The ecosystem approach to human health is an innovative concept that incorporates ... In ancient Greece, in the 4th Century B.C., Hippocrates described illness among lead miners ..... In Brazil, the Evandro Chagas Institute, which specializes.
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In: D.J. Rapport, W.L. Lasley, D.E. Rolston, N.O. Nielsen, C.O. Qualset, and A.B. Damania (eds.) Managing for Healthy Ecosystems, Lewis Publishers, Boca Raton, Florida USA. (2003)
Integrating Human Health into an Ecosystem Approach to Mining Donna Mergler
INTRODUCTION The ecosystem approach to human health is an innovative concept that incorporates human health into the dynamic interrelations of ecosystem analyses. In this approach, humans are not solely the drivers and disrupters of the ecosystem or the passive victims of environmental destruction, but are in continuous interaction with changing environmental, social, and economic conditions. In this dynamic process, ecosystem changes, resulting from human interventions (mining, agriculture, urbanization, etc.), driven by the need for subsistence or the forces of economic development, affect current and future well-being, not only of the present, but also for coming generations. Human health and well-being are, in turn, determinants of social, economic and cultural development. Appropriately applied to environmental and health impact studies, the ecosystem approach can be a useful tool toward attaining sustainable and equitable development. Human health deterioration and its consequences for the quality of life are most often omitted from environmental and cost-benefit impact studies. Here, we propose a means of integrating human health into the ecosystem analysis, using mining activities as an example. Four major issues, keys to the understanding of the relation between mining and human health, are examined: (1) miners’ health; (2) a framework for focusing on the impact of mining development and activities on human health; (3) a model for examining human health deterioration; and (4), the notion of fragile ecosystem, using the example of gold mining in the Brazilian Amazon.
MINERS’ HEALTH The extraction and transformation of minerals and quarrying are almost as old as civilization, and so are the accidents and diseases that have afflicted those who are engaged in these activities. In ancient Greece, in the 4th Century B.C., Hippocrates described illness among lead miners (Landrigan et al., 1990). Five hundred years later, Pliny the Elder called lead poisoning “one of the diseases of slaves” and described a bladder-derived protective mask to be used by laborers subjected to large amounts of dust or lead fumes (Hamilton, 1943).
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The lure of easy riches brought the Spanish and Portuguese to South America, in the search for gold and silver bearing ores, which native populations had been mining for centuries. Anxious for large and quick profits, the conquistadores set up mining operations in areas such as the mountain of Potosi in Bolivia, one of the first to be exploited; even today, the Spanish expression vale un potosi means that something has much worth. Indians were brought in as miners within a harsh system called la mita. In 1585, Fray Rodrigo de Laoyza, a predecessor of the modern Latin American activist priests, describing the conditions and lives in this silver mine, stated that the Indians were being consumed like sardines (Gumucio, 1988). The recent photographs by Sebast o Salgado of Brazilian gold mining (Salgado, 1997) evoke the sardines of Fray Rodrigo, and show that harsh working conditions and child labour are not things of the past. Worker’s health is most often completely ignored when considering the environmental impact of mining. The workforce is usually incorporated into the production process and considered in terms of labor and liability costs. Although increased income certainly contributes positively to the health of workers and their families, the history of mining is fraught with occupational diseases and accidents. In countries with mining activities, mining is almost always at the head of the list of sectors with the highest incidence of accidents and occupational diseases. Although mining is not a major employer, accounting for about 1% of the world’s workforce (some 30 million people), it is responsible for about 7% of fatal accidents at work, which is estimated by the International Labour Office (ILO) to be around 15,000 per year. No reliable data exist for accidental injuries, but they are significant, as is the number of workers affected by occupational diseases (such as pneumoconioses, hearing loss, vibration disease, metal poisoning, cancers), whose premature disability and even death can be directly attributed to their work (International Labor Office, 1998). Small-scale mining is expanding rapidly, and often uncontrollably, in many developing countries, employing large numbers of women and children in dangerous conditions and generating a workplace fatality rate up to 90 times higher than mines in industrialized countries (International Labor Office, 1999). Mining takes its toll not only on humans, but also on the environment in its yearly production of approximately 23 billion tons of minerals, including coal. For high-value minerals, the quantity of waste produced is many times that of the final product. For example, each ounce of gold is the result of dealing with about 12 tons of ore, and each ton of copper comes from about 30 tons of ore. For lower value materials, such as sand, gravel, and clay — which account for the bulk of the material mined — the amount of waste material that can be tolerated is clearly minimal. According to a recent report of the ILO (1998), the world’s mines must process at least twice the final amount of earth required (excluding the removal of surface overburden that is subsequently replaced and therefore handled twice); some 50 billion tons of ore are mined each year, which is the equivalent of digging a 1 meter deep hole the size of Switzerland.
