Presentation to the Portfolio Committee on Health 22 August 2012 Occupational Health and Workers’ Compensation

Overview Background Occupational health issues Compensation system Activities of Department of Health Way forward Background Occupational health issues Compensation system Activities of Department of Health Way forward

Global Worker Health 7 billion people with 3 billion workers 2m die every year from occ injuries & diseases 160 m new cases of occ diseases 250 m occ accidents & fatalities 4% of world GDP 7 billion people with 3 billion workers 2m die every year from occ injuries & diseases 160 m new cases of occ diseases 250 m occ accidents & fatalities 4% of world GDP

Occupational Health in South Africa fragmentation of policy and legislative framework (Health, Labour, Mineral Resources) inadequate occupational health system no surveillance of injuries and diseases deficient occupational health services lack of human resources for occupational health problems of access, coverage and equity in compensation systems concerns about mining sector, migrant workers (internal and cross border) fragmentation of policy and legislative framework (Health, Labour, Mineral Resources) inadequate occupational health system no surveillance of injuries and diseases deficient occupational health services lack of human resources for occupational health problems of access, coverage and equity in compensation systems concerns about mining sector, migrant workers (internal and cross border)

Workers’ Compensation in South Africa

Demography of Workers in South Africa 17m work (13m formal & 4m informal)

Labour Force Survey. Statistics South Africa, 2008 Workers per Employment Sector (‘000)

Labour Force Survey. Statistics South Africa, 2008 Gender Distribution of Workers

The Second Economy

Migrant Mine Workers in South Africa YearRSAMozambiqueLesothoSwaziland% Non- RSA * * Data from TEBA

Occupational Ill-health hard to find data; if found, difficult to interpret 3822 persons with occ diseases reported to DoL in 2005 (45 per workers) 3 die every day from accidents Mine Health & Safety (2005) miners exposed to airborne pollutants (44.5%) R50m paid to 1392 miners (occ lung disease) undiagnosed / uncompensated persons* hard to find data; if found, difficult to interpret 3822 persons with occ diseases reported to DoL in 2005 (45 per workers) 3 die every day from accidents Mine Health & Safety (2005) miners exposed to airborne pollutants (44.5%) R50m paid to 1392 miners (occ lung disease) undiagnosed / uncompensated persons* Naidoo R. WAHSA Project Report , * Nogueira C, et al. WAHSA Project 7

Disease Rates per 1000 autopsies Pathaut: 1998, 2008

Reference: PATHAUT Database, NIOH Pathaut, NIOH. 2010

Nelson et al. Three decades of silicosis: disease trends at autopsy in South African gold miners. Environ Health Perspect. 2010

Gold Price (2000 – current)

Wilson K. NIOH. 2011

Fatalities Target: 20% reduction in the incidence of compensated work-related fatalities by 30 June 2012 with an interim target of 10% by 2006–07. Result: The interim target was achieved in 2006–07 and a 17% decrease has been recorded up to 2007–08. Figure 2 shows that as long as this improvement is maintained the 2012 target is achievable. Aspirational target Target: Australia to have the lowest work-related traumatic injury fatality rate in the world by Result: While Australia has one of the fastest falling fatality rates among the best performing countries world wide, it has remained in 7th place. Safe Work, Australia. 2010

HIV Prevalence (Review) Year of Study Author Study Population HIV Prevalence 2000Rees et al.Gold miners27% 2003Lurie Gold miners (migrants) 25.9% 2006Stevens et al.Platinum miners24.6% 2008Anglo CoalCoal Miners15% 2009Anglo Gold AshantiGold Miners30% 2009 Impala Platinum (Implants) Platinum Miners23%

TB Incidence (Review) Year of Study Author Study Population TB Incidence (per ) 2007 South African Department of Health Tuberculosis Strategic Plan for South Africa 2007 – 2011 Gold Mining Industry to Brendan V Girdler-Brown, Neil W White, Rodney I Ehrlich, Gavin J Churchyard 779 former gold miners in Free State AngloGold AshantiGold miners Anglo Platinum Platinum Miners 1 200

