Mette Bendixen and colleagues point out the environmental, social and economic harms that sand extraction might cause (Nature 571, 29–31; 2019). It can also affect human health, a particularly important point for workers. A global agenda for sustainable sand extraction should incorporate workers’ health policies to prevent silicosis and other serious lung diseases.

The surface properties that make sand from deserts or beaches unsuitable for the building industry also make it less hazardous when inhaled by humans. However, long-term inhalation of small crystalline particles of silica (sand’s primary component) can lead not just to silicosis, a progressive and incurable fibrotic lung disease, but to lung cancer, chronic obstructive pulmonary disease, autoimmune disease and tuberculosis (P. Cullinan et al. Lancet Respir. Med. 5, 445; 2017). Hazardous jobs that involve exposure to freshly fractured silica include crushing, milling, processing, drilling, grinding, polishing and cutting materials containing quartz. Silicosis remains a public-health problem in emerging economies.

Regulations and strategies for controlling exposure have helped to reduce the incidence of silicosis in high-income countries. However, outbreaks among workers fabricating countertops from natural stone powders in resin binders demonstrate an unacceptable ignorance of this health hazard (Lancet Respir. Med. 7, 283; 2019).