Kurt Straif

Climate change, toxic pollution, and social inequities are converging to create new risks for workers and communities, particularly in the Global South. Yet occupational and environmental health research and policy still tend to address these stressors in isolation, not considering their interactions. To synthesize the main messages of the COP30 side event, “Amazon and Heat: Community-First Climate–Environment–Health Action from the Amazon Basin to Africa and Europe”, presented in the context of the LIMA2025 Conference on Occupational Medicine, and to propose a framework for integrated climate–environment–health action in work and community settings. This conference report and policy perspective are based on a narrative synthesis of presentations and discussions delivered during the COP30 side event and subsequently presented at LIMA2025 by researchers, Indigenous leaders, occupational health practitioners and civil society organizations from the Amazon Basin, Africa and Europe. Contributions were grouped into thematic domains: (1) climate and toxic exposures in the Amazon; (2) work and heat in African and Southern European settings; and (3) cross-cutting challenges and policy opportunities. The analysis followed a qualitative thematic approach. Across regions, participants described intersecting exposures to heat, toxic chemicals, air pollution, deforestation and psychosocial stress, disproportionately affecting workers, Indigenous peoples, traditional populations, pregnant women and children. Evidence from cohort studies, intervention projects, and remote-sensing analyses highlighted: (i) elevated mercury exposure and increasing microplastics and diesel contamination in Amazonian communities, alongside climate-sensitive food-system vulnerabilities; (ii) growing heat-related health risks among children and pregnant women in African cities; and (iii) dehydration, kidney dysfunction, and cardiometabolic risks among agricultural and construction workers in Southern Europe. Cross-cutting themes included exposure mixtures, inequities in access to care and justice, persistent data gaps, and the need for locally owned technologies, capacity building, and sustainable solutions. The side event catalyzed the development of an Amazon Climate–Environment–Health Consortium and a shared policy agenda. Integrated, equity-focused action on heat, toxic exposures, and work is essential for a just climate transition.

Objectives. Complementing the previously published cohort-internal comparison we hereby compare the cause-specific mortality in workers of the Asbest Chrysotile Cohort study (ACC) with the general population of Sverdlovsk Oblast where the mine and factories are located.Methods. The ACC cohort database and the regional Federal State Statistic Service for the Sverdlovsk Oblast population were used. We calculated sex-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CI) for the main ICD-10 disease groups and for selected cancer sites for the populations ≥15 years from 1980 to 2015. In relation to exposure, we applied the Sverdlovsk rates to the person-years in each exposure category to obtain expected numbers of lung cancer deaths. For comparing types of ACC workers (mine, enrichment factories, both), we calculated lung cancer SMRs in men by duration of employment (< 5 years, 5–14 years, and ≥ 15 years) and start of employment (before or after 1975) with miners as reference in each stratum.Results. Overall mortality of men in the ACC was reduced by 14%, mainly because of the most common cause of death, circulatory disease; this effect was much weaker in women. Elevated mortality was observed for both sexes from diseases of the digestive system (10–30%) and blood and blood forming organs (121–181%). Lung cancer mortality in men was increased from the 3rd quartile of chrysotile containing dust and in the highest quartile with SMR 1.30, 95% CI 1.07–1.57, while the increase in high exposed women was not reaching statistical significance (SMR 1.69, 95% CI 0.87–2.96). No increased SMRs were seen for laryngeal, stomach or ovarian cancers. Male factory workers first employed before 1975 had higher lung cancer mortality compared to miners, but not when employed after 1974.Conclusions. The observed excess in lung cancer confirms previous observations in the ACC. Risk management measures in the enrichment factories may have reduced the lung cancer risk to the level of the miners in recent decades.Ethics. The ACC was approved by the International Agency for Research on Cancer (IARC/WHO) Ethics Committee (IEC No. 12–22, September 2012).Contributions:Ann Olsson — preparation of the manuscript, project administration, data processing, including quality control, interpretation of the received data;Joachim Schüz — manuscript preparation, cohort formation, project administration, formal analysis, interpretation of the data obtained;Hans Kromhout — preparation of the manuscript, evaluation of the exposition;Evgeny Kovalevskiy — manuscript preparation, cohort formation, project administration, data processing, including quality control, interpretation of the received data;Monika Moissonnier — preparation of tables and figures, data processing, including quality control, and formal analysis;Igor Bukhtiyarov — cohort formation, project administration, and data interpretation;Kurt Straif — cohort formation;Eleonora Feletto — conducting an exposure assessment, data processing, including quality control, and conducting a formal analysis;Iraklii Tskhomariia — project administration, data processing, including quality control, and data interpretation;Tatiana Morozova — project administration and data interpretation;Evgenia Ostroumova — data processing, including quality control and data interpretation;Gilles Ferro — data processing, including quality control, formal analysis;Graham Byrnes — conducting a formal analysis.Acknowledgements. Dr Sergey Kashanskiy from the Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russian Federation was instrumental in the conduct of the study but died on February 9, 2023 and is deeply missed by the entire study team. We acknowledge the data entry team in Asbest town who rigorously entered written information into electronic format: the late Isolina Smirnova, Zoya Lapuhina, and Yulia Nurdinova; and Dr Sara J. Schonfeld for her valuable contribution to the ACC overall and the re-coding of the oblast data from ICD-9 to ICD-10. The authors also wish to acknowledge the independent Scientific Advisory Board (SAB). The scientific advisory board members provided their reviews of this manuscript, but the integration of their comments remained at the discretion of the authors.Funding. The work was supported by the Ministry of Health of the Russian Federation in the framework of the Federal target program "National System of Chemical and Biological Safety of the Russian Federation" of 2009–2014 and of 2015–2020 under a general framework of action between the Federal state budgetary scientific institution “Izmerov Research Institute of Occupational Health” (IRIOH) and the International Agency for Research on Cancer (IARC).Conflict of interest. Dr Kovalevskiy reported receiving, on behalf of their institutes and personally through consulting firms, payments from companies to evaluate exposure to asbestos and risk of asbestos-related disease in those workplaces. All other authors have no competing interests to declare. For full transparency, Dr Kovalevskiy reported participation as an occupational and environmental health expert as part of the delegation of the Russian Ministry of Health at multiple World Health Assembly meetings as well as at the Conference of the Parties to the Basel and Rotterdam Conventions. Dr Kovalevskiy reported attending meetings organized by the International Chrysotile Association and reported that all expenses for attendance were paid by their respective institutes.Disclaimer. Where authors are identified as personnel of IARC/WHO, the authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions, policy, or views of IARC/WHO.Data availability. Raw data cannot...

