Even when stakeholders share a commitment to promote public health, opinions about how to best achieve this goal may differ significantly. This is not surprising since different stakeholders have different mandates, concerns, interests, priorities, and preferences. Consequently, stakeholders may have different positions regarding how public health issues related to resource extraction should be addressed. For a policy to be implementable and effective, it needs to have some minimum acceptance and legitimacy across stakeholders. The Q-methodology study (Q-study) explores perspectives of relevant stakeholders in Burkina Faso, Ghana, Mozambique, and Tanzania on public health-related policy options in natural resource extraction projects.