Malays J Med Sci. May-Jun 2016; 23(3): 1-8www.mjms.usm.my © Penerbit Universiti Sains Malaysia, 2016

For permission, please email:mjms.usm@gmail.com11

Introduction

Bauxite mining in Kuantan offers someexciting economic opportunities for variousparties including individual land owners.Nevertheless, the “bauxite boom”; the extensiveand uncontrolled mining activities have greatpotentials to cause adverse impacts on theenvironment, health and quality of life of thepeoplelivingintheaffectedareas. BauxiteminingisnotaneweconomicactivityforMalaysia.TheminingofbauxitehastakenplaceinthestateofJohorsinceearly2000(1).WhilstbauxiteminingoperationinTelukRamuniaJohorhasbeenoperatingformorethan15yearswithoutmuchcontroversy,bauxitemininginKuantanhascreatedadifferentscenariowithinashortperiodof time. Extensive and aggressiveminingwhichincludetransportingandstockpilingofbauxiteinhugequantitiescauseenvironmentalproblemstoemergewithin a short period of time leading tocommunityoutrage.

Editorial

Potential Impacts on Health

The health of people and the health of theplanet that we live in are inextricably linked.Destruction of our habitat threatens our accessto the most fundamental requisites for humanexistence: safe water, clean air, safe foodand shelter. Aggressive uncontrolled bauxitemining in Kuantan, if sustained over time willcause irreversible changes to the state of theenvironment that threatens the ecosystems.Because of environmental pollution issues, theMinistryofNaturalResourcesandEnvironmenthas imposed a three-month suspension on theindustry starting from 15 January 2016. Thepollutedecosystemshavegreatpotentialtocreatechronic and unpredictable exposures, leadingto direct or indirect, immediate and long-termpotentialimpactsonhealth.Anumberofphysical,chemical,biological,ergonomic,andpsychosocialhazards exist throughout theminingprocess, as

Potential Health Impacts of Bauxite Mining in KuantanNoor Hisham AbdullAh1, Norlen MohAMed2, Lokman Hakim SulAiMAn3, Thahirahtul Asma ZAkAriA2, Daud Abdul rAhiM2

1 OfficeofDirectorGeneralofHealth,Level12,E7, MinistryofHealth,62590Putrajaya,Malaysia

2 EnvironmentalHealthUnit,Level2,E3,DiseaseControlDivision, MinistryofHealth,62590Putrajaya,Malaysia

3 OfficeofDeputyDirectorGeneralofHealth(PublicHealth), Level12,E7,MinistryofHealth, 62590Putrajaya,Malaysia

1

Abstract Bauxite mining is not known to most Malaysian except recently due to environmental pollution issues in Kuantan, Pahang. Potential impacts are expected to go beyond physical environment and physical illness if the situation is not controlled. Loss of economic potentials, and the presence of unpleasant red dust causing mental distress, anger and community outrage. More studies are needed to associate it with chronic physical illness. While evidences are vital for action, merely waiting for a disease to occur is a sign of failure in prevention. All responsible agencies should focus on a wider aspect of health determinants rather than merely on the occurrence of diseases to act and the need to emphasize on sustainable mining to ensure health of people is not compromised.

Keywords: healthimpact,bauxite,mining,environmentalpollution,disease,Malaysia

Submitted: 25Feb2016Accepted: 28Feb2016

2 www.mjms.usm.my

Malays J Med Sci. May-Jun 2016; 23(3): 1-8

described in the articlebyDonoghueandOlney(2). Based on our observation, the potentialimpactsonhealthcanbedirectandindirectandthe potential linkages betweenmining activitiesandhealthareasshowninFigure1. Thereareanumberofreasonswhybauxitemining in Kuantan can cause environmentalproblem which will subsequently propagateto impact on health if the issue is not resolvedor controlled. One of the reasons is relatedto its location which is close to the humansettlementarea.Otherreasonisassociatedwithunsustainableminingprocessesthatleadtoveryextensiveandaggressiveminingactivities.

Miningimpactzone

The locationofminingactivities in relationtohumansettlementisofgreatconcerntopublichealth.While remote locations andwell definedzoning area are common in bauxite miningin other countries (2), it is a totally differentscenarioinKuantan.Theminingareaisscatteredand occurring near to and within communitysettlementswithout a clearly defined zone. It isalso close to school areas whereby most of thevulnerable children spend their time (Figures2and3). It isverydifficult toestimate the totalareainvolvedastheminingactivitiesareoperatedby both legal and illegal individualminers. Thenumber of illegal individualminer is said to bemuchbiggerthanlegalminersmakingthecontroloftheareaandminingoperationsverydifficult.

Air,foodandvisualpollutionduetodust

Airpollutionisoneofthemainissuesfacedbythecommunity.Openmininginvolvessubstantialclearing and removal of land. The processes ofexcavating, removal of top soil and vegetation,transportationofbauxiteandunwantedelementsand stockpiling of bauxite cause degradation ofairqualitymainlyrelatedtodustpollution.Dustisasolidparticulatematter, in thesizerangeof1 to 75microns in diameter. Dust smaller than10micrometerindiameter,knownasparticulatematter PM10 and PM2.5 are of great healthconcernbecause it canbe inhaleddeep into therespiratory system.Data collectedby researcherinDecember 2015, revealed that 24-hour PM10level(μg/m3)rangedfrom164to277μg/m3whichexceeded the Malaysian National Ambient AirQualityStandard2015(3). Largerparticulatemattersareassociatedwithnuisance. Nuisance dust reduces environmental

amenity, contaminates clothes, properties,vegetation and water, and has negative effectsonpersonalcomfortandhealth.Thissituationisoftenthecasewithbauxiteasitisobviouslyvisibledue to its high content of iron oxide. From ourobservation, thewhole stretchof roadalong theKuantan–KuantanPortistainteddarkred.Thetree,vehicles,houses,clothesandfoodpremisesalongtherouteofthelorriestransportingbauxitewerealsocontaminatedwithreddust(Figures4and5). Nuisance dust particles are too large to beinhaled. Apart from causing visual pollution, ithas the potential to cause irritation to the eyes,nose and throat. It also produces visual impactthat can lead to mental health stress especiallyto those living in proximity to mining sites,particularlywhenitcanbeseenfromtheirhome(4).Furthermore,dustdepositedonpremiseshasthe potential to contaminate food sources andclothes. Fineparticlesarewelldocumentedtocauseor trigger the occurrence of respiratory andcardiovascular diseases (5). The WHO advisesthat there is ‘nosafe level’offineparticulateairpollution, PM10 and PM2.5. Both PM10 and PM2.5arerespirableparticleswhichcanpenetratedeepinto the respiratory system and are associatedwithincreasedhospitaladmissionsforheartandlungdiseasesandprematuredeath(6,7).Itisofgreathealthconcernwhenminingactivityoccurinproximitytoschoolareaaschildrenisamongthemostsusceptiblesubpopulationswithregardsto harmful effects of exposure to particulatematter, PM10 (8, 9). As their physiological andimmunological systems are still developing,childrenreceiveahigherdoseofairborneparticlesrelative to the lung size compared to adult (10,11). Surveillance data gathered from the BukitGoh Health Clinic, located within the area ofminingoperationhasshownasteadilyincreasedin patient attendance for asthmatic and upperrespiratory tract infection (URTI) for 2015 ascomparedtopreviousyear.However,workisstillinprogress toassociate the increase inpatient’sattendancetotheminingactivities.

Waterpollutionandriskofmudflood

Water pollution was widely reported bymainstream and social media. The sources ofwater pollution are mainly related to extensivelandclearing,extractionofbauxiteleadingtosoilerosion and sedimentation; washing of bauxiteand effluent from the bauxite washing pond

Editorial | Health impacts of bauxite mining

www.mjms.usm.my 3

whichflows into thenearby river; and stockpileof bauxite in large quantities without a properdrainage system. Beside river and sea waterpollution, an uncontrolled mining activity canalso cause severemud flood due to soil erosionandsurface runoffofcleared land.Fortunately,therecentmonsoonwasnotaccompaniedbytheusually heavy rain due to the effects of ElNinowhichlessenthemonsooneffects.

Potentialtocontaminatedrinkingwater

Therearefourwatertreatmentplantslocatedin the area of bauxite mining which are BukitGoh,BukitSagu,BukitUbi,andSemambuWaterTreatmentPlantinKuantan.Astheyarelocateddownstream, the mining activities have greatpotentials to contaminate the drinking watersources. Bukit GohWater Treatment Plant wasclosedonceon29December2015due toseverepollutionofSungaiRiau.Figures6and7showsa bauxite washing pond whereby the effluent

MainProcess

Land clearing and removal of top soil and trees

Export using sea transport

Extraction and transporting bauxite to washing bay

Washing of bauxite by soaking it in water

Stockpile and transporting bauxite to ship

Transporting bauxite to stockpile places

Hazards

Soil erosion and sedimentation

Release of minerals and other natural occurring impurities

including heavy metals

Noise Dust

Movement of vehicle, traffic gases, & accident

Biological hazard land and forest destruction

Impact on Health

Acute Impact

Intermediate and long term impact

Acute impact associated with short-term exposure to dust, road accident, and vector-borne diseases

