I often get quizzical looks from public health professionals when, after explaining that I am interested in international health, I tell them that I got my MPH in Environmental Health. For example, while riding the shuttle from the airport to the Convention Center for the APHA Annual Meeting this past November, I struck up a conversation with an Environmental Health professor. She seemed puzzled when I told her that I was a member of the International Health section and then explained that my MPH focus (and my current job) was in environmental and occupational health. She then (very politely) invited me to the Environmental Health Section’s social hour.
While I certainly appreciated the invitation, I remain puzzled (and slightly frustrated) that there is relatively little discussion of environmental and occupational health issues in international health. The field is dominated by discussion of the Big Three diseases (HIV/AIDS, malaria, and TB), sanitation, tropical worms, MCNH issues, malnourishment, and poverty. While these are all very important issues deserving of attention and funding, EOH should by no means be left out: after all, every human being is affected by the environment around him or her, and nearly all of us hold some kind of occupation to put food on the table.
One story in particular caught my eye a few weeks ago. Nearly 300 children in Zamfara state in northern Nigeria have died from lead poisoning due to mining activity over the last two years; another 742 are currently being treated for high blood lead levels. Lead poisoning fall squarely under environmental health – my cubicle neighbor is a nurse for the Texas Childhood Lead Poisoning Prevention Program – but this story had all of the trappings of a “classic” IH scenario: poor people in small villages in a developing country, Doctors without Borders, and sick African babies.
Mining is a significant issue, and a heated debate, in the field of development. Proponents of mining include the World Bank, which maintains that mining provides jobs, government revenues, and local economic benefits, and that it can provide sustainable development to communities with appropriate regulation. Critics argue that the pollution and environmental damage generated by mining operations outweigh the benefits, that it exploits local communities, and that the revenues are largely kept by local elites and foreign shareholders. And we all know that resources are too often followed by bloody conflict: civil wars in Sierra Leone, Angola, and Liberia, and armed conflict in the DRC, are just a few examples that come to mind. There are a number of health ramifications as well: constant exposure to rock dust makes miners more susceptible to tuberculosis, which they can spread to their families. Artisanal gold mining in particular, which supplies at least one fourth of the world’s total gold supply, is one of the most significant sources of the release of mercury into the environment.
Despite the hazards and health risks, however, the issue gets relatively little attention compared to the traditional global health villains of sanitation and infectious disease. This is unfortunate because all of the same factors play into mining in impoverished communities: residents and farmers take up mining and mineral extraction to improve their livelihoods because it pays better and provides more security than subsistence farming. There are issues of sustainability, ownership, exploitation, and corruption. Somit Varma, director of the Oil, Gas, Mining & Chemicals Department of the World Bank/IFC, has said that “the social and economic characteristics of small-scale mining fully reflect the challenges of the Millennium Development Goals, including: health, environment, gender, education, child labour, and poverty eradication.”
Advocates are becoming more vocal in drawing attention to “non-typical” international health issues, including cancer and mental illness. We should add environmental and occupational health issues to that list as well. While these issues are inevitably more complicated to prevent, screen for, and treat than the Big Three or NTDs – after all, you can’t pass out condoms or implement DOTS for lead poisoning or silicosis – they still impact the world in a major and often devastating way and are still deserving of our attention.