Issue 3 Academic Highlights

Mapping research on resource extraction and health: A scoping review. Brisbois BW, Reschny J, Fyfe TM, Harder HG, Parkes MW, Allison S, et al. The Extractive Industries and Society. 2019 Jan 1;6(1):250–9. Brisbois et al set out to map “the scope of published literature that addresses the links between extraction of resources from the earth’s crust (i.e. mining and oil & gas extraction) ... and health outcomes”. They selected a scoping review methodology for its “ability to characterize the quantity, range and nature of existing research, and to identify gaps”, later acknowledging the need for several, deeper systematic reviews to explore topics that emerged. Specifically, they employed the 6-step scoping review approach developed by Levac et al (2010). Several important themes emerged from the analysis. The first was that the literature overwhelmingly centred on mining (85.6% of titles), in comparison to oil & gas extraction activities (15.0%). Furthermore, most studies focused directly on workers (67.9%) rather than on communities adjacent to resource extraction activities (22.3%). Secondly, the literature predominantly considers the impacts of “direct exposures to toxic substances”, rather than what the authors refer to as the more expansive ‘cumulative impacts’ - namely, not only “recognising the environment as a source of hazardous exposures, but also not[ing] that ecosystems and biodiversity, the living systems on which life and health depend, contribute to the determinants of health through livelihoods, lifestyles, culture and identity”. The geographic focus of research was concentrated in a few, high-income countries, likely exacerbated by inclusion of only English language papers - 1841 publications for high-income countries and upper-middle-income countries, compared to 350 for lower- middle-income countries and low-income countries. As the authors point out, this echoes the frequently cited ‘10/90’ gap phenomenon, that “90% of the world’s health research resources target the health problems of the world’s wealthiest 10%”. Related to this, there is an unsurprising dearth of research that considers the experiences and health outcomes of Indigenous populations, despite disproportionately experiencing the negative impacts of resource extraction. Among reasons for this, the authors highlight that “research on mining and health can be generated, funded or influenced by mining companies to avoid community or regulatory resistance to mining developments”. However, and perhaps most strikingly, the paper builds on this last point of research inequity by raising the importance of retaining a historical and political economy lens in this analysis. They acknowledge how this research gap is in stark juxtaposition to the colonial and imperial histories that were often the reason for the establishment of sites of resource extraction, particularly mines - they cite examples of mines on stolen Indigenous land in Canada, and on dispossessed Black-owned land in South Africa. Similarly, they highlight the role of neocolonial structural adjustment programmes that liberalised global South economies and opened them up as sites for resource exploitation. These “political economic drivers of resource extraction are likely to create future health impacts in precisely the places most neglected by researchers”. The paper’s conclusions draw heavily on this final analysis. They propose that “political engagement and community empowerment, which are far less 'productive' in terms of research outputs than the descriptive studies that dominate existing scholarship uncovered in this review, should be prioritized as strategies to mitigate adverse health impacts of resource extraction.” Connecting the right to health and anti-extractivism globally. Arteaga-Cruz E, Mukhopadhyay B, Shannon S, Nidhi A, Jailer T. Saúde Em Debate. 2020 Aug 17;44:100–8. The authors of this piece are activists from around the world, and all part of the People’s Health Movement - a global network of grassroots health activists, civil society organisations and academic institutions from around the world, particularly from low- and middle-income countries (LMICs). Here, Arteaga-Cruz et al explore whether there is any space for extractive industries in our society, and how extractivism impinges on the universal right to health - both human and planetary. In particular, they draw out the tension between acquisition and exploitation of natural resources by large corporations, and the framing of these as necessary to fund state social security infrastructure - a false dichotomy that “pits the environment and public health against social well-being”. They put forward a definition for extractivism as follows: “a mode of accumulation that favors extraction of natural resources (minerals...and fossil fuels, but also commercial farming, forest, and fishing industries) from countries of the global South that export their resources”. The authors raise several powerful points, using case studies from Canada, India and Ecuador throughout. The tension described above is explored through the case of Ishpingo-Tambococha-Tiputini (ITT) oil field in the middle of the mega-diverse Yasuní National Park in Ecuador. Oil exploitation funded substantial investment - in excess of $470 million - into Amazonian health infrastructure. Yet Arteaga-Cruz et al question whether the “right to life of these [Indigenous] peoples … is inferior to the right to health of the population that would benefit from the construction of hospitals funded by oil exploitation in the area”. The authors question the service provision-centric, curative model of healthcare - rooted in “a state complicit with neoliberalism, an economic system prioritizing profit” - leaving no room for “ancestral systems and practices … [or] population health”. Indeed, despite “losing [a] ... landmark case contesting putting Waorani territory up for sale by international auction without previous informed consent”, they highlight the continued violations pushing extractivism in these territories by the Ecuadorian state. The vital importance of connecting health justice with anti-extractive struggles is also made clear. Examples include defeating the asbestos lobby in Canada, and organising against the occupational lung disease silicosis for labourers in quarries, quartz-crushing factories and slate pencil industry in India - the latter culminating in a victory for workers in the Supreme Court of India. The piece concludes with a call to arms, setting out a vision for the People’s Health Movement and allies to “strengthen struggles for Indigenous people’s rights, land rights, forest rights, and human rights movements that are people’s movements”, holding both governments and multilateral organisations to account. How extractive industries affect health: Political economy underpinnings and pathways Schrecker T, Birn A-E, Aguilera M. Health Place. 2018 Jul 1;52:135–47 In this piece, Schrecker et al outline their more expansive conceptualisation of extractive industries, drawing together the political economy of extractivism before mapping out pathways linking this to health. The authors define extraction to include “agricultural land, water, and sand, and addressing not only the acquisition of these resources, but also the institutional and political processes that make acquisition possible”. They draw on several case examples demonstrating the current state of extraction. These range from more conventional cases of the continuing mining boom in South America and oil production in the Gulf of Guinea region through to more contemporary, growing instances of land and water grabs for purposes of agriculture, alongside sand mining, valuable as a key commodity in construction. The paper contrasts the economic and political rewards from these practices for transnational companies (TNCs) with the fact that “those suffering the consequences of extraction are disproportionately located in (territorially or socially defined) peripheries” - a phenomenon they term ‘extractive injustice’. As per Schrecker et al, these practices and power asymmetries are further ossified through two practices. The first is extractive sector investment by international financial institutions. A prime example of this is the World Bank, who between “2004 and 2013 financed projects in a range of sectors that displaced 3.4 million people, either physically (by forcing them from their homes and/or land) or economically (by harming their livelihoods)”. The second is the preservation of tax havens facilitating flight of capital, often from extractive activities. The authors cite the African continent as a key site of illicit financial flows “depriv[ing] economies of desperately needed resources for investing in development, including in poverty reduction measures and comprehensive and equitable health systems”. Strikingly, the authors highlight the self-perpetuating cycle of “the power structures, rules, and imperatives undergirding extraction as a prime and long-term feature of global capitalism [in] shap[ing] and interact[ing] with national-level politics, institutions, and policies that promote and facilitate extraction”. They reference the much-cited concept of the ‘resource curse’, whereby “resource-rich economies are claimed to underperform relative to others on growth and … social indicators”, but underscore that the literature on this often overlooks “the networks of international complicity that underpin” the “the international political-economic and institutional environment and domestic politics”. Echoing findings from Brisbois et al, the authors reiterate the importance of considering not only proximal determinants of health - centred around environmental exposures and workplace hazards - but social determinants of health. They focus on five pathways linking extractivism with health:

