Health Impact Assesment in Permitting for "Factory Farms"

Health ImpactHealth Impact Assessment in CAFO 

Permitting 

I i i h lth i CAFOImagining health in CAFO permitting

Ellen Mee, JD Director of Environmental 

Health Policy Ohio Environmental Council

A t 5 2011August 5, 2011

Health in all policies . . .    

“(The) toxic combination of bad policies(The) toxic combination of bad policies, economics, and politics is, in large 

ibl f th f t th tmeasure, responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible.” g y p

– Who  Commission on Social Determinants of Health (2009)Health (2009)

Industrial Agricultureg

Some characteristics   

• Size (chickens 125,000; dairy 700 or more)

D it• Density

• Concentration of facilities, related industry

• Vertical integration

• Corporate ownerships or control

• Technology/breeding/animal specializationTechnology/breeding/animal specialization 

• Mechanization

• Pharmaceutical practice 

Impact on communities & environment

PositiveLower costs for meat, milk & eggs due to  more efficient feeding,  housing 

Larger facilities requiring less land

Increased employment

Increased tax revenue

Increased demand for local commodities

NegativeExcess manure stored or applied locally (3‐20 times human waste in U.S.)

Environmental impacts to water resources, aquatic life

l h d l f l lHealth impacts due to  release of agricultural chemicals, pathogens, pharmaceuticals into air, water and soil

Quality of life‐social impacts

Stress

Power imbalance

h i i i i / i l h iChanges to community activities/social  cohesion

Interference with daily activities, life‐style

Loss of local political control/authority

Increased large truck traffic

Infrastructure damage (roads, bridges) costs paid by local tax revenue

Connecting health to CAFO policy – a few hurdles?

The  EPA, DEQ, Agriculture Department, etc., are NOT  health agencies 

Deeply entrenched notions of independence of “farming” activitiesDeeply entrenched notions of independence of  farming  activities

Power politics! Industry v. rural community

Weak regulatory systems at both state and local levels, few (no?) formalized requirements for consideration of health impacts

Little understanding of “health” impacts (as opposed to nuisance)Little understanding of  health  impacts (as opposed to nuisance)

Public health agencies largely removed from jurisdiction

f fNo funding for health studies

Disconnect between health (science‐driven) and policy (economics, politics, public choicepublic choice

Right‐to‐farm laws

Building on the role of community health

Assessment:Assessment:  Collecting and tracking public complaints InvestigationAssistance with monitoring (rodents, flies, well water)Monitor ER visits related to work environmentsMonitor ER visits related to work environments

Policy development:Some HDs may adopt limited health‐based regulations (but, Iowa regulations overturned)regulations overturned)

Advocacy & Education:Convene public meetingsEducate agency personnel on public health impactsEducate agency personnel on public health impactsEducate facility owners/managersPromulgate recommendations  and regulations (limited)Work with producers/agency to promote mitigation strategies

Bridging the gap with health impact assessment

What is a health impact assessment?Set of procedures, methods, and toolsp , ,

Systematically judges the potential effects of a policy or project  on the health of a population and distribution of those effects within the population

Goals?Achieve changes in policies and proposals so that they support better health and reduce health inequalities. 

The recommendations of an HIA can include suggestions for enhancing positive aspects of proposals, as well as recommendations to mitigate any potentially negative aspectsnegative aspects. 

Many HIAs therefore overtly aim to influence the decision‐making process.

Make health impacts (broadly defined)  more explicit

Goals   

Primary GoalsAchieve changes in policies and proposals so that they support better health and reduce health inequalitiesand reduce health inequalities

Recommendations for enhancing positive aspects of proposals or mitigating potentially negative aspects

Influence the decision‐making process (promote voluntary actions)

Make health impacts (broadly defined)  more explicitp ( y ) p

Secondary GoalsEngage & empower community

Emphasize everyday experience

Build consensus

Build relationships & collaborations

Key elements  Screening: 

Determines the need and value of a HIA

Scoping :Scoping :Determines what impacts to evaluate, methods for analysis, work plan

Assessment Provides:A profile of existing health conditionsAn evaluation of potential health impactsStrategies to manage identified adverse health impacts

Reporting Includes:Development of the HIA reportCommunication of findings & recommendations

Monitoring Tracks:Impacts on decision‐making processes and the decisionImpacts of the decision on health determinantsp

Screening Worksheet  

Project and TimingHas a project, plan or policy been proposed?

Is there sufficient time to conduct an analysis before the final decision is made?

Health ImpactsHealth ImpactsDoes the decision have the potential to affect environmental or social determinants that impact health outcomes?   If so, which determinants and which health outcomes?

Would health inequities be impacted? In what ways?

Are the proposal’s impacts to health likely to be significant in terms of theAre the proposal s impacts to health likely to be significant in terms of the number of people impacted, the magnitude, breadth and/or immediacy of impacts?

Do evidence, expertise, and/or research methods exist to analyze health impacts of the decision?

Screening Worksheet 

Stakeholder Interest and CapacityHave public concerns about the health impacts of the decision been voiced or documented?documented?

Who are the stakeholders and interest groups involved in the decision‐making process?

Do stakeholders have the interest to participate in the HIA?

Do stakeholders have the capacity (resources skills etc ) to participate in theDo stakeholders have the capacity (resources, skills, etc.) to participate in the HIA?

Would stakeholders use the HIA to inform or influence the decision‐making process? How?

Screening Worksheet 

Potential Impact of HIA Findings 

Is health already being considered in the proposal or as part of the decisionIs health already being considered in the proposal or as part of the decision‐making process?

Are the links between the proposal and health or health determinants clear?

Is the decision‐making process open to the HIA and /or recommendations for changes to design, mitigations and/or alternatives?

If applied, would HIA findings and recommendations potentially improve the impact that the proposal has on health?

Screening Worksheet 

Potential Impact of the HIA Process on secondary goals?

What are the potential impacts of the HIA process? (e g buildingWhat are the potential impacts of the HIA process? (e.g., building relationships, empowering community members, voluntary intervention, demonstrating how health can be used in decision making)

Starting at the beginning 

Document baseline conditions, including –

Population health vulnerabilities based on the population characteristics

Inequalities in health outcomes/impacts among subpopulations or places.

What is a significant health impact?  

direction

magnitude

likelihoodlikelihood

distribution within the population

permanence

Using the best available evidence  

Assessments of health impacts should be based on a synthesis of the best available evidence. 

Existing data, empirical research, professional expertise, and the products of original investigations

When available, practitioners should utilize evidence from well‐designed andpeer‐reviewed systematic reviews

Previously published evidence, both supporting and refuting particular health impacts

The expertise and experience of affected members of the public (localknowledge), whether obtained via the use of participatory methods, collected via formal qualitative research methods, or reflected in public testimony, is potential evidence.

Community data collection 

Water quality monitoring

Ai li i iAir quality monitoring 

OSHA complaints 

Journals/web‐based reporting 

SurveysSurveys

Documented complaints

Recommendations 

The HIA should include specific recommendations to manage the health impacts identified, including:

Alternatives to the decision

Modifications to the proposed policy, program, or project 

Mitigation measuresMitigation measures

Where needed, expert guidance should be utilized to ensure recommendations reflect current effective practices

Criteria

Developing recommendations and mitigation –

Responsive to predicted impactsSpecific Technical feasible Enforceable  Within the authority of decision‐makers or 

Recommendations may include those for monitoring, reassessment, and adaptations to help manage uncertainty in impact assessment.

Using HIA process

HIA identified (self) in the U.S.

100 – 120 HIAs in process or completed in U.S.

15 involved natural resources and the environment15 involved natural resources and the environment

6 agriculture and food policy

CAFO i i /i d i l i l 0 (Mi hi ?)CAFO permitting/industrial agriculture:  0   (Michigan?)

Using HIA to move up the ladder

Can health impact assessment help rural communities “move up the ladder?

Arnstein S. 1969. Ladder of citizen participation.JAIP 35 (4) 216 224JAIP 35 (4): 216‐224

Resources

Health Impact ProjectRobert Wood Johnson Foundation and The Pew Charitable TrustsNational initiative designed to promote the use of health impact assessments (HIAs) as a decision‐making tool for policymakers.http://www.healthimpactproject.org

Human Impact Partners Offers policymakers, project leaders, public agencies, community groups and advocacy organizations the support they need to conduct HIAs and use the results to make informed choiceshttp://www.humanimpact.org/hips‐hia‐tools‐and‐resources

International Association for Impact Assessment (IAIA)International Association for Impact Assessment (IAIA)organized in 1980 to bring together researchers, practitioners, and users of various types of impact assessment from all parts of the world. IAIA involves people from many disciplines and professions. h // i i /http://www.iaia.org/

Questions?Questions?