Hazardous Chemical Exposure - ILO

International
Labour
Organization
X Exposure to hazardous
chemicals at work and
resulting health impacts:
A global review
Exposure to hazardous chemicals at
work and resulting health impacts:
A global review
Copyright © International Labour Organization 2021
First published 2021
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Exposure to hazardous chemicals at work and resulting health impacts: A global review
International Labour Office – Geneva: ILO, 2021
ISBN: 978-9-22-034219-0 (web PDF)
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Contents
Executive Summary v
Introduction 1
Methodology 7
Summary of Findings 9
Chemical exposures 11
Asbestos 12
Silica 16
Heavy metals 20
Spotlight on e-waste: Hazardous substances within the life cycle
of high tech electrical and electronic products 28
Solvents 33
Dyes 37
Spotlight on textiles: One of the largest employers worldwide 39
Manufactured nanomaterials (MNMs) 41
Perfluorinated chemicals (PFAS) 45
Endocrine-disrupting chemicals 49
Pesticides 56
Workplace air pollution 61
Priority action areas 65

National level action 65
Workplace level action 67
Research priorities 70
Social dialogue 71
References 73
iv X Exposure to hazardous chemicals at work and resulting health impacts:
A global review
X Acknowledgements
With the strategic oversight and research conceptualisation of Manal Azzi (Senior OSH specialist, ILO),
and technical backstopping, input and coordination from Halshka Graczyk (Technical OSH specialist, ILO),
the first draft of this review was prepared by Daniele Mandrioli (Ramazzini Institute). The ILO is thankful
to Sara Brosché (International Pollutants Elimination Network) who revised the draft and added gender
considerations, Lacye Groening (Junior technical officer, ILO) who contributed to the text, and Balint
Nafradi (Technical officer, ILO) for his valuable comments and assistance on statistics. Natasha Scott
(Independent Consultant) developed the priority actions and chemical chapter content, conducted a
technical review of the figures and text, and edited the final report in preparation for layout. We would
additionally like to thank the ILO's Bureau for Employers' Activities (ACTEMP) and the Bureau for Workers'
Activities (ACTRAV) for their valuable comments, and in particular Rory O'Neill (International Trade Union
Confederation) for his continued insight and guidance.
We gratefully acknowledge the contribution of a number of peer-reviewers, including Victoria Arrandale
(University of Toronto), Aurelie Berthet (Unisanté), Beat Brüschweiler (Swiss Federal Food Safety and
Veterinary Office), Aleksandra Fucic (Institute for Medical Research and Occupational Health), Cara Haldin
(US Public Health Service), Michael Riediker (Swiss Centre for Occupational and Environmental Health),
and Kyle Steenland (Emory University).
This report was prepared in the framework of the Safety + Health for All Flagship Programme, thanks
to the financial contribution of the Federal Ministry for Environment, Nature Conservation and Nuclear
Safety of Germany. For more information on the project "Enhancing the role and engagement of the
world of work actors, including ministries of labour, employer and worker organisations in SAICM Beyond
2020”, see this link: https://www.ilo.org/global/topics/safety-and-health-at-work/programmes-proj-
ects/ WCMS_722473/lang--en/index.htm For more information on the Safety + Health for All Flagship
Programme, see this link: www.ilo.org/safety-health-for-all
v
X Executive Summary
Background
Workers around the world are facing a global health crisis due to occupational exposure to toxic chemi-
cals. Every year more than 1 billion workers are exposed to hazardous substances, including pol-
lutants, dusts, vapours and fumes in their working environments. Many of these workers lose their
life following such exposures, succumbing to fatal diseases, cancers and poisonings, or from fatal injuries
following fires or explosions. We must also consider the additional burden that workers and their fami-
lies face from non-fatal injuries resulting in disability, debilitating chronic diseases, and other health
sequela, that unfortunately in many cases remain invisible. All of these deaths, injuries and illnesses
are entirely preventable.
The International Labour Organization (ILO) has long recognized that the protection of workers from
hazardous chemicals is essential to ensuring healthy populations as well as sustainable environments.
Nevertheless, workers continue to be disproportionally exposed to chemicals across almost all
workplace sectors. Production of chemicals as well as the industries using them are expanding, which
means a high potential for increased occupational exposure. Moreover, with new chemicals intro-
duced every year, mechanisms for regulating exposure such as the implementation of occupational expo-
sure limits, struggle to keep up. There is therefore an urgent need to take action and implement a range
of effective measures to prevent harm to workers, their families, and wider communities.
In response to growing international concern over chemical safety, the Strategic Approach to
International Chemicals Management (SAICM) was developed to serve as a policy framework to pro-
mote chemical safety. Occupational exposure considerations should be at the core of SAICM Beyond 2020
and even stronger measures are needed in this new framework to protect workers from chemical
exposures.
This global review was undertaken in order to provide a sound evidence base towards policy efforts. As
such, it represents a necessary and comprehensive analysis of recent trends and priorities when it comes
to protecting the health and safety of workers from occupational chemical exposures.
Main findings
The top chemical exposures identified as priorities include:
1. Asbestos
2. Silica
3. Heavy metals
4. Solvents
5. Dyes
6. Manufactured nanomaterials (MNMs)
7. Perfluorinated chemicals (PFAS)
8. Endocrine disrupting chemicals (EDCs)
9. Pesticides
10. Workplace air pollution
X For the great majority of chemical exposures, data does not exist for local, regional and global esti-
mates and the number of workers exposed cannot even be estimated.
vi X Exposure to hazardous chemicals at work and resulting health impacts:
A global review
X Only a limited number of chemical occupational exposures are considered, monitored and regulated
in workplaces. Because of the lack of comprehensive information on chemical exposure of workers
and respective outcomes such as death, cancer, etc., global burden of disease calculations are often
missing or are severely underestimated.
X Whilst some hazardous chemicals have been phased out, a number of toxic substances are still used
globally, and workers in low- and middle-income countries (LMIC) are particularly exposed.
X Cancer is the main cause of work-related death, and more than 200 different substances have been
identified as known or probable human carcinogens, with many of these exposures occurring in the
workplace.
X Occupational chemical exposures have toxic effects on different body systems, including reproduc-
tive, cardiovascular, respiratory and immune systems, as well as specific organs, such as the liver
and brain.
Respiratory Neurotoxicity
diseases
Immune Reproductive
toxicity toxicity
Cancer Cardiovascular
disease
Nephrotoxicity
Poisoning
Obesity &
diabetes Endocrine
disruption
Liver toxicity
Priority Actions
This review clearly demonstrates the need for prompt action to protect workers across various economic
sectors worldwide. Key actions to ensure worker protection and prevention efforts include strict and
evidence-based occupational exposure limits, workplace measures following the hierarchy of control,
and chemical phase outs and restrictions. Additional key points include:
X Policies for the sound management of chemicals should always follow a systems approach, as out-
lined in the ILO Promotional Framework for Occupational Safety and Health Convention No. 187.
X International labour standards are crucial in responding to the occupational health crisis posed by
chemicals. Key ILO conventions pertaining to the safe management of chemicals, including ILO
vii
Chemicals Convention No. 170 and the Prevention of Major Industrial Accidents Convention No.
174, should be ratified and implemented as a priority.
X A preventative safety and health culture should be established at national and workplace levels,
with diverse stakeholders engaged at all levels.
X Harmonised and evidence-based Occupational Exposure Limits (OELs) must be established, up-
dated, implemented and enforced for all major hazardous chemicals.
X At the workplace level, a programme approach for the sound management of chemicals is recom-
mended, as well as a workplace strategy involving chemical identification, comprehensive risk
assessment and implementation of control measures.
X Preventative measures should be implemented following the Hierarchy of Controls, as set forth in
ILO guidance.
X There is an urgent need for harmonized global data repositories and databases of chemical expo-
sure information and resulting health effects on workers.
X Further research on non-communicable diseases (NCDs) should be considered a priority, as well the
interlinkages with chemical exposures and infectious disease. The COVID-19 pandemic highlighted
the need to develop responsive policy efforts that take into consideration the multi-dimensional as-
pects of OSH.
X Efforts are needed to generate gender disaggregated data to identify and prevent exposures and
impacts that are magnified by gender and biological factors.
X Social dialogue is essential for promoting transparent and active communication between stake-
holders at all levels.
X There is a need for increased engagement of world of work stakeholders in SAICM and other
international policy efforts dealing with chemicals, as well as the development of sound governance
frameworks.
Although the health effects of some occupational chemical exposures are well established, it is likely that
the long-term health impacts of certain chemicals will only become evident in years to come. What is clear
however, is that the utilisation of hazardous chemicals in consumer products and industrial processes
will continue to increase in the coming years, leading to a higher burden of disease and adverse
consequences for the environment. We can no longer afford to be complacent in our global misman-
agement of chemicals and a new approach is urgently needed to protect the billions of workers exposed
on a daily basis. Effective and evidence-based systems for the sound management of chemicals
must be implemented at both the national and workplace level as a matter of urgency.
Safe and healthy working
conditions are fundamental
to decent work.

XILO Centenary Declaration for the
Future of Work, 2019
ix
X Acronyms
ACGIH American Conference of MWCNT Multi-walled carbon nanotubes

Governmental Industrial Hygienists
NAFLD Non-alcoholic fatty liver disease
ASGM Artisanal small-scale gold mining
NCD Non-communicable disease
BC Black carbon
NHL Non-Hodgkin Lymphoid
BMI Body mass index
NIOSH United States National Institute for
BPA Bisphenol A Occupational Safety and Health
CCA Chromated copper arsenate OEL Occupational exposure limits
CNT Carbon nanotubes OSHA United States Occupational Safety

and Health administration
COPD Chronic obstructive pulmonary
disease PCBs Polychlorinated biphenyls
DALY Disability adjusted life year PCP Pentachlorophenol
DDT Dichlorodiphenyltrichloroethane PD Parkinson’s disease
DEP Diethyl phthalate PEL Permissible exposure limit
DES Diethylstilboestrol PFAS Per- and polyfluoroalkyl substances
ECHA European Chemicals Agency PFOA Perfluorooctanoic acid
EDC Endocrine-disrupting chemicals PFOS Perfluorooctane sulfonate
EPA Environmental protection agency OPM Particulate matter
EU European Union PNC Particle number concentration
GBD Global burden of disease POPs Persistent organic pollutants
GHS Globally Harmonized System of PPB Parts per billion

Classification and Labelling of
Chemicals PPE Personal protective equipment
HHP Highly hazardous pesticide REL Recommended exposure limit
HIC High-income countries RR Risk ratio
IARC International Agency for Research on SAICM Strategic Approach to International

Cancer Chemicals Management
ILO International Labour Organization SDG Sustainable development goal
IPCS International Programme on SMR Standardized mortality ratio

Chemical Safety SWCNT Single walled carbon nanotubes
IPEN International Pollutants Elimination TWA Time weighted average
Network
UEEE Used Electric and Electronic
LMIC Low- and middle-income countries Equipment
MEHP Mono-2-ethylhexyl phthalate UNECE United Nations Economic
MMP Monomethyl phthalate Commission for Europe
MNMs Manufactured nanomaterials UNEP United Nations Environment

Programme
WHO World Health Organization
© ILO / Marcel Crozet

1
X Introduction
Purpose of the study and over longer time periods, increasing their
risk of significant health effects. The ILO has
highlighted the importance of chemical expo-
As the production and use of chemicals in work-
sures as a top priority for advancing occupational
places around the world increases, workers are
safety and health (OSH) agendas worldwide and
ever more at risk of hazardous chemical expo-
calls attention to significant interlinkages that
sures which may be detrimental to their health.
exist between the world of work and other sec-
Aside from those employed by the chemical in-
tors, such as health, environment, agriculture and
dustry itself, workers from across almost all eco-
economic development.
nomic sectors are exposed to hazardous and toxic
chemicals. Previous estimates published by the In response to growing international concern
ILO have found that over 2,780,000 workers die over chemical safety, the Strategic Approach to
globally each year due to their working conditions International Chemicals Management (SAICM)
and that exposure to hazardous substances claim was developed with the overall objective of en-
the lives of almost 1 million workers (Hämäläinen suring the sound management of chemicals
et al. 2017). This translates to at least one worker throughout their life cycle. The ILO Governing
dying every 30 seconds due to occupational Body endorsed SAICM in 2006, noting that this
chemical exposure (UN 2018). global policy framework is a remarkable tool to
harmonise and integrate important elements
Due to scale of the problem, a comprehensive
needed for a universal approach to the sound
review of the evidence was needed to better un-
management of chemicals worldwide.
derstand the risks posed by hazardous chemicals
and to identify measures to protect the health An intersessional process is now underway to pre-
and safety of exposed workers. Chemical prior- pare recommendations regarding SAICM Beyond
ities in this study were identified based on the 2020. Occupational exposure considerations
following criteria: should be at the core of SAICM Beyond 2020
and even stronger measures are needed in this
X Expected burden of exposure among workers
new framework to protect workers from chem-
(the higher the exposure and production ical exposures. This global review aims to provide
trends, the higher the priority) important considerations on exposure scenarios,
X Expected burden of disease and related mor-
the magnitude of worker exposure and health
effects, as well as priorities for action during the
tality for workers (the higher the mortality, the
intersessional process and beyond. The ILO also
higher the priority).
hopes that the publication of this global review
X Potential for improving and implementing pro- will bring attention to the global health crisis
tective and preventive measures for workers workers are currently facing. It aims to promote
(i.e. chemical exposures for which occupational the meaningful and active participation by world
exposure limits are currently missing, chemical of work stakeholders, to ensure that the views of
exposures where low to middle income coun- the labour sector are fully taken into account.
tries could implement measures based on cur-
rent practices from high income countries).
Trends in OSH and
Why it is important to carry chemical safety
out a global review now? The chemical industry has a long history of steady
growth of about 4 to 4.5 per cent per year, al-
The sound management of chemicals and waste though some flattening has occurred over the
is directly linked to the world of work. While all past few years (UNEP 2019b). Global sales, in-
populations may be exposed to chemicals, cluding pharmaceuticals, were valued €3.47 tril-
workers tend to face exposure to higher doses lion in 2017, making the chemicals industry the
2 X Exposure to hazardous chemicals at work and resulting health impacts:
A global review
X Figure 1. Value Chain of the Chemical Industry: from extraction to finished products
Chemical Downstream Industrial Industrial Industrial and

Extraction
manufacture, chemical and consu- and consu- consumer
of raw
processing or products mer products mer products product dispo-
material
refining manufacture manufacture use and reuse sal and waste
Source: (UNEP 2019a).
world's second largest production sector (ILO exposures can result in acute health effects,
2018). Asia is the region that currently produces such as poisoning from pesticides, or in chronic
and consumes the largest amount of chemicals. disease, such as cancers. Moreover, the produc-
China has the largest chemical industry in the tion, use and storage of chemicals can result
world, with 37 per cent of global sales. With a in fires and explosions, resulting in large scale
market share of around 16 per cent, the European fatal and non-fatal injuries. A recent example
Union (EU) ranks second, followed by the US with is the Beirut explosion (August 2020), when
around 13 per cent. The global chemical industry's ammonium nitrate held in storage led to a
production capacity nearly doubled to around series of explosions, claiming over 200 lives
2.3 billion tons between 2000 and 2017 (Cayuela and resulting in more than 7,500 injuries.
and Hagan 2019), indicating potential future in-
Non-communicable diseases (NCDs), such as
creases in the quantity of chemicals produced.
cardiovascular disease, cancers and respiratory
Sales growth is expected to continue, though at
diseases, are another important consideration,
a somewhat slower pace than in the past decade.
as these may be triggered by exposure to haz-
The global value chain of the chemical industry ardous substances. Indeed, NCDs represent the
can be divided into key segments, as shown in vast majority of work-related diseases and an
Figure 1 (UNEP 2019a). In a first step, feedstocks increased risk of NCDs is often associated with
(e.g., natural gas and minerals) are processed into occupational chemical exposures (Budnik et al.
high-volume, low-value bulk chemicals. These are 2018). Recent estimates showed that occupational
conventionally produced in high-capacity refin- cancer accounted for 27 per cent of the 2.4 mil-
eries and milling facilities. Intermediate chemicals lion deaths per year, as shown in Figure 2 (Takala
are generally developed for further use in produc- et al. 2014; Takala 2015). The estimated number
tion or manufacturing processes, for example, of deaths attributable to occupational cancer an-
dyes for paint production. Chemical processing nually increased from 666,000 deaths in 2011 to
and product manufacturing in downstream fa- 742,000 deaths in 2015, an increase that could
cilities are connected to innumerable product be explained by different variables, such as the
manufacturers in sectors such as agriculture, con- evidence on new carcinogens, the methods of
struction and electronics. The various segments estimation, changes in the industry distribution
may span a number of countries across the world. of workers and a growing and ageing population.
Industrial and consumer product use, re-use, dis- The ILO has released global data that also shows
posal and waste can vary widely among different an increase in the number of fatal work-related
products and regions. cancers that occur every year (ILO 2018). In the
EU alone, occupational cancer was responsible
Workers face hazardous exposures at all
for 102,500 deaths in 2011 and 106,300 in 2015.
stages of the global chemicals value chain.
Considering these data, it is clear that occupa-
In addition, workers are exposed to a variety of
tional cancer now represents one of the primary
chemicals across economic sectors, including
causes of work-related deaths globally and in
but not limited to, agriculture, mining, construc-
many regions of the world, and that the numbers
tion, manufacturing, and services. Chemical haz-
continue to grow (Iavicoli et al. 2019).
ards, both classic (such as asbestos), as well as
emerging (manufactured nanomaterials), pose a
direct threat to workers and can exacerbate ex-
isting health problems. Occupational chemical
X Introduction 3
X Figure 2. Global burden of global work-related diseases by regions. Total number of work-related
fatalities was 2.4 million
100%
90%
80%
Occupational injuries
70% Genitourinary diseases
60% Digestive diseases
50% Respiratory diseases
40% Circulatory diseases
30% Neuropsychiatric conditions
20% Malignant neoplasms
10% Communicable disease
0%
HIGH AFRO AMRO EMRO EURO SEARO WPRO
Source: Hämäläinen 2017
Figure based on WHO regional groupings: HIGH - High Income countries Low- and middle-income countries: AFRO - countries of the African
Region AMRO - countries of the Americas EMRO - countries of the Eastern Mediterranean Region EURO - countries of the European Region
SEARO - countries of the South-East Asia Region WPRO - countries of the Western Pacific Region
Exposure to chemicals in exposures to even low doses of chemicals, es-

pecially during critical periods of biological de-
the world of work: a cross- velopment, can cause devastating and lifelong
cutting labour issue functional impairments. Victims of forced labour
and discrimination are also more likely to be af-
Changes in working practices, demographics, fected by chemical exposure due to often unsafe
technology and the environment have resulted working conditions. The same applies to workers
in new OSH concerns and in growing trends of who are not allowed to organise and bargain for
occupational health inequalities among workers their rights to be protected against hazardous
worldwide, particularly when it comes to ex- substances.
posure to toxic substances. Certain groups of
workers, such as young workers, aging popula-
tions, migrant workers, women and workers in
The role of gender in
the informal sector, may face increased exposures occupational exposure
to hazardous chemicals and suffer disproportion-
ally from their health effects.
to chemicals
The protection of workers against exposure Working towards gender equality in the
to chemicals is closely linked to the ILO’s ef- world of work is integral to the mission of the
forts to promote decent work and especially ILO, which adopted its Resolution on Equal
Fundamental Principles and Rights at Work Opportunities and Equal Treatment for Men
(FPRWs). These include the elimination of child and Women in Employment in 1985 (ILO 1985).
labour, forced labour and discrimination at work, Gender equality in the world of work refers to,
as well as the right to freedom of association and amongst other criteria, equal access to safe
collective bargaining. With regard to child labour, and healthy working environments (ILO 1985).
A global review
X Figure 3a. Sectors with prevalent female workforce (based on data for 121 countries,
representing 63% of global employment. (Data for China and India are not available)
53 - Personal care workers 12% 88%
32 - Health associate professionals 24% 76%
91 - Cleaners and helpers 26% 74%
41 - General and keyboard clerks 29% 71%
22 - Health professionals 31% 69%
23 - Teaching professionals 32% 68%
42 - Customer services clerks 34% 66%
44 - Other clerical support workers 39% 61%
94 - Food preparation assistants 40% 60%
51 - Personal service workers 44% 56%
26 - Legal, social and cultural professionals 47% 53%
34 - Legal, social, cultural and related 48% 52%

associate professionals
33 - Business and administration associate professionals 48% 52%
52 - Sales workers 49% 52%
75 - Food processing, wood working, garment and 49% 51%

other craft and related trades workers
24 - Business and administration professionals 49% 51%
43 - Numerical and material recording clerks 49% 51%
0 20 40 60 80 100
Men Women
Source: ILOSTAT 2020
X Figure 3b. Sectors with prevalent male workforce
93 - Labourers in mining, contruction, 83% 17%

manufacturing and transport
54 - Protective services workers 84% 16%
31 - Science and engineering associate professionals 84% 16%
01 - Commissioned armed forces officers 90% 10%
74 - Electrical and electronic trades workers 91% 9%
02 - Non-commissioned armed forces officers 93% 9%
03 - Armed forces occupations, other ranks 95% 5%
72 - Metal, machinery and related trades workers 96% 4%
83 - Drivers and mobile plant operators 97% 3%
71 - Building and related rades workers, 97% 3%

excluding electricians
0 20 40 60 80 100
Men Women
Source: ILOSTAT 2020

X Introduction 5
Gender and biological sex are important aspects carcinogens, exposed workers were 91 per cent
to consider in relation to occupational exposure to men and 9 per cent women (Scarselli et al. 2018).
chemicals. Gender should be understood as the In some sectors, male workers constitute the ma-
socially constructed differences between males jority of the workforce and are more exposed to
and females, dependent on context and within chemical hazards, as for example in construction,
societies and cultures (ILO 2007). Biological sex on mining, agriculture and metal production (ILO
the other hand refers to the biological differences 2010). However, chemical exposures in female
between men and women, including differences workers are dramatically increasing and are
in gonads and reproductive organs, hormonal often underestimated, particularly in in-
cycles, fat distribution and immune response formal sectors and in Low and Middle Income
(IPEN 2020).1 Countries (LMICs) (Hohenadel et al. 2015; IPEN
2020). Furthermore, in different sectors female
Biological sex can lead to important differences
workers constitute the majority of the workforce
in exposure and health effects when it comes to
and are more exposed to chemical hazards, for
chemicals. For example, the susceptibility of
example in health professions, textile production
women to hazardous chemicals can vary based
and in the cleaning sector (Figure 3). In the gar-
on their reproductive cycles and at different
ment sector, female workers are disproportion-
life stages such as pregnancy, lactation, and
ately exposed to a number of hazardous dyes and
menopause, when their bodies undergo phys-
solvents, some of which are proven carcinogens,
iological changes that may affect their vulner-
as well as endocrine disrupting chemicals. In ad-
ability to health damage from chemicals. This
dition, work tools and personal protective equip-
is especially pronounced in pregnant women, for
ment (PPE) has been traditionally designed for the
whom even low doses of chemicals might elicit
Western male body and therefore may fit female
dramatic effects in the developing foetus. This
workers poorly, leading to reduced protection and
is particularly relevant for endocrine-disrupting
increased risk of chemical exposure.
chemicals (EDCs) that are able to induce hormonal
effects at extremely low dosages, affecting fer-
tility, fecundity and development (Vandenberg The COVID-19 pandemic
et al. 2012; Di Renzo et al. 2015). Also, as females
are more likely to have more adipose tissue, this
and its effect on workers’
can lead to bioaccumulation of chemicals such as chemical exposures
persistent organic pollutants (POPs) and heavy
metals like mercury. These exposures can cause The COVID-19 pandemic severely disrupted the
consequences to reproductive health, such as chemical sector worldwide and increased the
spontaneous abortion, birth defects and neu- risk of different hazardous chemical exposures.
robehavioral consequences. A range of chemicals, Indeed, the overall burden of chemical exposure
including dichlorodiphenyltrichloroethane (DDT) in workers did decline amid the COVID pandemic,
and phtalates, have also been shown to impact particularly in highly industrialised areas. This
male fertility and development, including devel- effect was clearly demonstrated by the ubiquitous
opment of the reproductive organs (Gore et al. reduction in air pollution amid the COVID-19 epi-
2014). demic in areas where lockdown measures were
adopted and where a severe decline of chemical
In addition, gender-related differences in the
production was observed (Bauwens et al. 2020).
occupational roles of men and women can influ-
ence level, frequency and source of exposure to However, in all workplaces, especially in key es-
chemicals. Overall, men tend to be more exposed sential services, such as health care, transporta-
to hazards caused by substances that are carcino- tion, grocery stores, emergency personnel and
genic or may cause circulatory and respiratory other sectors of the workforce, workers may find
disease (ILO 2010). In a recent study on 166,617 themselves frequently working in the presence
exposure measurements selected for 40 different of chemicals and disinfectants (ILO 2020b). Due
1 The terms “gender” and “biological sex” are not interchangeable; gender identity may or may not correspond with the bio-
logical sex assigned. Gender identity exists on a spectrum and is not necessarily confined to an identity that is completely
male or completely female (WHO 2016b).
A global review
to a likely global increase in demand for many of Both shut down and start-up of industries require
these disinfectants, people working in the chem- special attention to prevent the occurrence of
ical industry may also work with increasing vol- chemical accidents. Two recent accident cases,
umes of these compounds (ILO 2020b). Some of that occurred when restarting a plant after shut-
the chemicals frequently used to disinfect against down due to the COVID-19 pandemic, exemplify
COVID-19 include quaternary ammonium, hy- these risks: in a polymer plant in India a leak of
drogen peroxide, peroxyacetic acid, isopropanol, hazardous gas led to the death of at least
ethanol, sodium hypochlorite, octanoic acid, phe- 11 people and injuries to hundreds more; an
nolic, triethylene glycol, L-lactic acid, glycolic acid, explosion at a plastics factory in Italy killed one
or dischloroisocynurate dehydrate (Fair, 2020). person and injured two others (EC-JRC 2020). The
Quaternary ammonium and sodium hypochlo- COVID-19 pandemic has also led to an increase
rite, in particular, carry an increased risk of COPD in the production of disinfectants, chemicals and
(Dumas et al. 2019), may impact fertility (Melin et PPE. The rapid scale up of these productions may
al. 2014) and can exacerbate asthma symptoms pose risks for industrial accidents and challenges
(Fair 2020). for OSH.
7
X Methodology
A scoping review was conducted to frame the cancer data were prioritised, as cancer represents
most recent trends and priorities for chemical one of the primary causes of work-related deaths
exposure and health effects for workers. Scoping globally. Data on other significant health impacts
reviews are useful for identifying and mapping associated with occupational chemical exposure,
available data and scientific literature and are including pneumoconiosis, neurotoxic effects and
particularly relevant for assessing emerging ev- endocrine disruption, were also included. As this
idence. We searched the following databases was a scoping review, it was not possible to in-
(2010-present day): PubMed, Scopus and Web clude all occupational chemical exposures and
of Science. Additionally, we searched for rele- all possible health impacts.
vant data and reports from the following agen-
Based on the priorities that emerged in the
cies repositories (2010-present day): ILO, WHO,
review, a number of actions were identified that
IARC, IPCS, UNEP, NIOSH, OSHA, EPA, ECHA and
can help promote safer chemicals management
European Commission.
within the world of work. Actions were selected
Reviews, reports and data published after 2010 for both national and workplace levels, with re-
in English served as key references. Based on the search gaps and social dialogue also considered.
available evidence, the report identified priorities The identified actions are proposed as a working
for chemical exposures. Due to the number of ex- foundation to stimulate future discussions and
isting occupational chemicals, specific exposures are not meant to be exhaustive.
were considered in this review if they were well-
known or it was assumed that at least 1 million
workers worldwide are currently exposed to the
substance. Burden of disease and figures related
to mortality were also considered. Occupational
A global review

9
X Summary of Findings
SUBSTANCE PRIMARY GLOBAL WORK-RELATED HEALTH SELECTED PRIORITY ACTIONS

HEALTH BURDEN OF IMPACT* AND PROGRESS
IMPACTS+ OCCUPATIONAL
EXPOSURE*
Asbestos Cancer >125,000,000 >233,000 deaths annually Phase out of asbestos has proven effective
(mesothelioma, (WHO 2018)# (GBD 2019) and has already been implemented in over
cancer of the 50 countries. Continued use and exports
lung, larynx, to LMICs continues to pose a threat to
ovary) workers. Effective and safe substitutes are
Asbestosis and needed.
pleural disease
Silica Cancer >50,000,000 >65,000 deaths annually Sandblasting bans, regulation and OELs
(lung) (Limited data (GBD 2019) have proven effective and have been
covering 35 successfully implemented, in particular in
Silicosis countries) high-income countries. Continued efforts
(OSHA 2002; IOM are needed in selected sectors (textiles,
2011) # masonry) as well as in LMICs.
Heavy metal: Cancer >1,800,000 Limited data (>900,000 due to Phasing out lead from gasoline, paint
Lead (stomach) (UE-OSHA 2014; environmental lead exposure and batteries has proven effective in
CAREX-Canada (GBD 2019)) reducing human exposure in selected
Neurotoxicity 2020) regions. Further global efforts are needed,
particularly in LMICs. Updated and
Cardiovascular harmonised OELs are needed.
disease
Heavy metal: Neurotoxicity >19,000,000 Limited Data Stronger workplace prevention efforts
Mercury (Limited data for (>2,000,000 DALYs are needed, as well as phase out across
Nephrotoxicity artisanal small- attributable to chronic various economic sectors. The Minamata
scale gold mining metallic mercury vapour Convention has been implemented in
Immune toxicity only) intoxication) over 120 countries. Nevertheless targeted
(Steckling et al. (Steckling et al. 2017) strategies are needed at both the national
Reproductive 2017) and workplace level to protect workers’
toxicity health, particularly in LMICs and in the
informal economy.
Solvents Cancer Limited data Limited data The phasing out and ban of the most
hazardous solvents has proven effective
Neurotoxic in selected countries and regions;
effects however national laws and workplace
including regulations are still needed in the majority
‘chronic of workplace settings. Increased efforts
solvent-induced are needed in LMICs and the informal
encephalopathy’ economy.
(CSE)
Reproductive
toxicity
Dyes Cancer Limited data Limited Data The phasing out and ban of the most
(bladder) toxic azo dyes has been effective and
successfully implemented, in particular in
high-income countries. Evidence-based
and harmonised OELs must be developed
for all dyes.
A global review
Manufactured Limited data Limited data Limited data National regulations based on evidence
Nanomaterials from risk assessments should be
(MNMs) Suggestion of developed for MNMs. Different OELs have
cancers been implemented, but evidence of the
(mesothelioma effectiveness of these OELs is still limited
and lung and harmonised OELs are missing.
cancer)
Perfluorinated Cancer Limited Data Limited Data PFOS and PFOA have been phased out
chemicals (testicular, liver in different countries, however, these
(PFAS) and kidney) substances can bioaccumulate and remain
in tissue long after they are removed from
Immune toxicity use. There are currently thousands of
PFAS still in use and the effectiveness of
Liver toxicity OELs and other protective measures to
prevent risk in workers are still unclear.
Reproductive
toxicity
Endocrine Reproductive Limited Data Limited Data The phasing out and ban of the most toxic
Disrupting toxicity (what we know: EDCs has been successfully implemented,
Chemicals >20 million IQ points loss, in particular in high-income countries.
(EDCs) Obesity >800,000 cases of male Increased efforts are needed to identify
infertility in the US and EDC exposure and to implement
Diabetes Europe due to environmental control strategies in LMICs. Gender
exposure at normal levels) considerations should be mainstreamed in
Neurotoxicity (Trasande et al. 2016; Attina et OSH regulations.
al. 2016)
Cancers
(breast,
prostate)
Pesticides Poisoning Limited Data >300,000 deaths annually The phasing out and ban of the most toxic
(although due to pesticide poisoning HHPs has been successfully implemented,
Cancer (various) presumably (Jørs at al. 2018), with >10,000 in particular in high-income countries.
a significant fatalities due to unintentional Increased action is needed for LMICs,
Neurotoxicity number of global acute pesticide poisoning particularly for regulation and practical
agricultural (Boedecker 2020) workplace prevention efforts. OELs
Endocrine workers may for HHPs should be implemented and
disruption be exposed - enforced globally.
approximately
Reproductive 883 million
toxicity agricultural
workers (ILO,
2019; Carvalho
2017)
Workplace Air Cancers >1.2 billion >860,000 deaths annually Targeted pollution control strategies been
Pollution (lung) (WHO 2018c) (WHO 2018c) successfully implemented, in particular
in high-income countries. More efforts
Respiratory are needed to design and implement
disease workplace prevention measures, with a
focus on LMICs.
Cardiovascular
disease
+
Indicated as main health impacts only; a number of additional health impacts may also be related to exposure to this substance.
*
Figures presented should be interpreted as low-end estimates, thus indicated with a “>”, given the lack of comprehensive reporting and
data available, particularly from LMICs and informal sectors.
#
Based on estimates from 2018. A new WHO/ILO joint estimate is under development
11
X Chemical exposures
Asbestos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Silica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Heavy metals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Spotlight on e-waste: Hazardous substances within the
life cycle of high tech electrical and electronic products . . . . . . . . . . . . . 28
Solvents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Dyes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Spotlight on textiles: One of the largest employers worldwide. . . . . . . . . . 39
Manufactured nanomaterials (MNMs). . . . . . . . . . . . . . . . . . . . . . . . 41
Perfluorinated chemicals (PFAS). . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Endocrine-disrupting chemicals. . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Pesticides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Workplace air pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

