Mining, Minerals and
Sustainabl e Development



September 2001
No. 22

The Community Health
Dimension of Sustainable
Development in
Developing Countries
Henry Brehaut
Global Sustainability Services Inc., Canada
Copyright © 2002 IIED and
This report was commissioned by the MMSD project of IIED. It remains the sole
WBCSD. All rights reserved
responsibility of the author(s) and does not necessarily reflect the views of the

Mining, Minerals and
MMSD project, Assurance Group or Sponsors Group, or those of IIED or WBCSD.
Sustainable Development is
a project of the International
Institute for Environment
and Development (IIED).
The project was made
possible by the support of
the World Business Council
for Sustainable Development
(WBCSD). IIED is a
company limited by
guarantee and incorporated
in England. Reg. No.
2188452. VAT Reg. No. GB
440 4948 50. Registered
Charity No. 800066

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Table of Contents


1 Introduction
3
2 Community Health Impacts
3
2.1 Mortality
3
2.2 Healthy Living
4
2.3 Economic (Neira 2001)
4
3 Community Health Program Needs
5
4 Historical Approaches
6
5 Current Initiatives
7
5.1 World Alliance for Community Health
8
5.2 WHO
9
5.3 Oil & Gas Industry
9
5.4 World Economic Forum
10
6 Sustainability & Health
10
7 Long-Term Business Value
11
7.1 Sustainability Perspective
12
7.2 Strategic Health Management
12
7.3 Partnership Model
13
7.4 Business Partners for Development
13
8 Path Forward
13
Acknowledgements 15
References 15
Appendix: The Community Health Dimension of Sustainable Development in Developing
Countries 16
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The Community Health Dimension of Sustainable Development in Developing Countries

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1 Introduction
Communicable diseases and poor health delivery systems impose a heavy personal and
economic burden on society at large and in the work place whether it is at a mine or on a
small plot of land. The need for improved health delivery services and expanded programs
is particularly acute in developing nations where diseases are having a major impact on the
health and quality of life of all people. Under serviced areas of developed countries also
suffer from inadequate community health programs and have similar burdens and needs.

Mining companies with operations in such areas can and should play an important role in
assisting national governments in the provision of health services to local communities.
Such involvement can be justified on the basis of both corporate values and long-term
business objectives and, in fact, is an essential outcome of any policy that addresses
sustainable development in a comprehensive manner.

Mining companies have generally contributed to improved health services in areas in which
they operate by providing access to mine related health facilities. Current initiatives are
showing that mining companies are now taking on a broader role in community health
programs by working in partnership with other stakeholders and by working towards the
development of sustainable delivery systems.

The purpose of this paper is to illustrate the range of community health needs; to review
historical practices and current initiatives: to justify the strong link between sustainable
development values and a corporation’s support for community health; to make the business
case that can be made for the application of sustainable development principles in the area of
community health; and to identify the principles and best practices that must be applied in
working towards the establishment of sustainable community health programs. While the
focus of this paper will be on developing nations, the same needs and responses also apply to
under serviced areas of developed nations.

2 Community Health Impacts
The need for improved community health services and programs in developing nations can
be discussed from three main perspectives, either one of which provides more than
sufficient justification for a role by the private sector.

2.1 Mortality
Reported deaths or new statements of mortality related to HIV/AIDS, TB and malaria are
common occurrences. TB reportedly kills almost 2 million people every year and malaria
over a million more. While not in the headlines, measles, diarrhoreal diseases and acute
respiratory infections have also been identified as major killers also needing the attention of
society at large.

In identifying the range of diseases that need attention, the New York Times in an article
titled “In the Shadow of AIDS, a World of Other Problems” dated June 24, 2001, stated:

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There is no shortage of contenders. Immunization rates for measles have been falling
again, yet the disease kills nearly one million children a year in the developing world. Or
there is rotavirus, which causes severe diarrhea in 125 million children a year and kills
600,000 of them, the vast majority in the developing world. Or hepatitis B, which kills
more than a million adults every year because they did not get vaccinated when they were
young.