Mental stress associated with daily nuisance

Long-term impact associated with air, water, food and noise pollution

Risk of natural disaster: Mud flooding and related diseases

Impact on Environment

Sea and river water pollution

Visual Pollution

Air pollution Noise pollution

Destruction of fauna and flora ecosystem

Impact on socioeconomic

Loss of natural fishing and recreational places

Healthy lifestyle is badly affected

Loss of economic activities especially food premises along the affected road

Red dust deposited on premises and vehicles: Cost of cleaning increases and devaluation of asset/property

Figure 1: Linkagesbetweenbauxiteminingactivitiesandpotentialsimpacts

4 www.mjms.usm.my

Malays J Med Sci. May-Jun 2016; 23(3): 1-8

Figure 2: Miningactivitiesoccurringclosetoschoolarea

Figure 3: Dustdepositedonflooroftheschool

Editorial | Health impacts of bauxite mining

www.mjms.usm.my 5

Figure 4: ReddustdepositedonwindowofquarternexttoKuantanPort

Figure 5: RoadstretchtowardKuantanPortheavilycoveredbydarkreddust

6 www.mjms.usm.my

Malays J Med Sci. May-Jun 2016; 23(3): 1-8

Figure 6: Bauxitewashingpondshowing“redwater”

Figure 7: WaterfromthepondweredischargedintoSungaiTawehandSungaiRiau

Editorial | Health impacts of bauxite mining

www.mjms.usm.my 7

waterweredischargedintoSungaiTawehwhichflows downstream causing severe pollution toSungaiRiau.Generally, bauxite containsmainlyAluminumoxide(40–50%),ferricoxide(20%)and3–5% combined silica (12). However, accordingtoRajah,bauxite inKuantan ischaracterisedbyhigh ferric oxide content ranging from 14.4 to40.6%dependingonthearea(13).Becauseofitscomposition, aluminum and iron are the maincontaminants that pollute the water resourcesbut depending on the geological characteristicsof the land and surrounding land use activities,other toxic metals such as arsenic, mercury,cadmium, lead, nickel andmanganesemay alsocontaminate drinkingwater resourceswhen thenatural ecosystem is aggressively removed andexcavated.Chronicexposuretotoxicmetalsmaycausemultipleorgantoxicityandincreasecancerrisk.Whereas,highlevelexposuretoaluminuminthestomachpreventtheabsorptionofphosphate,achemicalcompoundrequiredforhealthybonesand may cause bone diseases in children (14).ChronicexposuretoaluminumwashypothesisedtocauseAlzheimerdiseasebutscientificevidencetodateisinconsistent(15). Based on a continuous drinking watermonitoring conducted by the Department ofPahangStateHealth,sofartheconcentrationofaluminumintreatedwatertakenfromtheaffectedwatertreatmentplantswerebelowtheProvisionalTolerableWeeklyIntake(PWTI)of0.9mg/l(16).The concentration of other heavy metals werealso below theNationalDrinkingWaterQualityStandard.Apparentlytheconventionaltreatmentmethod used in these water treatment plants iscapable of managing the treat of heavy metalscontaminations.

Noisepollution

Noise is an important consideration in thecontextofmining,andafactorthatcanpotentiallyhaveserioushealth impactsacrossawiderangeofdeterminants.Noisepollutionusuallyoccursinthreephases: access to thebauxiteminingarea,extractionofbauxiteusingheavymachineryandmovementoflorriesfromminingareatostockpileplaces.Someof theminingactivitiesare locatedvery close to and within community settlementwhich make environmental pollution a realconcerntothecommunity.Iftheproblempersists,environmental noise has a great impact on thehealthofthepeople.Thepotentialhealtheffectsidentified includehearing lossor lossofhearingsensitivity, sleep disturbance, cardiovascular

and physiological effects, mental health andbehavioural effects, cognitive performanceincluding poor performance by school children(11,17).

Public Health Surveillance System

Acknowledging the potential impacts onhealth, Pahang State Health Department hasestablished a surveillance system to monitorcontinuouslyfoodanddrinkingwaterqualityanddiseasesintheareaofKuantan.Thesurveillancesystem is known as Kuantan Environmental-Public Health Tracking System (KEPTS).The elements of KEPTS include a continuousmonitoringofairpollutionrelateddiseases,roadtrafficinjury,treatedwaterqualityandmonitoringofrawfoodandreadytoeatfoodsoldwithinthebauxiteminingareas.Inadditiontothat,amentalhealthsurveywasalsoaddedintoKEPTS.Whilethe manual data collection has already takenplace,theKEPTSis intheprocessofdevelopingautomateddatasystemthatsupportsandenablelinkingalldatacollectedincludingenvironmentaldata fromvariousauthorities for thepurposeoffuturefollowupandanalysis.

