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TB  and Mining – South Africa, Southern Africa

TB and mining in South Africa

In 2011 there were an estimated 760,000 new cases of TB related to South Africa’s mining sector, which was a third of all new cases in Africa that year. This was a staggering 9% of all new cases worldwide. Aside from HIV mining is the largest driver of the TB epidemic.

The incidence rate of TB among workers in South Africa’s mines is the highest in the world, somewhere between 3,000 and 7,000 cases per 100,000 people. As WHO classifies 250 cases per 100,000 people as a “health emergency” it is not surprising that the spread of TB in the mining sector has been described as “the worst public health epidemic that we’re facing today”.1“The ‘worst public health epidemic we’re facing today’? Tuberculosis in the Mining sector”, THINK AFRICA PRESS June 2013 www.health-e.org.za/2009/07/20/sa-tb-programme-gets-a-cautious-thumbs-up/

“.. silicosis and TB have reached pandemic levels, with thousands of active and former mineworkers in South Africa and neighbouring countries dying each year, silently and painfully. Public health experts have even shown that South Africa has the highest TB rates in any mining and working population in the world. Despite this, little is being done to admit to the problem in a sustainable and industry wide manner.”2Hassan, Fatima “Lost narrative of silicosis, TB among mine workers post Marikana, Mining Weekly, 9th November 2012 www.miningweekly.com/article/lost-narrative-of-silicosis-tb-among-mineworkers-post-marikana-2012-11-09/

TB and the migrant labour system

Urging greater action on TB by South Africa, the South African Minister of Health said:

“If TB and HIV are a snake in Southern Africa, the head of the snake is here in South Africa. People come from all over the Southern African Development Community to work in our mines and they export TB and HIV, along with their earnings. If we want to kill a snake, we need to hit it on its head.”
Aaron Motsoaledi, South African Minister of Health, June 2010

Every year half a million men travel across the Southern African region to work in South Africa’s mines. In doing so they contract TB as well as HIV. This pattern of migration, men arriving at the mines to work, developing active TB, and returning home again has created an enormous health crisis not only in South Africa but across the whole Southern Africa region.

Poor housing conditions contributed to miners developing TB

Poor housing conditions contributed to miners developing TB

If a miner developed TB whilst working at the mine they would be repatriated to their home in a rural area in communities anywhere from Angola to Mozambique. This facilitated the spread of TB among their families. Often there would be no compensation from the mining company, no cross border health referral, and no source of income to support themselves and their families whilst they were out of work receiving treatment.

During their time at the mine many of the migrant labourers were housed near the mine in roughly built hostel type compounds. These compounds were overcrowded and together with the poor working conditions were an idea environment for the spread of infectious diseases such as TB.

TB in the mines during apartheid

This system of migrant labour and the resulting high levels of TB has been happening for many years. According to one estimate nearly 50,000 black miners died during the decade to 1912. The high TB mortality rates in black mine workers led to an enquiry into the health of black mine workers in the Witwatersrand area being included in the brief of the 1912 Tuberculosis Commission. This was the first of many investigations into the problem. Although the official figures of TB mortality among mine workers was high, they did greatly underestimate the true mortality rate, as those who died after being repatriated were not included in mine mortality statistics.

TB and mining after the ending of Apartheid

For a number of years South Africa had been praised for leading the world in mine safety, and medical care and compensation. However after the ending of apartheid in 1994 it began to be apparent that the level of TB among both current and previous miners in South Africa, was much higher than it had previously been made out to be.

The Leon Commission

The Leon Commission was the first enquiry after the end of apartheid to hear the testimony of black miners. The commission found in 1995 that dust levels were hazardous and had probably been that way for more than 50 years. Most of the research that had taken place had been on in service miners and biased towards white miners. The last research on black former miners had taken place in the 1930s.3Graham, Eric, “Silicosis rampant in South Africa’s mines”,  World Socialist Web Site, https://www.wsws.org/en/articles/2012/10/safr-o09.html

It was said in evidence to the Leon Commission that the mines had played a major role in the spread of TB.

It seems to be generally agreed that the mining industry made a major contribution to the development of TB among miners in South Africa, and from the miners who then circulate it back home to their families.

Mine workers’ compensation

There had in South Africa for several decades been a legislative system for compensating workers who are injured at work or who contract an occupational disease. The compensation is paid from a fund fed by a levy on employers who are required by law to pay contributions based on their wage bill.

It might well have been expected that soon after the ending of apartheid, the government would have revised the worst aspects of the mine workers’ compensation regime. This was a regime which they had inherited from the apartheid state.

Miners in South Africa

Miners in South Africa

It included :

  • a requirement for a higher clinical threshold for mine workers to qualify for compensation for lung disease, compared with other workers in South Africa;
  • paying out lower amounts over real time (in real value terms) to mine workers with with lung disease compared with non mineworkers;
  • using a lump sum payment system instead of pension payouts;
  • taking a very long time (in some cases four to five years) to process claims and an even longer time to payout;
  • paying out only a small percentage of claims (in some cohorts of workers, less than 5% were compensated);
  • and requiring the family of a deceased mine-worker to “send” the heart and lung of the deceased mine worker to an office in Johannesburg for organ inspection etc.4Hassan, Fatima “Lost narrative of silicosis, TB among mine workers post Marikana, Mining Weekly, 9th November 2012 www.miningweekly.com/article/lost-narrative-of-silicosis-tb-among-mineworkers-post-marikana-2012-11-09/

Yet the new democratic government has never once, despite promises made, amended the Compensation Act which governs mineworkers.

Southern African Development Community (SADC)

In August 2012 the 15 SADC heads of state signed the SADC Declaration on TB and the Mining Industry. The declaration committed to:

“moving towards a vision of zero new infections, zero stigma and discrimination, and zero deaths resulting from TB, HIV, silicosis and other occupational respiratory lung diseases.”

Increased political commitment to combat the problem of TB in the mining industry is to be welcomed, but also needs to be combined with practical action.

Major sources

The Hidden Epidemic Among Former Mine Workers: Silicosis, Tuberculosis and the Occupational Diseases in Mines and Works Act in the Eastern Cape, South Africa Jaine Roberts, Health Systems Trust

Tuberculosis in South Africa’s Gold Mines: A united call to action Results UK

References

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1. “The ‘worst public health epidemic we’re facing today’? Tuberculosis in the Mining sector”, THINK AFRICA PRESS June 2013 www.health-e.org.za/2009/07/20/sa-tb-programme-gets-a-cautious-thumbs-up/
2. Hassan, Fatima “Lost narrative of silicosis, TB among mine workers post Marikana, Mining Weekly, 9th November 2012 www.miningweekly.com/article/lost-narrative-of-silicosis-tb-among-mineworkers-post-marikana-2012-11-09/
3. Graham, Eric, “Silicosis rampant in South Africa’s mines”,  World Socialist Web Site, https://www.wsws.org/en/articles/2012/10/safr-o09.html
4. Hassan, Fatima “Lost narrative of silicosis, TB among mine workers post Marikana, Mining Weekly, 9th November 2012 www.miningweekly.com/article/lost-narrative-of-silicosis-tb-among-mineworkers-post-marikana-2012-11-09/