2.2 Healthy Living
While death rates gain the headlines, the main challenge and needs remains amongst the
living. As stated by Dr Maria Neira of WHO:

Infectious diseases impede efforts to bring developing countries out of poverty. They
keep children away from school and prevent adults from working or caring for their
children. Serious illness is one of the major reasons why poor people remain poor.
Poverty breeds infections; infections breed poverty.
(Neira 2001)

As an example of the burden of disease, worms like hookworm and schistosomiasis infect
1.3 billion people a year and represent 40% of the disease burden due to all tropical diseases,
excluding malaria. WHO has reported (WHO, March 2001) that:

Indirect morbidity is particularly important in children, ranging from malnutrition,
anaemia, growth retardation, irritability and cognitive impairment, as well as increased
susceptibility to other infections and acute complications…

Another example of the wide range of diseases that have to be addressed is lymphatic
filariasis, a disabling, disfiguring disease caused by parasitic worms. It is estimated that 120
million people are infected in around 80 countries throughout the tropics and subtropics.
While rarely fatal, the disease is a major contributor to poverty, and the program to eliminate
it will reduce disability, social stigmatization and economic reductions in life opportunities
and will improve child and maternal health and development. (WHO LF2000)

2.3 Economic (Neira 2001)
Recent evidence provided by the Harvard economist Jeffrey Sachs, the London School of
Hygiene and Tropical Medicine, and WHO shows that Africa’s GDP in the year 2000
would have been $100 billion greater if malaria had been eliminated years ago. A case of
malaria can keep someone out of work for many days. One case of malaria will not slow a
continent’s economic growth. But 300 million cases certainly will.

TB affects adults in their most wage-earning years, inflicting unnecessary handicap on the
economic development of low-income countries. Because of these and other costs TB and
its resistant strains is likely to cost the Thai economy US$7billion by the year 2015. Lost
wages also translate into lower profits for corporations caused by absenteeism, lower
productivity and employee treatment costs.

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The Community Health Dimension of Sustainable Development in Developing Countries

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Malaria is hurting living standards of Africans today and prevents those of the future as well.
In addition to the cost of lost working days, the cost of treatment of repeated bouts of
malaria can be a huge cost burden to families. In Nigeria subsistence farmers can spend up
to 13% of total household expenditures on malaria treatment.

As can been seen above, the diseases that need to be conquered are many and varied. Each
country and each community will have its own problems and priorities. The impacts on
each mining companies activities will be equally unique and have the potential to be very
costly if not addressed in a comprehensive manner involving the whole community. The
challenge is to focus the abilities of many stakeholders in the development of health
programs on a community by community basis.

3 Community Health Program Needs
As stated by Dr Gro Harlem Bruntland, Director-General WHO
…it is possible to reverse the impact of infectious diseases and reproductive health
conditions – even in the poorest countries. We know what works.
(WHO CD2000)

The main challenge is often found in the delivery system, from national government
leadership to the provision of health services in the community. WHO has argued that
proper delivery systems or case management must be seen as not only a key component of
any control program, but also a fundamental right of all populations. With regard to malaria,
WHO has stated:
In reality case management is often highly inadequate. Inappropriate drugs are prescribed,
compliance with the recommended regimen is low, drugs are often ineffective due to
resistance or poor quality, and patients with severe malaria are managed inappropriately.
(Global Health 2000)

A delivery system with adequately trained personnel resources is the key to progress. Not
only are cost effective health interventions and tools available, but also resources from
external sources can be accessed for well planned and managed programs. Unfortunately,
cases are known where committed funds are not being spent due to the lack of good health
management systems and the people available to lead and carry out the work. In this
context, it should be noted that the short-term priority for the new AIDS global fund is to
finance prevention campaigns, save babies from the virus, train health workers and build
laboratories. Treatment programs will proceed once the delivery systems have been
established.