A global review
Asbestos and 85 countries manufacturing asbestos prod-

ucts (Nishikawa et al. 2008).
X Asbestos describes a group of naturally oc- Currently about 125 million people in the world
curring minerals that includes chrysotile, cro- are exposed to asbestos at the workplace (WHO
cidolite, amosite, anthophyllite, tremolite and 2018). The United States Occupational Safety and
actinolite. Although chrysotile is the most com- Health administration (OSHA) estimated in 2008
monly known form, all types of asbestos are oc- that 1.3 million employees in construction and
cupational carcinogens. general industry faced significant asbestos expo-
sure on the job in the United States of America
X Occupational exposure to asbestos occurs
(OSHA, 2008). In Europe, estimates of the number
through inhalation of fibres from air contam- of workers exposed to asbestos have been devel-
inated with asbestos, for example, during the oped by the CAREX study. Based on occupational
handling of asbestos and asbestos-containing exposure to known and suspected carcinogens
materials.
collected during 1990–93, the CAREX database
X Occupational exposure to asbestos causes an estimates that a total of 1.2 million workers were
estimated 233,000 deaths each year worldwide exposed to asbestos in 41 industries in the 15
and about 125 million people in the world are es- Member States of the EU (EU-OSHA 2014). CAREX
timated to be exposed to asbestos at the work- Canada estimates that 152,000 Canadians are
place (Furuya et al. 2018, WHO 2018). exposed to asbestos in their workplaces (CAREX-
Canada 2020).
X Major producers of asbestos continue to export
asbestos to countries around the world, espe-
cially to LMICs where use has increased, while
Health effects
use in other countries has decreased due to reg-
ulation. Cancer
X Since asbestos is predominately used in occupa- Asbestos is classified by the International Agency
tions with manual labor, such as construction, for Research on Cancer (IARC) as carcinogenic
occupational exposure to asbestos predomi- to humans (group 1), i.e. that there is sufficient
nately occurs in men, with the exception of the evidence in humans for the carcinogenicity of all
asbestos textile industry. Women run a higher forms of asbestos. Asbestos causes mesothe-
risk of secondary exposure or exposure through lioma and cancer of the lung, larynx, and ovaries.
contaminated consumer products. There are also observed associations between
exposure to all forms of asbestos and cancer
of the pharynx, stomach, and colorectum (IARC
Exposure 2012). An increased risk of colorectal cancer had
also been confirmed. A recent case-control study
Occupational exposure through inhalation, and to
of over 5,000 cases of cholangiocarcinoma, or
a lesser extent ingestion, occurs in the mining and
bile duct cancer, in Finland, Iceland, Norway and
milling of asbestos (or other minerals contami-
Sweden, showed a positive association between
nated with asbestos), the manufacturing or use
occupational exposure to asbestos and the risk
of products containing asbestos, construction,
of intrahepatic cholangiocarcinoma (Farioli et al.
automotive industry, and the asbestos-abate-
2018).
ment industry (including the transport and dis-
posal of asbestos-containing waste). At present, Occupational exposure to asbestos causes an
more than 50 countries have banned asbestos. estimated 233,000 deaths each year worldwide
Unfortunately, as the developed world was due to a number of diseases: mesothelioma, lung
phasing out or restricting the use of asbestos, cancer, larynx and ovary cancers, and asbestosis
LMICs were greatly increasing use of this toxic (Furuya et al. 2018). This estimate is much higher
material. The current world total production is still than the previous estimates by WHO of 105,000
estimated to be 1,100,000 metric tons (Bernhardt deaths per year, that were based on a more limited
and Reilly 2019). Peak world production was esti- number of diseases (lung cancer, mesothelioma
mated to be 5,090,000 metric tons in 1975, with and asbestosis) (Prüss-Ustün et al. 2011); (WHO
approximately 25 countries producing asbestos 2014b); (Abubakar et al. 2015). However even the
X Chemical exposures 13
Asbestos
most recent estimates might still be an underesti-

mate, since they do not account for other forms of
Occupational exposure to cancers that have been positively associated with
asbestos (cancer of the pharynx, stomach, and
asbestos causes an estimated colorectum) (IARC 2012). Furthermore, because
233,000
asbestos is more likely to cause lung cancer than
mesothelioma, the estimated total burden of as-
deaths
bestos related lung cancer might still be an under-
estimate. The WHO estimates a risk ratio of 6:1 for
contracting lung cancer versus mesothelioma
each year worldwide following chrysotile exposure (WHO 2014b).
Asbestosis and pleural disease
Asbestosis is a type of pneumoconiosis caused
by the inhalation of asbestos fibres and occurs
primarily as a result of occupational exposure.
The WHO estimated that the number of deaths
per year from asbestosis was 7,000 to 24,000
(Abubakar et al. 2015). The WHO/ILO are currently
performing a series of systematic reviews that will
inform the new estimates of the Global Burden of
Disease (GBD) regarding asbestosis. Asbestos ex-
125 million people

posure can also cause pleural disease, a non-can-
cerous lung condition that causes changes in the
membrane known as the pleura, that surrounds
are estimated to be exposed to the lungs and chest cavity.
asbestos
at the workplace
A global review
Even the most recent estimates might Latin America. China and India have been major
still be an underestimate, since they consumers of asbestos. India produces little to no
asbestos, however has become a major importer
do not account
with exponential growth in the manufacture of
asbestos cement and pipes (Frank 2014). The few
epidemiological studies available show clear evi-
dence of clusters of mesothelioma in municipal-
ities with a history of asbestos consumption and
a forecasted rise in its incidence in Argentina and
for other forms of Brazil for the next decade (Algranti et al. 2019).
cancers that have been
positively associated
with asbestos The role of gender
(cancer of the pharynx, stomach, There is a strong gender dimension in the expo-
and colorectum) sure to asbestos. Occupations that are high risk
for asbestos exposure generally involve physical
labor such as construction, mining and demolition
and are predominately held by men. The one no-
Regional trends table exception is the textile industry, which has
a large proportion of female workers, where as-
In 2018, the major producers of asbestos were bestos is often used, for example, for protective
Russia (650,000 metric tons), Kazakhstan (220,000 clothing. A study from Southeast China looked at
metric tons), China (100,000 metric tons), and mesothelioma cases in workers in asbestos textile
Brazil (100,000 metric tons) (Bernhardt and Reilly workshops, who also could perform hand-spin-
2019). It has been estimated that half of the as- ning at home in their spare time (Gao et al. 2015).
bestos produced is used by China and India, fol- Out of the 28 workers with a confirmed mesothe-
lowed by Brazil, Indonesia and Russia (Marsili et lioma diagnosis, all were females.
al. 2016).
Because of occupational gender differences,
Major producers continue to produce and export women have a higher risk of exposure from do-
asbestos to countries around the world, espe- mestic products such as talc contaminated with
cially to LMICs. Over 2,030,000 tons of asbestos asbestos, or secondary exposure to asbestos, for
are consumed annually according to the latest example from family members working with as-
available consumption data (Furuya et al. 2018). bestos carrying residues home with them (Gordon
Considerable use of asbestos has continued in et al. 2014).
much of Asia, Africa, and in some countries in
X Case study: Multi-dimensional effects of an asbestos-cement factory in Sibaté, Colombia

The asbestos industry began operations in Colombia in 1942, with an asbestos-cement facility
located in the municipality of Sibaté. In recent years, residents have been complaining about
an unusually large number of people diagnosed with asbestos-related diseases. A study to
analyse the situation of Sibaté started in 2015, to verify if the number of asbestos related dis-
eases being diagnosed was higher than expected, and to identify potential asbestos exposure
sources in the town. Using geographic information systems, landfilled zones in the urban area
of Sibaté were identified, on top of which a school and different sports facilities were built. The
analysis of four soil samples collected in landfilled zones, confirmed the existence of an under-
ground layer of friable and non-friable asbestos. Not surprisingly, the estimated age-adjusted
incidence rate of mesothelioma in Sibaté was higher those reported in other cities, regions and
countries of the world (Ramos-Bonilla et al. 2019).
Asbestos
Major producers continue to produce and

export asbestos
to countries around the world, especially to LMICs
MAIN SECTORS PRIMARY HEALTH GLOBAL BURDEN OF WORK-RELATED

OF EXPOSURE IMPACTS OCCUPATIONAL EXPOSURES HEALTH IMPACT
Cancer >125,000,000 (WHO 2018)* >233,000 deaths

Mining
(mesothelioma, annually (GBD 2019)
Construction cancer of the lung,
larynx, ovary)
Agriculture;
plantations; other Asbestosis and
rural sectors pleural disease
Automotive
industry
Protective textiles
*Based on estimates from 2018. A new WHO/ILO joint estimate is under development
X Selected Priority Actions: Asbestos
Examples of national policy measures

Ratify and implement the ILO Asbestos Convention, 1986 (No. 162). This includes measures to be taken for the prevention
and control of, and protection of workers against, health hazards due to occupational exposure to asbestos. Key provisions:
X Replace asbestos or products containing asbestos with materials evaluated as less harmful.
X Prohibit (totally or partially) the use of asbestos or products containing asbestos in certain work processes.
X Implement measures to prevent or control the release of asbestos dust into the air and ensure that exposure limits or
criteria are complied with.
X Reduce exposure to as low a level as is reasonably possible.
Additional actions for policy makers
X Include measures in national OSH programmes to protect workers from exposure to asbestos.
X Eliminate the future use of asbestos.
X Develop national programmes for elimination of asbestos-related diseases.
X Establish regulatory controls and guidance on measures to prevent exposure to asbestos in place and during asbestos
removal (abatement).
X Establish worker registries with past and/or current exposures to asbestos, organise medical surveillance of exposed
workers and improve early diagnosis, treatment, and rehabilitation services for asbestos-related diseases.
X Promote prevention through safety by design to minimise occupational hazards for the future.
Occupational Exposure Limits (OELs)
X Update, implement and enforce OELs for various forms of asbestos and ensure global harmonisation of these OELs.
X Established OELs include: The European Union’s single maximum limit value for airborne concentrations of asbestos is 0.1
fibers/cm3, as an 8-hour TWA (Currently under review by the European Chemicals Agency (ECHA)).
Examples of practical workplace interventions
X Replace chrysotile asbestos with safer substitutes and prevent potential exposure to any other type of asbestos already
in place.
X Promote the elimination of the use of chrysotile asbestos among contractors and suppliers.
X Monitor the work environment for contamination with various forms of asbestos.
X Ensure compliance with exposure limits and technical standards for working with asbestos.
X Establish engineering measures for control of the exposure to asbestos at source.
X Provide special training for workers involved in activities with potential exposure to asbestos.
X Provide appropriate PPE, free of charge.
X Ensure registration and medical surveillance of workers exposed to asbestos.
X Promote the identification and proper management of all forms of asbestos currently in place.
Sources include: ILO 2007b, WHO 2014a

A global review
Silica for the production of metal castings (IARC 2012).

The oil and gas industry uses a water-sand mix-
ture to fracture rock and silica sand to prop open
X Silica, or silicon dioxide (SiO2), is a natural com-
fractures, which promotes hydrocarbon flow and
pound of silicon and oxygen found mostly
extraction. C-silica is used as an asphalt filler and
in sand. The most abundant form of silica is
in bricks, mortar, plaster, caulk, roofing granules,
α-quartz, and the term quartz is often used
wallboard, concrete, engineered/artificial stone
in place of the general term crystalline silica
and dimension stone in building materials (IARC
(c-silica) (Uhrlandt 2006).
2012).
X Inhalation leads to a range of lung-related
It has been estimated that approximately 2.3 mil-
diseases and IARC has concluded that there is lion workers in the United States (OSHA 2020), 3-5
sufficient evidence that c-silica causes cancer million workers in Europe (Matteis et al. 2017), 0.5
of the lung. Exposure also can cause silicosis, million workers in Japan, more than 23 million
a long-term progressive lung disease, caused workers in China, 11 million workers in India, and
by the deposition of fine particulate silica dust. over 6 million workers in South America (Brazil,
X It has been estimated that over 65,000 deaths
Columbia, Chile, Peru) are occupationally exposed
to silica.
occurred worldwide in 2019 due to occupa-
tional silica exposure and prevention of expo-
sure to silica is the most effective way to limit Health effects
silica-associated morbidity and mortality (GBD
2019).
Cancers
X WHO and ILO have recommended life-long
Crystalline silica (c-silica) is classified by IARC as
health surveillance for workers exposed to res- carcinogenic to humans (Group 1). According
pirable silica. to IARC there is sufficient evidence that c-silica
X While gender disaggregated data is mostly
causes cancer of the lung (IARC 2012). Effects of
inhaled c-silica are strictly associated with occu-
lacking, it is likely that silica exposure is most
pational exposure to particles that are of respir-
extensive in occupations involving manual
able size (<10 μm) (ATSDR 2019). Recent results
labour, that typically are predominately male.
of cohort studies and meta-analyses confirmed
that exposure to c-silica is associated with lung
Exposure cancer, even in the absence of silicosis (Liu et al.
2013; Poinen-Rughooputh et al. 2016). The risk
Occupational exposure to respirable c-silica most of lung cancer increased also for long-term ex-
frequently occurs at a wide range of processing posure below 100 μg/m3 (Liu et al. 2017). In fact,
and construction sites, such as metal, nonmetal, recent estimates on pooled data from 10 cohorts
and coal mines and mills; granite quarrying and with over 66,000 workers showed that a limit as
processing sites; hydraulic fracturing operations; low as 10 μg/m3 would significantly prevent the
crushed-stone industries; foundries; ceramics; number of deaths associated to lung cancer and
and sandblasting operations (NTP 2016). Silica other diseases caused by silica exposure (Keil et
can also contaminate other ore or materials being al. 2018). High levels of exposure to c-silica have
mined, or a mining environment, thus inadvert- been also associated to an increased risk of larynx
ently exposing workers. For example, substantial cancer (Hall et al. 2019).
exposure to respirable c-silica occurs amongst
coal miners in the central Appalachian coal mines Silicosis
in the United States, where thin seams of coal lie
Silicosis is a type of pneumoconiosis, or pulmo-
sandwiched between silica-rich sandstone.
nary fibrosis, caused by inhalation and pulmonary
The major component of sand and gravel is deposition of respirable dust containing c-silica,
c-silica. The quartz/c-silica content of crushed primarily as a result of occupational exposure. It
stone varies from region to region. Heavy industry is a permanent disease with no treatment or cure
uses quartz sand to produce high-temperature or and can become worse even after exposure to
refractory silica brick, foundry moulds, and cores respirable dust ceases (Dumavibhat et al. 2013;
Silica
© Pxfuel
It has been estimated that over

65,000 Hnizdo & Sluis-Cremer, 1993). The Global Burden
deaths of Disease Study (GBD 2019) estimated that all-

cause mortality from occupational silica exposure
occurred worldwide in 2019 resulted in 65,870 global deaths in 2019. Of this
total, 12,886 deaths were specifically due to sili-
due to occupational silica exposure cosis. Other significant causes of death included
tracheal, bronchial and lung cancer. The WHO/ILO
are currently performing systematic reviews that
Prevention
will inform new estimates of the GBD of silicosis.
Silicosis, a type of pneumoconiosis, is an incur-
of exposure to silica is the able disease with no available treatment.
most effective way to limit

silica-associated morbidity Regional trends
and mortality Workers in LMICs are the most exposed to silica.
However exposed workers within all countries
(GBD 2019)
are more likely to be migrant or racial/ethnic
minorities. In 2016, an estimated 179,000,000
metric tons of silica in the form of industrial
sand and gravel were produced throughout the
world (USGS 2016). The top producers included
Silicosis The United States (77,700,000 metric tons),
a type of pneumoconiosis Italy (13,900,000 metric tons), France (8,700,000
metric tons), Turkey (8,000,000 metric tons), and
is an incurable disease Germany (7,500,000 metric tons) (USGS 2016).
with no available treatment
A global review
The role of gender silica exposure than women (Scarselli 2018).

However, monitoring and health data that make
Many of the occupations that have high silica ex- gender clearly distinguishable is lacking on a
posure include heavy manual labour, which typi- global scale and the women working in these
cally means that the majority of workers are male. sectors should not be overlooked, as gender may
For example, a study from Italy concluded that influence severity of pulmonary diseases (Brass
men were more likely to suffer from occupational et al. 2010).
X Case study: Artificial stone workers in Australia

Occupational lung disease after inhalation of respirable silica is variable and potentially
life-threatening. As the artificial stone industry has grown over the last two decades, clini-
cians have described unique manifestations of silicosis with signs and symptoms different
from classic chronic silicosis. For example, a number of masons working with artificial stone
have been forced to undergo lung transplantation due to silicosis. These patients have both
fibrotic/nodular silicosis and conspicuous alveolar proteinosis within the same lung paren-
chyma. Radiological and histopathological correlates of disease has been shown clearly in
the literature (Levin et al. 2019).

Cancer (cancer of the >50,000,000 >65,000 deaths

Mining
lung); annually (GBD 2019)
(Limited data covering 35
Construction Silicosis countries) (OSHA 2002; IOM
2011)*
Agriculture;
plantations;
other rural sectors
Oil and gas
Manufacturing
(manufacturing
of non-metallic/
mineral products
(e.g. pottery,
ceramics, bricks)
and stone cutting,
shaping and
finishing)
Niche industries
using abrasive
sandblasting (e.g.
textiles/garments,
restoration)
*Based on estimates from 2018. A new WHO/ILO joint estimate is under development
Silica
X Selected Priority Actions: Silica

X Phase out the practice of sandblasting. Sandblasting has been banned in several countries (mostly high-income) for dec-
ades. Many LMICs have yet to ban sandblasting and enforcement of the ban has proven to be challenging, especially in
informal settings.
X Reinforce regulations and promote workplace inspections to ensure effective implementation of the sandblasting ban and
other measures to reduce workers’ exposures to silica.
X Update, implement and enforce OELs for silica and ensure global harmonisation of these OELs.
X Established OELs vary depending on the country and sector. The table below includes a sample of established OELs.
X Apply the Hierarchy of Controls, following national recommendations as relevant. Primary prevention through physically
removing the hazard or substitution through replacing the hazard with a less hazardous option is the most effective way
to limit silica-associated morbidity and mortality. For example, when conducting abrasive blasting, substituting the sili-
ca-containing abrasive with steel grit or steel shot is a substitution that eliminates exposure to silica.
X Carry out regular workplace sampling for respirable dust using best practice methods.
X Implement engineering controls to remove respirable c-silica from the environment such as ensuring drilling, mining, and
tunneling equipment are using water suppression systems to improve dust capture at the source. Water spraying systems
can also be used to capture dust at the impact site when cutting and finishing manufactured stone countertops containing
c-silica Using a tiered approach and applying multiple engineering controls to limit respirable dust at the source, through
the transmission path, and at the level of the worker can ensure that the chain of exposure is interrupted.
X Use administrative controls and PPE as a last resort. They are the least effective control methods and require increased
costs, as well as a great deal of effort from the worker to ensure adequate and sustained protection.
X Perform periodic screening and health surveillance of workers exposed to respirable c-silica. WHO and ILO have recom-
mended life-long health surveillance for workers exposed to respirable c-silica, including:
1. Chest radiography at baseline, after 2–3 years of exposure, and every following 2–5 years. This should be systematically
interpreted according to the 2011 ILO Guidelines for the use of the ILO International Classification of Radiographs of
Pneumoconioses.
2. Annual pulmonary function testing (spirometry) with respiratory symptom assessment.
3. Conduct tuberculosis testing as needed based on local rates. This will enable identification of sentinel cases of disease
and allow early interventions to prevent progression.
Sources include: NIOSH 2002 and 2015, NIOSH & OSHA 2015, Colinet et al. 2010, Organiscak et al. 2009, ILO &WHO 2006, ILO & WHO
2007, ILO 2011, Wagner 1996
X Example of the range of Respirable Silica OELs from various countries and organizations (Aug 2020)
Country/Organization Occupational Exposure Limit

American Conference of Governmental Industrial Hygienists (ACGIH) 1
0.025 mg/m3
Australia (SafeWork)2 0.05 mg/m3
Canada3* 0.025 mg/m3
European Commission Scientific Committee on Occupational Exposure Limits (SCOEL)4 0.05 mg/m3
South Africa 5
0.1 mg/m3
U.S. Non-regulatory (NIOSH)6 0.05 mg/m3
U.S. Regulatory (OSHA: General Industry/Maritime)7 0.05 mg/m3
U.S. Regulatory (MSHA: Mining)8 0.1 mg/m3
*Most, but not all, Canadian Jurisdictions follow ACGIH TLV OEL of 0.025 mg/m3
1- ACGIH TLVs and BEIs: Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices. 2012; Cincinnati, Ohio.
2-https://www.safeworkaustralia.gov.au/doc/workplace-exposure-standards-airborne-contaminants
3-https://laws.justice.gc.ca/eng/regulations/SOR-86-304/index.html; https://www.ccohs.ca/oshanswers/chemicals/chem_profiles/quartz_silica.html
4- SCOEL 2003. Recommendation from the Scientific Committee on Occupational Exposure Limits for Silica, Crystalline (respirable dust) SUM 94. http://ec.europa.eu/social/
BlobServlet?docId=3858&langId=en Accessed August 4, 2020.
5- South Africa Department of Labour (2004) National Programme for the Elimination of Silicosis. https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---
safework/documents/policy/wcms_118112.pdf Accessed August 4, 2020.
6- NIOSH (1974). Criteria for a recommended standard: occupational exposure to crystalline silica. Cincinnati, OH: U.S. Department of Health, Education, and Welfare, Public
Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, HEW Publication No. (NIOSH) 75-120, pp.54-55, 60-61.
7-https://www.federalregister.gov/documents/2016/03/25/2016-04800/occupational-exposure-to-respirable-crystalline-silica
8-30 CFR 70.101, 71.101, and 90.101 https://www.msha.gov/regulations/standards-regulations
A global review
Heavy metals protecting women from occupational exposure

of utmost importance.
X Heavy metals are metals with a high density
that in many cases are hazardous, such as ar- Exposure
senic, cadmium, lead, mercury and hexavalent
chromium. Arsenic is mostly used in industrial processes to
produce antifungal wood preservatives, which
X Occupational exposure to heavy metals and can lead to soil contamination, in particular chro-
their compounds occurs in a wide range of sec- mated copper arsenate (CCA). The production
tors such as construction, mining, electronics and use of CCA has been prohibited in the cer-
and the textiles industry. tain countries, however the presence of wood
treated with CCA is still ubiquitous (Chen and
X Arsenic, cadmium and hexavalent chromium
Olsen 2016). Arsenic is also used in the pharma-
are classified as carcinogenic to humans ceutical and glass industries, in the manufacture
whereas lead is classified as probably carcino- of alloys, sheep dips, leather preservatives, arse-
genic to humans, in addition to other health nic-containing pigments, antifouling paints and
impacts associated with exposure to heavy poison baits and, to a diminishing extent, in the
metals. WHO has identified arsenic, cadmium, production of agrochemicals (especially for use
lead and mercury as four of the top ten chemi- in orchards and vineyards). Arsenic compounds
cals of major public health concern. are also employed in smaller amounts in the mi-
X Occupational limits and restrictions of these croelectronics and optical industries. In 2019, the
substances are in place in several countries, world production of arsenic trioxide from mining
although there is still lack of international har- was 33,000 metric tons, with China (24,000 metric
monisation. tons) and Morocco (6,000 metric tons) being the
leading global producers, accounting for about
X Some heavy metals, such as lead and mercury, 90 per cent of estimated world production (USGS
can impact pregnancy outcomes and cause de- 2020). Inorganic arsenic is naturally present at
velopmental impacts in children, which makes high levels in the groundwater of a number of
Heavy metals
Globally
14-19 million workers
are employed as artisanal small-scale gold miners
25% and 33% of these miners
suffer from chronic metallic
mercury vapour intoxication
LMICs
carry the
largest burden of
exposure for
all heavy metals
countries, including Argentina, Bangladesh, Chile, are exposed to cadmium in their workplaces
China, India, Mexico, and the United States (WHO (CAREX-Canada 2020).
2019a). There is no global estimate of occupa-
Hexavalent chromium compounds are used
tional exposure to arsenic. NIOSH estimates that
widely in applications including: pigment for
70,000 workers, including approximately 16,000
textile dyes, paints, inks, and plastics; corrosion
female workers, were potentially exposed to ar-
inhibitors; wood preservatives; metal finishing
senic and arsenic compounds in the workplace
and chrome plating; and leather tanning. In 2019
from 1981 to 1983 (NIOSH 1990). The CAREX da-
the world production of chromium from mining
tabase estimates that 147,569 workers were ex-
was 44,000,000 metric tons and the leading
posed to arsenic and arsenic compounds in the
global producers were South Africa (17,000,000
EU between 1990– 1993 (EU-OSHA 2014). CAREX
Canada estimates that 25,000 Canadians are metric tons), Turkey (10,000,000 metric tons), and
currently exposed to arsenic in their workplaces Kazakhstan (6,700,000 metric tons) (USGS 2020).
(CAREX-Canada 2020). Exposure to chromium occurs in: production, use
and welding of chromium-containing metals and
The highest potential occupational exposures alloys; electroplating; production and use of chro-
to cadmium occur in production and refining of mium-containing compounds, such as pigments,
cadmium, nickel-cadmium battery manufacture, paints, catalysts, chromic acid, tanning agents,
cadmium pigment manufacture and formulation, and pesticides (IARC 2012). The CAREX database
cadmium alloy production, mechanical plating, estimates that between 1990-93, 785,692 workers
zinc smelting, brazing with silver-cadmium-silver were exposed to hexavalent chromium com-
alloy solder and polyvinylchloride compounding. pounds in the EU (EU-OSHA 2014). CAREX Canada
In 2019, the world production of cadmium from (2011) estimates that 83,000 Canadians are occu-
refineries was 25,000 metric tons and the leading pationally exposed to hexavalent chromium com-
global producers were China (8,200 metric tons),
pounds (CAREX-Canada 2020).
the Republic of Korea (5,000 metric tons), and
Japan (1,900 metric tons) (USGS 2020). The main Lead is used mainly in the production of lead-acid
anthropogenic sources of cadmium in the atmos- batteries, plumbing materials and alloys, as well
phere are smelting of non-ferrous metal ores, as in cable sheathing, paints, glazes and ammuni-
fossil fuel combustion, ferrous metal production (WHO 2017a). Lead is also still used in some
tion, municipal waste incineration and cement countries as a stabiliser in polyvinyl chloride (PVC)
production (WHO 2019b). There is no global esti- (ECHA 2016) and lead chromates as pigments in
mate of occupational exposure to cadmium. The yellow plastics (Stenmarck et al. 2017). In 2019,
CAREX database estimates that between 1990-93, the world production of lead from mining was
207,350 workers were exposed to cadmium and 4,500,000 metric tons and the leading global pro-
cadmium compounds in the EU (EU-OSHA 2014). ducer was China (2,100,000 metric tons) (USGS
CAREX Canada estimates that 35,000 Canadians 2020). The manufacture of these lead-containing
A global review
products can result in widespread occupational mercury and gold particles to form a paste which
exposure. Occupational exposure can also occur is applied to the idols. The mercury is then burned
during the application and removal of lead-con- off, leaving a gold coating and exposing the
taining paints; during the grinding, welding and workers to the mercury vapours (IPEN 2014).
cutting of materials coated with lead-containing
paints such as in shipbuilding, construction and
demolition industries; when recycling PVC and
Health effects
other plastics (Stenmarck et al. 2017); and in the
fabrication and carving of lead crystal glassware Cancer
(WHO 2019c). Mining, smelting, and formal and
IARC (2012) has classified arsenic, cadmium and
informal processing and recycling of electric and
hexavalent chromium as carcinogenic to humans
electronic waste can also be significant sources
(Group 1), noting that there is sufficient evidence
of exposure. Lead was used widely in the form of
to conclude that:
tetraethyl and tetramethyl lead as antiknock and
lubricating agents in petrol, emitting inorganic X Arsenic and inorganic arsenic compounds
lead particles from vehicles. This use has been cause cancer of the lung, skin, urinary bladder.
phased out in almost all countries, which has re- Also, positive associations have been observed
sulted in a significant reduction of human expo- between exposure to arsenic and inorganic ar-
sure and mean blood lead concentrations (UNEP senic compounds and cancer of the prostate,
2020b). The CAREX database estimates that be- kidney, liver and bile duct.
tween 1990-93, 1,500,000 workers were exposed
to lead and inorganic lead compounds in the EU X Cadmium and cadmium compounds cause
(EU-OSHA 2014). CAREX Canada estimates that cancer of the lung and positive associations
277,000 Canadians are presently occupationally have been observed between exposure to cad-
exposed to lead (CAREX-Canada 2020). mium and cadmium compounds and cancer of
the prostate and kidney.
Occupational exposure to mercury occurs in
mining, e.g. in mercury mining, gold mining X Hexavalent chromium compounds cause
where mercury is used in amalgamation, and cancer of the lung. Positive associations have
mining of other metals such as copper, zinc and been observed between exposure to hexava-
silver. In 2019, the world production of mercury lent chromium compounds and cancer of the
from mining was 4,000 metric tons and the
nasal cavity and paranasal sinus (IARC 2012).
leading global producer was China (3,500 metric
An increased risk of stomach cancer was also
tons) (USGS 2020). Approximately 15 million
observed in workers exposed to hexavalent
people participate in artisanal small-scale gold
chromium (Welling et al. 2015). However, ac-
mining (ASGM) in developing countries (Gibb and
cording to IARC there is limited evidence that
O’Leary 2014). Mercury is also used as a catalyst
hexavalent chromium compounds cause
in chlor-alkali production, vinyl chloride monomer
cancer of the stomach (IARC 2012).
production and other manufacturing processes,
posing a risk for occupational exposure. Mercury X Inorganic lead compounds have been clas-
occurs naturally in the earth´s crust, which leads to sified as probably carcinogenic for humans
coal and crude oil being contaminated by mercury (Group 2A) IARC (2006). This is supported by a
and potential for occupational exposure in coal- recent study that analysed data on two cohorts
fired power plants and the oil sector (IPEN 2014). of almost 30,000 lead-exposed workers with
Phenyl mercury acetate is sometimes added to past blood lead data (Finland: n=20,752, Great
pulp in the paper-making process as a fungicide Britain: n=9,122), which showed increased inci-
or slimicide, which can lead to occupational ex- dence trends for lung and brain cancer with in-
posure. In addition, mercury is a component of creasing blood lead level (Steenland et al. 2019).
dental amalgam and a source of occupational
exposure in dental care (Bjørklund et al. 2019).
Other health outcomes
Finally, mercury can be used in gold plating in a
process called “mercury gilding” or “fire gilding”, Long-term occupational exposure to high levels
practiced in the manufacturing of gilded crafts of inorganic arsenic often affect the skin, with
and religious idols. This involves mixing metallic hyperpigmentation as the most common dermal
Heavy metals
© Unsplash / Ivan Henao
effect (Baker et al. 2018), and hyperkeratosis in hexavalent chromium industries showed that
with bilateral thickening of the palms and soles exposure induced developmental toxicity of the
may also occur. Other effects of exposure to placenta (Banu et al. 2017).
high levels of inorganic arsenic include periph-
Chronic occupational exposures resulting in blood
eral neuropathy, gastrointestinal symptoms,
lead levels as low as 10 µg/dL in adults are asso-
conjunctivitis, diabetes, renal system effects, en-
ciated with impaired kidney function, high blood
larged liver, bone marrow depression, high blood
pressure, nervous system and neurobehavioral
pressure and cardiovascular disease (Baker et
effects, cognitive dysfunction later in life, and
al. 2018). Most cases of acute arsenic poisoning
subtle cognitive effects attributed to prenatal ex-
occur in occupational settings from accidental
posure (Banu et al. 2017). Occupational lead ex-
ingestion of insecticides or pesticides (Ratnaike
posure was recently shown to be associated with
2003). The clinical features initially invariably
increased risk of Amyotrophic Lateral Sclerosis
relate to the gastrointestinal system and include
(Meng et al. 2020). It is estimated that lead ex-
nausea, vomiting, abdominal pain, and diarrhoea
posure accounts for 1.06 million deaths and 24.4
(Ratnaike 2003).
million disability-adjusted life years (DALYs) due
The kidney is the main target of cadmium and to long-term effects on health (IHME 2020). In
cadmium accumulates primarily in the kidneys the United States, environmental exposures to
with a biological half-life in humans of 10–35 lead have been estimated to be responsible for
years (WHO 2019b). Osteomalacia (softening of 256,000 deaths a year from cardiovascular dis-
the bones) and osteoporosis may occur in those ease and 185,000 deaths a year from ischaemic
exposed through living or working in cadmi- heart disease (Lanphear et al. 2018).
um-contaminated areas. Long-term, high-level
Mercury and methylmercury are toxic to the
occupational exposure is associated with lung
central and peripheral nervous system. The in-
changes, primarily characterised by chronic ob-
halation of mercury vapour can produce harmful
structive pulmonary disease (WHO 2019b).
effects on the nervous, digestive and immune
Exposure to hexavalent chromium exposure can systems, lungs and kidneys, and may be fatal
induce asthma, irritation, kidney damage, liver (Bernhoft 2012). The inorganic salts of mercury
damage, pulmonary congestion and oedema. are corrosive to the skin, eyes and gastrointestinal
Some workers can also develop an allergic tract, and may induce kidney toxicity if ingested
skin reaction, called allergic contact dermatitis (Bernhoft 2012). One study showed that mercury
(OSHA 2006). A recent study in women working exposure in mining populations in Brazil lead to
A global review
autoimmune dysfunction and systemic inflam- The role of gender

mation (Gardner et al. 2010). A recent systematic
review reported a significant association be- Both genders are subject to occupational ex-
tween mercury and hypertension (Hu et al. 2018). posure to heavy metals, but gender related
Globally, 14-19 million workers are employed as variances in work tasks have an impact on the
artisanal small-scale gold miners and between 25 exposure sources and levels. Occupational expo-
per cent and 33 per cent of these miners (3.3-6.5 sure to lead from paint comes from work in paint
million miners globally) suffer from chronic me- factories, construction and demolition, painters
tallic mercury vapour intoxication. The resulting and in automotive repair shops. These are all
global burden of disease is estimated to range generally male-dominated occupations, especially
from 1.22 to 2.39 million DALYs (Steckling et al. in very traditional societies. In contrast, women
2017). are more likely to be exposed to lead from paint
through lead contaminated dust generated by de-
teriorating decorative lead paint. This is typically
Regional trends found at homes, pre- and primary schools and
other indoor environments common for typically
LMICs carry the largest burden of exposure for
female dominated occupations. Mercury is used
all heavy metals. Arsenic occupational expo-
extensively in ASGM which includes an estimated
sure is often higher in LMICs and its effects are
10 to 15 million miners, including 4 to 5 million
of particular concern where inorganic arsenic is
women and children (UNEP, 2019a). Women are
already naturally present at high levels like India
often involved in the amalgamation process,
and Bangladesh (Rahman et al. 2018). Cadmium
often in home environments with children nearby
exposure is commonly higher in cottage indus-
(Ismawati 2014).
tries in LMICs (Sethi and Khandelwal 2006) as well
as exposure to hexavalent chromium in tannery All the five heavy metals described in this chapter
workers, where protection measures are often can impact the reproductive system. In addition,
inadequate (Were et al. 2014). Also, many formal some of the metals accumulate in the human
and informal occupational activities are associ- body and many heavy metals are deposited in the
ated with lead exposure in LMICs, including bat- bones (Chang et al. 2018). This also includes lead.
tery manufacture, demolition work, welding, and When blood levels decrease through lowered
small businesses repairing automobile radiators exposure, lead in the bones can still be released,
(Kordas et al. 2018). ASGM largely occurs in LMICs, which keeps the blood concentration elevated.
accounting for the great majority of the burden of Both lead and mercury are transferred to the
occupational exposure to mercury (UNEP 2019a). fetus in pregnancy and the child during breast-
feeding, causing developmental harm to brain
and nervous systems.
X Case study: Mercury exposures in ASGM

There are more than 850 ASGM hotspots identified in 27 provinces of Indonesia, most
of which use mercury to extract gold (Yuyun Ismawati 2014). These provide liveli-
hood to more than 1 million people. In 2015, a study was conducted in a small village
(Pangkal Jaya) where all inhabitants either worked in the gold mining industry or were
engaged in some way. Ore processing took place close to homes within residential
areas. Samples were taken to assess mercury vapour in the air as well as within rice
collected in the area. The average concentration of mercury vapour in the air was
4.154 nanogram/m3, notably higher than recommended levels. The average mercury
content in the rice samples was 143 ppb, almost three times higher than the safe level
recommended by the government of Indonesia. Several community members and
children showed severe symptoms of mercury poisoning such as mental retardation,
cerebral palsy, muscular dystrophy and seizures.
Heavy metals
X Case study: Mercury exposures and symptoms in smelting workers of artisanal mercury
mines in China
Mercury exposures to smelting workers of artisanal mercury mines in Wuchuan,
China were evaluated by urine and hair mercury levels. The mean urinary mercury
(U-Hg), hair total mercury (T-Hg), and hair methyl mercury (Me-Hg) for smelting
workers was 1060 µg/g creatinine (µg/g Cr), 69.3 and 2.32 µg/g, respectively. The
results were significantly higher than that of control group, which is 1.30 µg/g Cr,
0.78 and 0.65 µg/g, correspondingly. The average urinary beta2-microglobulin (be-
ta2-MG) was 248 µg/g Cr for the exposed group, compared to 73.5 µg/g Cr for the
control group. The results showed a serious adverse effect on the renal system for
the smelting workers. The workers were exposed to mercury vapour through in-
halation and the exposure route of Me-Hg may be through intake of polluted diet.
Clinical symptoms including finger and eyelid tremor, gingivitis, and typical dark-line
on gums were observed in six workers. This study revealed that smelting workers
in Wuchuan had higher levels of mercury in their urine and hair, and also exhibited
higher levels of preliminary health impacts, evidenced by increased beta2-MG and
clinical symptoms (P. Li et al. 2008).

