Carole Hagedorn had been teaching foreign languages in schools in south-east England for more than 30 years when she was diagnosed with malignant mesothelioma – a cancer caused almost exclusively by exposure to asbestos fibres in the air.
Mesothelioma develops rapidly and has no cure. Symptoms include chronic productive coughing, breathlessness, chest pain and fatigue. While treatment innovations are progressing, approximately 60 per cent of patients die within a year of receiving a diagnosis.
The particular threat posed to teachers and school workers was highlighted in a recent analysis that suggested the risk to women in their late forties to mid-sixties who have worked in schools is statistically significant. This builds on earlier data that had identified a potential elevated risk for female teachers and education professionals.
Hagedorn, who died in 2014, told a NASUWT teaching union in 2009 she was shocked by her diagnosis, which is usually associated more with men who have worked in heavy industries. Having been forced to retire due to ill health, she said she was angry at being viewed as “some sort of collateral damage or natural wastage in the education game”.
But it is not just teachers and school workers who are of concern – many children may have been exposed while at school. However, since mesothelioma is regarded as an industrial disease and being a child is not an occupation, the Office for National Statistics (ONS) keeps no data on deaths from mesothelioma due to exposure to asbestos as a pupil.
Following her diagnosis, Hagedorn warned the Evening Standard in 2009 that “children are thought to be much more susceptible than adults, though we probably won’t know for another 20 or 30 years how many will already have contracted this cancer from exposure in schools”.
In March 2011, the UK’s Supreme Court ruled that Dianne Willmore had been exposed to asbestos while she was a pupil at Bowring Comprehensive in Liverpool in the 1970s. As a result, she developed what the court called the “hideous disease” of mesothelioma. Willmore died in 2009, aged 49 – just hours after the court of appeal first decided she was entitled to compensation. One of the UK’s leading experts on asbestos-related cancers, Professor Julian Peto, later estimated to a parliamentary select committee that 200-300 former pupils would die each year as a result of exposure to asbestos while at school in the 1960s and 1970s.
Yet today, deaths of former pupils from mesothelioma due to asbestos exposure are still not officially recognised. Instead, they remain hidden among the UK’s unusually high “background rate” of the disease, meaning the cases not included in ONS statistics. But children are particularly vulnerable to asbestos – a point made starkly ten years ago in a report for the Department for Education (DfE), which stated that “[exposure] of children to asbestos is likely to render them more vulnerable to developing mesothelioma than exposure of adults to an equivalent asbestos dose”.
Mesothelioma risk from asbestos is unlike lung cancer risk from smoking. If a smoker gives up, the risk of lung cancer declines over time. By contrast, the risk of mesothelioma from exposure to asbestos accumulates over time. A five-year-old child who is exposed to asbestos is estimated to be, according to that DfE report, five times more likely to develop mesothelioma during their lifetime than an adult who is first exposed at the age of 30.
In the absence of hard data on deaths from mesothelioma due to exposure as a pupil at school, a document from the US Environmental Protection Agency (EPA) is widely cited. Using US data to develop a model of the risk presented to both workers and pupils in schools, the report concluded that around 90 per cent of premature deaths due to asbestos exposure at school occur in people who were exposed as children.
Putting the Peto and EPA estimates together, the Joint Union Asbestos Committee subsequently reported that over the period 1980-2017, the number of UK mesothelioma deaths as a result of exposure to asbestos as school pupils was between 3,890 and 9,000.
In 2021-22, we conducted our own review of media and legal coverage of 84 people who had developed mesothelioma after being exposed to asbestos while working in UK schools. These included heart-rending interviews with patients and relatives who, despite their own suffering, were keen to highlight wider concerns about the threat that asbestos in schools might pose to children. For example, Mick Adkins, an electrician contracted to work in Birmingham schools and who died of mesothelioma, told the Sunday Mercury in 2007: “How many schools are swamped with asbestos? We literally caked them in it when I was building them, so God only knows how many people, young and old, have been exposed to it over the last 40 years.”
And Freddie Davis – husband of Pearl, a former primary school teacher in Gillingham and Chatham, Kent who died of mesothelioma – reflected after her death: “What was also incredibly upsetting to Pearl was the idea that children may have been put at risk on those premises. It doesn’t bear thinking about.”
The presence and problem of asbestos in schools has been known about for many years. A 2019 DfE survey suggested that around 81 per cent of primary and secondary state schools in England still have asbestos “present on their estate” – despite the use of asbestos in any form having been banned in the UK since 1999.
