While more and more companies are paying attention to site safety, there has been precious little headway in on-site health – and workers are paying the price.

Last summer, John Clements (not his real name)began to feel wheezy and short of breath after walking up a few flights of stairs. He thought it was strange. He had never smoked, didn’t drink heavily and always considered himself fit. But, after a series of visits to hospital, the former carpenter discovered to his horror he had mesothelioma – cancer of the lining of the lungs, caused by exposure to asbestos. He is 52, married, with three children, and he has six to 18 months to live. “I have worked in construction all my life, and now I have literally given my life to it,” he says.

Sudden, violent death is a daily hazard for construction workers, as last month’s crane collapse in Docklands reminded us, but the insidious nature of diseases such as mesothelioma, which can spend 20 years incubating, rarely grab the headlines. Annually, there are about 250 deaths from mesothelioma, 100 from asbestosis and 250 from lung cancer caused by asbestos exposure.

The effects of exposure to asbestos may not be apparent for 10-60 years. By then, the company that employed the worker has often been bought or stopped trading. Tracking down the insurer becomes all but impossible. The tragedy of terminal illness is then made worse by the difficulty in obtaining compensation, as John found. Many more asbestos-related cases can be expected, as those who worked with it during the 1960s and 1970s start to fall ill. The substance has now been banned but that does not mean that the threat of mesothelioma has gone away. There are still tons of asbestos in high-rise blocks and offices, although the Health and Safety Commission is considering drawing up a register of buildings that contain asbestos.

These fatal illnesses are one tragic element in an industry where occupational ailments, afflictions and complaints are rife. The Health and Safety Executive says there are 96 000 cases of musculo-skeletal-related injuries a year in the construction industry. Figures for respiratory diseases, skin complaints and hearing problems are not available but a 1995 survey of self-reported work-related illness in construction estimated that construction operatives had 2 million days off work each year.

The list of preventable work-related illnesses that afflict construction staff is shameful. Contact with concrete causes dermatitis of the hand or athlete’s foot; contact with tar or pitch can lead to skin cancer, with warts on the scrotum or eyelids. Musculo-skeletal ailments such as backache are commonplace, caused by lifting large bags of cement or concrete blocks. Plasterers and bricklayers contract painful repetitive strain injuries. White finger affects those who work with electric tools. Most of these victims also suffer from damaged hearing. Construction workers are also susceptible to asthma from dust resulting from cutting concrete blocks or sawing wood.

Union officials complain that most workers are not told of the dangers. “Contractors don’t do health-awareness training on site. The best you get is a qualified first-aider, someone who is familiar with resuscitation techniques,” says Allan Black, the GMB’s national construction officer.

A slow awakening

There are signs that the industry is finally realising that it needs to raise its game. Health has tended to play second fiddle to safety because the problems are much more difficult to pin down. Health and safety director at the Construction Confederation, Suzannah Thursfield, says: “The biggest problem is that if I go home with a cough or short of breath and discover I have asthma, I may not think it is caused by working in a dusty environment. Similarly, if I have a bad back and I’ve been lifting kerb stones, it can be difficult to make the connection with activities at work.”

Balfour Beatty is one firm that has decided it needs to be more proactive about health risks. It runs a mobile clinic that travels around sites testing hearing, sight, blood pressure and cholesterol. The occupational physician and nurse also look for signs of diabetes and dermatitis. Some 4200 people have been tested since the clinic was set up more than three years ago; 120 have been referred to their doctor, and 50 were signed off while they sought treatment, later returning to work. Balfour Beatty is exploring ways of offering this service to the rest of the industry.

Carillion also runs a screening service for operatives with nine fully equipped buses. Lung capacity and blood pressure are checked, and blood, urine, ear and eye tests are carried out. Carillion’s director of safety and project management systems, Tony Wheel, says that medical staff can detect early indications of more serious problems, such as white finger or diabetes, during the check-ups. “We have an obligation to our people. We don’t want a crane driver who didn’t realise he was diabetic to go hypoglycaemic while up in a tower crane. We don’t want to harm our people.” Wheel can also benchmark operatives’ health when they start on site. Should any of them then submit a claim at a later date, it is possible to assess when the health risk originated.

