Health surveillance for the mining sector – opportunities for better management and oversight

Introduction

There is a considerable volume of good published material about the need for, and operation of, health surveillance schemes for Western Australian (see for example the Government of Western Australia Department of Mines, Industry Regulation and Safety website; and Safe Work Australia website).

In the Western Australian (WA) mining sector, current guidance is provided in the risk-based health surveillance and biological monitoring guideline (Department of Consumer and Employment Protection, 2008) which supports a suite of requirements as per Section 75 of the Mines Safety and Inspection Act (1994) and Part 3, Division 4 of the Mines Safety and Inspection Regulations (MSIR; 1995).

Despite the legislative requirement, problems potentially arise if such important programs are not overseen regularly by those in authority, allowing health surveillance programs to fall into neglect with ensuing unwanted health effects affecting mine workers.

Sodhi-Berry et al (2017) have identified that WA mineworkers are still succumbing to worksite induced illnesses, such as lung cancer and susceptibility to other cancers, and cardiac and respiratory illnesses. A review of the health surveillance regulations in the MSIR in 2012 removed the industry-wide requirement to report data to the regulatory authority, and placed the onus on principal employers to maintain their own health surveillance systems for workers engaged in ‘specified occupational exposure work’. The revision removed the opportunity for early health-based intervention by the regulatory authority as industry-wide data is no longer available.

Health surveillance for workers in Western Australia

Health surveillance of non-mine workers who are engaged in ‘specified occupational exposure work’ in WA is governed by provisions in the Occupational Safety and Health Act 1984 and Regulations (1996). These requirements have similarities to those applicable to mine workers, but have some important differences which bolster the health surveillance system (Government of WA, DMIRS: Health Surveillance):

• It is the employers’ responsibility to provide health surveillance, and to do so at no cost to their employees.
• The purpose of health surveillance is to identify possible excessive exposure to hazardous substances such as diesel engine exhaust fumes, silica or any other carcinogenic dusts in the workplace atmosphere. Hopefully, the surveillance system will prevent illnesses occurring. It will also provide feedback to the employers so that improvements to safe work practices can occur.
• Health surveillance must be supervised by an Appointed Medical Practitioner (AMP), who is registered with the regulatory authority and is appointed by the employer in consultation with the employee.
• The AMP must be appropriately experienced, and understand the toxicology of hazardous substances and have an awareness of current medical literature.
• The AMP will provide a recommendation on the required frequency of health surveillance in accordance with the Guide for Medical Practitioners provided by the DMIRS. For example, in regard to a worker’s exposure to silica dust, a baseline health surveillance examination is recommended prior to commencement of work, followed by annual health surveillance with two-yearly imaging tests, unless otherwise recommended by the AMP.

Arguably, the health surveillance of mineworkers would benefit from the adoption of the provisions applicable to non-mineworkers, by extending the requirements of the OSH legislation into the mine safety legislative framework.

Statements from the USA’s Centre for Disease Control’s ‘National Institute for Occupational Safety and Health’

A recent Centre for Disease Control/National Institute for Occupational Safety and Health (CDC/NIOSH) pamphlet (2020) provides more detail on the risks faced by miners and the types of pneumoconiosis that affect mine workers.

Queensland Audit Office’s Select Committee report on ‘Addressing mine dust lung disease’ (Report 9. 2019 – 20).

The objective of this audit was to assess the uptake of the recommendations of the following independent reviews aimed at reducing the risk and occurrence of mine-dust lung disease:

• Review of Respiratory Component of the Coal Workers’ Pneumoconiosis [CWP] in Queensland by the Monash Centre for Occupational and Environmental Health, July 2016.
• The ‘Black Lung – White Lies’ reports 2 and 4 of the Select Committee into Coal Workers’ Pneumoconiosis (CWP).

It is of particular relevance to highlight the Select Committee’s findings that:

• coal mine operators did not have clear or consistent guidance from inspectors about actions required to demonstrate dust monitoring compliance
• there was a culture of complacency within the industry regarding the serious risk posed by respirable dust exposure.
• there was an absence of any regulated oversight of respirable dust monitoring or mandatory reporting of dust exceedances.
• the regulator, i.e. Department of Natural Resources, Mines and Energy (DNRME), was primarily focussed on mine safety, rather than on miners’ health and the risks posed by exposure to respirable dust.
• the regulator (DNRME) did not have a dedicated occupational physician to oversee the Health Surveillance scheme, as recommended by the Select Committee.

It is also noteworthy that the Select Committee recommended that coal mine workers be encouraged to report safety and health issues to their employer and/or workers’ representative. Indeed, the Commissioner for Mine Safety and Health promoted that ‘it is an offence to cause detriment to another person because they have made a complaint or have raised a mine safety issue.’

