Health impact assessments: Communities and extractive industries in Africa The global demand for non-renewable natural resources, i.e. minerals, oil and natural gas, is increasing. This has led to an acceleration in the development and expansion of extractive projects in Africa. Countries in Africa have an opportunity to use their natural resources as an important agent of positive economic and social development (APP, 2013). However, the inherent challenges, opportunities and risks that extractive industries pose need to be better anticipated and managed. Economic prosperity – locally, regionally and nationally – must also be balanced alongside environmental, social and health protection. Community health is both a prerequisite and an objective of sustainable project development and management. A health impact assessment (HIA), complemented by an environmental and social impact assessment, can help to protect and promote community health as part of a project’s sustainability objectives. It provides an important mechanism for maximising the positive impacts, and minimising the negative impacts, on community health and wellbeing associated with natural resource extraction projects. It enables tangible benefits to be realised for local communities, companies and governments by supporting this key component of sustainability across an extractive project’s whole lifecycle. A range of organisations have provided international support for HIAs being undertaken as part of extractive projects. These include the International Council on Mining and Metals (ICMM), the International Petroleum Industry Environmental Conservation Association (IPIECA), the International Association of Oil and Gas Producers (OGP), the World Health Organization (WHO) and the International Finance Corporation (IFC). The main driver for conducting HIAs in private-sector projects has been multilateral financial institutions’ lending requirements, i.e. the IFC’s Performance Standard 4 and the Equator Principles. In some cases, the driver has also been an extractive sector business’s internal social responsibility commitments or sustainability policies and standards (Viliani and Clarke, 2013). Though the application of HIAs is increasing, the lack of a regulatory framework in many countries, coupled with project financing that does not fully consider sustainability principles, means that community health risks and impacts are often not fully recognised or properly managed. This is true in many small- to medium-sized extractive projects and some larger scale projects as well. Community health challenges of extractive sector projects in low- and middle-income countries In Africa, countries carry a significant burden of disease and are often disproportionally affected by traditional communicable diseases, particularly in the tropics. However, the emergence of non-communicable diseases is also taking root. This generates a double burden on public health and health care systems in these countries in a context that already lacks the financial resources and organisational capacity to cope with either individually. It is against this backdrop that extractive projects can have significant and longterm positive impacts on community health and well-being by improving local, regional and national economic vitality through jobs in the project itself or ancillary businesses, improved local infrastructure and social investment programmes. However, they can also bring with them a range of unintended effects, especially if they are located near rural under-served communities with weak public services and a burden of disease higher than that of similar urban communities or the national average. Social and cultural challenges may occur alongside economic and environmental change, with vulnerable groups being particularly susceptible to changes associated with sudden economic and infrastructure development that can occur with extractive projects. This can amplify existing environmental, social and economic challenges, leading to a range of health and wellbeing impacts in communities that are already stretched, have little spare coping and adaptive capacity, and where there is limited institutional capacity in public health services to anticipate or respond to such impacts. Project-induced influx is one such impact and a common feature of many extractive projects due to their potential economic benefits. For example, a community in proximity to a mine in Mali grew from 850 inhabitants to more than 10,000 inhabitants in the space of ten years. This kind of rapid development is rarely anticipated and urban/regional planning often cannot, or does not, keep pace, leading to an increase in the transmission of infectious diseases, such as HIV/AIDS, tuberculosis and malaria; inflation in the prices of essential local foods, with an impact on basic nutrition; demand and unplanned pressure on existing social and health care services; and pressure on existing water resources and sanitation infrastructures that lead to soil- and water-transmitted diseases. Lack of urban planning can also limit the ability to support basic amenities such as emergency access in the event of fires, as occurred in communities that mushroomed along the transport corridor of the Chad/Cameroon oil pipeline. Migration of people can also introduce infectious diseases. A study conducted by the World Bank found that migrant miners in Swaziland and Lesotho were 15 per cent more likely to be HIV positive than the population as a whole, and women whose partner was a migrant mine worker tended to have an eight per cent higher chance of being HIV positive (Corno and de Walque, 2010). Changes in social structures, values and norms due to an increase in disposable income – and the influx of people with different social and cultural values – can exacerbate social ills such as Commonwealth Health Partnerships 2015 69 Filipe Silva, Mark Divall, Francesca Viliani and Salim Vohra
Commonwealth Health Partnerships 2015
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