Objective The association between occupational exposure to chlorinated solvents and lung cancer remains inconclusive. This study investigated this relationship using data from the internationally pooled SYNERGY study. Methods Data from 14 case–control studies conducted in 13 European countries and Canada were pooled, including 28 048 participants (12 329 cases and 15 719 controls). Lifetime occupational exposure to chlorinated solvents was assessed using the ALOHA+job-exposure matrix. ORs and 95% CIs were estimated using unconditional logistic regression, adjusted for study centre, age, sex, smoking (pack-years and cessation), cumulative exposure to five occupational lung carcinogens (asbestos, hexavalent chromium, polycyclic aromatic hydrocarbons, respirable crystalline silica and diesel engine exhaust), cumulative benzene exposure and employment in high-risk occupations (‘List A’ jobs). Associations were estimated across categories of exposure levels, durations and analyses stratified by smoking status and lung cancer subtypes. Results We found no evidence of an association between ever exposure to chlorinated solvents and lung cancer risk (OR 1.03; 95% CI 0.96 to 1.10). Among exposed individuals, a positive trend with cumulative exposure was observed (p=0.031), but not when non-exposed individuals were included (p=0.173). Positive trends were found with exposure duration (p=0.005 for exposed; p=0.048 overall); risks were modestly elevated (OR 1.11) in those exposed for 20 or more years. No increased risk was observed across smoking strata or lung cancer subtypes. Conclusions This pooled analysis provides limited evidence of an association between occupational exposure to chlorinated solvents and lung cancer, though exposure-response trends were noted among exposed individuals.

Introduction: Outdoor workers are exposed to high levels of solar ultraviolet radiation (UVR). UVR causes skin cancer and is a risk factor for cataract and other short- and long-term health effects, but there are significant knowledge gaps regarding the exposure-response relations based on quantitative measures of UVR exposure. We developed a quantitative UVR job-exposure matrix (JEM) for the general working population of Europe. Methods: Three experts from each of Northern, Central, and Southern Europe rated duration of outdoor work for all 372 occupations defined by the International Standard Classification of Occupations from 1988 (ISCO-88(COM)). A systematic literature search identified 12 studies providing 223 sets of summary workday UVR exposure for 49 ISCO-88(COM) occupations based on 75,711 personal workday measurements obtained from 2,645 participants and reported as arithmetic mean standard erythemal dose (SED). We combined the expert ratings with the measured occupational UVR exposure data and estimated harmonized workday UVR exposures for all 372 occupations in a linear mixed effects model. Results: Monotonically increasing workday UVR exposure of 0.68, 1.57, 1.80, and 2.49 SED were seen by increasing expert ratings of 0, 1 to 2, 3 to 4, and ≥5 h of daily outdoor work. The UVR exposure showed a 6-fold increase from lowest to highest exposed occupation. Farm hands, roofers, concrete placers, and other occupations within craft and related trades were among the highest exposed, while bartenders, wood-processing-plant operators, and several white-collar occupations who typically work indoor were among the lowest exposed. Conclusion: This quantitative JEM for solar UVR exposure proves able to provide substantial discrimination between occupations, shows good agreement with expert assessments, and may facilitate epidemiological studies characterizing the exposure-response relation between occupational solar UVR exposure and different health effects.