Commercial exploitation of asbestos in the UK began in the 1870s. Its resistance to high temperatures and fire made it valuable in steam-powered industries. The same properties later made it useful as a fire retardant and heat insulator in buildings. Between 1920 and 1970, the UK was the largest importer of asbestos in Europe. This period includes the massive postwar rebuilding programme which made widespread use of prefabrication, or system building, to rapidly erect buildings including many homes and schools, often with asbestos incorporated.
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Furthermore, the UK’s relatively cold climate meant that better insulating – but more dangerous – types of asbestos were used. And its links with former colonies, particularly Australia and South Africa, allowed the UK to import asbestos at cheaper rates than the rest of Europe. As a result of this high usage, the UK now has one of the world’s highest rates of mesothelioma. In 2020, there were 2,544 mesothelioma deaths registered. The annual UK total has increased year on year for more than 50 years, such that in the 2010s there were more than eight times as many deaths from mesothelioma as the 1970s.
The very first UK death from lung fibrosis caused by asbestos was reported in 1899. The first UK government regulations aimed at controlling exposure to asbestos were introduced in 1931, and carcinoma due to asbestos exposure was first described in 1935. By 1960, it was known that asbestos exposure at low levels could cause mesothelioma. Yet three years earlier, the Consortium of Local Authorities Special Programme (Clasp) had been introduced in England with the aim of developing prefabricated school buildings using a modular design around a steel framework.
The open and light nature of these structures made them vulnerable to fire, so asbestos was extensively used within them for its retardant properties. It was embedded in ceiling panels, wall boards, pipe lagging and to cover any structural gaps. The asbestos used in Clasp buildings included large amounts of the more dangerous amosite type, also known as “brown” asbestos.
Thousands of Clasp buildings – mainly schools – were constructed, particularly in coal-mining areas such as Nottinghamshire and Derbyshire that were likely to be affected by subsidence (the modular design allowed for easier replacement and repair). An estimate from 2016 suggested that around 3,000 of these buildings were still in use.
While other schemes similar to Clasp continued into the 1970s, system building in general fell out of favour. However, up to the UK’s outright ban on asbestos in 1999, it was still being used in specific building features such as radiator panels. Today, system-built schools remain of particular concern to health researchers as they age and deteriorate.
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Under the present Control of Asbestos Regulations 2012, those responsible for the maintenance and repair of non-domestic premises, such as schools, are required to follow a policy of “in-situ management”. This is based on the idea that asbestos presents little risk provided it is in good condition and not disturbed.
The estimated four in every five UK state schools that have asbestos are required to have an asbestos management plan, designed to ensure its condition is regularly monitored. Should its condition deteriorate, then the asbestos would be removed alongside compulsory monitoring of air quality. Between September 2022 and March 2023, the regulator Health and Safety Executive (HSE) carried out 400 school inspections to make sure asbestos in schools was being correctly managed.
But our research shows that such management plans can, in some cases, become little more than box-ticking exercises, and are not necessarily performed well.
Even well-kept management plans can be undermined by the fact that schools typically experience high levels of damage and deterioration. Asbestos can be found in panelling under radiators, within electric storage heaters with blowers, and in music room walls and ceilings, for example. All may be vulnerable to curious or mischievous schoolchildren.
A teacher of 27 years in north Lincolnshire, Elizabeth Belt, who died of mesothelioma in 2015, gave a statement before her death which outlined many occasions when she believed she had been exposed to asbestos. For example: “A boy had made a hole in the wall at one time and pupils would kick at the walls. There were holes in the corridor walls.”
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The “mischievous” nature of children was first considered to be of legal significance in 1893, when a case concerning the responsibilities of a schoolmaster acknowledged that “children by their ordinary nature had a tendency ‘to do mischievous acts and [a] propensity to meddle with anything that came their way'”.
This is legally important because those responsible for health and safety in schools, such as education authorities, are required to allow children to behave as they will when devising management plans. But there is little evidence that they do this in the asbestos plans kept by schools.
The Diane Willmore Supreme Court hearing, for example, cited several acts of mischief and bullying that may have exposed her to asbestos dust: “[Diane] was exposed to asbestos several times. Asbestos insulation ceiling tiles had been taken down and stacked in a busy corridor while electricians worked on cables… Bullies took children’s satchels and blazers and hid them in the ceiling tiles. And there had been vandalism in the girl’s toilets, where asbestos ceiling tiles were also stacked.“
And this point is supported by a collated report of 291 failures of asbestos management in schools that resulted in the release of asbestos fibres between September 2000 and March 2014. This report was written by Michael Lees, a founding member of the Asbestos in Schools Group, whose wife Gina was a nursery school teacher who died at the age of 51 following exposure to asbestos at work. In a 30-year teaching career, she had worked at 25 schools, most of which contained asbestos.
