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

Investigating health impacts of natural resource extraction projects in Burkina Faso, Ghana, Mozambique, and Tanzania: protocol for a mixed methods study

Natural resource extraction projects offer both opportunities and risks for sustainable development and health in host communities. Often, however, the health of the community suffers. Health impact assessment (HIA) can mitigate the risks and promote the benefits of development but is not routinely done in the developing regions that could benefit the most.; Our study aims to investigate health and health determinants in regions affected by extractive industries in Burkina Faso, Ghana, Mozambique, and Tanzania. The evidence generated in our study will inform a policy dialogue on how HIA can be promoted as a regulatory approach as part of the larger research initiative called the HIA4SD (Health impact assessment for sustainable development) project.; The study is a concurrent triangulation, mixed methods, multi-stage, multi-focus project that specifically addresses the topics of governance and policy, social determinants of health, health economics, health systems, maternal and child health, morbidity and mortality, and environmental determinants, as well as the associated health outcomes in natural resource extraction project settings across four countries. To investigate each of these health topics, the project will (1) use existing population-level databases to quantify incidence of disease and other health outcomes and determinants over time using time series analysis; (2) conduct two quantitative surveys on mortality and cost of disease in producer regions; and (3) collect primary qualitative data using focus groups and key informant interviews describing community perceptions of the impacts of extraction projects on health and partnership arrangements between the projects and local and national governance. Differences in health outcomes and health determinants between districts with and without an extraction project will be analyzed using matched geographical analyses in quasi-Poisson regression models and binomial regression models. Costs to the health system and to the households from diseases found to be associated with projects in each country will be estimated retrospectively.; Fieldwork for the study began in February 2019 and concluded in February 2020. At the time of submission, qualitative data collection had been completed in all four study countries. In Burkina Faso, 36 focus group discussions and 74 key informant interviews were conducted in three sites. In Ghana, 34 focus group discussions and 64 key informant interviews were conducted in three sites. In Mozambique, 75 focus group discussions and 103 key informant interviews were conducted in four sites. In Tanzania, 36 focus group discussions and 84 key informant interviews were conducted in three sites. Quantitative data extraction and collection is ongoing in all four study countries. Ethical approval for the study was received in all four study countries prior to beginning the fieldwork. Data analyses are underway and results are expected to be published in 2020 and 2021.; Disentangling the complex interactions of resource extraction projects with their host communities requires an integrative approach drawing on many methodologies under the HIA umbrella. By using complementary data sources to address the question of population health in project areas from several angles, bias and missing data will be reduced, generating high-quality evidence to aid countries in moving toward sustainable development.; DERR1-10.2196/17138

Health in the 2030 Agenda for Sustainable Development : from framework to action, transforming challenges into opportunities

The critically important role of health for development was underlined in the 16th World Development Report entitled “Investing in health”, published in 1993 [1]. Put forth by the World Bank and enhanced with input from the World Health Organization (WHO), the report examined the interplay between human health, health policy, and economic development. In the period 2000-2015, health for development was strongly emphasized in the Millennium Development Goals (MDGs). Indeed, three of the eight MDGs explicitly featured health [2]. Meanwhile, major achievements have been made in population health. For instance, average global life expectancy has increased by more than 20 years between 1950 and 2010 [3]. Yet, there are areas of unfinished business, such as reducing child mortality and improving maternal health [4]. Key vulnerable groups, such as the poorest and most isolated populations, have been left excluded and marginalized [4,5]. In addition, there are new challenges, as for instance non-communicable diseases have surpassed infectious diseases in terms of global burden [6], novel infectious threats from zoonoses [7] and anti-microbial resistance [8] have emerged, there are toxic mixtures of chemicals compromising human, animal, and ecosystem health, while climate change, urbanization, and migration have amplified health problems and vulnerabilities [9]. Taken together, there are multifactorial stresses that ask for innovative, multi-partner, integrated approaches.ISSN:2047-298

P2P Library in Golang (SA)