Designing for better health

Medical screening is one way to protect workers. Another is to ensure that on-site hazards are eliminated at the design stage. Says Thursfield: “Designers can do a lot. Wherever possible they can specify non-solvent paints. And why are workers lifting heavy concrete blocks of 25-45 kg day in, day out, when lighter blocks would prevent musculo-skeletal problems?”

The Association of Planning Supervisors is aware that much can be done during the design process to reduce health hazards. Solvent-based products are no longer specified, for instance, but, as Brian Law, chief executive of the APS, says: “The problem lies in trying to make a leap from what designers can do to what the operative does at the coalface.”

The Movement for Innovation is in the process of putting together a form identifying health risks in order to raise awareness. The subcommittee for health in the Respect for People initiative is adapting a test devised by the occupational health team at BP Amoco, where foremen and managers are given a chart to fill in so they can see which areas on site are risky and to whom. For example, if there is concrete, the chart requires information about the number of people in the area and the likelihood of their coming into contact with it. The foreman can then decide how to approach the problem. The subcommittee’s version of the chart should be ready later this year.

The subcommittee invited Angela Whitehead, BP Amoco’s senior occupational health adviser, to join it so that it could learn from the firm’s approach. “Managers are finding safety easier to manage,” she says. “But when you talk to them about health, they think it’s something people in white coats do. This tool shows that health is as much of a management process as anything else.”

Balfour Beatty and Carillion are giving a lead with their screening programmes, but progress depends on a comprehensive approach embodied in a national scheme. France, for example, has a national health screening programme in place for site operatives. The Construction Confederation and the Construction Industry Advisory Centre are rumoured to be investigating a programme along the French lines. As Allan Black points out: “Clearly we need a bigger programme than one bus trying to cover the whole of the country. We need 100 buses.”

Any initiative will be too late for men like John Clements, however, who are the victims of an industry that has traditionally paid too little attention to their well being. Asbestos may be banned, but unless more time and resources are given to avoiding preventable illness, people will continue to suffer.

John Clements tells his story

I first came into contact with asbestos in 1969. I was an 18-year-old apprentice carpenter working on a tower block where the steel frame was coated with the deadly substance. Because I wasn’t working directly with the asbestos, there was no need to wear protective clothing, but all the time I was breathing it in. What happens is that one tiny little fibre in the vessels starts to rub – like a blister on the heel of your foot if you are wearing new shoes – and fluid builds up. Last summer I started to feel out of breath, so I went to hospital and they drained two litres of fluid from my left lung. In March, I started to feel out of breath again. When I got to hospital they discovered that it wasn’t fluid this time but a solid mass of blood, gore and pus that couldn’t be drained. They had to operate by going through my back and removing the gunge. This time, when they did a biopsy for cancer, it came out positive. They diagnosed mesothelioma – not one individual tumour, but something that envelops the whole lung. I was very angry the day after I was given the bad news, but I realised that that wasn’t going to get me anywhere. Although it has been a great shock, my family has been great. I have a very loving relationship with my wife and children. If you were on your own with this, it would be very easy to become very embittered. On the other hand, if this had never happened I would have carried on working 12 hours a day, seven days a week. This has brought our lives so much more into focus. I am going on holidays and spending more time with my wife and kids. Fortunately I have insurance in place. I have a mountain of paper to put in order. I am also desperately trying to find out who the insurer was on the project I worked on where I contracted this disease, so that I can make a claim. But it’s very difficult when the firm has gone out of business. There should be some form of legislation so that the name of the insurer is included in the records at Companies House. You can imagine what it’s like when time is running out and you want the money. Although it is such a short time, I am still positive. I am starting chemotherapy soon to see if that will help. And I have things to pack in. I want to go to Venice and Florence and take a trip down the Nile. It’s so long ago that it’s difficult to be angry. If it were an immediate thing, I would feel far more aggressive. I’m stuck with it now.