There are also concerns about the level of knowledge among those who work in schools containing asbestos. The HSE’s guidelines require only fairly minimal interventions – for example, that the employee responsible for the asbestos plan “should stick labels on anything that contains or might contain asbestos if it is located where people are likely to disturb or damage it. Get these from safety sign companies.”
It seems unlikely that this adequately heeds the “mischievous” nature of children. In addition, there seems to be little requirement for education or training regarding asbestos.
According to the International Agency for Research on Cancer and the World Health Organisation, all types of asbestos cause cancer in humans, but the risk increases with type. The ratio of risk for white (chrysotile), brown (amosite) and blue (crocidolite) asbestos has been estimated at 1:100:500. The danger is related to each material’s “friability” – meaning how much it breaks down into smaller pieces – as well as to the toxicity of the fibres that are released and inhaled.
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Malignant mesothelioma is a rare and aggressive cancer. It most commonly affects the lungs, although it can also affect the abdomen and testes. It causes a range of debilitating symptoms including breathlessness, pain, fatigue and cough – which can often emerge quite suddenly.
According to the ONS, 463 former or current teaching and educational professionals (male and female) died from mesothelioma between 2001 and 2020. However, this is likely to be a significant underestimate – in part because the deaths of people over 75 years old are not recorded by former occupation. And of those that are recorded, only the final occupation is mentioned, so this total also doesn’t include people who moved on from teaching to another career.
Bernard Dawson, a father of five and grandfather of seven, taught maths and science for more than 50 years in Greater Manchester and Lancashire schools. Soon after retirement, he was diagnosed with mesothelioma but died aged 81, so would not have been included in the ONS statistics.
One problem for those who have not worked in the recognised high-risk industries, such as construction, is that the “index of suspicion” among health professionals may be low. In other words, symptoms that would trigger immediate suspicion in a former carpenter may not do so in a former nurse or teacher. There is also evidence that women in general may be viewed with a lower index of suspicion regarding possible symptoms of mesothelioma.
While no statistical research has yet investigated this, qualitative studies of school and hospital workers (including ours at the University of Sheffield), as well as of women, have identified numerous examples. As the retired school teacher Rosie Peters said in an interview less than a year before her death due to mesothelioma: “The chest surgeon… couldn’t believe a teacher would have it because I wasn’t in any of the industries known for this disease.”
People outside high-risk industries may also struggle to get compensation for the disease. While lawyers have noticed an increase in “white collar” cases of mesothelioma sufferers seeking compensation, one difficulty in such cases is establishing precisely whether and when any exposure took place that can be pinned to managerial negligence.
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A further reason for the persistent underestimation of UK deaths from mesothelioma among school workers is that not all non-teaching staff are included in the mortality data. Nineteen of the 84 cases we found in our review were non-teaching staff, including caretakers, cleaners and dinner ladies.
In fact, the nature of some of these roles may make exposure to asbestos more likely. Caretakers, cleaners and contractors such as electricians have identified exposure during work in boiler rooms, or around insulated heating pipes, as possible sources of exposure.
Margaret James had been a caretaker at a junior school in Llandudno from 1976 until 1992. Unknown to her, she was exposed to asbestos when completing numerous tasks including cleaning up after tradesmen following the building of a second school on the site. A legal report stated: “The building had suspended ceilings which were constructed of asbestos ceiling tiles. Once the school was operational, tiles would sometimes fall down and it was Margaret’s job to put them back up. The edges of the tiles were fibrous and dusty to touch when they were handled. In addition, one of the routine tasks Margaret did was to sweep out the boiler room and, in school holidays, dust down pipes throughout the school. These were lagged with asbestos and led to Margaret being exposed unknowingly to toxic dust.”
She became ill with shortness of breath and a chesty cough in 2019. Scans revealed a build-up of fluid on her lung, and a biopsy confirmed she had mesothelioma. The report concluded that, “An offer to settle was made in April 2020 and the council’s insurers made a counter offer in early May 2020, which was accepted by Margaret. The claim settled within five months for in excess of £120,000 and damages were also recovered for the hospice. Sadly, Margaret passed away only a few days later.”
