Asbestos-related disease in South Africa: the social production of an invisible epidemic

Our plain-English summary of Asbestos-related disease in South Africa: the social production of an invisible epidemic, by L. Braun, S. Kisting (American Journal of Public Health, 2006).

The study

• Authors: L. Braun, S. Kisting
• Journal: American Journal of Public Health
• Published: 2006;96(8):1386-96
• Type of article: Historical article
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

South Africa was the third largest exporter of asbestos in the world for more than a century. As a consequence of particularly exploitative social conditions, former workers and residents of mining regions suffered--and continue to suffer--from a serious yet still largely undocumented burden of asbestos-related disease. This epidemic has been invisible both internationally and inside South Africa. We examined the work environment, labor policies, and occupational-health framework of the asbestos industry in South Africa during the 20th century. In a changing local context where the majority of workers were increasingly disenfranchised, unorganized, excluded from skilled work, and predominantly rural, mining operations of the asbestos industry not only exposed workers to high levels of asbestos but also contaminated the environment extensively.

In plain English

This article was a historical analysis, not a medical or statistical study, of why asbestos-related disease in South Africa went largely undocumented. The authors examined the work environment, labor policies and occupational-health laws of the South African asbestos industry during the 20th century. That industry mined crocidolite, amosite and chrysotile. The authors drew on historical sources and on interviews with former workers and residents of former mining regions. They described family-based mining in which women and children separated, sorted and bagged fiber. Former workers recalled extremely dusty conditions and no protective equipment. The authors described widespread environmental contamination from dumps, riverbeds, roads and houses built with bricks mixed with asbestos. They reported that surveillance and compensation laws treated white and black workers differently, and that environmentally exposed and unregistered workers, including many women, were excluded from compensation. The authors acknowledged a lack of firm data. They argued that the epidemic and its invisibility were shaped by labor practices, by legislation under settler colonial rule and apartheid, and by ideas of disease causation that leave out social conditions.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Historical analysis drawing on historical sources and interviews with workers and residents of former mining regions (no quantitative study of its own)
• Who was studied: Former asbestos workers (mining, milling and asbestos cement manufacturing) and residents of former mining regions in South Africa (Northern Cape, North-West, Limpopo and Mpumalanga Provinces), covering the 20th century. The interviews are dated 2001 to 2004 in the notes. The article does not give the number of people interviewed.
• Exposure: Occupational and environmental exposure to crocidolite (blue), amosite (brown) and chrysotile (white) asbestos from mining, milling and asbestos cement manufacturing, and from contaminated surroundings
• Main results:
  • Mining was family-based. Women and children hand-cobbed, sorted, sieved, weighed and packed asbestos.
  • Interviewed men and women who worked in the mines between the late 1950s and early 1990s described extremely dusty conditions. They said the company provided no respiratory protection, gloves or training.
  • Families were exposed when workers' clothing, including handkerchiefs worn over the face, was washed by hand at home.
  • The authors identified many sources of environmental exposure, including dumps, riverbeds, roads, housing materials and bricks made by mixing asbestos with sand.
  • Under the 1973 Occupational Diseases in Mines and Works Act, white miners had yearly x-rays by state-employed doctors. Black workers were examined by company doctors.
  • Workers exposed through environmental contamination, and unregistered workers including many women, were excluded from the miners' compensation system.
  • The article contrasted figures from other sources. A company claim in 1984 reported 71 asbestosis cases diagnosed among a workforce of 24 000 at Everite plants since 1946. Audits of asbestos cement workers by health activists in the 1990s reported a 30% prevalence of asbestos-related disease. The authors suggested that the practice of 'dumping' sick workers in rural reserves might in part account for the company figure.
• The authors' conclusion: The authors concluded that the invisibility of the asbestos-related disease epidemic had many interconnected causes. They listed exploitative labor conditions, harsh living conditions, legislation favorable to industry, limits on black trade union bargaining power, the long-term nature of the disease, and concepts of disease causality that exclude social conditions.
• Limitations the authors state:
  • The authors noted a lack of firm data on the disease burden in exposed communities.
  • The authors noted that exposure levels were not documented until the 1940s.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Related studies

• The social context of occupational disease: asbestos and South Africa — J. Myers (1981)
• Double standards: the multinational asbestos industry and asbestos-related disease in South Africa — J. McCulloch, G. Tweedale (2004)
• Cape Plc: South African mineworkers' quest for justice — R. Meeran (2003)
• Scientific controversy and asbestos: making disease invisible — L. Braun, A. Greene, et al. (2003)
• Collaborative research, participatory solutions: research on asbestos in Kuruman, South Africa — N. Jacobs, S. Kisting, et al. (2004)
• Excess mortality from stomach cancer, lung cancer, and asbestosis and/or mesothelioma in crocidolite mining districts in South Africa — J.L. Botha, L.M. Irwig, et al. (1986)

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