Why Sydney tunnel workers remain at severe risk from toxic dust

Given the time it takes for such diseases to develop (or latency period), workers need to be carefully tracked over the next 20 to 40 years. Where medical monitoring (or respiratory surveillance) is implemented, not all systems yet conform to modern best practice. Recommendations for CT scanning made by the Thoracic Society of Australia and New Zealand in 2020 are not followed, for example, by the iCare screening program. Results of such monitoring are not accessible to anyone other than the employer and are not kept on any centralised database in NSW.

Current cases of silicosis on the SafeWork NSW Silica Dashboard total 480, with 36 deaths between 2017 and September 2024. This is likely to be a huge underestimate of the true burden of disease in NSW. In Queensland, there are both a comprehensive screening program for mining and quarrying and full recognition of the spectrum of dust-related disease. There, cases of non-pneumoconiosis outnumber those of silicosis and other pneumoconiosis by more than 240 per cent. These additional diseases are not even mentioned on the NSW dashboard.

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Medicine has made significant advances in improving both the understanding and detection of silica-related disease, yet regulatory or public agencies have not translated this knowledge into workers’ health protections. By the time cases of silicosis present to doctors like me, it is essentially too late. It is unacceptable that in the 21st century, workers are still exposed to levels of toxic dust well above the regulatory levels.

As well as dust control, implementing modern systems of disease detection and centralised data acquisition should be an urgent priority for WorkSafe and the NSW government. We need to ensure that our workers’ lung health is protected, not abandoned.