The right to health is a human right. In line with the SHE Way, the fundamental objectives of CHS management are to achieve zero harm from site-related impacts, to manage risks to the site operations and to improve overall community health and well-being.

Effective CHS management embraces the workforce and local communities as integral parts of a system that is dynamic, responsive to changing contexts, and allows for transparency and accountability.

Core community health concepts and principles

Understanding the following concepts will support a broadened and deeper understanding of CHS.

Box 4C.2 Core community health and safety concepts and principles

• The concept of health
• Health Impact Assessment (HIA)
• Key community health and safety areas (CHSAs)
• Determinants of health and health outcomes
• International guidance and national regulations/legislation
• Key considerations in assessing and managing CHS risks and impacts
• Lifecycle planning
• The inter-connectedness of community and workforce health
• The inter-connectedness of CHS management and health and wellness as part of socio-economic development (SED)

The concept of health

The World Health Organization (WHO) defines health as: “A state of complete physical and mental and social well-being and not purely the presence or absence of disease,” and “the extent to which an individual or a group is able, on the one hand, to realise aspirations and to satisfy needs, and on the other, to change or cope with the environment.”

Achieving good health also implies that people are safe. Unless stated otherwise, this tool uses the term “health” as encompassing CHS issues. Community health is highly dependent on context and can differ across geographical landscapes. Different communities and cultures might give importance to diverse aspects of health and well-being.

Health impact assessment (HIA)

The International Association of Impact Assessment (IAIA) defines HIA as a combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a project, programme, plan, policy or strategy on the health of a population, and the distribution of those effects within the population. HIA is the required methodology in identifying, analysing and managing CHS risks and impacts, with the approach focused on a mining project or operating site, and not on methods that consider policies or plans.

HIA is a structured planning and decision-making process using a variety of evidence sources for the identification and analysis of CHS impacts and risks, with the objective to produce prevention and management measures that are technically sound, socially acceptable, practically achievable and economically feasible (broadly ‘fit for purpose’). These management measures (aimed to protect and promote health) are presented in a structured Community Health and Safety Management Plan CHSMP), which is supported by an associated monitoring and evaluation process to evaluate changes in health indicators and adjust interventions as appropriate.

As HIA considers the ways in which a site or project may create health hazards and associated health impacts, as well as health promoters and associated health opportunities, it has application to both the analysis of negative impacts and risks but also on opportunities for socio-economic development associated with CHS (see Section 4A and as discussed later).

While an HIA can be a separate stand-alone process, it is generally more efficient when integrated with the assessment of other impacts and risks as part of a multi-disciplinary approach (such as Environmental Impact Assessments or Social Impact Assessments), as similar methodological steps are followed, with potential benefit to:

• Avoid duplications and minimise overlaps (for example, combined stakeholder engagement activities, reduce survey fatigue in data-collection efforts, etc.).
• Reduce costs and improve efficiency.
• Consider the interlinkages between bio-physical (environmental) and socio-economic determinants, especially in the collection of data and analysis of impacts and risks. For instance, baseline environmental health data such as water and air quality collected by the environmental team is utilised in the HIA, thus avoiding duplication of effort.

• Integrate management interventions by limiting siloed approaches.
• Develop a unified social (including CHS) management plan and/or environmental management plan that consider management measures and integrates the monitoring and evaluation system.

While it is likely that most Anglo American operations would require a more extensive level of assessment, as they tend to potentially cause significant adverse social impacts and/or risks that are diverse, irreversible, or unprecedented, the determination of the level or type of HIA required for a site is generally defined at scoping. Importantly, not all sites require a comprehensive assessment with extensive data collection or stakeholder engagement, with this decision process described under the guidance section (see Section 4C.2 Task 1 and Guidance Note 4C.1) considering the potential health impacts, social sensitivities and project footprint as outlined in Figure 4C.1².

 

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Figure 4C.1 Decision matrix on the level of health impact assessment

Finally, the HIA process relies heavily on inputs from external stakeholders (with health authorities, health experts, social workers, local communities, etc.). External stakeholder engagement supports the participatory process of HIA and promotes inclusive decision-making based on presented evidence if there is transparent and open consultation.

Key community health and safety areas (CHSAs)

To ensure that CHS assessments follow a systematic approach in considering relevant/appropriate CHS topics, a standardised methodological process should be followed that considers 12 CHS areas, termed community health and safety areas (CHSAs). This approach is aligned to the Environmental Health Area method as described in both the International Finance Corporation (IFC) Introduction to Health Impact Assessment (2009)³ and the International Association of Oil and Gas Producers Health Impact Assessment guide for the oil and gas industry (2016)⁴, considered as reference GIIP .

This method considers both environmental and social determinants of health, as well as different pathways where CHS outcomes may be influenced by direct and indirect site-related activities, which ultimately supports an integrated and holistic consideration of various CHS topics. Various health determinants and health outcomes are described in more detail below, with the 12 CHSAs outlined in Table 4C.1 and a more detailed description in Tool 4C.2. Notably, CHSA 9 and 10 relate to environmental and socio-economic determinants of health, with overlaps into the biophysical and external social context and how these could be affected by site-related activities.

It is recommended that the CHSAs approach be used for Tasks 1-3 (scoping, baseline heath data collection, and impact/risk assessment) as described in the guidance section, to ensure that a systematic process is followed, and that all CHS topics are scoped in at these stages. However, to support the cross-cutting nature of prevention and mitigation measures, the CHSAs are typically separated into thematic areas as part of the Community Health and Safety Management Plan.

Table 4C.1 Community health and safety areas

Community health and safety areas (CHSAs)

Communicable diseases linked to the living environment and housing

Vector-related diseases

Soil-, water- and waste-related diseases

Sexually transmitted infections

Food- and nutrition-related issues

Non-communicable diseases

Accidents/injuries and safety-related issues

Veterinary medicine and zoonotic diseases

Environmental health determinants

Social determinants of health

Health-seeking behaviours and cultural health practices

Health-systems issues

Determinants of health and health outcomes

The CHSA methodology is supported by the concept of determinants of health, which are factors that may influence, or be influenced by, health outcomes, and can be seen as the drivers of good or poor health and well-being for a given population. As described in Box 4C.3, determinants of health can be categorised specifically to a person’s individual characteristics and behaviours, while others are more collective in nature and include the socio-economic as well as bio-physical environment. Key bio-physical (environmental), social and health determinants and their inter-relationships are presented in Figure 4C.2, demonstrating complex overlaps and the need for a ‘simpler’ or more systematic approach to considering health topics as presented in the CHSA approach (Table 4C.1). Notwithstanding the CHSA approach, these determinants are especially important to consider, as they represent the ‘causes of the causes’ and are important in affecting or influencing disease profiles and health outcomes. In addition, they have a clear overlap to the SED elements presented in section 4A, with the interconnectedness in data-collection approaches between an HIA and an SED described below. The good-practice guidance on HIA (2009) developed by the International Council on Mining & Metals (ICMM) provides, in chapter 1.2, a detailed description of the impacts of mining projects on the various determinants of health.

Box 4C.3 Examples of determinants of health

Individual determinants of health	Environmental determinants of healt	Socio-economic determinants of health
Age Gender Ethnicity Genetics Income, employment and economy Education and learning Social status Health status Lifestyle, including substance abuse Diet and nutrition status Health and risk-taking behaviour Coping skills	State of the physical environment (built or natural), including aspects such as traffic, housing/shelter, ecosystems services, agriculture/food supply, water supply and sanitation Exposure to environmental or physical hazards, including waste management Exposure to hazardous substances Transport and connectivity	Employment and working conditions Livelihoods and local economy Access to goods and services Affordability of goods and services Culture, customs, faith and traditions Institutional capacity of health and other public services (police, justice, social care) War and conflict (safety/security) Social and community cohesion

There is the potential that HIA could follow a biomedical or health-outcome approach that purely considers disease or illness and related causal mechanisms. The focus of this approach may be excessively concentrated on disease processes and rates of disease, and neglect the cause, or contributing factors that influence or affect disease rates (the determinants of health; i.e. the ‘causes of the causes’). The CHSA approach gives due consideration to health outcomes, as well as related health determinants, in considering potential changes in the health status of communities or groups within the potentially affected stakeholders which are attributable, directly or indirectly, to site-related activities. Health outcomes are generally categorised into five broad categories:

• Infectious or communicable diseases, including vector-borne (malaria, dengue); water-borne (diarrhoeal, typhoid, cholera); sexually transmitted (HIV, syphilis); zoonotic (infections that can be passed between animals to humans e.g. Ebola, Covid-19); and respiratory/droplet transmitted conditions (TB, influenza, meningitis).
• Non-communicable diseases, including cardiovascular disease, diabetes, chronic lung disease and cancer.
• Nutritional disorders, including undernourishment, obesity, vitamin disorders or micronutrient deficiencies.

• Physical injuries, including road traffic accidents, failure of equipment or infrastructure (e.g. tailings storage facilities), drowning, non-accidental injury (assault), etc.
• Mental health and well-being, including stress and loss that may be associated with physical resettlement, financial stress, noise associated with a project, etc.

