E/Professor Odwyn Jones and C/Professor Bill Musk put the case for WA to instigate more rigorous oversight of the health of WA mine workers.
There is a considerable good material available on the need for, and operation of, health surveillance schemes for Western Australian and Australian workplaces. In the WA mining sector, current guidance is provided in the Risk-based health surveillance and biological monitoring, which supports a suite of legislative and regulatory requirements.
However, problems potentially arise if such programs are not overseen regularly, which plunge them into neglect and potentially put mine workers at risk.
Sodhi-Berry et al (2017) have identified that WA mine workers are still succumbing to work-site induced illnesses such as lung cancer and susceptibility to other cancers, and cardiac and respiratory illnesses.
A review of the health surveillance regulations 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.
Health surveillance of non-mineworkers engaged in “specified occupational exposure work” in WA is governed by the Occupational Safety and Health Act, 1984 and Regulations, 1996. These requirements have similarities to those applicable to mineworkers, but have some important differences which bolster the health surveillance system:
- It is the employers’ responsibility to provide health surveillance, and to do so at no cost to their employees. The employer should also appoint a medical practitioner to supervise health surveillance of their employees.
- The purpose of surveillance is to identify possible excessive exposure to hazardous substances such as diesel engine exhaust fumes and/or silica and/or any other carcinogenic dusts in the workplace atmosphere. Hopefully, by so doing, the surveillance system will prevent illnesses occurring and promote improvements to safe work practices.
- Health surveillance must be supervised by an “appointed medical practitioner” (AMP), who is registered with the regulatory authority.
- The AMP must be appropriately experienced and understand the toxicology of hazardous substances.
- 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, a baseline health surveillance examination of a worker exposed to silica dust is recommended before commencement of work, followed by annual health surveillance with two-yearly imaging tests.
Arguably, the health surveillance of mine workers would benefit from similar provisions.
A Queensland Audit Office report in 2019 examined mine dust lung disease to assess the uptake of the recommendations of independent reviews – Black Lung – White Lies – and a review of respiratory components of Queensland coal workers’ pneumoconiosis. The select committee found 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 monitoring or mandatory reporting of dust exceedances.
- The regulator was primarily focused on mine safety, rather than on miners’ health and the risks posed by exposure to respirable dust.
- The regulator did not have a dedicated occupational physician to oversee the health surveillance scheme, as recommended by the select committee.
Subsequently, a new digital occupational surveillance solution is being implemented to support the regulator in operating its coal mine workers health scheme. It is intended to:
- Digitally capture fitness for work health information from employers, workers and clinicians,
- Provide electronic storage of health assessments,
- Provide access to previous records by medical practitioners, employers, coal workers and others,
- Enable data analysis and reporting of health assessment data,
- Provide for clinical data exchange with other health management systems,
- Strengthen the approval of appropriately trained and qualified doctors who can provide health assessments of coal mine workers,
- Use ‘dual read’ chest x-rays for identifying early signs of dust lung disease.
Notwithstanding that improved diagnostic tools, which provide better results than chest x-rays, are available, the response by the Queensland Government to the crisis has been emphatic.
In WA, the contemporary legislative structures for health surveillance of mine workers does not allow for holistic observation by the regulatory authority, disavowing the opportunity for early intervention if ill-health trends develop.
As pointed out by Stewart A.G. et al., (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 mine workers exposed to only one type of dust. CWP, for example, is affected by the presence of silica, whereas hard-rock miners’ silicosis would be adversely compromised by the presence of asbestiform or nickel sulphide mineral dusts and/or environmental tobacco smoke (ETS).
As indicated by the Queensland Audit Office report, 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.
WA legislation
In WA, the health surveillance system 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 health surveillance resting with the principal employer.
However, an updated health assessment and surveillance systems need 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 APM system as provided for in the OSH Act and Regulations.
- A pre-employment medical health assessment 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 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 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.
- AMPs responsible for such health assessments are required to undergo an “industry induction program” prior to registration.
- 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 Mining Industry Advisory Committee (MIAC) composed of independent mining professionals, health scientists and statisticians to oversee the operation of the scheme.
Work Health and Safety Bill 2019 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. This Bill will replace the existing Occupational Safety and Health Act 1984, and other legislation including the Mines Safety and Inspection Act 1994.
Conclusions
Regardless of the ever-encroaching digital era with its automation of industrial activities and use of data analytics and robotics, 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 should be 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”. 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”.
The mining industry, being one of the most hazardous industries, places considerable responsibility on employers 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.
ED: The authors are grateful for the assistance of the DMIRS, Mines Safety Directorate, in proof reading this article.
– References on request