Subsequently, a new digital occupational surveillance solution is being implemented to support Resources Safety and Health Queensland in operating its Coal Mine Workers Health Scheme (which was established in 1983). More information can also be found here.

Notwithstanding that improved diagnostic tools that provide better results than chest x-rays are available, the response by the Queensland Government to the CWP crisis has been emphatic.

Multi-factorial nature of the challenge

The issue facing the WA mining industry can be summarised as:

• the contemporary legislative structures for health surveillance of mineworkers does not allow for holistic observation by the regulatory authority, disavowing the opportunity for early intervention if ill-health trends develop; while
• experience from other jurisdictions, and the findings of contemporary research indicate that the health of mine workers is at risk as a result of exposure to multiple contaminants in their workplace.

As pointed out by Stewart (2019), few diseases are unifactorial and pneumoconiosis is a term which defines a range of dust-induced lung diseases including CWP, as well as asbestosis and silicosis. Indeed, it would be highly unusual to have mineworkers exposed to only one type of dust. CWP, for example, is affected to a greater or lesser extent by the presence of silica, whereas hard-rock miners’ silicosis would be adversely compromised by the presence of asbestiform or nickel sulphide mineral dusts or environmental tobacco smoke in the workplace atmosphere.

As stated in a recent article by Entwistle et al (2019), ‘the complex nature of, and exposure to metalliferous mine dusts requires approaches that take this complexity into account if we are to correctly apportion and mitigate the impacts on human health’.

However, as indicated by the Queensland Audit Office report referred to earlier, the increased incidence of any dust-induced respiratory disease may well be due to inadequate regulatory control and/or failure of the operator’s risk assessment and/or supervisory regime.

The only way to circumvent such human failings is to ensure the effectiveness of the regulatory system, whereby the mines’ inspectors discharge their duties of checking the efficacy of the employers’ risk management systems and adequacy of dust monitoring systems, etc.

Radiological warning regarding efficacy of X-rays

The Royal College of Radiologists (October, 2019) stated that ‘Chest X-rays on workers exposed to dusts from artificial stone failed to reliably detect early signs of lung disease in more than 40 per cent of workers’. It therefore strongly recommended the use of ‘the far superior’ low dose CT scan for the early detection of dust diseases such as silicosis.

Legislative issues

Each jurisdiction in Australia has its own legislative requirements for its mining sector. For example, both Queensland and New South Wales (NSW) currently operate health assessment and surveillance systems based on:

• pre-placement medical assessments including X-rays prior to employees commencing work.
• periodic health surveillance carried out by an approved and registered medical practitioner every three years in NSW and at most five years in Queensland.
• in NSW all approved medical practitioners must complete a one-day ‘Coal Industry Medical Induction Program’ and an approved course in ‘Spirometry interpretation’.

In WA, the health surveillance system as defined in Sections 3.24 – 3.40 of WA’s Mines Safety and Inspection Regulations 1995 was revised in January 2012, following two reports indicating its apparent ineffectiveness. The role of the regulatory authority was diminished, with the lion’s share of responsibility for continuation of mineworker health surveillance resting with the principal employer.

However, an updated health assessment and surveillance system needs to be urgently re-established in WA, and following is a draft proposal for such a system:

• the WA mining industry legislation should adopt the Appointed Medical Practitioner system as provided for in the OSH Act and Regulations
• a pre-employment medical health assessment should be carried out including recording occupational history, radiographic imaging of the chest using low dose CT scan and assessment of lung function using forced expiry volume in one second (FEV1) and forced vital capacity (FVC) performed by an accredited lung function technician. This will provide an excellent baseline for future health assessments
• a somewhat similar health assessment should be carried out when changing employers, with appropriate reference being made to past assessments
• every underground miner should undergo periodic health assessments, carried out by an appointed medical practitioner (AMP) every three to five years
• health assessment information and lung images must be stored centrally and be assessed independently by qualified medical and health science personnel
• Appointed Medical Practitioners responsible for such health assessment procedures should be required to undergo an ‘Industry Induction Program’ prior to registration, which includes a well-organised visit to an operational hard-rock underground mine
• all health assessment records should be collated and analysed independently in order to allow interpretation of lung damage in its earliest stages, before it may be clinically apparent
• it is also suggested that consideration be given to establishing a sub-committee of the Mining Industry Advisory Committee (MIAC) composed of independent mining professionals, health scientists and statisticians to oversee the operation of the scheme.

