Disease should be a moment of solidarity instead of exclusion.
How often do people talk about disease? The answer may be never, or at least, not enough.
In Chinese culture disease is seen as unlucky, getting too close to someone ill would bring “晦气” (negative energy) to one’s own life. That sense of stigma is by no means unique to Chinese people.
Disease, physical or mental, is always the negative space in a conversation, a topic that is not allowed concrete shape, for fear that the monster may invade into the realms of life that we take as normal. Disease becomes the epitome of everything unpleasant: war, poverty, pollution, and other social ills. It is to be contained, forgotten in a shady corner, until it disappears naturally. However, problems never just disappear.
As the Covid-19 crisis demonstrates, diseases cannot go away without appropriate treatment. Denying the existence of disease, particularly when certain populations, for example racialised communities of migrant workers, are rendered more vulnerable, is to surrender.
Disease is contagious. The juvenile approach of foregoing responsibility actually puts oneself at risk. Only when appropriate medical and policy level measures are taken can the spread of disease be contained.
Disease is a social problem. A family member with a disease adds to the existing burden of household care-giving.
In the recent Chinese documentary Miners, Grooms, and Pneumoconiosis (2019), the former miner Zhao Pinfeng contracts pneumoconiosis, a deadly occupational lung disease caused by inhaling mineral dust created by mining operations. After spending most of his meagre savings on medical expenses, Zhao eventually passes away, leaving his wife and two young children behind.
This type of tragedy is common in rural Hunan province, where the film was shot. In an informal interview with the director Jiang Nengjie, whose father is also one of the pneumoconiosis patients from the village, he told me about the region’s long history of mining.
After the late Qing dynasty (1800s~), local farmers would mine iron and tungsten in the mountains whenever the market prices of the metals were relatively high. Artisanal mining has continued in recent decades, despite the hazards of mining accidents and lung diseases.
Occupational lung diseases such as silicosis can take up to ten years to manifest symptoms. By the time the symptoms become noticeable, they are already deadly. Silicosis patients have trouble breathing; they cough a lot since their lungs are clogged with mineral dust.
Wang Keqin, the founder of the Chinese charity organisation Daaiqingchen, which provides aid to farmers with pneumoconiosis, describes how sufferers have to “kneel down to breathe”. Due to the lack of formal contracts, these former miners face difficulties in seeking compensation.
To avoid responsibility, companies and government agencies rarely recognize occupational disease diagnoses. Zhang Haichao, a rural Chinese worker at the end-stage of pneumoconiosis, had to undergo lung biopsy just to provide proof, while the symptoms of his illness could not be more obvious.
The case exploded on Chinese media in 2009. Although Zhang eventually received a compensation of 1.2 million RMB (approximately £135,000) due to public pressure, he still struggles to cover the daily medical costs, since pneumoconiosis is a lifelong disease.
Without effective healthcare mechanisms, the endless medical bills often drive pneumoconiosis patients and their rural families deep into debt.
Occupational lung disease is a worldwide issue, especially in the time of COVID-19. Miners with pre-existing conditions of pneumoconiosis are at higher risk of coronavirus infection.
In Rajasthan, India, mine workers with silicosis are suffering from the delay in government compensation and medical care during the lockdown, and the burden of caring for the ill is falling instead on the women in the mineworkers’ families. This dynamic raises questions about who bears the social responsibility for such care work.
Occupational diseases are byproducts of global market demand. Those who contract occupational diseases typically work as miners in the upstream portion of global supply chains, or as construction workers building the foundation of urban infrastructure. The rates of certain occupational diseases also fluctuate based on changes in the economy, particularly the market demand for minerals.
During the Obama administration in the United States, incidences of black lung disease, a common occupational disease caused by inhaling coal dust, decreased in the US, as policies to adapt to climate change pushed towards a transition away from coal.
By contrast, under the Trump administration there has been a resurgence of black lung disease in the US as the federal government seeks to re-industrialise America.
Western countries are now feeling the need to revive national industries due to the disruption of supply chains during Covid-19, and it is not unreasonable to predict that the rates of occupational diseases in the West may rise again.
