Health Impact Assessments Subramaniam a/l Karuppannan, MCIEH, PJK Ms.Envt; B.Sc.(Hons)(Envt & Occ.Health); Dip RSH.

Health Impact Health Impact AssessmentsAssessments

Subramaniam a/l Karuppannan, Subramaniam a/l Karuppannan, MCIEH, PJKMCIEH, PJK

Ms.Envt; B.Sc.(Hons)(Envt & Occ.Health); Dip RSH.Ms.Envt; B.Sc.(Hons)(Envt & Occ.Health); Dip RSH.

Health Impact Assessment (HIA) Health Impact Assessment (HIA) • ""Environmental impact assessment (EIA)Environmental impact assessment (EIA)" denotes a study to identify, " denotes a study to identify,

predict, evaluate and communicate information about the impacts on predict, evaluate and communicate information about the impacts on

the environment of a proposed project and to detail out the mitigating the environment of a proposed project and to detail out the mitigating

measures prior to project approval and implementation (DOE, 2009). measures prior to project approval and implementation (DOE, 2009).

• A component in EIA specifically dealing with human health A component in EIA specifically dealing with human health

is called an "is called an "environmental health impact assessment environmental health impact assessment

(EHIA)(EHIA)“ that offers unique opportunities for “ that offers unique opportunities for the protection the protection

and promotion of human healthand promotion of human health (DOE, 2009) (DOE, 2009). . • Health is considered to be “Health is considered to be “a state of complete physical, mental and a state of complete physical, mental and

social well-being and not merely the absence of disease or infirmitysocial well-being and not merely the absence of disease or infirmity” ” (WHO 1946)(WHO 1946)..

(Bos, 2009)(Bos, 2009)

(Bos, 2009)(Bos, 2009)

Environmental Health Impact Assessment: Definitions

• WHO and IAIA have formulated a definition WHO and IAIA have formulated a definition for HIA that captures all essential elements: for HIA that captures all essential elements:

““A combination of procedures, methods and A combination of procedures, methods and tools that systematically judges the tools that systematically judges the potential, and sometimes unintended, potential, and sometimes unintended, effects of a policy, plan, programme or effects of a policy, plan, programme or project on the health of a population, and project on the health of a population, and the distribution of those effects within the the distribution of those effects within the population. HIA identifies appropriate population. HIA identifies appropriate actions to manage those effects. actions to manage those effects. (IAIA/WHO (IAIA/WHO 2006 and Bos, 2009).2006 and Bos, 2009).

Environmental Health Impact Assessment: Justifications

• HIA is justified by four compelling HIA is justified by four compelling arguments: arguments: 1)1) economics, economics,

2)2) equity, equity,

3)3) best public health practice and best public health practice and

4)4) good governancegood governance, ,

• All are required for policy implementation All are required for policy implementation based on principles of based on principles of sustainable sustainable developmentdevelopment (Bos (Bos et al. 2003et al. 2003 and Bos, and Bos, 2009).2009).

Environmental Health Impact Assessment: KeywordsEnvironmental Health Impact Assessment: Keywords

i.i. ImpactImpact – to have a direct effect (Merriam- – to have a direct effect (Merriam-Webster, 2009) Webster, 2009)

ii.ii. health impact assessment health impact assessment - demonstrate - demonstrate methodologies, eventually enabling HIA to methodologies, eventually enabling HIA to contribute to more informed decision-making contribute to more informed decision-making about public policies impacting health (UCLA, about public policies impacting health (UCLA, 2009).2009).

iii.iii. EvaluationEvaluation – to determine a value (Merriam- – to determine a value (Merriam-Webster, 2009) Webster, 2009)

iv.iv. health protection health protection - - equality of opportunity for equality of opportunity for people to enjoy the highest attainable level of people to enjoy the highest attainable level of health (EPHA, 2002). health (EPHA, 2002).

Environmental Health Impact Assessment: KeywordsEnvironmental Health Impact Assessment: Keywords

iv.iv. health promotion health promotion - generating long-term - generating long-term health behavior habits (Shani, health behavior habits (Shani, et. al, et. al, 2000).2000).

v.v. environmental management system environmental management system – –

An Environmental Management System (EMS) An Environmental Management System (EMS) is a set of processes and practices that is a set of processes and practices that enable an organization to reduce its enable an organization to reduce its environmental impacts and increase its environmental impacts and increase its operating efficiency. It provides information operating efficiency. It provides information and resources related to EMS for businesses, and resources related to EMS for businesses, associations, the public, and state and federal associations, the public, and state and federal agencies (USEPA, 2009). agencies (USEPA, 2009).

DETERMINANTS OF HEALTH AND THE HIA PROCESSDETERMINANTS OF HEALTH AND THE HIA PROCESSThe broad definition of health adopted by the WHO can be illustrated by The broad definition of health adopted by the WHO can be illustrated by considering the determinants of health as outlined in Table 1, where virtually considering the determinants of health as outlined in Table 1, where virtually every area of human activity influences health.every area of human activity influences health.

