Managing health issues
Our context
In line with our values, we believe that we cannot accept ill health as a natural consequence of our business operations, and that our employees must be able to go home fit and well at the end of each working day. Our definition of good health is a state of complete physical, social, mental and spiritual wellbeing and not merely the absence of disease and ill health.
We also subscribe to the value that ‘communities in which we operate will be better off for us having been there’, which implies that our approach to health encompasses community health issues.
In many areas of operation, we have found that employee and community health issues are inseparable, and integrated strategies are required. Approaches to malaria, HIV/AIDS and TB, for example, require community-level interventions as well as employee-level interventions to be successful.
The diagram below shows the model that we aim to adopt in analysing and managing health issues in the workplace, and the potential health exposures that employees face. These are significant, particularly in South Africa where we encounter many of our most pressing health risks.
Our most material health risks relate to:
- Silicosis – silicosis remains our most serious occupational health concern. Although the company has been able to eliminate new cases of silicosis at its Brazilian operations, we continue to report new cases in South Africa. The number of cases reported in South Africa remains high and in 2010 increased compared with the previous year.
In 2010, 459 new cases of silicosis were submitted to the Medical Bureau for Occupational Disease of South Africa, against 409 in 2009. This increase can be attributed to past exposures and potentially other factors such as the high level of HIV and TB prevalence in our South African workforce, which aggravates the disease.
- Noise-induced hearing loss (NIHL) – this remains a challenge in South Africa. The number of compensable cases declined from 79 in 2009 to 64 in 2010. However, the incidence of early NIHL remains high. 429 new cases of early NIHL were diagnosed in 2010, up from 332 cases in 2009. Early NIHL is defined as a loss of hearing of 5‑10% from baseline and is not compensable under current South African legislation.
- HIV/AIDS – HIV/AIDS is a health issue in South Africa, Tanzania, Ghana and the Democratic Republic of the Congo. High prevalence of HIV/AIDS contributes to absenteeism, hospital admission, ill-health retirement and death among affected employees.
- Malaria – malaria is a major health concern for AngloGold Ashanti’s operations in Ghana, Guinea, Mali and Tanzania. The prevalence of malaria in these regions can result in illness and absenteeism among employees, and has a significant impact on the health of employees’ families and that of the surrounding communities.
Failure to manage these issues adequately poses risks to the business in terms of increased potential for injuries and accidents, decreased productivity, fatigue, poor morale, increased medical and medical compensation costs and poor stakeholder relations, all of which can threaten the social and legal licence of the company to operate.
Our health strategy
AngloGold Ashanti is a global company which operates in a diverse range of settings. Health exposure risks therefore differ between regions and according to the type of mining operation undertaken. The company has not implemented a global health strategy or management system in the past and the management of health and wellbeing issues has not therefore always been consistent.
In 2011, we intend to move towards a structured approach to managing health issues, through the development and implementation of a global health strategy and health management system, thus improving the organisation’s ability to learn from the experience of different regions and to replicate good practice across the group.
The health strategy that we have developed has the following objectives:
- to sustain and improve the health status of the workforce through disease prevention, early disease identification, effective illness and injury management, and effective rehabilitation;
- to sustain and improve the health status of the communities in which we operate by managing the potential for positive and negative health impacts; and
- to provide a working environment conducive to health through pro-active and systematic hazard management.
A health management system will be designed and implemented which will be compatible with the best practice standards on occupational health and safety already in use at our operations and integrated with our broader business systems. These include key organisational change initiatives such as Project ONE as well as duty of care policies and practices, knowledge and information management systems, risk management systems and community relations strategies.
Standards and guidelines are being developed on key health issues such as health impact assessments, specific disease management and pre-placement medical examinations.
Health impact assessments will be conducted at operations over the next 18 months and health risk assessments will be updated or put in place where they do not already exist. They will also serve as a benchmark for new operations, which in future will be assessed at the feasibility stage.
Health targets for 2011 and 2012
We intend to take forward implementation of our health strategy and management system within the following time frames:
- undertake health risk assessments and health system audits at our operations in Continental Africa by the end of 2011; and
- complete heath risk assessments and health system audits for the balance of our operations by the end of 2012.
We have set the following goals relating to wellness and occupational environment:
- continue progress towards the industry milestone of no new cases of silicosis among previously unexposed employees in South Africa (2008 onwards) after December 2013;
- meet the industry milestone of no deterioration in hearing greater than 10% among occupationally-exposed individuals at South African operations;
- roll out integrated malaria programmes at operations in Mali, Tanzania and Guinea, drawing on the model implemented at Obuasi in Ghana; and
- in South Africa, continue efforts to reduce occupational tuberculosis (TB) incidence to 2.25% of all South African employees by 2015 and to successfully cure 85% of new cases (our long-term target is the reduction of TB incidence to 1.5% of all South African employees by 2029).
Health performance in 2010
In 2009, we committed to a number of targets relating to health issues, as set out below. All of them are centred on South Africa, where the need for progress has been most acute. This is due to the large numbers of people employed by the company in South Africa, as well as the incidence of silicosis, HIV/AIDS, NIHL and TB among this workforce. This section sets out progress against these targets as well as on addressing malaria at our African operations.
Silicosis
Our target is the elimination, by 2013, of new cases of silicosis among employees in South Africa who were not occupationally exposed prior to January 2008 (using present diagnostic techniques).
This target is the industry milestone, set at the 2003 Health and Safety Summit. However, it is still too early to provide a meaningful assessment of the group of employees exposed after January 2008 due to the latency period of the disease. Current diagnostic techniques do not allow us to make a meaningful assessment of performance at this stage.
