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COMMISSION
  
OF
  
INQUIRY
  
INTO
  
SAFETY
  
AND
  
HEALTH
  
IN
  
THE
  
MINING
  
INDUSTRY 
 
46 
response relationship, which in turn is used to determine acceptable levels of 
exposure.  Successful intervention to reduce the burden of disease attributable to 
work will depend on the accurate identification of risk, not only by agent but by task 
and by location. 
 
4.4.3  All the evidence presented to the Commission supports the view that urgent action is 
required to upgrade the standards of practice in respect of the measurement of 
workplace exposures, medical surveillance and the matching of these two data sets, 
and the COMMISSION RECOMMENDS accordingly.  Only in this way can the 
workplaces which actually lead to disease in workers be identified and targeted for 
remedial action. 
 
4.4.4  A safe working environment will remain a goal which cannot be reached so long as 
the fundamentals of occupational health are not more widely understood than 
appears to be the case at present.  Evidence submitted to the Commission established 
clearly the central role of the process of risk assessment.  This process must begin 
with the establishment of an expert occupational health programme provided at or 
near work places.  This is prescribed in terms of the OHS Act by Section 8(2) (d) 
which will be dealt with in the Commission’s Recommendations. 
 
4.5 
TRENDS IN OCCUPATIONAL DISEASE INCIDENCE OR PREVALENCE 
 
4.5.1  All witnesses agreed (either implicitly or explicitly) that there are considerable 
difficulties in determining trends.  As was stated elsewhere these difficulties include 
uncertainties in respect of both the numerators and the denominators used in making 
the calculations.  Numerators are unreliable as a result of widespread under 
ascertainment, due, inter alia to defects in medical surveillance, under reporting, the 
migrant labour system and the characteristic long lag period of many occupational 
diseases.  Denominator difficulties arise from the use of global figures for the 
number of workers employed and the difficulty in establishing the size of particular 
risk groups, such as stope workers, accurately.  In many calculations data from 
mines of widely differing depth and geographical location are aggregated, and in the 
case of minerals other than gold, platinum and coal, a wide spectrum of mines 
producing anything from andalusite to zinc are treated as a single group. 
 
4.5.2  A further complication is introduced by the division, in terms of the ODMW Act, of 
mines into those which are controlled and those which are not, and by the separation 
of those mines which are owned by companies which are members of the COM into 
a separate group, and a proportion of mines do not report at all.  Meaningful 
discussion of the health risks and the health trends in the mining industry will be 
difficult, if not impossible, until all mines are grouped by process and valid 
measurements made of the environmental conditions in all mines. 
 
4.5.3  The detailed evidence submitted to the Commission in writing and orally, 
approaches the problem in a systematic manner.  No evidence was submitted to 
suggest that occupational diseases had been adequately controlled by the industry as 
a result of the existing regulatory system.  The written submissions of Drs. White 
and Leger, supplemented by those of the Work Place Information Group and the 
Industrial Health Research Group, enabled the Commission to appreciate the nature 
and scope of the health problems in the industry. 
 
 
 

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COMMISSION
  
OF
  
INQUIRY
  
INTO
  
SAFETY
  
AND
  
HEALTH
  
IN
  
THE
  
MINING
  
INDUSTRY 
 
47 
4.5.4  Dr. White, a specialist in the field of lung disease, in a submission running to more 
than 120 pages, citing 134 references to mainly South African scientific studies, 
demonstrated that those response relationships have been established in South Africa 
and elsewhere for exposure to quartz and subsequent silicosis, for exposure to 
asbestos fibre and subsequent non-malignant and malignant asbestos related 
diseases, for length of mining experience or quartz exposure and pulmonary 
tuberculosis, and for exposure to mine air and chronic obstructive pulmonary 
disease.  A number of other diseases are also known to be associated with work in 
mines.  It has also been shown that severity of disease and life expectancy are 
negatively correlated. 
 
4.5.5  In determining the trends in incidence there are, it is agreed by White, Leger and 
others, formidable difficulties in establishing reliable numerators and denominators, 
as discussed above, and in piecing together fragments of information held by the 
various agencies involved, viz. the DMEA, the DoH, the Workmen’s Compensation 
Commissioner, the Rand Mutual Insurance Company, individual mines or mining 
conglomerates, etc. On balance it appears that there is no conclusive evidence of a 
downward trend in the incidence or prevalence of any of the diseases of major 
concern in the mining industry. 
 
4.5.6  More importantly the evidence suggests that in almost all instances there is evidence 
of under ascertainment of the number of cases, and that stabilisation of the 
workforce is likely to increase the incidence and the prevalence of occupational 
diseases among the smaller number of persons now employed in mines.  Leger (pp 
73-77) concludes that as occupational diseases are related to prolonged exposure in 
the work environment, increased length of exposure on its own will result in an 
increased incidence of disease.  However at least two other factors are likely to 
contribute to what may prove to be a very significant increase in the incidence of 
pneumoconiosis, noise induced hearing loss and tuberculosis.  Prior to stabilisation 
workers commonly left the industry before the disease became manifest, but as an 
increasing proportion remain in employment for 20 years or more they will develop 
the disease while still within range of diagnostic services.  The position will be 
compounded in respect of pulmonary disease by the fact that older workers are more 
susceptible to tuberculosis. 
 
Leger then cites evidence from a number of sources to show that, despite the fact 
that “No direct measures of mine service or the age profile of the workforce as a 
whole exists”, the demographic change is surprisingly rapid.  A series of studies of 
autopsy data shows that in 1988 58% of miners dying in service were between 20 
and 29 years of age, but by 1992 the comparable figure was 19%. 
 
4.5.7  Solutions to the problem depend on “the replacement of the pre-1993 system of 
medical intervention with one that is equitable and not racially discriminatory, 
effective in both the prevention and early detection of work related diseases, 
accessible and affordable, participatory and non-coercive and in addition to adequate 
compensation, also offers retraining or alternative placement options to miners with 
work related diseases” (White, p 78).  It is also evident that much of the information 
has been held in confidence by management and that access to mines for research 
purposes has not been easy to obtain.  There is some evidence that as a result of the 
Commission’s deliberations this will change. 
 
 
 

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