SUBSTANCE
Overview Various >25,000,000 Limited data

Mining
Lead Cancer (stomach) >1,800,000 (EU-OSHA 2014; Limited data (>900,000
Construction CAREX-Canada 2020) due to environmental
Neurotoxicity
lead exposure (GBD
Agriculture,
Cardiovascular 2019))
plantations, other
rural sectors Disease
Manufacturing Mercury Neurotoxicity >19,000,000 (Limited data Limited Data

for artisanal small-scale gold
Nephrotoxicity (>2,000,000 DALYs
Basic metal mining only) (Steckling et al.
production attributable to chronic
Immune Toxicity 2017)
metallic mercury vapour
Shipping, ports,
Reproductive toxicity intoxication) (Steckling
fisheries, inland
et al. 2017)
waterways
Utilities (water, Arsenic Cancer (lung, skin, >3,000,000 (GBD 2019) Limited data
gas, electricity) urinary and bladder)
Textiles, clothing,
Skin toxicity
leather, footwear
Mechanical Neurotoxicity
and electrical
Nephrotoxicity
engineering
sector
Cadmium Cancer (lung) >500,000 (GBD 2019) Limited data
Nephrotoxicity
Bone toxicity
Hexavalent Cancer (lung) >1,000,000 (GBD 2019) Limited data

Chromium
Nephrotoxicity
Lung toxicity
Skin toxicity
Liver toxicity
A global review
X Selected Priority Actions: Mercury

Refer to, ratify and implement the following conventions, as appropriate:
X ILO Safety and Health in Mines Convention, 1995 (No. 176). The main provision in Convention No.176 ad-
dressing chemicals is Art. 9, which mandates that employers must inform workers of existing chemical hazards
and all relevant preventative and protective measures for these hazards; take appropriate measures to eliminate
or minimise those hazards; provide free protective equipment in the event that safety cannot otherwise be en-
sured; and ensure provision of first aid, transportation and appropriate access to medical facilities for workers
suffering from injury or illness due to chemical hazards.
X ILO Employment Injury Benefits Convention, 1964 (No. 121). Workers should have access to a remedy to the
exposure to mercury (schedule I).
X ILO List of Occupational Diseases (revised 2010) in the annex of ILO Recommendation No. 194. The List
of Occupational Diseases and the Recording and Notification of Occupational Accidents and Diseases [List of
Occupational Diseases Recommendation, 2002], includes diseases caused by mercury or its compounds (para.
1.1.7).
X Minamata Convention. A global UN treaty with 128 signatories adopted to protect health and the environment
from releases of mercury and mercury compounds. The Convention obliges governments to take a range of
actions, including to address mercury emissions to air and to phase-out certain mercury-containing products.
Reducing mercury exposure from ASGM is one of the Minamata Convention’s most important aims.
X Eliminate the use of mercury in gold mining, especially in the ASGM sector where workers are especially highly
exposed. Prohibit the processing of mercury/gold amalgam in residential areas.
X Phase out of intentional mercury use in other sectors should also be implemented to prevent occupational
exposure.
X Stop the generation and extraction of new mercury as well as trade of mercury.
X Update, implement and enforce OELs for mercury and ensure global harmonisation of these OELs. Strict occu-
pational exposure limits for mercury in all sectors, including sectors where mercury is present as a contaminant,
should be adopted and implemented.
X Use mercury exposure reduction methods to more effectively concentrate gold (so as to reduce the quantity of
mercury used in the amalgamation process).
X Avoid open air burning of amalgam.
X Operate mercury capture devices such as retorts or fume hoods to capture mercury vapour emitted when the
mercury/gold amalgam is burned.
X Utilise mercury-free processes in ASGM, for example, gravity-only concentration methods, such as panning,
sluicing, centrifuges, spiral concentrators, vortex concentrators and shaking tables. Other concentration
methods include magnets and flotation.
X Provide effective PPE for all occupations using mercury. This should be designed to effectively protect people
of all body types, including physiological differences between genders.
Sources include: UNEP 2012 and 2019a, WHO 2016c, ILO 2017
X ILO Convention No. 176 and the Minamata Convention

A highlight of Convention No. 176 (C176) is its synergies with the Minamata Convention on Mercury. Use of
mercury in mining, especially in gold mining, continues to constitute a major health and environmental hazard.
While C176 does not mention mercury directly, the open provisions on chemicals in Art. 9 cover this substance
and therefore mandate the elimination or at least minimization of hazards relating to mercury as well as other
hazardous chemicals used in gold mining. Mercury in mining is also addressed by the Minamata Convention,
which contains provisions on the dangers relating to ASGM. C176 and the Minamata Convention therefore com-
plement each other, as C176 closes the gaps when it comes to chemical exposures, for example regarding other
hazardous chemicals used in mines such as cyanide and solvents.
Heavy metals
X Selected Priority Actions: Lead

X Refer to policy actions and examples set forth by the Global Alliance to Eliminate Lead Paint. Lead Paint is iden-
tified as an Emerging Issue of Concern under SAICM with the target of global elimination. To support this goal,
the Global Alliance was formed in 2009, which also aims to prevent workers’ exposure.
X Ratify and implement the ILO Safety and Health in Construction Convention, 1988 (No. 167). Provisions pro-
vided for protecting the health of workers from chemical hazards through the implementation of appropriate
preventive measures in the construction sector. Whilst lead exposure may occur in a number of sectors, there is
a need to focus on the construction industry, where lead exposure frequently occurs during tasks that generate
fumes and respirable dust containing lead, or when painting with leaded paint.
X Promote the phase out of lead from remaining sources of exposure, such as lead paint
X Strictly control lead exposure in industries such as the production and recycling of lead acid batteries
X Establish legal requirements for training and PPE for workers conducting lead paint abatement on legacy paint.
X Adopt, implement and enforce strict OELs for lead acid battery recycling
X Promote the phase out of lead from remaining sources of exposure, such as lead paint and other industrial
products.
X Strictly control lead exposure in industries such as the production and recycling of lead acid batteries.
X Integrate lead into national OSH programme considerations, specifically when it comes to requirements for
training and PPE for workers conducting lead paint abatement on legacy paint.
X Update, implement and enforce OELs for lead and ensure global harmonisation of these OEL. OELs specifically
for lead acid battery recycling are especially needed.
X Established OELs include:
- EU Directive 98/24/EC: 0.15 mg/m3 per 8 hour TWA and 70 μg lead/100 ml blood. Apply these for all workers
and indicate when suspension from lead work is required.
- Lower limits may be recommended and used at a national level, with still lower limits for young persons and
women. For example, the ACGIH recommends a limit of 30 μg/100 ml, which is the same limit used for women
of reproductive age in the UK.
X Eliminate the use of lead where possible.
X Substitute lead for a less hazardous material, for example apply non-leaded paint rather than a coating con-
taining lead.
X Use engineering controls, such as totally enclosed process and handling systems, processes which keep pro-
duction of dust, fumes and vapours to a minimum and ventilation systems.
X Utilise administrative controls, such as reducing worker hours and durations of exposure.
X Employ other safe work practices, such as regular cleaning of surfaces, safe storage of lead and lead waste,
prohibition of eating, drinking and smoking in contaminated areas and hygiene measures, for example, washing
contaminated clothing.
X Provide effective PPE designed to effectively protect people of all body types. For example, impermeable pro-
tective clothing is essential for work with lead alkyls if there is the risk of skin contact.
Sources include: WHO 2017 and 2019c, OSHA n.d., HSE 2002
X The Global Alliance to Eliminate Lead Paint

The Global Alliance to Eliminate Lead Paint (Lead Paint Alliance) is a voluntary partnership formed by the United
Nations Environment Programme (UNEP) and the World Health Organization (WHO) to prevent exposure to lead
through promoting the phase-out of paints containing lead. The ILO has joined the Alliance and leverages its
unique tripartite structure to promote social dialogue towards the phase out of the manufacture and sale of lead
paint. More information on tools to promote the phase out of lead in paint can be found here.
A global review
Spotlight on e-waste:
Hazardous substances
within the life cycle of
high tech electrical and
electronic products
© industriall-union.org
X The lifecycle of electronic products includes ex-

traction, production, transport, use, recycling
and waste management, all of which can lead
to exposure to various chemicals. More than
X More than 60 chemical elements can be found 60 chemical elements
in electronics, including aluminum, gallium,
arsenic, lead, cadmium, chromium, mercury,
can be found in
copper, manganese, nickel, iron, and zinc, electronics
many of which are potentially, or known to be,
hazardous. Additional chemicals may also be
present, such as brominated flame retardants
and polychlorinated biphenyls (PCBs).
X Health risks may result both in workers as well The majority of the
workforce in the
as in the community from direct contact with
heavy metals, from inhalation of toxic fumes
and particulate matter, hand to mouth transfer,
electronics industry
are young women
as well as from accumulation of chemicals in
soil, water and food.
X Exposure to the various chemicals, compounds

and biproducts present in e-waste have been
and case studies have
identified as carcinogenic to humans (group 1) shown increased rates of
by IARC. Other health effects include neurotox- leukaemia and adverse
icity and impacts to the reproductive system. pregnancy outcomes
X The majority of the workforce in the electronics as a consequence of
industry are young women and case studies occupational exposure.
have shown increased rates of leukaemia
and adverse pregnancy outcomes as a conse-
quence of occupational exposure.
Heavy metals
X Figure 4. Chemical classification of e-waste components and sources and routes of exposure
Component of electrical and Ecological source Route of exposure

electronic equipment of exposure
Persistent organic pollutants
Brominated flame retardants Fire retardants for electronic equipment Air, dust, food, water, and soil Ingestion, inhalation, and
Polybrominated diphenyl ethers transplacental
Polychlorinated biphenyls Dielectric fluids, lubricants and coolants in Air, dust, soil, and food Ingestion, inhalation
generators, capacitors and transformers, (bioaccumulative in fish and or dermal contact, and
fluorescent lighting, ceiling fans, dishwashers, seafood) transplacental
and electric motors
Dioxins
Polychlorinated dibenzodioxins and Released as combustion byproduct Air, dust, soil, food, water, and Ingestion, inhalation,
dibenzofurans vapour dermal contact, and
transplacental
Dioxin-like polychlorinated biphenyls Released as a combustion byproduct but Released as combustion Ingestion, inhalation, and
also found in dielectric fluids, lubricants byproduct, air, dust, soil, and dermal absorption
and coolants in generators, capacitors and food (bioaccumulative in fish and
transformers, fluorescent lighting, ceiling seafood)
fans, dishwashers, and electric motors
Perfluroalkyls Fluoropolymers in electronics Water, food, soil, dust, and air Ingestion, dermal
contact, inhalation, and
transplacental
Polyaromatic hydrocarbons
Acenaphthene, acenaphthylene, Released as combustion byproduct Released as combustion Ingestion, inhalation, and
anthracene, benz[a]anthracene, byproduct, air, dust, soil, and food dermal contact
benzo[a]pyrene, benzo[e]pyrene,
benzo[b]fluoranthene, benzo[g,h,i]
perylene, benzo[j]fluoranthene,
benzo[k]fluoranthene, chrysene,
dibenz[a,h]anthracene, fluoranthene,
fluorene, indeno[1,2,3-c,d]pyrene,
phenanthrene, and pyrene
Elements
Lead Printed circuit boards, cathode ray tubes, light Air, dust, water, and soil Inhalation, ingestion, and
bulbs, televisions (1·5–2·0 kg per monitor), dermal contact
and batteries
Chromium or hexavalent chromium Anticorrosion coatings, data tapes, and floppy Air, dust, water, and soil Inhalation and ingestion
disks
Cadmium Switches, springs, connectors, printed circuit Air, dust, soil, water, and food Ingestion and inhalation
boards, batteries, infrared detectors, semi- (especially rice and vegetables)
conductor chips, ink or toner photocopying
machines, cathode ray tubes, and mobile
phones
Mercury Thermostats, sensors, monitors, cells, printed Air, vapour, water, soil, and food Inhalation, ingestion, and
circuit boards, and cold cathode fluorescent (bioaccumulative in fish) dermal contact
lamps (1–2 g per device)
Zinc Cathode ray tubes, and metal coatings Air, water, and soil Ingestion and inhalation
Nickel Batteries Air, soil, water, and food (plants) Inhalation, ingestion,
dermal contact, and
transplacental
Lithium Batteries Air, soil, water, and food (plants) Inhalation, ingestion, and
dermal contact
Barium Cathode ray tubes, and fluorescent lamps Air, water, soil, and food Ingestion, inhalation and
dermal contact
Beryllium Power supply boxes, computers, x-ray Air, food, and water Inhalation, ingestion, and
machines, ceramic components of electronics transplacental
Source: (Grant et al. 2013).

A global review
in one large electronics manufacturer between

 DEFINITION: Electronic and electrical waste 1969 and 2001 found that overall proportional
(e-waste) is defined as any end-of-life “equip- mortality ratios were elevated in male and female
ment which is dependent on electrical currents or workers. Proportional cancer mortality ratios for
electromagnetic fields in order to work properly” brain, kidney, and pancreatic cancers were sig-
(UNEP 2007; ILO 2019a, 2019c, 2019d), including: nificantly higher in male workers, while female
small and large household appliances; information
workers experienced significantly elevated num-
technology and telecommunications equipment;
bers of deaths from kidney cancer, lymphoma,
lighting equipment; electrical and electronic tools,
and leukaemia (Clapp 2006). In the semiconductor
toys, and leisure and sports equipment; medical
devices; monitoring and control instruments; and industry, a number of reports of leukaemia and
automatic dispensers, components and parts of non-Hodgkin lymphoma (NHL), cancers known to
electrical and electronic equipment (batteries, have a similar pathophysiology, have generated
circuit boards, plastic casings, cathode-ray tubes, public concern. One study from the Republic of
activated glass, lead capacitors, etc.). Korea assessed leukaemia and NHL cases from a
semiconductor plant, finding that 17 workers suf-
fered from the illnesses, with 11 of them young
Exposure women. The relatively young age (mean = 28.5
years) at the time of diagnosis raises particular
Production and use of electronics is rapidly
concerns for the severity of the problem and re-
expanding. As a consequence, the amount of
quires further research into the exposure-out-
e-waste is expected to increase to 52.2 million
come causal relationship (Kim et al. 2012).
metric tonnes by 2021 and grow up to 111 million
tonnes by 2050 (Parajuly et al. 2019). High-volume Several compounds and biproducts present in
informal recycling of e-waste has been reported e-waste have been identified as carcinogenic to
in many countries, including China, Ghana, India, humans (group 1) by IARC, including PCBs, TCDD
Nigeria, the Philippines, Thailand, and Vietnam (2,3,7,8-tetrachlorodibenzo-p-dioxin), cadmium,
(Orisakwe et al. 2019). One case study in Nigeria nickel, hexavalent chromium, and beryllium
showed that in 2015/2016, EU member states were (Grant et al. 2013). A number of studies identified
the origin of around 77 per cent of Used Electric increased cancer risks in adults (lung cancer) and
and Electronic Equipment (UEEE) imported into children (lymphoma) working in e-waste disman-
Nigeria. Since LMICs generally have less e-waste tling and burn sites (Wang et al. 2012; Huang et
management infrastructure than higher income al. 2016; Zheng et al. 2015; Davis and Garb 2019).
economies, there are alarming exposure trends Workers in e-waste sites are often exposed to
that require urgent attention (Baldé et al. 2017). It very complex mixtures that vary over time, which
has been estimated that solid waste management makes the exact dose–response relations of the
and recycling provide employment for 19 to 24 carcinogenic effects of chemical mixtures in
million women and men worldwide, of which four e-waste sites difficult to assess (Grant et al. 2013).
million work in the formal waste and recycling Informal working conditions, lack of adequate
sector (ILO 2013). However, the lack of data and personal protective equipment and the frequent
issues of defining used electrical and electronic turnover of workers in e-waste sites further com-
equipment have rendered it impossible to provide plicate accurate risk assessments for long term
a global figure for employment in the e-waste carcinogenic effects that often occur decades
subsector (ILO 2019a). It has been estimated that after the exposures.
informal and formal e-waste workers are over
690,000 in China (Wang et al. 2013), 500,000 in Other health outcomes
India (Joon 2017), 100,0000 in Nigeria (Ogungbuyi
et al. 2012), 34,000 in Argentina (ILO 2020a). In the Republic of Korea, an analysis of epide-
miological data found evidence suggesting re-
productive risks to women from semiconductor
Health effects fabrication jobs including spontaneous abortion,
congenital malformation, and reduced fertility
Cancer (Kim 2014). A subsequent examination of repro-
ductive risks among female microelectronics
There is mounting evidence of an association be- workers aged 20 – 39 years old found a signifi-
tween occupational exposure to hazardous sub- cantly higher risk for spontaneous abortion and
stances during manufacture of electronics and menstrual aberration (Kim 2015).
cancer. An investigation of 32,000 worker deaths
Heavy metals
X Figure 5. Collection methods of e-waste
20% (8.9 Mt)

of e-waste is documented to be
collected and properly recycled
80% (35.8 Mt)

of e-waste in not documented
4% (1.7 Mt) of e-waste in

44,7 Mt higher income countries is
of e-waste thrown into the residual waste
generated
in 2016 The fate of 76% (34.1 Mt) of the
e-waste is unknown; this is
likely dumped, traded, or
recycled under inferior
conditions
Source: Baldé et al. 2017
In addition to its hazardous components, the Although e-waste is not generated exclusively by
processing or dismantling of electronic products wealthy countries, such countries contribute sub-
can also give rise to additional toxic by-products stantially to e-waste problems in LMICs because of
likely to affect human health, and not assessed regulatory ambiguities that allow e-waste export
in original product manufacture (Heacock et al. for re-use, regardless of actual product function-
2016). A systematic review showed that several ality (Heacock et al. 2016). The decommissioning
known neurotoxicants are found in e-waste, such of solar photovoltaic panels, a specific form of
as lead, mercury, cadmium, and brominated e-waste, also presents a considerable challenge.
flame retardants. Exposure to these substances With an average life of 30 years, many solar pho-
can lead to irreversible cognitive deficits in adults tovoltaic panels in the United States, Japan and
and children and behavioral and motor skill dys- Europe will soon reach the end of useful life and
function across their lifespan (Grant et al. 2013). will need to be recycled appropriately (Invernizzi
In particular, workers may directly encounter at al. 2020).
hazardous substances in fumes or dust through
One of the largest e-waste sites in the world is
inhalation, skin contact, or oral intake via dis-
Agbogbloshie, an area in Ghana’s capital city Accra
mantling activities they perform themselves or
that is also home to up to 80,000 people (Oteng-
that are performed by others nearby (Grant et al.
Ababio and Grant 2019). The people working in
2013). Alarmingly, children and adolescents are
this area have typically no mechanisms in place
commonly employed in e-waste recycling, posing
to protect against exposure to the hazardous
a significant risk to neurodevelopment (Heacock
chemicals in the e-waste they are handling, or
et al. 2016). A cohort of children and adolescents
protection against dust and the smoke at the site
exposed to lead through burning cable activities
that is contaminated with hazardous substances.
were assessed in Uruguay and showed an av-
Numerous studies have provided evidence of
erage blood level of 9.19 μg/dL, almost double
occupational exposure to chemicals and their
when compared to the level of concern (5 μg/dL)
health impacts at this site. Specifically, exposures
(Pascale et al. 2016).
to persistent organic pollutants such as PCBs
and dioxins, toxic metals and arsenic have been
Regional trends documented, as well as health impacts including
cancer, lung diseases, and cardiovascular disease.
In 2016, Asia was the region that generated by far Due to the extent of chemical contamination at
the largest amount of e-waste (18.2 million tonnes the site, Agbogbloshie has been named one of
- Mt), followed by Europe (12.3 Mt), the Americas the world’s ten worst toxic threats (Blacksmith
(11.3 Mt), Africa (2.2 Mt), and Oceania (0.7 Mt). Institute 2013).
A global review
X Case study: Contamination levels in the breast milk of Ghanaian women from an e-waste
recycling site
A recent study assessed the levels of polycyclic aromatic hydrocarbons (PAHs) in breast milk
samples from 128 Ghanaian women. PAHs have carcinogenic and mutagenic properties and
therefore have the potential to adversely impact the health on infants. These chemicals can be
produced unintentionally as a result of pyrolysis or incomplete combustion, for example when
burning plastic casings of e-waste. Samples were collected from a group of working women
from Agbogbloshie and one control group from non-working women living in a nearby resi-
dential area. Alarmingly, a total of 18 PAHs were detected in the samples from women in both
groups. The most carcinogenic of all the PAHs, benzo[a]pyrene (Kato et al. 2011), was detected
in 92 per cent of the milk samples from the working women in Agbogbloshie, but were below
the limit of detection in all the samples from women in the residential area. Overall, the mean
concentration levels of 13 of the 18 PAHs in the breast milk samples from working women in the
Agbogbloshie e-waste site were higher than the respective mean concentrations from residen-
tial non-working women (Asamoah et al. 2019).
The role of gender women and children conduct the manual pro-
cessing and therefore are more exposed to the
As described in the evidence above, many women hazardous chemicals (UNEP 2020c). A system-
work along the life cycle of the electronics sector
atic review showed that pregnancy outcomes
and suffer from adverse health effects as a result.
were negatively affected in workers exposed
In many cases these are young women. For ex-
to e-waste, including increases in spontaneous
ample, the electronics industry in Vietnam em-
abortions, stillbirths, premature births and re-
ployed 634,440 people in 2016, where around 70
duced birth weights (Grant et al. 2013).
per cent of the workforce was female. Over 85 per
cent of those workers were under the age of 35 Nevertheless, it is important to note that evidence
(UNIDO 2019). from this sector have shown that exposure and
In many countries, women and children play dom- resulting health impacts occur in both women
inant occupational roles in e-waste, increasing and men due to the wide variety of hazardous
their risk for potential exposures from chemicals chemicals used. As many of these chemicals may
released from the burning and disassembling affect the reproductive system, it is important to
of various electronic products. In some coun- conduct additional epidemiological studies to un-
tries, the work tasks included are segregated derstand the gender dimensions of OSH in this
by gender, where the men collect the waste and continually expanding sector.
X Spotlight on e-waste priority actions

Priority measures to prevent hazardous occupational exposure to e-waste includes restrictions and phasing out
the use of these substances, in addition to adopting and implementing strict OELs. However, the informal nature
of many of these workplaces makes implementation of regulations a challenge. Actions to reduce occupational
exposure and protect worker health must be locally tailored and take into consideration the large differences in
the scale of e-waste sites, which range from vast facilities to tiny family operations. Additional actions that can
be taken include:
X Share good practices from already existing regulations, such as the EU Directive on Restriction of Hazardous
Substances.
X Address the early life-cycle stages of e-waste, e.g., by taking proactive approaches such as adopting appli-
cable fiscal policies and design guidelines to foster development of electronics made with minimal use of
hazardous substances and by green manufacturing processes (UNEP 2020a).
X Properly address the situation of informal workers who handle e-waste through comprehensive OSH training
that focuses on hazard reduction and best practices, including the provision of PPE as a last resort option.
X Reduce dependence on open burning techniques by the provision and use of electric-powered, automated
wire-stripping machines (Caravanos 2015).
X Implement extended producer responsibility measures to ensure safe handling for e-waste. Bulk purchaser
and retailers should include requirement of safe production in their procurement, including listing prohibited
substances in the manufacturing process and proof of protection from occupational exposure (Caravanos 2015).
Solvents
Solvents workers are exposed to them globally and se-

rious health impacts have been identified by
X Solvents are hazardous substances used in
robust scientific evidence.
large quantities globally and in a wide range of
occupations. They are found in many products, Exposure
including cleaning materials, paints, adhesives,
inks and toiletries. Common examples are iso- The term ‘solvent’ is generic and may include hun-
propanol, benzene, toluene, xylene and solvent dreds of different chemical compounds. Solvents
mixtures, such as white spirits. are used to dissolve or dilute other substances
and are found in cleaning agents, fossil fuels,
X High solvent exposure occupations include paints, adhesives and varnishes and are used in
painters, lacquerers, printers, dry cleaners, the production of dyes, plastics, textiles, printing
footwear manufacturers, occupations in inks, agricultural products and pharmaceuticals.
graphics and plastic product works. Solvents are volatile agents and occupational ex-
X Inhalation of solvent vapours is the most posure generally occurs by inhalation of vapours.
common method of occupational exposure, Dermal exposure is also prevalent in some indus-
although dermal contact may be high in industries, such as painting and industrial degreasing
tries such as painting. (Dick 2006). Certain tasks, such as spraying, can
produce very high exposure levels.
X Acute, high-level exposures can lead to de-
Blood absorption occurs quickly after exposure,
lirium, respiratory depression and death.
with blood levels dependent on environmental
Chronic, low-level exposures are solvent spe-
cific and have been associated with cancer, factors, such as solvent concentration in the air,
reproductive concerns and neurotoxic effects. room ventilation and duration of exposure (Hurley
and Taber 2015). Solvents may also be retained in
X Solvents should be considered an occupational organs with high lipid content, such as the brain,
health and safety priority, as large numbers of with potentially adverse health impacts.
A global review

Aside from cancer, the principal health effects
most typically associated with organic solvent ex-
posure include nervous system damage, kidney
and liver damage, skin lesions and adverse re-
productive effects, such as sperm changes and
infertility. Virtually all solvents can cause adverse
Increased risks of effects to reproductive health. Specifically, they
gastrointestinal have been associated with cleft palates, miscar-
cancers
riage, newborn infection and childhood cancer
(Rim 2017). Acute health impacts include skin, eye
have been suggested following and lung irritation, headache, nausea, dizziness
and light-headedness (ILO 2004). Very high levels
exposure to toluene
can lead to unconsciousness, seizures and even
death, for example in unventilated spaces (Dick
and occupation as a painter has 2006).
consistently been associated with a Chronic exposure in the work environment can
40% increased risk of produce a range of adverse neurotoxic effects,

including headache, fatigue, memory and con-
lung cancer centration impairment, irritability, depression and

personality changes (White and Proctor 1997). A
meta-analysis of 46 cross-sectional studies
showed that occupational solvent exposure was
associated with deficits in cognitive function,
Health effects particularly for attention and procedural speed
(Meyer-Baron et al. 2008). There is strong evi-
Whilst acute health impacts are fairly consistent
dence that some solvents may cause peripheral
across solvent type, the effects of chronic solvent
neuropathy, which causes altered sensation, loss
exposure are usually solvent-specific and should
of vibration perception and impaired propriocep-
therefore be considered on an individual basis.
tion. The solvent n-hexane has been associated
This is a complex area of research due to the in-
with outbreaks of peripheral neuropathy in fur-
trinsic differences between solvent types, indi-
niture manufacturers, printers and shoemakers
vidual susceptibility and the impact of variables,
and methyl n-butyl ketone with an outbreak in an
such as dose and duration of chemical exposure.
Ohio textile printing plant (Dick 2006).
Cancer Chronic solvent induced encephalopathy (CSE)

can occur after long-term exposure to solvents,
IARC has classified benzene and trichloroethylene for example, in chronically exposed workers. This
(TCE) as carcinogenic to humans (group 1), and syndrome is characterised by symptoms of fatigue,
some solvents, for example, methylene chloride irritability and forgetfulness, as well as neurobe-
and tetrachloroethylene, as probably carcino- havioural deficits, such as decreased motor per-
genic (group 2A). Benzene has been specifically formance and information processing (Van Valen
linked with leukaemia (WHO 2019e) and chlorin- et al. 2012). A recent study of a cohort of CSE pa-
ated hydrocarbons to renal cancer (Brüning et al. tients found that 37 per cent were on permanent
2003). Increased risks of various gastrointestinal work disability pensions (Van Valen et al. 2018).
cancers have been suggested following expo- When taking into account the potential number of
sure to toluene, and occupation as a painter has workers impacted by CSE globally, the public health
consistently been associated with a 40 per cent implications may therefore be considerable.
increased risk of lung cancer. There is evidence for
increased risks of liver cancer and non-Hodgkin’s
lymphoma following trichloroethylene exposure,
Virtually
oesophagus and cervical cancer for tetrachlo- all solvents can cause
roethylene exposure and lymphohematopoi-
etic malignancies after carbon tetrachloride. An
adverse effects to
excess risk of liver and biliary tract cancers was reproductive
suggested in the cohort with the high exposure to health
methylene chloride (Lynge et al. 1997).
Solvents
Regional trends
Benzene
Solvent exposure is one of the most common
Exposure to benzene continues to be a major
chemical exposures in the workplace, following
occupational health concern. The presence of
benzene in petrol and as a common industrial gases and dusts (Benke et al. 2017). As aware-
solvent can result in significant occupational ness of the dangers of solvent exposure have
exposure and a range of acute and long-term become more evident, legislation and advances
health effects. Although benzene concentration in technology have resulted in decreased use of
in petroleum is now limited in many regions and the more hazardous solvents in Europe and the
solvent use is also restricted, exposure to benzene US. For example, the 1987 Montreal Protocol led
remains high in some industries, including shoe- to the restriction or phase out of many ozone-de-
making, painting, printing and rubber manufac- pleting solvents and water-based paints have
turing (Loomis et al. 2017). Acute effects include
replaced traditional, solvent-based coatings
headache, dizziness, confusion, tremors and eye,
(Dick 2006). In some industries, for example dry
skin and respiratory irritation. Chronic exposure
cleaning, improvements to equipment and pro-
can lead to cancers such as leukaemia, aplastic
anaemia, DNA damage and immunosuppressive cesses have lessened solvent use. In LMICs how-
effects (WHO 2019e). ever, standardised regulations are minimal and
solvent use is most likely inadequately controlled.
X Case study: The association between occupational solvent exposure and cognitive
performance
The French CONSTANCES study evaluated the association between occupational solvent exposure and cognitive
performance in a cohort of over 40,000 participants, aged 45-69 years old. Cognitive function, episodic verbal
memory, language ability and executive function were evaluated using a standardised battery of cognitive
tests. Results showed that men occupationally exposed to gasoline, white spirits or cellulosic thinner were at
greater risk of cognitive impairment, whilst women exposed to white spirits or exposed for more than 20 years
had poorer cognitive performance, with an exposure-effect relationship found for the number of solvents used
and cumulative exposure time. Specifically, cognitive performance decreased with the number of solvents to
which individuals were occupationally exposed and with the cumulative exposure time (Letellier et al 2020).

Cancer Limited data Limited data

Food; drink; tobacco
Neurotoxic effects
Mechanical and including ‘chronic
electrical engineering solvent-induced
encephalopathy’
Construction
(CSE)
Chemical industries Reproductive toxicity
Printing
Plastics
Rubber
Textiles; clothing;
leather; footwear
Manufacturing
Dry cleaning
A global review
X Selected priority actions: Solvents

X Develop national laws or regulations that prescribe the measures to be taken for the prevention and control of,
and protection against, occupational hazards due to solvents.
X Phase out the use of toxic solvents in certain work processes where alternative practices exist and replace sol-
vents with less harmful substitute products when available. For most of the hazardous solvents it is possible to
find a substitute with the same characteristics, but less drastic effects on health.
X Refer to other national examples, such as the EU, who has banned or restricted a number of hazardous solvents,
such as dichloromethane-based paint strippers and N-Methyl-2-pyrrolidone, a solvent widely used in coatings
and cleaning agents.
X Develop targeted research programs to identify and prioritize preventative actions in order to reduce worker
exposure to solvents.
X Update, implement and enforce OELs for various forms of solvents and ensure global harmonisation of these
OELs.
X Refer to individual OELs that have been assigned by selected countries and agencies, such as the EU and the
ACGIH.
X Eliminate and substitute the use of hazardous solvents at the workplace level where possible.
X Open doors and windows to increase ventilation, however mechanical ventilation may be necessary in some
places. Encapsulation systems can also help reduce exposure. Ventilation is important, as solvents quickly create
high concentrations of vapours in confined spaces.
X Store solvents in properly labelled suitable containers, using dispensers where possible to keep evaporation to
a minimum and reduce spillage.
X Dispose of solvent-soaked rags in closed containers.
X Train workers in specific handling and use of solvents. Training should include but not be limited to – physical
properties, health effects, routes of exposure, how to minimize exposure, PPE, first aid, spillages, and disposal.
X Apply good practices in measuring exposure to solvent vapours in order to understand whether the controls in
place are sufficient to protect workers’ health.
X Provide appropriate safety equipment, including fire extinguishers and absorbent material, for situations such
as spillage or emergency.
X Prohibit eating, smoking or drinking when hazardous solvents are handled.
X Make PPE available free of charge, such as protective overalls, gloves and masks with filters, which should be
used according to the recommendations. Store all PPE in a clean place away from possible contact with solvent
vapours.
Sources include: ILO 2004 and 2014, ESIG 2018
X Spotlight on Benzene Priority Actions

As a solvent, benzene can be substituted with a variety of less hazardous ones. A number of solvents have similar
characteristics to benzene, however with less hazardous effects.
X Engineering controls using enclosed or exhaust ventilation can be effective, and isolation of operations can
also reduce exposure.
X Benzene should be stored in tightly closed containers in a cool well-ventilated area.
X Metal containers need to be grounded to avoid ignition from sparks caused by static electricity. Benzene
reacts violently with oxidizing agents, such as permanganates, nitrates, peroxides, chlorates and perchlo-
rates.
X Labels on bottles or containers should carry symbols indicating the health risk, following the GHS.
X PPE, for example breathing protection, is a last resort but may be necessary in some situations. It is essential
to use the correct equipment, i.e., mask and filter type A and viton or polyvinyl alcohol (PVA) gloves, although
even these have limited resistance to benzene.
Source: ILO 2004
Dyes
© Wikimedia / Andy Musa Chantu
Dyes Exposure
Dyes are chemical substances that bond to a
X Synthetic dyes are used in different industries, substrate and are classified according to their
such as textiles, leather, pharmaceuticals, food chemical properties and solubility. They are used
and cosmetics. to modify the colour of different substrates,
such as textiles, paper and leather. Occupational
X Azo dyes, the most commonly used dye, are
exposures to dyes occur during their produc-
aromatic hydrocarbon derivatives of benzene,
tion and use. There are an estimated 800 dyes
toluene, naphthalene, phenol and aniline.
X Azo dyes and their by-products, aromatic

amines, have been linked to various cancers
and allergic reactions.
The global demand of dyestuff
corresponds to approximately
9 million tonnes
X Women are more likely to be exposed to dyes
in the workplace and are therefore at a higher
likelihood of adverse health outcomes, espe-
cially in relation to pregnancies. Furthermore,
they experience gender-related disadvantages,
such as lower pay and limited career advance-
70% with
ment, as well as being at risk of sexual harass-
ment and gender-based violence.
azo dyes
A global review
currently in use, including azo dyes (Licina et al.

2019). Although originally from natural sources, Hairdressers exposed to hazardous dyes
modern dyes are synthetic substances which can Hairdressers are frequently exposed to dyes during
be hazardous to health and polluting to the envi- the course of their work. The major pathway for ex-
ronment. posure is via skin contact, followed by dermal ab-
sorption. The IARC has identified occupational dye
The global demand of dyestuff corresponds to ap- exposures as a hairdresser are probably carcino-
proximately 9 million tonnes (Rawat et al. 2016), genic to humans (IARC 2010b). In particular, the risk
with azo dyes making up greater than 70 per cent of bladder cancer was considered to be increased,
of this figure (Benkhaya et al. 2020). The textile in- particularly for men. In 2007, the EU banned the use
dustry consumes two-thirds of production world- of 135 individual ingredients in hair dyes.
wide, however dyes are also commonly used in
pharmaceuticals, food and cosmetics (Ventura- Dyes can also cause respiratory problems due to
camargo, Marin-morales 2013). Some azo dyes inhalation of dye particles and also may cause skin
degrade under certain conditions, leading to the irritation and other allergic symptoms (Hassan
release of carcinogenic aromatic amines, such as and Nemr 2017). For example, p-phenylenedi-
aniline, benzidine and 2-naphthylamine (Licina et amine, another azo dye component, is a known
al. 2019). contact allergen (Chung 2016).
Health effects Regional trends

Cancer The manufacturing of benzidine is specifically
prohibited in the EU, Japan, the Republic of Korea,
Although many azo dyes are non-toxic, some Canada and Switzerland. From November 2020,
have been identified as having mutagenic or car- the EU has restricted the use of azo dyes in the
cinogenic effects. Carcinogenic aromatic amines textile/garment sector (EU-Commission 2018).
are of particular concern for workers. Bezidine, Textiles make up a significant proportion of dye
for example, has been found to be carcinogenic use globally, with China, Bangladesh and Vietnam
to humans and has been specifically linked to being three of the world’s top five garment ex-
bladder cancer (IARC 2010b). Analysis of 86 tex- porters (ILO 2019f). The textile industry generates
tile products in Japan detected carcinogenic aro- large amounts of industrial effluents each year
matic amines in low concentrations on a variety causing water pollution which is not only harmful
of clothing items (Kawakami et al. 2010). Other for aquatic life, but also mutagenic to humans.
chemicals identified as carcinogenic to humans The safe disposal of industrial waste containing
(IARC group 1) include 4-Aminobiphenyl, a dye potentially carcinogenic dye effluents is therefore
intermediate, and those used in the production especially concerning in these regions (Hassaan
of auramine and magenta dyes (IARC 2010b). and Nemr 2017). Alternative colouring processes,
Numerous dyes contain the chemical ortho-tolui- for example, using pigments or digital printing, are
dine, which has also been linked to bladder cancer examples of more sustainable fabric colouring pro-
(IARC 2010b). cesses, with less of a reliance on toxic chemicals.

