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Taiwan's Asbestos Ban Actions and Experiences International Journal of Environmental Research and Public Health Article Transnational Dynamics Amid Poor Regulations: Taiwan’s Asbestos Ban Actions and Experiences Harry Yi-Jui Wu 1, Ro-Ting Lin 2,* ID , Jung-Der Wang 3 and Yawen Cheng 4 1 Medical Ethics and Humanities Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; [email protected] 2 Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung 40402, Taiwan 3 Department of Public Health College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; [email protected] 4 Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei 10055, Taiwan; [email protected] * Correspondence: [email protected]; Tel.: +886-4-22053366 (ext. 6215) Academic Editors: Ken Takahashi, Jukka Takala and Annette M. David Received: 21 September 2017; Accepted: 14 October 2017; Published: 17 October 2017 Abstract: This article describes the history of the asbestos use regulation process in Taiwan and the associated factors leading to its total ban in 2018. Despite the long history of asbestos mining and manufacturing since the Japanese colonial period, attempts to understand the impact of asbestos on the health of the population and to control its use did not emerge until the early 1980s. We attempted to investigate the driving forces and obstructions involved in asbestos regulations by reviewing available public sources and scientific journal articles and conducting interviews with key propagators of the asbestos regulation and ban. Correlation between asbestos exposure and asbestos-related diseases has already been established; however, authorities have been unable to effectively regulate the extensive application of asbestos in various light industries that support economic growth since the 1960s. More stringent regulations on asbestos use in industries and an eventual ban were caused indirectly by appeals made by visionary scholars and healthcare professionals but also due to the subsidence of asbestos-related industries. With the elucidation of factors that affect asbestos regulation and ban, a thorough long-term healthcare plan for the neglected victims of asbestos-related diseases and upstream measures for policy change must be developed. Keywords: asbestos; asbestos-related diseases; health policy; Taiwan 1. Introduction The implementation of the national policy leading to the total asbestos ban in Taiwan on 1 January 2018 marks a historic moment for the country [1]. Such a ban reveals a health policy-making process resulting from the transnational dynamics among public health scientists. Asbestos has long been widely used in the construction and manufacturing industries [2]. Asbestos use in Taiwan varied as the types of industry changed during the past century. Various ways of asbestos utilization and levels of asbestos exposure are related to its effects on human health. Meticulous efforts have been conducted in Taiwan to establish the relationship between asbestos exposure and asbestos-related diseases (ARDs); however, regulations and the final total ban on asbestos depend largely on growing environmental awareness, transnational networking among advocates, and the decline of asbestos-related industries. Asbestos remains an environmental hazard despite the forthcoming stringent regulations on its industrial use. Int. J. Environ. Res. Public Health 2017, 14, 1240; doi:10.3390/ijerph14101240 www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Public Health 20172017,, 14,, 1240 2 of 10 The industrial application of asbestos in Taiwan can be divided into three stages: before 1945 (underThe Japanese industrial rule), application 1945–1983 of (the asbestos development in Taiwan of canthe befundamental, divided into light, three and stages: heavy before industry), 1945 (underand 1984–2017 Japanese (high rule),‐tech 1945–1983 industry (the development). development Asbestos of the fundamental,deposits were light,first discovered and heavy on industry), the east andcoast 1984–2017 of Taiwan (high-tech in 1917 and industry were mined development). on a large Asbestos scale to support deposits Japanese were first industrial discovered development on the east coastplans offrom Taiwan 1937 in to 1917 1944 and [3,4]. were The mined asbestos on mine a large produced scale to support 105–820 Japanese metric tons industrial asbestos development per year in plansthis period from (Figure 1937 to 1) 1944 [5]. Since [3,4]. 