Mulch containing asbestos has now been found at 41 locations in New South Wales, including Sydney parks, schools, hospitals, a supermarket and at least one regional site. Tests are under way at other sites.

As a precautionary measure, some parks have been cordoned off and some schools have closed temporarily. Fair Day – a large public event that traditionally marks the start of Mardi Gras – was cancelled after contaminated mulch was found at the site.

The New South Wales government has announced a new taskforce to help investigate how the asbestos ended up in the mulch.

Here’s what we know about the risk to public health of mulch contaminated with asbestos, including “friable” asbestos, which has been found in one site (Harmony Park in Surry Hills).

What are the health risks of asbestos?

Asbestos is a naturally occurring, heat-resistant fibre that was widely used in building materials from the 1940s to the 1980s. It can be found in either a bonded or friable form.

Bonded asbestos means the fibres are bound in a cement matrix. Asbestos sheeting that was used for walls, fences, roofs and eaves are examples of bonded asbestos. The fibres don’t escape this matrix unless the product is severely damaged or worn.

A lot of asbestos fragments from broken asbestos products are still considered bonded as the fibres are not released as they lay on the ground.

Friable asbestos, in contrast, can be easily crumbled by touch. It will include raw asbestos fibres and previously bonded products that have worn to the point that they crumble easily.

The risk of disease from asbestos exposure is due to the inhalation of fibres. It doesn’t matter if those fibres are from friable or bonded sources.

However, fibres can more easily become airborne, and therefore inhalable, if the asbestos is friable. This means there is more of a risk of exposure if you are disturbing friable asbestos than if you disturb fragments of bonded asbestos.

Who is most at risk from asbestos exposure?

The most important factor for disease risk is exposure – you actually have to inhale fibres to be at risk of disease.

Just being in the vicinity of asbestos, or material containing asbestos, does not put you at risk of asbestos-related disease.

For those who accessed the contaminated areas, the level of exposure will depend on disturbing the asbestos and how many fibres become airborne due to that disturbance.

However, if you have been exposed to, and inhaled, asbestos fibres it does not mean you will get an asbestos-related disease. Exposure levels from the sites across Sydney will be low and the chance of disease is highly unlikely.

The evidence for disease risk from ingestion remains highly uncertain, although you are not likely to ingest sufficient fibres from the air, or even the hand to mouth activities that may occur with playing in contaminated mulch, for this to be a concern.

The risk of disease from exposure depends on the intensity, frequency and duration of that exposure. That is, the more you are exposed to asbestos, the greater the risk of disease.

Most asbestos-related disease has occurred in people who work with raw asbestos (for example, asbestos miners) or asbestos-containing products (such as building tradespeople). This has been a tragedy and fortunately asbestos is now banned.

There have been cases of asbestos-related disease, most notably mesothelioma – a cancer of the lining of the lung (mostly) or peritoneum – from non-occupational exposures. This has included people who have undertaken DIY home renovations and may have only had short-term exposures. The level of exposure in these cases is not known and it is also impossible to determine if those activities have been the only exposure.

There is no known safe level of exposure – but this does not mean that one fibre will kill. Asbestos needs to be treated with caution.

As far as we are aware, there have been no cases of mesothelioma, or other asbestos-related disease, that have been caused by exposure from contaminated soils or mulch.

Has asbestos been found in mulch before?

Asbestos contamination of mulch is, unfortunately, not new. Environmental and health agencies have dealt with these situations in the past. All jurisdictions have strict regulations about removing asbestos products from the green waste stream but, as is happening in Sydney now, this does not always happen.

What if I’ve been near contaminated mulch?

Exposure from mulch contamination is generally much lower than from current renovation or construction activities and will be many orders of magnitude lower than past occupational exposures.

Unlike activities such as demolition, construction and mining, the generation of airborne fibres from asbestos fragments in mulch will be very low. The asbestos contamination will be sparsely spread throughout the mulch and it is unlikely there will be sufficient disturbance to generate large quantities of airborne fibres.

Despite the low chance of exposure, if you’re near contaminated mulch, do not disturb it.

If, by chance, you have had an exposure, or think you have had an exposure, it’s highly unlikely you will develop an asbestos-related disease in the future. If you’re worried, the Asbestos Safety and Eradication Agency is a good source of information.

