Investigating health impacts and equity in communities surrounding large natural resource extraction projects in sub-Saharan Africa: a contribution to sustainable development

Background: Large natural resource extraction projects (NREPs) can have positive but also negative effects on the health of surrounding communities, governed by demographic, economic, environmental, physical and social changes. Health impact assessment (HIA) is a decision-support tool that aims at maximizing benefits and minimizing negative impacts on people's health. Yet, HIA is underutilized in sub-Saharan Africa, where about a third of the remaining world’s mineral reserves are located. In the frame of a larger research project, this PhD project is a contribution to strengthen HIA in sub-Saharan Africa by generating scientific evidence about perceived health impacts of mining industries on local populations. Specifically, the work presented focuses on the social determinants of health and health equity in communities next to industrial mining sites.
Objectives: The following five specific objectives were pursued: (i) to assess whether and to what extent is HIA utilized to address health equity in the context of NREPs in sub-Saharan Africa; (ii) to explore community member’s perception of the mechanisms through which their health has been affected by mining projects and to identify health implications of different extraction settings in Burkina Faso, Mozambique and Tanzania; (iii) to understand how NREPs influence the wider environmental, economic and social determinants of health and how the respective health outcomes are distributed in communities, with a focus on the differences between men and women; (iv) to deepen the understanding of health equity in communities next to industrial mining projects; and (v) to investigate how mining projects affect the health of local communities through impacts on water and water infrastructure by combining qualitative and quantitative data.
Methodology: The first objective was addressed with a literature review scrutinizing health and health equity of different population groups in impact assessment guidelines and peer-reviewed literature pertained to impact assessment in areas of natural resource extraction. All other objectives were based on a qualitative field study with affected communities in Burkina Faso, Ghana, Mozambique and Tanzania. More specifically, we conducted participatory focus group discussions (FGDs) in 12 study sites in the four countries. For the fifth objective, an additional set of geo-referenced qualitative data from two study sites in Tanzania were integrated and triangulated with geo-referenced quantitative data.
Principal findings: The literature review showed that health equity is addressed in impact assessment by looking into different population groups. However, specific guidance for community stratification and evidence pertained to differential health impacts remains weak. Drawing on the perception of affected communities from the different countries, the implementation of the mine induces changes on various aspects of environmental, social and economic determinants of health, which consequently affected their perceived health and well-being. Negative changes for their health and well-being prevailed, while particularly women were affected disproportionally. Positive changes were primarily related to interventions such as new health centers or water access points, yet benefits were not distributed equally among impacted communities. Engaging with affected communities revealed concerns about water quality and availability, which were hidden in the positive trend of water infrastructure in mining regions.
Conclusion: HIA is a promising approach to systematically address health impacts and their distribution among affected population groups. However, the predominating negative perception of affected communities indicates a gap between theory and practice. Hence, there is pressing need to strategically manage health impacts of large NREPs with particular attention on most marginalized population groups. Especially in the light of the 2030 Agenda for Sustainable Development, HIA offers a unique opportunity. Adopted by the countries’ legislation, commissioned by the extractive industries and driven by the citizens HIA hold promise to act on wider determinants of health, which is needed to reduce health inequities and ultimately contribute to good health and well-being for all. To foster the institutionalization of HIA, this PhD thesis lays a foundation for the forthcoming policy dialogue to promote the application and uptake of HIA in producer regions in sub-Saharan Africa.