At the heart of developments in this sector has been influential Dr Sophia Kisting, executive director of the National Institute of Occupational Health, who has decades of knowledge to share, whilst reflecting on some of the latest technological advancements.
Dr Kisting, a UCT medical Alumnus of 1975, was previously a senior researcher in the Centre for Environmental and Occupational Health Research (CEOHR) at UCT before taking up her position as director of the global International Labour Organisation (ILO) Programme on HIV/AIDS and the World of Work based in Geneva until 2012.
In 2003, the Journal of Epidemiology and Community Health (USA) recognised Dr Kisting as one of ten influential women in occupational health and safety internationally. Gregory Simpson caught up with Kisting recently for the inside scoop.
Please tell me about your background in health and safety?
My road to occupational medicine includes experiences of such significance that these impacted my career choices towards the health and safety of people at work. As a medical student I spent several months at a then mission hospital in the Eastern Cape. My main task was to do pleural aspirations (a standard practice at the time) on people on hospitalized for TB. There were many wards filled with people sick with TB. Significantly, the majority were men who previously worked in gold mines as migrant workers. In the evenings there will be singing from some of the wards and some of the songs will be about working life on the mines. This stayed with me.
As a group of young doctors doing our internships in public hospitals in 1976 we were profoundly affected and influenced by the many wounded patients, often in the flower of their youth, we successfully treated and sadly more often lost in that year. Our medical training did not prepare us for those experiences. That too stayed with me and with my colleagues. In the 1990’s I had the opportunity to work for about 5 years in the Soweto Community Health Centres. In the process I learnt a lot about occupational health and especially by examining workers with recurrent crippling episodes of TB. Many lived in hostels scattered around the greater Johannesburg area. These experiences of major work-related diseases were deepened during the many years of working at the “Workers Clinic” where 85% of the referrals were from trade unions and in the many public hospitals in southern Africa in which I served.
I had the unusual opportunity, with several of my colleagues, to examine large numbers of mineworkers and factory workers exposed to asbestos over a period of nearly 8 years. This was with the support of several trade unions, but at the time, in particular the National Union of Mineworkers (NUM). This joint and inclusive medical work contributed to the South African Parliamentary Asbestos Summit with extensive community and worker involvement as well as to the legal settlement with mining companies which resulted in the establishment of the Asbestos Relief Trust. In my working life I had the significant opportunity to experience occupational medicine regionally in several countries in Africa as well as globally in both developed and developing countries. As part of this I coordinated the WHO/ILO Joint Effort on Occupational Health in Africa for some years and worked for more than 6 years for the International Labour Organization (ILO) in Geneva as head of the global Programme on HIV/AIDS and the World of Work. At the ILO the principles of the interdependence as well as independence of governments, workers and employer organizations and the central importance of finding the workplace common ground through social dialogue has re-enforced my belief in the importance of policy coherence for the protection of health and safety. Similarly the central importance of awareness and adherence to international best practice and to the support of international labour standards for universal access to health and safety became very evident.
My workplace experience indicate that there is too little focus on the very large contribution workplaces are making to the heavy burden of disease nationally and globally which impacts unequally on the poor and golden opportunities for prevention and for sustaining workplaces are lost. The most outstanding lessons about the dignity of work, about our common humanity and the importance of being engaged in decent work, I learnt from men and women workers many of whom who had very limited opportunity for education. All these factors strengthened my resolve to help find collective ways to not only diagnose occupational diseases and injuries for compensation purposes but to strengthen preventive practices and to work for greater equity at workplaces.
What are some of the gender related challenges and opportunities in the mining sector?
Our constitutional democracy now makes it possible for women to work underground in mines. This is a big and important step forward. However, interviews with women workers reflect that they face many challenges in the mines especially when working underground. These include problems related to inappropriate personal protective equipment being provided, lack of adequate toilet and ablution facilities, episodes of sexual harassment as well as charges of rape. These problems in part are related to the relatively small number of women underground but also reflect patriarchal societal norms practiced by mine management as well as by fellow workers. In addition, it is the perception of many interviewed that the nature of the migrant labour system, living conditions, the limited living-out allowance and an increase in precarious work on the mines all contribute to an increasing vulnerability to HIV, AIDS and TB.
It is clear that ongoing teaching and training as well as monitoring and evaluation are essential to enable women to benefit from a workplace that is safe, free from harassment and equipped with adequate toilet and ablution facilities. Good collaborative research is done on these challenges and many of these problems are being recognised and addressed in a participatory manner. The Mine Health and Safety Council (MHSC) had a most important and informative conference in 2015 where the findings of excellent research supported by the MHSC were presented on some of the challenges as well as the possible solutions.
