This report is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an IA framework was utilized to analyze economic, social, health, and environmental data, and co-develop evidence-based responses with pertinent stakeholders. The current analysis focuses on the health of ASGM miners and community members, and synthesizes extant data from the literature as well as co-authors’ recent findings regarding the causes, status, trends, and consequences of ASGM in Ghana. The results provide evidence from across multiple Ghanaian ASGM sites that document relatively high exposures to mercury and other heavy metals, occupational injuries and noise exposure. The work also reviews limited data on psychosocial health, nutrition, cardiovascular and respiratory health, sexual health, and water and sanitation. Taken together, the findings provide a thorough overview of human health issues in Ghanaian ASGM communities. Though more research is needed to further elucidate the relationships between ASGM and health outcomes, the existing research on plausible health consequences of ASGM should guide policies and actions to better address the unique challenges of ASGM in Ghana and potentially elsewhere.

Purpose – This paper aims to determine the nutritional profile of popular takeaway meals in the UK. Fast food has a poor nutritional profile; research has focused on the major catering chains, with limited data on takeaway food from independent establishments. Design/methodology/approach – Random samples of takeaway meals were purchased from small, independent takeaway establishments. Multiple samples of 27 different takeaway meals, from Indian, Chinese, kebab, pizza and English-style establishments (n = 489), were analysed for portion size, energy, protein, carbohydrate, total fat, salt and total sugars. Findings – Takeaway meals were inconsistent with UK dietary recommendations; pizzas revealed the highest energy content, and Chinese meals were lowest in total fat. However, there was a high degree of variability between and within categories, but the majority of meals were excessive for portion size, energy, macronutrients and salt. Research limitations/implications – The present study focused on energy, macronutrients, salt and total sugars. Future research should analyse the quality of fat and carbohydrates and micronutrients to provide a more detailed nutritional profile of takeaway food. Practical implications – The nutritional variability between establishments suggests that recipe reformulation should be explored in an attempt to improve the nutritional quality of takeaway foods. In addition, portion size reduction could favour both the consumer and the industry. Social implications – Takeaway outlets do not provide nutritional information; due to the excessive nutritional profiles, regular intake may increase the risk of non-communicable disease. Therefore, there is a pressing need for this provision to help consumers make conscious food choices. Originality/value – This is the first study to analyse energy and macronutrient content of independent takeaway meals in the UK.

This paper is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an integrated assessment (IA) framework was utilized to analyze socio-economic, health, and environmental data, and co-develop evidence-based responses with stakeholders. This paper focuses on the causes, status, trends, and consequences of ecological issues related to ASGM activity in Ghana. It reviews dozens of studies and thousands of samples to document evidence of heavy metals contamination in ecological media across Ghana. Soil and water mercury concentrations were generally lower than guideline values, but sediment mercury concentrations surpassed guideline values in 64% of samples. Arsenic, cadmium, and lead exceeded guideline values in 67%, 17%, and 24% of water samples, respectively. Other water quality parameters near ASGM sites show impairment, with some samples exceeding guidelines for acidity, turbidity, and nitrates. Additional ASGM-related stressors on environmental quality and ecosystem services include deforestation, land degradation, biodiversity loss, legacy contamination, and potential linkages to climate change. Though more research is needed to further elucidate the long-term impacts of ASGM on the environment, the plausible consequences of ecological damages should guide policies and actions to address the unique challenges posed by ASGM.

Occupational injury is one of many health concerns related to small-scale gold mining (ASGM), but few data exist on the subject, especially in sub-Saharan Africa. In 2011 and 2013, we examined accidents, injuries, and potential risk factors in a Ghanaian ASGM community. In 2011, 173 participants were surveyed on occupational history and health, and 22 of these were surveyed again in 2013. Injury rates were estimated at 45.5 and 38.5 injuries per 100 person-years in 2011 and in 2013, respectively; these rates far surpass those of industrialized mines in the U.S. and South Africa. Demographic and job characteristics generally were not predictive of injury risk, though there was a significant positive association with injury risk for males and smokers. Legs and knees were the most common body parts injured, and falling was the most common cause of injury. The most common type of injuries were cuts or lacerations, burns and scalds, and contusions and abrasions. Only two miners had ever received any occupational safety training, and PPE use was low. Our results suggest that injuries should be a priority area for occupational health research in ASGM.

