Improving Health in the United States The Role of Health Impact Assessment (2011) / Chapter Skim
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Appendix A: Experiences with Health Impact Assessment
Appendix A: Experiences with Health Impact Assessment
Pages 130-177
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The first is to incorporate HIA into existing assessment processes -- for example, environmental impact assessment (EIA) under the National Environmental Policy Act (NEPA)
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. Healthy Public Policy Health and environment are under provincial jurisdiction in Canada.
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In 2011, the national public health director and the assistant deputy minister in the Ministry of Health and Social Services (Ministère de la Santé et des Services Sociaux) of Québec stated that there were 434 requests for advice from 2003 to 2011 (Poirier 2011a)
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. Examining Human Health in Environmental Impact Assessment In 1995, the Federal-Provincial-Territorial Committee on Environmental and Occupational Health convened a task force in response to reviews that demonstrated that health aspects were inconsistently or only partially addressed in EIA.
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was influential in establishing a case for examining human health in environmental assessment in Canada. A major output of the initiatives was the Canadian Handbook on Health Impact Assessment, a comprehensive resource that was first published in 1998 and has since been updated (Health Canada 2004a,b,c,d)
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Approaches for integrating health into environmental assessment across Europe are discussed next,3 and then other approaches that have been put into place across Europe to enable HIA to be conducted are reviewed. 2 Regarding environmental assessment in the EU, human-health measures are included in directives and legislation that regulate the effects of development on the environment.
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. Reviews show a small increase in the number of mentions of the word health in the European Commission's impact assessment reports; thus, although progress is slow, consideration of health in the framework is increasing (Ståhl 2010)
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Environmental assessment is a key mechanism for evaluating individual projects identified by the EIA directive (Council of the European Union 1985) or public plans or programs identified by the strategic environmental assessment (SEA)
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Environmental Impact Assessment The EIA directive applies to public and private projects (Council of the European Union 1985) .5 Annex I of the directive stipulates projects for which it is mandatory to conduct an EIA, such as railways, roads, waste-disposal installation, and waste-water treatment plants.
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. Strategic Environmental Assessment The SEA directive (EP/Council 2001)
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, and in indicating that health authorities should be consulted at the different stages of the process. Examples of Advancing Health Impact Assessment Independently of Environmental Impact Assessment and Strategic Environmental Assessment Member countries have taken different approaches to advancing HIA outside the environmental-assessment process.
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More recently, Finland introduced norms and guidelines for implementing integrated impact assessment, which has been required by law for many years and is led by the Ministry of Internal Affairs. The norms established minimum requirements for impact assessments and allowed questions to be raised if health issues were not included.
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for successful implementation of impact assessment. In the Finnish context, the use of integrated impact assessment, which is required by law, is seen as the best way to integrate health and environment issues into policy-making (T.
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Although working across sectors is desirable, increasing the capacity for HIA outside the discipline of public health will have long-term implications for the development of HIA. AUSTRALIA This section reviews the Australian experience in addressing health in EIA, in advancing HIA by using alternative methods, and in strengthening the consideration of health equity in HIA.
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. The Australian federal government established the enHealth Council, a national body with responsibility for implementing a National Environmental Health Strategy and providing leadership on integrating health into EIA (Harris and Spickett 2011)
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. Health Impact Assessment Independent of Environmental Impact Assessment Around 2000, there was a move to promote HIA independently of EIA as a way to influence healthy public policy (such as in the transportation and housing sectors)
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In 2002, the Ministry of Public Health established a Division of Sanitation and Health Impact Assessment to define HIA systems and to support healthy public policy, especially among local governments. The focus changed in 2003 to HIA in healthy public policy as a learning process, and this process was to be developed in parallel with obtaining support for the concept of the NHSR and with development of a critical mass of HIA knowledge and skill in the country.
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The commission expressed concern over health impacts (Colson 1971) and, in cooperation with WHO, included health assessments in its deliberations (WHO 2000a)
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. The WHO experience with EIA and HIA for healthy public policy was used to inform and influence the negotiations of the new SEA protocol to the United Nations Economic Commission for Europe Convention on EIAs (Dora 2004)
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recommended that WHO support health-equity impact assessments of important global, regional, and bilateral economic agreements and in all government policies, including finance, as a way to address health disparities. It was recommended that member states of WHO redesign their health sectors to integrate a focus on social determinants of health into relevant sectors (CSDH 2008)
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The IFC adopted safeguards for projects submitted for funding and developed a set of criteria for assessing potential impacts on the environment, employment, occupational health, and safety. In 2006, the IFC developed additional safeguards for public health after a debate about the oversight of adverse health impacts of projects funded by IFC that could possibly pose a risk to businesses and therefore to the IFC itself (IFC 2006)
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The Eastern Neighborhoods Community Health Impact Assessment, completed in 2006, analyzed three rezoning plans for former industrial neighborhoods and focused on issues of displacement and environmental quality (Corburn and Bhatia 2007; Farhang et al.
