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Abstract
Following the 2008 global financial crisis, small-scale gold mining operations proliferated worldwide. Along Ghana’s Offin River, the landscape has been radically transformed by mining, including disruptions to agriculture and surface hydrology, with adverse health outcomes. Yet, health research on small-scale mining tends to focus on miners’ mercury exposure. Further, studies on the relationships between disease and landscape change typically examine disease clustering and risk factor identification, rather than complex nature–society dynamics shaping infection and uneven vulnerability. Combining ethnographic, remote sensing, and quantitative methodological approaches, we detail how the socioecological outcomes of mining—from food insecurity and water-logged pits to profound anxiety and mercury contamination—combine to increase local malaria incidence. We argue that these changes interact with existing sociostructural conditions and Plasmodium falciparum’s unique biological capacities to render women and children most vulnerable to the disease. We suggest that mental health profoundly shapes malaria incidence and, countering individualized constructions of risk, family members’ health is deeply interconnected. This article contributes to current geographic debates in several ways. First, a cumulative vulnerability approach helps scholars conceptualize how biological, psychological, structural, and social conditions interrelate to shape humans’ conjunctural vulnerabilities along axes of difference, particularly in health contexts. We also highlight the importance of materiality in mediating vulnerability and malaria dynamics. Finally, we argue for more scholarly attention to familial relationships of care and mental health, heretofore unexplored topics in political ecologies of health.
2008年全球金融危机之后，小规模的掏金在全世界盛行。加纳欧分河（Offin River）的沿岸地景已因挖矿而彻底改变，包括农业与表土水文的瓦解，并产生严重的健康后果。但小规模掏金的健康研究，倾向聚焦挖矿者的重金属暴露。此外，疾病与地景变迁关系之研究，一般检视疾病的群聚与指认风险因素，而非形塑感染和不均脆弱性的复杂自然—社会动态。我们结合民族志、遥测以及量化方法，仔细纪录挖矿的社会生态后果——从粮食不安全、水涝矿坑到深度的不安全与金属污染——如何结合以增加本土疟疾发生率。我们主张，这些变迁与既有的社会结构条件和恶性疟原虫的特殊生物能力相互作用，使得女性和孩童最易患病。我们主张，心理健康深刻地形塑疟疾发生率，而与个人化风险建构相反的是，家庭成员的健康紧密地相互连结。本文在若干方面对当前的地理辩论做出贡献：首先，累积的脆弱性方法，有助学者概念化生物、心理、结构和社会条件如何相互连结，以形塑人类随着差异轴线的耦合脆弱性，特别是在健康的脉络中。我们同时强调物质性在中介脆弱性和疟疾动态上的重要性。最后我们主张，须有更多的学术研究，关注照护与心理健康的家庭关系这个在健康政治生态学中至今尚未探索的主题。
Después de la crisis financiera mundial del 2008 las operaciones en pequeña escala de la minería de oro proliferaron por todo lado. A lo largo del Río Offin, en Ghana, la minería transformó radicalmente el paisaje, afectando incluso la agricultura y la hidrología superficial, con consecuencias adversas para la salud. Con todo, la investigación de la salud relacionada con minería artesanal tiende a concentrarse en la exposición de los mineros al mercurio. Aún más, los estudios sobre las relaciones entre las enfermedades y la transformación del paisaje típicamente examinan más el agrupamiento de la enfermedad y la identificación de factores de riesgo que la compleja dinámica naturaleza–sociedad que configura la infección y la vulnerabilidad desigual. Mediante la combinación de enfoques de percepción remota y de metodología cuantitativa, determinamos en detalles el modo como las consecuencias socioecológicas de la minería ––desde la inseguridad alimentaria y excavaciones encharcadas hasta la ansiedad profunda y la contaminación con mercurio–– se juntan para incrementar la incidencia local de la malaria. Sostenemos que estos cambios interactúan con las condiciones socioculturales existentes y con las habilidades biológicas singulares del Plasmodium falciparum para hacer más vulnerables a la enfermedad a las mujeres y los niños. Sugerimos que la salud mental profundamente configura la incidencia de la malaria y que, contrarrestando las construcciones individualizadas del riesgo, la salud de los miembros de la familia está profundamente interconectada. Este artículo contribuye a los debates geográficos actuales de muchas maneras. Primero, un enfoque de vulnerabilidad acumulativa ayuda a los eruditos a conceptualizar el modo como se interrelacionan las condiciones biológicas, psicológicas, estructurales y sociales para darle forma a las vulnerabilidades coyunturales humanas a lo largo de los ejes de diferencia, particularmente en contextos de salud. También destacamos la importancia de la materialidad para mediar la dinámica de la vulnerabilidad y la malaria. Por último, demandamos más atención académica a las relaciones familiares del cuidado y la salud mental, temas hasta ahora sin explorar en las ecologías políticas de la salud.
