South Africa faces an epidemic of asbestos contamination of the environment. Thousands of people across the nation currently suffer from such ARDs as asbestosis, mesothelioma and lung cancer. Hundreds die each year in what is arguably South Africa's single largest environmental health catastrophe. In areas where asbestos was mined for decades, the disease burden is staggering. In some areas, over 30% of the population is sick from a mineral dust that is highly persistent and sometimes not even visible.
Although all the asbestos mines and mills in South Africa are now effectively closed, their legacy lives on. Because of the long latency periods for ARDs, public health researchers expect to see the effects of occupational mining exposure for at least the next thirty to forty years. Just as important, environmental exposure continues. However, this is not a danger arising from the natural environment, but from industrial contamination. Despite efforts by the government, no more than half of the nation's former mines are adequately rehabilitated. Fibres can travel up to 100km in the wind, and most mines are well within 20km of settlements. In many of these villages, asbestos continues to contaminate houses, streets, gardens, schools and playgrounds. Yet with limited resources for cleanup, health education, surveillance and treatment, the burden of ARDs continues.
This report presents the results of eight weeks of research in South Africa and several months of study in the United States, examining ARDs and the consequences of disease for health care, the legal system, and public policy. Invited by the IHRG to revisit the Asbestos Summit of 1998, eleven students from Brown University, the University of Fianarantsoa, Madagascar, New York University School of Law, Peninsula Technikon, Rice University, and Yale University investigated the impact of asbestos and the progress made since the 1998 Summit. We interviewed hundreds of individuals, including government officials, residents of contaminated rural villages, trade unionists, researchers, health care providers, and local activists in order to assess the burden of ARDs in areas in the Northern Cape and North-West provinces of South Africa.
Our research in Cape Town, Johannesburg, Kimberley, Kuruman and the surrounding villages, Pretoria, and Prieska focused on the issues of rehabilitation, health care, compensation, education, surveillance, the legal system and alternatives to asbestos. Overall, we found a deep commitment on the part of many involved-government officials, trade unionists, and people living in affected areas -to address the asbestos problem in South Africa. We uncovered a deep desire to improve the lives of those suffering from or affected by ARDs.
The South African government has been instrumental in putting ARDs on the national agenda. The Portfolio Committee on Environmental Affairs and Tourism organised the all-stakeholder Parliamentary Asbestos Summit of 1998 that delineated the many dimensions of the asbestos problem in South Africa. The national government has also made impressive strides in rehabilitating abandoned asbestos mines and dumps and has lent substantial support to the Cape Plc. asbestos case in the UK. The Department of Health (DoH) has established ex-miners clinics and Occupational Health Units in most provinces, has instituted a nurses' training programme in occupational health at both the University and Technikon level, and has initiated the computerisation of compensation files and certification of claims. The DoL is finalising the Amended Asbestos Regulations. Furthermore, the recent Commission of Inquiry into Comprehensive Social Security initiated by the Department of Social Development is examining whether the compensation system meets the basic needs of its clients. The trade unions have played a crucial role in campaigning for health services and surveillance, awareness of the dangers of asbestos, prevention of exposure, and the needs of retrenched workers. Local citizens organisations have also been involved in crucial ways. Advocacy groups such as Concerned People Against Asbestos (CPAA) in Prieska and the Ncweng Asbestos Committee near Kuruman, have mobilised to educate their communities about asbestos and advocate for their needs.
However, there still exist a number of structural barriers to meeting the most basic needs of those affected by ARDs. We have divided the major barriers we identified into the following categories: economic, institutional/political, and socio-cultural.
Economic Barriers:
- Cost of and access to transportation to and from clinics for those affected by ARDs
- Cost of treatment for people suffering from ARDs
- Cost of finding and funding substitutions for asbestos in industry without retrenchment
- Cost of sustainable development projects, such as those ensuring gainful employment and skills development, in asbestos-contaminated regions
- Cost of rehabilitating environmental contamination
- Absence of companies responsible for human exposure and industrial contamination of the environment
Institutional/Political Barriers:
- Non-compliance with health and safety measures on the part of industry
- Historically inadequate training of health service providers to adequately diagnose and manage ARDs
- Lack of infrastructure and financial resources for occupational health and safety training of workers, specifically with regards to health problems and compensation related to asbestos exposure
- Lack of structural and financial resources to train workers and health professionals about the compensation system
- Difficulty in procurement of the labour histories and work records necessary for ex-miners to claim compensation
- Lack of access to services for non-occupationally ill people within the current compensation system· Inefficiency of the compensation system in reaching all those eligible for and in need of its resources
- Fragmentation in laws and political jurisdictions and between governmental agencies
- Lack of communication between government and affected populations
- Lack of resources for participatory research on ARDs
- Inadequate enforcement of current regulations
Socio-cultural Barriers:
- Unsatisfactory treatment and care of people living with ARDs by health care professionals
- Fear and distrust of government among citizens due to the legacy of neglect by the former government
- Language barriers between ARDs sufferers and health care providers and compensation officials
- Suspicion, among citizens, of South African medical professionals due to misinformation about the health care system and a history of inadequate health services under the former regime
Recommendations
Based upon our research, primarily the testimony of people living with ARDs, we make the following recommendations. We strongly believe that involving union and community structures during all stages of policy development and implementation is critical to the success of these recommendations.
