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

1. OCCUPATIONAL HEALTH &
PRIMARY HEALTHCARE
Dr Brian Brink – Chief Medical Officer

2. HEALTH
Effective management of occupational health risks protects our
people, enhances productivity, and helps 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

3. HEALTH STRATEGY
Global
Health
Health Management Communities
Information 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
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4. OCCUPATIONAL HEALTH
Zero harm to health
Creating and instilling a company culture that
protects people from harm and improves their health
and well-being
Operational excellence
Realising exceptional operational value by
managing health risks and identifying value-creating
opportunities

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).
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6. HEALTH RISK
Health Risk arises from exposure to a health hazard at a level which can cause
harm 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 they
cause a health effect.
The dose can be delivered fast in high level exposure or slowly (over many
years) with low level exposure. In the former there may be acute illness whereas
in the latter illness may develop over a long period of time.
This is the basis of the occupational exposure limit (OEL).
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7. OCCUPATIONAL EXPOSURE LIMITS
The OEL is defined as a level at which nearly all workers can be repeatedly
exposed, 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 working
lifetime is typically taken as 40 years.
OELs are constantly being revised downwards as new information on health risk
becomes available.
If exposure is constantly above the OEL then an adverse outcome is highly likely
over time; the higher the exposure the shorter the time required for the adverse
affect to appear.
Since many people are exposed the number of people who will experience an
adverse outcome is always large.
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8. MANAGEMENT OF HAZARD EXPOSURE AND HEALTH RISK
The 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 pollutants
Silica dust 0.1 mg/m3
Coal dust 2 mg/m3
Nickel 0.1 mg/m3
Diesel particulates 160 µg/ m3
Sulphur dioxide 2 ppm
Carbon Monoxide 30 ppm
Blasting fumes (NOX) Individual components
Acid mist 0.2 mg/m3
Platinum salts 0.002 mg/m3
Noise 85 dB(A)
Thermal stress Combination of thermal load, workload & time exposed
Ionising radiation 20 mSv
Hand-arm vibration 2.5 m/sec2
Whole body vibration 1.15 m/sec2
9

10. SOME MEDICAL CONSEQUENCES OF EXCESSIVE
EXPOSURE 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
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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
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13. HIERARCHY OF CONTROLS
FOR DEALING WITH HEALTH HAZARDS
Most Effective
ELIMINATION AT SOURCE
SUBSTITUTION
ENGINEERING
SEPARATION
ADMINISTRATIVE
PPE
Least Effective
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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 DANGERS
FROM DUST AND NOISE
Communication and engagement programme
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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.
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19. Critical questions
Have you identified all
the sources of dust
and noise wherever
you operate?
19

20. Critical questions
Do you know what’s in
the dust that your
employees might be
exposed to?
20

21. Critical questions
Are you constantly
measuring your
employees’ exposure
to dust and noise with
the right tools,
equipment and
expertise?
21

22. Critical questions
Do you know who’s
doing what job and
for how long? –
location, duration of
employee exposure.
Do you have records
to prove it?
22

23. Critical questions
Do your people
understand the health
risks that they might
be exposed to and are
they sufficiently
trained on how to
protect themselves
from them?
23

24. Critical questions
Are your supervisors
clear on their role?
Do they understand
which machines and
activities pose the
biggest threat?
24

25. Critical questions
Have you committed
sufficient resources –
time, money and
people – to ensure
compliance with
occupational health
standards and
ultimately to protect
your people?
25

26. WE NEED TO MINIMISE
THE IMPACT OF DUST
AND NOISE ON OUR PEOPLE
AND OUR BUSINESS
WE NEED TO MAXIMISE
EVERY OPPORTUNITY TO
CONTINUOUSLY 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
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28. HIV AND AIDS

29. ANGLO AMERICAN’S STRATEGIC APPROACH TO
MANAGING 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 Treatment
are inseparable
Early Diagnosis is essential
Early access to treatment gives
the best results

32. PROGRESSION OF HIV INFECTION OVER TIME
IMMUNITY (CD4 COUNT)
Deteriorating health
Absenteeism
HIV TREATMENT Tuberculosis
Disability
Risk of death
AIDS TREATMENT
YEARS
32

33. HIV COUNSELLING AND TESTING AT ANGLO AMERICAN
SOUTHERN 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 INDICATORS
SOUTHERN AFRICAN SITES
2008 2009 2010 2011
Number of employees 81,450 66,661 73,129 77,075
Best estimate of HIV prevalence 18% 18% 16.5% 16.7%
Estimated number of HIV positive employees 14,444 12,057 12,066 12,864
Number of employees participating in HCT
63,817 54,662 68,741 70,909
during year
Percentage HCT uptake 78% 82% 94% 92%
New HIV infections 902
HIV incidence 1.17%
Number of HIV positive employees enrolled in
7,361 6,116 7,105 7,846
HIV 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 ANTIRETROVIRAL
TREATMENT
• 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
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36. HIV Incidence trend amongst employees at Thermal Coal
HIV Incidence 94% of
employees
2.5%
retested for
HIV every year
2.0% since 2006
1.5%
HIV Incidence
1.0%
0.5%
0.0%
2005 2006 2007 2008 2009 2010 2011 2012
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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 Africa
Gesine 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 STUDY
The 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 AIDS
The savings under ART are mainly due to reductions in benefit payments and
absenteeism costs
Anglo American Thermal Coal mines have been saving 9% on the annual cost
of HIV/AIDS by making ART available to their workforce since 2003 ($31.2
million reduced to $27.6 million)
These results are based on real programme experience over 10 years
The 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
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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 INDICATORS
SOUTHERN 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
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43. TUBERCULOSIS IN SOUTHERN AFRICA
SADC DECLARATION ON TB IN THE MINING SECTOR 18TH AUGUST 2012
We the Heads of State or CONCERNED that the mining sector is one of the hardest hit by the TB and TB/HIV
Government 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 region
The Republic of Angola RECOGNISING that the mining sector contributes to TB prevalence in the Region
The Republic of Botswana and that mineworkers are disproportionately affected by TB
The Democratic Republic of Congo
FURTHER RECOGNISING that the TB and TB/HIV epidemics in the mining sector
The Kingdom of Lesotho
are driven by many factors including high prevalence of Silicosis resulting from long
The Republic of Madagascar term exposure to silica dust in the mines and that in addition, high prevalence of
The Republic of Malawi HIV in the mines combined with generally poor living conditions of mineworkers
The Republic of Mauritius further increases the risk of contracting and developing active TB
The Republic of Mozambique
AWARE of the challenges being experiences by mineworkers and ex-mineworkers
The Republic of Seychelles
(including migrant mineworkers and contract or casual workers) their families and
The Republic of South Africa communities.
The Republic of Swaziland
The United Republic of Tanzania COMMIT to moving towards a vision of zero new infections, zero
The Republic of Zambia stigma and discrimination , and zero deaths resulting from TB,
The Republic of Zimbabwe HIV, Silicosis and other occupational respiratory diseases
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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 THAT
THE SOUTH AFRICAN MINING INDUSTRY IS RICH
WITH TB, WE FINALLY HAVE THE POLITICAL WILL IN
THE REGION TO CREATE AN EMERGENCY
RESPONSE TO ARREST ITS SPREAD.
FOR THE HEALTH OF THE REGION—AND TO
PROTECT A WORLD AT GREATER RISK FROM TB—
WE MUST SEIZE THE OPPORTUNITY AND END THIS
DISEASE.
ARCHBISHOP EMERITUS DESMOND TUTU
WALL 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.
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47. COMMUNITY HEALTH
Facilitating tangible health
improvements in local communities
and
Being a positive influence on health in
developing countries

48. THANK YOU