石綿暴露的危害認知與職業石綿疾病的監測機制

Perception of Asbestos Exposure and Surveillance System of Occupational Asbestos-related Diseases

蕭汎如(Fan-Ju Hsiao)

指導教授 ： 鄭雅文

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2017年)

https://doi.org/10.6342/NTU201701251

摘要

研究背景與目的：
工作中暴露於石綿粉塵，已知在30-40年後會增加惡性癌症的罹病風險，然而社會大眾與政府職業安全健康部門對此問題並不重視。本研究目的有三：第一，探討曾有石綿粉塵暴露經驗的工作者目前的健康狀態、過去的職業石綿暴露經驗，以及他們對石綿疾病的風險認知與態度；第二，探討他國監測石綿疾病之制度設計；第三，探討職業醫學科醫師對於職業石綿疾病之診斷或監測機制的看法。

方法：
本研究包括三個研究主題，採深度訪談法與文獻分析法。在訪談部分共計訪談20位受訪者，包括石綿粉塵暴露作業工作者、管理者、職業工會專職人員與醫療專業工作者。

研究結果：
針對第一個研究主題，研究者發現，大部分石綿暴露作業不清楚石綿危害，但參與工會者對於職業健康保護制度的態度較為積極；具管理職的受訪者質疑職業病罹病者的求償動機，且擔心職業病認定可能伴隨的法律責任。針對第二個研究主題，研究結果指出，日本、英國、德國、法國、波蘭、芬蘭等國以職災保險或公共基金籌措財源，對石綿作業的現職工作者與離職者提供定期健康檢查服務，並對確認罹病者提供醫療照顧與經濟補償;而澳洲、法國與南韓另針對惡性間皮瘤建立疾病監測機制，蒐集的疾病與暴露資料成為政府評估石綿疾病發生趨勢與制訂相關政策的依據。針對第三個研究主題，研究者整理醫療專業工作者對石綿作業工作者離職後健檢制度的態度，分以下面向進行討論：受檢族群的界定、石綿暴露的認定、診斷工具與專業人員、財源與應對機制、公義與後果。

結論：
本研究發現，台灣工作者對於石綿危害的認知薄弱，政府對於潛伏期漫長的職業病並無監測措施。政府應積極宣導，提高工作者的風險危害意識、加強管理者的職業病教育，並應針對石綿作業工作者建立離職後職業健檢機制。此外，除了職業性石綿疾病之外，亦應思考思考如何提升其他職業病的認定率。

關鍵字

石綿暴露作業工作者 ； 職業石綿疾病 ； 暴露危害認知 ； 職業健康檢查 ； 國際比較

並列摘要

Background and Objective:
Asbestos exposure is known to increase the risks of malignant diseases after 30-40 years. However in Taiwan, this issue has not been concerned nor been addressed by occupational health system (OHS) of Taiwan. There were 3 objectives in this study: first, to understand asbestos-exposed workers’ current health status and their knowledge and risk perception of asbestos hazards; secondly, to learn from the experiences of other countries on disease surveillance programs designed for asbestos-exposed workers; thirdly, to explore medical professionals’ perspectives towards the disease surveillance programs of occupational asbestos-related diseases.

Methods:
In-depth interviews and literature analyses were conducted. A total of 20 persons were interviewed, including workers with known current or past exposure to asbestos, managers of asbestos industries, representatives of unions, and medical professionals.

Results:
Results from the first part showed that most workers were unaware of asbestos health risks, but union members were more positively about the roles of occupational health programs; those who held managerial positions expressed concerns on workers’ motives in claiming occupational diseases and on potential legal responsibilities in consequence of such claims.
Results from the second part indicated that in Japan, the United Kingdom, Germany, France, Portland and Finland, workers recognized as having current or past occupational exposure to asbestos are eligible to participate in occupational health examination programs, which are financed either through workers’ compensation insurance schemes or through public funds. Surveillance programs of mesothelioma were established in Australia, France and South Korea, and identified asbestos-related disease cases were investigated on asbestos exposure history. Information generated by disease surveillance programs provide empirical evidences for disease prevention and compensation policies.
Results from the third part summarized medical professionals’ perspectives towards the establishment of post-exposure occupational health examination program for asbestos workers in the followoing aspects : the defination of elegible population, the recognition of occupational asbestos disease, tools for screening and qualification of personnel, , finance mechanism, fairness and negative consequences.

Conclusions:
Findings of this research indicated that social awareness of asbestos risks is low and the current occupational health systems fail to detect occupational diseases with long latency. The government should enhance awareness of asbestos risks among workers, strengthen occupational education and training among managers, expand the scope of occupational health examination programs to workers with past occupational exposure to asbestos, and establish post-exposure surveillance mechanisms for mesothelioma. Furthermore, efforts should be made to increase the recognition of other occupational diseases beside asbestos-related diseases.

並列關鍵字

Asbestos-exposed workers ； Occupational asbestos disease ； Awareness of risk and exposure ； Occupational Health examination ； International comparison

參考文獻

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