Objective: To conduct meta-analyses of occupational asbestos exposure and oesophageal, stomach and colorectal cancer risk, including a critical exposure assessment approach. Methods: The search strategy was executed on MEDLINE, Embase, CINAHL, Scopus and Web of Science databases (March 2022, March 2024). Effect estimates (ORs, HRs, standardised incidence ratio and standardised mortality ratio) from eligible cohort and case-control studies were combined in random effects models. Meta-relative risks (mRRs) were calculated by cancer site and exposure characteristics. Investigators with occupational epidemiology and hygiene expertise came to a consensus on the estimates where there was confidence in significant asbestos exposure. Results: A total of 82 (oesophageal), 153 (stomach) and 144 (colorectal) papers met the inclusion criteria. Elevated mRRs were observed for any occupational asbestos exposure for oesophageal (1.17 (95% CI 1.07 to 1.29)), stomach (1.14 (95% CI 1.05 to 1.23)) and colorectal cancer (1.16 (95% CI 1.08 to 1.24)). There was consistency of mRR estimates and higher mRRs in meta-analyses where there was increased confidence in the categorisation of highly exposed workers, including among the highest exposed workers in exposure-response studies (oesophageal: 1.63 (95% CI 1.29 to 2.06); stomach: 1.28 (95% CI 1.09 to 1.52); colorectal: 1.29 (95% CI 1.09 to 1.53)), among asbestos insulation workers (oesophageal: 1.68 (95% 1.19 to 2.36); stomach: 1.53 (95% 0.93 to 2.51); colorectal: 1.59 (95% 1.14 to 2.23)) and among workers in cohorts with a twofold or greater risk of asbestos-related lung cancer (oesophageal: 1.40 (95% CI 1.14 to 1.71); stomach: 1.33 (95% CI 1.14 to 1.56); colorectal: 1.47 (95% CI 1.34 to 1.61)). Conclusion: The meta-analyses support a causal link between occupational asbestos exposure and the risk of oesophageal, stomach and colorectal cancer.

Background. We investigated mortality in workers of the world’s largest chrysotile mine and enrichment factories located in the town of Asbest, Russian Federation. Methods. This historical cohort study included all workers employed for at least 1 year between 1975 and 2010 and follow-up until the end of 2015. Cumulative exposure to dust was estimated based on workers’ complete occupational history linked to dust measurements systematically collected from the 1950s. Exposure to chrysotile fibers was estimated using dust-to-fiber conversion factors. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated as mortality rate ratios in Poisson regression models. Results. A total of 30 445 (32% women) workers accumulated 721 312 person-years at risk and 11 110 (36%) died. Of the workers, 54% had more than 30 years since their first exposure. We found an exposure-response between cumulative dust and lung cancer mortality in men. No clear association with dust exposure but a modest increase in the highest category of fiber exposure was seen for lung cancer in women. Mesothelioma mortality was increased (RR=7.64, 95% CI=1.18 to 49.5, to at least 80 fibers per cm3 years and RR=4.56, 95% CI=0.94 to 22.1, to at least 150 mg/m3 years [dust]), based on 13 deaths. For colorectal and stomach cancer, there were inconsistent associations. No associations were seen for laryngeal or ovarian cancer. Conclusion. In this large-scale epidemiological study in the world’s largest active asbestos mine, we confirmed an increased risk of mesothelioma with high fiber exposure and an increasing mortality for lung cancer in men with increasing dust exposure. Less clear-cut increased lung cancer mortality was seen in the women. Continued mortality follow-up is warranted.

We investigated mortality in workers of the world’s largest chrysotile mine and enrichment factories located in the town of Asbest, Russian Federation. This historical cohort study included all workers employed for at least 1 year between 1975 and 2010 and follow-up until the end of 2015. Cumulative exposure to dust was estimated based on workers’ complete occupational history linked to dust measurements systematically collected from the 1950s. Exposure to chrysotile fibers was estimated using dust-to-fiber conversion factors. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated as mortality rate ratios in Poisson regression models. A total of 30 445 (32% women) workers accumulated 721 312 person-years at risk and 11 110 (36%) died. Of the workers, 54% had more than 30 years since their first exposure. We found an exposure-response between cumulative dust and lung cancer mortality in men. No clear association with dust exposure but a modest increase in the highest category of fiber exposure was seen for lung cancer in women. Mesothelioma mortality was increased (RR = 7.64, 95% CI = 1.18 to 49.5, to at least 80 fibers per cm³ years and RR = 4.56, 95% CI = 0.94 to 22.1, to at least 150 mg/m³ years [dust]), based on 13 deaths. For colorectal and stomach cancer, there were inconsistent associations. No associations were seen for laryngeal or ovarian cancer. In this large-scale epidemiological study in the world’s largest active asbestos mine, we confirmed an increased risk of mesothelioma with high fiber exposure and an increasing mortality for lung cancer in men with increasing dust exposure. Less clear-cut increased lung cancer mortality was seen in the women. Continued mortality follow-up is warranted.

Objectives This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe. Methods A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022. Results The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries. Conclusions COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems.