In response to the recent lit­i­ga­tion against Anglo Gold/Anglo Amer­i­can South Africa (AASA)
By Jonathan Smith

There are a lot of pub­lic health mys­ter­ies; count­less dis­eases have lay­ers of com­plex­ity requir­ing a sophis­ti­cated knowl­edge of epidemiology.This is not one of them. This is basic pub­lic health. And this is a pub­lic health disaster.

For con­text of this arti­cle, a precedent-setting case for South African min­ers was won on March 3rd 2011. In short, in a sur­pris­ing deci­sion by the Con­sti­tu­tional Court, the recent over­rul­ing of the Supreme Court of Appeal’s judge­ment made in 2008 has bro­ken ground for thou­sands of for­mer min­ers stricken with the deadly dis­eases of tuber­cu­lo­sis and/or sil­i­co­sis to make direct claims against their employer. Now, eigh­teen for­mer minework­ers are tak­ing Anglo Amer­i­can South Africa (AASA) to court, claim­ing they devel­oped sil­i­co­sis and tuber­cu­lo­sis from pro­longed under­ground expo­sure to sil­ica dust.

“You can pre­dict where minework­ers pri­mar­ily migrate from based on the level of wid­ows in the com­mu­nity. Does any­one else find this com­pletely absurd?”

And as if Hol­ly­wood scripted the set­ting, the for­mer Angl­o­Gold Ashanti worker in the ini­tial case, Them­bek­ile Mankayi, trag­i­cally died six days before the mon­u­men­tal rul­ing due to com­pli­ca­tions with silico-tuberculosis But Mankayi is not a mar­tyr, actu­ally far from it. The only dif­fer­ence between him and tens of thou­sands of minework­ers every year is the fact that his death was noticed.  The method­i­cal exo­dus of these deathly ill, highly infec­tious men has been prac­ticed for well over a cen­tury, but these deaths are hid­den in the crevices of Africa — far from the court­rooms of Johan­nes­burg.  These deaths are equally as painful, how­ever, and even more dev­as­tat­ing to the fam­i­lies of these workers.

I will cut past the human rights talk. The impor­tance of this tran­scends the obvi­ous human rights vio­la­tions and one does not even have to dis­cuss eth­i­cal con­sid­er­a­tions to sup­port this rul­ing.  Plus, I need you to pay atten­tion, this is impor­tant. I am inter­ested in pub­lic health — it is not about who is good, who is bad. This issue, quite sim­ply, is about pub­lic health. I can’t say that enough.

This per­sis­tance of this issue is quite frankly ludi­crous. We are lit­er­ally run­ning out of pub­lic health sta­tis­tics to throw at it.  Lets put the issue of indi­vid­ual rights and health aside for a moment and focus on the impact this has on the gen­eral pop­u­la­tion.  Up to 760,000 inci­dent TB cases can be attrib­uted to the cir­cu­lar migra­tion of these men (Stuck­ler, et al) and count­less other sta­tis­tics prove that min­ing is not only dan­ger­ous to indi­vid­ual health but to the com­mu­nity as well. You can actu­ally gauge the extent of min­ing activ­ity in any sub saha­ran coun­try based on its inci­dent TB rate in the gen­eral pop­u­la­tion. You can pre­dict where minework­ers pri­mar­ily migrate from based on the level of wid­ows in the com­mu­nity. Does any­one else find this com­pletely absurd? Can you imag­ine in the U.S. if there was an indus­try directly respon­si­ble for a dis­ease in the gen­eral pop­u­la­tion? I can say with full con­fi­dence that it would not take 107 years for a law­suit to be won. Remem­ber Andrew Speaker? Prob­a­bly not, but he was the U.S.‘s MDR-TB patient that flew to Europe a few years back to make sure he got to his wed­ding.  He got on a plane and the entire west­ern soci­ety went into hys­te­ria.  He was hit by at least 8 law­suits that com­bined for $1.3 mil­lion from pas­sen­gers — none of which were even infected. This hap­pens thou­sands of times a year in the min­ing indus­try, but these men are more infec­tious and live in cramped, squalid con­di­tions where dis­ease can more eas­ily be trans­mit­ted. This is a pub­lic health prob­lem of con­sid­er­able dimension.

The above men­tioned paper con­tin­ues to state, “com­pre­hen­siveTB con­trol strate­gies should explic­itly address the role of min­ing activ­ity and envi­ron­ments in the epi­demic.” The gen­eral pop­u­la­tion of South Africa will never over­come their TB epi­demic, one of the largest in the world, if noth­ing is done to stop it at its pri­mary source: the min­ing indus­try.  As South Africa’s Min­is­ter of Health Dr. Aaron Mot­soaledi so elo­quently states, “If TB and HIV were a snake, the head would be in South Africa, in the mines. Minework­ers come from all over the sub­re­gion to fetch TB and HIV and take it back home. We are export­ing TB and HIV.”  Any pub­lic health ini­tia­tive that seeks to lower TB in the gen­eral pop­u­la­tion will be seri­ously under­mined if it fails to address the min­ing industry’s impact on the epi­demic.  We don’t need more sta­tis­tics, more rhetoric, we need action. If there is any health issue that pub­lic health offi­cials can pick and be able to win (and there are only a few of these, mind you), it is lung dis­ease in the min­ing indus­try.  The resources are there. The means are there. Its a con­trolled envi­ron­ment.  The infra­struc­ture to enforce checks and poli­cies are there. Every­thing is there, already in place.  The past cen­tury has been plagued by polit­i­cal and finan­cial deci­sions that have directly resulted in this epi­demic, but this is in no way insur­mount­able.  Sil­i­co­sis is an occu­pa­tional haz­ard that can be sig­nif­i­cantly reduced given the polit­i­cal and finan­cial will. Tuber­cu­lo­sis is eas­ily pre­ventable and cur­able with drugs that have been used for decades. It is increas­ingly frus­trat­ing to think about how absurd this sit­u­a­tion is, and how eas­ily steps can be taken to fix it.  These court rul­ings are exam­ples of the steps we should be tak­ing, and pro­vide some com­fort in those of us who are fight­ing this battle.

But as pub­lic health peo­ple, what we have to under­stand is that we don’t just need the pub­lic health under­stand­ing and real­iza­tion of this issue. Its there, trust me.  Every pub­lic health offi­cial with a mother has com­mented on the issue and damned it to hell and back. We need help. In order to address this we can’t just keep regur­gi­tat­ing num­bers and sug­ges­tions. We need to under­stand that this is a mul­ti­dis­ci­pli­nary bat­tle that must be approached both polit­i­cally and legally.  This rul­ing will not only pro­vide the minework­ers with finan­cial resources to obtain the crit­i­cal med­i­cines they need, but also fur­ther influ­ence pol­icy and action to be taken on this issue. Mines will begin to seri­ously con­sider their dust level reduc­tion and TB pro­grams, because quite sim­ply, they wont be able to afford not to any­more. The deci­sions in this indus­try have always been made on a finan­cial basis, and allow­ing minework­ers to sue their employ­ers for direct neg­li­gence will directly force the mines to con­sider this issue. The sup­port of these cases is para­mount to over­com­ing the chal­lenge that lies ahead.