SPHERES OF IMPACT: A FRAMEWORK FOR EXAMINING HUMAN HEALTH This disruption of the ecosystem has effects not only on the workers, who are in direct contact with the mining process, but also on other sectors of the community. The framework presented in Figure 87.1 is generic and can be applied to many situations of environmental disturbance. Here, it is used as a framework analysis of the human health consequences of mining activities whereby the positive and negative effects of economics, social, and cultural reorganization, geophysical alterations, and chemical changes in the environment can be examined within a nested hierarchy of four spheres: workers, the local community, remote communities, and the general population. The arrows are bidirectional. For example, toward the center: the economic situation in a country can determine whether mining activities are permitted as well as the control on its environmental impact; workers’ economic condition can bring them to mining and are an important determinant for their health. On the other hand, mining activities can provide wealth for the different sectors
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general population remote communities local community workers geo-physical & chemical environment
culture mining activities
Figure 87.1 A concentric framework for studying the positive and negative impacts of mining activities on human health in an ecosystem perspective.
of the population, which may or may not be equally distributed; this wealth can contribute to improving the health of the four levels of the population. The spheres are not completely closed since the activities of one can affect the others, influencing their respective health status. Mine Workers Mining activities are situated in the center of the sphere and the workers constitute the first group whose health and well-being is affected by the working conditions. The statistics from the ILO on accidents and illnesses constitute only the tip of the iceberg. Since reporting these events is dependent on the capacity and the will of different countries, they are often underreported for various reasons. Among these reasons is the question of liability and compensation. Moreover, illegal small mining operations are rarely included in official reports. In addition, there is the healthy worker effect, which occurs when workers’ health deteriorates to the point where they are unable to continue and abandon the workplace, leaving behind only those who are physically and emotionally capable of carrying out the work. The workers in poor health leave the mines and their illnesses and disabilities are not attributed to mining, while those that are healthy enough to continue to work constitute the healthy workforce. A high turnover of workers in mining activities can be an indicator of poor health; the statistics on accidents and illnesses often do not reflect this reality. Working conditions in mines have improved over the centuries, and these improvements have accelerated during the last century, with resulting improvement in miners’ health. Much of this improvement has been the result of major battles, waged by workers, their wives, and their unions, to obtain better working conditions and health services for themselves and their families. In 1975, International Women’s Year, Domitila Barrios de Chungara told the world of struggles of the tin miners and their families in Bolivia, high in the Andes (Viezzer, 1976). Films, such as Harlan County USA, Miner’s Daughter, The Salt of the Earth, and Germinal have brought vividly to our screens stories of mining families’ battles to improve their working and living conditions. Threatened with the possibility of losing their jobs if the mine closes down, miners may often oppose environmental measures. Their voice must be heard and included in all multistakeholder endeavors and research for good ecosystem management.
