PoPulationand Public HealtH etHics

The framework provided by the case book steering committee to ensure a
more standard approach in each of the case analyses in the casebook follows
this model quite nicely.
Key public health issues
Grave harms can arise when a community has neither the infrastructure
nor the sophisticated knowledge about the cautions needed before rushing
forward to embrace an industrial activity made possible by access to machinery;
in this case, grinding machines. Infrastructure needs could include
artisanal mining approval processes and compliance monitoring to ensure
that the activity should remain within both safety and health limits. It appears
that inspections and penalties for operating outside of the law were
neither implemented nor enforced, given that, over time, the illnesses occurred.
The absence of law enforcement reveals how desperate people will
resort to desperate means to make ends meet. And, because poverty drives
people to extremes in order to survive, it will remain one of the great predictors
of premature morbidity and mortality, exposing how law and reality
need to be practical in order to better support community needs. The fact that
a group of people was poor enough that its members broke the law in order
to engage in artisanal gold mining warrants some attention as an upstream
determinant of behaviours (i.e., the law) resulting in grave harms. Indeed,
the collision between poverty and economic opportunity in an unregulated
and unenforceable social environment is one that has, in this case, resulted
in an epidemic of environmentally preventable toxic exposures.
The key relevant information (i.e., biologic, economic, social, political,
or ethical) and knowledge gaps, as well as the basis for these facts
It is not clear who provided grinding machines for rock crushing purposes.
Given that they were available to the local population, one could ask how it is
that the government could not remove them, akin to the classic case of John
Snow removing the Broad Street pump handle to control cholera in Britain
in the 1850s. Not so acting could be construed as the launch of an industrial
activity by virtue of access to machinery that would facilitate illegal work.
The consequences of exposures ought to have been considered and should
be the responsibility of the entity facilitating the industrial activity. Ways of
protecting vulnerable people from hazards ought to be put into place prior
to facilitating an activity.
Whose role is it to deal with societal determinants of health?
181