The history of health surveillance in the NSW coal industry reflects ongoing efforts to address worker health risks, particularly those related to dust exposure and respiratory diseases.
From the early 20th century, a series of Royal Commissions highlighted the need for regulatory oversight, leading to the establishment of the Joint Coal Board in 1946. Over the decades, key initiatives such as medical surveillance programs, legislative reforms, and the introduction of health assessment orders have evolved to improve coal mine worker health outcomes. These measures have been strengthened over time in response to emerging health concerns, including the re-identification of coal workers’ pneumoconiosis (CWP) and cardiovascular risks, ensuring ongoing protection for the coal industry workforce.
1929-1945
Three Royal Commissions reviewed issues in the coal industry. In 1929, a regulatory board was recommended, and in 1939 and 1945, commissions led to amendments in regulations, mechanisation, and the
creation of the Joint Coal Board (JCB).
1946
The Joint Coal Board (JCB) was established in 1946 under an arrangement between the Commonwealth and NSW governments, in accordance with the provisions of the Coal Industry Act 1946 (Cth) and
the Coal Industry Act 1946 (NSW).
At the time, dust was a major problem in coal mining because of the very limited dust control measures in place. In 1946, dust-related lung disease was prevalent in the NSW coal mining workforce with an estimated 16% of coal mine workers understood to have coal workers pneumoconiosis at the time and some employers were being levied over 40% for workers compensation premium as a result.
1947-1948
The JCB commenced operations in 1947 and focused on addressing dust-related problems through medical surveillance, promoting dust control measures, and managing the related compensation issues.
The JCB established medical bureaus in each major NSW coal region to perform regular medical examinations of the workforce and examination of new entrants to identify and remove ‘dusted’ workers; and protect those at risk. At the same time, rehabilitation services were established for those who were ill, and an extensive medical research and post-mortem program established.
First annual report of the Joint Coal Board 1947-48The JCB was committed to 'the elimination of health hazards, such as the incidence of dust' so that 'all men in the industry will know that everything possible is being done to protect them from occupational complaints.'
2001-2002
The JCB ceased operations in December 2001. On 1 January 2002 the Coal Industry Act 2001 (NSW) was enacted. The legislation included provisions for Coal Services Pty Limited and its subsidiary entities (Coal Services) to undertake the functions formerly performed by the JCB and the NSW Mines Rescue Board.
2009
Coal Services strengthened health surveillance requirements after poor coal mine worker attendance and identified issues with pre-employment medicals, especially for workers from overseas or other states.
2011
Order 41 was introduced in February 2011 to formalise and provide minimum guidelines for health assessments for the coal industry in line with other safety critical industries such as rail, road transport and aviation as well as fire brigades, police and ambulance.
2015-2017
In late 2015, it was confirmed that several cases of Coal Workers Pneumoconiosis (CWP) had been diagnosed amongst the Queensland coal industry workforce. The evidence showed significant systemic
failures in the Queensland health surveillance system. Coal Services subsequently commissioned two independent reviews of Order 41 medicals against what would be considered best practice in the
health surveillance setting. The reviews verified the quality and rigour of the Order, but also provided recommendations to further strengthen the systems and process in place. Industry consultation took place on a number of proposed changes to the medical content of Order 41.
2018
NSW Coal Order 43 (Order 43) was approved by the Minister under the Coal Industry Act 2001 (NSW) and came into effect on 1 July 2018. The changes were made to strengthen the heath surveillance system and to align with other workplace legislation to provide ongoing protection for the health of these workers.
2020
CS Health implemented the Cardiovascular Risk Management Guidelines for the NSW coal industry (the guidelines) on 1 January 2020 following an assessment of medical data showed that a significant proportion of the industry’s workforce had multiple risk factors for cardiovascular disease. The assessment of cardiovascular risk had been a routine element of an Order 43 medical for many years; however, there had not been an agreed guideline for the assessing doctors on how to manage coal mine workers who presented with elevated risk factors. The guidelines apply a standardised approach to the health and safety risks posed by increased cardiovascular risk.
2021
The initiative to streamline and enhance Order 43 was prompted by an internal review and industry feedback in relation to service provision and process. Initial consultation commenced in 2021 regarding areas of the Order that could be further improved.
2022-2023
In 2022, the NSW Government (Department of Regional NSW) engaged the University of Illinois School of Public Health to undertake an independent quality assurance review of the NSW Health Surveillance Scheme for Coal Mine Workers. The independent review was a recommendation of, and overseen by, the NSW Mine Safety Advisory Council (MSAC).
The final report found that CS Health has a robust system of medical health surveillance and noted the considerable improvements made to the scheme since the re-identification of black lung in Australia in 2015. The report also included recommendations to consider to strengthen the scheme.
2024
Coal Services introduced the NSW Coal Industry Respiratory Health Standard (the Respiratory Health Standard) in August 2024. It contains current best practice medical guidelines and management protocols for when a coal mine worker presents with abnormalities with their chest x-ray or spirometry. The Respiratory Health Standard was developed to ensure consistent decision making from Order 43 medical practitioners and to support the implementation of the MSAC Review recommendations.
2025
Industry consultation continued throughout 2024 and early 2025 regarding updates to Order 43. It is anticipated that the updated Order will be released in early 2026. The co-designed Order will continue to protect the health of coal mine workers through regular monitoring and early detection of occupational and non-occupational health issues.