CommodityClinics Total employed New TB (2009) Incidence rate per Coal Diamond Gold Platinum Other Total Incidence Rates of TB by Commodity Global and SA TB incidence 139 and 948 per population respectively

Occupational Exposure Limits for Silica (2008) Country / Province # OEL (mg / m 3 ) Argentina0.05 # British Columbia0.025 Chile0.04 Ireland0.05 Italy0.05 Japan0.03 Portugal0.05 USA - ACGIH*0.025 USA - NIOSH*0.05 *Advisory organisation Source: Maciejeska A Int J of Occ Med & Env Health 21 (1): 1-23

Mining Sector in South Africa 18 Trillion Rand sector (net asset value) Employs persons entities 7.7% of annual GDP DMR 2010

DMR Database of Mines & Quarries (2010) ProvinceCoalDiamondGoldPlatinumOtherTotal Eastern Cape Free State Gauteng Kwazulu-Natal Limpopo Mpumalanga North West Northern Cape Western Cape Total108395* * Diamond mines were mostly mineral rights rather than active mines

In summary… Problem – lack of proper system, fragmentation, measurement ? Paradox – collecting lots of data, little or no analysis, some reports Pressure – multiple fronts Potential for change Promise …. COM. 2011

Approach of Department of Health to Development of the Occupational Health System

Workers Compensation (CCOD) Phase 1 –Review and restructure CCOD, MBOD and NIOH (unified management structure) –Review of Strategic Plan –Policy & legislative reforms to ODMWA –Enhance corporate governance and management –Develop surveillance system –Conduct research –Effective and efficient compensation system for miners / ex-miners Phase 1 –Review and restructure CCOD, MBOD and NIOH (unified management structure) –Review of Strategic Plan –Policy & legislative reforms to ODMWA –Enhance corporate governance and management –Develop surveillance system –Conduct research –Effective and efficient compensation system for miners / ex-miners

Workers Compensation (CCOD) Effective and efficient compensation system for miners / ex-miners Clear backlogs Improve Turn-Around-Times (claims certification, processing & payments) Ensure financial sustainability of the Fund Decentralised benefit examinations (labour sending areas inside and outside South Africa) Effective and efficient compensation system for miners / ex-miners Clear backlogs Improve Turn-Around-Times (claims certification, processing & payments) Ensure financial sustainability of the Fund Decentralised benefit examinations (labour sending areas inside and outside South Africa)

Major Urgent Interventions Preparation of 2010/11 and 2011/12 annual reports Development of 2012/13 APP Response to Auditor-General’s report Establish medical inspectorate Strengthen links to Dept of Mineral Resources (Risk Committee) Enhance Governance and Management Preparation of 2010/11 and 2011/12 annual reports Development of 2012/13 APP Response to Auditor-General’s report Establish medical inspectorate Strengthen links to Dept of Mineral Resources (Risk Committee) Enhance Governance and Management

The Compensation Fund (2012/13) One national office (Johannesburg) 2011/122012/13 Fund AssetR1.77bR1.75b Fund LiabilityR1.8b RevenueR317mR313m ExpenditureR202mR309m SurplusR115mR4m

Fund Review 188 monthly pensions claims paid since 2003; 41 claims last year (Eastern Cape project) 188 monthly pensions claims paid since 2003; 41 claims last year (Eastern Cape project)

CCOD Preliminary Analysis (2010/11)

Gender & Race of Claimants (2010/11) Number of Claims MaleAfricanColouredWhite OSB %96%3%1% OSB %91%2%7% TB75% 25399%98%1% TB % 00 TB %91%4%5%

