State of the World's Minorities and Indigenous Peoples 2013 - Bolivia

In Bolivia, according to the national census some 71 per cent of the population is considered to be indigenous. During 2012, resource extraction continued to be a major factor in national life, affecting the economy and also the general health of the population.

The US$2.642 billion Bolivia earned from mining products in 2010 represented about 22 per cent of the overall national GDP. However, according to the ECLAC the state spent just 4.8 per cent of GDP on health, one of the very lowest expenditures in the Americas region. The limited expenditure means that some areas – especially rural and indigenous – have no health clinics or access to doctors or nurses.

Nevertheless, Bolivia's historically marginalized indigenous population makes up the bulk of the approximately 79,000 employed – both formally and informally – in the mining sector. Their health and well-being, therefore, are closely tied to these activities.

Mining sector health is not related solely to extraction issues. It can also be influenced by social and political factors like the ongoing mine nationalization that began in 1952. In January 2011, the Bolivia government reported 29 unresolved – and sometimes violent – conflicts involving cooperative and unionized mining workers. According to BBC reports, one such dispute over ore access rights at the recently nationalized Colquiri mine caused injuries and death during 2012. Rival groups of miners signed a deal that ended the clashes in September.

Mining and community health

In addition to unionized miners directly employed by the state-owned mining corporation, COMIBOL, there are about 650 private cooperative mining groups nationwide, employing 75,000 people. In 2012 they helped make Bolivia the world's sixth largest producer of tin.

With global tin prices at an all-time high, there is a boom in places such as Potosi and Huanuni in the department of Oruro. Critics claim the tin rush is extracting a heavy toll on the health and social fabric of the community. Local sources indicate that the population of Huanuni has now more than doubled from the 15,500 of just a few years ago. This has prompted many changes in the overall social and environmental health situation – with special consequences to those local women who are dependent on wage-earning males. The severe air pollution from mining and tin smelting can cause watery eyes and running noses after just three hours of exposure. The tin extraction tailings continue to be discharged into the nearby river, turning the waters black.

Given the long history of tin mining in the Bolivian altiplano, a particular indigenous health concern across many generations has been the effect of free crystalline silica. It is the most abundant compound in the earth's crust and the most common element in the dust that Bolivian mine workers inhale.

According to the International Labour Organization (ILO), prolonged silica exposure can produce silicosis. This is a respiratory ailment that can cause shortness of breath, coughs and fevers within months, and significant impairment or death within a few years. Silica exposure is also associated with an increased risk of fluid in the lungs, tuberculosis, lung cancer and some autoimmune diseases such as rheumatoid arthritis. The mining-related population spike in Huanuni has not only increased the overall spread risk of communicable pathogens such as tuberculosis but also of socially related diseases such as HIV and hepatitis (B and E). The rapid population boom has also created environmental health risks arising out of a surplus of rubbish, which ends up in the local river.

As well as large mining operations, there are many small indigenous family-run zinc, silver and tin mines in the altiplano region. In addition to male miners, these are also worked by indigenous women and by adolescents and children. According to UNICEF, under-age miners constitute some 10 per cent of the total Bolivian artisanal mining workforce.

Thousands of indigenous women and under-age artisan miners work up to 14 hours a day on mountainsides and deep underground in extremes of heat and cold. Consequently, like male miners, women and children in Bolivia are also exposed to mining-related health risks, especially silicosis.

Women in the Bolivian mining areas are sometimes doubly affected, by both health risks as miners and the social consequences of any town becoming a mining boom town.

Members of a local women's support network in Huanuni were especially concerned during 2012 about the social effects of the boom on indigenous women, particularly with respect to the relationship between over-indulgence in alcohol and violence (physical, sexual, psychological) against women.

Government legal services do exist for victims of domestic violence and neither Bolivian law nor authentic traditional indigenous culture tolerate such behaviour. However, violence against women is endemic. According to the female doctors at the Huanuni health centre, around six cases of domestic violence are treated each weekend – some with injuries that require hospital attention. Sexually transmitted diseases, cervical cancer and AIDS are also evident among the town's indigenous female population.

In a country where, according to the ECLAC, the maternal mortality rate is 190 per 100,000 live births, the doctors are also concerned about the health consequences of high teenage pregnancy rates in the boom town. About half occur among those under 15 years of age, with some 19-year-olds on their third pregnancy.

According to the NGO Development and Peace, during 2012, local environmental organizations succeeded in having the government declare Huanuni an environmental emergency zone. The government indicated that it will promote plans, programmes and projects to address the negative aspects – for the environment and the population – of the mining upsurge in the Huanuni area.