Malawi is the world’s largest producer of burley tobacco and its population is affected by the negative consequences of both tobacco consumption and production. In producer countries, tobacco control involves control of the whole tobacco supply chain, rather than only control of consumption. The authors reviewed the impact of tobacco cultivation in Malawi to illustrate through this example the economic, environmental, health and social issues faced by low- and middle-income countries that still produce significant tobacco crops. The authors placed these issues in the context of the sustainable development goals (SDGs), particularly goal 3a, which calls on all governments to strengthen the implementation of the World Health Organisation Framework Convention on Tobacco Control. Other goals address the negative effects that tobacco cultivation has on development. The authors suggest that without external assistance, Malawi has relatively limited capacity to develop alternatives to tobacco production that are economically viable, but could benefit greatly from becoming a party to the FCTC to receive assistance through the incorporation of the FCTC into the SDGs.
Health equity in economic and trade policies
Studies were carried out in Krugersdorp, South Africa, to evaluate the ecological and human health risks associated with exposure to metals and metalloids in contaminated soils in mine tailings from gold mining. Human health risk was assessed using Hazard Quotient (HQ), Chronic Hazard Index (CHI) and carcinogenic risk levels, where values of HQ > 1, CHI > 1 and carcinogenic risk values > 1×10−4 represent elevated risks. Values for HQ indicated high exposure-related risk for arsenic, chromium, nickel, zinc and manganese. Children were more at risk from heavy metal and metalloid exposure than adults. Cancer-related risks associated with metal and metalloid exposure among children were also higher than in adults. The authors identify that there is significant potential ecological and human health risk associated with metal and metalloid exposure from contaminated soils around gold mine tailings dumps. They note that this could be a potential contributing factor to poor health of residents in informal settlements in the mining area, particularly for those whose immune systems are already compromised by HIV.
As the demand for mineral resources and fossil fuels continues to grow worldwide, the impact of mining will be an increasingly important concern. In Africa, local communities have been exposed to the detrimental effects of contamination arising from mining and its effects on public health, agriculture and the environment. The legacy of mining has left thousands of sites in Africa contaminated by mining and associated mine dumps such as tailings and slag material. The number of studies focused on the impacts of mining on the environment and human health in Africa have increased during the last decade. This paper reports on a project designed to correlate and integrate the results of multidisciplinary studies carried out in contaminated sites and areas using the best contemporary procedures for statistical analysis, management and compilation of the geochemical data; to strengthen the capacity of African institutions in environmental geochemistry, to raise public awareness of the impacts of mining on the environment and human health and to facilitate cooperation among geoscientists and medical scientists.
This paper aimed to investigate the relationship between mining and tuberculosis (TB) in sub-Saharan Africa. The authors used multivariate regression to estimate the contribution of mining activity to TB incidence, prevalence, and mortality, as well as rates of TB among people living with HIV, with control for economic, health system, and population confounders. Mining production was associated with higher population TB incidence rates, with an increase of mining production of 1 SD corresponding to about 33% higher TB incidence or 760 000 more incident cases, after adjustment for economic and population controls. Similar results were observed for TB prevalence and mortality, as well as with alternative measures of mining activity. Independent of HIV, there were significant associations between mining production and TB incidence in countries with high HIV prevalence and between log gold mining production and TB incidence in all studied countries. The authors conclude that mining is a significant determinant of countrywide variation in TB among sub-Saharan African nations. Comprehensive TB control strategies should explicitly address the role of mining activity and environments in the epidemic.
Samir Amin is one of Africa's foremost radical thinkers. In this interview organised by African Research and Cooperation for Endogenous Development Support, Amin reflects on a life spent at the cutting edge of radical theory and practice and African politics. Amin questions what social progressive change means today. He argues that there needs to be a strengthening of socialist consciousness - instead of ‘moving up’ within capitalism, people need to orientate in the opposite direction, and intensify the contradictions between an anti-capitalist alternative and what capitalism can offer. He argues against the concept of a single ‘revolution’, preferring instead to talk about advances and changes which create the possibility of later, further advances. He also rejects the view that it is possible to produce change without political and state power. Amin notes that all the peoples of Africa are today facing a big challenge. African societies are integrated in a form of globalisation that is damaging for the continent. He argues that Africans must 'delink’ from it and reject the logic of unilateral adjustment to the needs of further capitalist and imperialist expansion, starting at national level.
Internationally, the involvement of women working underground is a relatively new phenomenon. In South Africa, women were recently allowed to work in the underground mines. However, the challenges of women and men are different and their coping mechanisms are not the same. This research investigated how women cope under the occupational and labour culture, and health and physical demands inherent to this type of work. By means of the non-probability sampling method, ten (10) women were purposively selected and a qualitative collective case study design was used. The findings illustrate that women in the mining industry experience challenges with regard to labour, health, occupational challenges, work-life balance, sanitation facilities and sexual harassment. They were found to use different mechanisms to cope with the challenges they face on a daily basis. The authors call for the mining industry management to devise ways to meet the needs of women and offer support in response to their daily challenges.
The author argues that fair trade isn’t only about coffee and bananas. The Fairtrade Foundation points out that it doesn’t matter what the commodity is, people should get a fair price for the work they do. African gold miners are often exploited, but the author argues that workers do not have a choice; it’s dig or starve and it’s accept a pittance for their labors or work harder the following day. The Fairtrade Foundation is reported to have intervened and to be gradually improving conditions on mines. In this photo - essay Ian Berry reflects on the Ugandan gold trade as efforts are made to encourage fairer trading practices. He follows the gold from Ugandan mines to the London workshops of jewellers.
New analysis of data detailing the extent of sexual violence in the Rustenburg area indicates that one in five HIV infections (approximately 6,765 of all female cases) and one in three cases of depression among women (5,022 cases) are attributable to rape and intimate-partner violence (IPV), while one in three women inducing abortion (1,296 cases) was pregnant as a result of sexual violence. These results have emerged from an in-depth 2015 survey conducted by Medecins Sans Frontiers (MSF) among more than 800 women living in communities along the mining belt where the health consequences of sexual violence remain largely unaddressed and demand urgent action. Much additional suffering could have been prevented if survivors had been able to access a basic package of healthcare services, but opportunities are missed each day to prevent HIV infection, psychological trauma, and unwanted pregnancy for victims of sexual violence in on the platinum mining belt, because there are too few health facilities with the capacity to provide essential care. As South Africa finalises its next five-year National Strategic Plan (NSP) on HIV, TB and STIs (2017-2022), MSF is calling for the inclusion of ambitious targets for increasing sexual violence survivors’ access to medical and psychosocial services at all health facilities. Key interventions include providing post-exposure prophylaxis (PEP) to prevent HIV and other sexually transmitted infections, psychosocial support including trauma counselling, emergency contraception, other basic medical services (e.g. first aid), and the option of forensic examination..
The author reports on 2013 loans taken without parliament approval in Mozambique totaling $2 billion. External funders suspended credit to Mozambique because of the loans, and the national currency fell by 70% in 2016. Restructuring the loans means imposed austerity on a population already living in extreme austerity and eventually repaying the creditors from revenues derived from Mozambique’s natural gas deposits that come on the market in 2023. The author presents information on the case, the funders and the implications for other African countries.
According to the authors, achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This is argued to present a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.