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.