Compensation for environmental asbestos-related diseases in South Africa: a neglected issue

Our plain-English summary of Compensation for environmental asbestos-related diseases in South Africa: a neglected issue, by N. Ndlovu, J.T. Naude, J. Murray (Global Health Action, 2013).

The study

• Authors: N. Ndlovu, J.T. Naude, J. Murray
• Journal: Global Health Action
• Published: 2013;6:19410
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Environmentally acquired asbestos-related diseases (ARDs) are of concern globally. In South Africa, there is widespread contamination of the environment due to historical asbestos mining operations that were poorly regulated. Although the law makes provision for the compensation of occupationally acquired ARDs, compensation for environmentally acquired ARDs is only available through the Asbestos Relief Trust (ART) and Kgalagadi Relief Trust, both of which are administered by the ART. This study assessed ARDs and compensation outcomes of environmental claims submitted to the Trusts.

Methods: The personal details, medical diagnoses, and exposure information of all environmental claims considered by the Trusts from their inception in 2003 to April 2010 were used to calculate the numbers and proportions of ARDs and compensation awards.

Results: There were 146 environmental claimants of whom 35 (23.9%) had fibrotic pleural disease, 1 (0.7%) had lung cancer, and 77 (52.7%) had malignant mesothelioma. 53 (36.3%) claimants were compensated: 20 with fibrotic pleural disease and 33 with mesothelioma. Of the 93 (63.7%) claimants who were not compensated, 33 had no ARDs, 18 had fibrotic pleural disease, 1 had lung cancer, and 44 had mesothelioma. In addition to having ARDs, those that were compensated had qualifying domestic (33; 62.2%) or neighbourhood (20; 37.8%) exposures to asbestos. Most of the claimants who were not compensated had ARDs but their exposures did not meet the Trusts' exposure criteria.

Conclusions: This study demonstrates the environmental impact of asbestos mining on the burden of ARDs. Mesothelioma was the most common disease diagnosed, but most cases were not compensated. This highlights that there is little redress for individuals with environmentally acquired ARDs in South Africa. To stop this ARD epidemic, there is a need for the rehabilitation of abandoned asbestos mines and the environment. These issues may not be unique to South Africa as many countries continue to mine and use asbestos.

In plain English

This study reviewed records of South Africa's Asbestos Relief Trust and Kgalagadi Relief Trust, the only route to compensation for asbestos-related diseases acquired outside work. It covered all environmental claims entered from 2003 to April 2010. These were claims based on domestic exposure (living with asbestos workers) or neighbourhood exposure (living near asbestos operations). Of 15,463 claims, 146 (0.9%) were environmental: 74 women and 72 men. Malignant mesothelioma was diagnosed in 77 claimants (52.7%), fibrotic pleural disease in 35 and lung cancer in 1. Another 33 had no asbestos-related disease. Of the 146, 53 (36.3%) were compensated, including 33 with mesothelioma. The other 93 (63.7%) were not, including 44 with mesothelioma. Fifty-six of those not compensated had disease, but their exposures did not meet the Trusts' criteria, for example because they had lived more than 10 km from a designated operation. Based on where they had lived, 70 mesothelioma claimants were assigned likely crocidolite exposure. The authors concluded there is very little redress for people with environmentally acquired disease, and said their figures probably underestimate the problem.

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: Record review of a compensation database (case series), using cross-sectional passive surveillance methodology for environmental cases
• Who was studied: 146 environmental claimants (74 women, 72 men; mean ages 61.8 and 56.8 years respectively) out of 15,463 claims registered with the Asbestos Relief Trust and Kgalagadi Relief Trust in South Africa, from the Trusts' inception in 2003 to April 2010
• Exposure: Domestic exposure (living with asbestos workers) or neighbourhood exposure (living near asbestos operations) from former asbestos mining in South Africa. To qualify, exposure had to be within 10 km of an asbestos work site, in the qualifying period of 1955 to 2002, and with no occupational exposure. For mesothelioma cases, likely fiber type was assigned by area of residence, not measured: crocidolite for Northern Cape and North West Provinces, amosite for Limpopo, chrysotile for Mpumalanga.
• Main results:
  • Of the 146 environmental claimants, 77 (52.7%) had malignant mesothelioma and 1 had lung cancer
  • 35 claimants had fibrotic pleural disease (pleural thickening, with 3 cases of pleural plaques grouped into this category), 23.9% of the environmental claims
  • 33 (22.6%) of the 146 claimants did not have an asbestos-related disease
  • 53 of the 146 claimants (36.3%) were compensated: 20 with fibrotic pleural disease and 33 with mesothelioma. Their qualifying exposures were domestic in 33 (62.2%) and neighbourhood in 20 (37.8%).
  • 93 claimants (63.7%) were not compensated. 37 did not qualify medically (33 had no asbestos-related disease, 3 had pleural disease with less than 10% lung function impairment, 1 had lung cancer). The remaining 56 (12 with fibrotic disease, 44 with mesothelioma) had exposures that did not meet the Trusts' criteria.
  • Reasons exposures did not qualify, among the 56: 2 claimants with severe fibrotic disease had previous occupational exposure; 4 with mesothelioma were exposed in non-qualifying periods; 23 had lived more than 10 km from a designated operation (3 with mild to moderate fibrotic disease, 20 with mesothelioma); no reason was given for 27
  • Of 128 claimants with a known year of first exposure, 58 (45.3%) were first exposed in childhood, 20 of them from birth. No significant differences in age at first exposure, duration of exposure or time since first exposure were seen between disease categories.
  • Mesothelioma was diagnosed in 34 (44.2%) women and 43 (55.8%) men
  • Based on area of residence, 70 mesothelioma cases (90.9%) were assigned likely crocidolite exposure (64 Northern Cape, 6 North West). 1 was assigned amosite (Limpopo) and 6 had unknown origin.
• The authors' conclusion: The authors concluded that, while compensation systems exist for occupationally acquired asbestos-related diseases, there is very little redress for people with environmentally acquired disease. They called for urgent attention to compensation for environmental mesotheliomas.
• Limitations the authors state:
  • The proportion of environmental claims may be an underestimate, because claimants must provide evidence of disease, which may be costly
  • The Trusts have limited geographical coverage, and migration may take potential claimants out of the Trusts' target areas
  • Under-diagnosis of asbestos-related diseases in public health care facilities contributes to under-ascertainment

Topics

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

Medical terms in this study, explained in our Lexicon: Lung Cancer, Malignant Mesothelioma, Mesothelioma.

Related studies

• Asbestos-related disease in South Africa: the social production of an invisible epidemic — L. Braun, S. Kisting (2006)
• South African experience with asbestos related environmental mesothelioma: is asbestos fiber type important? — N. White, G. Nelson, et al. (2008)
• Double standards: the multinational asbestos industry and asbestos-related disease in South Africa — J. McCulloch, G. Tweedale (2004)
• Lung cancer, tobacco, and environmental factors in the African population of the Northern Province, South Africa — O. Mzileni, F. Sitas, et al. (1999)
• Health effects of amosite mining and milling in South Africa — J. Murray, G. Nelson (2008)
• Asbestosis in South Africa--certain geographical and environmental considerations — G.K. Sluis-Cremer (1965)

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