Rehabilitation
- Increase efforts to fully implement the government's progressive policies to involve people in affected villages in all stages of the rehabilitation process. Local people should continue to voice their concerns and requests regarding issues of asbestos pollution. To this end, the establishment of strong community organisations concerned with asbestos should be encouraged. At the same time, all parties need to recognise that while rehabilitation jobs can be a valuable source of income in the short-term, they are not likely to be a source of sustainable development or job creation in affected areas.
- Address secondary asbestos pollution in villages, waterways and on roads. Action must be well co-ordinated, transparent and informed by local concerns. Any delegation of responsibility must be coupled by a greater provision of funds from Parliament to address the issue.
- Evaluate critically the methodology currently used to rehabilitate dumps. Areas to investigate include the strength of health and safety measures, the independence and thoroughness of post-rehabilitation monitoring and the permanence of the method's outcome.
Health
- Disseminate information about ARDs to local people and health service providers. People in the Kuruman area should be informed about the nature of diseases, as well as the services available for people suffering from ARDs. This will include publicising information such as the location of recognised Benefit Medical Examination (BME) centres. All BME centres should have full recognition agreement with and training by the MBOD to reduce problems of fraud and multiple submissions.
- Institute a programme to ensure systematic training for doctors and nurses regarding diagnosis and treatment of ARDs.
- Patients should be reimbursed for travel costs to clinics for BMEs. Public hospitals and clinics need greater funding to procure necessary equipment and to improve the treatment and diagnostic services available for ARDs.
- Co-ordinate the compensation and health care systems. Currently, the systems are fragmented and people often apply for compensation without receiving a full medical examination. As a result, many individuals experience unnecessary delays in diagnosis and treatment.
- Establish the prevalence of ARDs and related diseases (including cancers and asbestosis) in historically undocumented populations, people environmentally exposed from industrial contamination, and people occupationally exposed to asbestos. These studies should draw on the co-operative resources of non-governmental organisations (NGOs), national research units, universities, trade unions, local government, and affected communities to inform policies for the allocation of resources in relation to health care provision, education, and compensation.
- Co-ordinate existing and planned health education structures to encourage comprehensive reporting of ARDs through Surveillance of Occupational Respiratory Diseases in South Africa (SORDSA) and the Medical Bureau of Occupational Disease (MBOD) compensation structures, especially for required populations such as ex-miners and for required diseases such as mesothelioma and lung cancer.
Compensation
- In the long-term, create a new legal framework for compensation as part of an integrated strategy to relieve and develop communities devastated by the legacy of asbestos mining.
- In the short-term, engage existing community structures in attempts to optimise benefits under the current system.
- Review the criteria used by the Certification Committee of the MBOD and extend the statute of limitations for filing an appeal of a certification.
- Extend the statute of limitations for compensation claims by family members after the death of a mineworker.
- Simplify the compensation application process, and create a system of oral evidence for labour histories.
- Decentralise the administration of the compensation system and investigate fraud and corruption.
- Draft a single, unified body of legislation to ensure that all people suffering from ARDs have access to diagnostic services and medical care and that they receive compensation.
- Compensate those with ARDs from exposure due to industrial contamination as an occupational disease, basing the amount of compensation on the severity of the illness and the degree of pain and suffering, rather than on wages.
- Establish a trust fund with contributions from industry to compensate affected communities as a whole, and to support development efforts. Identify and support valid and honest community organisations to facilitate the application process for compensation.
- Since it is known that mesothelioma is caused by asbestos, consider compensating every person suffering from mesothelioma.
Education
- Improve the co-ordination and availability of education programmes aimed at people in contaminated areas.
- Raise awareness among residents of affected villages and workers regarding their rights in relation to compensation and a healthy environment. This can be done through the health promotion departments in the DoH. Popular media, such as community radio in local languages, can also play an important role.
- Introduce in the school curriculum awareness programmes dealing with preventive environmental protection as well as occupational health and safety.
- Continue to support governmentally funded community groups, such as CPAA, Progressive Primary Health Care Network (PPHCN), and the Ncweng Asbestos Committee, who take responsibility for disseminating information and advocating for local needs.
- Revisit and continue to support recommendations set forth in the 1998 Asbestos Summit.
Alternatives
- Ban the manufacture and importation of chrysotile-containing products.
- Maintain on-site medical surveillance programmes after the transition to substitutes in recognition of the scientific uncertainty regarding the health effects of these materials. Regulations should remain current with international trends regarding the safety of these substitutes.
- Further integrate occupational health and safety regulation and enforcement in order to maximise efficiency and eliminate gaps. More resources should be allocated to training novice inspectors.
In conclusion, while there are many important new programmes and policies that have been implemented over the last seven years to improve the lives of those affected by ARDs, more must be done. The above recommendations are intended to build on already existing programmes and policies to further reduce the asbestos problem, particularly in the Northern Cape and North-West provinces.