Table 1: Determinants of healthTable 1: Determinants of health (adapted from enHealth 2001) (adapted from enHealth 2001)

DeterminantsDeterminants Health Impact (Examples)Health Impact (Examples)

1) Fixed 1) Fixed GenesGenesGenderGenderAgeingAgeing

2) Social and economic 2) Social and economic PovertyPovertyEmploymentEmploymentSocial exclusionSocial exclusionCommunity structure and infrastructureCommunity structure and infrastructure

3) Lifestyle and behaviour 3) Lifestyle and behaviour DietDietPhysical activityPhysical activitySmokingSmokingAlcoholAlcoholSexual behaviourSexual behaviourDrugsDrugsCoping skillsCoping skills

(Bos, 2009)(Bos, 2009)

DETERMINANTS OF HEALTH AND THE HIA PROCESSDETERMINANTS OF HEALTH AND THE HIA PROCESS

4) Access to services EducationHealth servicesSocial servicesTransportLeisure

5) Environment Air qualityNoise

HousingWater qualitySocial environmentRisk of injurySun exposureDisease vectors

(Bos, 2009)(Bos, 2009)

DeterminantsDeterminants Health Impact (Examples)Health Impact (Examples)

The Environment Health Model (Blum, 1981).

The HIA processThe HIA process• Step 1: ScreeningStep 1: Screening• a desk-based preliminary exercise applied to a a desk-based preliminary exercise applied to a

proposed project, programme or policy, to decide proposed project, programme or policy, to decide whether investing in a full-scale HIA is warranted. whether investing in a full-scale HIA is warranted.

• For projects, a description and general knowledge For projects, a description and general knowledge of location, size and complexity, number of of location, size and complexity, number of workers and affected people in surrounding workers and affected people in surrounding communities, operations and likely exposures is communities, operations and likely exposures is essential. essential.

• In many developing country contexts there is no In many developing country contexts there is no substitute for on-sight screening.substitute for on-sight screening.

The HIA processThe HIA process• Step 2: ScopingStep 2: Scoping• a process that sets the a process that sets the temporal and spatialtemporal and spatial

boundaries for the HIA, identifying the range boundaries for the HIA, identifying the range and types of and types of negative and positive health negative and positive health effectseffects

• considering specific phases of a project, and considering specific phases of a project, and identifying vulnerable population groups. identifying vulnerable population groups.

• The output of the scoping can be utilized as a The output of the scoping can be utilized as a basis for a formal set of basis for a formal set of terms of referenceterms of reference for for the HIA.the HIA.

Screening process to guide decision on Screening process to guide decision on whether to conduct a HIA (whether to conduct a HIA (Cole Cole et al. 2003)et al. 2003)

The HIA processThe HIA process• Step 3: AssessmentStep 3: Assessment • the actual the actual hazard/promoter identification, risk hazard/promoter identification, risk

assessment and impact synthesis processassessment and impact synthesis process, , followed by the followed by the formulation of conclusions formulation of conclusions and recommendations for safeguards, and recommendations for safeguards, mitigating measures and health promotionmitigating measures and health promotion (normally carried out by consultants). (normally carried out by consultants).

• A key issue for HIAs carried out in developing A key issue for HIAs carried out in developing country settings is country settings is the lack of quality baseline the lack of quality baseline health datahealth data..

The HIA processThe HIA process• Step 4: AppraisalStep 4: Appraisal • the quality control component of HIA, the quality control component of HIA,

focusing on the focusing on the objectivity, objectivity, comprehensiveness and evidence basecomprehensiveness and evidence base of of the HIA and on the the HIA and on the technical soundness, technical soundness, social acceptability and economic social acceptability and economic feasibility of proposed measuresfeasibility of proposed measures – – normally carried out by the government normally carried out by the government regulator in the Ministry of Health.regulator in the Ministry of Health.

The HIA processThe HIA process• Step 5: Formulating and Step 5: Formulating and

prioritising recommendationsprioritising recommendations • consolidation of consolidation of

recommendations into a recommendations into a public public health management planhealth management plan, with , with well founded arguments to well founded arguments to obtain the necessary resources.obtain the necessary resources.

The HIA processThe HIA process• Step 6: NegotiationsStep 6: Negotiations • with the Ministry of Finance and/or with the Ministry of Finance and/or

external donor agency over aexternal donor agency over allocation llocation of fundsof funds for the different components for the different components of the of the public health management planpublic health management plan and with the and with the proponentproponent and other and other relevant relevant line ministriesline ministries over the over the institutional arrangements determining institutional arrangements determining roles and responsibilities for the plan’s roles and responsibilities for the plan’s implementation.implementation.

The HIA processThe HIA process• Step 7: Implementation of the Step 7: Implementation of the

public health management planpublic health management plan

• the key activity is the key activity is monitoring of monitoring of compliancecompliance with the agreed with the agreed plan, of the health status of plan, of the health status of affected communities and of affected communities and of the effectiveness of the the effectiveness of the proposed measures.proposed measures.

(Fehr, 1999)

Environmental Health Impact Assessment., Evaluation of a Ten-Step Model (Fehr, 1999)

Environmental Health Impact Assessment., Evaluation of a Ten-Step Model (Fehr, 1999)

• The following components were identified as key elements of an

integrated environmental health impact assessment model:

i. project analysis, analysis of status quo (including regional

analysis, population analysis, and background situation),

ii. prediction of impact (including prognosis of future pollution

and prognosis of health impact),

iii. assessment of impact,

iv. recommendations,

v. communication of results, and

vi. evaluation of the overall procedure.

Environmental Health Impact Assessment., - A Case Study

Environmental Health Impact Assessment., - A Case Study

• The concept was applied to a project of extending a waste disposal facility and to a city bypass highway project.

