Submission to Cancer Care Ontario: Strategic Plan Consultation Document
Submission to CANCER CARE ONTARIO Re: Strategic Plan Consultation Document By: Canadian Auto Workers
Dr. Kenneth H. Shumak, MD, FRCPC
Dear Dr. Shumak:
Thank you for sending us a copy of your Strategic Plan Consultation Document.
Our members have died and are dying as a result of exposures to workplace and environmental carcinogens. We want this carnage to stop. Our union launched a major Prevent Cancer Campaign beginning in December, 1997. From coast to coast, and especially in the industrial heartland of Canada, Ontario, CAW local unions and workplace union leadership have been diligently pursuing this issue.
We held three major national conferences on the issue of cancer prevention, one each in the fields of occupational health, environmental health, and workers' compensation as well as regional conferences on the same themes from Nova Scotia to British Columbia. With the assistance of the Occupational Health Clinics for Ontario Workers, we published a large compendium of known carcinogens with strategies for their elimination from workplaces and sent 1,500 of these documents to local unions across the country. The Workers Health and Safety Centre produced two videos on occupational and environmental cancers, Before Their Time and They Speak in Whispers which were shown at CAW conferences and which we mailed out to Local Unions across the country where they raised awareness at our membership meetings to the need to grapple with this enormous but critical issue of cancer prevention. We distributed the book, Workplace Roulette: Gambling with Cancer to all local unions and are giving it to participants in all our health, safety, environment and workers' compensation courses held at our Family Education Centre in Port Elgin. We published booklets, Devil of a Poison, and Second Hand Smoke: Butt it Out as well as the complementary booklet, If You Think Hemp is a Drug, Smoke This Book so that it is clear that there is a financially viable alternative to tobacco growing and cigarette production in Canada. We distributed a total of approximately 100,000 copies of the three booklets to CAW members across Canada.
As well, we have been meeting with employers to plan strategies regarding how to analyse workplace substances to determine whether they contain carcinogens and how to eliminate them, once discovered. These meetings have been held with joint health and safety committees at the workplace level, meetings at the corporate (national) level, and meetings with a variety of employers. We have begun to eliminate carcinogens from coast to coast in workplaces as diverse as airline reservation offices (removal of crumbling asbestos insulation and carcinogenic computer screen cleaners) to underground mines (replacing diesel driven equipment with electrical equipment and replacing lubricating oil with lubricating grease). In our auto and auto parts plants we have eliminated carcinogenic solvents and metal cleaners such as methylene chloride and trichloroethylene with safer substitutes and processes.
In our recently concluded 1999-2002 collective agreement with the Ford Motor Company covering 13,300 members of our union, we succeeded in prohibiting the introduction of 14 hazardous substances, most of them carcinogens, including asbestos, PCBs and vinyl chloride.
We met with government officials from the Ministry of Health, the Ministry of Environment, the Ministry of Labour, including the Minister himself, and the Workplace Safety and Insurance Board to impress upon them the importance of taking effective legislative, regulatory and policy action to prevent cancer and to compensate those who unfortunately have contracted cancer as a result of their work.
Cancer is an issue we take very seriously. We have devoted considerable resources to our Prevent Cancer Campaign. We look forward to working with Cancer Care Ontario on the important issue of cancer prevention.
Basil "Buzz" Hargrove
cc: J. O'Neil, NEB, C. Walker, G. Botic, N. De Carlo, National Health & Safety Coordinators, CAW Council Health & Safety Committee, CAW Council Environment Committee, CAW Council Workers' Compensation Committee
Sections in Document
Direction: Vision, values, goals
Concerning the six goals proposed in the document, we recommend that you change the second goal to read. "To prevent cancer by eliminating the causes of cancer in order to reduce the incidence and mortality of cancer in Ontario."
Reason: For clarity and for emphasis. The document states this basic goal better on page 25, first bullet under 4.2 which states: "Prevention, i.e., the elimination of the causes of cancer. This strategy aims to reduce both cancer incidence and mortality."
