Reviewer ’s report  
Title: Selected indicators and determinants of women's health i n the vicinity of a copper mine 
development in northwestern Za mbia  
 
Version: 0 Date: 11 Dec 2016  
 
Reviewer: Jennifer S. Hirsch  
 
Reviewer's report:  
This discussion of the Health Impact Assessment of a copper mine in NW Zambia addresses an 
important topic about which there is limited existing rigorous empirical research - the extent to 
which health impact assessments are a useful tool for holding the private sector accountable for 
the possible harms associated with industrial developments and, conversely, encouraging them to 
carry out development projects in ways that have positive health externalities.  
 
There are several ways in which the paper might be strengthened. First, it is not clear why the 
focus is on those three particular health impacts (birth in a health facility, beliefs about witchcraft 
and HIV, and HIV testing). There is also some background  information that would be useful to 
enhance the generalizability of the work to other sites: what was the process by which the mining 
company agreed to carry out (and presumably pay for) a HIA? Was there government 
involvement, a regulatory process, or ci vil society demands? Also, does the HIA contain a 
broader model of the various pathways through which the mine development might affect 
population health? It would be useful to push the paper a bit more towards a cconceptual 
framework, so that it moves bey ond describing what happened in this one particular instance and 
serves as a model for thinking about how this might be evaluated elsewhere. For example, one 
could imagine population -health impacts thorugh pollution and environmental change; changes 
in ins titutions (schools, bars, leisure time options); access to health services; economic 
opportunities; and changes in population composition. Since there was no baseline data 
collected, which the authors note as a significant shortcoming, it is hard to know i f any positive 
change was actually a result of the healthy migrant effective; given that significant 
methodological shortcoming to the HIA, all the more reason to use this as a roadmap to indicate 
how subsequent more rigorous work might be done.  
 
The pape r would also be strengthened by a clearer articulation of why the focus is on women, 
particularly given that those employed by the project were, presumably (but maybe not actually?) 
men. It seems that women were not employed by the project, and so at minim um some framing 
in terms of the gendered social production of health would be useful.  
 
It also seems like a missed opportunity for the HIA to have focused exclusively at the level of 
individual health outcomes. To the extent that the project changed the e nvironment (roads, water, 
sanitation, schools, access to medical care), all of that would be relevant to really assessing the 
health impact of the project. In particular, it was notable that there was discussion of HIV testing, 
but no mention of access to Anti-retroviral therapy.  
 
Also, what is a health road show? Not well explained.  
 
There is a reference to the impact of the project on children, but the title of that paper does not 
indicate what the health impacts were, and so it would be useful just to include one sentence 
more of description about the findings from that paper.  
 
It appears that one of the authors is a mining company employee - how did the authors address 
possible conflict of interest in terms of company desire to show positive findings?   
 
Overall, to realize the potential of this paper to contribute to the literature on health impact 
assessments, the authors should go beyond describing the specifics of the findings and develop a 
discussion of how this advances that field conceptually, as  well as what are the key questions to 
be addressed by further research.  
 
Also, the second sentence of the abstract is confusingly written.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, plea se specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manuscript  or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects req uire further 
assessment in your comments to the editors.  
I recommend additional statistical review  
Quality of written Engl ish 
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
Declaration of competing interests  
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