Peter Franklin, Associate Professor and Director, Occupational Respiratory Epidemiology, The University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

People considering cosmetic surgery – such as a breast augmentation, liposuction or face lift – should have extra protection following the release this week of new safety and quality standards for providers, from small day-clinics through to larger medical organisations.

The new standards cover issues including how these surgeries are advertised, psychological assessments before surgery, the need for people to be informed of risks associated with the procedure, and the type of care people can expect during and afterwards. The idea is for uniform standards across Australia.

The move is part of sweeping reforms of the cosmetic surgery industry and the regulation of medical practitioners, including who is allowed to call themselves a surgeon.

It is heartening to see these reforms, but some may say they should have come much sooner for what’s considered a highly unregulated area of medicine.

Why do people want cosmetic surgery?

Australians spent an estimated A$473 million on cosmetic surgery procedures in 2023.

The major reason people want cosmetic surgery relates to concerns about their body image. Comments from their partners, friends or family about their appearance is another reason.

The way cosmetic surgery is portrayed on social media is also a factor. It’s often portrayed as an “easy” and “accessible” fix for concerns about someone’s appearance. So such aesthetic procedures have become far more normalised.

The use of “before” and “after” images online is also a powerful influence. Some people may think their appearance is worse than the “before” photo and so they think cosmetic intervention is even more necessary.

People don’t always get the results they expect

Most people are satisfied with their surgical outcomes and feel better about the body part that was previously concerning them.

However, people have often paid a sizeable sum of money for these surgeries and sometimes experienced considerable pain as they recover. So a positive evaluation may be needed to justify these experiences.

People who are likely to be unhappy with their results are those with unrealistic expectations for the outcomes, including the recovery period. This can occur if people are not provided with sufficient information throughout the surgical process, but particularly before making their final decision to proceed.

What’s changing?

According to the new standards, services need to ensure their own advertising is not misleading, does not create unreasonable expectations of benefits, does not use patient testimonials, and doesn’t offer any gifts or inducements.

For some clinics, this will mean very little change as they were not using these approaches anyway, but for others this may mean quite a shift in their advertising strategy.

It will likely be a major challenge for clinics to monitor all of their patient communication to ensure they adhere to the standards.

It is also not quite clear how the advertising standards will be monitored, given the expanse of the internet.

What about the mental health assessment?

The new standards say clinics must have processes to ensure the assessment of a patient’s general health, including psychological health, and that information from a patient’s referring doctor be used “where available”.

According to the guidelines from the Medical Board of Australia, which the standards are said to complement, all patients must have a referral, “preferably from their usual general practitioner or if that is not possible, from another general practitioner or other specialist medical practitioner”.

While this is a step in the right direction, we may be relying on medical professionals who may not specialise in assessing body image concerns and related mental health conditions. They may also have had very little prior contact with the patient to make their clinical impressions.

So these doctors need further training to ensure they can perform assessments efficiently and effectively. People considering surgery may also not be forthcoming with these practitioners, and may view them as “gatekeepers” to surgery they really want to have.

Ideally, mental health assessments should be performed by health professionals who are extensively trained in the area. They also know what other areas should be explored with the patient, such as the potential impact of trauma on body image concerns.

Of course, there are not enough mental health professionals, particularly psychologists, to conduct these assessments so there is no easy solution.

Ultimately, this area of health would likely benefit from a standard multidisciplinary approach where all health professionals involved (such as the cosmetic surgeon, general practitioner, dermatologist, psychologist) work together with the patient to come up with a plan to best address their bodily concerns.

In this way, patients would likely not view any of the health professionals as “gatekeepers” but rather members of their treating team.

If you’re considering cosmetic surgery

The Australian Commission on Safety and Quality in Health Care, which developed the new standards, recommended taking these four steps if you’re considering cosmetic surgery:

1. have an independent physical and mental health assessment before you commit to cosmetic surgery

2. make an informed decision knowing the risks

3. choose your practitioner, knowing their training and qualifications

4. discuss your care after your operation and where you can go for support.

My ultimate hope is people safely receive the care to help them best overcome their bodily concerns whether it be medical, psychological or a combination.

Gemma Sharp, Associate Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.