- Occupational lung diseases and tuberculosis have declined significantly across South Africa’s mining industry over the past decade.
- Noise exposure, heat stress and inconsistent implementation of prevention measures continue to threaten worker health.
- Rising non-communicable diseases, mental health disorders and poor health data quality pose the industry’s next major challenge.
Examining occupational health and safety trends in South African mining requires a critical, data-driven narrative that recounts key indicators while interrogating the forces shaping them.
From 2016 to 2025, regulatory interventions, epidemiological shifts and persistent structural challenges interacted in complex ways. The central question is whether these changes amount to genuine improvement across mine health and safety.
Occupational exposures continue to be dominated by three hazards: airborne pollutants, excessive noise and heat. These directly influence the prevalence of occupational lung diseases, noise-induced hearing loss and heat-related disorders.
Lung disease and tuberculosis show remarkable declines
Reported occupational lung diseases have declined markedly over the past decade. Asbestosis cases fell from 635 in 2016 to just 12 by 2021.
Pulmonary tuberculosis among mineworkers has followed a similar trajectory, dropping from 2,580 reported cases in 2017 to 839 in 2023. This represents a significant achievement given mining’s historical tuberculosis burden, driven largely by silica dust exposure and high rates of HIV co-infection.
These improvements align with broader industry trends. The Department of Mineral and Petroleum Resources reported a 17% decline in occupational disease cases, from 2,233 in 2023 to 1,864 in 2024, while the Minerals Council recorded a 72% reduction in incidence since 2014. Even so, occupational disease notifications remain lagging indicators because surveillance, diagnosis and disease latency continue to influence reporting.
The persistent threat of noise and heat
Noise exposure remains one of mining’s most pervasive occupational risks. More than 234,000 employees are exposed to sound levels above the occupational exposure limit of 85 dB(A), with the platinum group metals sector accounting for the largest share.
Despite hearing conservation programmes and engineering controls, reported cases of noise-induced hearing loss have not declined consistently. Cases peaked at 966 in 2019 before fluctuating, with 702 cases still reported in 2024.
This suggests that prevention measures have reduced some risk, but implementation gaps remain, particularly in gold and platinum operations where exposure levels are highest.
Recognising this challenge, tripartite stakeholders adopted ambitious 2034 milestones in 2024. These include limiting equipment emissions to 104 dB(A) and preventing new cases of noise-induced hearing loss among workers entering the industry from 2025. The targets reinforce a shift towards engineering controls as the primary prevention strategy, rather than relying on personal protective equipment or post-exposure monitoring.
Heat exposure presents another ongoing concern, especially in deep-level gold and platinum mines. The proportion of employees exposed above occupational heat limits continues to vary across commodities and years, reflecting both climatic conditions and the effectiveness of ventilation and cooling systems.
A changing disease burden
Medical incapacity resulting from occupational diseases declined substantially from 2,741 cases in 2017 to 440 in 2021, indicating meaningful gains in prevention and earlier intervention.
However, the burden of non-occupational illness has grown sharply. Between 2021 and 2025, reported metabolic conditions, including hypertension, obesity and dyslipidaemia, increased from 79,319 cases to 188,222. Diabetes mellitus also continued its upward trend, reaching 17,632 reported cases in 2025.
Mental health disorders, although still widely underreported, more than doubled during the same period, rising from 599 cases in 2021 to 1,289 in 2025. The increase reflects broader societal pressures while highlighting the psychosocial demands of mining work, including shift schedules, job insecurity and repeated exposure to traumatic incidents.
Mortality data reveals a critical blind spot
The industry recorded 816 natural deaths across mining commodities in 2025. Gold, platinum and coal operations accounted for nearly three-quarters of these fatalities.
Although one in five deaths was attributed to non-communicable diseases or chronic conditions, 76.6% lacked sufficient detail for reliable classification. This absence of accurate cause-of-death information significantly limits targeted health interventions and exposes weaknesses in surveillance and reporting systems.
HIV and TB programmes continue to deliver results
Infectious disease control remains one of the strongest areas of occupational health performance.
By 2025, 85.9% of mine employees had received HIV counselling and 67% had undergone testing. The HIV positivity rate fell to a record low of 1.8%, with the platinum sector consistently achieving the highest counselling and testing coverage.
Tuberculosis screening reached 97.1% of employees, and every diagnosed case was initiated on treatment. Multidrug-resistant tuberculosis stabilised between 2% and 4%, while extensively drug-resistant tuberculosis became virtually non-existent.
The industry’s tuberculosis incidence rate fell to 178 cases per 100,000 people in 2025, the lowest level on record. Although this is substantially below South Africa’s broader national burden, the gold sector continues to face concentrated risk with an incidence rate of 348 per 100,000.
The reforms mining still needs
Despite measurable progress, several systemic weaknesses continue to undermine occupational health outcomes. Prevention gaps remain evident in exposure control and risk assessment, while inconsistent data quality limits the ability to identify emerging trends and respond effectively.
Fragmented health programmes often separate occupational disease prevention from broader workforce wellness, even as chronic illness and mental health become increasingly significant contributors to incapacity. Smaller mining operations also face financial constraints that limit the expansion of successful tuberculosis and HIV interventions.
Strengthening engineering controls, improving integrated health data systems, closing corrective-action gaps and fostering collaboration between occupational hygienists, ventilation engineers and occupational medicine specialists will be essential. Equally important is expanding prevention beyond traditional occupational hazards to include non-communicable diseases and mental wellbeing.
Progress worth protecting
The evidence presents a nuanced picture. South Africa’s mining industry has achieved genuine gains in tuberculosis control and the reduction of occupational lung diseases, demonstrating that sustained investment and coordinated public health interventions can deliver measurable results.
Yet progress remains uneven and fragile. Persistent noise exposure, the rapid rise of chronic illness and mental health disorders, and enduring accountability and data gaps threaten to erode these achievements. A healthier workforce is not only a public health imperative but also the foundation of safer operations, greater productivity and the long-term resilience of the mining industry.
Dr Clarence Tshitereke is an honorary professor at Unisa’s Thabo Mbeki School of Public & International Affairs and Chief of Staff in the Ministry of Minerals and Petroleum Resources. He writes in his capacity as part of the Government Communication and Information System.
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