Gary R. Krieger

Preparing for Resettlement Associated with Climate Change

Mitigation and adaptation projects will lead to increased population displacement, calling for new research and attention to past lessons. Although there is agreement that climate change will result in population displacements and migration, there are differing views on the potential volume of flows, the likely source and destination areas, the relative role of climatic versus other factors in precipitating movements, and whether migration represents a failure of adaptation (1, 2). We argue that climate change mitigation and adaptation (M&A) actions, which will also result in significant population displacements, have not received sufficient attention. Given the emergence of resettlement as an adaptation response, it is critical to learn from research on development-forced displacement and resettlement (DFDR). We discuss two broad categories of potential displacement in response to (i) climate impacts themselves and (ii) large-scale M&A projects. We discuss policy approaches for facilitating migration and, where communities lack resources to migrate, suggest guidelines for organized resettlement.

Nanotechnology and nanotoxicology : A primer for clinicians

Nanotechnology is the manipulation of matter in dimensions <100nm. At this size, matter can take on different chemical and physical properties, giving the products characteristics useful to industry, medicine and technology. Government funding and private investors provide billions of research dollars for the development of new materials and applications. The potential utility of these technologies is such that they are expected be a trillion-dollar industry within the next 10 years.However, the novel properties of nanoengineered materials lead to the potential for different toxicity compared with the bulk material. The field of nanotoxicology is still in its infancy, however, with very limited literature regarding potential health effects. Inhalational toxicity is to be expected, given the known effects of inhaled fine particulate matter. However, the degree to which most nanoparticles will aerosolise remains to be determined. It has been proposed that dermal exposure will be the most relevant route of exposure, but there is considerably less literature regarding dermal effects and absorption. Less defined still are the potential effects of nanoproducts on fetal development and the environment.

Baseline health situation of communities affected by the Nam Theun 2 hydroelectric project in central Lao PDR and indicators for monitoring

Hydroelectric projects offer opportunities for infrastructure development and economic growth; yet, if not well designed, implemented and operated, they have the potential to negatively affect the health and well-being of local and distant downstream communities. Remote rural populations are particularly vulnerable to the sudden influx of men, materials and money, and associated population mixing that accompany project construction phases. Two large-scale baseline health surveys, carried out in 2001/2002 in two communities that were affected by the Nam Theun 2 hydroelectric project in central Lao PDR, were analysed. For the population to be resettled on the Nakai plateau it was observed that access to clean water and basic sanitation facilities was lacking. Faecal examinations revealed a high infection prevalence for Ascaris lumbricoides (67.7%), but relatively low prevalences for hookworm (9.7%), Taenia spp. (4.8%), Enterobius vermicularis (4.4%), Trichuris trichiura (3.9%), Strongyloides stercoralis (1.4%) and Opisthorchis viverrini (0.9%). For the population in the Xe Bang Fai downstream area, rapid diagnostic tests for malaria carried out in the rainy season found a prevalence below 1%, which might be explained by the complete coverage of households with insecticide-treated nets (99.8%). Anthropometric measurements in both populations suggest that wasting, stunting and underweight in under 5-year-old children were moderate to high; 15.9–17.5%, 40.4–55.7% and 35.8–55.7%, respectively. One out of six individuals aged above 14 years were malnourished, most likely as a result of early childhood wasting. Moderate anaemia, assessed by age- and sex-specific haemoglobin levels, was present in 43.8% (Nakai) and 54.9% of the individuals examined (Xe Bang Fai). Several indicators were extracted that can be utilised for monitoring changes in health, well-being and equity, as the project is implemented and operated.

Barbarians at the gate: storming the Gothenburg consensus

The concept, techniques, and applications of health impact assessment (HIA) hold promise to raise the profi le of health within the overall project, policy and programme planning, and assessment cycle. HIA in the public sector has progressed over the past two decades with a strong Eurocentric focus on transportation and social programmes and policies. In 1999, the publication of the Gothenburg consensus from WHO’s European Centre for Health Policy further enhanced the visibility of HIA, but achieved little to put its high ideals into operation. By contrast, the private sector HIA has had a more focused history, with an emphasis on large industrial projects in the developing world with rigorous adherence to assessment protocols. Has the post-Gothenburg HIA movement expanded beyond being Eurocentric and moved towards a global perspective? These considerations are relevant clear focus on the health needs of vulnerable migrant populations is needed to prevent inequalities in health outcomes for tuberculosis due to limited access to health care, which prevents migrant populations from accessing information that would enable them to avoid tuberculosis or to obtain early diagnosis and treatment. Ensuring access to and proper diagnosis and treatment is not only important from a public health standpoint but also to prevent and combat racism and xenophobia. Second, surveillance must be strengthened but with due consideration of the special confi dentiality issues related to legal status. In low-incidence high-income countries, entry screening of immigrants for tuberculosis while costly, has had little overall eff ect and has not proven to be cost eff ective. Thus, third, a much more cost-eff ective and sanguine approach is increased investment in global tuberculosis control. One analysis concluded that US-funded investments to expand tuberculosis control in Mexico, Haiti, and the Dominican Republic could reduce tuberculosis-related morbidity and mortality in migrants to the USA, and would result in substantial cost savings to the USA. Our best strategy to deal with tuberculosis in migrants is to invest in global tuberculosis control, strengthening national tuberculosis programmes, in line with the Global Plan to Stop TB (which is based on the WHO Stop TB Strategy). Additionally, we must invest in development of better tools (new drugs, diagnostics, and a vaccine) to enhance tuberculosis control as well as a new vision for migrant health. In view of globalisation and migration, the mantra, “tuberculosis anywhere is tuberculosis everywhere” rings true.

