Health, Extractivism, and the Green Transition

Health, Extractivism, and the Green Transition

New Evidence from the Democratic Republic of Congo, Tanzania, Zambia, and Zimbabwe Reveals the True Cost of Mining

Rachel Boakye, PhD Candidate, Department of Politics, York University

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As the world races toward a green transition, the demand for critical minerals is reshaping Africa’s mining frontier. Minerals such as cobalt, copper and lithium power the electric vehicles, solar panels, and batteries that governments and companies insist will define a sustainable future. Thus, in policy circles, government officials talk about securing adequate supply, foreign investment, and industrial growth.

But on the ground, far from the halls of power, mineral extraction for the green transition is unfolding in far more personal ways: in the air they breathe, in the water they drink, and in the soil where they grow their food. New evidence from Health Impact Assessments (HIAs) in the Democratic Republic of Congo, Tanzania, Zambia and Zimbabwe—supported in part by the African Extractivism and the Green Transition (AEGT) project and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through Training and Research Support Centre(TARSC)—paint a very different picture. In an interview with the AEGT, TARSC Director and Zimbabwean epidemiologist Dr. Rene Loewenson discussed how Africa’s role in supplying the world’s critical minerals cannot be separated from questions of public health, social equity, and community well-being.  

EQUINET and SATUCC, working with a range of partners and in collaboration with the East, Central and Southern African Health Community, have carried out research, regional training, and policy dialogues on health in mining and on HIA throughout the 2000s. Their work aims to highlight and address the health impacts of commercial activities in the region, particularly those associated with mining. HIAs offer governments a blueprint for change by assessing how proposed laws, strategies, and projects will affect health before they are approved. They demonstrate how it is possible to shift the trajectory of the sector towards risk prevention, protection, and long-term sustainability. For the AEGT project, this regional initiative has offered a space to explore more deeply how this applies in relation to critical minerals.

Overview of the Health Impact Assessment Training (HIA)

As explained in more detail on the EQUINET site, HIA is a structured, evidence-based process used to examine how a proposed law, project, strategy, or economic activity may affect the health and well-being of people before it is implemented. It looks at health in a broad sense— direct or indirect, intended or unintended—and translates findings into practical recommendations for decision makers. An HIA can be conducted on its own or alongside an Environmental Impact Assessment (EIA) to ensure that development decisions protect both the environment and communities.

The HIA training is part of a rigorous four-month regional program run by EQUINET, TARSC, the ECSA Health Community, and their partners. It teaches participants how to conduct an HIA, using real policy proposals or economic activities from their own countries, and with a globally recognized 5-6 step process. Participants learn each step through live sessions and apply it to their own mentored case study. For the AEGT project, four teams from the DRC, Tanzania, Zambia and Zimbabwe participated in the HIA training in 2025. Each team selected a country-specific case study. Course resource people mentored the teams to draft an HIA, the summaries of which are featured in a set of briefs on the EQUINET website.

What the Four HIA Briefs Reveal

Zambia: A Forward-Looking Assessment Before the Law Takes Effect

The Zambia HIA analyzed the Minerals Regulatory Commission Act No. 14 of 2024 before its implementation. The brief highlights persistent health concerns, including unsafe working conditions, severe air and water pollution, and losses in health and education services following community displacement. The team led by Southern African Institute for Policy and Research offered recommendations to strengthen regulatory standards, improve environmental monitoring, and ensure that essential services remain accessible to communities affected by mining activity.  

Zimbabwe: Toxic Exposure and River Contamination in Bubi District

The Zimbabwean team’s HIA examined the health impacts of artisanal gold mining and custom milling in Bubi District. Miners and downstream communities face high rates of accidents, respiratory disease, and exposure to toxic chemicals such as mercury and cyanide. With the Mbembesi River at risk of contamination, the team led by University of Zimbabwe and partner institutions called for rigorous inspections, safer milling technologies, improved waste management practices, and mandatory HIAs for all ASM operations seeking licenses.