1. Effects on poverty and inequalityDespite the implicit understanding that growth from extractivism “will create jobs and increase governments’ fiscal capacity (in theory enabling increased investment in health systems and social protection)”, the authors point to sources that suggest extractive practices tend to exacerbate poverty, and resultantly poor health.

2. Workplace hazards

The detrimental occupational health effects of extractive industries are well established, particularly in the context of mining - from tuberculosis to exposure to particulate carcinogens - even more so in the poorly regulated ‘artisanal’ mining sector*. In the case of agricultural land exploitation, exposure to carcinogenic pesticides is another example of a highly prevalent public health issue. ***This topic is explored further in Race & Health’s podcast on deforestation.

1. Environmental degradation

Mining is closely associated with contamination of water supplies and land through leaching of toxic compounds such as cyanide and heavy metals e.g. mercury. In the case of oil and gas extraction, the authors cite the case of the Niger Delta, “one of the most oil-impacted ecosystems in the world”.

1. Loss of livelihoods and depression

The authors highlight how “vulnerable communities within vulnerable countries (i.e. those most impacted by changes in food prices) are also those more susceptible to livelihood loss due to the land rush” - sub-Saharan Africa is an obvious and important example. Repossession of productive land relates directly to food insecurity, and thus poor health. Associated ‘water grabs’ form an unavoidable extension to these ‘land grabs’ - again inciting water security in already precariously supplied areas. Environmental degradation “jeopardize[s] farming, fisheries and forestry, particularly affecting Indigenous livelihoods''. Going “beyond, the material dimensions of loss of livelihood, the health effects of social dislocation must be considered”, where “lack of “control over destiny” generates negative health outcomes across multiple scales, including at the macro level through “traumatic social transitions””. Authors draw our attention to the disproportionate impact of expulsion and dispossession on Indigenous populations, their lands attractive precisely because of their “rural and remote location and longstanding non-depleting uses of land and water resources consistent with Indigenous ways of life”.

1. Violence and Conflict

Suppression of activist opposition has long been a mainstay of “violent government[s], paramilitar[ies], and private security firm[s]” globally, with examples from throughout Latin America, India and Canada specifically cited. This is compounded by conflicts between parties vying for control of mineral resources - a notable example being the First and Second Congo wars, which killed over five million people. The authors underscore the need to shift our understanding of the power asymmetries away from simply contrasting powerful TNCs with national governments of LMICs, instead considering “corporate governmental alliances (in both HICs and LMICs) and the local communities affected by the ‘structural violence’ of resource extraction”. They conclude by putting forward several proposals including calls for a comprehensive mapping of “where extraction takes place, for what purposes, to be traded where, and affecting the health of whom” and “global initiatives to address the governance and health challenges” that centre transparency and accountability. Schrecker et al leave us with a final question of the limitations of our extractivist growth-seeking paradigm, and whether this is compatible with the preservation of the world’s “biospheric life support mechanisms”.