TomP2P ist eine Peer to Peer (P2P) Library, die eine Distributed Hash Table (DHT) für verteilte Anwen-dungen bereitstellt. Die Realisierung der Library in der Programmiersprache Java und die Verwendung des Internetprotokolls TCP verlangsamen die Applikation. Im Gegensatz dazu, bietet das neue QUIC-Protokoll mit seinem intelligenten Congestion Control Algorithmus eine performantere und auf die heu-tigen Anforderungen zugeschnittene Alternative. Sie ist allerdings wegen ihres breiten Anwendungs-spektrums sehr komplex. Entwickelt werden soll deshalb ein auf UDP aufbauendes Protokoll, das die Zuverlässigkeit von TCP sicherstellt und zur Congestion Control den «Bottleneck Bandwidth and Round-trip propagation time» (BBR) Algorithmus von QUIC verwendet. Für die sichere Übertragung der Daten von P2P soll das Noise-Framework zum Einsatz kommen. Zu Beginn wurde basierend auf dem UDP-Protokoll ein Automatic Repeat reQuest (ARQ) Protokoll in der Entwicklungsumgebung Goland realisiert. Parallel dazu wurde eine Testumgebung aufgebaut, welche die Implementation integral auf die Standard- und Spezialfälle hin testet. Die Continuous Integration (CI) erfolgte auf einer virtuellen Maschine der OST mit Gitlab CI. Im späteren Verlauf wurde die für die BBR unverzichtbare Delivery Rate Estimation entwickelt. Die Korrekheit wurde anschliessend auf dem Internet mithilfe von GCloud getestet und interaktiv verbessert. Gegen Ende wurde die Security mit dem Noise-Framework realisiert. Die entwickelte Lösung erlaubt eine sichere, performante und zuverlässige Kommunikation zwischen mehreren Peers

Haskell Substitution Stepper (BA)

Functional programming languages such as Haskell are fundamentally different from imperative languages. While Haskell code is very expressive and elegant, the language involves a steep learning curve. Concepts like higher-order functions, lazy evaluation and recursion are difficult to teach. Moreover, debugging a functional language is more difficult due to a less intuitive execution model compared to imperative languages. This thesis presents the implementation of the „Haskell Substitution Stepper“, a tool aiming to address those issues. The goal is to create an environment in which developers can analyze Haskell expressions. To achieve this, the evaluation of those expressions is done step by step, and an explanation for each reduction is given. Such step by step reductions are often printed in textbooks to help understand a small program. The first step was to research how the Glasgow Haskell Compiler (GHC) transforms and evaluates expressions in the backend. Existing similar solutions were assessed and ideas for improvement were collected. Finally, the „Haskell Substitution Stepper“ was implemented using the intermediate representation „Core“ from GHC. The result is a command line application. Developers can load a source file with Haskell expressions into the stepper and see the individual reduction steps. The tool can be used for debugging or to better understand specific Haskell expressions. While the stepper is using the Core intermediate representation for the reduction, the result can be pretty printed in a format that looks like regular Haskell code

Health impact studies of climate change adaptation and mitigation measures – A scoping review

Climate change affects both mental and physical health. Besides limiting the extent and consequences of climate change, mitigation and adaptation measures can have additional and potentially unintended health impacts. This scoping review outlines how health effects of climate mitigation and adaptation measures have been studied in the scientific literature. We conducted a systematic literature search in the databases PubMed, Scopus and Web of Science without time restriction. All peer-reviewed articles reporting quantified health impacts linked to specific climate change adaptation and mitigation measures were included. Overall, the 89 included articles considered only a narrow range of health determinants and health outcomes. Adaptation- and mitigation-related articles most frequently investigated the environmental health determinants air temperature and air pollution, respectively. Non-communicable diseases were predominantly studied while other relevant health outcome categories, such as mental health, food- and nutrition-related issues, and communicable diseases were rarely reported. The scarcity of studies focusing on the social health determinants and providing stratified health impacts among vulnerable population groups in assessments points to an inadequate consideration of health equity aspects. Increased efforts to quantify health impacts more comprehensively and to identify underlying vulnerability factors among specific population groups seem needed. This information could provide policymakers with more accurate evidence to address health equity aspects, limit adverse health impacts and promote health co-benefits of climate change adaptation and mitigation measures

Daily variation of heavy metal contamination and its potential sources along the major urban wastewater channel in Kampala, Uganda

