As UN prioritizes TB eradication: India must invest in reducing dust exposure at workplace, save lives

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By Jagdish Patel*

The United Nations General Assembly recently called for the establishment of prevention programmes to reduce uberculosis (TB) among miners and other workers exposed to silica dust. This declaration was released in advance of the first ever UN General Assembly high-level Meeting on TB on September 26, 2018.

India has declared its goal is to be TB free with zero deaths and disease by 2025, but it has failed to recognize the importance of preventing TB with workplace dust controls. The UN declaration says that governments should commit to “preventing TB by implementing primary prevention in high-risk occupations by reducing silica dust exposures in mining, construction and other dusty workplaces.”

It will be difficult for Government to meet ambitious TB goals unless it targets workplaces to reduce exposures of silica dust to the legally prescribed limits. National Human Rights Commission of India has already recommended in 2011 to make it mandatory to carry out half yearly dust surveys in all hazardous industries.

TB is the biggest killer in India claiming about 4 lakh lives every year. India also has the highest incidence of the disease—about a quarter of total cases worldwide—each year. Miners, stone crushers and others working in dusty environments have a four times greater risk of acquiring active TB.

Silicosis is entirely preventable by reducing exposures to silica dust in the workplace with improved ventilation and the use of wet methods. In small stone crusher mills in India with limited resources, water spray misting reduced respirable silica by 80% .

Reducing exposures to silica has the added benefit of reducing silicosis, lung cancer and other diseases along with preventing TB.

Recognizing the importance of workplace dust controls to prevent TB, the International Commission on Occupational Health (ICOH) published a statement http://dx.doi.org/10.1016/S2214-109X(18)30313-9 this year calling on Governments to “develop, adopt, disseminate and enforce regulations for controlling silica exposures in the workplace and invest in building capacity within relevant regulatory agencies.” It also calls for the development of national guidelines and specifications for large infrastructure projects to include specific requirements to control silica dust exposures.

Perry Gottesfeld, Executive Director of Occupational Knowledge International said, “The UN General Assembly is taking an important step in highlighting the need for governments and global health funders to invest in primary prevention to reduce silica dust hazards in high-risk workplaces. This UN action recognizes that we can take action to prevent TB and not just treat it.”

The UN TB declaration specifically asks countries to commit to “implementing primary prevention in high-risk occupations by reducing silica dust exposures in mining, construction and other dusty workplaces.” There are 230 million workers exposed to silica dust on the job and the majority are in countries with the highest prevalence rates of TB.

Dr Eric Goosby, the United Nations Special Envoy on Tuberculosis, said http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30313-9/fulltext, “It is imperative that Governments and donors invest in workplace controls to prevent new cases of TB among the most vulnerable workers with some of the highest reported incidence of TB.”

*Director, Peoples Training & Research Centre, Vadodara


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