Consultation and remediation in the north: meeting international commitments to safeguard health and well-being

BACKGROUND: International commitments exist for the safeguarding of health and the prevention of ill health. One of the earliest commitments is the Declaration of Alma-Ata (1978), which provides 5 principles guiding primary health care: equity, community participation, health promotion, intersectoral collaboration and appropriate technology. These broadly applicable international commitments are premised on the World Health Organization's multifaceted definition of health. The environment is one sector in which these commitments to safeguarding health can be applied. Giant Mine, a contaminated former gold mine in the Northwest Territories, Canada, represents potential threats to all aspects of health. Strategies for managing such threats usually involve an obligation to engage the affected communities through consultation. OBJECTIVE: To examine the remediation and consultation process associated with Giant Mine within the context of commitments to safeguard health and well-being through adapting and applying the principles of primary health care. METHODS: Semi-structured interviews with purposively selected key informants representing government proponents and community members were conducted. RESULTS: In reviewing themes which emerged from a series of interviews exploring the community consultation process for the remediation of Giant Mine, the principles guiding primary health were mapped to consultation in the North: (a) “equity” is the capacity to fairly and meaningfully participate in the consultation; (b) “community participation” is the right to engage in the process through reciprocal dialogue; (c) “health promotion” represents the need for continued information sharing towards awareness; (d) “intersectoral collaboration” signifies the importance of including all stakeholders; and (e) “appropriate technology” is the need to employ the best remediation actions relevant to the site and the community. CONCLUSIONS: Within the context of mining remediation, these principles form an appropriate framework for viewing consultation as a means of meeting international obligations to safeguard health.