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Local Communities Mining activities have a major direct and indirect impact on the health of local communities. People from outside the region, looking for jobs in mining or associated areas, can upset the structure of the existing society. Gender relations are affected since mining jobs are mainly available to men, with women in satellite roles (Wasserman, 1999). Hierarchical relations are modified through the introduction of a new power structure in the community. The movement of populations, particularly in areas with a potential for dissemination of infectious diseases, creates a further health hazard. Sexually transmitted diseases are known to increase in such situations (Campbell and Williams, 1999), and, in the case of gold-mining in areas with endemic tropical diseases, miners also constitute a vector for the transmission of malaria and other infectious diseases into local communities (Rambajan, 1994; Carvalho et al., 1999). The well-being and health of the local community can also be affected by the increased burden to families of workers who have been injured in mining accidents or are suffering occupational diseases. There are also economic benefits to the local communities, which can have a positive impact on health, the most important being job opportunities. Many communities, living near mines or proposed mining areas, in different Latin American countries have used organized protests to obtain the setting up of clinics, sewage systems, and other collective installations, which positively affect health. After undertaking a cost-benefit analysis, a Peruvian private mining company set up an integrated health care and family planning program, resulting in improved children’s health and reduced cost for pharmaceuticals (Foreit et al., 1991). Remote Communities The greatest biophysical environmental destruction is most often, but not always, in the direct vicinity of the mining activities. Deforestation can have devastating and long lasting effects, changing ecosystem dynamics. Many mining activities require great quantities of water, affecting the aquifers, that are essential to human health and well-being. Pollution from the particular metal being mined or the waste products of the production process enter the surrounding ecosystem, potentially affecting the health of plant, animal, and human populations. Even communities living far away from mining activities may be affected through water and airborne pollution (Figure 87.2). Rivers can carry pollutants over hundreds of kilometers into the sea, affecting the wildlife, fish, and seafood, which are then unknowingly consumed by the communities living far from the source. Ores are often transported by trucks or rail over large distances, polluting the areas through which they pass, and thus affecting the health of people living near these routes. The effects of low level, long term exposure to environmental pollutants are a subject of current concern, particularly in relation to their effects on the reproductive, neurological, immune, and endocrine systems. General Population The general population within a country can benefit from the accrued income from mining activities if regulations and policies so permit. However, while different segments of the population may reap benefits, others may become more impoverished. In the 1999 Pan-Canadian Ecohealth Lecture Tour, in which the theme was mining, Labonne (1999) pointed out that the activities of the extractive industry are now increasingly located in developing countries. These are countries where paradoxically, mineral resources endowment, including oil, have had a corruptive effect on many governments, causing both the impoverishment and restlessness of the population living in the mineral and oil producing regions. Finally, since to date, there has been little effort to plan for closure on the part of mining companies. The social and economic costs of clean up are often taken on by the country, particularly
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general population remote communities local community workers air pollutants
physical factors (e.g. noise, vibration)
water use & pollution
food pollution land use
Figure 87.2 A concentric framework for studying the health of populations affected by geophysical and chemical environmental changes from mining activities.
when a mine has closed down, leaving behind waste and devastation and a population whose health has been affected by poor working and living conditions.
HUMAN HEALTH DETERIORATION ON A CONTINUUM Human health is much more than the absence of disease. Ecosystem disruption associated with mining (with the exception of major disasters or spills), usually does not produce dramatic immediate effects on human health. Rather, there are slow, insidious changes in biological functions, reflecting diminishing well-being and affecting the quality of life and the collective capacity of the community to intervene and improve the situation. Schematically, the deterioration of human health can be represented on a continuum (Figure 87.3). The first stage corresponds to an increase in the prevalence of nonspecific symptoms of dysfunction that reflect early biological impacts among human populations resulting from ecosystem stress. The second stage includes early functional changes that are also not apparent in individuals, but can measured, on a group basis, in exposed populations (Mergler, 1998). By the third stage, individuals are manifesting subclinical signs of
symptoms of discomfort
increasing exposure Figure 87.3 Stages of the health deterioration continuum. Exposure dose contributes to increasing deterioration. The areas within the triangle correspond to the relative frequency of the population at risk at different stages.