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The state also expressed an intent "to create the healthiest state in the nation." The law established a mechanism under the purview of the State Board of Health to undertake health impact reviews on the request of a state legislator or the governor (Revised Washington Statutes 43.20.285)
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. In Alaska, the Department of Health and Social Services has established an HIA program to provide technical assistance to other agencies involved in conducting integrated environmental and health impact assessments (Alaska HSS 2011)
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. Under NEPA, agencies are required to publish procedures that provide categories of actions that an agency has determined generally require the preparation of EISs and environmental assessments and actions that are excluded from written documentation.
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A decision was made by the U.S. Supreme Court that the fears did not need to be analyzed by the Nuclear Regulatory Commission under NEPA, and this was interpreted by some to mean that health effects were not subject to challenge under NEPA.
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Public-interest organizations have also become more aware of HIA and have been advocating, with mixed success, its inclusion into a wider array of NEPA analyses. The Natural Resources Defense Council, for example, now advocates the inclusion of a comprehensive assessment of potential human health impacts in EISs that analyze the impacts of oil and gas exploration and production on federal lands (Mall et al.
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. Health Impact Assessment Independent of the National Environmental Policy Act The practice of HIA has also been used for federal decision-making outside the NEPA process.
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Another example of intensive involvement in HIA in an academic setting is the Health Impact Assessment Project at UCLA. The project began in 2001 with an assessment of the potential avenues for the development of HIA, either 13 See http://www.healthypeople.gov/2020/default.aspx.
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Outside the United States, there have been cases in which non-Western systems of knowledge have been incorporated into HIA, and indigenous peoples and traditional ways of thinking have played an active role in the HIA process. There are both similarities and differences between indigenous peoples' approaches to knowledge and Western impact assessment.
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states that indigenous communities are rarely engaged in impact assessments undertaken by academe, industry, or government officials. Although tribal environmental policy acts have been enacted by several tribes in the United States and may provide a mechanism for including HIA, it appears that today Alaska is the only state in which American Indian tribes have conducted HIA work.
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Several multinational oil companies have developed internal corporate standards for HIA or for environmental, social, and health impact assessment (IPIECA/OGP 2007, ICMM 2010; Chevron 2011)
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Lack of guidance has sometimes led to minimal health analyses, especially when HIA has been incorporated into EIA, SEA, or other integrated assessment frameworks. The international experience demonstrates that having adequate capacity for conducting HIA (expertise and resources)
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Development of Health Impact Assessment in the United States The increased use of HIA in some local communities and states in the United States indicates that more value is being placed on it. Demand for HIA initially has come from grassroots activities, and growth of the practice in the medium term will depend somewhat on constituent demand.
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ECHP Health Impact Assessment Discussion Paper No.
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2011. Facilitating communities in designing and using their own community health impact assessment tool.
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2007. Health impact assessment in San Francisco: Incorporat ing the social determinants of health into environmental planning.
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2009. Influencing Healthy Public Policy with Community Health Impact Assessment, National Collaborating Centre for Healthy Public Policy, Canada.
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2007. Eastern Neighborhoods Community Health Impact Assessment, Final Report.
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Area Health Impact Assessment. Human Impact Partners, Oakland, California [online]
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2005. A Guide to Health Impact Assessments in the Oil and Gas Industry.
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2009. The introduction of health impact assessment in the WHO European Healthy Cities Network.
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2007. Whanau Ora Health Impact Assessment.
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2003. Report on the Qualitative Evaluation of Four Health Impact Assessments on Draft Mayoral Strategies for London, London Health Commission, Greater London Authority and the London Health Observatory.
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2010a. Is the increasing policy use of Impact Assessment in Europe likely to undermine efforts to achieve healthy public policy?
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1991. Convention on Environmental Impact Assessment in a Transboundary Context –the Espoo (EIA)
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2000b. Intersectoral Decision-Making Skills in Sup port of Health Impact Assessment of Development Projects: Final Report on the Development of a Course Addressing Health Opportunities in Water Resources Development 1988- 1998.
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Presentation at the Second Meeting on Health Impact Assessment, May 12, 2010, Washington, DC. Wismar, M., J
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