Implementation of national policies for a total asbestos ban: a global comparison

Background Two international Conventions from the International Labor Organization (ILO; C162 Asbestos Convention) and the UN (Basel Convention) offer governments guidelines for achieving a total asbestos ban policy, but the long-term effect of these Conventions on policy implementation, and the role of government effectiveness, remains unknown. We aimed to investigate associations between government ratification of the ILO and UN international Conventions, government effectiveness, and implementation of a national total asbestos ban. Methods We obtained data for year of a national asbestos ban, year of ratification of one or both international Conventions, and World Bank government effectiveness scores for 108 countries that ever used asbestos. We did a survival analysis for countries with data in the follow-up period (March 22, 1989, to Feb 2, 2018) to assess whether ratification of the international Conventions and greater government effectiveness were associated with time of implementation of a national total asbestos ban. Findings Of 108 countries with data for asbestos consumption, nine were excluded because they implemented an asbestos ban before 1989. Therefore, 99 countries were included in the survival analysis. 26 countries ratified both international Conventions and 73 ratified either one or no Convention. Countries that ratified both Conventions had a shorter time to adoption of a total asbestos ban (mean 8.9 [SD 6.4] years) than did countries that ratified one or no Conventions (16.9 [6.1] years). After controlling for government effectiveness, countries that ratified both Conventions had a significantly higher conditional probability of banning asbestos than did those ratifying one or no Convention (hazard ratio [HR] 41.8, 95% CI 4.5-383.3; p=0.0010). For every 1 point increment in government effectiveness, the percentage change in HR for persistent asbestos consumption significantly increased by 127% (95% CI 13-354; p=0.021). Interpretation This study confirms that adoption of both the C162 Asbestos Convention and the Basel Convention facilitates countries in moving towards a total asbestos ban. The effect was reinforced by government effectiveness. Both international programmes and new agreements towards total asbestos bans and government commitments are needed. Funding: China Medical University, and the Ministry of Science and Technology (Taiwan). Copyright (c) 2019 The Authors(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.