Mercury is utilized worldwide in artisanal and small-scale gold mining (ASGM) and may pose a risk for miners and mining communities. While a number of studies have characterized mercury in ASGM communities, most have focused on a single media and few have taken a holistic approach. Here, a multiple media exposure assessment and cross-sectional study of mercury was conducted in 2010 through 2012 in northeast Ghana with a small-scale gold mining community, Kejetia, a subsistence farming community, Gorogo, and an urban ASGM gold refinery in Bolgatanga. The objective was to assess mercury in a range of human (urine and hair) and ecological (household soil, sediment, fish, and ore) samples to increase understanding of mercury exposure pathways. All participants were interviewed on demographics, occupational and medical histories, and household characteristics. Participants included 90 women of childbearing age and 97 adults from Kejetia and 75 adults from Gorogo. Median total specific gravity-adjusted urinary, hair, and household soil mercury were significantly higher in Kejetia miners (5.18 µg/L, 0.967 µg/g, and 3.77 µg/g, respectively) than Kejetia non-miners (1.18 µg/L, 0.419 µg/g, and 2.00 µg/g, respectively) and Gorogo participants (0.154 µg/L, 0.181 µg/g, and 0.039 µg/g) in 2011. Sediment, fish, and ore Hg concentrations were below guideline values. Median soil mercury from the Bolgatanga refinery was very high (54.6 µg/g). Estimated mean mercury ingestion for Kejetia adults from soil and dust exceeded the U.S. Environmental Protection Agency reference dose (0.3 µg Hg/kg·day) for pica (0.409 µg Hg/kg·day) and geophagy (20.5 µg Hg/kg·day) scenarios. Most participants with elevated urinary and household soil mercury were miners, but some non-miners approached and exceeded guideline values, suggesting a health risk for non-mining residents living within these communities.

Artisanal and small-scale gold mining (ASGM) is growing in many regions of the world including Ghana. The problems in these communities are complex and multi-faceted. To help increase understanding of such problems, and to enable consensus-building and effective translation of scientific findings to stakeholders, help inform policies, and ultimately improve decision making, we utilized an Integrated Assessment approach to study artisanal and small-scale gold mining activities in Ghana. Though Integrated Assessments have been used in the fields of environmental science and sustainable development, their use in addressing specific matter in public health, and in particular, environmental and occupational health is quite limited despite their many benefits. The aim of the current paper was to describe specific activities undertaken and how they were organized, and the outputs and outcomes of our activity. In brief, three disciplinary workgroups (Natural Sciences, Human Health, Social Sciences and Economics) were formed, with 26 researchers from a range of Ghanaian institutions plus international experts. The workgroups conducted activities in order to address the following question: What are the causes, consequences and correctives of small-scale gold mining in Ghana? More specifically: What alternatives are available in resource-limited settings in Ghana that allow for gold-mining to occur in a manner that maintains ecological health and human health without hindering near- and long-term economic prosperity? Several response options were identified and evaluated, and are currently being disseminated to various stakeholders within Ghana and internationally.

Water scarcity, quality, and control are growing problems worldwide. In this paper, values associated with water—sociocultural, economic, and chemical—in a small-scale gold mining community in northeastern Ghana are considered. Mining activities have affected the quality of locally scarce water resources. In an area without government provision of water, this situation has also forced community members to develop innovative water strategies that reflect the ways that water is understood and valued with regard to personal health and the environment as well as to the seasonality of water acquisition. These community evaluations of water in the gold mining community are then compared with the chemical analysis of water samples collected near the gold mining site. The ways in which these evaluations of water quality—based on particular knowledge systems—coincide and differ suggest the need for community participation in environmental and health assessment as well as government oversight and water provision. An examination of the connections between gold mining, water, and health; work and gender; and cultural and chemical assessments of water quality situates this particular water world within larger global concerns about small-scale gold mining, the roles of mining communities and government, and water sustainability.

This descriptive paper describes factors related to demographics and health in an artisanal and small-scale gold mining (ASGM) community in Ghana’s Upper East Region. Participants (n = 114) were surveyed in 2010 and 2011, adapting questions from the established national Demographic Health Survey (DHS) on factors such as population characteristics, infrastructure, amenities, education, employment, maternal and child health, and diet. In the study community, some indicators of household wealth (e.g., radios, mobile phones, refrigerators) are more common than elsewhere in Ghana, yet basic infrastructure (e.g., cement flooring, sanitation systems) and access to safe water supplies are lacking. Risk factors for poor respiratory health, such as cooking with biomass fuel smoke and smoking tobacco, are common. Certain metrics of maternal and child health are comparable to other areas of Ghana (e.g., frequency of antenatal care), whereas others (e.g., antenatal care from a skilled provider) show deficiencies. Residents surveyed do not appear to lack key micronutrients, but report lower fruit and vegetable consumption than other rural areas. The results enable a better understanding of community demographics, health, and nutrition, and underscore the need for better demographic and health surveillance and data collection across ASGM communities to inform effective policies and programs for improving miner and community health.