The adoption of Health Impact Assessments in the Mongolian mining sector: A case study of the diffusion of policy innovation

Mongolia’s rapid economic growth, propelled by rapid development of the extractives sector requires that the country be better prepared for potential negative impacts to the health of the people and the country. People are both excited for the remarkable development opportunities that mining promises and are concerned with the potential social, environmental and health risks it could bring. As a country highly dependent on the mining sector, Mongolia has realized that it needs to develop a strategy and institutional process to manage the public health impacts of mining activities. With the support of an SFU-based team of researchers and policy advocates, Mongolia is thus in the process of adopting Health Impact Assessments (HIA), a policy innovation tool that has potential to inform the decision making process through assessing underlying health problems and generating evidence-based recommendations. However, the values, principles, methods and deliverables of HIA are not easily understood in capacity-limited Low and Middle Income Country (LMIC) settings, including Mongolia, which makes full adoption and proper use of HIA a difficult process to achieve. The overall goal of the research was to evaluate the uptake and adoption rate of the HIA concepts, tools and methods in the emerging Mongolian mining sector. This evaluation process involved key informant interviews, observations, literature reviews and policy analysis as data collection methods. To understand the processes of HIA adoption, the theory of the Diffusion of Innovations (DOI) was used as an analytical lens. Analysis of HIA adoption processes suggested that DOI theory was a useful framework to understand and improve the rate of uptake of new public health policy innovations such as HIA in that it assists with understanding both the attributes of innovation and the communication actions that influence adoption. The existing literature on HIA lacks analysis of how it is adopted and implemented in diverse settings. This research thus contributes to the knowledge needed to inform discussion of how to improve the rate and success of HIA adoption. I conclude that the adoption of systematic methods to manage the public health impacts of mining in Mongolia, centered on the HIA, is generally off to a good start. However, there are many remaining challenges, including: a lack of government leadership, poor collaboration between relevant public and private institutions, low levels of capacity to conduct and evaluate HIAs, poor quality or non-existent baseline data. These challenges will need to be addressed in order to keep the momentum going. Following from the research, I offer the following recommendations: to develop HIA management system, to implement existing MoU between relevant ministries, to create HIA training center, and to enact an independent HIA law. In conclusion, the currently legislated system, which incorporates HIAs into a newly redesigned licensure system based on international standard environmental impact assessment methods, must be implemented. Ideally, the development of an independent HIA system will be required if Mongolia is to build and sustain an effective public health system in mining-affected regions.