Examples of coupled human and environmental systems from the extractive industry and hydropower sector interfaces

Large-scale corporate projects, particularly those in extractive industries or hydropower development, have a history from early in the twentieth century of creating negative environmental, social, and health impacts on communities proximal to their operations. In many instances, especially for hydropower projects, the forced resettlement of entire communities was a feature in which local cultures and core human rights were severely impacted. These projects triggered an activist opposition that progressively expanded and became influential at both the host community level and with multilateral financial institutions. In parallel to, and spurred by, this activism, a shift occurred in 1969 with the passage of the National Environmental Policy Act in the United States, which required Environmental Impact Assessment (EIA) for certain types of industrial and infrastructure projects. Over the last four decades, there has been a global movement to develop a formal legal/regulatory EIA process for large industrial and infrastructure projects. In addition, social, health, and human rights impact assessments, with associated mitigation plans, were sequentially initiated and have increasingly influenced project design and relations among companies, host governments, and locally impacted communities. Often, beneficial community-level social, economic, and health programs have voluntarily been put in place by companies. These flagship programs can serve as benchmarks for community–corporate–government partnerships in the future. Here, we present examples of such positive phenomena and also focus attention on a myriad of challenges that still lie ahead.

Multinational corporations and infectious disease: Embracing human rights management techniques.

BackgroundGlobal health institutions have called for governments, international organisations and health practitioners to employ a human rights-based approach to infectious diseases. The motivation for a human rights approach is clear: poverty and inequality create conditions for infectious diseases to thrive, and the diseases, in turn, interact with social-ecological systems to promulgate poverty, inequity and indignity. Governments and intergovernmental organisations should be concerned with the control and elimination of these diseases, as widespread infections delay economic growth and contribute to higher healthcare costs and slower processes for realising universal human rights. These social determinants and economic outcomes associated with infectious diseases should interest multinational companies, partly because they have bearing on corporate productivity and, increasingly, because new global norms impose on companies a responsibility to respect human rights, including the right to health.MethodsWe reviewed historical and recent developments at the interface of infectious diseases, human rights and multinational corporations. Our investigation was supplemented with field-level insights at corporate capital projects that were developed in areas of high endemicity of infectious diseases, which embraced rights-based disease control strategies.ResultsExperience and literature provide a longstanding business case and an emerging social responsibility case for corporations to apply a human rights approach to health programmes at global operations. Indeed, in an increasingly globalised and interconnected world, multinational corporations have an interest, and an important role to play, in advancing rights-based control strategies for infectious diseases.ConclusionsThere are new opportunities for governments and international health agencies to enlist corporate business actors in disease control and elimination strategies. Guidance offered by the United Nations in 2011 that is widely embraced by companies, governments and civil society provides a roadmap for engaging business enterprises in rights-based disease management strategies to mitigate disease transmission rates and improve human welfare outcomes.

Experience and lessons from health impact assessment for human rights impact assessment.

As globalisation has opened remote parts of the world to foreign investment, global leaders at the United Nations and beyond have called on multinational companies to foresee and mitigate negative impacts on the communities surrounding their overseas operations. This movement towards corporate impact assessment began with a push for environmental and social inquiries. It has been followed by demands for more detailed assessments, including health and human rights. In the policy world the two have been joined as a right-to-health impact assessment. In the corporate world, the right-to-health approach fulfils neither managers’ need to comprehensively understand impacts of a project, nor rightsholders’ need to know that the full suite of their human rights will be safe from violation. Despite the limitations of a right-to-health tool for companies, integration of health into human rights provides numerous potential benefits to companies and the communities they affect. Here, a detailed health analysis through the human rights lens is carried out, drawing on a case study from the United Republic of Tanzania. This paper examines the positive and negative health and human rights impacts of a corporate operation in a low-income setting, as viewed through the human rights lens, considering observations on the added value of the approach. It explores the relationship between health impact assessment (HIA) and human rights impact assessment (HRIA). First, it considers the ways in which HIA, as a study directly concerned with human welfare, is a more appropriate guide than environmental or social impact assessment for evaluating human rights impacts. Second, it considers the contributions HRIA can make to HIA, by viewing determinants of health not as direct versus indirect, but as interrelated.