Abstract
BackgroundNatural resource extraction projects can have positive but also negative effects on the health of affected communities, governed by demographic, economic, environmental, physical and social changes. Negative effects often prevail and these might widen existing health inequities. Health impact assessment (HIA) is a decision-support tool that aims at maximizing benefits and minimizing negative impacts on people's health. A core value of HIA is equity; yet, little is known about health equity in the frame of HIA, particularly in sub-Saharan Africa. MethodologyWe conducted a scoping review to determine whether and to what extent HIA in sub-Saharan Africa addresses health equity. We included peer-reviewed publications and guidelines pertaining to HIA, environmental impact assessment (EIA) and social impact assessment (SIA). Health equity was investigated by identifying (i) how health considerations were addressed and (ii) whether health was stratified by subgroups of the community. ResultsOut of 1′640 raw hits, we identified 62 articles (16 HIA, 36 EIA, one SIA and nine integrated assessments), 32 of which specifically addressed health. While 20 articles focused on a specific health topic, 12 articles used a more comprehensive approach to address health. In 15 articles there were specific subgroup analyses (e.g. mothers, children or marginalized groups) as a measure of health equity. Another 12 papers referred to the community in a more general way (e.g. affected). Without exception, health was an integral part of the nine included guidelines. HIA guidelines addressed health systematically through environmental health areas, risk assessment matrix or key performance indicators. ConclusionsWe found evidence that previously conducted HIA in sub-Saharan Africa and current guidelines address health equity. However, there is a need to stratify community subgroups more systematically in order to determine health differentials better. Future HIA should consider community heterogeneity in an effort to reduce health inequities by “leaving no one behind”, as suggested by the Sustainable Development Goals.
Highlights
Natural resource extraction projects (NREPs) in sub-Saharan Africa have the potential to foster economic and social development, and play a role in the current era of the Sustainable Development Goals (SDGs) (UNDP, 2016)
The work presented here is guided by the overarching question: “Whether and to what extent is Health impact assessment (HIA) utilized to address health equity in the context of NREP in sub-Saharan Africa?” by means of a scoping review, we aimed to evaluate how the health of different population groups is integrated in impact assessment for NREPs in sub-Saharan Africa
By triangulating the analysis of the HIA peer-reviewed literature and guidelines included in our review, we found evidence that HIA for NREPs in sub-Saharan Africa is underpinned by a consistent and field approved methodology across different guidelines, including equity as a core value
Summary
Natural resource extraction projects (NREPs) in sub-Saharan Africa have the potential to foster economic and social development, and play a role in the current era of the Sustainable Development Goals (SDGs) (UNDP, 2016). NREPs can improve health through changes in people's socio-economic status or by upgrading infrastructure and public services, such as education and access to clean water, sanitation and hygiene (WASH) (Knoblauch et al, 2018; Utzinger, Wyss, Moto, Tanner, and Singer, 2004; Winkler et al, 2012). These examples highlight that NREPs act on the wider determinants of health (Carney and Gushulak, 2016; Dahlgren and Whitehead, 1991). In 15 articles there were specific subgroup analyses (e.g. mothers, children or marginalized groups) as a measure of health equity Another 12 papers referred to the community in a more general way (e.g. affected). Future HIA should consider community heterogeneity in an effort to reduce health inequities by “leaving no one behind”, as suggested by the Sustainable Development Goals
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