Acknowledgments
We thank the many people who have contributed to this research, including Kelly Afful, Richard Amankwah, Grace Yeboah-Asuamah, Daniel Ati, Bernadette Atosona, Seth Boahen, Augustus Chang, Stephen Diko, Emmanuel Effah, Kyle Hartfield, James Kwarteng, Alexus Lizardi, Coryanne Mansell, Graciela Mentz, Allan Kordzo Norviewu, Helen Olsen, Natasha Sastri, and Carrie Taylor. We also thank the two anonymous reviewers and James McCarthy, whose comments and guidance significantly improved this article. Finally, we are especially grateful to the many Ghanaians who generously shared their time and experiences with us.
Notes
1 Lengthy licensing procedures and fees hinder most Ghanaians’ abilities to obtain concessions (Teschner Citation2012); scholars debate whether the sector is truly formalized (Hilson et al. Citation2017; Hilson and Maconachie Citation2017).
2 Because half the world’s population is at risk, and environmental factors mediate transmission, malaria is a major focus of spatial epidemiologists and landscape scientists.
3 As Mitchell (Citation2002) famously questioned, to trouble human action and intention as the impetus of change, “Can the mosquito speak?” Although Mitchell’s exceptional analysis examines interrelations between Egyptian techno-politics, landscape change, and malaria, he was less concerned with uneven and cumulative vulnerabilities.
4 World-making through complex relations is nothing new to indigenous people, prompting calls for posthuman theory’s decolonization (TallBear Citation2013; Sundberg Citation2014).
5 Immunological memory provided by antibody-producing B cells requires “boosting” from persistent asymptomatic infection (e.g., following seasonal transitions; Hviid, Barfod, and Fowkes Citation2015).
6 Sequestration of infected red blood cells in the placenta represents a critical vulnerability to malaria during (especially first) pregnancy. Rather than infection from mosquito bites, asymptomatic women might suffer placental malaria due to pregnancy (Ofori et al. Citation2018).
7 Although often used interchangeably, susceptibility typically refers to inherent physical predisposition factors (genetics), whereas vulnerability refers to external factors (poverty; Bell et al. Citation2013).
8 In 2013, Ghana experienced an estimated 5,900 to 18,000 malaria-related deaths (WHO Citation2015).
9 The annual number of infective bites received per person.
10 Effective, non-Western malaria control techniques also exist (e.g., Amoah et al. Citation2015).
11 From 2006 to 2011, malaria control financing increased from US$24 million to more than US$100 million (WHO Citation2015).
12 During RBM’s early years, the World Bank insisted that ITNs be sold to at-risk populations, rather than freely distributed: “For the bank, ITNs were the ideal neoliberal health intervention. They represented a commodity that could be marketed to populations at risk, shifting responsibility for the costs of health care away from the state and onto individuals” (Packard Citation2016, 287).
13 Avoidance of ITN use might also influence acquired immunity (Hviid, Barfod, and Fowkes Citation2015).
14 Survey participants were selected using a high-resolution satellite image from January 2013. Points were created for each roofed structure in the two study communities and randomly selected for the survey sample using QGIS. Structures were located using handheld maps and Global Positioning System units. For structures not housing people (cocoa shed, church), we identified the closest family compound.
15 For other recent and creative examples of mixed methods work in political ecology, see Kelley et al. (Citation2017) and Paul (Citation2018).
16 For more on land-use changes, gendered land markets, and land tenure politics in the region, see Hausermann et al. (Citation2018).
17 Galamsey, from “gather them and sell,” is the local term for small-scale mining.
18 There is no networked electricity in these communities. At night, children gather outdoors around one television powered by a generator. These practices are associated with malaria risk elsewhere in Ghana (Monroe et al. Citation2015) and differ from more protective (and likely air-conditioned) evening spaces enjoyed by big men.
19 See Hilson (Citation2010) for a general discussion of child labor in small-scale mining.
20 Arsenic, also linked to immune suppression, is another common contaminant in and around Ghana’s small-scale mining sites (e.g., Hagarty et al. Citation2015; Bempah and Ewusi Citation2016).
21 Women also go to (or through) pits to collect and use water (e.g., washing), sell food and water, travel to farms, and so on.
22 There are many exceptions to this generalization. Similarly, men also suffer psychological distress due to land and water degradation and food insecurity.
23 These findings, echoed in other studies of land grabs in Ghana (see Ferring, Hausermann, and Effah Citation2016; Nyantakyi-Frimpong and Bezner Kerr Citation2017; Hausermann et al. Citation2018), counter dominant discourses of mining-supported rural agriculture in academic and development literatures.
Additional information
Notes on contributors
David Ferring
DAVID FERRING is a Doctoral Candidate in the Department of Geography at Rutgers University, Piscataway, NJ 08854-8045. E-mail: [email protected]. His research interests include the politics of landscape change and critical health geographies.
Heidi Hausermann
HEIDI HAUSERMANN is an Assistant Professor in the Department of Anthropology and Geography at Colorado State University, Fort Collins, CO 80521. E-mail: [email protected]. She employs mixed methods to address research questions spanning health and environment interaction, resource politics, landscape change, and rural livelihoods.