Protecting public health in mining: a Q-methodology examination of policy space and reform pathways in Tanzania

Abstract Background Mining is a driver of economic development in low and lower-middle-income countries, particularly in sub-Saharan Africa. In Tanzania, the mining sector’s contribution to GDP is rising rapidly; digitalisation and the energy transition are driving demand. This growth entails significant risks to the environment, social well-being, and public health. Despite mandatory Environmental Impact Assessments, environmental outcomes remain weak and public health receives limited attention. Drawing on the expertise and experience of stakeholders involved in implementing impact assessment in Tanzania, this study identifies measures to improve outcomes. Methods Q-methodology is used to elicit stakeholder perspectives on the most effective measures to advance public health protection within Tanzania’s industrial mining sector. Stakeholders were selected across different sectors to reflect a wide range of expertise, experience and viewpoints. Data were analysed to identify areas of consensus and divergence among stakeholders. Results The study finds a shared recognition of the need for reform to strengthen public health regulation. Yet, study participants do not see merit in broad legal reforms such as introducing mandatory health impact assessments or overhauling environmental impact assessment legislation. The emphasis is on making the existing rules work as intended. Three perspectives dominate: The Compliance Perspective prioritises stronger public monitoring, enforcement, and sanctions regimes, with mining companies bearing the costs. The Local Perspective emphasises the need to shift resources and competences for monitoring to subnational authorities and to strengthen accountability towards communities. The Partnership Perspective, representing the smallest number of study participants, favours operational guidance documents on addressing public health in impact assessments and the active involvement of companies in the delivery of health services. Conclusions Stakeholders identify a clear policy space for reform to strengthen public health protection in Tanzania’s mining sector and favour measures that improve the implementation of existing regulations. Priority actions include baseline health data collection, stronger consultation and grievance mechanisms, transparent monitoring and reporting, improved inter-agency coordination, and closer collaboration between mining companies and local health services. These findings suggest that implementation-focused reforms are more politically feasible and promise better outcomes than comprehensive regulatory change.