• Currently, the coverage of human health aspects in environmental impact assessment still tends to be incomplete, and public health departments often do not participate.

• Environmental health impact assessment as a tool for health protection and promotion is underutilized.

• It would be useful to achieve consensus on a comprehensive generic concept.

• An international initiative to improve the situation seems worth some consideration.

Integrated EHIA ApproachThree components were identified as key elements of an integrated

EHIA model:

i. analysis of status quo,

ii. prediction of impacts, and;

iii. assessment of impacts.

i. A need for communication of the results, and; evaluation of the overall

procedure.

ii. A "generic“ EHIA concept can be designed with appropriate adjustments both

for specific project types and suited to local situations.

iii. This concept is meant to be applicable to a wide range of development projects.

Integrated EHIA ApproachIEHIA model consists of 10 steps (Figure l).

• Project analysis: expected to cover both normal operation and accidental releases and aims at the characterization of expected hazards, including acute toxicity and carcinogenicity.

• Regional analysis: analysis of physio-geography, meteorology, natural features, and land use and includes a definition of the study area for further investigation.

• Population analysis: described by size, age, gender, health status, and behavioral patterns, e.g. food consumption patterns and hobby activities.

• Background situation: characterized on the basis of the preceding three steps and on environmental monitoring of existing pollution.

Integrated EHIA Approach• Prognosis of future pollution uses analogies and dispersion

modeling, of future pollution, including air, surface and ground water, soil, flora, and fauna.

• Prediction of health impacts - key component of the whole procedure.

• It consists of three interrelated components.

a). Qualitative assessment of changes concerning neighborhood features and quality of life as well as citizen concerns.

• In accordance with common scientific reasoning, a distinction is then made between agents for which a "threshold" of exposure can be defined vs other agents without this feature.

Integrated EHIA Approachb).b).Compare to appropriate limit valuesCompare to appropriate limit values - for - for threshold agents, predicted threshold agents, predicted

levels of chemical pollution and intensities of other agents, such as levels of chemical pollution and intensities of other agents, such as noise (medium-specific)noise (medium-specific). .

• The assessment is implied in the comparison of the The assessment is implied in the comparison of the predicted values vs limit values. predicted values vs limit values.

c).c).Quantitative estimate of riskQuantitative estimate of risk - for non threshold agents, especially - for non threshold agents, especially carcinogens, including all relevant pathways and agents. In addition, carcinogens, including all relevant pathways and agents. In addition, decisions are needed on "decisions are needed on "acceptable additional riskacceptable additional risk." ."

• A commonly used level is a risk of 10A commonly used level is a risk of 10-5-5, i.e. one additional , i.e. one additional lifetime cancer case per 100,000 persons exposed. lifetime cancer case per 100,000 persons exposed.

• A summary assessment of the predicted health A summary assessment of the predicted health impacts is made.impacts is made.

Integrated EHIA Approach• Recommendations are made on based on information in the

preceding steps, on planning alternatives, emission control, monitoring, public information, post project analysis, etc.

• Considering the complexity of the overall procedure, the numerous details of the methods and the range of assumptions involved, it is no easy task to communicate the results.

• EHIA demands special efforts to communicate the underlying assumptions, the resulting predictions, and the assessments correctly and efficiently to all parties involved, including planners, decision makers, and the public at large.

• Risk comparisons and visualization methods may be helpful in this respect.

Integrated EHIA Approach• Whenever one of the project alternatives that were scrutinized

by EHIA is actually put into reality, the opportunity arises to

evaluate EHIA methods and assumptions.

• This can be done by comparing the predicted impact to the

actual situation, for example, by establishing specific

monitoring procedures and continually evaluating the state of

the environment as well as human exposures and health

outcomes.

Field ApplicationsField Applications

Field Applications• The ten-step model described above was first applied to the The ten-step model described above was first applied to the

enlargement of an existing waste disposal facility in Lower Saxony. enlargement of an existing waste disposal facility in Lower Saxony.

• Another model application refers to a highway planned in the City of Another model application refers to a highway planned in the City of Krefeld, North Rhine Westphalia. Krefeld, North Rhine Westphalia.

• Regarding the planned extension of a nontoxic waste disposal site, Regarding the planned extension of a nontoxic waste disposal site, a task force on EHIA was formed, and the ten-step EHIA model a task force on EHIA was formed, and the ten-step EHIA model approach was applied. approach was applied.

• Selected results of the first four EHIA steps are summarized in Selected results of the first four EHIA steps are summarized in Tables 1 and 2. Tables 1 and 2.

• Even in the "common," nontoxic waste disposal site, complex Even in the "common," nontoxic waste disposal site, complex physicochemical processes take place, depending on the waste physicochemical processes take place, depending on the waste composition, including solubility and volatility of components, on composition, including solubility and volatility of components, on humidity, acidity, and temperature. humidity, acidity, and temperature.

Field Applications• These processes last for long time spans These processes last for long time spans

(decades) beyond the filling phase of the (decades) beyond the filling phase of the disposal site. disposal site.

• They strongly change over time and involve They strongly change over time and involve discharges of gases, dust, microbial discharges of gases, dust, microbial contamination, and fluids (leachate). contamination, and fluids (leachate).

• In the typical case, gases are collected and In the typical case, gases are collected and incinerated, resulting in stack emissions incinerated, resulting in stack emissions composed of a variety of inorganic and composed of a variety of inorganic and (chlorinated) organic compounds. (chlorinated) organic compounds.

