators say that all construction workers in India are potentially at risk of exposure to asbestos – even if they do not work with, on or come into direct contact with the substance – as high levels of asbestos may be present on construction sites due both to its use as a building material and in the fabric of existing buildings.

According to the World Health Organization (WHO), asbestos causes “lung cancer, mesothelioma (a rare cancer of the lining of the lungs, heart, or abdomen), cancer of the larynx and ovary, and asbestosis (fibrosis of the lungs)”.

Workplace exposure to the fibres and handling or inhaling them therefore poses a significant risk of later developing serious and fatal diseases.

A study in a peer-reviewed journal estimates that there could be more than 6,000 workers affected by asbestosis (an untreatable lung ailment) and another 600 suffering at the minimum from asbestosis-related lung cancer in India at present, according to the Ban Asbestos Network of India (BANI).

'One of the largest sources of occupational cancer'
“Occupational cancer from asbestos poses an increasingly serious health problem” said a spokesperson from BANI. “But the subject has attracted relatively little attention from industry, labour, public health bodies or the medical profession. Asbestos is one of the single largest sources of occupational cancer.”

Dr Naresh Gupta, former director-professor of medicine at Lok Nayak Hospital in Delhi, warns that diseases caused by asbestos exposure often have a long-latency period, sometimes taking three to four decades to manifest. “This means that many workers may not show symptoms until years later, making early detection difficult.”

India’s unparalleled level of exposure to asbestos means that over the next few decades, more than six million people may develop an asbestos-related disease, which includes more than 600,000 cases of cancer, according to a study by Mumbai’s Tata Institute of Social Sciences (TISS).

“It is high time to introspect about our ability to engage with this future problem,” states Abhijeet Vasant Jadhav, the principal author of the study.

Asbestos-related cancers are incurable and mesothelioma carries a life expectancy of one to three years, so palliative care, which is the mainstay of asbestos-related disease, will be critical.

“But the palliative care system is in its nascent stage in India,” said Jadhav.

In their latest joint estimates of the global scale of asbestos-related disease, the WHO and the International Labour Organization (ILO) say that occupational exposure to asbestos results in over 200,000 deaths globally every year, based on 2016 data. This figure accounts for more than 70 per cent of all deaths attributable to work-related cancers.

A systematic review jointly conducted by the WHO and ILO indicated that existing studies suggest that a substantial proportion of manual workers in the construction industry globally are exposed to asbestos.

However, the quality of the available evidence has been assessed as ‘low’, and additional research is needed on this, say WHO and ILO.

Incidentally, after the September 11 2001 terror attacks in New York City, many first responders – firefighters, paramedics, police officers and construction workers – were exposed to a mix of toxic dust and debris from the collapse of the Twin Towers in Manhattan. This dust contained a variety of chemicals, including asbestos, which was used extensively in the buildings’ construction.

The health impact on the 9/11 first responders has been significant. The World Trade Center Health Program has documented thousands of cases of respiratory diseases, cancers, and other health issues linked to their exposure, both on the day of the attack and during the subsequent rescue attempts and later site clearance.

Even today, the New York City authorities continue to identify new people with emerging cases of cancer or other serious illnesses related to the toxic cloud that hovered over Manhattan for several weeks.

Dust-related occupational lung diseases
Meanwhile, in Rajasthan, labourers in the unorganised stone quarrying, crushing, cutting and polishing industries endure physically demanding work amid extreme temperatures, excessive noise levels, poor housing conditions and low wages.

This environment significantly increases their vulnerability to dust-related occupational lung diseases, such as silicosis, an irreversible lung condition caused by inhaling dust during activities such as mining, quarrying and cutting stone, rock, sand and clay substances like sandstone, which results in a major loss of lung function and increases the risk of premature death from problems like heart failure. Exposure to silica dust also increases the risk of workers developing other diseases already common in India, like tuberculosis.

Meanwhile, the informal nature of the quarrying and stone workers’ employment terms means they are unable to access social security benefits.

As awareness of silicosis has risen, many local Rajasthani labourers have chosen to leave the state’s stone mining, quarrying and polishing industries, leading to an influx of migrant workers from economically disadvantaged and lower caste communities in Bihar, Uttar Pradesh, Madhya Pradesh, and West Bengal.

These migrants, driven by economic necessity, often disregard the health risks present in the sector.

In fact, at 48,448, Rajasthan has the highest number of registered silicosis cases.

Lack of compensation
Unfortunately, many workers who develop the debilitating and life-shortening lung disease are unable or unlikely to receive compensation from their employer or the state due to difficulties in establishing a direct correlation between their employment and the development of the cancer; insufficient safety regulations to base their claim upon; a general lack of awareness of occupational cancers among the workforce and population; and difficulties in navigating the legal system to secure damages. This situation is particularly true for migrant workers, who often have limited access to healthcare and legal assistance.

Historically, skin cancer has been less common in India than in Western nations; however, recent data reveals a concerning rise in its occurrence throughout the country. Despite the presence of a subtropical climate and a population with higher melanin levels, India is not immune to the worldwide rise in skin cancer cases.

Factors related to occupation, particularly outdoor work in sectors like agriculture and construction, lead to extended sun exposure, thereby heightening the risk of skin cancer among these labourers. Additionally, issues such as climate change and air pollution further exacerbate this situation.

According to WHO and ILO estimates, working in the sun causes nearly one-third of non-melanoma skin cancer deaths globally. In 2019, approximately 1.6 billion people of working age (15 years and older) were exposed to solar ultraviolet radiation while working outdoors, accounting for 28 per cent of all working-age people. In the same year, nearly 19,000 people in 183 countries died from non-melanoma skin cancer as a result of working outside in the sun. The majority (65 per cent) were men.

“Unprotected exposure to solar ultraviolet radiation at work is a major cause of occupational skin cancer. But there are effective solutions to protect workers from the sun's harmful rays and prevent their deadly effects,” said Tedros Adhanom Ghebreyesus, WHO director-general.

Gilbert F. Houngbo, ILO director-general, added: “A safe and healthy working environment is a fundamental right at work. Death caused by unprotected exposure to solar ultraviolet radiation while working is largely preventable through cost-effective measures.

“It is urgent that governments, employers and workers and their representatives work together in a framework of well-defined rights, responsibilities and duties to reduce the occupational risk of UV exposure. This can save thousands of lives every year.”

WHO calls for action on UV exposure at work
WHO is therefore calling for greater action by government and employers to protect workers from hazardous outdoor work in the sun that can cause skin ageing, damage and cancer. Governments should establish, implement and enforce policies and regulations that protect outdoor workers from sun-induced skin cancer by providing shade, adjusting working hours to avoid the need for people to work in the middle of the day when the sun’s UV rays are at their strongest, providing education and training, and equipping workers with sunscreen and personal protective clothing.

Because skin cancer develops after years, if not decades, of exposure, workers must be protected from solar ultraviolet radiation from a young age, warns WHO. 

Experts point out that in the next few decades India’s construction industry will continue to grow, eventually employing nearly 100 million workers. This suggests the rate of temporary migration from poorer states to wealthier states where construction work is available will continue to increase, and the occurrence of occupational cancer among construction workers is also predicted to rise in a corresponding fashion. This indicates that the occupational health challenges and requirements of India’s growing construction workforce are likely to increase, warranting immediate attention from policymakers.