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Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
Occupational health and primary healthcare
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Occupational health and primary healthcare

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Dr Brian Brink, chief medical officer, presents on occupational health and primary heathcare. …

Dr Brian Brink, chief medical officer, presents on occupational health and primary heathcare.

At Anglo American we are committed to effective management of occupational health risks to our people, in order to enhance productivity, and to help maintain our licence to operate and our global reputation.
Promoting a healthy community and a safe and healthy workforce is beneficial for all of us.

You can find out more about Anglo American here:
http://www.angloamerican.com/
http://www.facebook.com/angloamerican
http://www.twitter.com/angloamerican
http://www.youtube.com/angloamerican
http://www.flickr.com/photos/angloamerican
http://www.linkedin.com/company/anglo-american

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  • 1. OCCUPATIONAL HEALTH &PRIMARY HEALTHCAREDr Brian Brink – Chief Medical Officer
  • 2. HEALTHEffective management of occupational health risks protects ourpeople, enhances productivity, and helps maintain our licence tooperate and our global reputation.Promoting a healthy community and a safe and healthyworkforce is beneficial for all of us
  • 3. HEALTH STRATEGY Global HealthHealth Management CommunitiesInformation Systems Families Employee Health and Wellness Including HIV/AIDS and TB Occupational Health Anglo American Occupational Health Way Occupational Hygiene Occupational Medicine Leading indicators Leading and Lagging indicators Benchmarking Standards Guidelines Support Assurance 3
  • 4. OCCUPATIONAL HEALTHZero harm to healthCreating and instilling a company culture thatprotects people from harm and improves their healthand well-beingOperational excellenceRealising exceptional operational value bymanaging health risks and identifying value-creatingopportunities
  • 5. KEY OCCUPATIONAL HEALTH CONCEPTS• Occupational Health is driven by two disciplines – Occupational Hygiene and Occupational Medicine. The two work in tandem through a process of health risk assessment and management.• Occupational Hygiene is a scientific discipline devoted to the anticipation, recognition, evaluation and control of health hazards in the working environment.• Occupational Medicine is a branch of clinical medicine concerned with employee fitness for work; medical surveillance of employees; medical emergency management; and management of return to work (rehabilitation and disability). 5
  • 6. HEALTH RISKHealth Risk arises from exposure to a health hazard at a level which can causeharm either in the short or long term.The level of risk is determined by: – the toxicity (stored energy); – the level of exposure; and – the amount of time over which exposure occurs.Most health hazards require a certain dose (exposure level X time) before theycause a health effect.The dose can be delivered fast in high level exposure or slowly (over manyyears) with low level exposure. In the former there may be acute illness whereasin the latter illness may develop over a long period of time.This is the basis of the occupational exposure limit (OEL). 6
  • 7. OCCUPATIONAL EXPOSURE LIMITSThe OEL is defined as a level at which nearly all workers can be repeatedlyexposed, day after day, over a working lifetime without adverse health effects.The work day is taken as an 8 hour day and a 40 hour work week, and a workinglifetime is typically taken as 40 years.OELs are constantly being revised downwards as new information on health riskbecomes available.If exposure is constantly above the OEL then an adverse outcome is highly likelyover time; the higher the exposure the shorter the time required for the adverseaffect to appear.Since many people are exposed the number of people who will experience anadverse outcome is always large. 7
