Fractured from fracking: examining the health and wellbeing implications of unconventional natural gas development in rural communities

Coal seam gas (CSG) is an unconventional natural gas (UNG) that is extracted from wells via coal seams, and reserves are found in Australia, the USA and the UK. Other UNG include shale and tight gas, which are sourced from different geological formations and utilise similar processes to CSG mining, and are extracted in Canada, Europe, Asia, the Middle East and Australia. In recent decades, UNG extraction has grown exponentially, with hydraulic fracturing or ‘fracking’ occurring across regional and rural landscapes and in close proximity to communities. Whilst major development projects can facilitate employment and other opportunities in surrounding communities through population growth and increased demand for services, there is evidence that negative impacts on health and wellbeing can outweigh any benefits. Commonly referred to as the ‘resource curse’, when the costs of extraction and exporting natural resources outweigh the economic benefits, the expansion of CSG activity was often met with trepidation from local communities and the broader public. There was uncertainty around the impacts and consequences of rapid development, particularly in the USA and Australia, stemming from a lack of prior experience, mixed messages in the media, perceived lack of governmental support, and little empirical evidence. Presented with the opportunity to address the gap in the literature, this research explores the broader implications of mining activity on surrounding communities, with a focus on CSG and the social determinants of health and wellbeing. The level of community interaction throughout a project lifecycle is greater in CSG mine settings compared to traditional mining methods (like coal, for example) because of their proximity to communities, and so there is a greater expectation of the mining company to monitor and mitigate impacts on the communities in which they operate. There is emerging evidence that the extractives industry may play a more diverse role in regional communities than previously expected, but the pathways in which they do this in the health sector are not clear. Integral to the provision of health services in regional areas is the integration of services and partnerships – it is common for stakeholders external to the health sector, like transport, police or environmental departments to be involved in the planning and availability of health services. There is a dearth of scientific evidence of the ways in which the extractives industry interacts with the health system in the communities in which they operate; what the costs and benefits of this interaction might be and how the relationship might be optimized to enable long-lasting health improvements. This is particularly important in mining communities, where health outcomes could fluctuate with the various stages of mining activity, and more so in communities where mining activity is soon to cease, leading to uncertainty and economic downturn. Objectives This research was conducted in order to inform the regional and rural health sector, extractives industry, and communities who are undergoing a period of uncertainty with little peer reviewed evidence to provide objective direction. The research aims to: respond to the demand in understanding broader public health and wellbeing outcomes of mining beyond direct, physical and biological outcomes; contribute to the growing evidence base around CSG development and potential community-level impacts; and to comment on the interaction between stakeholders in the health system and the extractives industry at a local level. Methods This thesis has been organised in to three parts to meet the stated objectives: 1. Two systematic reviews to synthesise the evidence for broader, indirect health and wellbeing implications at community level associated with mining activity in low, middle and high income countries in order to provide a comprehensive account of how communities may be affected by mining; 2. Synthesis of qualitative data collected via a Health Needs Assessment (HNA) in Queensland, Australia to explore the determinants of health and wellbeing in communities living in proximity to CSG developments in order to strengthen understanding of how community and health services can prepare for fluctuations that might come with a mining boom or bust; and 3. Critically review regional health systems and the interaction between the extractives industry and key stakeholders at a local level in order to compile a set of recommendations that optimise health outcomes for local communities. Results Sixteen publications were included in the systematic review of high-income countries, and included studies that took place in the USA, Australia and Canada. Products mined included coal and mountain-top mining. There was evidence that mining activity can affect the social, physical and economic environment in which communities live, and these factors can in turn have adverse effects on health and wellbeing if not adequately measured and mitigated. Specific examples of self-reported health implications included increased risk of chronic disease and poor overall health, relationship breakdown, lack of social connectedness, and decreased access to health services. Twelve publications were included in the systematic review of low and middle-income countries, and included studies that took place in Ghana, Namibia, South Africa Tanzania, India, Brazil, Guatemala and French Guiana. Products mined included gold and silver, iron ore and platinum. Mining was perceived to influence health behaviours, employment conditions, livelihoods and socio-political factors, which were linked to poorer health outcomes. Family relationships, mental health and community cohesion were negatively associated with mining activity. High-risk health behaviours, population growth and changes in vector ecology from environmental modification was associated with increased infectious disease prevalence. The HNA was implemented in four towns in regional Queensland situated in proximity to CSG development. Eleven focus group discussions, nine in-depth interviews, and forty-five key informant interviews (KIIs) with health and community service providers and community members were conducted. Framework analysis was conducted following a recurrent theme that emerged from the qualitative data around health and wellbeing implications of the CSG industry. CSG mining was deemed a rapid development in the otherwise predominantly agricultural, rural communities. With this rapid development came fluctuations in the local economy, population, social structure and environmental conditions. There were perceived direct and indirect effects of CSG activity at an individual and community level, including impacts on alcohol and drug use; family relationships; social capital and mental health; and social connectedness, civic engagement and trust. Before examining the interaction between the health system and mining sector, it was important to describe the rural health system and its complementary parts. Systems theory underpinned analysis of qualitative data from KIIs to assist in describing the characteristics of the health system and unique influences on its functionality. Results showed that communities are closely interconnected with the health system, and that the rural health systems in the case study were defined by geography, climate and economic fluctuations. Understanding unique system pressures is important for recognising the impact that policy decisions may have on rural health. Decentralisation of decision making, greater flexibility and predictability of programs will assist in health system strengthening in rural areas. Another key theme emerged from the HNA: the mining sector played a diverse role in health and community service planning and delivery. Key informant transcripts were analysed again using phenomenology theory. Of these, 23 mentioned the presence of CSG or mining activity at least once during the interview without any specific reference to the extractives industry. Mining activity was perceived to influence the ability of service providers to meet demand, recruit and retain staff, and effectively plan and maintain programs. The level of interaction between mining companies with service providers and regulatory bodies varied and was commented on extensively. Several key informants identified pathways for the mining sector to engage with services more effectively, which included strengthening multi-sectoral engagement and enabling transparent, public consultation and evidence-based funding initiatives. Conclusion Unconventional natural gas extraction and the implications of mining activity on nearby communities is a subject of major concern internationally. Through the application of core public health theories and methodologies, including the Social Determinants of Health model, complex adaptive systems theory and health needs assessments; this thesis has significantly contributed to the discourse and demonstrated a significant association between mining activity and health. This thesis sought to strengthen the evidence base of the association between the extractives industry and the social determinants of health of surrounding communities, with a focus on the potential impacts of CSG developments. The hypothesis that there may be broader, direct and indirect impacts on health and wellbeing at an individual or community-level was tested and proven. The secondary aim was to examine the relationship of stakeholders in the local health system with the mining sector, with the intention to develop recommendations that improve measurement, monitoring and response to potential impacts of mining in surrounding communities. This research established that there are both common and unique health and wellbeing issues experienced by communities living in proximity to mining internationally. Our understanding of the ways in which CSG mining activity can i

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.