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Figure 4C.2 Decision matrix on the level of health impact assessment

International guidance and national regulations/legislation

National laws regarding the consideration of CHS impacts/risks from mining sites can be extremely variable and are often included in the regulatory framework typically addressed by the environmental and social impact assessment process, Environmental Management Act or equivalent. The detail on methodology and expected outputs in these regulations may be limited; as a result, merely following local legislation and permitting processes may not be sufficient to adequately manage impacts and risk related to CHS, especially to the standard described in this section. In addition, there is often inadequate alignment and integration between the various ministries in host governments to ensure that CHS impacts are effectively addressed as part of the mandated Environmental Impact Assessment (EIA) process. Conversely, national regulations and legislation may prescribe methodological steps that need to be aligned with the tasks described in this section.

Country-specific guidance is available for Australia, Canada, Brazil⁵ and other jurisdictions, but where these are not available it is recommended to follow GIIP guidelines, fully aligned to the standards described in this section, including:

• IFC (International Finance Corporation), 2009: Introduction to Impact Assessment
• ICMM (International Council on Mining & Metals), 2010: Good Practice Guidance on Health Impact Assessment
• IPIECA – IOGP (International Association of Oil and Gas producers), 2016: Health Impact Assessment: a guide for the oil and gas industry.
• The Initiative for Responsible Mining Assurance (IRMA) standards (see Box 4C.4)⁶

Box 4C. 4 Initiative for Responsible Mining Assurance (IRMA)

Chapter 3.3 of the IRMA standard for responsible mining (June 2018) addresses community health and safety under the social responsibility section. This current 4C toolkit substantially meets the requirements outlined in IRMA , but special note is taken of the specific provisions on HIV/AIDS, TB, malaria, and other emerging infectious diseases in section 3.3.4 of the IRMA standard. If the CHS area method (see Table 4C.1 and Tool 4C.2) is followed in the recommended systematic fashion, it is anticipated that these communicable disease threats will be identified at the scoping phase and be subject to adequate baseline data collection so that evidence-based impact and risk assessments can be performed, and effective management measures proposed.

Key considerations in assessing or managing CHS risks and impacts

To effectively understand and manage CHS impacts and risks, the following are important to note:

• Health inequality and health inequity
  Health inequalities are differences in health status or in the distribution of health determinants between different population groups. Some health inequalities are attributable to biological variations or free choice, and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. In the latter, health inequalities may also lead to health inequities, where equity in health refers to fair, just and unavoidable differences in exposure to health-risk factors and status, among groups of people. As an example, significant differences in mortality or environmental risk exposure between low and high-income groups would be considered unfair and avoidable, and therefore considered an equity challenge.
  
  This is important, as a site can cause “hidden costs” on affected communities and the health system at large in the form of an increased burden of disease and reduced well-being. The adverse health effects are often experienced most by groups that are vulnerable. As an example, loss of land, pollution of various sources (especially water and air), and inflation (food and basic services) may disproportionally affect those suffering from poverty or those with pre-existing diseases. However, extended benefits supported by company-sponsored health programmes can bring about more significant improvements in vulnerable populations or groups as their needs may be so much higher; but this depends on the appropriate recognition, targeting and successful implementation of interventions.
  
  Task 5 in Section 2 (Review and Planning) outlines systemic vulnerabilities in detail with the presentation of five capitals. It is essential that the HIA process consider these vulnerabilities to evaluate vulnerable groups and assess potential inequalities that may emerge or increase in relation to site-based activities.

• Privacy and protection of health data
  Health data is privileged and the privacy and protection of information about people and their health status must be ensured. Maintaining identifying health information of community members can bring discriminatory harm to individuals if mishandled. Self-reported health status data also requires sensitivity. This information, if collected, should be anonymised, with restricted access. Data protection and privacy considerations within Anglo American are described in Box 4C.5, and these will be expanded in the baseline data collection section related to ethics of data collection and management as described in Box 4C.8.

• Working with local authorities
  Local health authorities should be viewed as long-term partners with deep insight, knowledge, and expertise on community health and how health determinants affect health outcomes at the local level (the ‘causes of the causes’). Local health authorities are often the most trusted and influential stakeholders in a local community. A good relationship with community health workers, local doctors, nurses, hospital administrators and other allied health-related professionals (emergency-response professionals, etc.) and non-health professionals (police, social workers) helps ensure collaboration to implement joint actions and approaches required to safeguard and promote community health and safety. In many cases, local authorities have insight into health information not captured by other data (participatory data); for example, they may have knowledge of an influence on health outcomes that should be considered (e.g. increased disposable income leading to an increase in drug use, use of traditional medicine as a preference in care-seeking behaviour). Ideally, as part of stakeholder engagement, a site should collaborate with local authorities to complete relevant health assessment work, request access to primary and secondary data, assist in the implementation of mitigation measures, and play an essential role in monitoring and evaluation activities.