  • 8. MANAGEMENT OF HAZARD EXPOSURE AND HEALTH RISKThe level of exposure determines the likelihood of an adverse outcome Exposure level relative to OEL C B A OEL 10% 50% 100% Supervision Control Intervention Extreme  Do not need active  Need active  Need  exposure control  control to ensure  intervention to  Safety risk Verify periodically exposure remains  reduce exposure  below OEL to below OEL Health effect  No health effect  Health effect will  unlikely but  expected occur possible 8 8
  • 9. EXAMPLES OF HEALTH HAZARDS IN MINING Hazard Occupational Exposure Limit (OEL)Airborne pollutantsSilica dust 0.1 mg/m3Coal dust 2 mg/m3Nickel 0.1 mg/m3Diesel particulates 160 µg/ m3Sulphur dioxide 2 ppmCarbon Monoxide 30 ppmBlasting fumes (NOX) Individual componentsAcid mist 0.2 mg/m3Platinum salts 0.002 mg/m3Noise 85 dB(A)Thermal stress Combination of thermal load, workload & time exposedIonising radiation 20 mSvHand-arm vibration 2.5 m/sec2Whole body vibration 1.15 m/sec2 9
  • 10. SOME MEDICAL CONSEQUENCES OF EXCESSIVEEXPOSURE TO OCCUPATIONAL HEALTH HAZARDS• Occupational Lung Disease– Silicosis– Coalworkers’ pneumoconiosis– Massive pulmonary fibrosis– Silico-tuberculosis– Occupational asthma– Lung cancer• Noise induced hearing loss• Nasopharyngeal cancer• Occupational skin disorders (irritant or allergy)• Altitude sickness• Heat exhaustion or Heat Stroke• Hand Arm Vibration Syndrome• Back pain and injuries• Repetitive strain injuries• Occupation related stress disorders• Radiation induced occupational cancers
  • 11. WHAT WE ARE DOING TO ADDRESS OUR MAIN HEALTH RISKS?APPLICATION OF OCCUPATIONAL HEALTH STANDARDS• Focus on preventing the adverse health consequences of exposures to occupational health hazards• Programmatic approach Risk assessment Education and training Controls Monitoring and review• Initial standards address priority risks  Noise  Airborne pollutants  Fatigue  Emergency Medical Response  Alcohol and Substance Abuse  Ergonomic Factors (musculoskeletal) – in development 11
  • 12. HEALTH RISK ASSESSMENT• The process for managing health risk is exactly the same as for safety using the same terminology and skills as the Operational Risk Management Process (ORMP) – Documented in the Anglo American Occupational Health Way – Risk and (Critical) Control Registers – Issue based risk assessment – Identification of gaps – Reporting and investigation of health incidents – Learning From Incidents – Health Improvement Plans 12
  • 13. HIERARCHY OF CONTROLSFOR DEALING WITH HEALTH HAZARDS Most Effective ELIMINATION AT SOURCE SUBSTITUTION ENGINEERING SEPARATION ADMINISTRATIVE PPE Least Effective 13 13
  • 14. ALLOWABLE EXPOSURE Noise level (dB) Allowable exposure 85 8 hours 88 4 hours 91 2 hours 94 1 hour 97 30 minutes 100 15 minutes 103 7 min 30 sec 106 3 min 45 sec 109 1 min 52.5 sec 112 56.25 sec 14 14
  • 15. MANAGING OUR HEALTH RISKS:INTRODUCING THE DANGERSFROM DUST AND NOISECommunication and engagement programme 15
  • 16. KEY ELEMENTS 16
  • 17. KEY ELEMENTS● Dedicated “Why dust and noise matter for our future” briefing pack for site General Managers/leadership teams to be used in Mineco meetings, site meetings, etc.● Interactive tools to walk managers through the issues and requirements● Range of materials for use with frontline to highlight how they can best manage the health risks, emphasising the options within their influence ● Introducing the dangers from noise and dust ● The dangers of dust ● Keeping safe and sound from noise ● Toolbox talks 17
