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New Clinic Report Calls for Reform of South Africa’s Compensation System for Mine Workers Suffering from Lung Disease

Mine workers in southern Africa have some of the highest rates of occupational lung disease in the world. These diseases, including silicosis and tuberculosis, acquired in the gold mines of South Africa have, over many decades, left hundreds of thousands of men disabled, in penury, or dead. Under South African law, these men and their families are entitled to financial compensation, but only a small proportion of them ever receive it. When they do, it is often insufficient for their needs.

A report released on January 13 by the Global Health Justice Partnership (GHJP), a joint initiative of Yale Law School and Yale School of Public Health, explores solutions for this longstanding injustice. The 69-page report, Fulfilling Broken Promises: Reforming the Century-Old Compensation System for Occupational Lung Disease in the South African Mining Sector, analyzes the failures of the South African compensation system for mine workers with occupational lung disease. It then critically examines how other countries around the globe have addressed their obligations to compensate workers, and specifically miners, for occupational diseases, seeking lessons that might help policymakers and stakeholders reform South Africa’s system. “South Africa’s broken compensation system is harming the mine workers and families whom it is actually supposed to protect,” student Ryan Boyko ’18 Ph.D. says. “This tragic irony demands immediate action, and it is our hope that, in providing comparative perspectives, informed suggestions, and directed research questions, this report will be a valuable tool that can spur and inform such action.”

The report relies on an analysis of both published and grey literature, supported by interviews with dozens of experts in occupational health and mining in South Africa, mine workers and government officials in southern Africa, and experts in human rights, history, economics, public health, and medicine from around the world.

The major problems addressed by the report include:

• The separate and unequal treatment of mine workers with occupational lung disease under industry-specific compensation law, in comparison to workers outside of the mining sector;
• The gross underfunding of the compensation system in South Africa for mine workers, which, by conservative estimates, is more than 600 million rand (U.S. $67 million) below the level required to cover current liabilities;
• Difficulties in diagnosis for mine workers because of inadequate access to medical personnel and facilities;
• Challenges in the process of filing claims including a lack of employment documentation, distance from the centralized authority that must certify diagnosis and approve compensation, and a backlog of cases presented to that authority, which can lead to delays of four or more years;
• The amount and structure of compensation awards, which, when made, are low and only available in lump sums. There is also only one chance for receiving increased benefits for a disease’s progression, and levels do not accurately reflect degrees of impairment;

The report finds that giving effect to claimants’ right to compensation requires effort on several fronts and the involvement of many actors, including the South African and regional governments, mining companies, labor unions, medical professionals, and human rights advocates.

“Based on our review of policies and experiences in other countries (the United States, Germany, Canada, China, Australia, India, the United Kingdom, Indonesia, Ghana), we find that reform of South Africa’s compensation law and its full and appropriate application should be the principal avenues for change,” says Rose Carmen Goldberg ’15 J.D. “In the short term, some obstacles could be overcome or mitigated by administrative efforts, such as forming a network of workers’ advocates who can assist claimants with the application process. In the longer term, improving compensation funding mechanisms and raising benefit levels will likely require multi-stage legislative reform.”

“A better compensation system can serve as a key component in the broader project of providing health justice to some of South Africa’s most vulnerable workers and their families,” Seyward Darby ’13 M.A. adds. “Our report shows that it is possible to build and maintain just compensation systems in a wide variety of circumstances across the globe. South Africa is no exception.”

The report was written by GHJP students Ryan Boyko ’18, Ph.D. Epidemiology of Microbial Diseases at YSPH; Seyward Darby ’13, M.A. Jackson Institute for Global Affairs at Yale; Rose Carmen Goldberg ’15 J.D. YLS; and Zorka Milin ’13, M.A. Jackson Institute for Global Affairs at Yale. The GHJP trains the next generation of scholars and practitioners to tackle the complex interdisciplinary challenges of global health. The report was made possible by support from the Oscar M. Ruebhausen Fund at YLS, the Gruber Foundation at Yale, and the Open Society Initiative for Southern Africa.