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illness, while at the fourth stage, frank illness is present. For the most part, environment-related disease processes are irreversible, or even relentlessly progressive. The final stage is death. The rapidity with which persons progress along the continuum, depicted in Figure 87.3, depends not only on the degree of ecosystem disruption, but also on individual factors (genetic makeup, age, lifestyle, other illness) and social factors (poverty, malnutrition, discrimination, lack of autonomy). These factors often interact with each other. In the early stages of health deterioration, it is not possible to make diagnoses in individuals, but diagnosis of dysfunction within populations (community health) can be linked to ecosystem stressors. Early biological alterations constitute not only an early warning for increased risk of eventual illness, but, more importantly, reflect diminished well-being and impaired functional capacities. It is at this stage that intervention can be effective. Diminished well-being, associated with an environmental pollutant, is well-illustrated by the numerous studies on the relation between lead exposure from gasoline and children’s IQ. While the levels of lead exposure from gasoline may not be sufficient to provoke clinical illness in the major cities where it is still used, the levels are sufficient to affect children’s development, reducing the mean IQ of the exposed populations by about 4 to 10 points. Individually, this effect is not necessarily detectable; it is, however, measurable on a group basis, using sensitive, quantitative tests. A reduction of IQ of 5 points means that approximately twice as many children will have learning problems (< 70 IQ points) and half as many children will have very high IQs (> 130 IQ points) (Rice, 1998). Higher blood levels of lead are also associated with hyperactivity in children and reduced ability to concentrate. It is society that suffers and its capacity to develop fully. As a result, an increasing number of children become aggressive, have learning disabilities, drop out of school, and miss out on higher education (Needleman et al., 1996). Even very low levels of lead exposure can affect well-being and become dramatic when coupled to poverty, malnutrition, poor living conditions, inadequate health care, and poor schooling. From the perspective of an ecosystem approach to human health, these factors should be considered and included in analyses, rather than controlled or adjusted, when assessing the situation and working with communities to propose mitigating measures. A Triangle of Risk The proportion of the population at different stages along the continuum of health deterioration, can be represented by a triangle with illness and death at the top. At similar levels of environmental destruction, those who are in poorest conditions and the most vulnerable may become very ill or die. At the base of the triangle, there are the many more persons who are, to some extent, capable of resisting and adapting to the loss of adequate life support systems and increasing toxic exposure, but who present the subtle, subclinical effects indicative of loss of well-being. As ecosystem stress increases, breaking down the human organism’s adaptive capacity, more and more persons suffer from severe illness and di.e., Consequently, there is the need for more efforts in occupational and environmental health research to develop and apply quantitative and qualitative indicators of early health deterioration and loss of well-being, with a view to preventive intervention (Mergler, 1999). Methodological considerations differ with respect to where one studies the impact of mining activities on population health along this continuum. Traditionally, we have examined the health impacts from mining at the tip of the triangle, where very large study populations are required, since fewer persons will be suffering from specific illness or die of specific causes. The outcomes are dichotomous (ill/not ill, dead/not dead). Moreover, the most vulnerable persons reach this level more quickly, making it difficult to distinguish between the health impact of ecosystem disruption resulting from mining and the effect of individual factors. As one goes further down the continuum, more people are affected; Toward the base of the triangle, performance measurements can be made on everyone within the designated population, as was the case with studies of the effects of lead on IQ. With this approach, smaller populations can provide statistically relevant information.
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An example of a study of early alterations associated with mining is provided by a study of 36 children in the Njamba gold mining area of Ecuador, where mercury is used in the process of extracting gold (Counter et al., 1998). In this study, a significant relation was observed between blood mercury and hearing threshold. Although the children were not deaf, their hearing was increasingly impaired with increasing mercury exposure. In a comprehensive approach to health, the consequences of these changes are important in terms of learning capacity and future capabilities. Moreover, they should be furthered examined within the context of the other stresses on humans arising from the ecosystem disruption associated with these mining activities.
