Impact of mining projects on environmental determinants of health and associated health outcomes in sub-Saharan Africa: insights for guiding impact assessment practice

Background: About one quarter of the global burden of disease is attributed to environmental risk factors, commonly termed environmental determinants of health (EDH). Spanning across all three dimensions of sustainable development – economy, environment and society– the EDH are a cross-cutting theme in the 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs). They include, for example, air and water pollution, housing quality, and climate factors. Sub-Saharan Africa (SSA) is among the regions carrying the largest health burden from the EDH. Large industrial mining projects can have substantial positive and negative impacts on the EDH and associated health outcomes, and hence on the SDGs, through a variety of direct and indirect pathways. Directly, mining projects can for example increase air or water pollution. Indirectly, the development of a mining project can provide livelihood opportunities that may trigger investments in housing, and improvements in water or sanitation infrastructures. Mines also attract large numbers of people potentially leading to overcrowded settlements and overburdened public infrastructures. Ideally, potential health impacts of these different pathways are systematically assessed in health impact assessments (HIA). However, the use of HIA in SSA is limited. For promoting its application, a deeper understanding of positive and negative effects of mining projects on EDH is needed.
Objectives: The overarching aim of this PhD thesis was to assess the impact of mining projects in SSA on the EDH and associated health outcomes in affected communities. More specifically, with a focus on SSA, the objectives of the thesis were to (i) quantify annual settlement growth patterns in rural mining settlements; (ii) study associations between mining projects and housing conditions and respiratory diseases in children; (iii) assess impacts of mining projects on water and sanitation infrastructures and associated child health outcomes; and (iv) determine how health is integrated in impact assessment practice of mining projects.
Research partnerships: The research is embedded in the “Health impact assessment for sustainable development” (HIA4SD) project. Six PhD students and project partners in a governance work stream conducted research on different aspects around health in resource extraction regions in different parts of SSA, supplemented with literature reviews.
Methods: The methods applied include a machine learning application for quantifying annual settlement growth patterns in mining areas. Land use classifications were done using support vector machine classifiers. Historic Google Earth imagery served as training data for the classifier that was applied to a stack of Landsat imagery to derive annual land use maps. For the assessment of the impacts of mines on household and child health indicators, all Demographic and Health Survey (DHS) datasets from SSA were merged with a comprehensive list of mines in SSA. Regression analyses were used to compare the temporal and spatial trends between impacted and comparison areas. The inclusion of health aspects in impact assessment practice was studied by a documentary analysis of impact assessment reports. These were obtained through a systematic online search and by contacting mining companies and ministries. Lastly, three videos were produced outlining the research approach and sharing community voices on the perceived impacts of mines on health.
Results: The merging of DHS data with the information on mines yielded the largest available dataset on household and child characteristics in SSA, comprising of data on more than 40,000 households and 30,000 children from 23 countries used for longitudinal analyses. Furthermore, the land use classification achieved overall accuracies between 58.5% and 95.1%, depending on training data availability and climatic conditions. The analyses showed that in mining areas, (i) no increased annual settlement growth or evidence for overcrowding was observed; (ii) access and quality of infrastructures increased; (iii) indoor smoking rates increased; and (iv) some health indicators, such as stunting and underweight, improved while wasting, diarrheal diseases, and acute respiratory infections did not differ from comparison areas. Furthermore, large differences in these impacts between countries and across socioeconomic strata were observed. In general, people from poorer households benefited less from the positive impacts on infrastructures. Screening of 44 impact assessment reports showed that (i) impact assessment practice in SSA had a strong environmental focus, putting little attention to health outcomes; (ii) there was a lack of transparency in impact assessment in the mining sector; and (iii) the collection of primary data as baseline indicators for health outcomes was rare.
Conclusions and significance: The positive impacts of mining projects on infrastructures underline the potential of the mining sector to promote community development in producer regions. However, for these positive impacts to firstly reach all societal strata and secondly translate into better health outcomes, the shortcomings of current impact assessment practice need to be addressed. Firstly, a broader consideration of health outcomes, as well as the inclusion of the wider determinants of health, should be promoted in national and international policies and legislations. Secondly, the considerations of environmental health aspects in impact assessments should look beyond the mine as only source of pollution and recognize the different indirect pathways how mining projects could affect environmental pollution. Thirdly, the particular health needs of vulnerable population groups should be addressed in an equitable manner. This should include an assessment of the root causes determining the unequal distribution of risks and benefits. Lastly, the disadvantages of secondary data identified in this thesis warrant an increased collection of primary data for impact assessment. Taken together, the findings of this PhD thesis suggest that with the right policy frameworks in place, the mining sector has the potential to make positive and substantial contributions towards achieving the 2030 Agenda for Sustainable Development. Having entered the “Decade of Action” to achieve the SDGs by 2030 while facing the challenges of a global pandemic, this opportunity should not be missed.