  • 18. Example Occupational Health Standard RESPIRATORY PROTECTION PROGRAMME STANDARD AIM To provide a consistent and rigorous approach to the prevention of ill-health from airborne pollutants occurring in the work environment. The Standard provides the basis for a programme to manage the risk from inhalable hazards. STANDARD ELEMENTS ● Risk assessment  Identify the sources and characteristics of the hazard, the tasks and people that are affected.  Assess the level of exposure (intensity and dose) for each task.  Indentify the opportunities for control and protection of any employees who may be exposed. ● Education and training of employees  On the respiratory hazards to which they are exposed, the controls that are in place and how to prevent exposure. ● Controls  Application of the hierarchy of controls to management of sources of airborne particulate and gaseous emissions. ● Monitoring and Review  Monitoring the effectiveness of controls and of the exposure of the employees at risk through the occupational hygiene and medical surveillance programmes and using the information obtained to further improve the controls. 18
  • 19. Critical questionsHave you identified allthe sources of dustand noise whereveryou operate? 19
  • 20. Critical questionsDo you know what’s inthe dust that youremployees might beexposed to? 20
  • 21. Critical questionsAre you constantlymeasuring youremployees’ exposureto dust and noise withthe right tools,equipment andexpertise? 21
  • 22. Critical questionsDo you know who’sdoing what job andfor how long? –location, duration ofemployee exposure.Do you have recordsto prove it? 22
  • 23. Critical questionsDo your peopleunderstand the healthrisks that they mightbe exposed to and arethey sufficientlytrained on how toprotect themselvesfrom them? 23
  • 24. Critical questionsAre your supervisorsclear on their role?Do they understandwhich machines andactivities pose thebiggest threat? 24
  • 25. Critical questionsHave you committedsufficient resources –time, money andpeople – to ensurecompliance withoccupational healthstandards andultimately to protectyour people? 25
  • 26. WE NEED TO MINIMISETHE IMPACT OF DUSTAND NOISE ON OUR PEOPLEAND OUR BUSINESSWE NEED TO MAXIMISEEVERY OPPORTUNITY TOCONTINUOUSLY IMPROVE 26
  • 27. EMPLOYEE HEALTH AND WELLNESS• All employees should receive an annual health screening and basic medical examination: – Medical history screening for common diseases and lifestyle risks – Height, Weight, Body Mass Index (BMI) – Visual acuity – Blood pressure – Haemoglobin – Blood sugar – Cholesterol – Substance abuse screening – Voluntary counselling and testing (VCT) for HIV• Early diagnosis, early access to counselling, care, support and treatment• Reduces absenteeism, improves productivity• Allows for analysis of health trends over time 27
  • 28. HIV AND AIDS
  • 29. ANGLO AMERICAN’S STRATEGIC APPROACH TOMANAGING HIV/AIDS• AIDS Policy - Human rights framework• Strong line management leadership• HIV counselling and testing (the entry point for both prevention and treatment)• Prevention through education, reproductive health, condoms• Care, support and treatment for HIV +ve employees & families• Results focus• Engaging the business supply chain and customer base• Community partnerships and health systems strengthening 29
  • 30. HIV/AIDS Policy
  • 31. HIV Prevention and Treatmentare inseparableEarly Diagnosis is essentialEarly access to treatment givesthe best results
  • 32. PROGRESSION OF HIV INFECTION OVER TIMEIMMUNITY    (CD4 COUNT) Deteriorating health Absenteeism HIV TREATMENT Tuberculosis Disability Risk of death AIDS TREATMENT YEARS 32
  • 33. HIV COUNSELLING AND TESTING AT ANGLO AMERICANSOUTHERN AFRICAN SITES Uptake of HIV testing 2003 <10% 2004 21% 2005 31% 2006 63% 2007 72% 2008 77% 2009 82% 2010 94% 2011 92% 33
  • 34. HIV/AIDS KEY INDICATORSSOUTHERN AFRICAN SITES 2008 2009 2010 2011Number of employees 81,450 66,661 73,129 77,075Best estimate of HIV prevalence 18% 18% 16.5% 16.7%Estimated number of HIV positive employees 14,444 12,057 12,066 12,864Number of employees participating in HCT 63,817 54,662 68,741 70,909during yearPercentage HCT uptake 78% 82% 94% 92%New HIV infections 902HIV incidence 1.17%Number of HIV positive employees enrolled in 7,361 6,116 7,105 7,846HIV wellness programmes% HIV Wellness programme enrolment 51% 51% 60% 61%Number of employees taking ART 3,072 3,211 3,971 4,730% of HIV positive employees taking ART 21% 27% 33% 37%