Tanzania: Evaluating Health Gaps in a National Minerals Strategy

Tanzania’s HIA brief examines how effectively the draft Critical and Strategic Minerals Strategy integrates health concerns. It identifies gaps and opportunities to strengthen the draft strategy. The teamled by Mkwawa University College of Education identified several risks, including: respiratory illness, water contamination, mental stress linked to mining displacement, and injuries among artisanal miners while noting gaps in environmental governance and community participation. They recommended mandatory HIAs for all critical mineral projects, stronger monitoring systems, and robust awareness of environmental, social, and governance (ESG) standards on mining sites.  

DRC: Health Risks in Artisanal Cobalt Mining

The DRC brief assesses health implications of artisanal cobalt and copper mining under Decree 19/15 in Lualaba Province. The team led by Centre of Expertise in Mining Governance and Environment reported persistent child labour, exposure of pregnant women to hazardous mining sites, extensive environmental degradation, and widespread toxic contamination. They recommended strengthening legal protections, building enforcement capacity, supporting cooperative organizations, and improving occupational health and safety training across ASM sites.

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How Mining Shapes Home, Health, and Daily Survival

The HIA reveals that the impact of mining extends far beyond the site. They connect mineral production to the lived realities of surrounding communities. The HIA briefs reveal how the pressures of mining extend into social and economic systems, influencing access to clean water, food security, mobility, and essential services such as health care and education.

Across the four country cases communities clearly recognize the links between environmental harm and declining well-being, even when laws and policies do not.   Residents spoke of sulphur emissions that cause chronic respiratory problems in children and the elderly. Miners describe long-term illnesses linked to sustained exposure to dust, chemicals, and unsafe working conditions.  

In several communities, mining has also led to displacement, reduced access to arable land, and the weakening of local economies that once depended on farming and small-scale trade.  HIAs help bridge the gap between high-level policy decisions and everyday experiences, ensuring that community realities are visible in conversations about health, mineral wealth, governance, and the green transition.

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Health and the Environment: Coping, Resisting, and Surviving

In the mining districts and provinces of the country cases the link between environment and health isn’t theoretical—it is lived every day. It shapes how people breathe, what they drink, what they touch, and what their bodies carry. As Dr. Loewenson notes, residents dust, contaminated water, stress, and their children's persistent coughing because these are the conditions they navigate daily.  

In Kankoyo Township on Zambia’s Copperbelt, residents point to roofs decaying owing to acid rain and high rates of asthma cases. In Bubi District, “coping” means living along a river turned toxic, where 74,000people face risks of heavy metal poisoning, cholera, malaria, and diarrheal diseases. Accidents are common, and terms such as silicosis and tuberculosis are frequently mentioned. Yet people return to the mines each day because gold and other minerals remain a fragile lifeline.

In Lualaba, DRC, survival and extraction are even more closely linked. Women work at cobalt and copper sites with infants strapped to their backs. Pregnant women sort ore in intense heat, inhaling dust and handling contaminated soil in pits where a single misstep can be fatal. These are the risks they carry simply by trying to stay alive.

But what stands out across the four countries is not only the scale of harm, but the silence surrounding it. The hardships faced by communities and workers in these mining districts are not inevitable; rather, they are the consequence of an extractive economy that prioritizes minerals over individuals. Communities continue to breathe, drink, and work in conditions that make them sick, not because they are unaware of the risks, but because no one has provided them with safer choices.

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Hidden Burdens that Rarely Enter Policy Conversations

Mining health hazards are widely acknowledged, yet the Health Impact Assessments reveal a quieter crisis—one that rarely enters policy spaces. Beyond water contamination, accidents, communities living near mines shoulder an uncounted mental burden. A recent study in the South African Journal of Psychiatry found that about a third of assessed mine workers experienced moderate to severe psychological distress indicators consistent with symptoms of anxiety and depression.

