Indonesia's impending dust diseases epidemic.

By Lauren Gumbs

Indonesia, despite being the world’s third-largest asbestos user (after China and India) and fifth-largest importer and exporter, with more than 7,700 people directly employed by asbestos processing industries, has recorded just one case of mesothelioma among its 250 million people. That said, little data is available on the real number of sufferers of mesothelioma and other asbestos-related diseases (ARDs), but millions of Indonesians are exposed every day – at work, at home and in their communities. Mesothelioma and ARDs, such as asbestosis, are the result of inhaling very small particles of carcinogenic asbestos dust.

Indonesia, despite being the world’s third largest asbestos user (after China and India) and fifth largest importer and exporter, with more than 7,700 people directly employed by asbestos processing industries, has recorded just one case of mesothelioma among its 250 million people. That said, little data is available on the real number of sufferers of mesothelioma and other asbestos related diseases (ARDs), but millions of Indonesians are exposed every day - at work, at home and in their communities. Mesothelioma and ARDs, such as asbestosis, are the result of inhaling very small particles of carcinogenic asbestos dust. The tiny dust particles are barbed and when inhaled, they hook themselves onto the protective lining of internal organs, and there they stay, and can eventually cause cancer and/or respiratory disease. Indonesia, with little legal scaffolding or public awareness, is facing an epidemic of ARD deaths in the near future. 

Asbestos use is proliferating and with it decades of health problems. Australia on the other hand, has banned asbestos and installed systems to tackle the problems associated with decades of asbestos use. While efforts to keep asbestos out of the country continue, Australia has many learnings it can share with Indonesia, such as the legal and medical systems in place to prevent asbestos use and support those affected by ARDs. In Australia, workers unions had a key role to play in successful efforts to ban and control the deadly substance.  

 Unions could likewise become key actors in the Indonesian narrative should they form effective alliances with non-governmental organisations at home and abroad and push for government imposed reform in industry sectors. Australian based Union Aid Abroad -APHEDA is one such collective campaigning to spread the message among South East Asian and Indonesian unions and to facilitate support from Australian based unions for a broad-based campaign. 

This year it launched ‘Asbestos. Not Here. Not Anywhere‘. The campaign seeks to link campaigns across the globe to push for asbestos bans. Fifty seven countries around the world have banned asbestos and the organisation believes successful eradication starts with workers and unions, particularly when bans can leave those most exposed out of jobs.  It has teamed up with Indonesian union SERBUK and activist occupational health and safety labour organisation LION Indonesia, in an attempt to get asbestos imports and production banned in Indonesia.

Kate Lee, Executive Officer at Union Aid Abroad - APHEDA, says Australian unions have been keen to help with the campaign and Indonesian organisations are tapping into that in the hope they can duplicate some of the strategies that led to success in banning asbestos. “We’ve had very broad support from across the Australian union movements,” Ms Lee said.

“We’ve also had two visits this year, from LION and INABAN (the Indonesia Ban Asbestos Network), our partner organisations in Indonesia. They’re trying to run the campaign locally in Indonesia and to build support with other organisations. That’s how you win something this big; you have a broad based collation of support. They’re currently trying to help workers organise effectively in 26 different factories. These factories have at least 100 or more workers per factory who are directly involved in asbestos manufacturing. They’re trying to work with frontline workers forward to move this issue.”

Australia’s support is crucial to what are still very grassroots Indonesian movements as is getting neighbouring countries on board with efforts to ban asbestos. Indonesia’s asbestos use is not just a danger to itself but also other countries. Illegal imports of asbestos containing materials have made their way to Australia from Indonesia despite strict regulations on the Australian side. It is an insidious product, as with many forms of asbestos only testing reveals if it is there or not. It is therefore in Australia’s interests to assist South East Asian countries to eradicate the dangerous material or else risk undermining its own efforts to keep asbestos out. During LION’s visit in March this year, Wira Ginting visited the Gold Coast and spoke in front of 500 delegates at the Maritime Union of Australia conference. He also visited with Union Aid Abroad - APHEDA activists and union leaders in Brisbane including Queensland Teachers, Queensland Nurses, the Construction, Forestry Mining and Energy Union and the Electrical Trades Union of Australia. In Sydney, Wira met with Unions NSW, the Fire Brigade Employees Union, the Health Services Union, the Asbestos Eradication and Safety Agency and more, then in Melbourne meetings were held with the Australian Nurses and Midwifery Federation (the Victoria branch), the Victorian Trades Hall Council and the Occupational Health and Safety committee, the National Union of Workers and the Australian Council of Trade Unions Executive. 