On 16 March 2016 with support from government departments, employer groups and trade unions the NIOH launched the Gender@Work Programme. Amongst the uplifting goals of this programme is to ensure adequate consideration is given to gender informed risk assessment and risk management at workplaces. Similarly the importance of implementing the Code of Good Practice for Pregnant and Breastfeeding Women and the Code of Good Practice on the Arrangement of Working Time under the Basic Conditions of Employment Act are being emphasized.
What have been some of the technological developments over the years?
Advances in technology are contributing significantly to the possibility of better health and safety practice at all workplaces. These include developments in engineering devices as well as personal protective equipment and more efficient ways of diagnosing and treating diseases and injuries. There is however a great need to improve OEHS systems and to utilize technology more optimally to improve communication of research findings and best international practice. At the NIOH we have in collaboration with the University of British Columbia, Canada, developed an electronic occupational health and safety information system (OHASIS) which is having a major positive impact on the practice of OEHS in workplaces where it has been implemented. It is our conviction that the use of this system will greatly enhance OEHS practice in both the public and the private sector and will assist with more effective compliance with regards to OEHS legislation.
Is legislation adequate in South Africa to keep-up with some of the new safety measures needed for new chemicals, asbestos and nanotechnology?
The key legislation includes the Mine Health and Safety Act (1996) and the Occupational Diseases in Mines and Works Act (1973). As new technology and processes are deployed in industry, OEHS legislation will often lag behind the latest developments but important principles which are covered in the current legislation are often not adequately implemented or adequately monitored or enforced. There are important national and global developments that will require changes to legislation and it is important to strive for universal global standards for the protection of human health and safety at work. To this end we should continue to pursue, with great vigour, the improvement of occupational exposure limits (oel’s) as well as changes of the compensation act that will provide incentives for the prevention of occupational diseases and help address the major historic and current issues of inequality and a social justice deficit. The NIOH has specialized laboratories and equipment to identify and study asbestos, chemicals, nanoparticles and immunological challenges at work. The research conducted at the NIOH has produced data to help inform regulators. Nationally we need to continue to work towards greater policy coherence in OEHS and we need we build much greater capacity to implement, monitor, evaluate and enforce health and safety measures in all workplaces.
In addition to legislative interventions it will also be a great asset to the health and safety of the nation if we support efforts for greater public awareness of OEHS preventive practice. It would enhance health and safety practice enormously if we start to teach the basic principles in our schools and through public awareness programmes nurture a culture of greater prevention. Several countries have significantly improved their health and safety practice by implementing some of these approaches.
What can miner autopsies on miners tell researchers to avoid future health issues?
Autopsies performed at the NIOH from 1975 are on a database called PATHAUT. The importance of PATHAUT is that it records the findings of lung disease in great detail. A report is produced annually and over time the data have been showing important trends. It can be used to show the importance of interventions in mining practice. It clearly reflects the impact of HIV and the positive effects due to ART. It is showing a continuing upward trend in the prevalence of silicosis amongst former mineworkers indicating that silica dust remains inadequately controlled. Over the years the PATHAUT database has assisted researchers in producing over 100 scientific publications in peer reviewed journals which has helped to inform OEHS teaching and practice in South Africa and other countries.
Where does one draw the fine line between profit and worker safety?
Profits can never be more important than the protection of human life and health. Occupational diseases and injuries are matters of health, but they are also matters of economics. The economic perspective on OEHS is very important and encompasses causes and outcomes. Economic considerations may play a role in workplace accidents and ill-health which affects the economic prospects for individual workers, for enterprises, for our countries, and at the global level. However, it is important to remember that neither the causation nor the human significance of OEHS can be reduced to its economic elements only. The importance to protect human health and well-being at work is an integral part of the movement to achieve economic sustainability. This is also reflected in the SDG’s of which decent work and sustainable economies are integral parts. The identification and measurement of the economic costs of occupational diseases and injuries can motivate the broader public to take these problems more seriously. This is true at all levels, from the enterprise that may not be aware of the toll that worker ill-health and absenteeism takes on its performance to national governments that may not fully realize the impact of OEHS problems on economic growth, on the public health budget and on overall national development. Hence the central importance of conducting more dedicated research to identify the contribution of workplace ill-health to the national burden of disease. Most of the ill-health generated in workplaces can be prevented through the requisite health and safety interventions.
Absenteeism figures in several economic sectors in our country are extremely high and yet the prevention of these is not adequately explored. A good understanding of the link between the way enterprises and markets function and the nature of OEHS problems that arise is crucial for the development of successful public policy. Why is OEHS practice better in some economic sectors or regions than others and why are particular groups of workers at greater risk of workplace ill-health?
What is the likely effect of changes in social insurance coverage, new government legislation or even globalization on OEHS? What is the impact of precarious labour on OEHS, both physical and mental health?
