Urgent Need for a Comprehensive Public Health Response to Artisanal Small-Scale Mining.

Informal sector mining is a growing enterprise in countries around the world providing livelihood to >40 million self-employed miners. The use of mercury in gold processing has been the sole focus of most research and public health interventions in artisanal mining. Few programs work to improve health among communities mining other commodities including sand, aggregates, quartz, lead, gemstones, coal and other materials. Although mercury is a major environmental challenge in countries with extensive gold mining, artisanal miners are also exposed to silica dust, metals and other safety hazards. The available evidence regarding hazardous exposures among self-employed miners suggests that the public health implications are much broader. There is a growing body of evidence linking exposures to silica dust to tuberculosis and other lung diseases among artisanal miners. Studies have also documented exposures to lead and other metals including arsenic, cadmium, cobalt and chromium in informal mining communities. Silica-dust exposures are higher in artisanal mining than levels reported in large industrial mining. There is ample evidence that artisanal miners are experiencing health impacts not just from mercury but also from exposures to noise, silica dust and metals. Practical, low-cost solutions have been pilot tested and shown to reduce respirable silica dust and metal exposures among miners and ore processors. Governments, development agencies and global health funders should invest in comprehensive public health programs to respond to these needs.

Accessing Occupational Health Services in the Southern African Development Community Region.

Only 15% of the global population has access to occupational safety and health services. In Africa, only 5% of employees working from major establishments have access to occupational health services (OHS). Access to primary health care (PHC) services is addressed in many settings and inclusion of OHS in these facilities might increase efficiency in preventing occupational diseases. A cross-sectional study was conducted in four Southern African Development Community (SADC) countries aiming at assessing the availability of OHS at PHC facilities and the organization of OHS. We conducted a literature review to assess the provision and organization of OHS services. In addition to the review, a total of 23 doctors from Zambia were interviewed using questionnaires in order to determine the availability of OHS and training. Consultations with heads of ministries were done in four SADC countries. Results showed that in the SADC region, OHS are fragmented and lack a comprehensive approach. In addition, out of 23 PHC facilities, only two (13%) provided occupational health and PHC. However, OHS provided at PHC facilities were limited to TB screening and audiometric testing. Our study showed a huge inadequacy of trained occupational health practitioners. This study supports the World Health Organization's advocacy to integrate OHS at the PHC level.