Mr Ginting gathered information, strategic advice and support in a mammoth ten day visit, planning on taking the campaign into a higher gear with a better strategic vision gained from collaborations in Australia. LION organiser Darisman joined SERBUK’s General Secretary Subono Bono on a campaign visit to Australia again in May this year and outlined a clear intent about the outcomes they were seeking in Indonesia. At a demonstration in Circular Quay Mr Darisman said, “Firstly, there must be provisions put in place for compensation for workers who get sick – and we know from international experience that there is going to be many, many workers and their families who will get sick. Secondly, there must be support for the factories to be refitted to produce non-asbestos commodities, or support for the workers to re-train.” Australia established very similar protocols when it moved to ban and control asbestos.

Australia is currently ranked number two in the world for mesothelioma (per capita it is first), behind the UK at number one, though this is not because Australia continues to use asbestos containing materials – since the eighties asbestos use plummeted and in 2003 it was completely banned – but because Australia, like the UK who banned asbestos four years earlier, is equipped with diagnostic resources and political mobilisation. Australia has a national register of mesothelioma sufferers and research bodies to record and identify cases. Both the UK and Australia were major asbestos users but are now signatories to the International Labour Organisation’s 1986 Asbestos Convention. 

They have established dedicated regulatory authorities that oversee occupational work health and safety obligations and compensation schemes for dust diseases sufferers. There are strict laws around safe handling and disposal methods as well as awareness campaigns and advisory bodies to ensure the risks and dangers of asbestos are well known. The Australian Council of Trade Unions says efforts to ban asbestos in Australia were the result of decades of campaigning by unions. Union campaigning was crucial to force the hand of governments and companies to pay compensation to victims, and unions now work closely with government and non-government organisations to ensure the issue stays on the table.

Conversely, Indonesia has a powerful national asbestos lobby and lacks the political will to tackle the issue and rid its industries of asbestos containing materials. In fact asbestos use is on the increase and public awareness remains worryingly low. The Indonesian Ban Asbestos Network said that in 2012, asbestos use actually increased by 30 per cent in just one year. As ARDs are long latency diseases, this means the consequences to people’s health will compound in the coming years when those exposed fall victim later in life. The Indonesia Ban Asbestos Network is one of a handful of grass root actors trying to make asbestos a prominent public concern. The World Health Organisation believes there is an epidemic in Asia and names Indonesia as an in-danger state. In 2013 WHO presented a global action plan at the 66th World Health Assembly – an irrefutable statement of concern that things need to change. Asbestos is one of the cheapest and most easily found building materials - even the Indonesian government uses it in public housing and other projects. 

So how are the many asbestos induced deaths flying under the radar? Kate Lee says the issue that Indonesia is dealing with and what they have faced in other Mekong countries, is that mesothelioma and asbestosis are not recognised as diseases. “It is a new issue. There is no medical recognition. Nobody has had the training to identify ARDs, so these diseases tend to get categorised as cancer. To start getting much needed identification and testing services going, we’ve been providing the experience of Australian groups in the Mekong countries – the Asbestos Disease Research Institute for example. Asbestos Disease Research Institute experts have been going across to Lao, Cambodia Vietnam and Indonesia to help train medical professionals to understand and categorise the disease. It will of course, take time for Indonesia to develop a body of expertise just as it took time for Australia to do.” 

Peter Dunphy, Executive Director of SafeWork NSW, the work health and safety regulator in NSW Australia, said asbestos is the leading cause of work-related disease in Australia. He says homes built or renovated before 1987 are likely to contain asbestos and on the spot fines are issued to both individuals and businesses who hire unlicensed asbestos removalists. “We have rigorous laws to manage asbestos in NSW and in order to keep communities safe from exposure we need to ensure the only people paid to handle asbestos are those licensed to do so,” Mr Dunphy said. “We are party to the NSW Statewide Asbestos Plan, a government, industry and community initiative to deal with the legacy of asbestos use in NSW.” While SafeWork NSW oversees laws that relate to workers, asbestos exposure is an issue for everyone. 

One in three homes in NSW are said to contain asbestos, as well as countless workplaces and buildings. When damage occurs such as in fires, storms and floods, asbestos removalists need to be called in and the materials properly disposed of so that the community is not affected. Because identifying asbestos can be an issue, when home owners undertake renovations and do-it-yourself (DIY) projects they also risk exposing themselves and anyone nearby. In fact the Australian penchant for DIY home renovation has also put many people at risk of exposure. Such is the trend for home renovations, DIY-ers who contract ARDs are called the ‘fourth wave’.