Community health programs must also be considered in terms of their key objectives.
Treatment, while a necessary part of any program, is limited in effect if carried out alone.
No one aspect can be truly effective if not carried out as part of a comprehensive program
with prevention, control and eradication being equally important objectives. Similarly, it is
being recognized that an employee’s health cannot be adequately protected from
communicable disease unless health programs are extended to the broader community.

The Community Health Dimension of Sustainable Development in Developing Countries
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In planning effective community health programs, attention must also be paid to issues as
basic as safe water supply, good sanitation and immunization. These are all essential
requirements for healthy living and, if not available, must be addressed as key elements in
developing a community health plan.

4 Historical Approaches
Many mining companies have a long history of providing for the health needs of their
employees and their families. Historical practice, in under serviced communities, has often
been for a mining company to retain experienced health professionals and to provide health
facilities as required to provide a high standard of health care to employees. Access to such
services was usually provided to local citizens with an emphasis on care and treatment.
Where experienced professionals were not available within the country, expatriates from
developed countries were retained. This in turn led to the provision of developed country
standards for facilities and services in, what has been termed, a paternalistic manner. The
Business Partners for Development has termed this a company-led approach. (BPD Briefing
Note)

As indicated above, the predominant historical approach has been on the provision of health
care, with a strong focus on the provider, not the external community. In the words of a
senior mining executive, referring to the construction of hospitals at two company mines:
Mining companies are good at mining however they are not specialists in the cost of
effective provision of public health services. Under normal circumstances neither of these
hospitals would have been built or are required according to the local demographics.
While good things are done at these hospitals it is recognized that they do not represent
the most cost effective use of money or current resources for creating sustainable public
health outcomes. As with most resource companies we have tended to target medical
services and support in a developed country context rather than in a developing country
context.
(Private correspondence)

Also, in the words of one health professional:
Historically, mining companies have made every effort to treat their own employees. But
few of these endeavors have made every effort to control sexually transmitted infections
among the sexual contacts of the miners. Not only did this place a high burden of disease
on the surrounding community, but also provided a constant source of re-infection for the
miners and increased sexual transmission on HIV.
(Private correspondence)

While from a different industry, the comments made in a paper titled Shell – Dilemmas and
Challenges from the Real World by Geert de Jong of Shell International offer similar insights
that could equally apply to mining. The paper presents some useful perspectives on what is
called the traditional approach. Key characteristics mentioned were:

• Focus on hospitals
• High tech equipment
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The Community Health Dimension of Sustainable Development in Developing Countries

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• Lack of consultation
• Public relations driven
• Low sustainability of programs
• Structured approach lacking

One common thread in all the above statements is the recognition that there has to be a
better way to plan and deliver real health benefits to the host communities. Each of the
above statements was made in the context of trying to identify the better way, which will be
examined in the following sections.

From another perspective, difficulties have been and continue to be faced by companies in
engaging governments, granting agencies and foundations and other stakeholders. Where a
climate of distrust exists, it is very difficult and time consuming for a company to overcome
well entrenched attitudes. This is a major challenge that must be addressed for substantial
progress to be made. WHO is showing that it can act as an important catalyst in bringing
parties together in a constructive manner and it is in this role that it can make valuable
contributions in the future.

5 Current Initiatives
Notwithstanding the generalized comments about historical approaches presented in the
previous section, some companies and individual business units have been adopting more
proactive approaches to community health. Each has typically grown out of local needs and
initiative and each has strong roots in the principles of sustainable development. The
common threads are well-planned programs based on consultation, partnerships and
capacity building with all aspects working towards long-term sustainability.

As an example of what can be achieved, a mining company has reported that by providing
health services to the broader community, infant mortality has been reduced from 33% to
3%, average life span has increased from 30 to 50 years and the incidence of malaria has been
reduced from 70% to 15% among village children. Other examples illustrating current
company initiatives are provided in an attachment to this paper.