Textiles; clothing; Cancer (bladder) Limited data Limited data

leather; footwear
Chemical industries
Food; drink
Pharmaceuticals
Cosmetics
Dyes
X Selected priority actions: Dyes

X Develop national laws or regulations that prescribe the measures to be taken for the prevention and control of,
and protection against, occupational hazards in the working environment due to hazardous dyes.
X Refer to existing national regulations, for example, azo dyes releasing one of the 22 known carcinogenic aro-
matic amines are banned from clothing textiles in the European Union (Annex XVII of the REACH regulation; No,
1907/2006). The regulation can be found here
X Approve the use of less hazardous dyes as much as possible. For example in textiles, benzidine-based dyes
should be replaced with safer substitutes.
X Develop evidence-based OELs for hazardous dyes and methods to implement and enforce them. Ensure global
harmonisation of these OELs.
X Consider if there are less hazardous forms of the dyestuffs available. Choosing low-dusting dyes such as those
in granular, dust-suppressed or liquid form can be a very important factor in reducing exposure.
X Prevent secondary exposure to dust from powdered dyes from settled deposit by using appropriate storage
methods, ventilation methods and cleaning.
X Train workers about sensitisation, how to handle dyes safely and how to report health symptoms.
X Make appropriate PPE available free of charge, as well as training on how it should be used.
X Carry out health surveillance for workers at risk of being exposed to reactive dyes.
Sources include: EC 2009, HSE n.d.
Spotlight on textiles:
One of the largest
employers worldwide
The Asia-Pacific region accounts for 60 per cent
of the world’s total apparel exports – a fact that
has led it to be labeled the “clothing factory of the
world” (ILO, 2020c). The region employed an esti-
mated 65 million garment sector workers in 2019,
accounting for 75 per cent of all garment workers,
bringing the global total to 80 million (ILO 2020c).
Three of the world’s top five garment exporters
are China, Bangladesh and Vietnam (ILO 2019f).
Despite some progress in occupational standards,
concerns about working conditions in LMIC persist
and exposures to hazardous substances remain
high (Barua and Ansary 2017; Ahsan et al. 2019).
Thousands of dyes and solvents are used in textile
production, many of which have mutagenic and
carcinogenic properties (Singh and Chadha 2016).
Commonly used chemicals include:
X Crease-resistant agents: Used in finishing pro-

cesses, they may contain formaldehyde, known
for its toxicity and regulated in many countries.

A global review
Women constitute more than as well as increased mortality for diabetes and is-
chaemic heart disease (Zanardi et al. 2011).
Women constitute more than 80 per cent of the
80 of the workforce
% workforce in the textiles, clothing, leather and
footwear industry (ILO 2019). Within the Asia-
in the textiles, Pacific region, the majority of garment workers
are women (35 million), with the garment sector
clothing, leather and employing 5.2 per cent of all working women in
footwear industry the region (ILO 2020c). Many of these are young
women and therefore concerns exist regarding
X Flame retardant chemicals: These include or-
the potential impact on current and future preg-
nancies (ILO 2019e). For example, trichloroeth-
ganophosphorus and organobromine com-
ylene, a solvent used to scour cotton, wool, and
pounds, which have been associated with
other fabrics has been shown to cross the pla-
adverse health outcomes.
centa and can cause congenital heart defects in
X Azo dyes: Constitute 60-70% per cent of all the developing fetus (ATSDR 2019).
dyestuff used in textile production (Rawat et Phasing out the most hazardous chemicals is
al. 2016), however are known to release car- considered a priority action for the textile in-
cinogenic aromatic amines, many of which are dustry. The EU has provided a good example by
banned from clothing textiles in the EU. restricting the use of 33 substances classified as
Increased incidence of bladder cancer and lung carcinogenic, mutagenic or toxic for reproduction
cancer have been consistently reported in textile (CMR) in the textile/garment sector, starting from
industry workers exposed to carcinogens (Singh November 2020 (EU-Commission 2018). Extending
and Chadha 2016). In addition, increased inci- this ban globally could prevent exposure to chem-
dence of dermatitis has been reported in textile icals known to be carcinogenic, mutagenic or toxic
workers (Chen et al. 2017). Higher frequency of for reproduction. The EU restriction covers polar
chronic bronchitis and COPD have also been ob- aprotic solvents and azo-dyes and acrylamines, as
served among textile workers (Nafees et al. 2016) well as a number of others.
X Case study: A disease burden analysis of garment factory workers in Bangladesh proposal
for annual health screening
Health status of garment and textile factory workers in Bangladesh was charac-
terized in a retrospective review of worker health information using 1906 medical
records. The mean age of the workers was 27.9±7.3 y, with 60 per cent female and
40 per cent male. One-fifth of all workers were found to be anaemic. Elevated blood
pressure was also present among 12 per cent of workers, and elevated fasting blood
glucose among 8 per cent. A majority of these health conditions had not been pre-
viously diagnosed. Despite the relatively young mean age, significant percentages
of workers were identified as having undiagnosed health conditions which required
urgent medical attention. The findings suggest that provision for annual health
screening, either by mobile on-site clinics or by training the existing in-house medi-
cals staff, will help improve health of garment workers (Solinap et al. 2019).
 Reminder
The Global Alliance to Eliminate Lead Paint (Lead Paint Alliance) is a voluntary partnership formed by the United
Nations Environment Programme (UNEP) and the World Health Organization (WHO) to prevent exposure to lead
through promoting the phase-out of paints containing lead. The ILO has joined the Alliance and leverages its
unique tripartite structure to promote social dialogue towards the phase out of the manufacture and sale of lead
paint. More information on tools to promote the phase out of lead in paint can be found here.
Manufactured nanomaterials (MNMs)
© Pxfuel
Manufactured
nanomaterials (MNMs)
X Manufactured nanomaterials (MNMs) do not
belong to any specific group of chemicals, Humans have long been exposed
but are defined as materials that have at least
to unintentionally produced
nanoparticles
one dimension (height, width or length) that is
smaller than 100 nanometers. However, they
can be grouped further according to compo-
sition.
X The recent increase in production and use of

MNMs in a wide variety of industries and prod-
ucts highlights the need to comprehensively
assess OSH impacts.
X Health hazards can result from inhalation, in-

gestion or skin absorption of MNMs.
X Multi-walled carbon nanotubes and titanium

dioxide have been classified by IARC as pos-
sible carcinogens (group 2B). Other health
impacts for a range of MNMs include specific such as those from combustion
organ toxicity after chronic exposure.
processes, but the recent increase
X The field of nanotechnology is expanding rap- in MNM production represents a
idly, which means that much is still unknown
about additional health effects and gender re-
novel exposure risk for workers
lated impacts.
A global review
Exposure carcinogens (Bucher 2002), and these have been

performed on MNMs. In vitro assays for relevant
In the workplace, health hazards can result from key characteristics of carcinogens (Guyton et al.
inhalation, ingestion or skin absorption of MNMs. 2018) have also been performed on different
The human lungs represent an excellent entry MNMs.
portal for MNMs due to their high surface area,
thin epithelial barriers and extensive vasculature. One type (Mitsui-7) of Multi-Walled Carbon
While dermal and oral exposure may occur, inha- NanoTubes (MWCNT) have been classified by
lation is more likely to result in a larger systemic IARC as possible carcinogens (group 2B) (IARC
dose of MNMs (WHO 2017b). 2018). This type of MWCNT was found to induce
malignant mesothelioma when administered by
The global nanotechnology market is expected intrascrotal or intraperitoneal injection in rodents,
to grow by a compound annual growth rate of 18 and an inhalation study demonstrated that rats
per cent from US$39.2 billion in 2016 to US$90.5 exposed to respirable MWCNT developed lung
billion by 2021 (BCC Research 2017). This includes tumours (Sakamoto et al. 2009; Kasai et al. 2015).
the market for nanoparticle-based sunscreen MWCNT were shown to induce both lung tumours
products and nano-catalyst thin films for cata- and malignant mesothelioma in rats, when admin-
lytic converters, thin film solar cells, nanolitho- istered by trans-tracheal intrapulmonary spraying
graphic tools and nanoscale electronic memories (Numano et al. 2019). Progress has been made in
and many other applications (BCC Research 2017). understanding carbon nanotube (CNT)-induced
Nanosilver, due to its antibacterial and antimicro- pathologic conditions in recent years, demon-
bial properties, is widely used in the manufac- strating a close interconnection with inflamma-
ture of consumer products, with most uses in tion, fibrosis and cancer. The key factors seem to
electronics, information technology, health care, be that MWCNT are long, rigid and biopersistent
textiles and personal care products. Titanium di- fibres that are small enough to reach the periph-
oxide and silicon dioxide nanoparticles are also eral lungs, similar to asbestos fibres (Poland et al.
widely used and constitute, together with nanos- 2008). Mechanistically, a number of mediators,
ilver, 25 per cent of the nanoproducts introduced signaling pathways, and cellular processes are
on the market (Inshakova and Inshakov 2017). identified as major mechanisms that underlie the
MNMs are also increasingly used for pest control interplay between inflammation, fibrosis, and ma-
(Athanassiou et al. 2018). lignancy, and serve as pathogenic bases for these
disease conditions in CNT-exposed animals. These
Health effects studies indicate that CNT-induced pathological
effects, in particular, inflammation, fibrosis, and
The physicochemical properties and the asso- cancer, are mechanistically, and in some cases,
ciated health effects of MNMs depend on their causatively, interrelated (Dong and Ma 2019).
characteristics, such as size, shape, composition,
Titanium dioxide or TiO2 (not size-specific) was
surface characteristics, charge and extent of their
classified by IARC as possibly carcinogenic (group
solubility. Humans have long been exposed to
2B) (IARC 2010b) and as a suspected carcinogen
unintentionally produced nanoparticles, such as
by the European Chemicals Agency (ECHA) (Canu
those from combustion processes, but the recent
et al. 2019). The US NIOSH has classified inhaled
increase in MNM production represents a novel
ultrafine TiO2 as a potential occupational carcin-
exposure risk for workers.
ogen. These evaluations were based on studies
that found an increased risk of lung cancer in
Cancer studies on rats. In particular, an inhalation study
Epidemiological evidence of occupationally-re- showed a statistically significant increase in lung
lated tumours typically emerge only after dec- cancer in rats exposed to ultrafine TiO2 at an av-
ades of latency. Since MNMs were introduced erage concentration of 10 mg/m3 (Heinrich et al.
quite recently on the market, this means that such 1995). More recently, chronic exposure to food
evidence is currently not available. As a compar- grade TiO2 (E171, a white coloring agent with up
ison, the peak of asbestos-related mesothelioma to 36 per cent of MNMs) was able to initiate and
occurs only after 65 years of age. However, there promote the expansion of preneoplastic lesions
are different long-term cancer bioassays that in the colon of rats, which parallels the develop-
are the most predictive toxicological assays for ment of an inflammatory microenvironment in
Manufactured nanomaterials (MNMs)
X Case study: Carbon nanotube and nanofiber exposure and sputum and blood biomarkers of
early effect among U.S. workers
An industry wide cross-sectional epidemiological study of 108 workers from 12 US

worksites was conducted to evaluate associations between occupational carbon na-
notube and nanofiber (CNT/F) exposure and sputum and blood biomarkers of early
health effect. CNT/F exposure was assessed via personal breathing zone, filter-based
air sampling. A number of biomarkers of early health effect were associated with
CNT/F exposure. Inhalable rather than respirable CNT/F was more consistently asso-
ciated with fibrosis, inflammation, oxidative stress, and cardiovascular biomarkers
(Beard et al. 2018).
the mucosa, and the selection of preneoplastic which means that workers in these countries are
cells in vitro (Bettini et al. 2017). at greater risk of the potential negative health
effects than their counterparts in high-income
Other health outcomes countries (WHO 2017b).
Apart from carcinogenic effects, many other non-

cancer effects have emerged from toxicological The role of gender
studies. For single-walled carbon nanotubes
There are still many unknowns about the diverse
(SWCNT) there is evidence of a hazard for germ
group of MNMs and their impact on human
cell mutagenicity and specific organ toxicity after
health, including gender impacts. Due to the wide
repeated exposure. For MWCNT, there is evidence
use of MNMs, the gender balance of the workforce
of a hazard for eye damage, germ cell mutagen-
is hard to assess. While most studies of health
icity and specific organ toxicity after repeated ex-
impacts of nanomaterials have been conducted
posure. For silver nanoparticles, there is evidence
on animals such as rodents, there are some in-
of a hazard for respiratory/skin sensitisation and
dication of health impacts especially relevant for
specific target organ toxicity after repeated ex-
the female workforce. Preliminary evidence has
posure. For gold nanoparticles, there is evidence
indicated that carbon nanotubes may harm the
for specific target organ toxicity after repeated
female reproductive system, cross the placenta
exposure. For silicon dioxide, there is evidence
and cause embryo lethality, early miscarriages
for specific target organ toxicity after repeated
and fetal malformations in female mice (Hansen
exposure. For titanium dioxide, there is evidence
and Lennquist 2020). Titanium dioxide nanoparti-
for reproductive toxicity and specific organ tox-
cles can cause ovarian dysfunction, affect genes
icity after repeated exposure. For cerium dioxide,
regulating immune response, disrupt the normal
there is evidence of specific target organ toxicity
balance of sex hormones and decrease fertility
after repeated exposure. For zinc oxide, there is
(Sun et al. 2013). In addition, many MNMs can
evidence for specific organ toxicity after re-
cross the placenta where they can cause altered
peated exposure (WHO 2017b).
development of internal organs and morphology
as well as defects in the reproductive and nervous
Regional trends systems of the offspring (Sun et al. 2013).
The United States, South Korea, China, and Japan

are the largest producer of nanoproducts and
hold the largest proportions of those nanotech-
nology patents (StatNano 2019). Middle-income
 Reminder
countries such as Brazil and South Africa pro- ILO Chemicals Convention No.170 has an all-en-
duce MNMs and have research laboratories that compassing scope and covers all chemicals and all
produce CNTs. LMICs produce nanosilver that is mixtures including novel and emerging chemical
hazards. As such, C170 represents a legislative gap
incorporated in milk packs, fabrics and clothes
filler and ratifying and implementing the conven-
and MNMs are also produced for use by the
tion can be seen as a priority for MNMs. More in-
pharmaceutical industry. The implementation of formation can be found here.
OSH regulations is usually less effective in LMICs,
A global review

SUBSTANCE
Carbon Nanotubes Cancer Limited data Limited data

Chemical industries (MWCNT) (mesothelioma and
lung cancer)
Food; drink; tobacco
Health services
Titanium Dioxide Cancer (lung cancer) Limited data Limited data
Mechanical and
electrical engineering
Textiles; clothing;
leather; footwear
X Selected priority actions: Manufactured Nanomaterials

X Develop national laws or regulations that focus on enhanced risk assessment and reduce occupational exposure
to MNMs in the workplace.
X Gather and make publicly available information about MNM health hazards. An example includes Nanodatabase,
produced by the Danish Ecological Council and Danish Consumer Council. This database now includes more than
5,000 products containing MNMs.
X Make resources available for increased workplace research on MNMs and their occupational health impacts,
including gender- and sex-differentiated studies of impact.
X Establish regulatory data requirements on MNMs in the workplace, taking into account their properties and life
cycles, to inform future hazard and risk assessments.
X Strengthen social dialogue and promote concerted actions at the international level to work towards common
definitions and toxicological grouping strategies for MNMs.
X Ensure legislation for harmonised labelling for MNMs, particularly in light of the increasing evidence concerning
the workplace hazards related to MNMs exposure.
X Develop evidence-based OELs for MNMs and methods to implement and enforce them, as comprehensive reg-
ulatory OEL values for MNMs in workplaces do not currently exist. Ensure global harmonisation of these OELs.
X Assess if workplace exposures exceed the proposed OEL values in annex 1 of the WHO Guidelines on Protecting
Workers From Potential Risks Of Manufactured Nanomaterials. Workplace exposure studies indicate that in
many situations, exposure can rapidly exceed the proposed OELs. The chosen OEL should be at least as protec-
tive as a legally mandated OEL for the bulk form of the same material.
- NIOSH recently proposed a quantitative framework to group nanoscale and microscale particles by hazard
potency to derive OELs. This demonstrated that the development of OELs for MNMs remains a priority. The
EU also emphasises the creation of a robust evidence-base and practical approaches for regulating MNMs in
the workplace.
Practical workplace interventions
X Consider, as a first control measure, changing the process in such a way that no MNMs will be released into the air.
X Use engineering controls when there is a high level of inhalation exposure or when there is no, or very little, toxi-
cological information available.
X Prevent dermal exposure by occupational hygiene measures such as surface cleaning and the use of appropriate gloves.
X Conduct worker exposure assessments using comprehensive exposure assessment using evidence-based methods.
X Educate potentially exposed workers on the risks of MNMs and how best to protect themselves. Topics should
include which hazards are specific to MNMs and different from the bulk material; which hazard classes are as-
signed to MNMs; which routes of exposure are important; which workplace exposures have been measured and
which tasks put workers most at risk; how proposed OELs can be interpreted; when and how control banding,
specific controls and PPE for MNMs can be used.
X Use PPE in the absence of appropriate engineering controls, especially respiratory protection, as part of a res-
piratory protection programme that includes fit-testing.
Sources include: WHO 2017b, UNEP 2020a, Drew et al. 2017, Hodson et al. 2019, EU-Commission 2020b, EU-Commission 2020b.
Perfluorinated chemicals (PFAS)
Perfluorinated X PFAS have been used in a wide range of prod-
chemicals (PFAS) ucts, including textiles, paper products, food

contact materials, semiconductors, automo-
tive and aerospace components, cookware,
X First created in the 1930s, perfluorinated
food packaging, stain repellant clothing and
chemicals (PFAS) include over 4,730 man-made firefighting foams.
chemicals that contain fluorine atoms bonded
to a carbon chain. Perfluorooctanoic acid X PFAS have been linked to a variety of cancers and
(PFOA) and perfluorooctane sulfonate (PFOS) are known to interfere with immune function, en-
have been manufactured the longest, are the docrine function and breast development.
most widespread in the environment and are
the most studied PFAS to date. X Biological sex can influence effects resulting
from exposure to PFAS as well as bioaccumu-
X The chemical composition of PFAS makes them lation and clearance. Since PFAS are so widely
oil and water repellent, stabile at high and low used, it is difficult to assess gender implications
temperatures, and effective for friction reduc- for exposure and health impacts. Studies have
tion, marking them as important additives for shown elevated levels of PFAS in the blood of
many consumer products. both male and female firefighters.
A global review

Perfluorinated chemicals (PFAS) A review of epidemiological studies reported
potential associations between perfluoroalkyl
include over exposure and several health outcomes related
4,730 man-made to the liver, including liver damage, as shown by

increases in serum enzymes and decreases in
chemicals serum bilirubin levels (specifically for PFOA, PFOS,
PFHxS), and increases in serum lipids, particularly
that contain fluorine atoms total cholesterol and low-density lipoprotein (LDL)
bonded to a carbon chain cholesterol (specifically for PFOA, PFOS, PFNA,
PFDeA) (ATSDR 2018). Another systematic review
concluded that PFOA and PFOS are presumed
to be a hazard to immune system functioning in
Exposure humans (NTP 2016). This conclusion is based on
evidence that PFOA and PFOS suppressed the an-
Human exposures to PFAS are extremely wide- tibody response in animal studies and that these
spread and particularly high levels are often chemicals affect multiple aspects of the immune
found in workers in chemical industries. The system in humans, including decreases in anti-
US National Health and Nutrition Examination body production (Kielsen et al. 2016). Furthermore
Survey (NHANES) reported detectable PFAS blood PFOA and PFOS cause developmental toxicity in
serum concentrations in virtually all individuals animals and human epidemiology studies also
in the United States (97 percent). Workers in the show associations between some PFAS and devel-
chemical industries have the highest potential opmental effects (Butenhoff et al. 2009; Koustas
exposure to PFAS, followed by highly-exposed et al. 2014; Valvi et al. 2017). A systematic review
residents and then the general population. In one and meta-analysis of the data estimated that a
study of workers at the Washington Works facility 1ng/mL increase in serum or plasma PFOA was
in West Virginia, the average serum PFOA level associated with a -18.9 gram difference in birth
in 2001–2004 was 1,000 ng/mL (Sakr et al. 2007); weight in humans (Johnson et al. 2014). PFAS also
the mean PFOA level in highly-exposed residents present endocrine disrupting properties, specifi-
(without occupational exposure) near this facility cally human and animal studies showed an asso-
was 423 ng/mL in 2004–2005 (Emmett et al. 2006). ciation of PFAS exposures with thyroid hormones
By comparison, the geometric mean concentra- imbalances and decreased fertility (Donat-Vargas
tion of PFOA in the US population was 3.92 ng/mL et al. 2019; Hines et al. 2009; Preston et al. 2018;
in 2005–2006 (K. Kato et al. 2011). Bach et al. 2016).
Health effects Regional trends

PFAS contamination is ubiquitous in humans and
Cancer
in the environment (Hu et al. 2016). However the
IARC has classified PFOA as possibly carcinogenic highest levels of exposure tend to be observed
to humans (Group 2B) (IARC 2017) and the US near PFAS producing facilities or disposal sites,
Environmental Protection Agency (EPA) (2016e, both in developed and developing countries
2016f) concluded that there was suggestive evi- (Guelfo et al. 2018). While different developed
dence of the carcinogenic potential of PFOA and countries are starting to phase out PFAS and are
PFOS in humans. The US National Toxicology imposing more restrictive limits (OECD 2015), in
Program (US NTP) recently showed that there was LMICs this is not occurring and the production of
clear evidence of carcinogenic activity following PFAS have been largely moved from the US and
PFOA exposure in rats (NTP 2019). Increases in Europe to Asia, with China being the main pro-
testicular, liver and kidney cancer have been ducer (Song et al. 2018). In 2009, PFOS was listed
observed in workers and communities chron- under the Stockholm Convention for global elimi-
ically exposed to high levels of PFAS (Barry et nation and in 2019, the Conference of the Parties
al. 2013; Steenland and Woskie 2012; Vieira et al. of the Stockholm Convention listed PFOA for
2013; Girardi and Merler 2019). global elimination.
© Pxfuel
X Case study: Male workers exposed to polyfluoroalkyl acids with high internal dose of
perfluorooctanoic acid
The association between exposure to PFASs and mortality in a cohort of 462 male employees in a
factory that had been producing PFOA and PFOS was investigated. Measurements of workers´ PFOA
serum concentration were used to predict a cumulative serum PFOA concentration of each cohort
member. Mortality rates were compared to the regional population using the standardised mortality
ratio (SMR) and to workers of a nearby metalworking plant in terms of risk ratio (RR), across categories
of probability of PFASs exposure and tertiles of cumulative serum PFOA concentrations. Internal PFOA
serum concentration among 120 PFAS workers was classified as very high (Geometric mean: 4048 ng/
mL; range 19-91,900 ng/mL). Overall mortality in the PFAS worker cohort was increased for liver cancer
and malignant neoplasm of lymphatic and haematopoietic tissue. In comparison with metalworking
plant workers, the RRs for mortality were increased in PFAS workers for overall mortality, diabetes, liver
cancer and liver cirrhosis. Mortality for these causes increased in association with probability of PFASs
exposure and with cumulative PFOA serum concentrations. The cohort showed increased mortality
for all causes and subjects in the highest cumulative internal dose of PFOA had a statistically significant
increase for mortality of liver cancer, liver cirrhosis, diabetes, malignant neoplasms of lymphatic and
haematopoietic tissue in both comparisons (Girardi and Merler 2019).
The role of gender wide variety of occupational settings since they

are used in numerous products. It is therefore
Biological sex has implications for health effects difficult to draw any general conclusions on gen-
resulting from PFAS exposure, such as impact on der-related differences of exposure. However,
hormones, fertility and pregnancy. Also, physio- several studies have shown that firefighters
logical differences can impact bioaccumulation have higher blood levels of PFAS compared to
and clearance. For example, one study showed the general population due to exposure from
that female workers below 50 years of age in a PFAS-containing firefighting foam, as well
fluorochemical plant in China had a lower half-life as PFAS treated protective gear. Firefighting
of perfluoroalkyl acids in the body compared to is generally a male-dominated occupation and
the male workers (Fu et al. 2016). most studies have been focussed on male worker
While workers in PFAS manufacturing are espe- cohorts. However, a recent study of an all-female
cially exposed, exposure to PFAS can occur in a cohort of firefighters showed that all of the 86
A global review

Cancer (testicular, Limited data Limited data

Chemical industries
liver and kidney)
Food, drink, tobacco Immune toxicity
Liver Toxicity
Textiles, clothing,
leather, footwear Reproductive Toxicity
Construction
Electronics
manufacturing
Aerospace
Automotive
Emergency response
X Selected priority actions: Perfluorinated chemicals

X Develop regulations to address PFAS use at the workplace, focused on eliminating and substituting with safer
alternatives.
X Refer to the 2020 EU Commission’s new set of comprehensive actions to address the use of and contamination
with PFAS due to “a full spectrum of illnesses and the related societal and economic costs”. The actions aim to
ensure that the use of PFAS is phased out in the EU unless it is proven essential for society. Due to the ubiqui-
tous nature of PFAS exposure across workplaces and proven health impacts, the phase out of PFAS for safer
alternatives marks a priority initiative that should be replicated globally.
X Refer to and implement the Stockholm Convention and other related policies for PFAS:
- Since 2009, perfluorooctane sulfonic acid (PFOS) and its derivatives have been included to eliminate their use.
In 2019, governments agreed to a global ban on perfluorooctanoic acid (PFOA), its salts and PFOA-related
products.
- PFOS and PFOA have also been phased out in the EU under the POPs Regulation.
X Consider listing additional types of PFAS under the Stockholm Convention for global elimination, using a
grouping approach for increased effectiveness.
X Implement or prioritise the use of safer non-persistent alternatives for all PFAS uses that cannot be contained.
This includes firefighting foams, a major source of PFAS contamination, for which fully effective alternatives are
now available, such as non-persistent fluorine-free foams. Any operational differences between persistent and
non-persistent foams can now either be engineered out or dealt with by appropriate training.
X Harmonise classification and labelling, applying the GHS as relevant.
X Develop evidence-based OELs for PFAS. The US EPA plans to develop cancer and noncancer toxicity values for
PFAS, where sufficient health effects data currently exist, are publicly available and adequately support human
health toxicity value derivation.
X Provide targeted preventative measures to occupations especially exposed to PFAS, such as firefighters and
workers in the chemicals industries and products manufacturing
X Ensure that appropriate training is given when non-persistent alternatives are used.
X Supply effective PPE designed to effectively protect people of all body types, including physiological differences
between genders.
X Ensure medical surveillance of exposed workers, using new approaches to biomonitoring, such as general sus-
pect screen (GSS). GSS integrates exposure knowledge and serum suspect screening and has proven to be an
effective technique in female firefighters.
Sources include: IPEN 2019, EU-Commission 2020a, Grashow et al. 2020

Endocrine-disrupting chemicals
female firefighters included had at least four

PFAS detected in their serum samples (PFHxS,
PFOA, PFOS, and PFNA). Three additional PFAS
were detected in 70 per cent of the firefighters
(Trowbridge et al. 2020).
© FotoAndalucia / stock.adobe.com
Endocrine-disrupting X EDCs have been implicated in multiple repro-

ductive disorders in men and women, as well
chemicals as cancers, neurodevelopmental disorders and
obesity.
X Endocrine disrupting chemicals (EDCs) are sub-
stances that can act at very low doses to impact X Scientific studies have estimated significant
the functioning of the endocrine system. This costs due to health effects of EDCs: US$217 bil-
can lead to adverse health effects in an or- lion per year in the EU and US$340 billion per
ganism, its offspring or populations, such as year in the United States.
changes in the morphology, physiology, growth,
X Endocrine-disrupting chemicals impact both
development, reproduction or life span.
sexes, but exposure to the same chemicals may
X EDCs belong to many different chemical cause different effects in men and women.
groups, which means that exposure can occur
in a wide range of occupations.
Scientific studies have estimated significant

costs due to health effects of EDC
Exposure to EDCs
can occur in a very
US$340 billion US$217 billion wide range of
per year per year
occupations
A global review
X Figure 6. List of EDCs (part 1)
Chemical Name CAS Completed assessments as the Other completed Ongoing and planned
Number(s) basis for inclusion * assessments assessments
BENZOPHENONES
Benzophenone-1; 131-56-6 SIN, Danish Criteria (Cat. 2a) EU Priority List
2,4-Dihydroxybenzophenone; Category 1
Resbenzophenone
Benzophenone-2; 131-55-5 SIN, Danish Criteria (Cat. 1) EU Priority List
2,2',4,4'-tetrahydroxybenzophenone Category 1
Benzophenone-3; Oxybenzone 131-57-7 SIN, Danish Criteria (Cat. 2a) EU Impact Assessment EU CoRAP
4,4'-dihydroxybenzophenone 611-99-4 SIN, Danish Criteria (Cat. 2a) EU Priority List
Category 1
3-BC, MBC, EHMC
3-Benzylidene camphor (3-BC); 15087-24-8 SIN, Danish Criteria (Cat. 1) EU Impact
1,7,7-trimethyl-3- (phenylmethylene) Assessment, EU
bicyclo[2.2.1]heptan-2-one Priority List Category 1
3-(4-Methylbenzylidene) camphor; 36861-47-9 SIN, Danish Criteria (Cat. 1) EU Priority List
1,7,7-trimethyl-3-[(4- methylphenyl) Category 1
methylene]bicyclo[2.2.1] heptan-2-one
2-ethylhexyl 4-methoxycinnamate 5466-77-3 /
83834-59-7 SIN, Danish EU Impact Assessment, EU EU CoRAP
Criteria (Cat. 1) Priority List Category 1
BISPHENOLS F AND S
Bisphenol F 620-92-8 SIN
Bisphenol S 80-09-1 SIN EU Impact Assessment EU CoRAP
PARABENS
Methylparaben 99-76-3 Danish Criteria (Cat. 2a) EU Impact EU CoRAP
Assessment, EU
Priority List Category 1
Ethylparaben 120-47-8 Danish Criteria (Cat. 2a) EU Priority List EU CoRAP
Category 1
Propylparaben; propyl 94-13-3 SIN, Danish Criteria (Cat. 2a) EU Impact EU CoRAP
4-hydroxybenzoate Assessment, EU
Butylparaben; butyl 94-26-8 SIN, Danish Criteria (Cat. 1) EU Priority List
4-hydroxybenzoate Category 1
PHTHALATES (NON-EU REACH SVHCs)
Diethyl phthalate (DEP) 84-66-2 SIN, Danish Criteria (Cat. 2a) EU Impact US EDSP, Japan EXTEND
Assessment, EU
Dihexyl phthalate (DHP) 84-75-3 SIN, Danish Criteria (Cat. 1) EU Impact Japan EXTEND
Assessment, EU
REACH SVHC **
Dicyclohexyl phthalate (DCHP) 84-61-7 SIN, Danish Criteria (Cat. 1) EU Priority List EU CoRAP, Japan
Category 1 EXTEND
Dioctyl phthalate 117-84-0 SIN
Diisodecyl phthalate (DiDP) 68515-49-1 / SIN
26761-40-0
Diundecyl phthalate (DuDP), branched 3648-20-2 SIN
and linear
OTHER PHENOL DERIVATIVES
4-nitrophenol 100-02-7 SIN, Danish Criteria (Cat. 2a)
2,4,6-tribromophenol 118-79-6 SIN
Resorcinol 108-46-3 SIN, Danish Criteria (Cat. 1) EU Impact EU CoRAP
Assessment, EU
BHT AND BHA
Butylated hydroxytoluene (BHT) 128-37-0 SIN EU CoRAP
Tert.-Butylhydroxyanisole (BHA); tert- 25013-16-5 SIN, Danish Criteria (Cat. 1) EU Impact EU CoRAP, US EDSP
butyl-4-methoxyphenol Assessment, EU
DITHIOCARBAMATES
Metam-sodium 137-42-8 SIN, Danish Criteria (Cat. 1) EU Priority List
Category 1
Zineb 12122-67-7 SIN, Danish Criteria (Cat. 1) EU Impact Japan EXTEND
Assessment, EU
Ziram 137-30-4 SIN EU Impact Assessment EU CoRAP, US EDSP,
Japan EXTEND
Thiram 137-26-8 SIN, Danish Criteria (Cat. 1) EU Impact

Assessment, EU
PCP, TEBUCONAZOLE, AND
TRICLOSAN
Pentachlorophenol (PCP) 87-86-5 SIN, Danish Criteria (Cat. 1) EU Priority List US EDSP, Japan EXTEND
Category 1
Tebuconazole 107534-96-3 Danish Criteria (Cat. 1) EU Impact Assessment US EDSP
Triclosan 3380-34-5 Danish Criteria (Cat. 1) EU Impact Assessment EU CoRAP
MISCELLANEOUS
Tert-butyl methyl ether; MTBE; 1634-04-4 SIN, Danish Criteria (Cat. 1) EU Impact EU CoRAP, US EDSP
2-methoxy-2-methylpropane Assessment, EU
Quadrosilan; 2,6-cis- 33204-76-1 SIN, Danish Criteria (Cat. 1) EU Priority List
Diphenylhexamethylcyclotetrasiloxane Category 1
Carbon disulphide 75-15-0 SIN EU Impact Assessment EU CoRAP

