Despite being both preventable and curable, tuberculosis (TB) remains one of the most serious health problems facing sub-Saharan Africa. According to the World Health Organisation, an estimated 2.3 million people in Africa contracted the disease in 2011, and some 220,000 died from it. The disease represents a major health crisis, is a heavy drain on public resources, and, especially as drug resistant strains become increasingly prevalent, is today an ever more urgent challenge.
TB is an archetypal “disease of poverty”. It has been all but eradicated in the developed world yet remains a real threat particularly amongst those suffering from malnutrition or HIV/AIDS, and in areas where public goods such as access to healthcare are limited.
Eradicating the disease in sub-Saharan Africa will therefore require concerted and multi-faceted efforts on a number of fronts – one of which is the mining sector.
TB interventions and discussions have typically focussed on issues such as healthcare, malnutrition and HIV/AIDS, however recently the role played by the mining industry has gained increased attention.
According to research, an estimated 760,000 new cases of tuberculosis in 2011 were related to South Africa’s mining sector – that’s a third of all new cases in Africa that year and a staggering 9% of all new cases worldwide.
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. Given the World Health Organisation classifies 250 cases per 100,000 people as a ‘health emergency’, it is not surprising that Jonathan Smith, a lecturer in Epidemiology of Microbial Diseases and Global Health at Yale University who has made two films on the subject, describes the spread of TB in the mining sector as the “worst public health epidemic that we’re facing today”.
There are a number of reasons why the mining sector has proven such fertile ground for the spread of TB.
One factor is the prevalence of HIV/AIDS. The incidence rate of HIV/AIDS is often high in mining communities, in part due to the role of sex-workers. The disease weakens immune systems, making the contraction of TB more likely.
The physical conditions in which miners find themselves do not help either. Accommodation is often cramped and low-quality, providing an ideal environment for the spread of airborne strands of the bacteria. Meanwhile many miners suffer from silicosis, a condition caused by breathing in the silica dust found in mines, which increases vulnerability to infection.
Until relatively recently, there had also been little aftercare on offer from mining companies for miners who contracted diseases while at work. Workers diagnosed with TB were, in the words of a documentary on the subject, simply “sent home to die” at the end of their contracts. “Once these mine workers leave, they disappear”, Saoirse Fitzpatrick, a campaigns assistant focused on tuberculosis in the mining industry at Results UK, told Think Africa Press.
And given that many miners are migrants coming from other poor areas in which healthcare may also be limited and rates of HIV high, the return of TB-infected miners to their home communities tends to increase TB prevalence there too.
The link between TB and mining has typically received insufficient attention, but now there seems to be growing recognition of the problem among politicians. This March, leaders from the Southern African Development Community (SADC) meeting in Swaziland signed a document outlining the need to combat tuberculosis in the mining industry.
A number of campaigners, such as Aaron Oxley, Executive Director of Results UK, are optimistic about the Swaziland Statement. “The amount of political capital being burned by health ministers and heads of states on this is real”, says Oxley.
This political impetus is also underpinned by important legal changes over the past few years. In 2009, miner Thembekile Mankayi brought a compensation claim against his former employer, the global gold mining company AngloGold Ashanti, after catching silicosis at work. He didn’t live to see outcome of his case, but the final ruling set a landmark precedent: that mining companies could be held accountable for the contraction of silicosis-related diseases. This shifted the treatment and safety of workers from an ethical consideration towards being a legal necessity, and since the landmark ruling, a number of similar court cases have been brought in South Africa and London.
Mining companies are now slowly starting to make changes in recognition of these health issues. For example, miners are increasingly being asked to wear masks to stop the contraction of silicosis and some single-sex hostels are being knocked down in favour of family housing, in the hope that it will decrease demand for sex-workers. This is just a start, however, and Fitzpatrick stresses that these practices are still “very sporadic”.
The imperative to address TB in the mining sector is clear. And if the fact that a third of all new TB cases in Africa are related to mining is not enough to convince mining companies and governments that the issue should be a priority, the economic costs of not confronting the link between mining and the disease is also highly persuasive.
A recent preliminary report by the World Bank, for example, suggests that tackling tuberculosis in South African mines could not only considerably reduce the cost of the TB epidemic for mining companies – estimated at around $900 million per year – but also bring about higher productivity, possibly culminating in an overall economic benefit of $783 million per year.
It therefore seems to be in the strong interests mining companies, African governments, and miners themselves that the links between TB and mining are explored and addressed in concerted ways. And with greater attention being drawn to the issue and the tide slowly turning, many are cautiously hopeful.
“We know where the problem is, we know where the actors are, we know how much it is going to cost to fix”, says Oxley. “This is not rocket science. We can start working on it right now and get it done”.
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For further reading around the subject see:
|Tuberculosis: High Prices for a Poor Man's Disease||Nursing a Nation: Community Health Workers in South Africa||Funding the Future: Getting Pharmaceuticals to Tackle Disease in Africa|