Australia’s national framework is contained with the Asbestos Safety and Eradication Agency, a high level document that establishes a framework within which jurisdictions work both cooperatively and independently to achieve set objectives. In response to this, each state in Australia then has their own jurisdictional framework for communication between state agencies and local councils in the safe management of asbestos. NSW has the Heads of Asbestos Coordinating Authorities of which SafeWork NSW is chair. This body is responsible for coordinating asbestos management and response in the workplace, residential settings, transport and disposal, in the ground and site contamination, emergency management and prohibitions on the manufacture and supply of asbestos. 

Apart from prevention programs they also run a public awareness campaign called ‘Renovation Roulette’ which is geared toward home owners and potential DIY-ers being able to identify and seek assistance to manage asbestos if it is present in their homes.

Peter Dunphy said NSW has come a long way since the national ban in 2003, but there are significant challenges to full eradication both from within and without. 

“Dumping is a big problem at the local level and councils are constantly dealing with it, particularly in areas where asbestos where most of the homes were built before 1987. State authorities such as SafeWork NSW and the Environmental Protection Agency need to weigh in whenever there has been damage to a workplace or building containing asbestos to make sure workers are not being exposed and it is disposed of correctly. Australia and its states have implemented effective mechanisms to manage and regulate asbestos, however we are not only still faced with the existing asbestos in our built environment, but also imported asbestos containing materials slipping through and making it into the supply chain. Maintaining quality control is a priority for all of the agencies involved in asbestos management; however our open trade environment makes it impossible to oversee everything. Many products found to be tainted with asbestos are labelled asbestos free and only random sampling by customs at the point of entry, or testing by workplace safety authorities on-site confirm if asbestos is present. It is not just building products but also contaminated car parts and even children’s crayons that have entered the country illegally from China and other nations who still deal in asbestos,” Mr Dunphy said.

This year, Australian workplace safety authorities were monitoring more than 50 sites suspected to be contaminated with asbestos products originating from China. SafeWork NSW was monitoring 17 of these. Sixty four sites Australia-wide were confirmed to contain asbestos-tainted concrete fibre sheeting after being inadvertently installed by a South Australian building company who had imported them from China. Just recently, asbestos roof panels were found in a children’s hospital being built in Western Australia. The Chinese supplier Yuanda is an international company that has supplied many other projects in Australia and overseas and is now under the microscope in case other works are also contaminated. Twenty one Yuanda containers are being investigated but Chinese imports of manufacturing products are only on the increase. The China Australia Free Trade Agreement came into force in June 2016 with unions and industry groups worried ‘dodgy building products’ would flood the market and important safeguards against the importation of asbestos containing products could be undermined by the deal. The federal government sought to allay these fears head on, publishing a myth versus reality fact sheet that stated, “There are no changes to restrictions on the import of asbestos and other dangerous products.” Nonetheless, the establishment of free trade deals with Indonesia will no doubt endure similar reservations while Indonesia remains oblivious to the dangerous material.

Kate Lee says it’s a slow burning issue and the impacts aren’t seen for decades. The sooner a country bans asbestos and gets on top of the eradication process the better. “There’s no doubt tens of thousands of Indonesians will die from asbestos in the coming decades. Australia is still dealing with the impacts years later. The only way to stop this is a total global ban. APHEDA is starting the long process by helping save lives in countries in our immediate region in order to push out profit making industries.” And despite the impending asbestos epidemic, APHEDA and co are making the sorts of changes that could soon provide a critical juncture for Indonesia and other South East Asian countries to move away from asbestos and implement total bans. 

There is an upcoming South East Asian ban asbestos meeting set to take place in Jakarta, in early November 2016. Australian unions will also take part in this. Research is also being undertaken by APHEDA to identify where the corporate movements are in Indonesia, where the pro-asbestos connections lie in order to help inform anti-lobbying efforts. Lion and INA are working hard to get more Indonesian trade unions such as health professionals on board. APHEDA is not just making progress in Indonesia; it’s work in other ASEAN countries has shown results. Vietnam announced in November 2014 that they would ban asbestos by 2020 despite Russia, a major asbestos exporter, counter-campaigning with Vietnamese industry. Vietnam also voted in favour, for the first time, at the Rotterdam Convention to list asbestos as a poisonous substance. In Cambodia the minister for labour recently announced the establishment of a ministerial group that will announce a ban of asbestos in that country too.

 Cambodia included a range of senior union representatives in these reforms. Indonesia is on the precipice of change and although it will endure years of asbestos related deaths for its willingness to sustain asbestos industries, with neighbourly support, and concentrated efforts from the inside, Indonesia can prepare to meet the challenges of impending diseases and provide guarantees of a future without asbestos.

Lauren Gumbs is a communications professional who works for the Government of NSW in Australia. Lauren is also a director of the Indonesia Institute Inc.