  • 35. THE IMPORTANCE OF ACCESS TO ANTIRETROVIRALTREATMENT• Access to treatment has transformed the management of HIV and AIDS• New evidence supports the vital role that treatment plays in prevention• Anglo American was the first large business in South Africa to offer free antiretroviral therapy to all its employees – 6th August 2002• This commitment was extended to the dependants of all employees in 2008• AIDS treatment costs ~R900 per employee per month, but can save up to R1500 per employee per month through reduced absenteeism, reduced hospital costs, reduced staff Source: UNAIDS – AIDS at 30 : Nations at the crossroads turnover and reduced benefit payments 35
  • 36. HIV Incidence trend amongst employees at Thermal Coal HIV Incidence 94% of employees2.5% retested for HIV every year2.0% since 20061.5% HIV Incidence1.0%0.5%0.0% 2005 2006 2007 2008 2009 2010 2011 2012 36
  • 37. MOAE0203 Company-level ART provision to employees is cost saving A modelled cost-benefit analysis of the impact of HIV and ART in a mining workforce in South AfricaGesine Meyer-Rath1,2,3,4, Jan Pienaar10,11, Brian Brink11, Andrew van Zyl6, Debbie Muirhead5,6, Emma Beruter6, Alison Grant6,7, Rory Leisegang6,8,9, Lilani Kumaranayake5, Gavin Churchyard6, Charlotte Watts5 , Peter Vickerman5 1 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK 2 Center for Global Health and Development, Boston University, US 3 Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, South Africa 4 Faculty of Health Sciences, University of the Witwatersrand, South Africa 5 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK 6 The Aurum Institute, South Africa 10 Anglo Coal Highveld Hospital, South Africa 11Anglo American, South Africa 7 Department of Clinical Research, London School of Hygiene and Tropical Medicine, UK 8 Division of Clinical Pharmacology, University of Cape Town 9 Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town
  • 38. CONCLUSIONS OF LSHTM STUDYThe cost of AIDS in the workforce is due to: • Increased benefit* payments 44% • Absenteeism 39% • Training and recruitment 7% • Medical costs 10%The cost of ART makes up only 5% of the cost of AIDSThe savings under ART are mainly due to reductions in benefit payments andabsenteeism costsAnglo American Thermal Coal mines have been saving 9% on the annual costof HIV/AIDS by making ART available to their workforce since 2003 ($31.2million reduced to $27.6 million)These results are based on real programme experience over 10 yearsThe results demonstrate strongly that investment in treatment is worthwhile*Benefits 38 include: disability, ill-health early retirement, death benefits, dependant pensions
  • 39. HIV/AIDS CHALLENGES FOR ANGLO AMERICAN• Stopping the new HIV infections• Moving from measuring prevention processes to measuring prevention outcomes• Early diagnosis of HIV infection• Early access to treatment• Ensuring treatment adherence and retention• Improving access to HIV testing and care, support and treatment for dependants• Ensuring that contractors have access to care, support & treatment• Containing the tuberculosis epidemic• Health systems strengthening in communities associated with Anglo American operations 39
  • 40. TUBERCULOSIS
  • 41. TUBERCULOSIS• TB in the mining industry has reached crisis proportions. It is fuelled by the HIV/AIDS epidemic.• People living with HIV are about 37 times more likely to develop TB, than people without HIV.• TB is difficult to diagnose, especially in people living with HIV.• TB is curable, but treatment takes at least 6 months and requires meticulous adherence.• If treatment is not taken properly, then the TB bacilli rapidly become resistant. – Multidrug Resistant TB (MDR-TB) requires two years of treatment at more than 30 times the cost – Extensively Drug Resistant TB (XDR-TB) is untreatable 41
