Managing disease on the goldmines: 'work-related' and 'non-work-related' diseases.

OBJECTIVE

The mining industry in South Africa makes a distinction between work-related and non-work-related diseases because of the legal obligation to provide compensation for work-related diseases such as the various pneumoconioses. In this paper we consider the ways in which this distinction helps or hinders the delivery of health care services in the mining industry in South Africa. In particular we examine the inter-relationship between silicosis, which is compensatable, tuberculosis, for which limited compensation is made, and HIV, which is not compensatable, in order to suggest ways to manage these diseases.

SETTING

Goldmines in South Africa.

RESULTS

While the South African mining industry has excellent hospital facilities offering a high standard of care, the incidence of tuberculosis is increasing rapidly, silicosis is common, and although no data have been published on the prevalence of HIV it is probably in the region of 20-30%. The impact of HIV is likely to be particularly severe among this group of workers, especially given the interactions between HIV and tuberculosis and tuberculosis and silicosis, and the likely impact of silicosis on the progression of HIV.

CONCLUSIONS

Historically the distinction between work-related and non-work-related diseases has been of importance in the mining industry because of the need to provide compensation for the former class of diseases. In order to promote the overall health of workers this distinction is problematical because of the way in which the various diseases interact and because successful health promotion plans should locate diseases within the broader social context in which mineworkers live and work. In order to address the health of workers there is a need to set up appropriate health surveillance systems for the most important diseases, to shift the emphasis from hospital- and clinic-based biomedical interventions to preventive approaches based on sound epidemiological and social studies, and to ensure that health is dealt with jointly by mine management, medical services and the trade unions with the active involvement of the workers.