Field Applications• In addition, trucks delivering waste will travel to and from In addition, trucks delivering waste will travel to and from

the waste disposal site, so traffic emissions (chemicals and the waste disposal site, so traffic emissions (chemicals and noise), and traffic-related injuries also need to be noise), and traffic-related injuries also need to be considered.considered.

• The second EHIA application reported here refers to a The second EHIA application reported here refers to a planned major bypass road in the City of Krefeld. planned major bypass road in the City of Krefeld.

• Because of a long-standing problem of traffic congestion Because of a long-standing problem of traffic congestion within inner-city areas of Krefeld, plans were made to build within inner-city areas of Krefeld, plans were made to build a bypass road, relieving inner-city areas partially from traffic a bypass road, relieving inner-city areas partially from traffic flows. flows.

• The environmental impact assessment procedure for the The environmental impact assessment procedure for the bypass road took six different routes into consideration. bypass road took six different routes into consideration.

Field Applications• Changes of traffic flow had been computed using two Changes of traffic flow had been computed using two

different planning scenarios, the first of which implied different planning scenarios, the first of which implied constant numbers of employees in the area, whereas the constant numbers of employees in the area, whereas the second scenario implied slightly increased numbers in future second scenario implied slightly increased numbers in future years. years.

• The environmental impact assessment had led to the The environmental impact assessment had led to the recommendation of one specific route alternative (variant No. recommendation of one specific route alternative (variant No. 6).6).

• For the EHIA, we selected two of the route variants and added For the EHIA, we selected two of the route variants and added the "null" variant, the "null" variant, ie, the option to build no ie, the option to build no additional city additional city bypass road at all. These three variants were studied in both bypass road at all. These three variants were studied in both study area A, study area A, ie, the area potentially ie, the area potentially relieved from traffic. relieved from traffic.

Field Applications• In both study areas, receptor points were defined for each In both study areas, receptor points were defined for each

routing variant.routing variant.

• Selected results of the first four steps of EHIA for this Selected results of the first four steps of EHIA for this project are summarized in Tables 1 and 2, in a parallel way project are summarized in Tables 1 and 2, in a parallel way to those of the waste disposal project.to those of the waste disposal project.

• Results concerning the predicted changes of pollution levels and Results concerning the predicted changes of pollution levels and the health impacts are shown for both projects in Tables 3 and 4. the health impacts are shown for both projects in Tables 3 and 4.

• For the extension of the waste disposal site, the prognosis For the extension of the waste disposal site, the prognosis of future pollution levels was based on extrapolations of of future pollution levels was based on extrapolations of measurements of current emissions from existing measurements of current emissions from existing disposal fields, supplemented by data from the technical disposal fields, supplemented by data from the technical literature. literature.

Field Applications• "Receptor points" corresponding to the four villages in the study

area were defined, and dilution factors were obtained from modeling results performed by an outside agency (TOV Hannover Sachsen, using the Miktoskaliges Klima- und Ausbreitungsmodell (Microscale Climate and Dispersion Model).

• For all receptor points, the predicted air concentrations were below recognized limit values. It was calculated, however, that in a neighborhood close to the waste disposal site, 1,1-dichloroethane concentrations and hydrogen sulfide concentrations would surpass current limit values.

• Although these concentrations would not lead to significant exposure of the resident population, the finding may be relevant for waste disposal workers.

Field Applications• The leachate was found to contain a variety of toxic substances, The leachate was found to contain a variety of toxic substances,

thus underlining the need for efficient purification and thus underlining the need for efficient purification and continuous control. continuous control.

• Traffic noise levels were predicted to increase by 3.2 dB(A) in Traffic noise levels were predicted to increase by 3.2 dB(A) in one place and <1.6 dB(A) in several other places.one place and <1.6 dB(A) in several other places.

• Concerning the prognosis of impacts, a Concerning the prognosis of impacts, a qualitative assessment qualitative assessment was prepared in close cooperation with the local health was prepared in close cooperation with the local health department, medical practitioners, and local citizens and department, medical practitioners, and local citizens and included concerns about odors as well as a loss of recreational included concerns about odors as well as a loss of recreational functions. functions.

• Because of compliance of Because of compliance of predicted environmental burdens predicted environmental burdens with with relevant limit values, specific negative health effects from relevant limit values, specific negative health effects from threshold agents were not expected to take place.threshold agents were not expected to take place.

Field Applications• As for carcinogenic effects, a As for carcinogenic effects, a quantitative risk assessment quantitative risk assessment

based on the following eight chemicals was performed:based on the following eight chemicals was performed:

i.i. benzo(a)pyrene, benzo(a)pyrene,

ii.ii. benzene, dichloromethane, benzene, dichloromethane,

iii.iii.trichloromethane,trichloromethane,

iv.iv.dioxins (toxic equivalents), dioxins (toxic equivalents),

v.v. ethyleneethylene

vi.vi.trichloride, trichloride,

vii.vii.ethylene tetrachloride, and ethylene tetrachloride, and

viii.viii.vinyl chloride.vinyl chloride.

Field Applications• Using the Health Risk Assessment computer program,“ the exposure analysis was based Using the Health Risk Assessment computer program,“ the exposure analysis was based

on a wide range of pathways, including air, soil, skin, meat, milk, water, and fish, and on a wide range of pathways, including air, soil, skin, meat, milk, water, and fish, and calculated individual cancer risk for 70 years of exposure, as well as cancer burdens of the calculated individual cancer risk for 70 years of exposure, as well as cancer burdens of the four villages.four villages.