1945, The asbestoswith the end mine of producedJapanese rule 105–820 and the metric Second tons World asbestos War, per Taiwan year inentered this period a period (Figure of economic1)[ 5]. development. Since 1945, with Taiwan the end imported of Japanese asbestos rule extensively and the Second from South World Africa War, Taiwanand Canada entered [6]. aMost period unmanufactured of economic development. asbestos was Taiwanconsumed imported in four asbestos sectors: extensivelyasbestos cement, from Southabrasion Africa resistant and Canada products, [6]. Most insulation, unmanufactured and textiles asbestos [7]. wasMeanwhile, consumed Taiwan in four sectors:dominated asbestos the cement,worldwide abrasion ship demolition resistant products, industry insulation, to extract and raw textiles materials [7]. Meanwhile, from ships Taiwan to support dominated domestic the worldwideindustrial development ship demolition [8]; industry however, to extract data on raw asbestos materials‐containing from ships materials to support (ACMs) domestic from industrial these developmentdemolished vessels [8]; however, are lacking. data on asbestos-containing materials (ACMs) from these demolished vesselsAsbestos are lacking. consumption peaked in 1983 and gradually decreased following the growing awarenessAsbestos about consumption asbestos hazards, peaked the in 1983 establishment and gradually of asbestos decreased regulations, following the the industrial growing awareness transition aboutto the asbestosmanufacture hazards, of high the‐ establishmenttech products, of and asbestos decreasing regulations, demand the for industrial asbestos transition products tofrom the manufactureTaiwan’s trade of partners high-tech [9,10]. products, Consumption and decreasing suddenly demand peaked again for asbestos in 1986 productsfor house fromreconstruction Taiwan’s tradeafter the partners devastating [9,10]. typhoon Consumption Wayne suddenly [11,12]. peakedMost asbestos again in was 1986 consumed for house in reconstruction the mid‐1980s, after but theno devastatingregulation was typhoon established Wayne to [11 prohibit,12]. Most asbestos asbestos consumption was consumed until in 1989. the mid-1980s, but no regulation was establishedEstablishing to asbestos prohibit regulations asbestos consumption was an important until 1989. factor that accounted for the decrease in asbestosEstablishing consumption asbestos after regulations the 1980s, whereas was an importantthe efforts factorof public that health accounted scholars for to the stimulate decrease the in asbestosawareness consumption of asbestos workers after the about 1980s, asbestos’ whereas hazards the efforts were of publicanother health critical scholars factor that to stimulate contributed the awarenessto the drastic of asbestosdecline in workers asbestos about use. During asbestos’ this hazards period, were officially another registered critical factorfactories that that contributed operated towith the asbestos drastic declinewere subjected in asbestos to asbestos use. During regulations, this period, which officially enabled registered public health factories scholars that operated to enter withthese asbestos factories were and subjectedconduct a to national asbestos survey regulations, on asbestos which exposure enabled publicamong health workers scholars who handled to enter theseasbestos factories textiles, and cement, conduct insulation, a national and survey brake‐ onlining asbestos materials exposure [13,14]. among In addition, workers the who presence handled of asbestosinvestigators textiles, equipped cement, with insulation, the highest and level brake-lining of personal materials protective [13, 14equipment]. In addition, (PPE) the to presenceconduct air of investigatorssamplings surprised equipped many with workers the highest and employers level of personal of the inspected protective asbestos equipment factories (PPE) during to conduct the time air samplingswhen many surprised workers manyand employers workers and lacked employers awareness of the of inspectedthe health asbestos risks from factories asbestos during exposure. the time when many workers and employers lacked awareness of the health risks from asbestos exposure. Figure 1. Trends of unmanufactured asbestos import, production, and consumption in Taiwan, 1930 to Figure 1. Trends of unmanufactured asbestos import, production, and consumption in Taiwan, 1930 2016 [5,15–19]. * Consumption = Production + Import. to 2016 [5,15–19]. * Consumption = Production + Import. Int. J. Environ. Res. Public Health 2017, 14, 1240 3 of 10 2. Asbestos-Related Regulations in Taiwan Internationally, Selikoff et al. raised concern about elevated mesothelioma risks among insulation workers, mostly due to the occupational exposure to asbestos, in the 1960s [20]. Since then, knowledge of the health impact of exposure to asbestos has emerged and grown among asbestos-consuming countries. Taiwan’s regulations pertaining to asbestos control were finally announced by
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