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The use of asbestos in Indonesia
The earliest record of asbestos imports to Indonesia are found in the Statistical Summary of the Mineral Industry, Production, Exports, and Imports, 1950-1955 from the Colonial Geological Survey(1). The 1958 Five Year Development Plan of the Republic of Indonesia listed asbestos as one of the minerals that needed to be investigated for further utilization in the country(2).
Subsequently, several asbestos factories began to operate following the national plan. As the Indonesian asbestos industry grew in the latter half of the 1900’s, the serious health hazards of carcinogenic asbestos were discovered and emerged as a widespread concern in other parts of the world.
The number of asbestos imports sharply increased in the last 20 years following asbestos bans in many developed countries. The peak of consumption totalled 163,412 tons in 2012, making Indonesia the second highest importer of asbestos in the world to present (Figure 1)(3). Undoubtedly in the next 10 to 20 years Indonesia will face an explosion case of asbestos-related diseases (ARDs).
Regulation of asbestos related diseases
In 1970, the Principal Law on Occupational Safety and Health in Indonesia, the Work Safety Act was issued, which was the first national regulation to address worker safety. In 1980, the government acknowledged for the first time the danger of asbestos when an article was written into a Ministry of Manpower and Transmigration Act about Occupational Health and Safety in Constructions Works stating, "Asbestos shall be used only when other less dangerous substitute materials are not available".
Asbestos-related disease reporting was covered in the annex to the Ministry of Manpower and Transmigration Act on Occupational Diseases in 1981. In 1985, the Ministry of Manpower and Transmigration issued an occupational safety and health regulation on asbestos use. It required general workplace protections, including a worker’s right to information about the health effects of asbestos, a health check-up, personal protective equipment, and specified work clothing. It also specified that the company should provide designated clothing for work that should be cleaned and kept inside the company to protect workers’ families from being exposed. This law also banned the use of crocidolite and announced the penalty for breaching the act was IDR 100,000 (=USD 7.1).
The most recent regulation related to asbestos is the 2019 Presidential decree (PP no 7, 2019) about Occupational Disease. It updated the list of occupational diseases. It also said that reporting of occupational diseases is required not only by company management, but also by health facilities. It gives an opportunity of workers and health facility collaboration especially when company management are reluctant to report or take action on ARDs.
The latest permissible exposure limit for asbestos was set at 0.1 f/ml regardless of the type of asbestos used. Specific procedures for health examinations to monitor asbestos-exposed workers, methods to diagnose an ARD, disability assessment, and return-to-work accommodations for employees with ARD are however still not available. The compensation of ARDs is regulated as part of the occupational disease compensation system. Guidelines and training on how to diagnose and report occupational diseases are needed as a result of the new regulation.
Like many other developing countries, Indonesia faces a problem with occupational and environmental health enforcement. Even though non-asbestos building materials are currently available, the widespread use of asbestos roofing is evidence of ongoing violations of the law. Almost all obligations for company management to protect workers are breached. There is no special clothing inside workplaces and the workers never get information about the level of asbestos in the workplace. It is general knowledge that asbestos workplace air monitoring is rarely conducted. The workers also have limited knowledge about asbestos health effects, do not get proper health examinations, and even when given an exam, they do not receive any information about the results. Many companies are not easily persuaded to implement effective occupational safety and health programs because enforcement is not stringent enough and the penalties are very low.
Public health concern
It is easy to find some public buildings like schools, traditional markets, or health facilities using asbestos roofing in Indonesia. The public does not have good information about asbestos-containing materials (ACMs) and their health effects. Unfortunately, there is no list of ACMs available for community members. The public lacks awareness that they can get exposed to asbestos from destroyed buildings during natural disasters, demolition processes, big fires in residential areas, and cracked asbestos that is randomly disposed of by residents and building renovations.
Report and compensation of ARDs
In July 2017, more than sixty-five years after the first use of asbestos, the Indonesian government compensated the first case of occupational ARD. It is well known that ARDs are underdiagnosed and underreported in developing countries. Medical doctors receive insufficient occupational safety and health training, so they have difficulties diagnosing ARD and making the link between workplace exposure. The managers of health facilities also do not have enough information about ARDs, and fail to provide the necessary equipment, training and environment. leading to continued hazardous work practices. For example, the histology department in a large Indonesian hospital does not have sufficient mesothelioma antibody markers to diagnose mesothelioma.
Reasons for under-reporting of ARDs are multiple. Many company managers are reluctant to report occupational diseases and make the compensation claim. Unfortunately, the worker who suffers from an occupational disease do not have right to make the compensation claim report so it will go unreported if management does not. Another reason for underreporting is that ARD often develops decades after the first exposure. Many workers are diagnosed more than three years after retirement (retirement age for Indonesian workers is 55 years).
The peak of asbestos consumption in Indonesia occurred during the 2010’s and, given the disease latency, Indonesia will face an explosion of asbestos-related diseases in the next 10-20 years. Without adequate policy, ARDs will continue to be underdiagnosed and underreported, and people’s lives will continue to be in danger.