Triphenyl phosphate 115-86-6 SIN EU Impact Assessment EU CoRAP
Source: UNEP
The chemicals which appear in this table have not been identified as known or suspected EDCs as part of a regulatory review which considers
and weighs all available evidence, engages external peer review and is open and responsive to public review and comment.
* Specific categorization from the Danish criteria results is provided. Cat. 1 = Category 1 (endocrine disruptor), Cat. 2a = Category 2a (suspected
endocrine disruptor).
** This initiative has chemicals included specifically due to their endocrine disrupting potentials, however, these chemicals were included in
the initiative for other reasons.
X Figure 7. List of EDCs (part 2)
Chemical Name CAS Number(s) Completed assessments as Other completed Ongoing and planned
the basis for inclusion assessments assessments
Bis(2-ethylhexyl) 117-81-7 EU REACH SVHC EU Impact US EDSP, Japan EXTEND
phthalate; DEHP Assessment, EU
Priority List Category
1
Diisobutyl phthalate; 84-69-5 EU REACH SVHC EU Impact
DIBP Assessment
131-55-5 SIN, Danish Criteria (Cat. 1) EU Priority List
Category 1
Dibutyl phthalate; DBP 84-74-2 EU REACH SVHC EU Impact US EDSP, Japan EXTEND
Assessment, EU
1
Benzyl butyl phthalate; 85-68-7 EU REACH SVHC EU Impact US EDSP, Japan EXTEND
BBP Assessment, EU
1
4-(1,1,3,3- 140-66-9 EU REACH SVHC EU Impact
tetramethylbutyl) Assessment, EU
phenol Priority List Category
1
4-(1,1,3,3- 2315-67-5/ 2315-61-9/ 9002-93-1/ EU REACH SVHC
tetramethylbutyl) 2497-59-8/ Others not specified
phenol, ethoxylated
4-Nonylphenol, 84852-15-3/ 26543-97-5/ 104-40-5/ EU REACH SVHC EU Priority List EU CoRAP*
branched and linear 17404-66-9/ 30784-30- 6/ 52427- Category 1
13-1/ 186825-36-5/ 142731-63-3/
90481-04-2**/ 25154-52-3**/ Others
not specified
4-Nonylphenol, 104-35-8/7311-27-5/ 14409-72-4/ EU REACH SVHC EU Priority List EU CoRAP
branched and linear, 20427-84-3/ 26027-38-3/ 27942- Category 1
ethoxylated 27-4/ 34166-38-6/ 37205-87-1/
127087-87-0/ 156609-10-8/ 68412-
54-4**/ 9016-45-9**/ Others not
specified
4-Heptylphenol, 6465-71-0/ 6465-74-3/ 6863-24-7/ EU REACH SVHC
branched and linear 1987-50-4/72624-02-3/ 1824346-
00-0/ 1139800-98-8/ 911371-07-8 /
911371-06-7 /911370-98-4/ 861011-
60-1/ 861010-65-3/ 857629-71-1/
854904-93-1/ 854904-92-0/ 102570-
52-5/ 100532-36-3/ 72861-06-4/
71945-81-8/ 37872-24-5/ 33104-11-9/
30784- 32-8/ 30784-31-7/ 30784-27-1
p-(1,1-dimethylpropyl) 80-46-6 EU REACH SVHC EU Impact EU CoRAP
phenol Assessment
Source: UNEP
* This initiative has chemicals included specifically due to their endocrine disrupting potentials, however, these chemicals were included in
the initiative for other reasons.
** Identified as additional CAS numbers by ChemSec for these compounds on the SIN List and are not originally on the EU REACH SVHC list.
A global review
Exposure
The definition of EDCs proposed by the WHO
Exposure to EDCs varies widely within and among and International Programme on Chemical
countries. It has been estimated that the majority Safety (IPCS) in 2002 is now widely accepted
(WHO 2002): “an endocrine disrupter is an exog-
of the health related costs caused by EDCs in the
enous substance or mixture that alters function(s)
United States are related to flame retardants,
of the endocrine system and consequently causes
while in Europe they are related to organophos-
adverse health effects in an intact organism, or its
phate pesticides (Trasande et al. 2016; Attina et progeny or populations.” An adverse effect is de-
al. 2016).The costs estimated for the health effects fined as: “a change in the morphology, physiology,
of exposure to 10 EDCs was US$217 billion per growth, development, reproduction or life span
year in the EU (Trasande et al. 2016) and US$340 of an organism, system or population (Tanakaya
billion USD per year in the United States (Attina et al. 2015) that results in an impairment of func-
et al. 2016). An additional important conclusion tional capacity, an impairment of the capacity to
to draw from these studies is the limited availa- compensate for additional stress or an increase in
bility of data on the burden of EDCs worldwide. susceptibility to other influences.”
Furthermore, these studies considered a limited
number of EDCs effects (only 10 EDCs were in-
cluded in the analysis), suggesting a possible un-
derestimation of the costs. The life cycles of EDCs Health effects
are of particular concern, since many of them can
While EDCs belong to different chemical groups
contaminate workers even decades after their
and have a wide range of different chemical-phys-
use has been discontinued. This is the case for
ical properties, they all share the capacity of
PCBs: even though their production was banned
altering the endocrine system. Hormones are se-
worldwide in the 1970s, they are still present and
creted into the blood or within organs and act on
continue to contaminate workers due to their bi-
target tissues throughout the body at extremely
opersistence (Ma et al. 2018; Gioia et al. 2014). The
low concentrations (typically in the part per tril-
life cycle of plastics containing EDCs represents,
lion to part per billion range). Similarly, endocrine
in particular, a global challenge, in light of the
disruptors can act at very low doses, acting as ex-
increasing production volumes and ubiquitous
ogenous hormones or altering the endogenous
environmental contamination with microplastics
hormone balance. UNEP has recently produced
(Chen et al. 2019). However specific data on prev-
three overview reports on EDCs (UNEP 2017a,
alence of exposure to EDCs in workers and related
2017b, 2017c) and produced a list of 45 substances
health effects, especially associated with fertility,
identified as EDCs or potential EDCs belonging to
are missing.
18 chemical groups.
The construction and plastics industries employ
millions of workers globally, which use large Cancer
quantities of chemicals that are known or sus-
Strong evidence has accumulated since the 1970s
pected EDCs. Current health surveillance of these
for an implication of oestrogens in the incidence
workers gives very limited insight into the health
of different types of cancers. Synthetic oestrogen
risks associated with exposure to EDCs (Butchko
diethylstilboestrol (DES) has been shown to in-
and Stargel 2001). A recent systematic review on
crease the risk of breast and vaginal cancer fol-
biomonitoring of occupational exposure to phtha-
lowing intra-uterine exposure (Newbold 2008;
lates highlighted the lack of recent occupational
Schrager and Potter 2004). Another example is
studies on both old and new phthalate exposure
a drug against breast cancer, Tamoxifen, which
in the EU and the need for a harmonised approach
inhibits oestrogen-stimulated growth of breast
(Fréry et al. 2020).
cancer cells, but is associated with potent oes-
trogen activity in the uterus. Consequently, ta-
moxifen has been classified by IARC as a known
carcinogen for the endometrium (Yang et al. 2013).
Bisphenol A (BPA), a common chemical in plastics,
also interacts with the oestrogen receptors and is
a possible risk factor for breast cancer (Seachrist
et al. 2016). Additionally, experimental evidence
X Case study: Phthalate exposure in sales clerks

High levels of phthalates in cosmetic products have raised concerns about phthalate exposure and
the associated risk for cosmetics sales clerks in southern Taiwan. The exposure and risk of phthalates
was analysed in 23 cosmetics, 4 perfume, and 9 clothing department store sales clerks. The urinary
levels of the phthalates mono-2-ethylhexyl phthalate (MEHP) and monomethyl phthalate (MMP) were
significantly higher after their shift than the corresponding pre-shift levels in cosmetics group, and
the post-shift levels of urinary MMP was significantly higher than the corresponding pre-shift levels
in the perfume group. Over half of the cosmetics (70 per cent) and perfume sale clerks had exceeded
cumulative risk of phthalate exposure for anti-androgenic effect. Cosmetic and perfume workers had
increased risks of reproductive or hepatic effects for diethyl phthalate (DEP) and DEHP exposure.
The study also noted that dermal exposure represents an important route of phthalate exposure for
cosmetics and perfume workers (Huang et al. 2018).
indicates that BPA exposure can lead to increased the risk increased with the increasing number of
susceptibility to prostate cancer (Seachrist et al. EDCs groups that women were exposed to (Birks
2016). Epidemiological case-control studies docu- et al. 2016).
mented that the xeno-oestrogenic burden, which
Both epidemiological and experimental studies
corresponds to the overall oestrogen-like activity
have shown that prenatal exposure to multiple
from molecules stemming from outside the body,
EDCs can diminish IQ or increase risk of neurode-
can be a predictor of breast cancer incidence
velopmental disorders and obesity (Braun 2017;
(Pastor-Barriuso et al. 2016). Increased incidence
Mughal et al. 2018; Ghassabian and Trasande
of papillary thyroid cancer has also been linked
2018). Some of the best studied EDCs adversely
by epidemiology and experimental evidence to
affecting neurodevelopment include PCBs, where
EDCs, including flame-retardants and pesticides
reductions in cognitive function were observed al-
(Perdichizzi et al. 2014; Hoffman 2017).
ready decades ago for the highest maternal PCBs
exposures (Jacobson and Jacobson 1996). Other
Other health outcomes known or suspected EDCs that can affect brain
A range of EDCs have been implicated in multiple development include phosphorylated and bromi-
reproductive disorders in men and women, from nated flame retardants, some phenols, phthalates
reduced fertility, fecundity (Trasande et al. 2016; and perchlorate (Demeneix 2019). Furthermore,
Skakkebaek et al. 2019) and testicular dysgenesis exposures to different EDCs have been associ-
syndrome (Skakkebaek et al. 2016). One of the ated with type-2 diabetes and obesity, including
EDCs most clearly linked to male reproductive BPA, phthalates, triclosan and benzo(a)pyrene (Le
disorders are phthalates (such as DEHP), which Magueresse-Battistoni et al. 2018).
have been linked to cryptorchidism, hypospadias,
reduced anogenital distance (Toppari et al. 2010;
Lioy et al. 2015). In females, phthalates, benzophe-
nones and dioxins have been linked to endometri- The construction and
osis (Smarr, Kannan, and Louis 2016; Bruner-Tran
et al. 2017). Experimental studies have shown that plastics industries
maternal exposure to different EDCs (DES, vin- employ
clozolin, BPA and PCBs) adversely affect mating,
reproduction and exert multigenerational effects
(Walker and Gore 2011; Krishnan et al. 2018).
Results from a meta-analysis on a large popula-
millions of workers
tion-based birth cohort design (almost 134,000
globally
mother–child pairs) indicate that employment
during pregnancy in occupations classified as pos-
which use large quantities of
sibly or probably exposed to EDCs, was associated chemicals that are known or
with an increased risk of low birth weight. Further,
suspected EDCs
A global review
Regional trends The role of gender

It has been estimated that environmental expo- Women and men share the same hormones, but
sure to EDCs induce a loss of over 20 million IQ the levels of different hormones can vary and
points and over 800,000 cases of cases of male in- affect the body differently. As such, exposure to
fertility in the US and Europe every year (Trasande the same EDCs may cause different effects in men
et al. 2016; Attina et al. 2016). A recent review ex- and women. Endocrine-disrupting chemicals may
plored in the general population if diabetogenic for example have adverse effects on regulation of
exposure to EDCs was associated with racial, female reproductive hormones and tissues. This
ethnic, and socioeconomic exposure disparities in turn can lead to reproductive disorders such as
in the US. Among Latinos, African Americans, and early puberty, infertility, abnormal cyclicity, pre-
low-income individuals, numerous studies have mature ovarian failure/menopause, endometri-
reported significantly higher exposures to dia- osis, fibroids, and adverse pregnancy outcomes.
betogenic EDCs, including polychlorinated biphe- Impacts on male reproductive health have been
nyls, organochlorine pesticides, multiple chemical suggested to include birth defects of male repro-
constituents of air pollution, BPA and phthalates ductive organs, increased incidence of testicular
(Ruiz et al. 2018). Comparison of occupational germ cell carcinoma and poor semen quality
exposure to EDCs and related effects among de- (Gore et al. 2015).
veloping and developed countries are currently
missing, however disparities might likely play a
role in occupational settings as well. Only a few
studies exist that are related to burden of disease
and exposure for EDCs in LMICs (Bedoya-Ríos et
al. 2018), however they are widely recognised as a
sensitive target in light of the waste cycles and the
lack of regulation (UNEP 2017c; Gioia et al. 2014;
Ma et al. 2018).
Impacts of EDCs on
female reproductive health include
early puberty, infertility, abnormal
cyclicity, premature ovarian failure/
menopause, endometriosis, fibroids,
and adverse pregnancy outcomes
Adverse reproductive effects for

men include
birth defects of male reproductive
organs, increased incidence of
testicular germ cell carcinoma and
poor semen quality

SUBSTANCE
Overview Various Limited data 800,000 cases of

Chemical industries male infertility
in the US and
Food; drink; tobacco Europe
Health services Phthalates Reproductive toxicity Limited data Limited data
Mechanical and Obesity

electrical engineering
Diabetes
Textiles; clothing;
leather; footwear Pesticides Neurotoxicity Limited data Limited data
(Organophosphates,
Oil and gas Triclosan)
production; oil
refining
Parabens Reproductive toxicity Limited data Limited data
Agriculture;
plantations; Bisphenols Cancer (breast, Limited data Limited data
other rural sectors prostate)
Obesity
Construction
Reproductive toxicity
Flame retardants Neurotoxicity Limited data Limited data
Reproductive toxicity
X Selected priority actions: Endocrine-disrupting chemicals

X Develop national laws or regulations that prescribe measures to be taken for the prevention and control of, and
protection against, occupational hazards in the working environment due to EDCs.
X Harmonize international policies on the labelling and regulation of EDCs. UNEP has produced a list of 45 sub-
stances identified as EDCs, or potential EDCs, belonging to 18 chemical groups and has also produced overview re-
ports on EDCs. These could be a starting point to build on for harmonised global labelling and regulation of EDCs.
Other more extensive lists building on scientific evidence are already available and could be integrated into the
UNEP list, such as the EU priority list of EDC chemicals, developed within the EU-Strategy for Endocrine Disruptors.
X Create a list of EDCs with a priority of phasing out the ones that are most potent and used most extensively,
with the highest risk of exposure.
X Gather, update and make publicly available information about use of EDCs, their health hazards and regulatory
measures taken in certain countries
X Use existing measures from industries such as agriculture, manufacturing and waste management to prevent
exposures to EDCs.
X Regularly synthesise and disseminate relevant scientific evidence in a policy-ready format to bring governments
and world of work stakeholders to the same level of awareness.
X Strengthen dialogues and concerted actions at all levels to enable an effective and efficient way forward, including
advancement and implementation of, for example, standard data requirements and testing methods, mutual
acceptance of data and existing assessments, joint assessments and joint strategies for addressing EDCs.
X Carry out research on gender-specific endpoints and mainstream gender considerations in OSH regulations
for EDCs.
X Develop evidence-based OELs for EDCs and methods to implement and enforce them. Ensure global harmoni-
sation of these OELs.
X Evaluate exposures to EDCs to ensure that decision-makers know how chemicals are being used, can access
robust biomonitoring data so that exposures can be characterised, and can implement OELs and other exposure
mitigation programmes as needed.
X Ensure EDCs in the workplace are identified, properly classified and labelled so workers and employers under-
stand they are working with EDCs. Prevention measures will differ based on the type of EDC workers are using.
X Apply the hierarchy of controls as relevant to ensure workers are protected from the harmful effects of EDCs.
Sources include: UNEP 2017a, 2017b and 2017c, EU 2020, Kassiotis et al. 2020
A global review
The developing embryo and fetus is especially plastics manufacturing, food canning, and met-
susceptible to EDCs during pregnancy. Exposure alworking, with the risk of premenopausal breast
to EDCs during this time can lead to adverse cancer highest for automotive plastics and food
birth outcomes and developmental effects and canning.
in some cases irreversible, life-long impacts
(Diamanti-Kandarakis et al. 2009). Since there is
a diverse range of chemicals with endocrine-dis-
rupting properties, there are also a wide range
of exposures. For women, occupational expo-
sures include for example agriculture, manufac-
turing facilities, and service jobs. A case control
study found that women in jobs with potentially
high exposure to carcinogens and EDCs have an
elevated breast cancer risk (Brophy et al. 2012).
These jobs included agriculture, automotive
© FAO / Abdulelah Al-Hebshi
Pesticides Health outcomes can also differ between men

and women.
X Pesticides are chemicals with biologically active The International Code of Conduct on Pesticide
ingredients used widely by large numbers of Management is a voluntary framework that
agricultural workers and those engaged in defines Highly Hazardous Pesticides (HHPs) as
vector control. Occupational exposure occurs pesticides that present particularly high levels
during handling, dilution, mixing, application of acute or chronic hazards to health or the en-
and disposal of pesticides, as well as during vironment according to internationally accepted
cleaning of containers and handling of crops. classification systems– such as from WHO or the
Globally Harmonized System of Classification and
X Exposure occurs primarily through dermal
Labelling of Chemicals (GHS) – or their listing in
and inhalation routes. Ingestion might occur relevant binding international agreements or
through consumption of contaminated food or conventions (WHO/FAO 2014). Some older pesti-
through oral contact with contaminated hands. cides are listed under the Stockholm Convention
Contaminated clothing is a significant source of for global elimination or restriction, since they are
exposure. persistent, bioaccumulative, cause adverse ef-
X A range of different pesticides have been classi-
fects and are transported over a long range (e.g.
lindane, mirex and DDT).
fied by IARC as carcinogenic to humans (group
1) and probably carcinogenic to humans (group
2A). Other health impacts include poisonings,
neurotoxic effects and endocrine disruption.
The introduction of
X Pesticide poisoning represents a major occu- regulations to
phase out the
pational health crisis with estimates indicating
that up to 44 per cent of farmers are poisoned
every year. use of HHPs
X While both women and men face risk of expo- has saved innumerous lives
sure to pesticides in the agricultural sector, the
magnitude will depend on country-specific con-
texts for which tasks men and women perform.
Pesticides
X HHPs Criteria Table
1 Pesticide formulations that meet the criteria of Classes Ia or Ib of the WHO Recommended
Classification of Pesticides by Hazard
2 Pesticide active ingredients and their formulations that meet the criteria of carcinogenicity Categories
1A and 1B of the Globally Harmonized System of Classification and Labelling of Chemicals (GHS)
3 Pesticide active ingredients and their formulations that meet the criteria of mutagenicity Categories 1A
and 1B of the GHS
4 Pesticide active ingredients and their formulations that meet the criteria of reproductive toxicity
Categories 1A and 1B of the GHS
5 Pesticide active ingredients listed by the Stockholm Convention in its Annexes A and B, and those
meeting all the criteria in paragraph 1 of annex D of the Convention
6 Pesticide active ingredients and formulations listed by the Rotterdam Convention in its Annex III
7 Pesticides listed under the Montreal Protocol
8 Pesticide active ingredients and formulations that have shown a high incidence of severe or irreversible
adverse effects on human health or the environment.
In addition, pesticides that appear to cause severe dermal and inhalation routes during application.
or irreversible harm to health or the environment Ingestion might occur through consumption of
may be considered to be highly hazardous (see contaminated food during or following work or
HHPs Criteria table). However, to date there is no through oral contact with contaminated hands.
harmonised, internationally agreed list of HHPs. Contaminated clothing is a significant source of
While some pesticides are classified as HHPs and exposure. Stocks of obsolete pesticides still rep-
banned in specific countries, in other countries resent an exposure hazard in many countries, in
they are approved for use. For example, phorate, particular if storage or disposal is inappropriate
which is classified as extremely hazardous (Class (WHO 2019d).
1a) by WHO has been banned in the EU, Brazil
and China, while it remains approved for use in Health effects
the United States (Donley 2019). WHO considers
HHPs as a major public health concern (WHO
2019d) and the introduction of regulations to Cancer
phase out the use of HHPs has saved innumerous A range of different pesticides have been classi-
lives (WHO/FAO 2019). fied by IARC as carcinogenic to humans (group 1):
X arsenic and arsenical compounds

Exposure X pentachlorophenol (PCP)
It is estimated that approximately 1.8 billion X lindane

people are engaged in agricultural activities X ethylene oxide
worldwide, and most use pesticides to protect
food and commercial products that they pro- Several pesticides have been also classified by IARC
duce (Carvalho 2017). During increased attention as probably carcinogenic to humans (group 2A):
from global policy makers in the last two dec- X dichlorodiphenyltrichloroethane (DDT)
ades, global pesticide use has continued to grow X organophosphates (malathion, diazinon,
steadily to 4.1 million tonnes per year in 2017, glyphosate)
an increase of nearly 81% from 1990 (FAOSTAT
X aldrin and dieldrin
2019). The greatest exposure to pesticides is for
X captafol
agricultural workers during handling, dilution,
mixing and application. Exposure is mainly by the X ethylene dibromide
dermal route for preparation of sprays and by the X formaldehyde
A global review
numbers are 3,000,000 hospitalised acute poi-

it is estimated that sonings, 25,000,000 less severe poisonings (not
385 million cases

requiring hospitalisation), and around 300,000
deaths from all types of poisoning per year (Jørs
et al. 2018). In terms of fatal self-poisonings, a sys-
of unintentional, acute tematic review showed that 110,000 to 168,000
pesticide poisoning (UAPP) deaths occur globally every year due to pesticides,
representing up to 20 per cent of global suicides
occur annually world-wide (Mew et al. 2017).
A systematic review of data published between
2006 and 2018, supplemented by mortality data
from WHO, found that there were approximately
740,000 annual cases of unintentional, acute
44% pesticide poisoning (UAPP), with 7,446 fatalities

and 733,921 non-fatal cases. On this basis, it is
of farmers are estimated that 385 million cases of UAPP occur
poisoned by annually world-wide including 11,000 fatalities.
These figures indicate that around 44 per cent
pesticides every year of farmers are poisoned by pesticides every year
(Boedeker 2020). As such, acute pesticide poi-
soning represents a major current global health
crisis. There is an urgent need to recognize the
In the Agricultural Health Study, a prospective high burden of non-fatal acute pesticide poi-
cohort study of over 89,000 farmers, cancer ex- soning, as the current focus only on fatalities
cesses were observed for prostate cancer, lip hampers international efforts in risk assessment
cancer, lymphomas, leukemia, thyroid cancer, and prevention of poisoning.
testicular cancer and peritoneal cancer among Acute and chronic neurotoxic effects have also
farmers exposed to pesticides (Lerro et al. 2019). A been increasingly associated with pesticides ex-
pooled analysis of non-Hodgkin Lymphoid (NHL) posure. A meta-analysis of 104 studies showed
malignancies by the AGRICOH Consortium that that exposure to paraquat (herbicide) or maneb/
included more than 316,270 farmers, showed el- mancozeb (fungicide) was associated with about
evated hazard ratios for NHL and use of terbufos; a 2-fold increase in risk of Parkinson Disease
chronic lymphocytic leukaemia/small lympho-
(Pezzoli and Cereda 2013). A systematic review
cytic lymphoma and deltamethrin; and diffuse
and meta-analysis showed a positive association
large B-cell lymphoma and glyphosate (Leon et al.
between pesticide exposure and Alzheimer’s
2019). A meta-analysis reported that the overall
disease (Yan et al. 2016). Organophosphates (in-
risk of NHL in individuals exposed to glypho-
secticides or herbicides) exposure have been
sate-based herbicides was increased by 41 per
associated with acute and chronic neurotoxicity,
cent. Animal studies also showed an association
cognitive impairment and depression (Freire and
between pure glyphosate and malignant lym-
Koifman 2013; Muñoz-Quezada et al. 2016). As de-
phoma (Zhang et al. 2019). Another systematic
scribed in previous chapters, pesticides can also
review showed that herbicide exposure and ag-
act as endocrine disruptors, in particular organo-
ricultural exposure to pesticides was associated
phosphate pesticides (Trasande et al. 2016; Attina
with an increased risk of thyroid cancer (Han, Kim,
et al. 2016).
and Song 2019).
Other health outcomes Regional trends

The incidence of pesticide poisonings among It is estimated that LMICs account for about 70
agricultural workers varies in accordance with per cent of worldwide HHP use, i.e. over 1.2 mil-
spraying circumstances. However, various global lion tonnes in 2017 (Public Eye 2020). The greatest
estimates on incidence of pesticide poison- number of unintentional acute pesticide poi-
ings have been made, and the most often cited soning cases is in southern Asia, followed by
Pesticides
X Case study: Occupational exposure to pesticides and resultant health problems among
cotton farmers of Punjab, Pakistan
Cotton is an important cash crop for Pakistan, but the amount of pesticides used in
crop production in Pakistan has increased rapidly in the recent years. At the same
time, farmers are unaware of the hazard and how to prevent exposure. A study
including 318 randomly selected male cotton farmers was conducted in 2008, as-
sessing exposure to pesticides and self-reported health problems. A quarter of the
participants did not know how to read and write. Based on WHO´s classification,
23 per cent of the amount of pesticides used (assessed as kg of active ingredient)
belonged to the category ‘highly hazardous’, and 55 per cent to the category of
‘moderately hazardous’. Common high exposure risks included: pesticide spills in
the stage of spray solution preparation (76 per cent), the use of low-technology and
faulty sprayers (68 per cent) and spraying in inappropriate weather (47 per cent).
More than a third of the farmers reported multiple symptoms caused by pesticide
use, where the most common were irritation of skin and eyes, headache and dizzi-
ness. It is worth noting that most farmers thought these symptoms were nothing out
of the ordinary and that few reported visiting the doctor (Khan and Damalas 2015).
south-eastern Asia and east Africa with regards East and Southeast Asia (FAO 2011). Data related
to non-fatal UAPP (Boedeker 2020). The propor- to gender aspects of pesticide use is incom-
tion of pesticide self-poisoning varies consider- plete and results inconsistent, partly because
ably between regions, from 0.9 per cent in LMICs of country differences due to cultural and social
in the European region to 48.3 per cent in LMICs norms, educational levels and awareness. For
in the Western Pacific region (Mew et al. 2017). example, it was noted that South African women
Since the 1960s, when pesticides were intro- farmers were on average as responsible for
duced into small-scale farming, an estimated spraying on their farms as men, and that women
14 million premature deaths have resulted carry out the bulk of spraying on oil palm plan-
from pesticide self-poisoning and over 95 per tations in Indonesia, but that male farmers were
cent of these deaths have occurred in LMICs much more likely to use pesticides in smallholder
(WHO/FAO 2019). rice production in northern Ghana (UNEP 2018).
There are also gender differences in exposures
The role of gender to pesticides other than during application in
tasks typically carried out by women, such as
The gender balance of agricultural work force during cotton picking, weeding and thinning
varies between regions. One estimate is that sprayed crops, picking tea leaves, washing out
women on average make up 40 per cent of agri- pesticide containers or washing pesticide-con-
cultural workers in LMICs, ranging from about 20 taminated clothing (Memon et al. 2019; Tsimbiri
per cent in Latin America to 50 per cent in Africa, et al. 2015).
SECTORS PRIMARY HEALTH GLOBAL BURDEN OF WORK-RELATED

Agriculture, Poisoning Limited Data (although >300,000 deaths

plantations, other presumably a majority of annually due to
Cancer
rural sectors global agricultural workers pesticide poisoning
Neurotoxicity (1.8 billion) exposed) (Jørs at al. 2018),
Chemical industries (Carvalho 2017) with >10,000
Endocrine disruption
fatalities due to
unintentional acute
pesticide poisoning
(Boedecker 2020).
A global review
There is an urgent need to phase out all HHPs, starting from the
Phasing out HHPs most toxic ones, in order to prevent deaths caused by exposure. The
has reduced introduction of regulations to control the use of HHPs in high-income
countries has saved innumerous lives, and mortality rates for acute
mortality rates poisoning are dramatically lower than in LMICs (WHO/FAO 2019).
X Selected priority actions: Pesticides

Refer to, and ratify/implement the following conventions/codes:
X ILO Safety and Health in Agriculture Convention, 2001 (No. 184). This Convention prescribes standards on
the safe use of chemicals used in agriculture, including pesticides.
X Stockholm Convention on Persistent Organic Pollutants. The Convention aims to eliminate or restrict the
production and use of persistent organic pollutants (POPs)
X Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and
Pesticides in International Trade. The Rotterdam Convention is a multilateral treaty to promote shared respon-
sibilities in relation to the importation of hazardous chemicals.
X FAO and WHO International Code of Conduct on Pesticide Management. Key provisions:
- Avoid using pesticides whose handling and application require the use of PPE that is uncomfortable, expen-
sive or not readily available.
- Collect reliable data and maintain statistics on health effects of pesticides and pesticide poisoning incidents
- Introduce the necessary policy and legislation for the regulation of pesticides, their marketing and use
throughout their life-cycle, and make provisions for its effective coordination and enforcement.
- Consider prohibiting the importation, distribution, sale and purchase of HHPs, if risk mitigation measures or
good marketing practices are insufficient to ensure that the product can be handled without unacceptable
risk to humans and the environment.
X Finalize the harmonized list of HHPs from the already advanced drafts in existence.
X Strengthen international support for LMICs to develop, adopt and implement legally binding instruments to
control HHPs in order to prevent worker exposure.
X Combat illegal trafficking of illicit pesticides.
X Enhance resources and capacities for treatment of existing HHP stockpiles at the workplace and HHP contam-
inated sites.
X Implement GHS to classify and label HHPs and effectively communicate hazards, without requiring workers to
read warning text. Train workers on GHS interpretation.
X Promote integrated pest management (IPM) and integrated vector management (IVM) through investment in
training, communication and further research, and monitoring of their effectiveness.
X Improve the availability and distribution of low-risk biological alternatives.
X Use good agricultural practice schemes and other non-regulatory options to promote substitution of HHPs by
pest management approaches and products that pose less risk.
X Consider using financial incentives (e.g. subsidy or taxation instruments) to favour low risk products, such as
biological control agents and most biopesticides, over high risk products.
X Update, implement and enforce OELs for HHPs and ensure global harmonization of these OELs.
X Start with elimination, which involves using biological controls and plant-based fertilisers and also techniques
such as crop covering. Also prioritise substitution using less toxic pesticides.
X Apply engineering controls where possible, specifically for less toxic pesticides. These include nozzle placement,
droplet size, equipment calibration, baffles, deflectors, air induction nozzles and tree-sensing technology.
X Introduce preventive occupational measures, including farmer training on IPM with good agricultural practices
and greater use of ecologic alternatives. These have proven effective not only at reducing the number of poi-
sonings but, in some cases, also in increasing profits.
X Promote communication and awareness-raising efforts to train workers in contact with HHPs about the health
hazard. This should include how to safely handle both HHPs and contaminated equipment, the risk of spray drift
to nearby waterways and communities, and the risk of exposure when handling crops sprayed with pesticides.
X Introduce procedures to limit environmental exposure, for example, managing the timing of application and
introducing buffer zone.
X Ensure availability of appropriate PPE and application equipment.
Sources include: FAO and WHO 2016, Weinberg et al. 2009

Workplace air pollution
© Unsplash / Brett Jordan
Workplace air pollution estimates that 860,000 deaths a year can be

attributed to occupational exposure to air
pollutants, although the real magnitude of
X Although not often considered an occupational
the health impacts on workplace air pollu-
exposure, pollution of air at the workplace,
tion is likely to be much higher.
either indoors in the work premises or during
work outdoors, can cause a range of acute and X Health impacts caused by air pollution may
chronic health impacts, and can be prevented. differ between women and men, most likely
due to an interplay between biological and gen-
X The most common pollutants considered in
der-related factors.
air pollution estimates include fine (PM2.5)
and course (PM10) particulate matter, ozone,
nitrogen dioxide (NO2), and sulfur dioxide
(SO2). Other air pollutants that can be impor-
tant for specific health issues and that are less
frequently considered in air pollution estimates
include benzene, formaldehyde or carbon
monoxide.
X Air pollution, particulate matter and diesel ex-

haust have been classified by IARC as carcino-
genic to humans (Group 1). Air pollution has Air pollution,
also been linked to to a wide range of diseases
in several organ systems such as cardiovas-
particulate matter
cular and pulmonary disease. and diesel exhaust
have been classified by IARC as
X Globally, over 1.2 billion workers spend most
of their working hours outdoors, at risk for carcinogenic
exposure to outdoor air pollution. The WHO
to humans
A global review
Exposure approximately 6 per cent of annual lung cancer

deaths in these workers may be due to diesel ex-
Workers across all economic sectors and haust exposure (Vermeulen et al. 2014). Smaller
throughout the supply chain are constantly ex- particles (PM0.1) have also been associated with
posed to air pollution, from when they commute a higher incidence of cancers, including in organs
to work to their workplaces. Worldwide at least other than lungs, such as brain and breast
1.2 billion workers work outdoors for a majority (Weichenthal et al. 2020) (Goldberg et al. 2018).
of their work time (WHO 2018c). Higher exposures
are observed for outdoor workers in areas with
high levels of air pollution generated by heavy
traffic or industries. Level of exposures are in PM2.5 is the best studied form of air pollution
general higher in LMIC megacities and industrial and is linked to a wide range of diseases in sev-
areas (Chen 2020). Dramatic air pollution reduc- eral organ systems. The strongest causal asso-
tions observed in China and in other countries fol- ciations are seen between PM2.5 pollution and
lowing COVID-19 related lockdowns clearly show cardiovascular and pulmonary disease. A cohort
how industrial operations and commuting affect study on 176,309 construction workers showed
air pollution and related deaths (Chen 2020). that occupational exposure to particulate air
pollution, especially diesel exhaust, increases
Occupational exposure to indoor air pollution is the risk for ischaemic heart disease (Torén et al.
also a major risk for workers. Indoor air pollution 2007). Increased risk of COPD was also observed
can be caused by chemicals, gases, fumes, aero- in diesel exhaust exposed workers (Doney et al.
sols, particles and other substances. It is particu- 2019). When compared to larger particles, smaller
larly common in sectors that include processes particulate matter (PM0.1) tends to have more
such as burning, cleaning or internal combus- detrimental effects, and exposure has been pro-
tion. In the absence of good ventilation, indoor posed to play an important role in cardiovascular
air pollutants can be more concentrated, putting health (Downward et al. 2018). Global Burden
workers at higher risk for harmful levels of expo- of Disease estimates performed by the Lancet
sure (WHO 2018). Commission on Pollution and Health attributes
In 2016, 91 per cent of the world’s population 4,200,000 deaths per year due to outdoor air pol-
was living and working in places where the WHO lution alone (Landrigan et al. 2018).
standards for air quality were not met (WHO WHO estimates that health effects of occupa-
2016a). Considering there are over 3.3 billion tional exposure to selected air pollutants at the
workers in the world (ILO 2020d), it is possible workplace can cause more than 860,000 deaths
that as many as 3 billion workers were living and a year (WHO 2018c), although the real magnitude
working in places where the air quality was below of the health impacts on workplace air pollution
WHO standards. is likely to be much higher. It is difficult to quan-
tify the GBD given the potential for concomitant
Health effects exposures, as well as the diversity of air pollut-
ants and occupational exposure scenarios across
workplaces, tasks and sectors (WHO 2018).
Cancer
Air pollution has been classified by IARC as car- Regional trends
cinogenic to humans (Group 1). According to IARC
there is sufficient evidence that air pollution can LMICs are the most affected by air pollution. In
cause cancer of the lung (IARC 2013b). Particulate fact, 89 per cent of deaths due to ambient air pol-
matter, a major component of outdoor air pollution occurred in LMICs (Landrigan et al. 2018).
lution, has also been classified by IARC as car- Several cities in India and China record average
cinogenic to humans (Group 1) (IARC 2013b). For annual concentrations of PM2.5 pollution of
lung cancer alone, air pollution causes 223,000 greater than 100 μg/m³, and more than 50 per
deaths/year worldwide (IARC 2013a, 2015). In cent of global deaths due to ambient air pollution
addition, diesel exhaust has been classified by in 2015 occurred in India and China. According to
IARC as carcinogenic to humans (Group 1) (IARC WHO, 98 per cent of urban areas in developing
2013c). Exposure-response estimates for workers countries with populations of more than 100,000
in the trucking industry and in miners show that people fail to meet the WHO global air quality
Workplace air pollution
X Figure 8. Air pollution levels and avoided cause-specific deaths during the COVID-19 outbreak in China
Reduction in cause-speciﬁc deaths (95% CI)

Jan 5–20, 2020 Feb 10–March 14, 2020
9000
6000
3000
3000
Mean tropospheric nitrogen dioxide column density (µ2)mol/m Nitrogendioxide PM2·5
0 50 100 150 200 250 300 350 400 450 ≥ 500 Hypertensive disease
Coronary heart disease
Stroke
Chronic obstructive pulmonary disease
Other diseases
Source (Chen 2020).
guideline for PM2.5 pollution of 10 μg/m³ of am- biological differences such as hormonal status,
bient air annually (WHO 2020). lung volume and body size or gender differences
in exposure such as activity patterns, smoking
behaviours and occupational roles is unknown,
The role of gender
but an interplay between the two is likely. While
The role of gender in air pollution and respira- results of studies vary, more studies on adults
tory health is emerging through growing epi- indicate stronger effects among women and
demiologic evidence that exposure and health studies of children suggest stronger effects
impacts may differ between women and men among boys in early life and among girls in later
(Cloughert y 2010). Whether this is due to childhood.
X Case study: Workers’ exposure to air pollutants during commuting in London - Are there
inequalities among different socio-economic groups?
Low income workers often experience higher exposures to air pollutants. Exposure
to particulate matter (PM1, PM2.5 and PM10), black carbon (BC) and ultrafine particles
(PNCs; 0.02–1 μm) for typical commutes by car, bus and underground from four London
areas with different levels of income deprivation was compared (G1 to G4, from most
to least deprived). The highest BC and PM concentrations were found in G1while the
highest PNC was in G3. Workers from less income-deprived areas have a predominant
use of cars, receiving the lowest doses during commute, but generating the largest
emissions per commuter. Conversely, workers from high income-deprived areas have
a major reliance on the bus, receiving higher exposures, while generating less emission
per person. These findings suggest an aspect of environmental injustice and a need to
incorporate the socioeconomic dimension in air pollution exposure assessments.