• In this analysis, maximum emission of burned gas over the whole study period was In this analysis, maximum emission of burned gas over the whole study period was assumed, although in reality the true level of emission is lower for much of the time.assumed, although in reality the true level of emission is lower for much of the time.

• Under these health,conservative assumptions, for the study area, the additional cancer Under these health,conservative assumptions, for the study area, the additional cancer burden caused by the waste site emissions over a 70-year operational period was burden caused by the waste site emissions over a 70-year operational period was calculated to be below 0.01 additional cases. calculated to be below 0.01 additional cases.

• The estimates of the additional lifetime cancer risks in the four villages are shown in Fig. 2.The estimates of the additional lifetime cancer risks in the four villages are shown in Fig. 2.• Similarly, the change of pollution levels and the resulting health impacts were predicted for Similarly, the change of pollution levels and the resulting health impacts were predicted for

the city bypass road project in Krefeld (Tables 3 and 4). the city bypass road project in Krefeld (Tables 3 and 4). • Outdoor air concentrations were predicted using the appropriate for other areas (MI-uS-92 Outdoor air concentrations were predicted using the appropriate for other areas (MI-uS-92

mode110 ). mode110 ). • Detailed examination was performed for five receptor points, ie, two in study area A and Detailed examination was performed for five receptor points, ie, two in study area A and

three in study area B, including the prognosis of carbon monoxide, benzene, nitrogen three in study area B, including the prognosis of carbon monoxide, benzene, nitrogen dioxide, lead, sulfur dioxide, and diesel soot as a function of estimated future traffic flows. dioxide, lead, sulfur dioxide, and diesel soot as a function of estimated future traffic flows.

Field Applications• According to the models used, the predicted additional burden of pollutants in According to the models used, the predicted additional burden of pollutants in

study area A is small or even unnoticeable, except for nitrogen dioxide, which study area A is small or even unnoticeable, except for nitrogen dioxide, which would increase by about 5070% at the receptor points. would increase by about 5070% at the receptor points.

• For both routing alternatives that were studied in detail, the benzene and diesel For both routing alternatives that were studied in detail, the benzene and diesel soot concentrations at the most unfavorable receptor points were predicted to be soot concentrations at the most unfavorable receptor points were predicted to be 60% and 230% higher than the recommended values, respectively. Concerning 60% and 230% higher than the recommended values, respectively. Concerning study area B, the predicted reductions were mostly smaller than 5%, and very study area B, the predicted reductions were mostly smaller than 5%, and very little difference between route variants 1 and 6 was found in this respect.little difference between route variants 1 and 6 was found in this respect.

• Concerning the noise impact of the various bypass road options, variant 6 affects Concerning the noise impact of the various bypass road options, variant 6 affects longer stretches of (planned) residential area and areas of higher population longer stretches of (planned) residential area and areas of higher population density.density.

• In both model applications, the prediction of future exposures turned out to be In both model applications, the prediction of future exposures turned out to be the hardest part of the exercise.the hardest part of the exercise.

• In the study concerning the waste disposal site, it was necessary, for example, to In the study concerning the waste disposal site, it was necessary, for example, to estimate the fractions of diet produced at home. estimate the fractions of diet produced at home.

• A small scale survey showed these fractions to vary considerably. A small scale survey showed these fractions to vary considerably.

Field ApplicationsField Applications• For example, the fraction of eggs produced on site ranged from 10 to 100%, and the For example, the fraction of eggs produced on site ranged from 10 to 100%, and the

fraction of meat varied between 10 and 30%. fraction of meat varied between 10 and 30%. • For risk analysis, the individual estimates were averaged. For risk analysis, the individual estimates were averaged. • Another important source of uncertainty refers to the long-range prediction of discharge Another important source of uncertainty refers to the long-range prediction of discharge

from the waste disposal site. from the waste disposal site. • Although it is known that there will be considerable decreases of gas and leachate Although it is known that there will be considerable decreases of gas and leachate

emissions after initial peaks, the expected maxima were applied to establish a safety emissions after initial peaks, the expected maxima were applied to establish a safety margin. margin.

• As a consequence, true exposures may be about 45% lower than in our model. As a consequence, true exposures may be about 45% lower than in our model. • On the other hand, by limiting our analysis to the eight carcinogens listed above, we On the other hand, by limiting our analysis to the eight carcinogens listed above, we

incur a chance of underestimation, although there is no evidence that inclusion of incur a chance of underestimation, although there is no evidence that inclusion of additional carcinogens would have changed the result significantly. additional carcinogens would have changed the result significantly.

• Similar reasoning holds for the bypass road project. Similar reasoning holds for the bypass road project. • Methods to handle uncertainty as well as true variation more adequately and to produce Methods to handle uncertainty as well as true variation more adequately and to produce

interval estimates were not available to us at the time when these analyses were done.interval estimates were not available to us at the time when these analyses were done.• On the basis of the predictions outlined above, both EHIAs included a number of On the basis of the predictions outlined above, both EHIAs included a number of

recommendations. recommendations.

Field Applications• Concerning the extension of the waste disposal site, the recommendations can be Concerning the extension of the waste disposal site, the recommendations can be

summarized as follows. summarized as follows.

(1)(1) As for emission and exposure reduction, inactive surface areas of the disposal site As for emission and exposure reduction, inactive surface areas of the disposal site should be sealed as early as possible. An existing water well in close downhill vicinity should be sealed as early as possible. An existing water well in close downhill vicinity of the disposal site should be closed, except for groundwater monitoring. Because of of the disposal site should be closed, except for groundwater monitoring. Because of current high levels of noise exposure in several parts of the study area, traffic noise current high levels of noise exposure in several parts of the study area, traffic noise control measures should be considered, even without the extension of the disposal control measures should be considered, even without the extension of the disposal site. site.

(2) Monitoring measures should include the amounts and concentrations of gaseous (2) Monitoring measures should include the amounts and concentrations of gaseous dumpsite emissions; of leachate, treated wastewater, and creek water; and of the dumpsite emissions; of leachate, treated wastewater, and creek water; and of the health status of village population and dumpsite workers. In addition, and independent health status of village population and dumpsite workers. In addition, and independent from the project under study, existing contaminated sites in the study area containing from the project under study, existing contaminated sites in the study area containing galvanic sludges should be examined in detail. galvanic sludges should be examined in detail.

(3) Finally, there should be increased transparency on all emissions, including periods of (3) Finally, there should be increased transparency on all emissions, including periods of temporary malfunction of the incinerator or of the leachate treatment plant. temporary malfunction of the incinerator or of the leachate treatment plant.

Field ApplicationsField Applications• Concerning the city bypass road project, recommendations included the following Concerning the city bypass road project, recommendations included the following

items. items.

(1) More consideration should be given to the "null" variant. The environmental impact (1) More consideration should be given to the "null" variant. The environmental impact

assessment should be extended in this respect. assessment should be extended in this respect.

(2) Variant 6, which was favored by environmental impact assessment, should be (2) Variant 6, which was favored by environmental impact assessment, should be

abandoned, because a relatively large population would negatively be affected, abandoned, because a relatively large population would negatively be affected,

especially by noise exposure. especially by noise exposure.

(3) In addition to the impact of changes of traffic flows, the impact of noise control (3) In addition to the impact of changes of traffic flows, the impact of noise control

measures should be modeled prospectively to improve the basis for decision making. measures should be modeled prospectively to improve the basis for decision making.

(4) If any bypass variant were actually to be built, monitoring measures should be (4) If any bypass variant were actually to be built, monitoring measures should be

implemented.implemented.

PerspectivesPerspectives

Perspectives• Prospective health impact assessment cuts across several Prospective health impact assessment cuts across several

disciplines, combining elements of epidemiology, toxicology, disciplines, combining elements of epidemiology, toxicology, mathematical modeling, and quantitative risk assessment. mathematical modeling, and quantitative risk assessment.

• It is difficult to properly assess the value of EHIA for health It is difficult to properly assess the value of EHIA for health protection and promotion yet, while avoiding pitfalls of both protection and promotion yet, while avoiding pitfalls of both overestimation and underestimation of the value of EHIA. overestimation and underestimation of the value of EHIA.

• As a rule, the prediction of health impact will tend to be As a rule, the prediction of health impact will tend to be incomplete, and the assessment of the predicted impacts by incomplete, and the assessment of the predicted impacts by necessity implies subjective decisions. necessity implies subjective decisions.

• In addition, it may be difficult to successfully introduce the EHIA In addition, it may be difficult to successfully introduce the EHIA results into the process of decision making where many other results into the process of decision making where many other aspects (for example, economic considerations) also call for aspects (for example, economic considerations) also call for attention.attention.

Perspectives• On the other hand, there is a chance of underestimating the role On the other hand, there is a chance of underestimating the role

of EHIA, because the very existence of this procedure may of EHIA, because the very existence of this procedure may already exert influence on decision makers.already exert influence on decision makers.

• These opportunities for health protection and promotion offered These opportunities for health protection and promotion offered by prospective impact assessment seem to be underutilized.by prospective impact assessment seem to be underutilized.

• EHIA, by its scope and nature, depends on efficient EHIA, by its scope and nature, depends on efficient interdisciplinary cooperation. interdisciplinary cooperation.

• Epidemiologic skills are essential for the completion of steps 3, 4, Epidemiologic skills are essential for the completion of steps 3, 4, 6, and 10. 6, and 10.

• The analysis of the background situation (step 4) is similar to a The analysis of the background situation (step 4) is similar to a standard community diagnosis, and the impact prognosis (step standard community diagnosis, and the impact prognosis (step 6) relies heavily on epidemiologic input, especially for exposure 6) relies heavily on epidemiologic input, especially for exposure estimation. estimation.

Perspectives• Step 10, where feasible, draws on epidemiologic Step 10, where feasible, draws on epidemiologic

techniques developed for program evaluation. techniques developed for program evaluation. • Still other steps of the procedure, such as the weighing of Still other steps of the procedure, such as the weighing of

evidence in steps 7 and 8 and appropriate communication evidence in steps 7 and 8 and appropriate communication with decision makers and the public (step 9), may benefit with decision makers and the public (step 9), may benefit from the experience of professional epidemiologists.from the experience of professional epidemiologists.

• The results of this project lead to the following The results of this project lead to the following conclusions.conclusions.

• For the sake of improved feasibility, the overall EHIA procedure For the sake of improved feasibility, the overall EHIA procedure needs to be broken down into manageable components. It would be needs to be broken down into manageable components. It would be useful to achieve consensus on a coherent concept of useful to achieve consensus on a coherent concept of comprehensive EHIA. comprehensive EHIA.

Perspectives• On the basis of such a generic EHIA concept, specific On the basis of such a generic EHIA concept, specific

standards and recommendations for each type of standards and recommendations for each type of development project are desirable, for example, development project are desirable, for example, concerning highway projects, waste disposal projects, etc. concerning highway projects, waste disposal projects, etc.

• Specific recommendations are particularly needed for the scope of Specific recommendations are particularly needed for the scope of noxious agents to be covered in EHIA. noxious agents to be covered in EHIA.

• To reduce current problems related to (health) data access, the To reduce current problems related to (health) data access, the existing systems of surveillance and health reporting could be existing systems of surveillance and health reporting could be improved. improved.

• Health departments should regularly be involved in the Health departments should regularly be involved in the scoping and, if necessary, in the subsequent complete scoping and, if necessary, in the subsequent complete EHIA procedures. EHIA procedures.

Perspectives• To handle uncertainty and true variation of parameters (for To handle uncertainty and true variation of parameters (for

example, concerning exposure assessment) more example, concerning exposure assessment) more adequately, new approaches of probabilistic modeling adequately, new approaches of probabilistic modeling should be explored.should be explored.

• For gradual improvement of current approaches, EHIAs For gradual improvement of current approaches, EHIAs need to be systematically evaluated, including post project need to be systematically evaluated, including post project analysis. analysis.

• There is a need to develop specific EHIA training programs There is a need to develop specific EHIA training programs to exchange theoretical concepts and to accumulate to exchange theoretical concepts and to accumulate practical experience.practical experience.

• An international initiative to improve the situation seems An international initiative to improve the situation seems worth some consideration. worth some consideration.

CHALLENGES IN HIACHALLENGES IN HIA• There are a number of challenges associated There are a number of challenges associated

with conducting an HIA, some of these relate with conducting an HIA, some of these relate to the choice of methodology, e.g. to the choice of methodology, e.g. quantification and stakeholder participation, quantification and stakeholder participation, while others apply to most assessments. while others apply to most assessments.

• These challenges are:These challenges are:– Public ParticipationPublic Participation– QuantificationQuantification– Data needs and availabilityData needs and availability– Possible biases.Possible biases.

CHALLENGES IN HIACHALLENGES IN HIA1)1) Stakeholder participationStakeholder participation• The inclusion of stakeholder participation and the level of participation will, The inclusion of stakeholder participation and the level of participation will,

largely depend upon the HIA method chosen and the level of HIA undertaken. largely depend upon the HIA method chosen and the level of HIA undertaken. • Some have argued that stakeholder participation is an essential feature of HIA Some have argued that stakeholder participation is an essential feature of HIA

(Douglas et al. 2001), while others have suggested that it can be helpful in some (Douglas et al. 2001), while others have suggested that it can be helpful in some contexts but not in others (Parry & Wright 2003).contexts but not in others (Parry & Wright 2003).

• The potential level of community participation in HIA depends on the prevailing The potential level of community participation in HIA depends on the prevailing governance systemgovernance system, on the , on the constitutional frameworkconstitutional framework, on , on local cultural practicelocal cultural practice, , on on determinants of the capacity of communitiesdeterminants of the capacity of communities to participate (e.g. literacy rates) to participate (e.g. literacy rates) and on capacity among and on capacity among professional to apply participatory methodsprofessional to apply participatory methods. .

• For the For the institutional stakeholder participationinstitutional stakeholder participation, incentives and sanctions may be , incentives and sanctions may be required, as intersectoral collaboration is not likely to materialize spontaneously.required, as intersectoral collaboration is not likely to materialize spontaneously.

• The The rapid rural appraisal approachrapid rural appraisal approach (Chambers, 1983) provides a good framework (Chambers, 1983) provides a good framework for HIA stakeholder participation, as it recognizes the need to respect local for HIA stakeholder participation, as it recognizes the need to respect local power structures in formal contacts with communities, but also encourages power structures in formal contacts with communities, but also encourages researchers to sample, informally, views and researchers to sample, informally, views and opinions of community members opinions of community members who may have been marginalizedwho may have been marginalized..

CHALLENGES IN HIACHALLENGES IN HIA2) 2) QuantificationQuantification• According to Veerman According to Veerman et al. (2005), quantification is comparatively rare in et al. (2005), quantification is comparatively rare in

HIAHIA. . • In a review of 98 prospective HIA studies only 17 reported quantitative In a review of 98 prospective HIA studies only 17 reported quantitative

estimates of exposure to determinants (e.g. environmental pollutants), of estimates of exposure to determinants (e.g. environmental pollutants), of which 16 reported quantified health outcomes. which 16 reported quantified health outcomes.

• Quantification can help decision makers (Kemm 2000; Veerman Quantification can help decision makers (Kemm 2000; Veerman et al. 2005) et al. 2005) and allow the easy comparison of and allow the easy comparison of alternatives. alternatives.

• It is clear, however, that not everything that is important can beIt is clear, however, that not everything that is important can be

quantified and sometimes it could be argued that “quantified and sometimes it could be argued that “not everything that can not everything that can be quantified is important” (Mindell et al. 2001). be quantified is important” (Mindell et al. 2001).

• The main difficulties in terms of The main difficulties in terms of quantification are the availability of quantification are the availability of

appropriate data and comparative metricsappropriate data and comparative metrics..