FRAGILE ECOSYSTEMS Certain ecosystems are more fragile than others with respect to resistance to stress. The ecosystem approach requires a sound knowledge of the biophysical, chemical and social parameters in management for ecosystem sustainability. For example, in a study of the mercury cycle in the soil, river sediment, and waters of the Amazonian Basin, my colleagues found that there were high levels of natural mercury in the soil. They also found that mercury used in gold mining was not the sole contributor to the high mercury levels observed in carnivorous fish and in the human populations who consumed these fish (Lebel et al., 1997; Roulet et al., 1998, 1999). Slash and burn agricultural practices throughout the Amazonian Basin, resulting in soil erosion and lixiviation, was also responsible for releasing mercury into the extensive water system of this region. The implication of this observation for ecosystem management of mining activities is that mercury released through mining activities cannot be isolated from the other activities that were likewise increasing the mercury burden in this ecosystem. The argument that mining activities are only adding a small proportion to the total mercury load is inappropriate. Because the fragile ecosystem already has high levels of naturally occurring mercury, the addition of even very small amounts from any source can have very important effects on ecosystem disruption and human health. Adequate mitigation measures depend on a comprehensive assessment of the ecosystem, as opposed to a random grab bag of measurements. Because mines are established in areas where there are mineral ore deposits, in many cases, the populations living on these deposits may already have relatively high levels of exposure to the substance through water, soil, and possibly food. For example, congenital disorders, identified in the Groote Eylandt population, that has been living since World War I in a manganese-bearing ecosystem, were subsequently exacerbated by manganese mining activities (Kilburn, 1987). The interaction among exposure to harmful metals, mining activities, ecosystem dynamics, and human health was recently demonstrated in studies of malaria in gold mining. The inordinately high prevalence of malaria observed in gold mining areas has been traditionally attributed solely to environmental destruction. In Brazil, the Evandro Chagas Institute, which specializes in tropical diseases, has traced most cases of malaria in Brazil to the gold-mining areas (Strickland et al., 1999). Recent studies suggest that exposure to mercury vapors, released during gold extraction processes that involve mercury amalgamation, can reduce resistance to malaria (Silbergeld et al., 1999). An ecosystem approach examining malaria in gold mining areas should consider the many factors that potentially contribute to increased malaria: breeding conditions for mosquitoes, influx of miners from remote areas with minimal resistance to the disease, exposure to mercury vapors, poor health services, etc. Indeed, exposure to toxic substances may not only have direct effects, but also indirect effects, through modulation of different physiological functions. In regions where tropical diseases are endemic, the use of chemicals that possibly affect people’s capacity to resist these diseases must be considered within a larger ecosystem context for adequate mitigation. Ecosystem management must strive to integrate rather than juxtapose information from various disciplines.
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Within the context of ecosystem management, human health needs should be pursued in a holistic manner, by focusing on early changes in biological, psychological, and social parameters. In this way, emphasis is placed on characterizing the health and well-being of population, disease prevention, and ecosystem equilibrium, rather than on treatment, disease, the assignation of respective responsibility and liability, and perhaps costly ecosystem remediation. Integrating human health considerations into environmental impact studies will help to contribute to more equitable mining development.