Cancer (lung) >1.2 billion (WHO 2018c) >860,000 deaths annually

All sectors
(WHO 2018c)
Respiratory disease
Cardiovascular disease
A global review
X Occupational exposure to outdoor air pollution

Occupational exposure to outdoor air pollution is a particular concern, because the exposed population is large
and conventional measures for engineering controls of workplace hazards, such as hazard elimination, encapsu-
lation and ventilation are not always applicable to the outdoor environment. Employers and workers themselves
may have little or no control over the sources of outdoor air pollution. Air pollution control in the world of work
would enhance employment, decent work for all and social protection (SDG 8) and slow the pace of climate
change (SDG 13) by transitioning to a sustainable, circular economy that relies on efficient industrial processes.
X Selected priority actions: Workplace air pollution

X Develop national laws or regulations that prescribe that measures to be taken for the prevention and control
of, and protection against, occupational hazards in the working environment due to air pollution. Air pollution
regulation to eliminate the source of pollutant release represents a priority and requires coordinated interna-
tional and national regulation.
X Ratify and implement the ILO Protection of Workers against Occupational Hazards in the Working
Environment Due to Air Pollution, Noise and Vibration Convention, 1977 (No. 148). Key provisions:
- Establish criteria for determining the hazards of exposure to workplace air pollution and specify exposure
limits on the basis of these criteria
- Eliminate any hazards due to air pollution in the working environment, by technical measures applied to
new plant or processes in design or installation, or added to existing plant or processes; or, where this is not
possible, by supplementary organisational measures.
X Promote the creation of green jobs, reduce the use of solid fuels in work processes and the move to cleaner and
more sustainable energy sources and processes.
X Implement guidelines at the national and local level to release warnings that reduce or stop work outdoors in
periods of severe air pollution.
X Raise awareness of employers and workers about ambient air pollution and their responsibility for occupational
health and safety.
X Recognise exposure to ambient air pollution while working outdoors as an OSH issue and use OSH regulations
and standards to provide protection of workers.
X Provide toolkits and programmes for engaging businesses and workplaces in prevention and control of air
pollution, for example by avoiding open air incineration and controlling other sources of air pollution at the
workplace.
X Engage with private sector, businesses and workplace undertakings for preventing emissions of air pollution
and improving their overall environmental performance.
X Stimulate initiatives combing occupational safety and health, environmental protection and green workplaces
and technological transfer and innovations to prevent ambient and workplace air pollution.
X Update, implement and enforce OELs for air pollution and ensure global harmonisation of these OELs.
X Air quality standards and OELs have been established for a large number of workplace air pollutants by organ-
izations and national committees. The international chemical safety data cards (ICSCs), developed by WHO and
ILO, contain references to the available standards for occupational exposure to more than 1700 substances.
X Reduce the exposure, through spending less working time outdoors, rotating workers and restricting work
during episodes of severe air pollution, including dust storms.
X Provide respiratory protection programmes, including appropriate respirators, fit testing and training of
workers.
X Implement medical surveillance of workers, which should include medical check-ups for underlying health con-
ditions that can worsen with exposure to air pollution, for example asthma, COPD and cardiovascular diseases,
such as heart attack and stroke.
X Carry out health surveillance of the working environment and record levels of air pollution from the municipal
sources.
X Report cases of occupational diseases that can be caused by ambient air pollution among exposed workers
(asthma, chronic obstructive pulmonary disease, lung cancer) and follow up with the employment injury scheme.
X Design programs for effective medical surveillance of workers, including medical check-ups for underlying
health conditions that can with exposure to air pollution.
Sources include: WHO 2018c

65
X Priority action areas
Based on the priorities that emerged in the review, a number of actions have been identified that can help promote safer
chemicals management within the world of work and beyond. Priority areas have been divided into:
National level action
Workplace level action
Research priorities
Social dialogue
The actions are proposed as a working foundation to stimulate future discussions and are not meant to be exhaustive
or apply to every situation.
National level action
Implement a national OSH system for the sound management of chemicals

A strong national OSH system is critical for the effective implementation of policies and programmes on OSH and the
sound management of chemicals, both at the national and workplace level. ILO instruments on OSH and chemical
safety (described below) provide a legal framework for managing risks posed by chemicals in the world of work and
should be ratified and implemented as a priority action. A coherent and effective method is to use a management
systems approach, based on the general ILO principles of these OSH instruments, as well as the ILO Guidelines on
occupational safety and health management systems (ILO–OSH 2001), in promoting the sound management of
chemicals throughout their life cycle.
Such a national policy framework should aim at the continuous harmonisation, integration and improvement of
preventive and protective OSH measures, management systems and tools and capacity building, encompassing
both the workplace and the environment. This includes effective labour inspection services provided with the means,
qualifications and training to fulfil their duties.
As per the ILO Promotional Framework for Occupational Safety and Health Convention, 2006 (No. 187) and its accom-
panying recommendation (No. 197), a national system for OSH:
Should include: Should also include, where appropriate:
X Laws and regulation, collective agree- X A national tripartite advisory body, or bodies, addressing OSH
ments where appropriate and any issues related to chemicals.
other relevant instruments on OSH X Information and advisory services on OSH measures regarding
pertaining to the sound management chemicals.
of chemicals.
X The provision of OSH training regarding the sound management
X An authority or body, or authorities or of chemicals.
bodies, responsible for OSH of chem-
icals, designated in accordance with X Occupational health services for workers exposed to chemicals, in
national law and practice. accordance with national law and practice.
X Mechanisms for ensuring compliance X Research on OSH for chemicals exposures.
with national laws and regulations X A mechanism for the collection and analysis of data on occupa-
regarding chemical management, in- tional injuries and diseases related to chemical exposures, taking
cluding systems of inspection. into account relevant ILO instruments.
X Arrangements to promote, at the X Provisions for collaboration with relevant insurance or social se-
level of undertaking, cooperation curity schemes covering occupational injuries and diseases from
between management, workers and chemical exposures.
their representatives, as an essential
X Support mechanisms for a progressive improvement of occupa-
element of workplace-related preven-
tional safety and health conditions for enterprises using chemicals,
tion measures for the sound manage-
including micro-enterprises, small and medium-sized enterprises
ment of chemicals.
and the informal economy.
A global review
X Promoting a national preventative safety and health culture

Building, implementing and continuously strengthening a preventative safety and health culture is essential for
improving safety in the workplace and minimizing any adverse impacts of chemical exposure. Actions taken at
the national level to develop a preventative culture must also be applied at the workplace level.
Ratify and implement International Labour Standards on OSH

States have the duty to ensure that the fundamental principles and rights at work and ratified international labour
standards protect and are applied to all workers. The ILO conventions as well as their accompanying recommenda-
tions have their own unique range of application in the field of OSH, which is not covered by any other international
instruments on chemicals. These standards can allow countries to develop their own legislative and regulatory frame-
work on chemical safety in the world of work. In the last 100 years, the ILO has adopted more than 50 legal instru-
ments on the protection of workers, as well as the public and the environment, from chemical hazards.
Main ILO Conventions on chemicals in the world of work
X Chemicals Convention, 1990 (No. 170)

X Prevention of Major Industrial Accidents Convention, 1993 (No. 174)
Risk specific Conventions
X Benzene Convention, 1971 (No. 136)*

X Occupational Cancer Convention, 1974 (No. 139)
X Working Environment Convention, 1977 (No. 148)
X Asbestos Convention, 1986 (No. 162)
Instruments dealing with the fundamental OSH principles that provide a framework for risk management,
including chemical risks
X Occupational Safety and Health Convention, 1981 (No. 155)

X Promotional Framework for Occupational Safety and Health Convention, 2006 (No. 187)
X Occupational Health Services Convention, 1985 (No. 161)
X List of Occupational Diseases Recommendation, 2002 (No. 194)
* Requiring further action to ensure continued and future relevance, as determined by the Governing Body upon recommendation of the
SRM TWG in 2017
Tackling Carcinogenic Chemicals: The Occupational Cancer Convention, 1974 (No. 139), provides for the
measures to be taken for the control and prevention of occupational hazards caused by carcinogenic substances
and agents. Key provisions include:
X periodically determining the carcinogenic substances and agents to which occupational exposure shall be
prohibited or made subject to authorisation or control;
X making every effort to have carcinogenic substances and agents to which workers may be exposed in the
course of their work replaced by non-carcinogenic substances or agents or by less harmful substances or
agents;
X reducing the number of workers exposed to carcinogenic substances or agents and the duration and degree
of such exposure to the minimum.
Improve recognition of occupational diseases caused by chemicals

The absence of reliable information about the incidence of occupational accidents and disease related to chemical ex-
posures is a major obstacle towards the design of effective policy responses. One mechanism that can ameliorate the
collection of data and statistics on occupational exposures and resulting disease is the implementation of a national
Occupational Disease List. The ILO List of Occupational Diseases (revised 2010) represents the latest worldwide con-
sensus on diseases which are internationally accepted as caused by work. It was designed to assist stakeholders in the
X Priority action areas 67
identification and recognition of occupational diseases, including those caused by chemical substances. Section No. 1.1
of the Annex lists 40 different chemical substances and groups of substances, of which exposure to can cause disease.
Implement the Globally Harmonized System of Classification and Labelling of Chemicals (GHS)
The GHS is an internationally-agreed upon system to standardise hazard information of chemicals through labels and
safety data sheets. Correct classification and labelling, as well as comprehensive worker training, can help improve
OSH and workplace safety systems. Appropriate handling, use and storage of hazardous substances can in turn
contribute to preventing hazardous exposures, as well as major industrial accidents. Social partners have supported
global implementation of GHS as a way to share safety and health information to prevent workers’ exposures to
hazardous substances.
Develop, update and harmonise evidence-based Occupational Exposure Limits (OELs)

Chemical safety at the workplace can no longer afford Occupational exposure limits (OELs) are regulatory values
which indicate levels of exposure that are considered safe for a chemical substance in a workplace. Unfortunately,
OELs do not exist for many chemicals and those that do exist are often outdated. There is also a lack of harmonised
data between different countries and safety bodies. Whilst databases of OELs provide valuable information on nu-
merous chemical exposures, keeping these lists updated and relevant is a huge task. Suggested actions include:
X Create a priority system for OELs, to focus on those that do not exist or need to be updated
X Ensure that OELs are easily understandable and accessible
X Consider all potential health hazards, rather than only acknowledging single health effects
X Develop an approach covering all chemicals in the workplace, rather than focusing on individual chemicals only
X Produce and implement harmonised international guidelines for OELs
X Promote OELs on an international level with policy makers and industry representatives to ensure that OELs are enforced
X Update key OELs on a systematic basis to reflect advancements in science and technology
Mainstream gender into OSH policy and practice

Chemical safety in the workplace can no longer afford to be gender-blind, and it is essential that inclusive and responsive
gender-sensitive OSH policies are developed. The ILO Maternity Protection Convention (No. 183) and accompanying
Recommendation (No.191) set out that pregnant women should not be obliged to carry out work that is a risk to her
or her child and provides for specific risk assessment concerning pregnant women, including chemical agents which
represent a reproductive hazard. The ILO has also developed Guidelines for Gender Mainstreaming in Occupational
Safety and Health to assist policy-makers and practitioners in taking a gender-sensitive approach for the development
and implementation of OSH policy and practice.
Workplace level action
Implement a workplace programme for the sound management of chemicals

The ILO recommends that the following components are used as a general blueprint for the sound management of
chemicals in the workplace. As always, national guidelines should be considered in the first instance.
Elements of the programme Components
General obligations, responsibil- X Role of the competent authority; responsibilities and duties of employers,
ities and duties workers, and suppliers
X Rights of workers
Classification and Labelling X Criteria for classification of hazards
following the GHS X Methods for classification
X Type of labelling on containers of hazardous chemicals
Chemical Safety Data Sheets X Provision of information and training
X Content of safety data sheet
Operational Control Measures X Assessment of control needs and elimination of hazards
X Control measures for: health hazards; flammable, dangerously reactive
or explosive chemicals; disposal and treatment of chemicals, and so forth
as appropriate
A global review
Design and Installation X Enclosed systems where feasible

X Separate areas for hazardous processes to limit exposures
X Practices and equipment that minimize releases
X Local exhaust ventilation and general ventilation, as appropriate
Work Systems and Practices X Administrative controls
X Cleaning and maintenance of control equipment
X Provision of safe storage for hazardous chemicals
Personal Protection X Personal protective equipment
X Welfare facilities and personal hygiene
X Practices to maintain equipment and clothing as necessary
X Training on personal protection
Information and Training X Workers should be provided information (labels and safety data sheets),
and be trained how to handle them safely, what to do in an emergency,
and how to obtain additional information
Maintenance of Engineering X Practices and procedures to keep engineering controls in good working
Controls order
Exposure Monitoring X Measuring methods
X Monitoring strategy and appropriate recordkeeping
X Interpretation and application of data
Medical and Health Surveillance X Medical exams as necessary and appropriate recordkeeping
X Use of results to evaluate program
Emergency Procedures and First X Planning should be done to anticipate possible emergencies, and have
Aid procedures to deal with them
X First aid should be available on-site
Investigation and Reporting X All incidents should be investigated to determine why they occurred, what
of Accidents, Occupational failed in the workplace or in the emergency plan
Diseases and Other Incidents X Authorities should be notified as required by national laws
Implement a workplace level strategy

The overall strategy to achieve the sound management of chemicals in the workplace and in protecting
the general environment can be simply described in three steps:
Identification of
Identification of
chemicals
control masures based
Classification of on risk assessment
hazards/labels and
Implementation of
safety data sheets
controls; evaluation of
STEP 2 effectiveness; and
maintenance of level
STEP 1 of protection
Determination of
potential exposures in
the workplace
STEP 3
Risk assessment
1. The first step is to identify what chemicals are present; classify them as to their health, physical, and environmental
hazards; and prepare labels and safety data sheets to convey the hazards and associated protective measures.
Without such information on chemicals in the workplace, or released to the environment, it is not possible to go
farther in terms of an evaluation of impact, and determination of appropriate preventive measures and controls.
Information provides the underlying structure needed to achieve the sound management of chemicals.
2. The second step is to evaluate how the identified and classified chemicals are used in the workplace, and
what exposures can result from this use. This may be accomplished through exposure monitoring, or through
application of tools that allow for estimation of exposures based on factors regarding the quantity used, the
potential for release given the conditions in the workplace or facility, and physical characteristics of the chemical.
3. Once the hazards have been identified, classified, communicated, and their risk has been assessed, the third
step is to use this information to design an appropriate preventive and protective programme for the workplace,
using the Hierarchy of Controls (below). Other provisions of a thorough program that support and enhance
these controls are exposure monitoring; information and training for exposed workers; recordkeeping; medical
surveillance; emergency planning; and disposal procedures.
X Simple and accessible OSH strategies for MSMEs

The industrial fabric across the globe is mainly made of micro-, small, and medium-sized enterprises (MSMEs).
There is a need to support MSMEs to conduct chemical risks assessments and to implement prevention measures
in a practical way. This relies on data sharing and the emergence of an open source information on chemicals
(e.g. GHS). More information on improving OSH in MSMEs can be found here.
Apply the Hierarchy of Controls

The Hierarchy of Controls is a system used to eliminate or minimise exposure to occupational hazards, such as chem-
icals. There are five categories in the hierarchy, with control methods at the top of the hierarchy potentially more
effective than those at the bottom:
More effective Elimination

Physically remove the hazard
Substitution
Replace the hazard
Engineering Controls
Isolate workers from the hazard
Administrative
Controls
Change the way work is performed
PPE
Protect the worker
with PPE,
as the last resort
Less effective
Most effective
e.g. Eliminate the use of mercury in artisanal and small-scale

Physically remove
Elimination gold mining. Consider alternative methods such as panning,
the chemical
sluicing or spiral concentrators
Replace the e.g. Substitute toxic pesticides such as paraquat and neonicoti-
Substitution
chemical noids for less toxic versions, such as biopesticides
e.g. Use a suitable local exhaust ventilation (LEV) to remove

Engineering Isolate workers
chemical fumes at source and ensure there is adequate room
Controls from the chemical
ventilation
e.g. Adjust work tasks or schedules to limit the time workers are
Administrative Change the way
exposed to chemicals and create written operating procedures
Controls work is performed
on handling hazardous substances
Least effective
Personal e.g. Workers should wear appropriate PPE, depending on the

Protect the worker
Protective chemical and the work tasks. These may include gloves, overalls,
with PPE, as the
Equipment masks with filters, and safety glasses, as deemed relevant by risk
last resort
(PPE) assessment
Elimination and substitution should be considered priority actions where possible. PPE should be only be used as
a last resort. When necessary, employers should make available, free of charge, a range of appropriate PPE that is
designed to effectively protect workers of all body types, including physiological differences between genders. When
clothing is contaminated it should be changed promptly to avoid absorption through the skin.
A global review
X Workplace monitoring for chemical hazards

Only selected chemical occupational exposures are considered, monitored and regulated in workplaces. It is
of paramount importance that monitoring and epidemiological surveillance in workplaces for hazardous sub-
stances is extended, starting from the over 200 substances classified as known or probable carcinogens by IARC,
that are mostly occupational carcinogens.
Research priorities
Increase research and harmonise global OSH data, specifically for LMICs and informal
sector
For the great majority of chemical exposures, data is not available and the number of workers exposed cannot be
even estimated because of the lack of such data (both locally and globally). As such, there is an urgent need for
increased research and harmonised global data repositories of chemical exposure information and related health
effects amongst workers. Moreover, whilst some evidence does exist for HICs, there is a there is a general lack of
data from LMICs. This includes studies about informal economy workers, who are at high risk of hazardous chemical
exposures. Due to the nature of the work, workplace protections are often limited and there is minimal adherence
to OSH regulations and general safety culture.
Strengthen Global Burden of Disease (GBD) estimates for occupational exposures and
outcomes
Due to the lack of information on chemical exposure of workers and relative outcomes (death, cancer, etc.), GBD
calculations are mainly missing or are severely underestimated. Enhanced data on economic costs to society
would promote stronger policy responses. When sufficient data are available, initiatives such as the WHO-ILO Joint
Methodology to produce systematic reviews on occupational exposures and risk factors are necessary to provide
the evidence-base to produce reliable estimates of the GBD.
Increase research on Non-Communicable Diseases (NCDs)

Cancer is still the main cause of work-related death, however more efforts should be made to retrieve additional data
on other NCDs that might be caused by occupational chemical exposures. Debilitating lung diseases, neurological
disabilities and reproductive impairments, such as infertility, are among various other health impacts that continue
to affect workers and their families.
Examine interlinkages with chemicals and infectious disease

Chemical exposures in workers are not only capable of causing NCDs, but also of increasing the incidence and risks
related to infectious diseases. At the same time, infectious diseases can qualitatively and quantitatively affect occupa-
tional chemical exposures, particularly in chemical industries, together with the implementation of safety procedures
and protections for workers. The COVID-19 pandemic highlighted the importance of this interplay, as exemplified by
the increased COVID-19 mortality associated with air pollution. Further research is required to explore how chemical
exposures may affect the onset and progress of infectious diseases.
Enhance the science-policy interface for OSH

Increased evidence is needed to support the implementation of regulations that take into account multiple occupa-
tional exposures, non-linear responses (particularly for endocrine disrupting chemicals) and windows of increased
susceptibility, such as pregnancy and development periods in childhood. Further research is needed to integrate
and translate toxicological evidence for workers’ protection and prevention and in general to strengthen the sci-
ence-policy interface in this respect. Developing a robust, two-way science-policy interface as part of the global
efforts for the sound management of chemicals represents a priority for the work of world.
Raise awareness of gender inequalities and impacts on reproductive health

Efforts are also needed on a global level to generate gender disaggregated data to identify and prevent exposures
that are magnified by gender factors, as well as impacts that are increased due to biological factors. Gender disaggre-
gated data can provide the critical foundation for evidence-based policy efforts at both the national and workplace
level. Raising awareness of the impact to women of reproductive age, pregnant and lactating women, as populations
specifically sensitive to the health effects of chemical exposures, can create important opportunities for training and
sharing of good practices (IPEN 2020).
Collect model policies, best practices and lessons learned

It is important to remember that some countries and stakeholders have already successfully implemented best
practices for the sound management of chemicals in the workplace. Given the global inequalities that exist when it
comes to OSH systems and safe chemicals management, it would be essential to collect examples of model policies
and apply the lessons learned in sectors and geographical areas which would benefit from them. Conducting this
type of policy research, and increased social dialogue (discussed below) among stakeholders to share model policies,
best practices and lessons learned marks a priority action for the future.
Social dialogue
Promote social dialogue at all levels

Social dialogue includes all types of negotiation and consultation between, or among, representatives of govern-
ments, employers and workers, on issues of common interest. The main goal of social dialogue itself is to promote
consensus building and democratic involvement among the main stakeholders in the world of work. Successful social
dialogue structures and processes have the potential to resolve important economic and social issues, encourage
good governance, advance social and industrial stability, and boost economic progress.
The extent of national-level social dialogue within the chemicals industries and throughout sectors using chemicals
varies from country to country. Nevertheless, employers and workers in the chemical industries, and governments,
have recognized the importance of social dialogue to help create an enabling environment to ensure safe, healthy,
decent and productive work (ILO, 2013). Social dialogue in the chemicals sector can increase profits by leading to
greater productivity and enhanced worker satisfaction (ILO, 2006). While examples and case studies of social dia-
logue in the chemicals industries have previously been reported there is a need to expand the scope of social dialogue
to additional sectors using chemicals and to further promote the exchange of information at levels.
Enhance sound governance frameworks

The sound management of chemicals requires effective governance through transparency, public participation, and
accountability among the world of work stakeholders and specifically governments, employers' organisations and
workers' organisations. Making better use of social dialogue is important in order to improve legislation and its im-
plementation. This includes effective labour inspection provided for with adequate means and conducted by suitably
qualified and trained inspectors. The active participation of employers’ and workers’ organisations is essential for
the development of national policies and programmes for the management of chemicals as well as its governance.
X Employers have a duty to take preventive and protective measures, through assessment and control of the risks
at work, including to those related to chemical exposures. They also can promote sound governance frameworks
at the national and workplace levels.
X Workers and their organisations have a right to be involved at all levels in formulating, supervising and imple-
menting prevention policies and workplace programmes. They have a right to be protected from workplace risks
and to take an active role in governance both at the national and workplace level.
X Policy makers, managers, supervisors, OSH professionals, and workers all have important roles to play, through
effective social dialogue and participation in risk-management systems as well as the promotion of sound gov-
ernance frameworks at all levels.
A global review
X Promoting the business case for OSH and chemical safety

Ensuring a safe and healthy work environment is a strategic goal for the global chemical industry. Employers
believe that excellence in operations, preventing accidents and occupational diseases, is critical for operations
in all countries. Responsible Care®, the global chemical industry’s initiative to drive continuous improvement is
an important element towards reaching the goal of sound chemicals management.
Increase engagement of world of work stakeholders in international policy efforts

There are a number of international policies, agreements and conventions in the field of chemical safety. SAICM in
particular represents a global policy framework that can harmonise and integrate important elements needed for
a universal approach to the sound management of chemicals worldwide. One of the key objectives of a revitalized
strategy for SAICM Beyond 2020 is increased multi-sectoral and multi-stakeholder engagement in order to ensure
that the new platform will be of interest to, and useful for, the work of the different ministries as well as a variety of
stakeholders.
While social partners, including employers from the chemical industries and workers organisations, have demon-
strated their commitment to SAICM and its processes, there is a continued need for enhanced participation and
engagement of key world of work stakeholders in ongoing policy negotiations. Occupational exposure considera-
tions should be at the core of SAICM Beyond 2020 and even stronger measures are needed in this new framework to
protect workers from chemical exposures. As such, enhanced social dialogue will be critical during the intersessional
process leading up to Fifth session of the International Conference for Chemicals Management (ICCM5), and beyond.
X The ILO and social dialogue in the chemicals sector

