A Global Comparison of the Implementation of National Policies for a Total Asbestos Ban

Abstract

Background: Two international conventions offer governments guidelines for achieving a total asbestos ban policy, but the conventions' long-term effect on policy implementation, and the role of government effectiveness, remains unknown. We investigated associations between government ratification of international conventions, government effectiveness, and implementation of a national total asbestos ban. Methods: We collected data on year of a national asbestos ban, year of ratification of conventions, and government effectiveness scores for 108 countries. We applied survival analysis for 99 countries with data in the follow-up period (1989-2018) to examine whether convention ratification and greater government effectiveness are associated with time of implementation of a national total asbestos ban. Findings: During the follow-up period, 26 countries ratified both international conventions and 73 ratified either one or no convention. Countries that ratified both conventions had a higher probability of a total asbestos ban and shorter time to adoption (9 years) than countries that ratified one or no conventions (17 years). Asbestos is less likely to persist in countries that ratified both conventions (hazard ratio = 41·75, 95% CI = 4·55, 383·31). For each 1 point increment in government effectiveness, the hazard of asbestos survival significantly increased by 126·60% (95% CI = 13·16, 353·79). Interpretation: This study confirms that the adoption of both international conventions facilitates countries moving toward a total ban. The effect was reinforced by government effectiveness. Both international programs and new agreements toward total asbestos bans and government commitments are needed. Funding Statement: This work was supported by China Medical University (CMU106-N-27 and CMU107-N-12) and the Ministry of Science and Technology, Taiwan (MOST 107-2314-B-039-062-MY3). Declaration of Interests: The authors declare no competing interests.