REFERENCES Campbell, C. and Williams, B., Beyond the biomedical and behavioural: towards an integrated approach to HIV protection in the southern African mining industry, Social Sciences and Medicine, 48, 1625–1639, 1999. Carvalho, L.H., Fontes C.J., and Krettli, A.U., Cellular responses to Plasmodium falciparum major surface antigens and their relationship to human activities associated with malaria transmission, American Journal of Tropical Medicine and Hygiene, 60, 674–679, 1999. Counter, S.A. et al., Blood mercury and auditory neuro-sensory responses in children and adults in the Njamba gold mining area of Ecuador, Neurotoxicology, 19, 185–196, 1998. Foreit, K.G. et al., Costs and benefits of implementing child survival services at a private mining company in Peru, American Journal of Public Health, 81, 1055–1057, 1991. Gumucio, M.B., Part 1 in Potos’, Patrimonio Cultural de la Humanidad, Compa–ia Minera del Sur, La Paz, Brazil, 1988. Hamilton, A., Exploring the Dangerous Trades, Little, Brown, Boston, 1943. International Labor Office, Sectorial Activities: Mining (coal, other mining), Geneva, 1998. International Labor Office, Social and Labour Issues in Small Scale Mines, Report for discussion at tripartite meeting on social and labour issues in small scale mining, Geneva, 1999. Kilburn, C.J., Manganese, malformation and motor disorders: findings in a manganese-exposed population, Neurotoxicology, 8, 421–430, 1987. Labonne, B., Cleaning-Up Our Mining Act: A North-South Dialogue, Keynote address in the Pan-Canadian 1999 EcoHealth Lecture Tour organized by the International Development Research Centre (IDRC) Academic Fellowship, 1999. Landrigan, P.J. et al., Lead in the modern workplace (editorial), American Journal of Public Health, 80, 907–908, 1990. Lebel, J. et al., Neurotoxic effects of low-level methylmercury contamination in the Amazonian Basin, Environmental Research, 79, 20–32, 1998. Lebel, J. et al., Fish diet and mercury exposure in a riparian Amazonian population, Water Air and Soil Pollution, 97, 31–44, 1997. Mergler, D., 1999. Combining quantitative and qualitative approaches in occupational health: towards a better understanding of the impact of work-related disorders, Scandinavian Journal of Work and Environmental Health, 25 Suppl 4, 54–60, 1999. Mergler, D., Manifestations of acute and early chronic poisoning, in Encyclopaedia of Occupational Health and Safety, 4th ed., Stellman, J.M., Ed., International Labour Office, Genève, Vol. 1, 1998, pp.7.13–7.14. Needleman, H.L. et al., Bone lead levels and delinquent behavior, Journal of the American Medical Association, 275, 363–369, 1996. Raizenne, M., Dales, R., and Burnett, R., Air pollution exposures and children’s health, Canadian Journal of Public Health, 89 Suppl 1, S43–S48, 1998. Rambajan, I., Highly prevalent falciparum malaria in north west Guyana: its development, history and control patterns, Bulletin of Pan American Health Organization, 28, 193–201, 1994. Rice, D., Issues in developmental neurotoxicology: interpretation and implications of the data, Canadian Journal of Public Health,89 Suppl 1, S31–S36, 1998. Roulet, M. et al., Distribution and partition of total mercury in waters of the Tapajós River Basin, Brazilian Amazon, The Science of the Total Environment, 213, 203–211, 1998.
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Roulet, M. et al., Effects of recent human colonization on the presence of mercury in Amazonian ecosystems, Water, Air and Soil Pollution, 112, 297–313, 1999. Salgado, S., Trabalhadores: uma arquelogia da era industrial, Sao Paulo. Companhia das Letras, Sao Paulo, Brazil, 1997. Silbergeld, E.K. et al., Mercury impairs host resistance to malaria, Mercury as a Global Pollutant, 1999, p. 458 (abs). Strickland, G.T. et al., Mercury exposure and disease prevalence among garimpeiros in Para, Brazil, Mercury as a Global Pollutant, 1999, p. 387 (abs). Viezzer, M., Domitila. Si on me donne la parole…, Petite Collection Maspero, Paris, 1976. Wasserman, E., Environment, health and gender in Latin America: trends and research issues, Environmental Research, 80, 253–273, 1999.
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