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In April 2022, a UK Work and Pensions (UKWP) Select Committee report recommended the gradual removal of all asbestos from UK buildings over the next 40 years – with priority placed on the most hazardous types of asbestos, and also those buildings at particular risk, including schools.
The UK government rejected this recommendation, pointing to the very low risk of exposure where in-situ management is effectively implemented. The HSE suggests that a “rush to remove asbestos” would pose a more significant risk in terms of asbestos exposure. However, our analysis suggests this does not take full account of the condition, and day-to-day use, of many UK schools.
There are grounds to believe that the current policy of in-situ management is inadequate and, as buildings deteriorate, likely to become increasingly so. The policy came under further pressure in November 2022, when the first annual data analysis report into asbestos in UK buildings highlighted that, “Of the 710,433 items of asbestos found, 507,612 (71 per cent) were recorded as having some level of damage.”
The chair of the UKWP committee, Stephen Timms, expressed extreme disappointment at the government’s decision, commenting: “To put it bluntly, the UK has one of the worst asbestos legacies in the world – and our current lack of an informed strategy for dealing with this is shocking. For any project involving old buildings it will mean increased costs, delays, and even untimely deaths. Industry, campaigners, patient organisations and unions are united in their disappointment of this missed opportunity.”
A parliamentary debate led by the MP for Loughborough MP Jane Hunt will today (19 April) discuss asbestos in the workplace. Trade unions whose members work in the education sector have long sought changes in the current policies of management and monitoring. As well as calling for the removal of asbestos from these environments, they also seek better monitoring in the meantime, and greater education of those who work and are schooled within them.
The permitted level of exposure to asbestos fibres in the air, set by the HSE, is currently in accordance with EU rules. However, these levels were based on what was technically feasible to monitor when the rules were set. This has now changed and many countries, including France, the Netherlands and Germany, have much stricter levels.
The EU is proposing to lower its current maximum level, and is also encouraging the removal of asbestos from all buildings. No such proposals have been approved in the UK.
A spokesperson for HSE said: “Asbestos was banned in Great Britain by 1999 and stringent regulatory controls are now in place to prevent people being exposed today. We understand the concern about asbestos in school buildings. Risk of exposure is low as long as schools follow the regulations and have the right measures in place. We provide clear guidance and advice to those who manage buildings that contain asbestos, and our recent inspection campaign checked whether schools had the right steps in place and were following the law.”
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HSE predicts that the total number of mesothelioma deaths across England, Scotland and Wales will decline steadily over the next three decades, with the rate falling faster among men than women. As asbestos is no longer used in new buildings, the number of people diagnosed after manufacturing or using asbestos products, such as (mostly male) construction workers, should tail off significantly.
However, the anticipated decline in mesothelioma cases may yet stall unless the issue of background exposure to asbestos in public buildings, including schools, is tackled. Despite the ongoing work of the parliamentary committee, there has been a striking lack of intervention and research in this area.
Professor Julian Peto has proposed further research that would build on the inhaled particulates study, which would involve taking tissue samples from teachers without a mesothelioma diagnosis during lung surgery for other conditions. These samples would be analysed to measure asbestos fibres as an indication of exposure in schools.
While there is no cure for mesothelioma, treatments are progressing, including surgery trials such as Mars 2 and targeted therapies including the Nero, Mitope and HIT-Meso trials.
Life-lengthening treatments and trials offer some promise to mesothelioma patients and their families. Carole Hagedorn, the teacher quoted at the start of this article, is reported to have undergone a radical pleurectomy in 2011 – a treatment that included having her lung lining removed in an attempt to eliminate much of the cancer.
But as Hagedorn herself highlighted, the most important issue now is to stop more young people becoming victims in later life. It is unacceptable that the level of exposure of pupils in UK schools is still unknown – and imperative that the public is made aware of the potential risks of asbestos exposure in all working, living and educational environments, past and present.
Without a programme of safe removal of asbestos, there are likely to be many more experiences like that of Chris Willis. He was diagnosed with mesothelioma aged 29 and claimed this was from being exposed to asbestos while at school. He died in 2022, leaving behind a young family. Following his diagnosis, Willis told the Newcastle Chronicle: “You don’t expect to go to school, get an education, and come out with what I’ve got… I don’t think schools realise how much asbestos is still dormant in buildings, and how much risk it poses to students.”
This article is co-published with the “Conversation” as part of its Insights long-read series.
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