We further recommend that the second goal become the first goal.
Reason: Prevention should always come first, both logically and in priority. If we can prevent cancer from occurring in the first place, we won't need to bother with any of the other issues.
The research frontier
As you may be aware, the Canadian Institutes for Health Research do not yet include an Institute for Occupational and Environmental Health. We recommend that you support the creation of such an institute.
Reason: So much ill health today (including, but certainly not limited to cancer) is caused by workplace and environmental exposures. Without researching this important piece to the puzzle of the causes of ill health in Canadian society, solving these problems will, in part, remain beyond our understanding.
Every other major industrialized country has an institute for researching occupational and environmental health. Some countries, such as the United States, have two, the National Institute for Occupational Safety and Health (NIOSH) and the National Institute for Environmental Health Sciences (NIEHS). Canada needs an equivalent institution.
Information and information technology
Although this section deals primarily with the internal needs of Cancer Care Ontario, our comments expand this concept to information needs about cancer beyond CCO.
We recommend that Cancer Care Ontario meet with and establish a working relationship as well as financial support for the Canadian Centre for Occupational Health and Safety (CCOHS).
Reason: In the area of providing occupational health information, Canada is one of the leading countries. The Canadian Centre for Occupational Health and Safety (CCOHS) was one of the first providers, world wide, of information through data bases which are linked electronically. As well, CCOHS developed CD-ROM data bases on occupational health and safety issues before many of us had even thought of the possibility.
There is no need for Cancer Care Ontario to "reinvent the wheel" with respect to providing compiling or providing information.
We recommend the CCORs invite the participation on the CCOR councils of the following groups: labour unions, environmental groups, cancer survivor groups.
Reason: The CCORs provide a welcome opportunity for community involvement with Cancer Care Ontario. Unfortunately, however, certain stakeholders have not been invited to the table, except in isolated instances. Unions have an important role to play in prevention, in providing a link with workers and workplaces, and in supporting activities such as data collection and submission. Environmental groups have knowledge of environmental exposures to carcinogens in their communities and of environmental sources of cancer in general. No-one has more stake in the cancer issue than cancer survivor groups. They are extremely motivated to ensure cancer services are well provided in the province and that cancers similar to their own are prevented so that others do not have to suffer the consequences of ill health and sometimes death.
Capacity to generate, gather, synthesize, use and disseminate knowledge about cancer
We recommend Cancer Care Ontario fund the expansion of the Windsor CROME Project to all locations in the province.
Reason: Cancer Care Ontario has a unique opportunity to ensure important data about cancer causation is gathered. The Windsor CROME Project which seeks to compile data about exposures of workers to substances in the workplace and link them with types of cancer, is doing fundamental and vital research work. If this project were expanded throughout the province and sufficient resources devoted to analysing this data, we would learn a great deal about new carcinogens and synergisms among existing carcinogens. Once we learn more about causes, we can take steps in prevention.
We recommend Cancer Care Ontario use the Mining Master File as a model to establish data bases among workers in other industries.
Reason: The Mining Master File has been a rich source of information about workers in the mining industry, their exposures and the health consequences of their work. Much of our information today about cancer in the mining industry has come from analysis of this data. Ontario is the industrial engine of the country. Concentrations of workers in industries such as auto and auto parts are among the highest per capita of any nation in the world. There is so much to learn. CCO should set up data bases, exposure records and worker job records for all Ontario workers so that we can learn about the relationship of workplace exposures and cancer.
We recommend Cancer Care Ontario set up a research capability similar to the BC Cancer Agency.
Reason: The BC Cancer Agency has done more work researching the links between cancer and occupational exposures than any organization in Canada. BC's major industries include pulp and paper, sawmills and smelters. There are, however, no auto or major auto parts plants or other large manufacturing facilities. It would make sense for CCO to concentrate its energies in industries such as auto and auto parts which is the major industry in Ontario.
