Employmentweb_low

eMployMent relations and health inequalities: pathways and MechanisMs
generated to deal with social complexity in public health we must
be content with specific pathways and mechanisms that explain
parts of models, and with pieces of evidence that are compatible
with the main features of the model.
Case study 62. The intertwined epidemic of silicosis, tuberculosis and HIV in Southern African gold miners - Joan
benach, Montse vergara duarte and yogan pillay
since the 1880s, south africa has been the source of a large proportion of the world’s gold supply. in 1970, south africa
produced about 68 per cent of the world’s production, but since then the country’s gold production has dropped steadily.
although south africa still is one of the world’s largest gold producers, since 2007, the most important gold producing country
has been china.
in south africa the mining industry has employed hundreds of thousands of miners, the majority being black workers from
both south africa and its neighbouring states, with a white minority occupying supervisory and management positions. a vast
number of migrant workers from inside the country or neighbouring states entered the gold mining industry (about 400,000 in
the 70s and 80s, and close to 130,000 in 2008).
gold mining is labour-intensive and workers suffer from hazardous and stressful working conditions that have been
responsible for high levels of disease and mortality. For example, between 1902 and 1930, a conservative analysis estimates
that around 108,000 black miners died of disease and injury in south african mines (Marks, 2006). Mine workers have long been
associated with an exceptionally high prevalence of various lung diseases such as silicosis resulting from prolonged exposure
to silica dust in mine shafts. studies have found a high prevalence in different areas of the country (between 22% and 37%)
among former miners (rees, 2005). during the 19th century, the arrival of large numbers of europeans suffering from
tuberculosis combined with the social changes associated with the discovery of minerals, especially the need to recruit migrant
labour on a large scale, provided ideal conditions for the spread and increase of tuberculosis. the crowded and unsanitary living
conditions combined with the stressful working conditions led not only to very high rates of silicosis and tuberculosis but also
to pneumonia and other diseases. the migration labour system, which originated in the mining industry and was reinforced by
apartheid-era laws, meant that workers from rural areas would spend many months away from their families and required
them to return to their homes between contracts, when they became ill or when they were no longer able to find work. this
process not only increased the vulnerability of miners but also resulted in the distribution of diseases in the rural areas being
related to the extent to which the population had been involved in migrant labour.
this situation was worsened dramatically in the 1990s by the hiv-aids epidemic, as south africa came to have one of the
most severe epidemics in the world (approximately 5.7 million people living with hiv in 2007, almost 1,000 aids deaths every
day, and about one out of five adults living with hiv/aids) (Join united nations programme on hiv/aids, 2008). Migration is
associated with a breakdown of family structure and separated families, and contributes to the spread of hiv through an
increase in the prevalence of high-risk sexual behaviours, including multiple concurrent partners (coffee, lurie, & garnett,
2007). it is estimated that the prevalence of hiv/aids in mineworkers is between 20 and 30 per cent (stevens, apostolellis,
napier, scott, & gresak, 2006).
the combined effect of silicosis, tuberculosis and hiv infection in gold miners constitutes a striking example of the
synergistic effect of risks and health problems exacerbating each other, which has created multiple and complex public health
epidemics. silicosis is a potent risk factor for tuberculosis, and even exposure to silica (without silicosis) predisposes individuals
to tuberculosis (rees & Murray, 2007). high rates of hiv transmission and confined, humid, poorly ventilated living conditions
increase the risk of tuberculosis. Migration labour practices also damage the health of workers, increasing their risk of being
hiv positive and contributing to the intertwined epidemic of silicosis, tuberculosis, and hiv/aids.
in the past few decades in particular, the many union strikes protesting against unsafe working conditions in mines across
the country (including mines devoted to the production of gold, platinum, and coal) indicate that there is an urgent need for
action to improve the situation of mine workers. interventions should include increasing awareness and education on health
conditions such as silicosis, tuberculosis and hiv/aids, particularly among prospective, current and former miners. this
should include information on the rights of miners, compensation policies and what to do if legal rights are not met. there is
also a need to increase access for mine workers to social and health services. given that most mine workers are migrants,
such rights should be extended to all migrant workers regardless of whether they are in the formal or informal sector and
regardless of their documentation status. the latter aspect is particularly relevant, as the number of economic refugees from
neighbouring Zimbabwe increases. a third type of action includes the effort to address prevention and treatment of tuberculosis
and hiv in migrant miners, efforts that must not overlook the various socio-economic issues that contribute to the cross-border
spreading of these epidemics (aids and rights alliance for southern africa, 2008).
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