We therefore measure current performance with reference to the occupational hygiene aspects of the industry milestones. These state that no more than 5% of samples measuring exposure should be above the occupational exposure limit of 0.1mg/m3 for respirable crystalline silica.
A continued focus on filtration strategies and footwall treatment has enabled us to continue reducing silica dust exposure and achieve compliance with the industry milestone. We are still maintaining a downward trend of dust exposure on an annual basis. We also maintained significantly higher sampling rates than those prescribed by legislation, increasing our confidence in the data collected and enabling us to manage the issue of silica exposure more closely.
We have now set ourselves a lower benchmark for dust readings for analysis than the industry milestone and investigate the root cause of all dust readings exceeding this benchmark. We are also in the process of defining a new baseline for dust readings by sampling all employees. This will enable us to evaluate high risk areas and occupations so that strategies can be adapted accordingly.
A former employee, Mr Thembekile Mankayi, instituted a legal action against AngloGold Ashanti in October 2006, claiming approximately $360,000 for damages allegedly suffered as a result of silicosis. AngloGold Ashanti learnt of the death of Mr Mankayi on 3 March 2011 and wishes to offer condolences to his family and friends.
In June 2008, judgement on an application was given in the company’s favour on the basis that mine employers are indemnified against claims by employees for damages relating to diseases compensated under existing legislation. An appeal by Mr Mankayi was dismissed by the Supreme Court of Appeal. In August 2010, the Constitutional Court of South Africa heard Mr Mankayi’s application for leave to appeal to the Constitutional Court. On 3 March 2011 the Constitutional Court granted the leave to appeal and simultaneously granted the Appeal. The effect thereof is that the executor of Mr Mankayi’s estate may return to the High Court to recover common law damages from AngloGold Ashanti and that they are not barred by legislation from doing so. AngloGold Ashanti has several defences available to it, and it will continue to defend the action.
Noise-induced hearing loss (NIHL)
Our target on NIHL is to achieve the industry milestone of no deterioration in hearing greater than 10% amongst occupationally-exposed individuals at South African operations. Audiograms are conducted on all occupationallyexposed employees in South Africa when they join the company and annually thereafter. The baseline for the target is the routine audiogram performed during 2009 or, for employees who joined the company after 1‑January 2009, the audiogram performed at the start of their employment.
Due to the lag between noise exposure and NIHL, we are not yet able to give a meaningful assessment of performance against this target. In the meantime, however, we continue compliance with noise targets (the industry milestone states that by December 2013, the total noise emitted by all equipment installed in any workplace must not exceed 110dB(A) at any location in that workplace). We have been in compliance with this hygiene target since 2008 and have now set a lower internal benchmark.
HIV/AIDS, voluntary counselling and testing (VCT) and wellness programmes
Our targets in this area for 2010 were:
- to maintain a rate of 80% of South African employees attending VCT, excluding those already attending current wellness clinics;
- to reduce by 50% the number of avoidable drop-outs from wellness clinic programmes in South Africa.
We were not able to achieve these targets. The uptake of VCT has been falling since 2008 and in 2010 it was 74%. We treated over 4,000 patients at wellness centres during the year but have not been able to measure retention on the programmes. Measuring retention is challenging because of the constant change in the number of patients, and the many reasons for not returning to the programme. These losses include resignation and voluntary and ill-health separations but are not always recorded as such.
The number of employees presenting themselves for VCT is declining. Testing and counselling programmes, which have been in place at AngloGold Ashanti since 2000, have helped curb the epidemic but do not appear to have resulted in a step change in prevalence, for which a major advance in treatment such as a cure or vaccine would be required.
Notwithstanding this situation, communications and awareness programmes have continued and are now conducted on a one-on-one basis as well as through mass media communication channels. Particular attention is given to VCT at induction.
A major advance in 2010 has been the introduction of linked testing, which enables follow up with affected employees and will also form the basis for a better estimate of the incidence of HIV/AIDS among our workforce. Anti-retroviral therapy (ART) continues to be supplied to approximately 2,500 employees for whom this treatment is clinically indicated.
Tuberculosis (TB)
We have met targets on occupational tuberculosis for 2010, which were to:
- reduce occupational TB incidence to 3% of all South African employees; and
- successfully cure 85% of new TB cases.
Occupational TB incidence in 2010 was reduced to 2.64% in 2010 and more than 90% of cases were successfully treated in 2009. Data for successful outcomes of TB cases treated in 2010 is not yet available as treatment programmes last between six and eight months. Prevalence of this disease among employees in South Africa is closely linked to HIV prevalence.
Malaria
Downward trends in malaria cases continued in 2010, as shown in the table below.
Number of malaria cases in affected countries (2007 – 2010)
| 2010 | 2009 | 2008 | 2007 | |
|---|---|---|---|---|
| Ghana | 3,219 | 5,085* | 4,947 | 7,786 |
| Tanzania | 218 | 447 | 1,557 | 3,212 |
| Guinea | 783 | 664 | 756 | 633 |
| Mali | 268 | 204 | 216 | 434 |
| Total | 4,488 | 6,400 | 7,476 | 12,065 |
* The number of cases of malaria in Ghana was incorrectly stated in our 2009 report as 5,075.
In 2009, AngloGold Ashanti was nominated as the principal recipient of a grant of $138 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria. The project will cover 40 districts in Ghana and will be based on the integrated malaria control model implemented at Obuasi. It is anticipated that this will run for five years and create approximately 3,800 jobs. Work on the project is scheduled to begin in the first quarter of 2011 following successful resolution with the Ghanaian authorities on taxation issues relating to the grant.
Starting in 2011, we intend to roll out the highly successful integrated model undertaken at Obuasi in Ghana to other malaria-affected areas where AngloGold Ashanti operates.