Heavy metal pollution from untreated industrial wastewater has become a major concern to the environment and public health in many rapidly growing cities in low-income countries. Previous studies on heavy metals of urban wastewater systems have focused on long-term (weekly or seasonal) variations, while only few studies investigated short-term (daily) variation to capture potential bulk discharges. To monitor and enforce wastewater discharge regulations and reduce industrial pollution, a better understanding of the short-term variation of these pollutants and industrial discharge practices is needed. The aim of this study is to assess the daily variation of heavy metals and physicochemical parameters along the major urban wastewater system in Kampala, Uganda. Over 1 week, daily water samples were collected at 16 locations and analyzed for lead (Pb), mercury (Hg), copper (Cu), and chromium (Cr) and a range of physicochemical parameters. Additionally, 25 key informant interviews with industries were administered to investigate their potential to contaminate the environment. Among 78 water samples, 29 exceeded the national standards for Pb (> 0.1 mg/L) and one for Hg (> 0.01 mg/L). High daily variation and peak concentrations were detected which are likely due to industries retaining their effluents and discharging them irregularly. Although 24 industries used heavy metals in their manufacturing processes and are likely to discharge heavy metals, only ten industries had a wastewater treatment system in place. Our results show that repeated measurements of heavy metals over short time intervals are needed to capture their high daily variation in an urban wastewater system. Furthermore, there is an urgent need to register industries and to assess their effluent composition in order to select appropriate wastewater management measures

Daily variation of heavy metal contamination and its potential sources along the major urban wastewater channel in Kampala, Uganda

Heavy metal pollution from untreated industrial wastewater has become a major concern to the environment and public health in many rapidly growing cities in low-income countries. Previous studies on heavy metals of urban wastewater systems have focused on long-term (weekly or seasonal) variations, while only few studies investigated short-term (daily) variation to capture potential bulk discharges. To monitor and enforce wastewater discharge regulations and reduce industrial pollution, a better understanding of the short-term variation of these pollutants and industrial discharge practices is needed. The aim of this study is to assess the daily variation of heavy metals and physicochemical parameters along the major urban wastewater system in Kampala, Uganda. Over 1 week, daily water samples were collected at 16 locations and analyzed for lead (Pb), mercury (Hg), copper (Cu), and chromium (Cr) and a range of physicochemical parameters. Additionally, 25 key informant interviews with industries were administered to investigate their potential to contaminate the environment. Among 78 water samples, 29 exceeded the national standards for Pb (> 0.1 mg/L) and one for Hg (> 0.01 mg/L). High daily variation and peak concentrations were detected which are likely due to industries retaining their effluents and discharging them irregularly. Although 24 industries used heavy metals in their manufacturing processes and are likely to discharge heavy metals, only ten industries had a wastewater treatment system in place. Our results show that repeated measurements of heavy metals over short time intervals are needed to capture their high daily variation in an urban wastewater system. Furthermore, there is an urgent need to register industries and to assess their effluent composition in order to select appropriate wastewater management measures

Estimating the mortality burden of large scale mining projects-Evidence from a prospective mortality surveillance study in Tanzania.

We set up a mortality surveillance system around two of the largest gold mines in Tanzania between February 2019 and February 2020 to estimate the mortality impact of gold mines. Death circumstances were collected using a standardized verbal autopsy tool, and causes of death were assigned using the InSilicoVA algorithm. We compared cause-specific mortality fractions in mining communities with other subnational data as well as national estimates. Within mining communities, we estimated mortality risks of mining workers relative to other not working at mines. At the population level, mining communities had higher road-traffic injuries (RTI) (risk difference (RD): 3.1%, Confidence Interval (CI): 0.4%, 5.9%) and non-HIV infectious disease mortality (RD: 5.6%, CI: 0.8%, 10.3%), but lower burden of HIV mortality (RD: -5.9%, CI: -10.2%, -1.6%). Relative to non-miners living in the same communities, mining workers had over twice the mortality risk (relative risk (RR): 2.09, CI: 1.57, 2.79), with particularly large increases for death due to RTIs (RR: 14.26, CI: 4.95, 41.10) and other injuries (RR:10.10, CI: 3.40, 30.02). Our results shows that gold mines continue to be associated with a large mortality burden despite major efforts to ensure the safety in mining communities. Given that most of the additional mortality risk appears to be related to injuries programs targeting these specific risks seem most desirable

Water and health in mining settings in sub-Saharan Africa: A mixed methods geospatial visualization

Industrial mining transforms local landscapes, including important health determinants like clean water and sanitation. In this paper, we combined macro-level quantitative and micro-level qualitative data to show how mining projects affect water infrastructures and ultimately the health of affected communities. Although we observed a positive trend of water infrastructure in mining settings, surrounding communities are also characterized by water scarcity and degradation of water quality. The video at the core of this publication showcases inter-linkages of the findings obtained at both the macro- and the micro-levels, embedding our results in a geospatial context. While mining projects can have positive impacts on the development of local water infrastructure, improved management of negative impacts of mining projects is needed for promoting 'Good health and well-being' and 'Clean water and sanitation' as promulgated by the Sustainable Development Goals of the 2030 Agenda.ISSN:1827-1987ISSN:1970-709