• Engaging local institutions in assessment and interventions
  When considering potential community health and safety partners for assessments and intervention, sites should try to engage with local academic institutions or local NGOs, as these are often experts in local data collection and analysis, can provide human resources to undertake larger surveys, and can help ensure that health strategies appropriate to the local context are developed. Collaborating locally can also strengthen regional capacity to address certain issues.
  
  In addition, sites should look for local implementation partners that have the correct skills and capacity to support the design, implementation and monitoring of certain health interventions. In the absence of suitable local implementation partners there should be a strong focus on building local capacity if external resources are required. The intent should be to create some degree of separation and limit the company from being entangled in the delivery of public health services, even through health system strengthening activities.

Box 4C.5 Data protection

Any personal data must be managed in accordance with the Anglo American Group Data Privacy Policy. Data must be processed: 

• Appropriately: only process data when we have a lawful reason to do so; take extra care with very sensitive data; recognise and respect the rights of the people (data subjects) whose information we hold. 
• Transparently: we must tell individuals when we are collecting their data and what we are going to do with it; and we can only use personal data for the purpose for which it was intended. If we want to use it for something else, then we need to go back to the ‘data subject’ and tell them. 
• Securely: We must protect personal data from harm, whether accidental or malicious loss, destruction, damage and unauthorised disclosure. If there is a breach, then we must act quickly, and report it to [email protected] immediately. We must not share personal data with anyone, unless this is deemed necessary. If it is, we must make sure the person or organisation we are sharing it with will give it the same protection we do. If it is with an external party, a data-sharing agreement may be needed. 
• Responsibly: We must only collect and use the personal data we need. If it does not help to achieve our intended business objective, then it is off limits. We must make sure the personal data we process is accurate and kept up to date. We cannot keep hold of personal data forever. We can only store and process it for as long as it is required, and then delete it. 

Lifecycle planning

The HIA process is flexible and can be used at any stage of a project/site lifecycle (from Discovery to feasibility, development and construction, site operations or as part of a modification of an existing activity) to anticipate impacts/risks, appraise a past event or to support planning for closure and social transition. The HIA process should consider various lifecycle stages when assessing potential impacts or recommending associated management measures; for example, impacts and management controls may be different in construction compared with operations (e.g. owing to the presence of a construction workforce) and some controls may need to extend into the post-closure phase in order to address impacts that may only become apparent at that stage (e.g. tailings storage facilities and water-quality management).

CHS and related risks and impacts should be considered during the Discovery phase, with guidance from the Social Way 3.0 Supplemental Guidance for Group Discovery and Geosciences, including specific CHS considerations based on the different stages of Discovery. This guidance refers to elements of this toolkit that apply, with due consideration for the timing and context of Discovery activities.

An HIA (the level discussed in Task 1 under guidance) or integrated study e.g. Environmental, Social and Health Impact Assessment (ESHIA) should be initiated as a scoping process as the site moves into the project stage. CHS should also be integrated into other relevant studies and plans as the site advances through project-study phases; for example, into feasibility assessments, resettlement and land-access planning (see Section 4F), and site-induced migration assessments (see Section 4G). Incorporating CHS into project planning as early as possible allows the project design to be adapted to avoid CHS impacts (as the most effective control).

Construction activities and the presence of a large construction workforce are likely to present significant CHS impacts and risks. Sufficient resourcing, including specialist expertise to manage certain issues, depending on context, should be planned for.

Once the site is operational, there should be regular review of CHS impacts and risks and associated management plans. Significant changes in the internal or external context may trigger a need for a more in-depth health assessment, which may include updating or expanding the HIA as applicable (see Figure 4C.1 and Guidance Note 4C.1 under scoping that outlines the various levels of HIA).

Box 4C.6 Closure planning: social transition

During operations, actions needed to achieve desired long-term community and employee health outcomes post-mining (e.g. no residual risk of adverse health impacts, particularly those related to exposure to environmental hazards) should be included in relevant management plans (operational social management plans, SED Plans, the CHS Management Plan and SHE plans, as well as Human Resources (HR) Plans), and in the social component of the Mine Closure Plan.

Community health and safety impacts related to social transition should be assessed either in a stand-alone HIA or as part of an integrated ESHIA when sites are five years from planned closure and the results integrated into the Final Closure Plan, as well as SHIRA, SMP and SEP .