In order to pull such examples together in an attempt to provide leadership for private sector
companies; the World Alliance for Community Health was formed in 1999 by 5 mining
companies; the International Association of Oil & Gas Producers (OGP) issued its Strategic
Health Management report in June 200 and the World Economic Forum announced its
Global Health Initiative in January 2001. In addition, WHO has helped establish a number
of disease focused initiatives that are eager for greater participation and support from the
private sector. An overview and an analysis of these initiatives will provide insights as to the
opportunities and challenges in getting private sector companies and their individual
business units to accept a broader role in community health programs.
The Community Health Dimension of Sustainable Development in Developing Countries
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5.1 World Alliance for Community Health (www.wacommunityhealth.org)
The World Alliance was formed by BHP, Pasminco, Placer Dome. Rio Tinto and WMC in
1999 with the objective of promoting the development and implementation of community
health projects in cooperation with the World Health Organization (WHO). Its members
recognized the value of working with other stakeholders in the implementation of long term
improvements in quality of life and sustainability in areas where they operate and desired to
build on this success.

To facilitate and earn recognition for its projects, the World Alliance entered into a
Cooperation Agreement with WHO under which members could seek to have a
community health project designated as a “WHO approved project” based on certain
requirements. A WHO approved project was defined as meaning that the project design has
been reviewed and approved by WHO and that the project objectives have been developed
in accordance with WHO’s recommendations.

The WHO agreement provided a list of matters that had to be addressed in the project plan
under the headings of Technical Program, Project Structure, Program Sustainability,
Financial Support and Reporting. The emphasis of these matters is clearly on partnerships,
capacity building and program sustainability. Sustainability was not seen as an absolute
requirement but each project had to be seen to be working towards that goal.

While the World Alliance has attracted genuine interest from health professionals and
corporate sustainability personnel only four projects have been developed for approval by
WHO and no new members have been found. One of the factors that may be limiting the
success of the World Alliance is the strict focus on the very high standards of partnership
and sustainability. To meet World Alliance/WHO requirements, a business unit considering
a project for WHO approval must

1. have a broad perspective in terms of defining its stakeholders,
2. be willing to engage in consultation and consensus building and
3. be willing to work in partnership with government, NGO’s and other parties.

Unfortunately, those that sites have been proactive in developing strong health programs for
their employees and host communities have not received sufficient public recognition if
their efforts did not meet these high expectations. Similarly, in the absence of industry or
corporate policies and best practice guidelines in this area, no measures exist to promote and
drive progress in the implementation of the community health policies and programs at
corporate sites.

Further analysis also suggests that strong corporate leadership, based on full acceptance of
the principles of sustainable development and long-term business objectives, is a necessary
ingredient to encourage local business units to become more active participants in the
delivery of health services to their host communities.

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The Community Health Dimension of Sustainable Development in Developing Countries

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5.2 WHO
WHO is the leader or major player in major initiatives such as the Lymphatic Filariasis
Alliance, Roll Back Malaria, STOP TB and UNAIDS. Each of these initiatives is based on
partnerships with other organizations and each seeks to promote projects in countries in all
parts of the world.

As an example of the partnerships established, Roll Back Malaria was formed with the
support of WHO, the World Bank, UN Children’s Fund and UNDP. This group has since
been joined many government funding agencies from developed countries, academic and
research institutions and a diverse group of NGO’s.

There are a few examples of companies working these global programs at individual mining
locations, but the opportunity exists for many sites to become involved in a mutually
advantageous manner in the future.

5.3 Oil & Gas Industry
In June 2000, the International Association of Oil & Gas Producers issued the report
“Strategic Health Management: Principles and guidelines for the oil & gas industry”
(SHM). The purpose of this document is to
provide a basis for incorporating workforce and community health considerations
systematically into project planning and management.
The guidelines in the report describe the main elements necessary to develop, implement
and maintain a strategic health management system.

