Mine Health and Safety Act, 1996 (Act No. 29 of 1996)

Notices, Guidance Notes, Compilation Guidelines

Guidance Note for the Prevention and Management of Non-Communicable Diseases and Mental Health Disorders in the South African Mining Industry

Part B: Aspect to be Addressed in the Guidance Note

1. Risk assessment and review
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1.1 The NSP for the prevention and management of NCDs aligns itself to the global approach of targeting the five major groups of NCDs+ (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes and mental health, including neurological conditions) which have the highest morbidity and mortality rates of the NCDs+. It also aligns with the five shared behavioural risk factors (tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol and air pollution). However, because it is recognised that all NCD+ conditions are of utmost public health importance, an integrated people-centred system approach is used to ensure it receive policy attention and consideration.

 

1.2 This guidance note supports the same global approach in identifying, preventing and managing NCDs and mental health disorders. In addition to focusing on the five main groups of NCDs+ and the five shared behavioural risk factors, the heightened attention will be given to NCDs+ and the associated risk factors which are prevalent in the South African mining industry. Environmental factors in the South African mining industry should also be given attention during risk management. See Annexure A for some examples of NCD and mental health disorders risk factors.

 

NOTE 1:

A risk assessment questionnaire to assist the employer in identifying NCDs and mental health disorders risk factors and vulnerable employees is attached as Annexure 2.

 

NOTE 2:

A self- assessment questionnaire to assist the employee in identifying NCDs and mental health disorders risk factors is attached as Annexure 3.

 

1.3 In terms of Section 11 of the MHSA, the employer must assess and respond to risk. This is to be conducted through a thorough risk assessment which should as a minimum include the following:

 

1.3.1 Quantifying the burden of NCDs and mental health disorders at a mine.
1.3.1.1This can be done through accessing employees’ medical records at the mine in accordance with the ethics of medical practice.

 

1.3.2Identifying vulnerable or high risk employees.
1.3.2.1While NCDs are often associated with older age groups, evidence shows that 17 million NCD deaths occur before the age of 70 years.
1.3.2.2Persons across all age groups are vulnerable to the risk factors contributing to NCDs, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke, the harmful use of alcohol or air pollution. Poor working environments associated with a negative workplace culture, discrimination and inequality, excessive workloads, workplace violence, low job control and job insecurity have been found to pose a risk to mental health.
1.3.2.3In essence, all employees in the South African mining industry are vulnerable to the risk factors contributing to NCDs and mental health disorders, however others may be at a higher risk and for the purpose of this guidance note, such employees are referred to as high-risk employees. These include employees who:
1.3.2.3.1Have a genetic predisposition to NCDs and mental health disorders because of family history.
1.3.2.3.2 Employees who are immunocompromised.
1.3.2.3.3 Employees with chronic occupational respiratory diseases.
1.3.2.3.4 Employees with multiple chronic diseases.
1.3.2.3.5 Employees who have been affected by mine accidents (The Mine Health and Safety Council research project SIM 050803 identified that the main determinant of post-traumatic stress disorder in the mines was a work-related factor which was the advent of a traumatic mines accident – most of these employees were underground workers).

 

NOTE 3:

The Mine Health and Safety Council website provides more information on the research project SIM 050803.

 

1.3.2.3.6Employees who are dependent on alcohol and other harmful substances as coping mechanisms (the Mine Health and Safety Council research project SIM 020103 discovered that some employees rely on alcohol and cannabis for reasons such as: coping with mental stress linked to production target pressure, isolation from families and partners while staying in single sex hostels for prolonged periods and nightshift employees keeping entertained during the day when they struggle to sleep).

 

NOTE 4:

The Mine Health and Safety Council website provides more information on the research project SIM 020103.

 

1.3.2.4High risk employees can be identified through:
1.3.2.4.1A medical screening questionnaire which are self-administered or administered by a health practitioner during wellness days.
1.3.2.4.2A mental health screening tool which is self-administered or administered by a health practitioner during wellness days (see Annexure C for the NCDs and mental health screening tool).
1.3.2.4.3Medical surveillance.
1.3.2.4.4Self-reporting or voluntary disclosure.
1.3.2.5The risk assessment must have clearly defined roles and responsibilities with competent people undertaking the process.

 

1.3.3 Identifying risk factors associated with NCDs and mental health disorders.
1.3.3.1In identifying risk factors associated with NCDs and mental health disorders, the following approach can be used:
1.3.3.1.1Health screening questionnaires.
1.3.3.1.2 Medical surveillance.
1.3.3.1.3 Mental health screening tools.
1.3.3.1.4 Mine environmental control practices.
1.3.3.2Where screening and testing is conducted, it must be done by competent persons.
1.3.3.3Once all the relevant data has been collected and analysed, based on the outcome, the mine may develop and implement a programme for the prevention and management of NCDs and mental health disorders.
1.3.3.4Below are the core NCD risk factors that should be considered as a minimum when undertaking risk assessment. In addition, environmental factors such as exposure to airborne pollutants should be considered:
1.3.3.4.1 Modifiable risk factors
(a) Substance and drug abuse.
(b) Physical inactivity.
(c) Unhealthy diet e.g. low fruit and vegetable consumption, diet high in salt, etc. This includes assessing the nature of food sold to employees at the mines’ canteens, drinks sold at vending machines, food served at mine compounds or residence and food prepared for mine events.
(d) Negative appraisals of life events.
(e) Psychosocial factors or issues (e.g. occupational stress, social interaction, cultural diversity, sleep quality, etc.)
1.3.3.4.2 Metabolic risk factors
(a) Metabolic risk factors contribute to four key metabolic changes that increase the risk of NCDs:
i. Raised blood pressure.
ii. Overweight and obesity.
iii. Hyperglycaemia (high blood glucose levels).
iv. Hyperlipidaemia (high levels of fat in the blood).
1.3.3.4.3 Environmental risk factors
(a) These include excessive exposure to airborne pollutants and ionizing radiation in the workplace. Environmental factors which may lead to mine accidents should also be considered. In assessing environmental risk factors, the following should be considered:
i. Nature of the work and the key workplace operations and activities that pose potential risks of NCDs and mental health disorders.
ii. Occupations and number of employees exposed to environmental risk factors.
iii. Essential occupations or critical skills of the mine that might be impacted by NCDs and mental health disorders.
iv. Control measures in place i.e. engineering, administrative, personal protective equipment, etc.

 

1.3.4 Early identification and management of risk factors associated with NCDs and mental health disorders as part of primordial prevention.
1.3.4.1Wellness campaigns.
1.3.4.2Health questionnaires.
1.3.4.3Self-reporting or voluntary disclosure.
1.3.4.4Medical surveillance.
1.3.4.5Fitness assessment.

 

1.3.5 Detection of NCDs and mental health disorders to promote other levels of prevention and management.
1.3.5.1Referral and/or linkage of employees to relevant health care service providers for further management. This may include but is not limited to:
1.3.5.1.1Psychiatric institutions.
1.3.5.1.2 Specialists.
1.3.5.1.3 Alternative medicine.
1.3.5.1.4 Provision of employee assistance programmes through an in-house or outsourced service model.