In many mining districts, the combination of poverty, insecurity, and forced displacement has become a major burden on mental health, particularly for youth, women and the elderly, who face the greatest social andeconomic strain. These health problems are further intensified by violent conflicts, deep power imbalances between mining companies and communities, and the lack of meaningful participation in decision-making processes, all of which feed chronic anxiety and a sense of powerlessness. As Dr. Loewenson notes, mentalhealth is one of the things that isn’t often discussed, as it’s not wellmeasured. These experiences, though deeply felt, remain largely invisible because health systems seldom track them, and mining laws rarely acknowledge them.

Pregnant women face layered vulnerabilities. When clean water or supplies are scarce, they are more likely to consume contaminated sources, heightening risks during pregnancy and child birth, especially in areas where health services are limited or inaccessible, exacerbating their mental and emotional distress.  In Zambia’s Copperbelt, for example, sulphur dioxide exposure and polluted water pose compounded dangers to mothers and infants, increasing the likelihood of health complications, low birth weight, and long-term developmental challenges.

Another overlooked reality is the gradual onset of respiratory and skin conditions that go undiagnosed simply because nearby communities lack access to proper testing and treatment. In rural Tanzania andthe DRC, people commonly report chronic coughing, fatigue, and persistent skin irritation long before a formal diagnosis is made—and often no diagnosis comes at all. These health emergencies are overlooked not because they are minor, but because they are harder to measure and fall between institutional mandates.

HIAs bring these harms into view, pushing mental health, maternal risks, and undiagnosed chronic conditions into the center of the conversation. They remind policymakers that a just mining future cannot be built by counting only what is easy to measure, but by confronting the full spectrum of what communities endure on the ground.

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Why Timing Matters: Early Assessment Prevents Harm

Zambia and Tanzania carried out a prospective HIA , evaluating health risks before new laws and strategies take effect, an unusually proactive move in the mining sector. Instead of waiting for communities to lose water sources owing to contamination, injuries to rise, or mining displacements to cut off access toclinics and schools, both country teams examined potential harms in advance. This timing is critical: early assessment allows risks to be prevented or reduced,rather than documented after the damage is done.

Zambia’s situation shows why timing matters. At the time of doing the HIA, the Minerals Regulation Commission Act (2024) had been passed but was not yet in force. Its detailed regulations are still being drafted, creating a rare opening to embed strong health protections at the outset. The HIA team used this moment to recommend mandatory ventilation standards, real-time pollution monitoring, safer mining conditions, and to ensure that displaced communities retain access to essential services, such as health care and education.

Tanzania faces a similar turning point as it finalizes its Critical and Strategic Minerals Strategy. The rapid expansion of graphite, nickel, and rare-earth mining could intensify air pollution, accidents, waterborne illnesses, andmental health pressures; risks documented across mining districts. By assessing health impacts early, Tanzania can put in place funds, monitoring systems, and community-reporting mechanisms that ensure mining revenues are reinvested in health, clean water, and social services, especially in remote mining regions.

In both countries, preemptive HIAs act as a safeguard, ensuring that the rush for critical minerals and the promise of a green transition strengthen public health rather than burden it. Assessing health implications before enacting regulations allows governments to incorporate protections into mining policies from the beginning.

A Green Transition That Protects People, Not Just Minerals

Mining will remain central to Africa’s economic aspirations and to the global green transition. But as demand for critical minerals grows, governments have a narrow window to build health protections into new mining laws and strategies. While African countries reposition themselves in the green economy, this moment offers a rare and consequential opportunity not just to regulate minerals, but to design frameworks that safeguard health, protect communities, and secure the futures of people living near mining sites every day.

This is why HIAs  matter: they help protect public health by examining how a policy, project, strategy, or economic activity affect people’s health before it is implemented. They insist that environmental and climate goals come with concrete protections for the people whose lives are closest to the points of extraction.

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