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Annex 1

International Seminar on Exposure to Silica
“Prevention and Control”
Curitiba – 6th to 10th November 2000

From November 6 to 10, 2000, the International Seminar on Exposure to Silica – Prevention and Control was held in Curitiba, with the participation of experts from Brazil and abroad who presented their experiences on various aspects related to the subject.

Throughout this week, the press reported information that certainly warned the population about the serious problem facing workers exposed to silica, affecting their survival, their quality of life, their family and their socio-economic contribution. We are sure that many have been sensitized and now know that this is a problem that can be solved as long as we have the political will to address it.

Now is the time to come up with a comprehensive action plan that includes different aspects related to the prevention and control of silica exposure situations, which can promote, within a realistic time frame, the gradual elimination of silicosis and its consequences.

This objective is perfectly achievable, taking into account the international and national experience accumulated in recent years, the solidary engagement of government representatives, workers and employers as well as international institutions such as the ILO and WHO.

During the seminar a series of proposals were presented by the participants of the event that are condensed into three items:

1- Government Policies and Legislation
2- Training / Capacity Building and Information;
3- Studies and Research.

At this time these proposals should be discussed by the Seminar Organizing Committee with the competent governing bodies and forwarded to all participants of the event.

1. GOVERNMENT POLICIES AND LEGISLATION

Another silicosis prevention and control mechanism to be considered is legislation that seeks to protect workers exposed to silica and promotes the replacement, where possible, of hazardous products with less aggressive ones.

Therefore, to enable a Silicosis Elimination Program, it is necessary to update the Brazilian legislation, as well as to establish a national policy that reflects an integrated and effective action of all social actors directly involved with the issue.

Some initiatives regarding legislation are already being taken by states and municipalities on the subject and others are being suggested in this document:

Present to the National Congress a bill that prohibits the use of sandblasting throughout the national territory, substituting for other products less aggressive to the health of the worker.
Ratify and support the measures already taken by states and municipalities on the subject such as the Rio de Janeiro State Law and Resolution No. 1076/97 of the Paraná State Department of Health, which prohibits the use of sandblasting.
Improve legislation regarding the prohibition of the use of equipment or work processes that use hazardous materials or products that are proven to be carcinogenic.
Adopt legislation regarding the requirement of manufacturers of equipment used in the area of risk of silicosis (drilling and blasting) to implement safety devices and collective protection.
Include in the legislation, in case of accident, the responsibility of the manufacturer and owner of the equipment used.
Develop framework legislation on the issue of carcinogens used in the workplace.
Review the limits for crystalline free silica dust (Annex 12 to NR 15) considering this chemical as a carcinogen.

Regarding government policies, it is necessary to establish a proposal that incorporates a state policy, which guarantees the full integration of the actions of the various government agencies, which may include the important participation of international agencies and organizations, as well as guaranteeing the participation of employers, workers in project planning and execution.

To elaborate a National Program for the Elimination of Silicosis that integrates the institutional actions, mainly in the Health, Labor and Welfare areas, ensuring that in its strategic projects it contemplates the elimination of SILICOSE and that it considers the possibility of the contribution of the World Health Organization, International Labor Organization, technical cooperation agreements with other countries, such as Italy, as well as the participation of other social actors involved in the issue.
Create a supra-institutional (or supra-state) nonprofit instance with social control with the aim of enabling control and elimination actions for silicosis. The body will work to plan and develop research and training activities with the support of government agencies responsible for the area of occupational safety and health. It will seek technical and financial resources from national and international organizations as well as the business sector that handles the product or others who decide to join the project.
Extend the prevention and control actions of the Ministry of Health’s Worker Health Program Silicosis to all Brazilian states, intensifying investments in the implementation of surveillance and health care services for workers in the states and municipalities.
Ratify the need to implement an information system on occupational accidents and illnesses by making these notification events mandatory, at national level, regardless of employment relationship.
Create through public agencies the implementation of a register of companies that generate or use silica, with data available to society.
Discuss in the tripartite committee, at national level, the whole legal process related to Unhealthiness, Legislation and Exposure Limits related to silica and also the elimination actions to be developed by the various sectors and social actors.
Establish contacts with the other countries of MERCOSUR and Latin America to incorporate the proposal for the elimination of silicosis, promoting similar seminars to the one held in Curitiba with the objective of encouraging joint action.
Provide INSS data on the disease and facilitate its access.
Conduct studies to review the definition of the concept of Occupational Disease adopted by the INSS.

2. INFORMATION AND TRAINING / TRAINING

One of the measures to prevent work-related accidents or illness is based on promoting information to workers and employers about the risks present at workplaces and the training of professionals who will act in the safety and health of workers.

The conclusions of the Seminar on Exposure to Silica point to some strategies of educational practices that were suggested by the participants:

2.1 DISSEMINATION OF INFORMATION

Promote a National Campaign to disseminate information on the risks of silica to workers’ health and appropriate measures to prevent and control its use. The Campaign should reach the workers and employers of the sectors that make use of silica in their work processes by elaborating educational and clarification documents about the risks and the disease, as well as the means and strategies that should be adopted for its prevention. Small and medium-sized enterprises should be prioritized in this campaign due to the high number of serious cases identified and their low investment power in occupational safety and health issues.
Disseminate the results of the seminar in the media as a mechanism for sensitization and dissemination of intentions as well as clarification on the subject.

2.2 WEBSITE

Create a SILICOSE DISPOSAL WEBSITE as a mechanism for disseminating and updating information on silicosis and measures being taken at national and local level for its control and elimination.
Provide database with results from case studies and research on measures, effective strategies and practical solutions to prevent and control exposure of workers to atmospheric dust.
Establish links with various national and international institutions that have technical and scientific information regarding exposure to silica and silicosis, such as PAHO’s virtual library.

