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Founded in 1919, the International Labour Organization( ILO) 133 is a United Nations agency uniting governments, employers, and workers from 187 member states to set global labor standards and promote human and labor rights. In 2022, it declared that a“ safe and healthy working environment” is a fundamental right. Under its conventions, member states are required to adopt policies that prevent injuries, improve workplace safety, and enforce compliance. The ILO and the World Health Organization( WHO) launched the Global Programme for the Elimination of Silicosis( GPES) in 1995, focusing on primary prevention, national public health surveillance, worker medical screenings, and fair compensation. 199 GPES emphasizes tripartite( labor, industry, government) collaboration, national assessments, preventive strategies, and monitoring systems— principles especially critical in the AS industry. Despite these clear standards, the rise of AS silicosis shows that the implementation of worker protections has faltered: rapid industry growth, weak enforcement, and unsafe practices such as dry cutting have fueled hazardous exposures. High case prevalence has been documented, but national surveillance systems to track, prevent, and compensate remain inadequate, highlighting the gap between international standards and local action.
Spain provides an instructive case in detection and compensation for AS silicosis, as it was the first to raise the alarm in the medical literature. 14 As home to both one of the largest AS manufacturers and numerous small fabrication workshops, it has become a European epicenter for AS silicosis. The first formal recognition came in 2002, when the Labour Inspectorate sanctioned a manufacturer after three cases of silicosis. 13 Between 2007 and 2023, 4,908 compensation claims for silicosis were recorded, of which 2,602( 53 %) were linked to stone cutting and finishing, including AS and NS processing. Industry pressure has complicated transparency, with documented efforts to influence reports and philanthropic initiatives that downplayed the epidemic.
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At the European Union( EU) level, systemic weaknesses remain. The complex and variable composition of AS falls outside the scope of REACH( Registration, Evaluation, Authorisation, and Restriction of Chemicals) regulation, despite the principle of“ no data, no market,” which places the burden of safety on manufacturers. 139 The EU adopted a binding OEL of 0.1 mg / m ³ only in 2017— two decades after crystalline silica was declared a Group 1 carcinogen— and continues to resist lowering it despite scientific consensus that it is too high.
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Economic interests remain powerful: the silica lobby( Eurosil) slowed revisions of the exposure limits, while the European Network on Silica( NEPSI) has promoted the“ safe use” of crystalline silica, delaying stronger preventive measures. This is reminiscent of the tactics employed by the asbestos industry.
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California illustrates a more decisive response. In 2016, the US federal OSHA promulgated stricter silica regulations for construction and general industry, including a permissible exposure limit of 50 µ g / m 3; these regulations were adopted by California. 35 In December 2023, in response to the rising number of AS silicosis cases in the state, California introduced additional emergency temporary standards that banned dry cutting and implemented comprehensive requirements, including wet methods, powered air-purifying respirators, dust monitoring, housekeeping protocols, training, and mandatory case reporting. 105 These were made permanent the following year, with the addition of a new requirement for screening using chest CT. 144, 145 In July 2025, silicosis was added to the state’ s list of reportable diseases and conditions, requiring healthcare providers to report silicosis cases to public health authorities. 146( p17) Complementary legislation passed in October 2025( the Silicosis Training Outreach and Prevention [ STOP ] Act) prohibits dry cutting of AS materials, expands data sharing among state and local agencies aimed at improving surveillance and enforcement, and institutes employer attestation for mandatory training for workers. 147 In May 2026, the California Occupational Safety and Health Standards Board voted to begin rulemaking to prohibit the fabrication and installation of artificial stone containing more than 1 % crystalline silica, marking a major step to address the silicosis epidemic in California. 148
Australia has gone further, moving to eliminate AS containing silica. The National Dust Diseases Taskforce, established in 2019, issued 20 urgent recommendations in 2021 documenting systemic failures. 189 A subsequent analysis by SafeWork Australia( Australia’ s national policy body for work health and safety and workers’ compensation) concluded that AS posed severe, and sometimes fatal, risks, and recommended a precautionary ban. 71 Following broad consultation and union advocacy, governments agreed in late 2023 to prohibit AS entirely. The ban took effect in July 2024, making Australia the first country in the world to
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