Economic analysis can clearly show that maintaining healthy and safe workplaces where decent work is practiced is complementary to other social goals such as those contained
in the SDG’s. It can also illuminate the negative effects when OEHS is compromised in the quest for profits and workers have to pay the price through ill-health, both physically and mentally because of their inability to work and the consequent unsustainability of workplaces.
Are we better equipped to handle disease break-outs in South Africa than elsewhere on the continent?
South Africa is a central part of the African continent and as such can assist with outbreak control of different diseases. As countries in Africa with many different health challenges we are completely interdependent to ensure good outbreak control responses. The very positive role our country played in the recent tragic Ebola outbreak in West Africa is an example of the need for ongoing collaborative interaction. Tragically, during this Ebola outbreak in West Africa, over 11,000 lives were lost. Over 800 of the people who died were health care professionals working to assist patients.
We need to ensure that OEHS systems are strengthened to help protect health care workers proactively during such outbreaks. The principles of OEHS are integral to infection control responses and the WHO is re-enforcing this through collaborative workshops in countries in Africa. The NIOH as a WHO Collaborating Centre will assist with the coordination of such a workshop on the role of occupational health and safety in outbreak control in June 2016 in Johannesburg.
Tell us about the work done at the National Institute for Occupational Health (NIOH).
The NIOH is a division of the National Health Laboratory Service (NHLS) and is currently administered under the NHLS Act by the NHLS Board and the NHLS CEO Mrs Joyce Mogale. The NIOH is celebrating its 60th anniversary this year and continue to engage in workplace service delivery, in teaching and training and in ground-breaking scientific research. The institute is a WHO OHS Collaborating Centre and has collaborating status with several other institutes around the globe.
The NIOH is part of a Centre of Excellence of the Mine Health and Safety Council (MHSC) and in that process we engage with research identified as necessary in the mining sector.
As part of remembering the good of the past and re-imagining a better future the NIOH is building on the immense strengths of the institute while at the same time giving recognition to the major challenges faced by the world of work and therefore by the institute. We continue to strive to contribute to decent work and to a meaningful and positive impact on the working lives of women and men.
Amongst the most important considerations for this year is our resolve to strengthen the internal “unity of purpose” of the institute while at the same time strengthening the links between the institute and government departments, workers and employers and their organizations in the quest for better occupational and environmental health and safety (OEHS). Similarly, we strive to strengthen networking with all occupational and environmental groups nationally, regionally and internationally.
This is essential to harness the immense potential of the world of work and to utilize it more optimally for prevention of work-related diseases and injuries as well as for working towards greater productivity, more sustainable workplaces and more sustainable employment opportunities. Of significant importance to achieve this is the great and ongoing need to find collective ways to strengthen the OEHS workforce, including amongst others, nurses, occupational therapists, occupational hygienists, ergonomists, psychologists, risk assessors, safety engineers and doctors, who can contribute to a positive OEHS impact at all workplaces in the formal and the informal economies.
The world of work is continually changing both nationally and globally and presents opportunities for the implementation of sustainable preventive practices in OEHS. The intention to establish the National Public Health Institute of South Africa (NAPHISA), the deliberations around the integration of compensation systems to ensure greater equity of pay-outs to workers rendered sick by their work, the potentially significant transformative developments around National Health Insurance (NHI), challenges to our financial and economic systems and the severity of the current cyclical downturn in the mining sector have all created new opportunities to inclusively examine new possibilities for a future occupational and environmental health and safety system (OEHSS) in South Africa.
It is of great significance that the Sustainable Development Goals (SDG’s) adopted by the United Nations in September 2015 as the global development agenda until 2030 included decent work, health, gender equity, youth employment, sustainable economies, and sustainable environments amongst the all-important 17 goals. These goals are a set of universally applicable goals that balance different dimensions of sustainable development mainly the environmental, the social, and the economic.
The SDG’s apply to all countries, are intended to promote human rights, greater equity, peaceful and inclusive societies, create decent and sustainable jobs and addresses the enormous environmental challenges of which climate change constitute a significant part. Within our world of work the SDG’s provide us with a golden opportunity to aspire more specifically and determinedly to reach the goal of decent work and therefore integrate OEHS into our development agenda in a very practical and sustainable manner. Climate change and environmental pollution secondary to workplace activities contribute enormously to the burden of non-communicable diseases in many countries including our own. It has therefore become urgent to consider environmental health in relation to industrial and workplace activity and to develop greater preventative strategies.
In 2015, South Africa ratified the International Covenant on Economic, Social and Cultural Rights (ICESR). While most of the rights in the ICESR are contained within the Constitution of South Africa, the right to work and the right to a decent standard of living is a reaffirmation by government to the concept of decent work.