Development of Occupational Health System Links to Primary Health Care –1 nurse at each facility trained to recognise work related injuries & diseases –1 doctor and 1 nurse at district hospital trained to manage work related injuries & diseases –Links to social services –Links to SA State Social Security Agency (payment of claims) – Links to private providers Links to Primary Health Care –1 nurse at each facility trained to recognise work related injuries & diseases –1 doctor and 1 nurse at district hospital trained to manage work related injuries & diseases –Links to social services –Links to SA State Social Security Agency (payment of claims) – Links to private providers

Development of Occupational Health System Occupational health unit at specialist hospital to manage workers with ill-health Occupational health academic units Links to NHI –Ensure collection systems in pilot districts get revenue from compensation system for work related diseases and injuries Development of surveillance system for occupational health Occupational health unit at specialist hospital to manage workers with ill-health Occupational health academic units Links to NHI –Ensure collection systems in pilot districts get revenue from compensation system for work related diseases and injuries Development of surveillance system for occupational health

Occupational Health System Phase 2 –Innovative models for occupational health services –Support the development of an integrated social security system for workers –Development of infrastructure and human resources for occupational health –Ensure appropriate funding for the occupational health system (prevention, treatment & care, rehabilitation & compensation) –Work with the Departments of Mineral Resources, Labour and Public Service & Administration in achieving a better health system for worker's health Phase 2 –Innovative models for occupational health services –Support the development of an integrated social security system for workers –Development of infrastructure and human resources for occupational health –Ensure appropriate funding for the occupational health system (prevention, treatment & care, rehabilitation & compensation) –Work with the Departments of Mineral Resources, Labour and Public Service & Administration in achieving a better health system for worker's health

Policy, Planning, Co-ordinating & Funding Inputs Briefing to Minister of Health Briefing to Portfolio Committee Briefing to Ministers of Labour, Mineral Resources & Finance Briefing to National Health Council Information to trade unions & employer bodies Briefing to Minister of Health Briefing to Portfolio Committee Briefing to Ministers of Labour, Mineral Resources & Finance Briefing to National Health Council Information to trade unions & employer bodies

In History… Barrier Miner (Broken Hill, NSW : ), Monday 13 November 1922, page 1 National Library of Australia MINERS' PHTHISIS IN AFRICA Tile South African Union legislature's select committee on public accounts reports that the compensation fund out of which compensation has to be paid to miners' phthisis victims on the Rand has still to face a liability estimated at £l4,000,000. As the exhausted mines close down it falls with cumulative effect on the surviving mines. The committee considers that no time should be lost in laying down measures to ensure the adequacy of the fund. Miners’ Phthisis Act 19 of 1912

BC r Hippocrates – Lead (4 th BC) Pliny – Zinc & Sulphur (1 st AD) – animal bladder Galen – Lead & Copper (2 nd AD)

Milner Commission

1930 Int. Silicosis Conf AJ Orenstein’s pioneering work on dust (NIOH) 1959 COM Dust Committee 1914

1994 Leon Mr Thembekile Mankayi vs AngloGold Ashanti 2011 Erasmus COM vs CCOD & Health

“Pravin targets bonuses” “Mine boss who smeared coal on face arrested” pg 16 Tuesday, Nov 15, miners died & 9 trapped – Sizhuang Coal Mine in Yunnan province LONMIN August 2012

"Two hundred thousand subterranean heroes who, by day and by night, for a mere pittance, lay down their lives to the familiar 'fall of rock' and who, at deep levels, ranging from 1,000 to 3,000 feet in the bowels of the earth, sacrifice their lungs to the rock dust which develops miners' phthisis and pneumonia." Sol Plaatje, first Secretary General of the African National Congress, describing the lives of miners in 1914 About a hundred years ago…

Acknowledgement Visionary leadership of the Minister of Health, DG and senior officials of the Department of Health Minister of Mineral Resources and the Department of Mineral Resources Chair and members of Audit and Risk Committee of CCOD Office of the Auditor-General Our team at NIOH – NHLS, CCOD, MBOD

Together we can! 011 – “Fit for work, Fit for life, Fit for tomorrow” HSE, 2005