Preventable yet persistent: silicosis and gaps in public health policy – a narrative review

Silicosis remains a critical, 100% preventable occupational lung disease that continues to persist as a global public health crisis in the 21st century. Despite decades of industrial safety knowledge, the disease is currently seeing a modern resurgence, particularly in the engineered stone industry, where high-intensity silica exposure leads to rapid, fatal disease variants. This review synthesizes current global and national evidence to highlight the staggering burden of silicosis, with a specific focus on India, where over 50 million workers are projected to be at risk by 2026. Epidemiological data from high-risk clusters in Rajasthan and Gujarat reveal localized prevalence rates as high as 69%, often complicated by a devastating "syndemic" of silicosis and tuberculosis. The persistence of this disease is fundamentally attributed to an "implementation gap" in occupational health policy, characterized by weak enforcement in the informal sector, the invisibility of migrant labor and diagnostic failures. While engineering controls and medical surveillance are established gold standards, their adoption remains inconsistent in low-resource settings. This review advocates for a transition toward a rights-based accountability model, mandatory digital reporting, and the integration of occupational health into broader public health strategies. Ultimately, eliminating silicosis requires moving beyond clinical observation toward robust inter-ministerial coordination and strict legal liability for workplace safety failures.