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U n i v e r s a l h e a l t h c o v e r a g e a n d c ommu n i c a b l e d i s e a s e s alcoholism, crime, domestic and communal violence, and drug abuse. These can have a long-term adverse effect on local community mental health and well-being. A Tanzanian mining project exacerbated local social issues such that it precipitated a breakdown in law and order, and helped lead to general civil unrest. The influx of economic migrants, local underdevelopment and an increase in criminal activity undermined the ability of the project to operate effectively and securely, thus adversely affecting community health by affecting both local livelihoods and the safety of local communities (Barrick Gold Corporation, 2011). Changes to the local landscape and ecosystem can create or increase the amount of ideal habitat for disease vectors, such as mosquitoes, filth flies and snails, and lead to an increase in malaria, cholera, schistosomiasis and other vector-borne diseases. Contamination of the environment with hazardous substances, such as mercury, lead, arsenic and other toxic metals, can lead to acute and chronic poisoning. In Nigeria, lead poisoning linked to unregulated artisanal copper mining activity led to the deaths of more than 160 people, mainly children. The long-term environmental legacies of extractive projects can also have a significant impact on the health of communities that can take decades to manifest. Physical resettlement can have adverse effects on existing social structures, and the physical and mental health of local communities. While economic displacement, associated with local people’s inability to apply for jobs on extractive projects due to lack of skills, for example, often results in missed opportunities for harnessing some of the most direct and immediate positive health benefits from such projects, as well as generating local resentment and distrust. The increase in project-related road traffic, with the associated increase in the risk of road-traffic-related injuries and deaths, air pollution, noise and motor vehicle-related soil and water pollution, and the potential employment- and spill-related exposure to chemical, biological and physical hazards, are other potential community health and safety risks. Negative community health impacts can also adversely affect project sustainability by making the investment climate less attractive, increasing the cost of doing business and posing serious reputational risks for companies. Government authorities, in turn, face the risk of inheriting large community health burdens left behind by poorly managed and unsustainable projects. Translating opportunities into tangible benefits for communities, companies and governments HIA is a key systematic approach to predicting the magnitude and significance of the possible health and well-being impacts, both positive and negative, of new plans and projects. HIAs use a range of structured and evaluated sources of qualitative and quantitative evidence that includes public and other stakeholders’ perceptions and experiences as well as public health, epidemiological, toxicological and medical knowledge. HIAs are particularly concerned with the distribution of effects within a population – as different groups are likely to be affected in different ways – and therefore look at how health and social inequalities might be reduced or widened by a proposed policy, programme or project. HIAs provide a process through which an extractive project can design out or minimise the potentially negative impacts on community health and well-being by understanding the direct and indirect implications of project activities. It can help to engage local, regional and national health, social care and welfare services to jointly address existing community health problems, and anticipate and help to prevent potential future ones caused by a project. It also supports the project’s stakeholder engagement process by helping to build trust, draw out community concerns and generate a dialogue with communities and public health officials about the best ways that the project can protect and improve the health of local communities. HIAs can also help to define the specific roles and responsibilities of key stakeholders in addressing community health and well-being, specifically pointing to what role the project can play in supporting the national or local health authority to fulfil its mandate of providing public health and health care services to local communities, thus contributing to health systems’ strengthening and the progressive achievement of universal health coverage. In many settings, community health and project worker health are inextricably linked with important implications for project workforce productivity and the social licence to operate. Hence, interventions that benefit workers’ health can also benefit local communities. For example, in malaria-affected areas, projectsupported public–private partnership programmes that provide malaria prevention and treatment to both local communities and project workers tend to be cost-effective for both worker productivity and non-project-linked local economic development. In Ghana, a mining company recognised malaria as a significant public health threat, with 20 per cent of its employees absent due to malaria at any one time. By developing a large integrated worker and community malaria programme, a 73 per cent reduction in the local incidence of malaria was achieved in two years. Another project demonstrated a positive return on investment in a two-year period due to malaria control interventions (Knight, no date). Similarly, where HIV prevalence is high, companies often need to back local sexual and reproductive health services to support employee productivity and reduce ill health as well as reducing the impact on surrounding communities. A public–private partnership, jointly funded by a mining company and an international aid agency, established a high-functioning ‘hub and spoke’ network of health facilities linked to community organisations in the Democratic Republic of Congo (DRC). This network provided a broad continuum of treatment, community care and support services for people living with HIV (ICCM, 2013). The 2014–15 Ebola outbreak in West Africa is a reminder of the importance of a universal, comprehensive and functioning health care system for protecting workers, local communities around projects and the population as a whole. The creation of meaningful and effective partnerships between national and local governments, civil society and other institutions, and extractive sector companies can maximise community health benefits through influencing the design and delivery of communitybased environmental, social and health programmes. HIA is one important means of developing and supporting such partnerships and programmes. 70 Commonwealth Health Partnerships 2015


Commonwealth Health Partnerships 2015
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