Abstract
BackgroundLarge projects in the extractive industry sector can affect people’s health and wellbeing. In low- and middle-income countries (LMICs), women’s health is of particular concern in such contexts due to potential educational and economic disadvantages, vulnerability to transactional sex and unsafe sex practices. At the same time, community health interventions and development initiatives present opportunities for women's and maternal health.MethodsWithin the frame of the health impact assessment (HIA) of the Trident copper mining project in Zambia, two health surveys were conducted (baseline in 2011 and follow-up in 2015) in order to monitor health and health-related indicators. Emphasis was placed on women residing in the mining area and, for comparison, in settings not impacted by the project.ResultsAll measured indicators improved over time, regardless of whether communities were affected by the project or not. Additionally, the percentage of mothers giving birth in a health facility, the percentage of women who acknowledge that HIV cannot be transmitted by witchcraft or other supernatural means and the percentage of women having ever tested for HIV showed a significant increase in the impacted sites but not in the comparison communities. In 2015, better health, behavioural and knowledge outcomes in women were associated with employment by the project (or a sub-contractor thereof), migration background, increased wealth and higher educational attainment.ConclusionsOur study reveals that natural resource development projects can positively impact women’s health, particularly if health risks are adequately anticipated and managed. Hence, the conduct of a comprehensive HIA should be a requirement at the feasibility stage of any large infrastructure project, particularly in LMICs. Continued monitoring of health outcomes and wider determinants of health after the initial assessment is crucial to judge the project’s influence on health and for reducing inequalities over time.
Highlights
Large projects in the extractive industry sector can affect people’s health and wellbeing
Several indicators improved over time in the impacted sentinel sites but not in the comparison sites: (i) the percentage of mothers giving birth in a health facility; (ii) the percentage of women who acknowledge that Human immunodeficiency virus (HIV) cannot be transmitted by witchcraft or other supernatural means; and (iii) the percentage of women having ever tested for HIV
In 2015, employment in the project or as a contractor, migration background, belonging to the richest wealth quartile and educational attainment of at least secondary schooling were associated with better health and behavioural and knowledge outcomes in women reflecting a social gradient in health [23]
Summary
Large projects in the extractive industry sector can affect people’s health and wellbeing. The Sustainable Development Goal (SDG) 2030 agenda situates health as a central feature of all three dimensions of sustainable development: society, economy and environment. It recognises that health is an important contributor to, and beneficiary of, development [1, 2]. As other natural resource development projects in subSaharan Africa, the Trident project potentially influences on all three dimensions of sustainable development: society (e.g. through in-migration and disruption of social cohesion) [7, 8]; economy (e.g. through shifts in occupational activities, increased disposable income or potential inflation of food or goods prices) [9]; and environment (e.g. through the alteration of ecosystems, mining and associated infrastructures) [10, 11]
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