Many sectors using chemicals are of strategic importance to the sustainable development of national econ-
omies. The ILO has noted the importance of the chemical sector since the early stages of the Organization’s
activities and has actively promoted social dialogue in the sector for many years. Sustainable industrial policies
underpinned by meaningful and effective social dialogue are key to managing the opportunities and challenges
arising from digitalization and other technological advances in the chemical and pharmaceutical industries.
In 2018, the ILO Global Dialogue Forum adopted Points of Consensus to guide governments, employers and
workers in shaping a future that works for all in the chemical and pharmaceutical industries.
73
X References
Abubakar, II, T Tillmann, and A Banerjee. 2015. “Global, re- and apoptotic proteins.” Reprod Toxicol 68: 171-190.
gional, and national age-sex specific all-cause and https://doi.org/10.1016/j.reprotox.2016.07.006.
cause-specific mortality for 240 causes of death, Barry, Vaughn, Andrea Winquist, and Kyle Steenland. 2013.
1990-2013: a systematic analysis for the Global “Perfluorooctanoic acid (PFOA) exposures and in-
Burden of Disease Study 2013.” Lancet 385 (9963): cident cancers among adults living near a chemical
117-171. plant.” Environmental health perspectives 121 (11-12):
Ahsan, M. A., F. Satter, M. A. B. Siddique, M. A. Akbor, S. 1313-1318.
Ahmed, M. Shajahan, and R. Khan. 2019. “Chemical Barua, U., and M. A. Ansary. 2017. “Workplace safety in
and physicochemical characterization of effluents Bangladesh ready-made garment sector: 3 years
from the tanning and textile industries in Bangladesh after the Rana Plaza collapse.” Int J Occup Saf Ergon
with multivariate statistical approach.” Environ Monit 23 (4): 578-583. https://doi.org/10.1080/10803548.2
Assess 191 (9): 575. https://doi.org/10.1007/s10661- 016.1251150.
019-7654-2.
Bauwens, M., S. Compernolle, T. Stavrakou, J.-F. Müller, J. van
Algranti, Eduardo, Juan Pablo Ramos-Bonilla, Benedetto Gent, H. Eskes, P. F. Levelt, R. van der A, J. P. Veefkind,
Terracini, Vilma S Santana, Pietro Comba, Roberto J. Vlietinck, H. Yu, and C. Zehner. 2020. “Impact of
Pasetto, Agata Mazzeo, Fulvio Cavariani, Andrés Coronavirus Outbreak on NO2 Pollution Assessed
Trotta, and Daniela Marsili. 2019. “Prevention of Using TROPOMI and OMI Observations.” Geophysical
Asbestos Exposure in Latin America within a Global Research Letters 47 (11): e2020GL087978. https://doi.
Public Health Perspective.” Annals of global health 85 org/10.1029/2020gl087978. https://agupubs.onlineli-
(1). brary.wiley.com/doi/abs/10.1029/2020GL087978.
Asamoah, A., M. Nikbakht Fini, D. K. Essumang, J. Muff, and Beard, J. D., A. Erdely, M. M. Dahm, M. A. de Perio, M. E.
E. G. Søgaard. 2019. “PAHs contamination levels Birch, D. E. Evans, J. E. Fernback, T. Eye, V. Kodali, R.
in the breast milk of Ghanaian women from an R. Mercer, S. J. Bertke, and M. K. Schubauer-Berigan.
e-waste recycling site and a residential area.” Sci Total 2018. “Carbon nanotube and nanofiber exposure and
Environ 666: 347-354. https://doi.org/10.1016/j.scito- sputum and blood biomarkers of early effect among
tenv.2019.02.204. U.S. workers.” Environ Int 116: 214-228. https://doi.
Athanassiou, CG, NG Kavallieratos, Giovanni Benelli, D org/10.1016/j.envint.2018.04.004.
Losic, P Usha Rani, and Nicolas Desneux. 2018. Bedoya-Ríos, Diego F, Jaime A Lara-Borrero, Verónica Duque-
“Nanoparticles for pest control: current status and Pardo, Carlos A Madera-Parra, Eliana M Jimenez, and
future perspectives.” Journal of Pest Science 91 (1): Andrés F Toro. 2018. “Study of the occurrence and
1-15. ecosystem danger of selected endocrine disrup-
ATSDR. 2018. “Toxicological Profile for Perfluoroalkyls.” tors in the urban water cycle of the city of Bogotá,
---. 2019. “Toxicological Profile for Trichloroethylene (TCE).” Colombia.” Journal of Environmental Science and
Health, Part A 53 (4): 317-325.
Attina, Teresa M, Russ Hauser, Sheela Sathyanarayana,
Patricia A Hunt, Jean-Pierre Bourguignon, John Benke, Geza, Michelle C. Turner, Sarah Fleming, Jordi
Peterson Myers, Joseph DiGangi, R Thomas Zoeller, Figuerola, Laurel Kincl, Lesley Richardson, Maria
and Leonardo Trasande. 2016. “Exposure to endo- Blettner, et al. 2017. “Occupational Solvent Exposure
crine-disrupting chemicals in the USA: a popula- and Risk of Glioma in the INTEROCC Study.” British
tion-based disease burden and cost analysis.” The Journal of Cancer 117 (8): 1246–54. https://doi.
Lancet Diabetes & Endocrinology 4 (12): 996-1003. org/10.1038/bjc.2017.285.
Bach, Cathrine Carlsen, Anne Vested, Kristian Tore Jørgensen, Benkhaya, Said, Souad M’rabet, and Ahmed El Harfi. 2020.
Jens Peter Ellekilde Bonde, Tine Brink Henriksen, and “Classifications, Properties, Recent Synthesis and
Gunnar Toft. 2016. “Perfluoroalkyl and polyfluoro- Applications of Azo Dyes.” Heliyon 6 (1). https://doi.
alkyl substances and measures of human fertility: a org/10.1016/j.heliyon.2020.e03271.
systematic review.” Critical reviews in toxicology 46 (9): Bernhardt, D, and II Reilly. 2019. “J. Mineral Commodity
735-755. Summaries 2019.” US Geological Survey, Reston, USA.
Baker, B. A., V. A. Cassano, and C. Murray. 2018. “Arsenic Bernhoft, Robin A. 2012. “Mercury toxicity and treatment: a
Exposure, Assessment, Toxicity, Diagnosis, and review of the literature.” Journal of environmental and
Management: Guidance for Occupational and public health 2012.
Environmental Physicians.” J Occup Environ Med Bettini, Sarah, Elisa Boutet-Robinet, Christel Cartier, Christine
60 (12): e63 4 - e639. ht tps: //doi.org/10.1097/ Coméra, Eric Gaultier, Jacques Dupuy, Nathalie Naud,
jom.0000000000001485. Sylviane Taché, Patrick Grysan, and Solenn Reguer.
Baldé, CP, V Forti, V Gray, R Kuehr, and P Stegmann. 2017. 2017. “Food-grade TiO 2 impairs intestinal and sys-
“The Global E-waste Monitor–2017, United Nations temic immune homeostasis, initiates preneoplastic
University (UNU), International Telecommunication lesions and promotes aberrant crypt development in
Union (ITU) & International Solid Waste Association the rat colon.” Scientific Reports 7: 40373.
(ISWA), Bonn/Geneva/Vienna.” Electronic Version: 978- Birks, Laura, Maribel Casas, Ana M Garcia, Jan Alexander,
92. Henrique Barros, Anna Bergström, Jens Peter Bonde,
Banu, S. K., J. A. Stanley, K. K. Sivakumar, J. A. Arosh, R. J. Taylor, Alex Burdorf, Nathalie Costet, and Asta Danileviciute.
and R. C. Burghardt. 2017. “Chromium VI - Induced 2016. “Occupational exposure to endocrine-dis-
developmental toxicity of placenta is mediated rupting chemicals and birth weight and length of
through spatiotemporal dysregulation of cell survival gestation: A European meta-analysis.” Environmental
health perspectives 124 (11): 1785-1793.
X Exposure to hazardous chemicals at work and resulting health impacts:
74
A global review
Bjørklund, Geir, Bjørn Hilt, Maryam Dadar, Ulf Lindh, and Jan Butenhoff, John L, David J Ehresman, Shu-Ching Chang, George
Aaseth. 2019. “Neurotoxic effects of mercury exposure A Parker, and Donald G Stump. 2009. “Gestational and
in dental personnel.” Basic & Clinical Pharmacology & lactational exposure to potassium perfluorooctanesul-
Toxicology 124 (5): 568-574. https://doi.org/https://doi. fonate (K+ PFOS) in rats: developmental neurotoxicity.”
org/10.1111/bcpt.13199. https://onlinelibrary.wiley.com/ Reproductive toxicology 27 (3-4): 319-330.
doi/abs/10.1111/bcpt.13199. Canu, Irina Guseva, Sandrine Fraize-Frontier, Cécile Michel, and
Blacksmith Institute. 2013. The World’s Worst 2013: The Top Sandrine Charles. 2019. “Weight of epidemiological evi-
Ten Toxic Threats. Cleanup, Progress, and Ongoing dence for titanium dioxide risk assessment: current state
Challenges.New YorkBlacksmith InstituteAvailable: and further needs.” Journal of exposure science & environ-
http://www.worstpolluted.org/docs/TopTenThreats2013. mental epidemiology: 1-6.
pdf [accessed 25 July 2014]. Caravanos J. 2015. E-waste interventions at Agbogbloshie, Accra,
Boedeker 2020. “The global distribution of acute unintentional Ghana. Prevention-Intervention Strategies to Prevent
pesticide poisoning: estimations based on a systematic Exposure to E-Waste Workshop; Depok, West Java,
review.” MC Public Health 20, 1875 (2020). https://doi. Indonesia. August 14 2015.
org/10.1186/s12889-020-09939-0. CAREX-Canada. 2020. “https://www.carexcanada.ca/.”
Brass, David M., Sean P. McGee, Mary K. Dunkel, Sarah M. Reilly, Carmen, Zaharia, and Suteu Daniela. 2012. “Textile organic
Jacob M. Tobolewski, Tara Sabo-Attwood, and Cheryl dyes–characteristics, polluting effects and separation/
L. Fattman. 2010. “Gender influences the response elimination procedures from industrial effluents–a crit-
to experimental silica-induced lung fibrosis in mice.” ical overview.” Organic pollutants ten years after the
American journal of physiology. Lung cellular and molecular Stockholm convention-environmental and analytical
physiology 299 (5): L664-L671. https://doi.org/10.1152/ update.
ajplung.00389.2009. https://pubmed.ncbi.nlm.nih.
gov/20729388 Carvalho, Fernando P. 2017. “Pesticides, environment, and food
safety.” Food and Energy Security 6 (2): 48-60.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980389/.
Cayuela, R. And Hagan, A. 2019. The Chemical Industry Under
Braun, Joseph M. 2017. “Early-life exposure to EDCs: role in child- the 4th Industrial Revolution: The Sustainable, Digital and
hood obesity and neurodevelopment.” Nature Reviews Citizens One. . Hoboken: NJ: Wiley-VCH Verlag GmbH.
Endocrinology 13 (3): 161.
Chang, Liang, Sheng Shen, Zhe Zhang, Xiaoxiao Song, and
Brophy, J. T., M. M. Keith, A. Watterson, R. Park, M. Gilbertson, Qing Jiang. 2018. “Study on the relationship between
E. Maticka-Tyndale, M. Beck, H. Abu-Zahra, K. Schneider, age and the concentrations of heavy metal elements in
A. Reinhartz, R. Dematteo, and I. Luginaah. 2012. “Breast human bone.” Annals of translational medicine 6 (16): 320-
cancer risk in relation to occupations with exposure 320. https://doi.org/10.21037/atm.2018.08.09. https://
to carcinogens and endocrine disruptors: a Canadian pubmed.ncbi.nlm.nih.gov/30363972
case-control study.” Environ Health 11: 87. https://doi.
org/10.1186/1476-069x-11-87. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186975/.
Bruner-Tran, Kaylon L, Juan Gnecco, Tianbing Ding, Dana R Glore, Chen, Amy Yuntzu-Yen, and Thomas Olsen. 2016. “Chromated
Virginia Pensabene, and Kevin G Osteen. 2017. “Exposure copper arsenate-treated wood: a potential source of ar-
to the environmental endocrine disruptor TCDD and senic exposure and toxicity in dermatology.” International
human reproductive dysfunction: translating lessons journal of women’s dermatology 2 (1): 28-30. https://doi.
from murine models.” Reproductive Toxicology 68: 59-71. org/10.1016/j.ijwd.2016.01.002. https://pubmed.ncbi.nlm.
nih.gov/28491998
Brüning, Thomas, Beate Pesch, Bernd Wiesenhütter, Sylvia
Rabstein, Marga Lammert, Axel Baumüller, and Hermann https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412102/.
M. Bolt. 2003. “Renal Cell Cancer Risk and Occupational Chen, Kai, Meng Wang, Conghong Huang, Patrick L Kinney, and
Exposure to Trichloroethylene: Results of a Consecutive Paul T Anastas. 2020. “Air pollution reduction and mor-
Case-Control Study in Arnsberg, Germany.” American tality benefit during the COVID-19 outbreak in China.” The
Journal of Industrial Medicine 43 (3): 274–85. https://doi. Lancet Planetary Health.
org/10.1002/ajim.10185. Chen, Qiqing, Annika Allgeier, Daqiang Yin, and Henner Hollert.
Brüschweiler, Beat J., and Cédric Merlot. 2017. “Azo dyes in 2019. “Leaching of endocrine disrupting chemicals from
clothing textiles can be cleaved into a series of mutagenic marine microplastics and mesoplastics under common
aromatic amines which are not regulated yet.” Regulatory life stress conditions.” Environment international 130:
Toxicology and Pharmacology 88: 214-226. https:// 104938.
doi.org/https://doi.org/10.1016/j.yrtph.2017.06.012. Chen, Y. X., B. A. Gao, H. Y. Cheng, and L. F. Li. 2017. “Survey of
http://w w w.sciencedirect.com/science/ar ticle/pii/ Occupational Allergic Contact Dermatitis and Patch Test
S0273230017301812. among Clothing Employees in Beijing.” Biomed Res Int
Bucher, John R. 2002. “The National Toxicology Program rodent 2017: 3102358. https://doi.org/10.1155/2017/3102358.
bioassay: designs, interpretations, and scientific contri- Chen, Ying, Oliver Wild, Luke Conibear, Liang Ran, Jianjun He,
butions.” Annals of the New York Academy of Sciences 982 Lina Wang, and Yu Wang. 2020. “Local characteristics
(1): 198-207. of and exposure to fine particulate matter (PM2.5) in
Budnik, Lygia Therese, Balazs Adam, Maria Albin, B et al. 2018. four indian megacities.” Atmospheric Environment: X
“Diagnosis, monitoring and prevention of exposure-re- 5: 100052. https://doi.org/https://doi.org/10.1016/j.
lated non-communicable diseases in the living and aeaoa.2019.100052. http://www.sciencedirect.com/sci-
working environment: DiMoPEx-project is designed to ence/article/pii/S2590162119300553.
determine the impacts of environmental exposure on Chung KT. Azo dyes and human health: A review. J Environ
human health.” Journal of occupational medicine and tox- Sci Health C Environ Carcinog Ecotoxicol Rev. 2016
icology (London, England) 13: 6-6. https://doi.org/10.1186/ Oct;34(4):233-261. doi: 10.1080/10590501.2016.1236602.
s12995- 018- 0186 -9. https://pubmed.ncbi.nlm.nih. Erratum in: J Environ Sci Health C Environ Carcinog
gov/29441119 Ecotoxicol Rev. 2017 Jan 2;35(1):67. PMID: 27635691.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800006/. Clapp, R. W. 2006. “Mortality among US employees of a large
Butchko, H. H., and W. W. Stargel. 2001. “Aspartame: Scientific eval- computer manufacturing company: 1969-2001.” Environ
uation in the postmarketing period.” Regulatory Toxicology Health 5: 30. https://doi.org/10.1186/1476-069x-5-30.
and Pharmacology 34 (3): 221-233. http://www.scopus. Clougherty, Jane E. 2010. “A growing role for gender analysis in air
com/inward/record.url?eid=2-s2.0-0035701818&part- pollution epidemiology.” Environmental health perspectives
nerID=40&md5=6ce6d747ef0ea03ddd2567142f47f14d.
X References 75
118 (2): 167-176. https://doi.org/10.1289/ehp.0900994. health parameters.” Journal of occupational and environ-
https://pubmed.ncbi.nlm.nih.gov/20123621 mental medicine/American College of Occupational and
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831913/. Environmental Medicine 48 (8): 771.
Colinet, J., Listak, J.M., Organiscak, J.A., Rider, J.P. and Wolfe, ESIG 2018. “Strategies and Techniques for Measuring Solvent
A.L., 2010. Best practices for dust control in coal mining. Vapour Concentrations in the Work Environment”.
NIOSH Information Circular 9517. https://www.cdc. EU.2020. “https://ec.europa.eu/environment/chemicals/endo-
gov/niosh/mining/UserFiles/works/pdfs/2010-110.pdf crine/strategy/substances_en.htm.”
Accessed August 3, 2020. EU-Commission. 2018. Commission Regulation (EU) 2018/1513 of 10
Davis, John‐Michael, and Yaakov Garb. 2019. “A strong spatial as- October 2018 a.
sociation between e‐waste burn sites and childhood lym- ---. 2020a. “ Chemicals – strategy for sustainability (toxic-free EU
phoma in the West Bank, Palestine.” International journal environment) “.
of cancer 144 (3): 470-475.
---. 2020b. Horizon 2020. Nanotechnologies, Advanced Materials,
Diamanti-Kandarakis, Evanthia, Jean-Pierre Bourguignon, Linda Biotechnology and Advanced Manufacturing and Processing.
C. Giudice, Russ Hauser, Gail S. Prins, Ana M. Soto, R.
Thomas Zoeller, and Andrea C. Gore. 2009. “Endocrine- EU-OSHA. 2014. Exposure to carcinogens andwork-related cancer: A
disrupting chemicals: an Endocrine Society scientific review of assessment methods.
statement.” Endocrine reviews 30 (4): 293-342. https://doi. ---. 2019. “Dangerous Substances e-tool.”
org/10.1210/er.2009-0002. https://pubmed.ncbi.nlm.nih. FAO. 2011. “The role of women in agriculture.”
gov/19502515
FAO and WHO. 2016. Guidelines on Highly Hazardous Pesticides.
FAOSTAT 2019. Pesticides used. Rome: Food and Agriculture
Dick, F. D. 2006. “Solvent Neurotoxicity.” Occupational and Organization of the United Nations. Available from:
Environmental Medicine. BMJ Publishing Group Ltd. http://www.fao.org/faostat/en/#data/RP.
https://doi.org/10.1136/oem.2005.022400.
Farioli, Andrea, Kurt Straif, Giovanni Brandi, Stefania Curti, et
al. 2018. “Occupational exposure to asbestos and risk of
Donat-Vargas, Carolina, Ingvar A Bergdahl, Andreas Tornevi, cholangiocarcinoma: a population-based case–control
Maria Wennberg, Johan Sommar, Hannu Kiviranta, Jani study in four Nordic countries.” Occupational and environ-
Koponen, Olov Rolandsson, and Agneta Åkesson. 2019. mental medicine 75 (3): 191-198.
“Perfluoroalkyl substances and risk of type II diabetes: Freire, Carmen, and Sergio Koifman. 2013. “Pesticides, depres-
A prospective nested case-control study.” Environment sion and suicide: a systematic review of the epidemi-
international 123: 390-398. ological evidence.” International journal of hygiene and
Doney, B., L. Kurth, C. Halldin, J. Hale, and S. M. Frenk. 2019. environmental health 216 (4): 445-460.
“Occupational exposure and airflow obstruction and Fréry, Nadine, Tiina Santonen, Simo P. Porras, et al. 2020.
self-reported COPD among ever-employed US adults “Biomonitoring of occupational exposure to phthalates:
using a COPD-job exposure matrix.” Am J Ind Med 62 (5): A systematic review.” International Journal of Hygiene and
393-403. https://doi.org/10.1002/ajim.22958. Environmental Health 229: 113548. https://doi.org/https://
Dong, Jie, and Qiang Ma. 2019. “Integration of inflammation, doi.org/10.1016/j.ijheh.2020.113548. http://www.science-
fibrosis, and cancer induced by carbon nanotubes.” direct.com/science/article/pii/S1438463920300316.
Nanotoxicology 13 (9): 1244-1274. Fu, Jianjie, Yan Gao, Lin Cui, Thanh Wang, Yong Liang, Guangbo
Dons, Evi, Luc Int Panis, Martine Van Poppel, Jan Theunis, Qu, Bo Yuan, Yawei Wang, Aiqian Zhang, and Guibin
Hanny Willems, Rudi Torfs, and Geert Wets. 2011. Jiang. 2016. “Occurrence, temporal trends, and half-
“Impact of time–activity patterns on personal expo- lives of perfluoroalkyl acids (PFAAs) in occupational
sure to black carbon.” Atmospheric Environment 45 (21): workers in China.” Scientific Reports 6 (1): 38039. https://
3594-3602. https://doi.org/https://doi.org/10.1016/j. doi.org/10.1038/srep38039. https://doi.org/10.1038/
atmosenv.2011.03.064. http://www.sciencedirect.com/ srep38039.
science/article/pii/S1352231011003359. Furuya, Sugio, Odgerel Chimed-Ochir, Ken Takahashi, Annette
Downward, George S., Erik J.H.M. van Nunen, et al. 2018. “Long- David, and Jukka Takala. 2018. “Global asbestos disaster.”
Term Exposure to Ultrafine Particles and Incidence International journal of environmental research and public
of Cardiovascular and Cerebrovascular Disease in a health 15 (5): 1000.
Prospective Study of a Dutch Cohort.” Environmental Gao, Z., K. Hiroshima, X. Wu, J. Zhang, D. Shao, H. Shao, H.
Health Perspectives 126 (12): 127007. https://doi.org/ Yang, T. Yusa, T. Kiyokawa, M. Kobayashi, Y. Shinohara,
doi:10.1289/EHP3047. https://ehp.niehs.nih.gov/doi/ O. D. Røe, X. Zhang, and K. Morinaga. 2015. “Asbestos
abs/10.1289/EHP3047. textile production linked to malignant peritoneal and
Drew, Nathan M, Eileen D Kuempel, Ying Pei, and Feng Yang. pleural mesothelioma in women: Analysis of 28 cases in
2017. “A quantitative framework to group nanoscale and Southeast China.” Am J Ind Med 58 (10): 1040-9. https://doi.
microscale particles by hazard potency to derive occu- org/10.1002/ajim.22494.
pational exposure limits: Proof of concept evaluation.” Gardner, Renee M., Jennifer F. Nyland, Ines A. Silva, Ana Maria
Regulatory Toxicology and Pharmacology 89: 253-267. Ventura, Jose Maria de Souza, and Ellen K. Silbergeld.
Dumavibhat N, Matsui T, Hoshino E, Rattanasiri S, Muntham 2010. “Mercury exposure, serum antinuclear/antinu-
D, Hirota R, Eitoku M, Imanaka M, Muzembo BA, Ngatu cleolar antibodies, and serum cytokine levels in mining
NR, et al. Radiographic progression of silicosis among populations in Amazonian Brazil: A cross-sectional
Japanese tunnel workers in Kochi. J Occup Health. study.” Environmental Research 110 (4): 345-354. https://
2013;55:142–148. doi.org/https://doi.org/10.1016/j.envres.2010.02.001.
EC-JRC. 2020. “Pandemic measures and chemical process safety.” http://w w w.sciencedirect.com/science/ar ticle/pii/
Lessons Learned Bullettin JRC 120768. S0013935110000228.
ECHA. 2016. Annex Xv Restriction Report – Lead Stabilisers In Pvc. Ghassabian, Akhgar, and Leonardo Trasande. 2018. “Disruption
in thyroid signaling pathway: a mechanism for the effect
Ellen.MacArthur.Foundation. 2017. “A New Textiles Economy: of endocrine-disrupting chemicals on child neurodevel-
Redesigning Fashion’s Future.”. opment.” Frontiers in endocrinology 9: 204.
Emmett, Edward Anthony, Hong Zhang, Frances Susan Shofer, Gibb, Herman, and Keri Grace O’Lear y. 2014. “Mercur y
et al. 2006. “Community exposure to perfluorooc- Exposure and Health Impacts among Individuals in
tanoate: relationships between serum levels and certain the Artisanal and Small-Scale Gold Mining Community:
76
A global review
A Comprehensive Review.” Environmental Health Hassaan, Mohamed A., and Ahmed El Nemr. 2017. “Health and
Perspectives 122 (7): 667-672. https://doi.org/doi:10.1289/ Environmental Impacts of Dyes : Mini Review.” American
ehp.1307864. https://ehp.niehs.nih.gov/doi/abs/10.1289/ Journal of Environmental Science and Engineering 1 (3):
ehp.1307864 64–67. https://doi.org/10.11648/j.ajese.20170103.11.
Gioia, Rosalinda, Abidemi James Akindele, Sunday Adekunle Heacock, Michelle, Carol Bain Kelly, Kwadwo Ansong Asante,
Adebusoye, Kwadwo Ansong Asante, Shinsuke Tanabe, Linda S Birnbaum, Åke Lennart Bergman, Marie-Noel
Alfons Buekens, and Annie J Sasco. 2014. “Polychlorinated Bruné, Irena Buka, David O Carpenter, Aimin Chen, and
biphenyls (PCBs) in Africa: a review of environmental Xia Huo. 2016. “E-waste and harm to vulnerable popula-
levels.” Environmental Science and Pollution Research 21 tions: a growing global problem.” Environmental health
(10): 6278-6289. perspectives 124 (5): 550-555.
Girardi, Paolo, and Enzo Merler. 2019. “A mortality study on male Health and Safety Executive (HSE). n.d. “Textiles - Dyes and
subjects exposed to polyfluoroalkyl acids with high in- Dyeing.” Accessed March 12, 2021. https://www.hse.gov.
ternal dose of perfluorooctanoic acid.” Environmental uk/textiles/dyes-dyeing.htm.
research 179: 108743. Health and Safety Executive (HSE) 2002. “Control of Lead at
Global Burden of Disease Study 2019 (GBD 2019) Reference Life Work,” no. Third edition.
Table. Seattle, United States of America: Institute for Heinrich, Uwe, R Fuhst, S Rittinghausen, O Creutzenberg, B
Health Metrics and Evaluation (IHME), 2021. Bellmann, W Koch, and K Levsen. 1995. “Chronic inhala-
Goldberg, Mark S., France Labrèche, Scott Weichenthal, et al. tion exposure of Wistar rats and two different strains of
2018. “Number concentrations of ultrafine particles mice to diesel engine exhaust, carbon black, and titanium
and the incidence of postmenopausal breast cancer.” dioxide.” Inhalation Toxicology 7 (4): 533-556.
Environmental Epidemiology 2 (1). https://journals.lww. Hines, Erin P, Sally S White, Jason P Stanko, Eugene A Gibbs-
com/environepidem/Fulltext/2018/03000/Number_con- Flournoy, Christopher Lau, and Suzanne E Fenton. 2009.
centrations_of_ultrafine_particles_and.1.aspx. “Phenotypic dichotomy following developmental expo-
Gordon, Ronald E., Sean Fitzgerald, and James Millette. 2014. sure to perfluorooctanoic acid (PFOA) in female CD-1
“Asbestos in commercial cosmetic talcum powder as a mice: low doses induce elevated serum leptin and insulin,
cause of mesothelioma in women.” International journal and overweight in mid-life.” Molecular and cellular endocri-
of occupational and environmental health 20 (4): 318- nology 304 (1-2): 97-105.
332. https://doi.org/10.1179/2049396714Y.0000000081. Hnizdo E, Sluis-Cremer GK. Risk of silicosis in a cohort of white
https://pubmed.ncbi.nlm.nih.gov/25185462 South African gold miners. Am J Ind Med. 1993;24(4):447-
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164883/. 457. doi:10.1002/ajim.4700240409
Gore, A. C., V. A. Chappell, S. E. Fenton, J. A. Flaws, A. Nadal, G. Hodson, Laura, Charles Geraci, and Paul Schulte. 2019.
S. Prins, J. Toppari, and R. T. Zoeller. 2015. “EDC-2: The “Continuing to protect the nanotechnology workforce:
Endocrine Society’s Second Scientific Statement on NIOSH nanotechnology research plan for 2018–2025.”
Endocrine-Disrupting Chemicals.” Endocr Rev 36 (6): E1- Hoffman, Kate, Julie A Sosa, and Heather M Stapleton. 2017. “Do
e150. https://doi.org/10.1210/er.2015-1010. flame retardant chemicals increase the risk for thyroid
Gore, Andrea C, David Crews, Loretta L Doan, Michele La Merrill, dysregulation and cancer?” Current opinion in oncology 29
Heather Patisaul, and Ami Zota. 2014. “Introduction to (1): 7-13.
endocrine disrupting chemicals (EDCs).” A guide for public Hohenadel, K., P. Raj, P. A. Demers, S. H. Zahm, and A. Blair.
interest organizations and policy-makers: 21-22. 2015. “The inclusion of women in studies of occupa-
Grant, Kristen, Fiona C Goldizen, Peter D Sly, Marie-Noel Brune, tional cancer: a review of the epidemiologic literature
Maria Neira, Martin van den Berg, and Rosana E Norman. from 1991-2009.” Am J Ind Med 58 (3): 276-81. https://doi.
2013. “Health consequences of exposure to e-waste: a org/10.1002/ajim.22424.
systematic review.” The lancet global health 1 (6): e350- Hu, Xindi C, David Q Andrews, Andrew B Lindstrom, et al. 2016.
e361. “Detection of poly-and perfluoroalkyl substances (PFASs)
Grashow, Rachel, Vincent Bessonneau, Roy R. Gerona, et al. 2019. in US drinking water linked to industrial sites, military
“Integrating Exposure Knowledge and Serum Suspect fire training areas, and wastewater treatment plants.”
Screening as a New Approach to Biomonitoring: An Environmental science & technology letters 3 (10): 344-350.
Application in Firefighters and Office Workers.” BioRxiv. Hu, Xue Feng, Kavita Singh, and Hing Man Chan. 2018. “Mercury
https://doi.org/10.1101/630848. Exposure, Blood Pressure, and Hyper tension: A
Guelfo, Jennifer L, Thomas Marlow, David M Klein, David A Savitz, Systematic Review and Dose–response Meta-
Scott Frickel, Michelle Crimi, and Eric M Suuberg. 2018. analysis.” Environmental Health Perspectives 126 (7):
“Evaluation and management strategies for per-and poly- 076002. https://doi.org/doi:10.1289/EHP2863. https://
fluoroalkyl substances (PFASs) in drinking water aquifers: ehp.niehs.nih.gov/doi/abs/10.1289/EHP2863.
perspectives from impacted US Northeast communities.” Huang, Chun-Li, Lian-Jun Bao, Pei Luo, Zhao-Yi Wang, Shao-Meng
Environmental health perspectives 126 (6): 065001. Li, and Eddy Y Zeng. 2016. “Potential health risk for resi-
Guyton, Kathryn Z, Ivan Rusyn, Weihsueh A Chiu, Denis E dents around a typical e-waste recycling zone via inha-
Corpet, Martin van den Berg, Matthew K Ross, David C lation of size-fractionated particle-bound heavy metals.”
Christiani, Frederick A Beland, and Martyn T Smith. 2018. Journal of hazardous materials 317: 449-456.
“Application of the key characteristics of carcinogens in Huang, Po-Chin, Kai-Wei Liao, Jung-Wei Chang, Shiou-Hui Chan,
cancer hazard identification.” Carcinogenesis 39 (4): 614- and Ching-Chang Lee. 2018. “Characterization of phtha-
622. lates exposure and risk for cosmetics and perfume sales
Hämäläinen, Päivi, Jukka Takala, and Tan Boon Kiat. 2017. “Global clerks.” Environmental pollution 233: 577-587.
estimates of occupational accidents and work-related Hurley, Robin A., and Katherine H. Taber. 2015. “Occupational
illnesses 2017.” World 2017: 3-4. Exposure to Solvents: Neuropsychiatric and Imaging
Han, Mi Ah, Jin Hwa Kim, and Han Soo Song. 2019. “Persistent Features.” Journal of Neuropsychiatry and Clinical
organic pollutants, pesticides, and the risk of thyroid Neurosciences 27 (1): 1–7. https://doi.org/10.1176/appi.
cancer: systematic review and meta-analysis.” European neuropsych.270101.
Journal of Cancer Prevention 28 (4): 344-349. IARC. 2006. Monographs on the evaluation of carcinogenic risks to
Hansen, Steffen Foss, and Anna Lennquist. 2020. “Carbon na- Humans, inorganic and Organic lead compound s, .
notubes added to the SIN List as a nanomaterial of Very ---. 2010a. “IARC Monograph Volume 93: Carbon Black, Titanium
High Concern.” Nature Nanotechnology 15 (1): 3-4. Dioxide, and Talc.”
X References 77
---. 2010b. “IARC Monograph Volume 99: Some Aromoatic ---. 2019e. “Progress and Potential: How Better Work is improving
Amines, Organic Dyes and Related Exposures.” garment workers’ lives and boosting factory competitive-
---. 2012. “review of human carcinogens–Part C: Arsenic, metals, ness.”
fibres and dusts.” IARC Monographs: 196-211. ---. 2019f. “Securing the competitiveness of Asia’s garment
---. 2013a. “Air Pollution and Cancer. IARC Scientific Publication sector.”
No. 161.” ---. 2020a. “E-waste and employment in Argentina.”.
---. 2013b. “ARC Monographs on the Evaluation of Carcinogenic ---. 2020b. “In the face of a pandemic: Ensuring safety and health
Risks to Humans Volume 109.” at work- Geneva: ILO 2020.”
---. 2013c. “Diesel and Gasoline Engine Exhausts and Some ---. 2020c. “The supply chain ripple effect: How COVID-19 is af-
Nitroarenes. IARC Monographs on the Evaluation of fecting garment workers and factories in Asia and the
Carcinogenic Risks to Humans Volume 105.” Pacific.”
---. 2015. “Outdoor Air Pollution. IARC Monographs on the ---.2020d “World Employment and Social Outlook Trends 2020”
Evaluation of Carcinogenic Risks to Humans Volume 109.” ILO-OSH. 2001. “Guidlines on Occupational Safety and Health
---. 2018. “IARC Monographs Volume 111: Some Nanomaterials Management Systems. Second Edition.”
and Some Fibres.”
Iavicoli, Sergio, Tim R Driscoll, Martin Hogan, Ivo Iavicoli, Jorma ILO/WHO Global Programme for the Elimination of Silicosis
Harri Rantanen, Kurt Straif, and Jukka Takala. 2019. “New (GPES), 2006. Outline for a National Programme for
avenues for prevention of occupational cancer: a global the Elimination of Silicosis (NPES). https://www.ilo.org/
policy perspective.” Occupational and environmental med- global/topics/safety-and-health-at-work/resources-li-
icine 76 (6): 360-362. brary/publications/WCMS_110415/lang--en/index.htm
IHME. 2020. “https://vizhub.healthdata.org/gbd-compare/.” Accessed August 4, 2020.
Accessed May 15th 2020. Inshakova, Elena, and Oleg Inshakov. 2017. “World market for
ILO. 1985. Resolution on equal opportunities and equal treatment nanomaterials: structure and trends.” MATEC web of
for men and women in employment, adopted by the inter- conferences.
national conference at its seventy-first session. Geneva: ILO. Invernizzi, Diletta Colette, Giorgio Locatelli, Anne Velenturf,
---. 1986. “Asbestos Convention, 1986 (No. 162).” Peter ED Love, Phil Purnell, and Naomi J. Brookes.
---. 2004. “Solvents.” International Occupational Safety & Health 2020. “Developing Policies for the End-of-Life of Energy
Information Centre. Infrastructure: Coming to Terms with the Challenges
of Decommissioning.” Energy Policy 144 (September):
---.2006. Vocational education and training in the chemical in- 111677. https://doi.org/10.1016/j.enpol.2020.111677.
dustry in India, Sectoral Activities Working Paper No. 244
(Geneva, ILO, 2006). IOM 2011. Health, socio-economc and environmental aspects of
possible amendments to the EU Directive on the protec-
---. 2007. “A manual for gender audit facilitators: The ILO partici- tion of workers from the risks related to exposure to car-
patory gender audit methodology. .” cinogens and mutagens at work. Respirable crystalline
---.2007b “The ILO position on safety in the use of asbestos” silica.
Geneva: ILO. IPEN. 2014. “An NGO Introduction to Mercury Pollution and the
---. 2010. “Providing safe and healthy workplaces for both women Minamata Convention on Mercury.”
and men.” ---. 2019 IPEN. “THE GLOBAL PFAS PROBLEM: FLUORINE-FREE
---.2011. “Restructuring, Employment and Social Dialogue in the ALTERNATIVES AS SOLUTIONS FIREFIGHTING FOAMS
Chemicals and Pharmaceutical Industries. Report for AND OTHER SOURCES — GOING FLUORINE-FREE.”
Discussion at Tripartite Meeting on Promoting Social Stockholm Convention 9th Conference of the Parties.
Dialogue on Restructuring and Its Effects on Employment
in the Chemical and Pharmaceutical Industries.”
---. 2020. “Gender Review Mapping with a focus on Women and
---. 2013. “Sustainable development, decent work and green Chemicals:
jobs.” Vol. 102. International Labour Office.
Impact of Emerging Policy Issues and the relevance for the
---. 2013b. “Global Dialogue Forum on Initiatives to Promote Sustainable Development Goals.
Decent and Productive Work in the Chemical Industry”
GDFCI/2013/8 .”
---. 2014. What Is a Solvent ? Preventing Exposure no. 5. http:// Jacobson, Joseph L, and Sandra W Jacobson. 1996. “Intellectual
www.ilo.org/wcmsp5/groups/public/---americas/---ro- impairment in children exposed to polychlorinated biphe-
lima/---sro-port_of_spain/documents/presentation/ nyls in utero.” New England Journal of Medicine 335 (11):
wcms_250196.pdf. 783-789.
---. 2017. “International Chemical Safety Cards - Mercury (ICSC Johnson, Paula I, Patrice Sutton, Dylan S Atchley, Erica Koustas,
0056).” 2017. https://www.ilo.org/dyn/icsc/showcard. Juleen Lam, Saunak Sen, Karen A Robinson, Daniel A
display?p_lang=en&p_card_id=0056&p_version=2.---. Axelrad, and Tracey J Woodruff. 2014. “The Navigation
2018. Decent Work and Digitalization in the Chemical and Guide—evidence-based medicine meets environmental
Pharmaceutical Industries Sectoral Policies Department. health: systematic review of human evidence for PFOA
https://www.ilo.org/wcmsp5/groups/public/---ed_di- effects on fetal growth.” Environmental health perspectives
alogue /- - -sec tor/document s/meetingdocument / 122 (10): 1028-1039.
wcms_649238.pdf. Joon, Veenu, Renu Shahrawat, and Meena Kapahi. 2017. “The
---. 2019a. Decent work in the management of electrical and elec- emerging environmental and public health problem of
tronic waste (e-waste), Issues paper for the Global Dialogue electronic waste in India.” Journal of Health and Pollution
Forum on Decent Work in the Management of Electrical and 7 (15): 1-7.
Electronic Waste (E-waste) ((Geneva, 9-11 April 2019). Jørs, Erik, Dinesh Neupane, and Leslie London. 2018. Pesticide
---. 2019b. “The future of work in textiles, clothing, leather poisonings in low-and middle-income countries. SAGE
and footwear “. Publications Sage UK: London, England.
---. 2019c. “Global Dialogue Forum on Decent Work in the Kasai, Tatsuya, Yumi Umeda, Makoto Ohnishi, Takashi Mine,
Management of Electrical and Electronic Waste “. Hitomi Kondo, Tetsuya Takeuchi, Michiharu Matsumoto,
and Shoji Fukushima. 2015. “Lung carcinogenicity of in-
---. 2019d. “ILO’s first ever meeting on e-waste adopts Points of haled multi-walled carbon nanotube in rats.” Particle and
Consensus to promote decent work in the sector.” fibre toxicology 13 (1): 53.
78
A global review
Kassotis CD, Vandenberg LN, Demeneix BA, Porta M, Slama R, Sprague-Dawley rats.” Environmental health perspectives
Trasande L. Endocrine-disrupting chemicals: economic, 126 (9): 097005.
regulatory, and policy implications. Lancet Diabetes Landrigan, Philip J, Richard Fuller, Nereus JR Acosta, Olusoji Adeyi,
Endocrinol. 2020 Aug;8(8):719-730. doi: 10.1016/S2213- Robert Arnold, Abdoulaye Bibi Baldé, Roberto Bertollini,
8587(20)30128-5. PMID: 32707119; PMCID: PMC7437819. Stephan Bose-O’Reilly, Jo Ivey Boufford, and Patrick N
Kato, I., K. L. Koenig, H. Watanabe-Meserve, et al. 2005. “Personal Breysse. 2018. “The Lancet Commission on pollution and
and occupational exposure to organic solvents and risk health.” The lancet 391 (10119): 462-512.
of non-Hodgkin’s lymphoma (NHL) in women (United Lanphear, B. P., S. Rauch, P. Auinger, R. W. Allen, and R. W.
States).” Cancer Causes Control 16 (10): 1215-24. Hornung. 2018. “Low-level lead exposure and mortality
Kato, Kayoko, Lee-Yang Wong, Lily T. Jia, Zsuzsanna Kuklenyik, in US adults: a population-based cohort study.” Lancet
and Antonia M. Calafat. 2011. “Trends in Exposure Public Health 3 (4): e177-e184. https://doi.org/10.1016/
to Polyfluoroalkyl Chemicals in the U.S. Population: s2468-2667(18)30025-2.
1999−2008.” Environmental Science & Technology 45 (19): Le Magueresse-Battistoni, Brigitte, Luc Multigner, Claire
8037-8045. https://doi.org/10.1021/es1043613. https:// Beausoleil, and Christophe Rousselle. 2018. “Effects of
doi.org/10.1021/es1043613. bisphenol A on metabolism and evidences of a mode
Kawakami T, Isama K, Nakashima H, Tsuchiya T, Matsuoka A. of action mediated through endocrine disruption.”
Analysis of primary aromatic amines originated from azo Molecular and cellular endocrinology 475: 74-91.
dyes in commercial textile products in Japan. J Environ Sci Leon, Maria E, Leah H Schinasi, Pierre Lebailly et al. 2019.
Health A Tox Hazard Subst Environ “Pesticide use and risk of non-Hodgkin lymphoid malig-
Keil, Alexander P, David B Richardson, Daniel Westreich, and Kyle nancies in agricultural cohorts from France, Norway and
Steenland. 2018. “Estimating the impact of changes to oc- the USA: a pooled analysis from the AGRICOH consor-
cupational standards for silica exposure on lung cancer tium.” International journal of epidemiology 48 (5): 1519-
mortality.” Epidemiology (Cambridge, Mass.) 29 (5): 658. 1535.
Khan, M., and C. A. Damalas. 2015. “Occupational exposure to Lerro, Catherine C, Stella Koutros, Gabriella Andreotti, et al. 2019.
pesticides and resultant health problems among cotton “Cancer incidence in the Agricultural Health Study after
farmers of Punjab, Pakistan.” Int J Environ Health Res 25 (5): 20 years of follow-up.” Cancer Causes & Control 30 (4): 311-
508-21. https://doi.org/10.1080/09603123.2014.980781. 322.
Kielsen, Katrine, Zaiba Shamim, Lars P Ryder, Flemming Nielsen, Letellier, Noémie, Guillaume Choron, Fanny Artaud, Alexis
Philippe Grandjean, Esben Budtz-Jørgensen, and Carsten Descatha, Marcel Goldberg, Marie Zins, Alexis Elbaz, and
Heilmann. 2016. “Antibody response to booster vaccina- C. Berr. 2020. “Association between Occupational Solvent
tion with tetanus and diphtheria in adults exposed to Exposure and Cognitive Performance in the French
perfluorinated alkylates.” Journal of immunotoxicology 13 CONSTANCES Study.” Occupational and Environmental
(2): 270-273. Medicine 77 (4): 223–30. https://doi.org/10.1136/oemed-
Kim, I., H. J. Kim, S. Y. Lim, and J. Kongyoo. 2012. “Leukemia and 2019-106132.
non-Hodgkin lymphoma in semiconductor industry Levin, Kovi, Catriona McLean, and Ryan Hoy. 2019. “Artificial
workers in Korea.” Int J Occup Environ Health 18 (2): 147- stone‐associated silicosis: clinical‐pathological‐radiolog-
53. https://doi.org/10.1179/1077352512z.00000000019. ical correlates of disease.” Respirology case reports 7 (7):
Kim, Inah, Myoung-Hee Kim, and Sinye Lim. 2015. “Reproductive e00470.
Hazards Still Persist in the Microelectronics Industry: Li, Jiehui, James E Cone, Robert M Brackbill, Ingrid Giesinger,
Increased R isk of Spont aneous A bor tion and Janette Yung, and Mark R Farfel. 2019. “Pulmonary
Menstrual Aberration among Female Workers in the Fibrosis among World Trade Center Responders: Results
Microelectronics Industry in South Korea.” PloS one from the WTC Health Registry Cohort.” International
10 (5): e0123679-e0123679. https://doi.org/10.1371/ journal of environmental research and public health 16 (5):
journal.pone.0123679. https://pubmed.ncbi.nlm.nih. 825.
gov/25938673 Li, Ping, Xinbin Feng, Guangle Qiu, Zhonggen Li, Xuewu Fu,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418732/. Minishi Sakamoto, Xiaojie Liu, and Dingyong Wang. 2008.
Kim, Myoung-Hee, Hyunjoo Kim, and Domyung Paek. 2014. “The “Mercury exposures and symptoms in smelting workers
health impacts of semiconductor production: an epide- of artisanal mercury mines in Wuchuan, Guizhou,
miologic review.” International journal of occupational and China.” Environmental Research 107 (1): 108-114. https://
environmental health 20 (2): 95-114. https://doi.org/10.117 doi.org/https://doi.org/10.1016/j.envres.2007.08.003.
9/2049396713Y.0000000050. https://pubmed.ncbi.nlm. http://w w w.sciencedirect.com/science/ar ticle/pii/
nih.gov/24999845 S001393510700165X.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090871/. Licina, Dusan, Glenn C. Morrison, Gabriel Bekö, Charles J.
Weschler, and William W. Nazaroff. 2019. “Clothing-
Kordas, Katarzyna, Julia Ravenscroft, Ying Cao, and Elena V. Mediated Exposures to Chemicals and Particles.”
McLean. 2018. “Lead Exposure in Low and Middle- Environmental Science and Technology 53 (10): 5559–75.
Income Countries: Perspectives and Lessons on Patterns, https://doi.org/10.1021/acs.est.9b00272.
Injustices, Economics, and Politics.” International journal
of environmental research and public health 15 (11): 2351. Lioy, Paul J, Russ Hauser, Chris Gennings, Holger M Koch, Philip
https://doi.org/10.3390/ijerph15112351. https://pubmed. E Mirkes, Bernard A Schwetz, and Andreas Kortenkamp.
ncbi.nlm.nih.gov/30356019 2015. “Assessment of phthalates/phthalate alternatives
in children’s toys and childcare articles: Review of the
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266944/. report including conclusions and recommendation of the
Koustas, Erica, Juleen Lam, Patrice Sutton, et al. 2014. “The Chronic Hazard Advisory Panel of the Consumer Product
Navigation Guide—evidence-based medicine meets en- Safety Commission.” Journal of exposure science & environ-
vironmental health: systematic review of nonhuman ev- mental epidemiology 25 (4): 343-353.
idence for PFOA effects on fetal growth.” Environmental Liu, Yuewei, Kyle Steenland, Yi Rong, Eva Hnizdo, Xiji Huang, Hai
health perspectives 122 (10): 1015-1027. Zhang, Tingming Shi, Yi Sun, Tangchun Wu, and Weihong
Krishnan, Krittika, Nitish Mittal, Lindsay M Thompson, et al. Chen. 2013. “Exposure-response analysis and risk assess-
2018. “Effects of the endocrine-disrupting chemicals, ment for lung cancer in relationship to silica exposure: a
vinclozolin and polychlorinated biphenyls, on physio- 44-year cohort study of 34,018 workers.” American journal
logical and sociosexual phenotypes in F2 generation of epidemiology 178 (9): 1424-1433.
X References 79
Liu, Yuewei, Yun Zhou, Eva Hnizdo, Tingming Shi, Kyle Steenland, functioning in farm workers: a review.” International
Xinjian He, and Weihong Chen. 2017. “ Total and journal of occupational and environmental health 22 (1):
cause-specific mortality risk associated with low-level 68-79.
exposure to crystalline silica: A 44-year cohort study from Nafees, A. A., Z. Fatmi, M. M. Kadir, and N. Sathiakumar. 2016.
China.” American journal of epidemiology 186 (4): 481-490. “Chronic Bronchitis and Chronic Obstructive Pulmonary
Loomis, Dana, Kathryn Z. Guyton, Yann Grosse, Fatiha El Disease (COPD) Among Textile Workers in Karachi,
Ghissassi, Véronique Bouvard, Lamia Benbrahim-Tallaa, Pakistan.” J Coll Physicians Surg Pak 26 (5): 384-9.
Neela Guha, Nadia Vilahur, Heidi Mattock, and Kurt Newbold, Retha R. 2008. “Prenatal exposure to diethylstilbestrol
Straif. 2017. “Carcinogenicity of Benzene.” The Lancet. (DES).” Fertility and sterility 89 (2): e55-e56.
Oncology 18 (12): 1574–75. https://doi.org/10.1016/S1470-
2045(17)30832-X. NHLBI. 2011. “Expert panel on integrated guidelines for cardio-
vascular health and risk reduction in children and adoles-
Lynge, Elsebeth, Ahti Anttila, and Kari Hemminki. 1997. cents: summary report.” Pediatrics 128 Suppl 5: S213-56.
“ Organic Sol vent s and Cancer.” Cancer Causes https://doi.org/10.1542/peds.2009-2107C.
and Control. Cancer Causes Control. ht tps://doi.
org/10.1023/A:1018461406120. NIOSH. 1990. National Occupational Exposure Survey. Available
at: http://www.cdc.gov/noes/default.html.
Ma, Shengtao, Guofa Ren, Xiangying Zeng, Zhiqiang Yu, Guoying
Sheng, and Jiamo Fu. 2018. “Polychlorinated biphe- ---. 2002. Health Effects of Occupational Exposure to Respirable
nyls and their hydroxylated metabolites in the serum Crystalline Silica. DHHS (NIOSH) Publication Number
of e-waste dismantling workers from eastern China.” 2002-129. https://www.cdc.gov/niosh/docs/2002-129/de-
Environmental geochemistry and health 40 (5): 1931-1940. fault.html Accessed August 3, 2020
Marsili, Daniela, Benedetto Terracini, Vilma S. Santana, Juan ---. 2015. “Hierarchy of Controls.” 2015. https://www.cdc.gov/
Pablo Ramos-Bonilla, Roberto Pasetto, Agata Mazzeo, niosh/topics/hierarchy/default.html.
Dana Loomis, Pietro Comba, and Eduardo Algranti. 2016. NTP (National Toxicology Program). 2016. Report on Carcinogens,
“Prevention of Asbestos-Related Disease in Countries Fourteenth Edition.; Research Triangle Park, NC: U.S.
Currently Using Asbestos.” International journal of envi- Department of Health and Human Services, Public Health
ronmental research and public health 13 (5): 494. https:// Service.
doi.org/10.3390/ijerph13050494. https://pubmed.ncbi. Numano, Takamasa, Hitomi Higuchi, David B Alexander, William
nlm.nih.gov/27187433 T Alexander, Mohamed Abdelgied, Ahmed M El‐Gazzar,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881119/. Dina Saleh, Hiroshi Takase, Akihiko Hirose, and Aya
Matteis, Sara et al. 2017. Current and new challenges in occupa- Naiki‐Ito. 2019. “MWCNT‐7 administered to the lung by
tional lung diseases. European Respiratory Review. 2017. intratracheal instillation induces development of pleural
26: 170080. DOI: 10.1183/16000617.0080-2017 mesothelioma in F344 rats.” Cancer science 110 (8): 2485.
Memon, Qurat Ul Ain, Shoaib Ahmed Wagan, Dong Chunyu, Ogungbuyi, O, IC Nnorom, O Osibanjo, and M Schluep. 2012.
Xiao Shuangxi, Luan Jingdong, and Christos A. Damalas. “e-Waste Country Assessment Nigeria, e-Waste Africa
2019. “Health problems from pesticide exposure and project of the Secretariat of the Basel Convention.”
personal protective measures among women cotton Basel Convention Coordinating Centre, Nigeria and
workers in southern Pakistan.” The Science of the total Swiss Federal Laboratories for Materials Science and
environment 685: 659-666. https://doi.org/10.1016/j. Technology (Empa), Switzerland.-2012.-93 p.
scitotenv.2019.05.173. http://europepmc.org/abstract/ Organiscak JA, Cecala AB. Doing the math—The effectiveness of
MED/31200258 enclosed-cab air-cleaning methods can be spelled out in
https://doi.org/10.1016/j.scitotenv.2019.05.173. mathematical equations. Rock Products. 2009 Oct;:20–22
Meng, E., Y. Mao, Q. Yao, X. Han, X. Li, K. Zhang, and W. Jin. 2020. Orisakwe, Orish Ebere, Chiara Frazzoli, Cajetan Elochukwu Ilo,
“Population-based study of environmental/occupational and Benjamin Oritsemuelebi. 2019. “Public health burden
lead exposure and amyotrophic lateral sclerosis: a sys- of e-waste in Africa.” Journal of Health and Pollution 9 (22):
tematic review and meta-analysis.” Neurol Sci 41 (1): 190610.
35-40. https://doi.org/10.1007/s10072-019-04067-z. OSHA. 1995. Occupational Safety and Health Standards-Detailed
Meyer-Baron, Monika, Meinolf Blaszkewicz, Henning Henke, Procedures for Asbestos
Guido Knapp, Axel Muttray, Michael Schäper, and Sampling and Analysis. Regulations (Standards - 29 CFR).
Christoph van Thriel. 2008. “The Impact of Solvent ---. 2002 Occupational Safety and Health Administration, US
Mixtures on Neurobehavioral Performance-Conclusions Department of Labor. Occupational exposure to respir-
from Epidemiological Data.” NeuroToxicology 29 (3): 349– able crystalline silica; proposed rule.
60. https://doi.org/10.1016/j.neuro.2008.02.005.
---. 2006. “Health Effects of Hexavalent Chromium.”
Mew, Emma J, Prianka Padmanathan, Flemming Konradsen,
---. n.d. “Controlling Lead Exposures in the Construction Industry:
Michael Eddleston, Shu-Sen Chang, Michael R Phillips,
Engineering and Work Practice Controls.” Technical
and David Gunnell. 2017. “The global burden of fatal
Manual. https://www.osha.gov/dts/osta/otm/otm_v/
self-poisoning with pesticides 2006-15: systematic
otm_v_3.html.
review.” Journal of affective disorders 219: 93-104.
Oteng-Ababio, Martin, and Richard Grant. 2019. “Ideological
Michael, Holly A. 2013. “An arsenic forecast for China.” Science 341
traces in Ghana’s urban plans: How do traces get worked
(6148): 852-853.
out in the Agbogbloshie, Accra?” Habitat International
Mihalache, Raluca, Jos Verbeek, Halshka Graczyk, Vladimir 83: 1-10. https://doi.org/https://doi.org/10.1016/j.habita-
Murashov, and Pieter van Broek huizen. 2017. tint.2018.10.007. http://www.sciencedirect.com/science/
“Occupational exposure limits for manufactured nano- article/pii/S0197397518305903.
materials, a systematic review.” Nanotoxicology 11 (1):
PAN, 2009. “PAN International List of Highly Hazardous
7-19.
Pesticides” Pesticide Action Network: March 2019.
Mughal, Bilal B, Jean-Baptiste Fini, and Barbara A Demeneix.
Parajuly, Keshav, Ruediger Kuehr, Abhishek Kumar Awasthi, Colin
2018. “Thyroid-disrupting chemicals and brain develop-
Fitzpatrick, Josh Lepawsky, Elisabeth Smith, Rolf Widmer,
ment: an update.” Endocrine connections 7 (4): R160-R186.
and Xianlai Zeng. 2019. “Future E-Waste Scenarios.”
Muñoz-Quezada, María Teresa, Boris Andrés Lucero, Verónica
Pascale, Antonio, Adriana Sosa, Cristina Bares, Alejandra
Paz Iglesias, et al. 2016. “Chronic exposure to organ-
Battocletti, María José Moll, Darío Pose, Amalia Laborde,
ophosphate (OP) pesticides and neuropsychological
Hugo González, and Gabriella Feola. 2016. “E-waste
80
A global review
informal recycling: an emerging source of lead exposure Ruiz, Daniel, Marisol Becerra, Jyotsna S Jagai, Kerry Ard, and
in South America.” Annals of global health 82 (1): 197-201. Robert M Sargis. 2018. “Disparities in environmental ex-
Pastor-Barriuso, Roberto, Mariana F Fernández, Gemma posures to endocrine-disrupting chemicals and diabetes
Castaño-Vinyals, et al. 2016. “Total effective xenoestrogen risk in vulnerable populations.” Diabetes Care 41 (1): 193-
burden in serum samples and risk for breast cancer in 205.
a population-based multicase–control study in Spain.” Sakamoto, Yoshimitsu, Dai Nakae, Nobutaka Fukumori, Kuniaki
Environmental health perspectives 124 (10): 1575-1582. Tayama, Akihiko Maekawa, Kiyoshi Imai, Akihiko Hirose,
Perdichizzi, Stefania, Maria Grazia Mascolo, Paola Silingardi, Tetsuji Nishimura, Norio Ohashi, and Akio Ogata. 2009.
Elena Morandi, Francesca Rotondo, Angela Guerrini, “Induction of mesothelioma by a single intrascrotal ad-
Luciana Prete, Monica Vaccari, and Annamaria Colacci. ministration of multi-wall carbon nanotube in intact male
2014. “Cancer-related genes transcriptionally induced Fischer 344 rats.” The Journal of toxicological sciences 34
by the fungicide penconazole.” Toxicology in vitro 28 (1): (1): 65-76.
125-130. Sakr, Carine J, Robin C Leonard, Kim H Kreckmann, Martin D
Pesch, B., J. Haerting, U. Ranft, A. Klimpel, B. Oelschlagel, and W. Slade, and Mark R Cullen. 2007. “Longitudinal study of
Schill. 2000. “Occupational risk factors for urothelial car- serum lipids and liver enzymes in workers with occu-
cinoma: agent-specific results from a case-control study pational exposure to ammonium perfluorooctanoate.”
in Germany. MURC Study Group. Multicenter Urothelial Journal of occupational and environmental medicine 49 (8):
and Renal Cancer.” Int J Epidemiol 29 (2): 238-47. http://ije. 872-879.
oxfordjournals.org/content/29/2/238.full.pdf. Scarselli, Alberto, Marisa Corfiati, Davide Di Marzio, Alessandro
Pezzoli, Gianni, and Emanuele Cereda. 2013. “Exposure to pesti- Marinaccio, and Sergio Iavicoli. 2018. “Gender differences
cides or solvents and risk of Parkinson disease.” Neurology in occupational exposure to carcinogens among Italian
80 (22): 2035-2041. workers.” BMC public health 18 (1): 413-413. https://doi.
org/10.1186/s12889-018-5332-x. https://pubmed.ncbi.
Poinen-Rughooputh, Satiavani, Mahesh Shumsher Rughooputh, nlm.nih.gov/29587708
Yanjun Guo, Yi Rong, and Weihong Chen. 2016.
“Occupational exposure to silica dust and risk of lung https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870210/.
cancer: an updated meta-analysis of epidemiological Schrager, Sarina, and Beth Potter. 2004. “Diethylstilbestrol expo-
studies.” BMC public health 16 (1): 1137. sure.” American family physician 69 (10): 2395-2400.
Poland, Craig A., Rodger Duffin, Ian Kinloch, Andrew Maynard, et Seachrist, Darcie D, Kristen W Bonk, Shuk-Mei Ho, Gail S Prins,
al. 2008. “Carbon nanotubes introduced into the abdom- Ana M Soto, and Ruth A Keri. 2016. “A review of the car-
inal cavity of mice show asbestos-like pathogenicity in a cinogenic potential of bisphenol A.” Reproductive toxi-
pilot study.” Nature Nanotechnology 3 (7): 423-428. https:// cology 59: 167-182.
doi.org/10.1038/nnano.2008.111. https://doi.org/10.1038/ Sethi, P. K., and D. Khandelwal. 2006. “Cadmium exposure: health
nnano.2008.111. hazards of silver cottage industry in developing coun-
Preston, Emma V, Thomas F Webster, Emily Oken, et al. 2018. tries.” J Med Toxicol 2 (1): 14-5. https://doi.org/10.1007/
“Maternal plasma per-and polyfluoroalkyl substance bf03161007.
concentrations in early pregnancy and maternal and Singh, Zorawar, and Pooja Chadha. 2016. “Textile industry and
neonatal thyroid function in a prospective birth cohort: occupational cancer.” Journal of occupational medicine
project viva (USA).” Environmental health perspectives 126 and toxicology (London, England) 11: 39-39. https://doi.
(2): 027013. org/10.1186/s12995-016-0128-3. https://pubmed.ncbi.
Prüss-Ustün, Annette, Carolyn Vickers, Pascal Haefliger, and nlm.nih.gov/27532013
Roberto Bertollini. 2011. “Knowns and unknowns on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986180/.
burden of disease due to chemicals: a systematic review.”
Environmental health 10 (1): 9. Skakkebaek, Niels E, Niels Jørgensen, Anna-Maria Andersson,
Anders Juul, Katharina M Main, Tina Kold Jensen, and
Public-Eye. 2020. The global market of highly hazardous pesticides Jorma Toppari. 2019. “Populations, decreasing fertility,
Rahman, M. A., A. Rahman, M. Z. K. Khan, and A. M. N. Renzaho. and reproductive health.” The Lancet 393 (10180): 1500-
2018. “Human health risks and socio-economic per- 1501.
spectives of arsenic exposure in Bangladesh: A scoping Skakkebaek, Niels E, Ewa Rajpert-De Meyts, Germaine M Buck
review.” Ecotoxicol Environ Saf 150: 335-343. https://doi. Louis, et al. 2016. “Male reproductive disorders and fer-
org/10.1016/j.ecoenv.2017.12.032. tility trends: influences of environment and genetic sus-
Ramos-Bonilla, J. P., M. F. Cely-García, M. Giraldo, P. et al. 2019. “An ceptibility.” Physiological reviews 96 (1): 55-97.
asbestos contaminated town in the vicinity of an asbes- Smarr, Melissa M, Kurunthachalam Kannan, and Germaine M
tos-cement facility: The case study of Sibaté, Colombia.” Buck Louis. 2016. “Endocrine disrupting chemicals and
Environ Res 176: 108464. https://doi.org/10.1016/j. endometriosis.” Fertility and sterility 106 (4): 959-966.
envres.2019.04.031.
Solinap, G., J. Wawrzynski, N. Chowdhury, H. Zaman, T. Abid, T.
Ratnaike, R N. 2003. “Acute and chronic arsenic toxicity.” A. Hoque, S. Afrooz, I. Hamid, R. Tanjin, C. T. Tabassum,
Postgraduate Medical Journal 79 (933): 391-396. https:// P. Paramita, R. B. Duda, and M. R. Abid. 2019. “A dis-
doi.org/10.1136/pmj.79.933.391. https://pmj.bmj.com/ ease burden analysis of garment factory workers in
content/postgradmedj/79/933/391.full.pdf. Bangladesh: proposal for annual health screening.” Int
Rawat, Deepak, Vandana Mishra, and Radhey Shyam Sharma. Health 11 (1): 42-51. https://doi.org/10.1093/inthealth/
2016. “Detoxification of azo dyes in the context of envi- ihy064.
ronmental processes.” Chemosphere 155: 591-605. Song, Xiaowei, Robin Vestergren, Yali Shi, Jun Huang, and Yaqi
REPUBBLICA, CAMERA DEI DEPUTATI - SENATO DELLA. 1997. Cai. 2018. “Emissions, transport, and fate of emerging
Audizione dei rappresentati dell’ENEA - COMMISSIONE per-and polyfluoroalkyl substances from one of the
PARLAMENTARE D’INCHIESTA SUL CICLO DEI RIFIUTI E major fluoropolymer manufacturing facilities in China.”
SULLE ATTIVITA’ ILLECITE AD ESSO CONNESSE. Environmental science & technology 52 (17): 9694-9703.
Rim, Kyung Taek. 2017. “Reproductive Toxic Chemicals at Work Steckling, N., M. Tobollik, D. Plass, C. Hornberg, B. Ericson, R.
and Efforts to Protect Workers’ Health: A Literature Fuller, and S. Bose-O’Reilly. 2017. “Global Burden of
Review.” Safety and Health at Work 8 (2): 143–50. https:// Disease of Mercury Used in Artisanal Small-Scale Gold
doi.org/10.1016/j.shaw.2017.04.003. Mining.” Ann Glob Health 83 (2): 234-247. https://doi.
org/10.1016/j.aogh.2016.12.005.
X References 81
Steenland, Kyle, Vaughn Barry, Ahti Anttila, Markku Sallmen, UNEP. 2012. “A Practical Guide: Reducing Mercury Use in Artisanal
William Mueller, Peter Ritchie, Damien Martin McElvenny, and Small-Scale Gold Mining. Geneva: United Nations
and Kurt Straif. 2019. “Cancer incidence among workers Environment Programme.”
with blood lead measurements in two countries.” ---. 2017a. Overview Report I: Worldwide Initiatives to Identify
Occupational and Environmental Medicine 76 (9): 603-610. Endocrine Disrupting Chemicals (EDCs) and Potential EDCs.
https://doi.org/10.1136/oemed-2019-105786. https:// 2017a.
oem.bmj.com/content/oemed/76/9/603.full.pdf.
---. 2017b. “Overview Report II: An Overview of Current Scientific
Steenland, Kyle, and Susan Woskie. 2012. “Cohort mortality study Knowledge on the Life Cycles, Environmental Exposures,
of workers exposed to perfluorooctanoic acid.” American and Environmental Effects of Select Endocrine Disrupting
journal of epidemiology 176 (10): 909-917. Chemicals (EDCs) and Potential EDCs. 2017b.”
Stenmarck, Åsa, Elin L. Belleza, Anna Fråne, Niels Busch, Åge ---. 2017c. “Overview Report III: Existing National, Regional, and
Larsen, and Margareta Wahlström. 2017. Hazardous sub- Global Regulatory Frameworks Addressing Endocrine
stances in plastics : – ways to increase recycling. 2017:505 Disrupting Chemicals (EDCs). 2017c.”
vols. Vol. 2017:505TemaNord. Copenhagen: Nordisk
Ministerråd. ---. 2018. Global Gender and Environment Outlook (GGEO).
Sun, Jianling, Qiu Zhang, Zhiping Wang, and Bing Yan. 2013. ---. 2019a. Global Mercury Assessment 2018. United Nations
“Effects of nanotoxicity on female reproductivity and Environment Programme, Chemicals and Health Branch
fetal development in animal models.” International journal Geneva
of molecular sciences 14 (5): 9319-9337. ---. 2019b. UN Environment Global Chemicals Outlook II-From
Takahashi, K., and P. J. Landrigan. 2016. “The Global Health Legacies to Innovative Solutions: Implementing the 2030
Dimensions of Asbestos and Asbestos-Related Diseases.” Agenda for Sustainable Development. 2019.
Ann Glob Health 82 (1): 209-13. https://doi.org/10.1016/j. ---. 2020a. An Assessment Report on Issues of Concern:Chemicals
aogh.2016.01.019. and Waste Issues Posing Risks to Human Health and the
Takala, Jukka. 2015. “Eliminating occupational cancer in Europe Environment.
and globally.” ---. 2020b. “The lead campaign. Leaded petrol phase-out glob-
Takala, Jukka, Päivi Hämäläinen, Kaija Leena Saarela, Loke Yoke ally. Nairobi, United Nations Environment Programme
Yun, Kathiresan Manickam, Tan Wee Jin, Peggy Heng, (https://www.unenvironment.org/explore-topics/trans-
Caleb Tjong, Lim Guan Kheng, and Samuel Lim. 2014. port/what-we-do/partnership-clean-fuels-and-vehicles/
“Global estimates of the burden of injury and illness at lead-campaign).”.
work in 2012.” Journal of occupational and environmental ---.2020c “WOMEN, CHEMICALS AND THE SDGs” United Nations
hygiene 11 (5): 326-337. Environment Programme, Chemicals and Health Branch
Tanakaya, K., Y. Furukawa, Y. Nakamura, K. Hirata, N. et al. 2015. Geneva.
“Relationship between smoking and multiple colorectal UNIDO, 2019. UN Industrial Development Organization. Viet
cancers in patients with Japanese Lynch syndrome: a Nam Industry White Paper. Manufacturing and Subsector
cross-sectional study conducted by the Japanese Society Competitiveness. 2019.
for Cancer of the Colon and Rectum.” Jpn J Clin Oncol 45 (3): USGS. 2020. “Mineral commodity summaries 2020: U.S.
307-10. https://doi.org/10.1093/jjco/hyu218. Geological Survey.”
Toppari, Jorma, Helena E Virtanen, Katharina M Main, and Niels Valen, Evelien Van, Christoph Van Thriel, Ritva Akila, Linda
E Skakkebaek. 2010. “Cryptorchidism and hypospadias as Nordling Nilson, R i t a B as t- Pet ter sen, Mar k ku
a sign of testicular dysgenesis syndrome (TDS): environ- Sainio, Frank Van Dijk, Gert Van der Laan, Maarten
mental connection.” Birth Defects Research Part A: Clinical Verberk, and Ellie Wekking. 2012. “Chronic Solvent-
and Molecular Teratology 88 (10): 910-919. Induced Encephalopathy: European Consensus of
Torén, K., I. A. Bergdahl, T. Nilsson, and B. Järvholm. 2007. Neuropsychological Characteristics, Assessment, and
“Occupational exposure to particulate air pollution and Guidelines for Diagnostics.” NeuroToxicology 33 (4): 710–
mortality due to ischaemic heart disease and cerebrovas- 26. https://doi.org/10.1016/j.neuro.2012.03.010.
cular disease.” Occup Environ Med 64 (8): 515-9. https://doi. Valen, Evelien van, Ellie Wekking, Moniek van Hout, Gert van der
org/10.1136/oem.2006.029488. Laan, Gerard Hageman, Frank van Dijk, Angela de Boer,
Trasande, Leonardo, RT Zoeller, Ulla Hass, A Kortenkamp, and Mirjam Sprangers. 2018. “Chronic Solvent-Induced
Philippe Grandjean, JP Myers, J DiGangi, PM Hunt, R Encephalopathy: Course and Prognostic Factors of
Rudel, and S Sathyanarayana. 2016. “Burden of disease Neuropsychological Functioning.” International Archives
and costs of exposure to endocrine disrupting chemicals of Occupational and Environmental Health 91 (7): 843–58.
in the E uropean U nion: an updated analysis.” Andrology https://doi.org/10.1007/s00420-018-1328-1.
4 (4): 565-572. Valvi, Damaskini, Youssef Oulhote, Pal Weihe, Christine Dalgård,
Trowbridge, Jessica, Roy R. Gerona, Thomas Lin, Ruthann A. Kristian S Bjerve, Ulrike Steuerwald, and Philippe
Rudel, Vincent Bessonneau, Heather Buren, and Rachel Grandjean. 2017. “Gestational diabetes and offspring
Morello-Frosch. 2020. “Exposure to Perfluoroalkyl birth size at elevated environmental pollutant expo-
Substances in a Cohort of Women Firefighters and sures.” Environment international 107: 205-215.
Office Workers in San Francisco.” Environmental Science & Ventura-camargo, Bruna De Campos, and Maria Aparecida
Technology 54 (6): 3363-3374. https://doi.org/10.1021/acs. Marin-morales. 2013. “Azo Dyes: Characterization and
est.9b05490. https://doi.org/10.1021/acs.est.9b05490. Toxicity– A Review.” Textiles and Light Industrial Science
Tsimbiri, Pamela F, Wilkister N Moturi, Judith Sawe, Phaedra and Technology, no. May.
Henley, and John R Bend. 2015. “Health impact of pesti- Vermeulen, R., D. T. Silverman, E. Garshick, J. Vlaanderen, L.
cides on residents and horticultural workers in the Lake Portengen, and K. Steenland. 2014. “Exposure-response
Naivasha Region, Kenya.” Occupational Diseases and estimates for diesel engine exhaust and lung cancer
Environmental Medicine 3 (02): 24. mortality based on data from three occupational co-
UN. 2013. Minamata Convention. Availble at: http://www.mercu- horts.” Environ Health Perspect 122 (2): 172-7. https://doi.
ryconvention.org/. org/10.1289/ehp.1306880.
---. 2018. “Report from the Special Rapporteur on Toxics “Workers’ Vieira, Verónica M, Kate Hoffman, Hyeong-Moo Shin, Janice M
Rights and Toxic Exposures” - report to UN Human Rights Weinberg, Thomas F Webster, and Tony Fletcher. 2013.
Council.” “Perfluorooctanoic acid exposure and cancer outcomes
82
A global review
in a contaminated community: a geographic analysis.” ---. 2019d. Preventing disease through healthy environments: expo-
Environmental health perspectives 121 (3): 318-323. sure to highly hazardous pesticides: a major public health
Walker, Deena M, and Andrea C Gore. 2011. “Transgenerational concern. World Health Organization.
neuroendocrine disruption of reproduction.” Nature ---. 2019e. “Exposure To Benzene: A Major Public Health Concern.”
Reviews Endocrinology 7 (4): 197. Preventing Disease Through Healthy Environments, 3–6.
Wang, Feng, Ruediger Kuehr, Daniel Ahlquist, and Jinhui Li. 2013. http://www.who.int/ipcs/features/cadmium.pdf.
“E-waste in China: A country report.” ---. 2020. “Global Urban Ambient Air Pollution Database.”
Wang, Jing, Shejun Chen, Mi Tian, Xiaobo Zheng, Leah Gonzales, WHO/FAO. 2019. “Preventing suicide: a resource for pesticide reg-
Takeshi Ohura, Bixian Mai, and Staci L Massey Simonich. istrars and regulators.”
2012. “Inhalation cancer risk associated with exposure Wu, Maoxin, Ronald E Gordon, Robin Herbert, Maria Padilla,
to complex polycyclic aromatic hydrocarbon mixtures Jacqueline Moline, David Mendelson, Virginia Litle,
in an electronic waste and urban area in South China.” William D Travis, and Joan Gil. 2010. “Case report: Lung
Environmental science & technology 46 (17): 9745-9752. disease in World Trade Center responders exposed to
Weichenthal, Scott, Toyib Olaniyan, Tanya Christidis, et al. 2020. dust and smoke: carbon nanotubes found in the lungs
“Within-city Spatial Variations in Ambient Ultrafine of World Trade Center patients and dust samples.”
Particle Concentrations and Incident Brain Tumors in Environmental health perspectives 118 (4): 499-504.
Adults.” Epidemiology (Cambridge, Mass.) 31 (2): 177-183. Yan, Dandan, Yunjian Zhang, Liegang Liu, and Hong Yan. 2016.
https://doi.org/10.1097/EDE.0000000000001137. https:// “Pesticide exposure and risk of Alzheimer’s disease: a
pubmed.ncbi.nlm.nih.gov/31714401 systematic review and meta-analysis.” Scientific reports
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004474/. 6 (1): 1-9.
Weinberg, Justine Lew, Lisa J. Bunin, and Rupali Das. 2009. Yang, Geniey, Somaira Nowsheen, Khaled Aziz, and Alexandros
“Application of the Industrial Hygiene Hierarchy of G Georgakilas. 2013. “Toxicity and adverse effects of
Controls to Prioritize and Promote Safer Methods Tamoxifen and other anti-estrogen drugs.” Pharmacology
of Pest Control: A Case Study.” Public Health Reports & therapeutics 139 (3): 392-404.
(Washington, D.C. : 1974) 124 Suppl: 53–62. https://doi. Yuyun Ismawati, Lelitasari, Sonia Buftheim. 2014. “Gold produc-
org/10.1177/00333549091244S107. tion in rural areas of Bogor Regency and its hidden haz-
Welling, R., J. J. Beaumont, S. J. Petersen, G. V. Alexeeff, and C. ards implication.” The 5th Environmental Technology and
Steinmaus. 2015. “Chromium VI and stomach cancer: a Management Conference “Green Technology towards
meta-analysis of the current epidemiological evidence.” Sustainable Environment”, November 23 - 24, 2015, Bandung,
Occup Environ Med 72 (2): 151-9. https://doi.org/10.1136/ Indonesia.
oemed-2014-102178.
Zanardi, F., E. C. Harris, T. Brown, S. Rice, K. T. Palmer, and D.
Were, Faridah H., M. Charles Moturi, and Godfrey A. Wafula. Coggon. 2011. “Mortality from diabetes and ischaemic
2014. “Chromium Exposure and Related Health Effects heart disease in textile workers.” Occup Environ Med 68
among Tannery Workers in Kenya.” Journal of Health and (3): 172-5. https://doi.org/10.1136/oem.2009.053835.
Pollution 4 (7): 25-35. https://doi.org/10.5696/2156-9614-
4-7.25. https://www.journalhealthpollution.org/doi/ Zhang, Kai, and Stuart Batterman. 2013. “Air pollution and
abs/10.5696/2156-9614-4-7.25. health risks due to vehicle traffic.” The Science of the total
environment 450-451: 307-316. https://doi.org/10.1016/j.
White, Roberta F., and Susan P. Proctor. 1997. “Solvents and scitotenv.2013.01.074. https://pubmed.ncbi.nlm.nih.
Neurotoxicity.” Lancet. Lancet Publishing Group. https:// gov/23500830
doi.org/10.1016/S0140-6736(96)07218-2.
WHO. 2014a. “Asbestos: elimination of asbestos-related dis-
eases.” Fact sheet N°343 July Zhang, Luoping, Iemaan Rana, Rachel M Shaffer, Emanuela
Taioli, and Lianne Sheppard. 2019. “Exposure to glypho-
---. 2014b. Chrysotile asbestos. 2014. sate-based herbicides and risk for non-Hodgkin lym-
---. 2016a. “Ambient Air Pollution: a global assessment of expo- phoma: a meta-analysis and supporting evidence.”
sure and burden of disease.” Mutation Research/Reviews in Mutation Research 781: 186-
---. 2016b. “FAQ on Health and Sexual Diversity - An Introduction 206.
to Key Concepts.” Zheng, Xiangbin, Xijin Xu, Taofeek Akangbe Yekeen, Yuling Zhang,
---. 2016c. “Artisanal and Small-Scale Gold Mining and Health,” 26. Aimin Chen, Stephani S Kim, Kim N Dietrich, Shuk-Mei
Ho, Shu-An Lee, and Tiina Reponen. 2015. “Ambient air
---. 2017a. “Recycling used lead-acid batteries: health considera- heavy metals in PM2. 5 and potential human health risk
tions. Geneva, World Health Organization.” assessment in an informal electronic-waste recycling site
---. 2017b. WHO guidelines on protecting workers from poten- of China.” Aerosol and Air Quality Research 16 (2): 388-397.
tial risks of manufactured nanomaterials. World Health Wagner, G. R. “Health screening and surveillance of mineral dust
Organization. exposed workers. Recommendation for the ILO Workers
---. 2018 “Asbestos: elimination of asbestos-related diseases” Group. Geneva.” World Health Organization (1996)
WHO: Geneva. https://www.who.int/news-room/fact-
sheets/detail/asbestos-elimination-of-asbestos-relat-
ed-diseases
---.2018b. Conference Concept Note. Breathe clean air: every-
where, for everyone. First WHO Global Conference on Air
Pollution and Health: Improving air quality, combatting
climate change – saving lives. 29 October 2018. Geneva.
---. 2018c. “First WHO Global Conference on Air Pollution and
Health: Improving air quality, combatting climate change
– saving lives” Pre-conference workshop report.
---. 2019a. “Exposure to Arsenic: a Major Public Health Concern.”
---. 2019b. “Exposure to cadmium: a major public health concern.
Geneva, Switzerland.”
---. 2019c. Exposure to Lead: A Major Public Health Concern.