Capacity to advocate for change on behalf of patients, the public and the cancer control system
We recommend Cancer Care Ontario advocate on behalf of cancer prevention by advocating laws and policies which will ensure that causes of cancer are eliminated from Ontario. Specifically, CCO should call on the provincial Ministry of Labour to update its regulations on workplace carcinogens. CCO should recommend that both the Ministry of Labour and the Ministry of Environment employ sufficient inspectors and prosecutors to enforce laws protecting Ontario residents from carcinogens.
Reason: Knowledge about the causes of cancer is useful as a first step. But we must do something with this knowledge. We must use it to implement programs to prevent cancer. There are existing laws which deal with occupational carcinogens. These are found in regulations passed pursuant to the Occupational Health and Safety Act. These regulations have not been comprehensively amended since 1986-87 and in some cases not since 1981. These must be updated if workers' health is to be protected. The new BC Occupational Health and Safety Regulation dealing with carcinogens which requires them to be substituted with less hazardous substances, is a good model to follow for Ontario. Workers in the federal jurisdiction who work in Ontario are better protected from carcinogens by provisions of the Canada Labour Code, Part 2 (occupational health and safety) and its regulations than their neighbours who work in the provincial jurisdiction.
Laws without teeth are ineffective. Cut-backs to environmental inspectors have contributed to making Ontario's pollution record one of the worst in North America. Some of these pollutants are carcinogens. Occupational hygienists have been laid off from the Ministry of Labour together with all of the air quality technicians who conducted workplace monitoring of carcinogens.
The Toronto Public Health Department sets a good example in Ontario of being involved in health issues and advocating protective by-laws for Toronto residents. The no smoking by-law is one example but there are a number of others. Having input into the reduction or elimination of benzene in gasoline and sulphur in diesel fuel are but two examples of the pro-active role of the Toronto Health Department.
Looking south of the border, the American Public Health Association sees itself firmly on the side of the disadvantaged and firmly as important social advocates. "Social justice in public health: empowering the disadvantaged" was the slogan of one of their annual conventions several years ago which was attended by some 10,000 members from a large variety of municipal, state and federal public health departments, including a number of Canadians.
Establish pilot projects to enhance the Ontario Cancer Registry, including capture of cancer stage data
We recommend that the CROME Project in Windsor be used as a guide in the development of any CCO Southeast Region pilot project.
Reason: Our comments here mirror the comments made above about the CROME Project in Windsor. Any pilot project in CCO Southeast Region should use all of the good work that has gone into the CROME Project in Windsor. Detailed occupational exposures must be solicited if good data on causation are to be gleaned.
Develop an active and effective program in the primary prevention of cancer
We recommend Cancer Care Ontario give primary focus in primary prevention of cancer to occupational sources of carcinogens.
Reason: Most of what we have learned about carcinogens we have learned from occupational exposures. Knowledge of other important carcinogens such as tobacco and alcohol we have learned from other studies of ill health. It makes sense, then, for us to concentrate our energies in prevention at the workplace. If we focus attention on tobacco and ignore other known carcinogens we have done a complete disservice to the workers who have already died and nothing on behalf of those workers who will die of cancer from their work.
Since so many environmental carcinogens originate in the workplace and are then emitted to the air, water or land, if we can eliminate these carcinogens from the workplace, we will at the same time protect the health of the surrounding community. Pollution prevention should start at the source.
To improve the knowledge of the public and professionals as to the causes, indicators and treatments of cancer
We recommend CCO publish information booklets on the occupational and environmental causes of cancer and their means of prevention by elimination and substitution of less harmful causes. We recommend CCO run advertisements on television and radio with the same message. We recommend CCO run advertisements in newspapers and magazines again, with the same message. We recommend CCO put information on the CCO home page so that this information can be read on the Internet.
Reason: Popular publications are very useful in getting this important message across. Once workers and employers realize the carcinogens that are present in their workplaces and that there are effective means of eliminating or at least reducing these hazards, steps can be taken to effectively prevent a major source of ill health.