SHM is intended to facilitate the co-operative interaction among industry groups, host
governments, the local health care system, community representatives and other
stakeholders. Its key messages are stated to be:

• Industry co-operation on health is beneficial;
• Industry can help host governments fulfill their responsibilities;
• Primary health care can have the greatest impact;
• Lasting improvements can be achieved through early stakeholder involvement and
consultation:

The success of this initiative to date is difficult to measure. The report, which is a major
contribution on the subject of community health, has been posted on the OGP web site
(www.ogp.org.uk). A case study section has been provided on the web site but only two
have been posted and, while they are excellent examples, they are somewhat dated. Based
on private conversations it would appear that the oil & gas industry is facing the same
challenges as the mining industry in gaining wide spread support for an expanded private
sector role in community health at the CEO and business unit levels.

The Community Health Dimension of Sustainable Development in Developing Countries
9

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5.4 World Economic Forum
In January 2001, the Global Health Initiative was announced by World Economic Forum
(WEF) member companies with the objective of stimulating large-scale corporate action in
the fight against TB, malaria and HIV/AIDS. Member companies were invited to participate
in a "kick-off" meeting in Geneva in March at which time it was decided to set up three
working groups in the areas of Best Practices, Resource Opportunities and Advocacy.

In July 2001, a small task force of the Best Practices group, with representatives from the
mining, aluminum and oil & gas industries, met with WEF staff with overall objectives and a
short term work program being agreed upon. In summary, it was agreed that for the Global
Health Initiative to be successful, it would have engage private sector CEO's ina meaningful
manner such that they would provide active support for the participation of their business
units in community health programs. It was further agreed that, for this to happen, it will
be necessary to convince the CEO’s that their company's participation in community health
initiatives will reinforce their long term business objectives, that such programs can be
implemented and managed in keeping with good business and health practices and that their
contributions will be recognized.

While detailed objectives and work program are in the process of being finalized, a start has
been made on the collection of case studies from a wide range of industries. It is anticipated
that such case studies will be used to illustrate the application of best practices in terms that
corporate CEO's will understand while at the same offering further guidance and help to
business units contemplating such programs. The response to date from the mining
industry has been good with 6 companies offering to provide 9 studies in total.

As companies become more comfortable with sustainable development as a guiding
framework, more proactive approaches are being tried. The various initiatives described
above are helping to move the agenda forward but more has to be done to clearly establish a
community health role for the private sector, and mining companies in particular, building
on the principles of sustainable development.

6 Sustainability & Health
The first principle of the Rio Declaration is that
Human beings are at the center of concerns for sustainable development. They are
entitled to a healthy and productive life in harmony with nature.

In a draft paper, dated July 2001,“The Social Dimension of Sustainable Development and
the Mining Industry” being prepared by the Minerals and Metals Sector of Natural
Resources Canada, it is stated that:
When dealing with the social dimension of sustainable development it is important to
remember that the main theme is people and how development can contribute to their
lives and their opportunities to make the present and the future better.

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The Community Health Dimension of Sustainable Development in Developing Countries

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Document Outline

• 1 Introduction
• 2 Community Health Impacts
  • 2.1 Mortality
  • 2.2 Healthy Living
  • 2.3 Economic (Neira 2001)
• 3 Community Health Program Needs
• 4 Historical Approaches
• 5 Current Initiatives
  • 5.1 World Alliance for Community Health (www.wacommunityhealth.org)
  • 5.2 WHO
  • 5.3 Oil & Gas Industry
  • 5.4 World Economic Forum
• 6 Sustainability & Health
• 7 Long-Term Business Value
  • 7.1 Sustainability Perspective
  • 7.2 Strategic Health Management
  • 7.3 Partnership Model
  • 7.4 Business Partners for Development
• 8 Path Forward
• Acknowledgements
• References
• Appendix: The Community Health Dimension of Sustainable Development in Developing Countries

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