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

2. 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

3. 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 & 300 000 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 & 300 000 fatalities 4% of world GDP

5. 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)

6. Workers’ Compensation in South Africa

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

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

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

10. The Second Economy

11. Migrant Mine Workers in South Africa YearRSAMozambiqueLesothoSwaziland% Non- RSA 192074 45277 92110 4393 44957 1940178 70874 88352 0447 15249 1960141 406101 73348 8246 62362 1980233 05539 63696 3085 05044 1995122 56255 14087 93515 30458 200099 57557 03458 2249 36057 2010*152 48635 78235 1795 00934 * Data from TEBA

12. Occupational Ill-health hard to find data; if found, difficult to interpret 3822 persons with occ diseases reported to DoL in 2005 (45 per 100 000 workers) 3 die every day from accidents Mine Health & Safety (2005) 196 411 miners exposed to airborne pollutants (44.5%) R50m paid to 1392 miners (occ lung disease) 480 000 undiagnosed / uncompensated persons* hard to find data; if found, difficult to interpret 3822 persons with occ diseases reported to DoL in 2005 (45 per 100 000 workers) 3 die every day from accidents Mine Health & Safety (2005) 196 411 miners exposed to airborne pollutants (44.5%) R50m paid to 1392 miners (occ lung disease) 480 000 undiagnosed / uncompensated persons* Naidoo R. WAHSA Project Report 2.1.10. 2007, * Nogueira C, et al. WAHSA Project 7

13. Disease Rates per 1000 autopsies Pathaut: 1998, 2008

14. Reference: PATHAUT Database, NIOH Pathaut, NIOH. 2010

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

16. Gold Price (2000 – current)

17. Wilson K. NIOH. 2011

18. 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 2009. 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

19. 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%

20. TB Incidence (Review) Year of Study Author Study Population TB Incidence (per 100 000) 2007 South African Department of Health Tuberculosis Strategic Plan for South Africa 2007 – 2011 Gold Mining Industry 3 000 to 7 000 2008 Brendan V Girdler-Brown, Neil W White, Rodney I Ehrlich, Gavin J Churchyard 779 former gold miners in Free State 2 198 2009AngloGold AshantiGold miners2 900 2009Anglo Platinum Platinum Miners 1 200

21. CommodityClinics Total employed New TB (2009) Incidence rate per 100 000 Coal98 994 38 423 Diamond44 365 11 252 Gold582 157 1 288 1 568 Platinum430 212134 444 Other2013 990 37 264 Total38139 718 1 508 1 079 Incidence Rates of TB by Commodity Global and SA TB incidence 139 and 948 per 100 000 population respectively

22. 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. 2008. Int J of Occ Med & Env Health 21 (1): 1-23

23. Mining Sector in South Africa 18 Trillion Rand sector (net asset value) Employs 500 000 persons 2 200 entities 7.7% of annual GDP DMR 2010

24. DMR Database of Mines & Quarries (2010) ProvinceCoalDiamondGoldPlatinumOtherTotal Eastern Cape0000140 Free State22604061 Gauteng63252129167 Kwazulu-Natal12010120133 Limpopo 30112134156 Mpumalanga85014089194 North West019962597327 Northern Cape01520076228 Western Cape02000177197 Total108395*53451 0021 603 * Diamond mines were mostly mineral rights rather than active mines

25. 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

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

27. 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

28. 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)

29. 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

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

31. Fund Review 188 monthly pensions 14094 claims paid since 2003; 41 claims last year (Eastern Cape project) 188 monthly pensions 14094 claims paid since 2003; 41 claims last year (Eastern Cape project)

32. CCOD Preliminary Analysis (2010/11)

37. Gender & Race of Claimants (2010/11) Number of Claims MaleAfricanColouredWhite OSB1 26997%96%3%1% OSB2 200100%91%2%7% TB75% 25399%98%1% TB1 40100% 00 TB2 54100%91%4%5%

40. 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

41. 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

42. 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

43. 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

44. In History… Barrier Miner (Broken Hill, NSW : 1888 - 1954), Monday 13 November 1922, page 1 National Library of Australia http://nla.gov.au/nla.news-article45589068 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

45. 1556 1633- 1714 1500 BC r Hippocrates – Lead (4 th BC) Pliny – Zinc & Sulphur (1 st AD) – animal bladder Galen – Lead & Copper (2 nd AD)

46. 1907 1910 1913 1902 - 3 Milner Commission

47. 1930 Int. Silicosis Conf AJ Orenstein’s pioneering work on dust (NIOH) 1959 COM Dust Committee 1914

48. 1994 Leon Mr Thembekile Mankayi vs AngloGold Ashanti 2011 Erasmus 1975 2012 COM vs CCOD & Health

49. “Pravin targets bonuses” “Mine boss who smeared coal on face arrested” pg 16 Tuesday, Nov 15, 2011 34 miners died & 9 trapped – Sizhuang Coal Mine in Yunnan province LONMIN... 16 August 2012

50. "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…

51. 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

52. Together we can! Barry.kistnasamy@nioh.nhls.ac.za 011 – 712 6413 “Fit for work, Fit for life, Fit for tomorrow” HSE, 2005