Role of Legislation in Occupational Disease Prevention: A Case of Chronic Silicosis with Progressive Massive Fibrosis

Abstract

Silicosis is a severe, irreversible occupational lung disease for which primary prevention remains the only effective intervention. Today, the principles of occupational medicine and the hierarchy of controls have evolved significantly. However, without a strong legal framework, implementing these preventive principles in actual workplaces is often challenging. This case report illustrates the contrast in occupational health management before and after the implementation of comprehensive legislation. We report a case of a male worker who developed symptomatic silicosis with progressive massive fibrosis at the age of 65 years during a 47-year career in a sanitary ware factory in Thailand. Throughout his employment, workplace hazard protection relied heavily on inadequate personal protective equipment, such as cloth masks. Notably, previous diagnoses of silicosis among his colleagues in 2007 and 2012 did not lead to the implementation of appropriate hazard control, probably due to health officials’ lack of legal authority to intervene in private enterprises. The turning point occurred in 2019, coinciding with the enactment of the Control of Occupational Diseases and Environmental Diseases Act B.E. 2562 (2019). Empowered by this legislation, health officials mandated an investigation and obtained legal entry to conduct a factory walkthrough. This led to direct consultations with the employer and the immediate implementation of mandatory annual chest radiographs and other appropriate preventive measures