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Cover photos: ©ILO/Marcel Crozet, ©FAO/Sia Kambou, ©FAO/Carl de Souza, ©Pxfuel.

Priority action areas 65

ACGIH American Conference of MWCNT Multi-walled carbon nanotubes

CCA Chromated copper arsenate OEL Occupational exposure limits

CNT Carbon nanotubes OSHA United States Occupational Safety

DALY Disability adjusted life year PCP Pentachlorophenol

DDT Dichlorodiphenyltrichloroethane PD Parkinson’s disease

DEP Diethyl phthalate PEL Permissible exposure limit

DES Diethylstilboestrol PFAS Per- and polyfluoroalkyl substances

ECHA European Chemicals Agency PFOA Perfluorooctanoic acid

EDC Endocrine-disrupting chemicals PFOS Perfluorooctane sulfonate

EPA Environmental protection agency OPM Particulate matter

EU European Union PNC Particle number concentration

GBD Global burden of disease POPs Persistent organic pollutants

GHS Globally Harmonized System of PPB Parts per billion

HHP Highly hazardous pesticide REL Recommended exposure limit

HIC High-income countries RR Risk ratio

IARC International Agency for Research on SAICM Strategic Approach to International

ILO International Labour Organization SDG Sustainable development goal

IPCS International Programme on SMR Standardized mortality ratio

MNMs Manufactured nanomaterials UNEP United Nations Environment

© ILO / Marcel Crozet

Chemical Downstream Industrial Industrial Industrial and

Source: (UNEP 2019a).

70% Genitourinary diseases

60% Digestive diseases

50% Respiratory diseases

40% Circulatory diseases

30% Neuropsychiatric conditions

20% Malignant neoplasms

10% Communicable disease

Source: Hämäläinen 2017

Exposure to chemicals in exposures to even low doses of chemicals, es-

53 - Personal care workers 12% 88%

32 - Health associate professionals 24% 76%

91 - Cleaners and helpers 26% 74%

41 - General and keyboard clerks 29% 71%

22 - Health professionals 31% 69%

23 - Teaching professionals 32% 68%

42 - Customer services clerks 34% 66%

44 - Other clerical support workers 39% 61%

94 - Food preparation assistants 40% 60%

51 - Personal service workers 44% 56%

26 - Legal, social and cultural professionals 47% 53%

34 - Legal, social, cultural and related 48% 52%

33 - Business and administration associate professionals 48% 52%

52 - Sales workers 49% 52%

75 - Food processing, wood working, garment and 49% 51%

24 - Business and administration professionals 49% 51%

43 - Numerical and material recording clerks 49% 51%

Source: ILOSTAT 2020

X Figure 3b. Sectors with prevalent male workforce

93 - Labourers in mining, contruction, 83% 17%

54 - Protective services workers 84% 16%

31 - Science and engineering associate professionals 84% 16%

01 - Commissioned armed forces officers 90% 10%

74 - Electrical and electronic trades workers 91% 9%