Western Australia’s progress in implementing the newly proposed Work Health and Safety Bill 2019 (WHS Bill)

The new WHS Bill was passed by the WA Legislative Assembly on 20 February 2020 and subsequently introduced to the Legislative Council, which referred it to a Standing Committee for further consideration (Ellery and Roach, 2020). This Bill will replace the existing Occupational Safety and Health Act 1984, and other legislation including the Mines Safety and Inspection Act 1994, and it is generally anticipated that this Bill, with some modifications will be passed by the Parliament before the end of the year and come into full effect in 2021.

As expected this Bill will require ‘Persons Conducting a Business or Undertaking (PCBUs)’ to ensure, as far as is reasonably practicable, the health and safety of its workers, and those other workers operating under its direction (eg contractors).

The Bill also defines due diligence as a personal obligation on ‘officers’, who may be a company director or secretary, and any person affecting the financial aspects or decisions affecting any part of the business of the PCBU. It also requires the PCBU to consult, as far as is practicable, with workers who are likely to be affected by a health and safety issue, as well as including industrial manslaughter provisions.

The Bill also states the PCBUs must ensure the health and safety of its workers, as far as is reasonably practicable, including psychological risks to health such as stress, fatigue and bullying.

Hopefully the Bill will also include a clause requiring PCBUs engaged in mining activity to have in place a health assessment and surveillance system along the lines referred to earlier.

Conclusion

Regardless of the ever-encroaching digital era with its automation of industrial activities and use of data analytics and robotics, the most important assets of any corporation or company are their employees. That being the case, it follows that there is nothing more important than providing employees with a safe and healthy place of work, as included in the WHS Bill currently before the WA Parliament.

The lessons from the Queensland CWP experience are salient for the WA mining industry. The Select Committee observed ‘in the field of occupational health and safety, there is often a distinction between efforts to address safety issues which involve more immediate risks of physical danger, and health issues, which typically involve longer term or chronic risks and effects’ (page 14); however, ‘… the results are no different – deaths, illness and enormous changes in working and family lives. Miners and their families are never the same again’ (page 1).

The mining industry, being one of the most hazardous industries, places considerable responsibility on PCBUs and their officers to discharge their duty of care for all employees. Learning from the Queensland experience, an important component of the duties is to establish, maintain and periodically review a health assessment and surveillance scheme within the matrix of organisational management at every mine-site.

Hopefully, this article progresses the ongoing discussion on how such systems can be designed, implemented and managed.

Acknowledgement.

The authors are extremely grateful for the assistance of the DMIRS, Mines Safety Directorate in proof reading this article

References.

• Department of Consumer Employment Protection, 2008. Risk-based health surveillance and biological monitoring – guideline: Resources Safety, Department of Consumer and Employment Protection, Western Australia. Available from: https://www.dmp.wa.gov.au/Documents/Safety/MSH_G_RiskBasedHealthSurveillanceAndBiologicalMonitoring.pdf
• Government of Western Australia, Mines Safety and Inspection Act 1994.
• Government of Western Australia, Mines Safety and Inspection Regulations 1995.
• Sodhi-Berry N, Reid A, Fritschi L, Musk B, Vermeulen R, de Klerk N and Peters S, 2017. Cancer incidence in the Western Australian mining industry (1996-2013). Cancer Epidemiol. 49:8-18.
• US Centre for Disease Control and Prevention National Institute for Occupational Safety and Health, 2020. ‘What is the health and safety problem?’ [online]. Available from: https://www.cdc.gov/niosh/mining/topics/RespiratoryDiseases.html#:~:text=Miners%20are%20at%20risk%20of,of%20dying%20from%20lung%20cancer
• Queensland Audit Office, “Addressing mine dust lung disease”, Report 9: 2020
• Stewart A G, 2019. ‘Mining is bad for health’. Environmental Geochemistry and Health, Vol. 42.
• Entwistle J, Hursthouse A, Reis A and Stewart A, 2019. ‘Metalliferous Mine Dust: Human Health Impacts and the Potential Determinants of Disease in Mining Communities. Current Pollution Reports 5(3).
• The Royal Australian and New Zealand College of Radiologists. Media Statement, “RANNZCR Unveils Guidelines for Diagnosis and Monitoring of Silicosis”, 11 October 2019
• Ellery N and Roach R, 2020. ‘WA work health and safety reform: where are things at?’, Lexology [online]. Available from: https://www.lexology.com/library/detail.aspx?g=15e4e541-9054-4824-babc-86b2f17259ff
• Government of WA. “Mines Safety and Inspection Regulations 1995, Division 4: Health Surveillance”
• Government of WA. ‘Mines Safety and Inspection Act 1994, Part 7, Specific duties relating to occupational safety and health.”