  • 42. ANGLO AMERICAN TUBERCULOSIS INDICATORSSOUTHERN AFRICAN SITES 2009 2010 2011 Employees 66,661 73,129 77,075 Pulmonary TB 786 582 758 Extra‐Pulmonary TB  133 145 148 Total new TB cases  919 727 906 TB Incidence per  1,379 994 1,175 100,000 population MDR TB Cases TB Deaths 86 65 42
  • 43. TUBERCULOSIS IN SOUTHERN AFRICASADC DECLARATION ON TB IN THE MINING SECTOR 18TH AUGUST 2012We the Heads of State or CONCERNED that the mining sector is one of the hardest hit by the TB and TB/HIVGovernment of; crisis imposing many costs on the business and eroding the positive contribution made by the mining sector to the economic development agenda of the regionThe Republic of Angola RECOGNISING that the mining sector contributes to TB prevalence in the RegionThe Republic of Botswana and that mineworkers are disproportionately affected by TBThe Democratic Republic of Congo FURTHER RECOGNISING that the TB and TB/HIV epidemics in the mining sectorThe Kingdom of Lesotho are driven by many factors including high prevalence of Silicosis resulting from longThe Republic of Madagascar term exposure to silica dust in the mines and that in addition, high prevalence ofThe Republic of Malawi HIV in the mines combined with generally poor living conditions of mineworkersThe Republic of Mauritius further increases the risk of contracting and developing active TBThe Republic of Mozambique AWARE of the challenges being experiences by mineworkers and ex-mineworkersThe Republic of Seychelles (including migrant mineworkers and contract or casual workers) their families andThe Republic of South Africa communities.The Republic of SwazilandThe United Republic of Tanzania COMMIT to moving towards a vision of zero new infections, zeroThe Republic of Zambia stigma and discrimination , and zero deaths resulting from TB,The Republic of Zimbabwe HIV, Silicosis and other occupational respiratory diseases 43
  • 44. TUBERCULOSIS IN SOUTHERN AFRICA• SADC Heads of State have highlighted a critical development challenge: – a regional crisis where a key economic sector (mining) is accelerating the spread of TB throughout the continent to the extent that Africa is the only region in the world that is not on track to reach the Millennium Development Goal (MDG) for Tuberculosis• South Africa’s half-a-million mineworkers have the highest TB incidence in the world: 3,000 per 100,000 compared with a global incidence rate of 128 per 100,000• Contractors are a significant and neglected part of the problem 44
  • 45. AFTER KNOWING FOR MORE THAN A CENTURY THATTHE SOUTH AFRICAN MINING INDUSTRY IS RICHWITH TB, WE FINALLY HAVE THE POLITICAL WILL INTHE REGION TO CREATE AN EMERGENCYRESPONSE TO ARREST ITS SPREAD.FOR THE HEALTH OF THE REGION—AND TOPROTECT A WORLD AT GREATER RISK FROM TB—WE MUST SEIZE THE OPPORTUNITY AND END THISDISEASE.ARCHBISHOP EMERITUS DESMOND TUTUWALL ST JOURNAL 8TH NOVEMBER 2012
  • 46. theHealthSource APPLAUD AWARD • A sophisticated Health Management Information System FINALIST 2012 • Provides the solution to managing many of the “Health” FOR INNOVATION problems in the SA mining industry – Contractors, migrancy, HIV/AIDS, TB, occupational health records• An innovation which goes far beyond anything else that is available in the health field today• Also holds huge potential for dealing with the multitude of health problems encountered in developing countries• Represents a major opportunity for Anglo American, together with its contractors, to be at the forefront of managing health issues in the mining industry. 46
  • 47. COMMUNITY HEALTHFacilitating tangible healthimprovements in local communitiesandBeing a positive influence on health indeveloping countries
  • 48. THANK YOU

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