2.3 TECHNICAL TRAINING

Develop a Training Program for Professionals working in the area of occupational safety and health aimed at:

Doctors who provide care to workers exposed to silica, promoting its updating in the clinical and laboratory diagnosis of the disease with emphasis on training of radiological reading of pneumoconioses by ILO standards.
Labor Engineers, Occupational Hygienists, Occupational Safety Technicians and others, in updating the technical strategies to be adopted in the prevention and control of silicosis.

The first stage of the Program should include identifying the needs of the area and also identifying existing resources to be later complemented with other proposals.

Courses should be programmed to meet the needs of all professionals involved with the problem, and should have times when sessions will be joint and other specialized in order to create a culture of multidisciplinary teamwork.

3. STUDIES AND RESEARCH

Another mechanism of fundamental importance for the prevention and control of silicosis is the promotion of studies and research on the effects of silica and especially the mechanisms that may protect the worker. These mechanisms range from the use of new technologies of collective and individual protection to the proposal of new alternative products that may present less danger to the health and safety of the worker. Therefore, an investment must be made in this area to make available to society the results that may contribute to the elimination of silicosis.

Carry out technical and epidemiological studies, with existing information sources that contribute to the elaboration of strategic programs.
To elaborate a National Bank of Exposed, that register the workers in relation to their functions and exposures that allow the development of surveillance and control programs.
Developing actions to strengthen the product safety issue, that is, must be produced and marketed without risk to the health and / or physical integrity of the worker.
Develop a minimum roadmap for risk recognition and qualitative and quantitative assessment of silica work environments.
Promote studies and research on silica substitutes in the various work processes.
Promote studies and research on effective measures and strategies that prevent or control worker exposure to atmospheric dust.

Annex 2
Report of the results presentation meeting of the International Seminar on Exposure to Silica, held in Brasilia, December 12, 2000, at the headquarters of the International Labor Organization.

Participants:

Armand Pereira – ILO / BRAZIL
Alcinéia M. dos Anjos Santos – FUNDACENTRO
Ana Maria Tibiriçá Good – FUNDACENTRO
Beatriz Cunha – ILO / BRAZIL
Berenice Goelzeer – WHO / GENEVA
Ciro Varejao – MPAS
Eduardo Algranti – FUNDACENTRO
Gilson Lucio Rodrigues – FUNDACENTRO
Jacinta de Fátima Sena da Silva – COSAT / MS
Jacira Cancio – PAHO / WHO / BRAZIL
Lenio Sérvio Amaral – FUNDACENTRO
Luiz Carlos Fadel – COSAT / MS
Néri Alcioly – ILO / BRAZIL
Mario Bonciani – DSST / MTE
Zuher Handar – PARANÁ’S EVANGELICAL COLLEGE

Schedule:

Opening by Dr. Armand Pereira – ILO Director in Brazil
Presentation of the proposed ILO / WHO Joint Program for the Elimination of Silicosis by Dr. Berenice Goelzer of WHO Geneva
Presentation of the report of the Curitiba Seminar by Dr. Zuher Handar as representative of the Organizing Committee of the event.
Comments and Debates from participants:

Magnitude of the problem
- Need to estimate the real magnitude of the problem.
- Identify available statistical data or recommend research from Universities and Research Institutes.
- Search for more information on the subject and the problem in Brazil and create a database on silica and silicosis exposure.
- Management with INSS / DATAPREV to update statistical data on the disease.

Cost benefit
- Evaluate the cost of the Silicosis Elimination Program, establishing the cost-benefit ratio between the investment in the Program and the cost of cases that have been occurring.
- Raise Social Security costs with notified or benefit-generating cases.
- Identify the costs with benefits, treatment and hospitalization with silicotics.
- Estimate social costs for patients’ families.

Actions in progress
- Occupational Lung Diseases Committee at the Ministry of Health with actions on Silicosis and Asbestosis
- Actions being taken by FUNDACENTRO and DSST / MTEM
- Identify the actions being developed in various parts of the country and create the database of these experiences.

Partnership
- Invite other social actors involved in the issue and establish a partnership in the elaboration and execution of the National Plan: representatives of workers, employers, government agencies, the Public Prosecutor, Universities, Training Institutions
- Conduct the Workshop with the participation of workers and employers to present the seminar results report and the proposal for the elaboration of the National Silicosis Elimination Program.

disclosure
- Promote wide dissemination of existing educational materials such as the Worker / FUNDACENTRO handbook.
- Promote a National Silicose Elimination Campaign using the media.
- Promote the dissemination of silica and silicosis by economic sectors and in the unions involved and in events.
- Create a website on the internet.
- Make existing texts such as WHO on silicosis available through the websites of several related institutions.

National Silicosis Elimination Program
- To define an inter-institutional articulation strategy that includes the participation of governmental and non-governmental organizations to elaborate a planning that integrates the state and society actions, defining responsibilities, goals and execution schedule.
- Organize a Project Coordination Center under the coordination of the ILO / WHO that will advise on the preparation and monitoring of Program implementation. This Center will have an ILO / WHO Advisory Group and an Executive Advisory Council made up of government representatives and representatives of the social actors directly involved.
- Creation of the provisional Coordination Center formed by the institutions present and the organizing committee of the Curitiba Seminar.
- Preparation of a reference document for the ILO and WHO to present to the Brazilian government the proposal of the National Silicose Elimination Program

Immediate Referrals
- To officialize to the Brazilian Government the proposal of a National Program for the Elimination of Silicosis in cooperation with the Joint ILO / WHO Program.
- Creation of Provisional Coordination Center
- Promote the Workshop with workers, employers and other partners to define the strategy for preparing the Program.
- Prepare reference document on the proposal.
- Create the site about silicosis.