The novel coronavirus breakout poignantly demonstrates that the global economy is bound to face major disruptions when dealing with a pandemic, because it is already afflicted with many underlying ‘diseases’.
The Covid-19 crisis has, in part, reached boiling point because issues including income inequality, unbalanced labour flows and inadequate healthcare systems have been accumulating in recent decades.
Now societies must face the consequences of ignoring these problems. Effective allocation of responsibility for the social and environmental costs of infrastructure and extraction, across governments and private sectors, is key to the treatment of occupational disease and economic recovery in a post-Covid world.
Occupational disease brings into question whether mining is essentially profitable.
With the help of Action for Southern Africa (Actsa), thousands of ex-gold mine workers suffering from silicosis in South Africa finally achieved a settlement of at least £268 million in 2019, with African Rainbow Minerals, Anglo American, AngloGold Ashanti, Gold Fields, and Harmony and Sibanye-Stillwater. The settlement was used to establish the Tshiamiso Trust, to fund compensation for eligible gold mine workers and their dependents in South Africa.
As a legacy of apartheid, most of the miners who undertook the most dangerous jobs were black. It took eight years of legal struggle for the workers and their families to get compensation.
The case demonstrates how the profits of the mining industry do not accurately the environmental and social costs incurred. Significant progress has been made since Actsa and other organisations have been pushing for mining companies to account for ecological and health damages.
But to prevent these tragedies from reoccurring, change needs to happen on the level of social norms. As the Indian scholar and environmental advocate Vandana Shiva argues, economics must recover its original function of sustaining life.
The exploitation of life for surplus profit disregards long-term health impacts on ecosystems and humans, particularly impoverished, racialised communities that are socially conditioned to engage in risky professions such as mining and construction.
Disease should be a moment of solidarity instead of exclusion.
While global unions have been advocating for the recognition of Covid-19 as an occupational disease, and countries such as Argentina, Belgium, Canada, Germany, Italy, and South Africa have already done so, government designations of coronavirus as a workplace risk have been mostly limited to the healthcare sector.
Even though mining has been designated - wrongly - as an essential service during the lockdown period in many countries, there is little discussion on the high exposure risks in narrow, underground mines, which may threaten the health of mine workers along with the communities they reside in.
The sector remains a blind spot in the public imagination regarding occupational health risks, perhaps precisely because the risks are so high.
According to Glen Mpufane, director of mining, diamond, gem, ornament and jewellery processing at IndustriALL Global Union, statistics show that occupational diseases kill more workers than mining accidents.
These health hazards are not the responsibilities of mineworkers themselves. Tackling such high exposure to occupational disease requires a commitment to safety standards on the part of governments and corporations.
The International Labour Organization’s (ILO) Convention 155 provides key recommendations for employers to ensure occupational safety and health, including providing appropriate training and allowing workers to refuse unsafe work until remedial action is taken (Article 19).
ILO Convention 156 further recognizes the rights of workers with family responsibilities, paving the way for workers to request childcare assistance from employers, as circumstances demand.
While a majority of countries have not yet ratified the ILO conventions, C155 and C156 frame workers’ safety and wellbeing in terms of legal rights. When asked about the feasibility of implementing workers’ right to refuse unsafe work, Mpufane replies, “it is an option when a union wants to organize around health and safety. Our strategy is to get countries to ratify the ILOs, to build capacity for workers to unionize and make demands.”
Mpufane points to increased corporate disclosure as a hopeful global trend, made possible by platforms such as the Responsible Mining Index, which reports data from 38 large-scale mining companies across 967 mine sites in 52 countries.
The Covid-19 crisis provides an opportunity to push for further data disclosure and monitoring mechanisms with regard to the health and wellbeing of workers in the mining sector.
Occupational health is a matter of sustenance. The purpose of work is to sustain life, for both the workers and the families they support. As Covid poignantly reveals, an economic system that places profit over life is bound to collapse.
Disease calls for remedy. In this case, the first step is to rethink the meaning of livelihood from the acquisition of material wealth to preserving the various relationships that sustain our presence on this planet.
Maynie Y is a researcher, writer and volunteer at the London Mining Network. This article was originally posted on the London Mining Network website.