Asbestos: avoiding a pyrrhic victory.

The recent announcement by the newly elected Quebec Government that it would withdraw its loan guarantee to the Jeffrey asbestos mine, and the subsequent announcement by the Federal Government that it would drop its objection to the inclusion of chrysotile asbestos on the United Nations’ Rotterdam Convention, constitute a major public health victory. Although Canada’s contribution to the worldwide production of asbestos is less than 20% (compared to Russia’s 50%), its international standing gave its position on chrysotile credibility and justified other countries’ continued production and export of the deadly fibre. Our country’s position that chrysotile was not harmful was particularly hypocritical given the incontrovertible evidence and the fact that our government was actively removing asbestos from public buildings. Canada’s assertion that chrysotile could be safely handled with proper protections, while exporting the fibre to countries with no or ineffective workers’ safety regulations, was indefensible and unethical and it led to a campaign by public health professionals and activists to pressure governments to abandon their support for the asbestos industry. The governments’ recent change of heart is good news for all except for the mining communities which profited from the local jobs created by the industry. These communities now face the critical task of renewing their employment base to insure their survival. Herein lies a new challenge for Canadian public health. As we enter more systematically and forcefully into the public policy arena, we have a moral responsibility to all those affected by our actions. In this case, we are now collectively accountable to the former mining communities to ensure that the ultimate outcome is favourable. It would be hypocritical for us to claim victory for saving lives of workers in countries that imported Canadian chrysotile while ignoring the plight of the workers of Quebec mining towns. Public health professionals unfortunately have little if any training and expertise in economic development or in many other sectors which collectively form what we call the social determinants of health. We can name these determinants, we try to influence them, but most of them are beyond our control and we have a very poor understanding of the dynamic processes that affect these determinants or of the intended and unintended outcomes of policy changes. Political and economic sciences are critical to building effective public health interventions and to effecting policy changes and managing consequences of our actions. Close partnerships with these and other disciplines are an imperative if we want public health practice to be effective over the next decade. We neglect the potential negative consequences of interventions at our own risk. Let us not transform our public health battles into pyrrhic victories.