• One possible quantification method uses disability-adjusted life years One possible quantification method uses disability-adjusted life years (DALYs).(DALYs).

CHALLENGES IN HIACHALLENGES IN HIA3) 3) Data needs and availabilityData needs and availability• one of the greatest challenges relates to the data needs for HIAone of the greatest challenges relates to the data needs for HIA• and the availability of the data, this is especially true where quantification is and the availability of the data, this is especially true where quantification is

an objective and when HIAs are to be done for projects, programmes and an objective and when HIAs are to be done for projects, programmes and policies to be implemented in a developing country setting. policies to be implemented in a developing country setting.

• Where desk-based or rapid HIAs are being conducted, there is little or no Where desk-based or rapid HIAs are being conducted, there is little or no opportunity to collect new data, meaning that the best must be made of opportunity to collect new data, meaning that the best must be made of what is available. what is available.

• This often means resorting to routine surveillance data. It should be noted, This often means resorting to routine surveillance data. It should be noted, however, that “however, that “evidence for actual or potential impacts on health can come evidence for actual or potential impacts on health can come from many sources and a good HIA will strive to ensure different types of from many sources and a good HIA will strive to ensure different types of evidence are properly identified and considered” (HDA 2002). evidence are properly identified and considered” (HDA 2002).

• As noted by Mindell et al. As noted by Mindell et al. (2004) literature reviews may unearth conflicting (2004) literature reviews may unearth conflicting evidence for health impacts or find that the evidence is either poor quality, evidence for health impacts or find that the evidence is either poor quality, insufficient or absent.insufficient or absent.

CHALLENGES IN HIACHALLENGES IN HIA4)4) Possible biasesPossible biases• A main challenge in HIA is to prevent biases from creeping into the procedure and A main challenge in HIA is to prevent biases from creeping into the procedure and

method. A quality HIA is objective, comprehensive and based on evidence.method. A quality HIA is objective, comprehensive and based on evidence.• Biases can be introduced into the actual HIA procedure and method, and they can also Biases can be introduced into the actual HIA procedure and method, and they can also

be introduced at the time when recommendations are formulated outlining mitigation be introduced at the time when recommendations are formulated outlining mitigation measures.measures.

• The terms of reference provide the first possible opportunity for biases, these are the The terms of reference provide the first possible opportunity for biases, these are the product of the screening and scoping exercises, and false assumptions, poor product of the screening and scoping exercises, and false assumptions, poor judgement and wrong information can result in terms of references that provide judgement and wrong information can result in terms of references that provide inadequate or outright wrong guidance to the HIA consultants, which will jeopardize inadequate or outright wrong guidance to the HIA consultants, which will jeopardize the process from the outset.the process from the outset.

• A number of additional factors may contribute to a lack of objectivity within the HIA, A number of additional factors may contribute to a lack of objectivity within the HIA, including:including:

i.i. conflicts of interest (between the client and consultant);conflicts of interest (between the client and consultant);

ii.ii. inappropriate timing and/or duration;inappropriate timing and/or duration;

iii.iii. inadequate budgeting;inadequate budgeting;

iv.iv. lack of expertise, experience or skill; andlack of expertise, experience or skill; and

v.v. lack of access to information.lack of access to information.

CHALLENGES IN HIACHALLENGES IN HIA

5)5) Multi-disciplinary natureMulti-disciplinary nature• HIA is, by necessity, a multi-HIA is, by necessity, a multi-

disciplinary approach, as the majority disciplinary approach, as the majority of proposals under investigation and of proposals under investigation and many of the determinants of health many of the determinants of health which they affect are likely to be which they affect are likely to be outside the field of public health outside the field of public health (Mindell et al. 2004; and Cole et al. (Mindell et al. 2004; and Cole et al. 2005).2005).

Conclusion

ConclusionConclusion• A collaborative project on EHIA might deal with the A collaborative project on EHIA might deal with the

following topics:following topics:

i.i. Status quo analysis, concerning EHIA needs, legal Status quo analysis, concerning EHIA needs, legal frameworks, and existing approaches;frameworks, and existing approaches;

ii.ii. Development of an assessment concept, covering both Development of an assessment concept, covering both health risks and health benefits;health risks and health benefits;

iii.iii.Recommendations concerning a standard procedure, Recommendations concerning a standard procedure, quality criteria, and evaluation strategies;quality criteria, and evaluation strategies;

iv.iv.Development of specific tools and resources, including Development of specific tools and resources, including software and databases; and,software and databases; and,

v.v. Provision of dedicated EHIA training programs.Provision of dedicated EHIA training programs.

• Bos, R. (2009). Bos, R. (2009). Environmental health impact assessment: Principles and practice. Environmental health impact assessment: Principles and practice. World Health Organization, Department of World Health Organization, Department of Public Health and EnvironmentPublic Health and Environment

• Fehr, R. (1999). EHIA evaluation of a 10 Step Model. Journal of Epidemiology, Fehr, R. (1999). EHIA evaluation of a 10 Step Model. Journal of Epidemiology, 1999;10:6186251999;10:618625

• Impact. (2009). In Impact. (2009). In Merriam-Webster Online DictionaryMerriam-Webster Online Dictionary..Retrieved February 23, 2009, from http://www.merriam-webster.com/dictionary/impactRetrieved February 23, 2009, from http://www.merriam-webster.com/dictionary/impact

References

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