Conclusion

Uncontrolled bauxite mining operationin Kuantan has caused severe environmentalpollution. Destruction of ecosystem threatensour access to the most fundamental requisitesfor human existence: safe water, clean air, safefood and shelter. The impact may persist ifthere is no proper rehabilitation plan done totheexploitedarea.Whilementaldistressdue tounpleasantlivingenvironmentbecomeapparent,more studies are needed to quantify the impactonchronicphysical illness.Eventhoughchronicphysicalillnessarenotapparentnowduetoitslowpathogenesis,thediseasesmayappearmanyyearslaterifthecurrentriskisnotproperlyaddressedand controlled. All responsible agencies shouldfocus on a wider aspect of health determinantsratherthanwaitingfortheoccurrenceofdiseasestobeforeacting.Itisimportanttoemphasiseonsustainable mining practices in order to avoidcompromisingthehealthofpeopleinthefuture.

8 www.mjms.usm.my

Malays J Med Sci. May-Jun 2016; 23(3): 1-8

Acknowledgements

We would like to express our deepappreciation to Dr Nur Aiza Zakaria and herofficersfromPahangStateHealthDepartmentforassistingusintakingphotosrelatedtothebauxiteminingactivitiesinKuantanandalsoforsharinginformation on Kuantan Environmental-PublicHealthTrackingSystem.

Correspondence

DrNorlenbinMohamedMD,MPHEnvironmentalHealthUnit,Level2,E3,DiseaseControlDivision,MinistryofHealth,62590Putrajaya,Malaysia.Tel:+603-88924421Fax:+603-88924548E-mail:norlen.mohamed@moh.gov.my

References

1. Minerals and Geoscience Department Malaysia.MalaysianMineralsYearbook2010.KualaLumpur:MineralsandGeoscienceDepartmentMalaysia;2010.Availablefrom:http://www.jmg.gov.my/component/rsfiles/download-file/files?path=penerbitan%2FMalaysian+Minerals+Yearbook%2Fmmy_2010.pdf.

2. DonoghueAM,FrischN,OlneyD.Bauxiteminingandaluminarefining:Processdescriptionandoccupationhealthrisk.JOEM.2014;56(5 Suppl.):12–17.

3. JamalHishamHashim(2016).Publichealthimpactsfrombauxiteminingactivities inKuantan. Bauxite Forum,16February2016,KualaLumpur.

4. Chadderton C, Elliott E, Williams G. A guide toassessing the health and wellbeing impacts ofopencast mining. Wales: Wales HIA Support Unit(WHIASU);2011.

5. World Health Organization (WHO).Health aspectsof air pollution: Results from the WHO project“systematicreviewofhealthaspectsofairpollutioninEurope”.Copenhagen:WHO;2004.

6. PopeCA,BurnettRT,ThunMJ,CalleeEE,KrewskiD,ItoK,etal.Lungcancer,cardiopulmonarymortalityand long term exposure to fine particulate airpollution.JAMA.2002;287:1132–1141.

7. Pope CA 3rd, Hansen ML, Long RW, Nielsen KR,EatoughNL,WilsonWE, et al. Ambient particulateair pollution, heart rate and blood markers ofinflammationinapanelofelderlysubjects.EnvironHealthPerspect.2004;112(3):339–345.

8. Annesi-Maesano I, Baiz N, Banerjee S, Rudnai P,RiveS.Indoorairqualityandsourcesinschoolsandrelatedhealth effects.J.ToxicolEnviron.HealthB.2013;16:491–550.

9. SchueppK,SlyPD.Thedevelopingrespiratorytractanditsspecificneedsinregardtoultrafineparticulatematter exposure.Pediatr.Respir.Rev. 2012;13:95–99.

10. Foos B, Marty, M, Schwartz J, Bennett W, MoyaJ, Jarabek AM. Focusing on children’s inhalationdosimetry and health effects for risk assessment:an introduction. J Toxicol Environ Health. 2008,71:149–165.

11. HealthEvidenceBulletins.HealthevidencebulletinsWales:Healthyenvironments.Cardiff:WelshOffice;1999.

12. Valeton,I.Bauxites.Amsterdam:ElsevierPublishingHouse;1972.

13. Rajah SS. Bauxite in the Kuantan area, PeninsularMalaysia.GEOSEAVProceedingsVol. I,BulletinoftheGeologicalSocietyofMalaysia.1986;19:315-325.

14. Agency for Toxic Substances and Disease Registry(ATDSR).Publichealthstatement:Aluminium.CAS#7429-90-5.Atlanta:ATDSR;2008.

15. Theodore I. Is the aluminum hypothesis dead?(Review).JOEM.2014:5(5 Supp.):73–79.

16. World Health Organization (WHO). Guideline fordrinking-water quality, 4th ed. Malta: Guterberg;2011.

17. Stansfield SA, Matheson MP. Noise pollution: non-auditoryeffectsonhealth(Review).BritishMedicalBulletin.2003;68:243–257.