Asbestos-related disease: In search of rural public health policy frameworks to address a slow-motion environmental event

The health-related dangers of asbestos exposure were recognized early in the twentieth century. However, the private sector initially failed to warn workers of the known dangers and the public sector was slow to implement protective policies. In the last quarter of the twentieth century, federal agencies such as the Environmental Protection Agency (EPA), Occupational Safety and Health Administration (OSHA), National Institute for Occupational Safety and Health (NIOSH), and the Agency for Toxic Substances and Disease Registry (ATSDR) documented the current state of asbestos-related exposure through public health assessments, enhanced regulation, and protective policy recommendations. Nonetheless, policy gaps exist with no one agency assigned oversight of present, past, and future asbestos-related conditions. The population of individuals with ARD as well those experiencing the protracted latency period prior to development of advanced disease symptoms are at risk for what has been described as a “patchwork” approach to health services. The study "A Descriptive Analysis of the Health Status of a National Asbestos-Related Cohort" is an academic-community partnership established to learn more about the health status and health service needs of persons exposed to an especially toxic form of amphibole asbestos mined in Libby, Montana. Dose-response complexities, post-exposure trajectories, co-factors, health service disparities, and variations in the human response to this pervasive environmental hazard call for a dynamic public policy model to address the population's health. Which framework would best elaborate the multi-determinants of asbestos exposure and the long-term effects of a developing illness? This presentation will explore the applicability and efficacy of three policy models. First, the "Care Across the Continuum Framework" (Mueller & McKinney, 2003), next, "Producing Health, Consuming Health Care" (Evans & Stoddart, 1990; 2003), and finally, the "Multi-Dimensional Model for Community Response to Slow-Motion Technological Disasters" (Hernandez, Black, Rowse, Cline, 2006).