Why Sydney tunnel workers remain at severe risk from toxic dust

When you next drive through a tunnel in or around Sydney, spare a thought for the tunnellers who have been working in unacceptably dusty conditions, inhaling toxic dust, to save your travel time.

The number of cases of silicosis in this workforce has not been made available nor transparently monitored in NSW. Such workers are also at risk of developing other lung disorders such as chronic obstructive pulmonary disease (COPD), interstitial lung diseases, preventable infections and lung cancer.

And if that were not enough, they are at risk of what are known as autoimmune diseases, such as rheumatoid arthritis and systemic sclerosis. Silicosis is only one of many diseases that can follow silica exposure, but these frequently go unrecognised.

Tunnel workers are exposed to high levels of crystalline silica.Credit: Kate Geraghty

Having practised in the field of work-related lung disease for more than 20 years, I care for many workers who suffer from entirely preventable conditions such as silicosis and coal miners’ lung disease. The ban on engineered stone in Australia in July 2024 was welcome and necessary, but silicosis and silica-related lung disease continue to be neglected in NSW.

The risks to lung health from inhaling silica dust have been tragically demonstrated by the recent cases of severe silicosis in those working on engineered stone benchtops. I have observed several deaths in young men who would otherwise be caring for their families. The ban on engineered stone will save many hundreds of lives.

Cutting into Sydney sandstone has been known to be dangerous for at least 100 years, with cases of silicosis labelled “sewer miners’ disease” in NSW. The danger in sewerage construction was a key grievance in the 1908 Sydney “rockchoppers’ strike”, when a victory was won against employers and the NSW government. Many young men, then as now, died. One Sydney contractor acknowledged in 1908 that within two years, strapping navvies “pine away to almost nothing”. Another drily commented that “killing is not murder when done for profit”.

Recent press reports have highlighted the fact that in NSW workers are still exposed to excessive levels of respirable crystalline silica (RCS). Thousands of tunnellers probably have had high RCS exposure for years during the construction of the Sydney road and rail tunnels. Accurate numbers of cases of disease that result will be difficult to track. At one in seven current worksites, air quality reports show silica dust levels exceed the work exposure standard (WES).

A WestConnex worker wears a full face mask to avoid breathing in dangerous dust.Credit: Jessica Hromas

Alarmingly, air monitoring results were only obtained by unions using freedom of information laws and are not readily available from SafeWork. Affected workers will not know their own dust monitoring results – nor will their doctors.

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.

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.

Professor Deborah Yates is a respiratory physician. She has practised in the field of work-related lung disease for more than 20 years.