A formal and documented mechanism must be established during social transition for following potentially affected stakeholders considered to be “at risk” (e.g. of exposure to environmental hazards) into the future, post-closure. This involves specific follow-up for exposure groups and general follow-up for the remainder of the affected community.

The interconnectedness of community and workforce health

Workplace health and safety and community health and safety are interconnected, with various health determinants potentially influencing or affecting health outcomes in both the community and the workplace. The term ‘health risks and impacts don’t respect the fence line’ is often used to demonstrate that activities in the workplace can influence community health and safety, and that prevailing diseases or health conditions in the community can influence worker health and safety. Some examples are demonstrated in Figure 4C.3, with an instance of an important cross-over consideration when workers act as transmission agents for potentially hazardous exposures (e.g. chemicals or infectious diseases) and potentially transmit the exposure effects from the workplace to the community. Notably, the workforce may originate from, live in or near a local community, use a local community’s social and health services, and spend recreational time in the area of influence.

The assessment methodology for workplace health and safety generally takes the form of a health-risk assessment that is captured into the workplace risk and controls register (WRAC) and defined by processes in Operational Risk Management (ORM) and SHE Way implemented by the occupational health and safety team. The health-risk assessment, or workplace health and safety risk assessment, is compared to the health-impact assessment process in 4C Tool 3, which includes a comparison between the assessment of potential community health impacts and the Sustainable Mining Plan Thriving Communities health and well-being stretch goal pillar (as discussed in the next section).

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Figure 4C.3 Inter-connectedness between workplace and community health and safety

The inter-connectedness of community health and safety management and health and wellness as part of socio-economic development

Recognition of the interconnectedness and overlaps between this section and the Thriving Communities elements described in SED toolkit 4A is vital so that similarities in approach and outcomes can be maximised, while differing objectives can be separated. Importantly, while objectives may differ between the HIA and SED processes, data-collection activities often share the same inputs and therefore integration opportunities may be possible.

Typically, an HIA anticipates and identifies appropriate actions to prevent or mitigate negative health impacts and risks, as well as ways to enhance or promote health benefits or opportunities. However, as the Anglo American’s Social Way 3.0 and the SHIRA process are focused on identifying potential negative impacts, the CHS assessment as described in this toolkit has this objective in mind.

SED toolkit 4A seeks to evaluate opportunities to make lasting positive contributions to communities or regions where Anglo American operates that include health and well-being as a key element of the living condition category. Most SED elements described in the Thriving Community model (presented in Figure 4A.1) consider determinants of health presented in Box 4C.3, including housing, water and sanitation, energy, connectivity, social cohesion and food security, with an overlap to the CHSAs as described in Tool 4C.2.

Even though the HIA process can identify benefits, two separate methods are recommended:

• health impact assessment (for 4C)
• health needs and opportunities assessment (for 4A).

As mentioned above, the health risk assessment approach may also have some relevance; however, it is not included within this section and is not subject to Social Way guidance. These three methods are described in detail in Tool 4C 3, with Figure 4C.4 outlining the various approaches, objectives and outcomes.

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Figure 4C.4 Various health assessment approaches

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² International Finance Corporation (IFC) (2009) Introduction to Health Impact Assessment. Available at:  https://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/sustainability-at-ifc/publications/publications_handbook_healthimpactassessment__wci__1319578475704 [Accessed January 2021]

³International Finance Corporation (IFC) (2009) Introduction to Health Impact Assessment. Available at:  https://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/sustainability-at-ifc/publications/publications_handbook_healthimpactassessment__wci__1319578475704 [Accessed January 2021]

⁴ International Association of Oil and Gas producers (IPIECA – IOGP) (2016) Health Impact Assessment: a guide for the oil and gas industry. Available at: https://www.iogp.org/blog/health/ipieca-iogp-launches-the-revised-health-impact-assessment-guide/ [Accessed January 2021]

⁵ Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância em Saúde Ambiental e Saúde do Trabalhador.Avaliação de Impacto à Saúde – AIS: metodologia adaptada para aplicação no Brasil / Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância em Saúde Ambiental e Saúde do Trabalhador – Brasília : Ministério da Saúde (2014). Available at: https://bvsms.saude.gov.br/bvs/publicacoes/avaliacao_impacto_saude_ais_metodologia.pdf [Accessed January 2021]

⁶ Initiative for Responsible Mining Assurance  (IRMA) (2018). Standard for Responsible Mining Std-001: Community health and safety requirement, Available at: https://responsiblemining.net/wp-content/uploads/2018/07/IRMA_STANDARD_v.1.0_FINAL_2018-1.pdf [Accessed January 2021]