Health Impact Assessment:
integrating health into the NEPA Process
Presentation to TRB
Jan 23, 2011
1
Aaron Wernham, M.D., M.S.
Director | The Health Impact Project
901 E Street, NW, Washington, D.C. 2004
p: 202.540.6346
e: awernham@pewtrusts.org
www.healthimpactproject.org
Outline of talk
• Legal foundations: how should agencies approach
health in NEPA analyses?
• Introduction to Health Impact Assessment (HIA), and its
use in the context of NEPA
• Applications of HIA to transportation decisions
Health analysis in NEPA
Current practice
1. Survey of 45 EIS:
-
No discussion of health in 83%
In the remainder, discussion of health limited to singlesubstance cancer risk assessment
Steinemann, A. 2000. Rethinking Human Health Impact Assessment. Environmental
Impact Assessment Review 20: 627-645
2. Survey of NEPA professionals:
-
Found little understanding, discussion, or analysis of
health among EIS professionals
Cole et al. 2004. Prospects for Health Impact Assessment in the United States: New and
Improved Environmental Impact Assessment of Something Different? Journal of
Health Politics, Policy, and Law 29 (6) 1153-1186
Health analysis in NEPA
Typical practice
1. Assessment of air and water quality impacts is common:
while health impacts are implied, they are rarely analyzed.
2. Single-substance risk assessments are sometimes
undertaken.
3. Rare to look at the public health baseline or identify
subgroups that are vulnerable to specific impacts.
4. Rare to look at indirect or cumulative health effects.
The “Determinants of Health”
Graphical representation
“Get more exercise”...
“I never thought of this as a health issue”
Car-friendly communities have almost double the rate of
obesity as pedestrian-friendly communities
Access to public parks and recreational facilities has been
linked to reductions in crime and juvenile delinquency,
and violent injury.
An E-Z Pass toll system reduced rates of premature birth.
NEPA and Human Health:
Purpose
The purposes of this Act are: … to promote
efforts which will prevent or eliminate damage
to the environment and biosphere and
stimulate the health and welfare of man; to
enrich the understanding of the ecological
systems and natural resources important to the
Nation; and to establish a Council on
Environmental Quality
NEPA Sec. 2 [42 USC § 4321]
CEQ Regulations and Guidance
40 C.F.R. 1508.8 Effects:
“Effects” includes ecological, aesthetic, historic, cultural,
economic, social, or health, whether direct, indirect, or
cumulative.”
40 C.F.R. 1508.27 Significantly:
(b) Intensity: includes “ The degree to which the proposed
action affects public health or safety.”
“Agencies should recognize the interrelated cultural, social,
occupational, historical, or economic factors that may amplify
the natural and physical environmental effects of a proposed
agency action.” CEQ (1997) Environmental Justice: guidance under NEPA
9
Congressional Intent…?
“When we speak of the environment,
basically, we are talking about the relationship
between man and these physical and biological
and social forces that impact upon him. A
public policy for the environment basically is
not a public policy for those things out there. It
is a policy for people."
Senator Henry Jackson. Hearings on S. 1075, S. 237,
and S. 1752, Senate Committee on Interior and Insular
Affairs, 91st Cong., 1st Session. 118 (1969)
Executive Orders
Each Federal agency shall:
make achieving environmental justice part of its mission by
identifying and addressing, as appropriate, disproportionately
high and adverse human health or environmental effects of its
programs, policies, and activities on minority populations and
low-income populations in the United States
Executive Order 12898: Federal Actions to Address Environmental Justice in Minority Populations
and Low-Income Populations (11 February 1994)
…make it a high priority to identify and assess environmental
health risks and safety risks that may disproportionately affect
children; and ... shall ensure that its policies, programs,
activities, and standards address disproportionate risks to
children that result from environmental health risks or safety
risks. Executive Order 13045: Protection of Children from Environmental Health Risks and Safety
Risks
HIA:
Definitions
A combination of procedures, methods and tools that
systematically judges the potential effects of a policy,
programme or project on the health of a population and the
distribution of those effects within the population. HIA identifies
appropriate actions to manage those effects.
(IAIA, 2006)
A practical approach for collaboration between health and other
sectors, translating public health research into predictions and
reasonable recommendations that policy makers can use to
ensure that new public decisions contribute to healthier
communities.
Health Impact Assessment
Current Applications:
Canada and Australia: considerable work, both within
EIA and for other policies and projects.
European Union: HIA done for any major new policy
• broad applications in policy-making, land-use, etc
• variety of governance structures
Many other nations: Australia and New Zealand;
Ghana; Thailand; Viet Nam
13
Health Impact Assessment
International business is starting to use it
World Bank and IFC: part of evaluation standards
for large development loans
(IFC Guidance Note 4:
http://www.ifc.org/ifcext/enviro.nsf/Content/GuidanceNotes)
Equator Principles: ratified by the majority of large
lending banks worldwide, the Equator Principles
delineate ethical requirements for large
development loans: they refer to IFC standards
(http://www.equator-principles.com/principles.shtml )
Completed and In Progress HIAs
1999–2010: 119
WA 8
ME 1
MT 3
MN 6
OR
12
NH 2
WI 1
MA 4
PA 2
OH
1
IL 1
CO 4
CA
47
MO
1
NM
1
NJ 1
MD 2
KY 1
TN 1
GA 8
TX 1
FL
1
AK 7
Map Courtesy of A. Dannenberg, A. Wendel,
CDC NCEH
HI 1
The HIA Process
1. Screening –is HIA feasible and likely to add value?
2. Scoping – determine the important health effects, affected
populations, available evidence, etc
3. Assessment – analyze baseline conditions and the direct,
indirect, and cumulative pathways through which health
can be affected.
4. Recommendations
5. Reporting – disseminate the report to the public,
stakeholders, solicit input
6. Monitoring and Evaluation
HIA in NEPA
First efforts occurred in Alaska
Tribal health department became cooperating agency with BLM
and MMS on several EISs for oil and gas leasing completed
HIAs that addressed a wide range of health issues:
– Local air quality concerns for a sensitive population (high
baseline rate of lung disease)
– Influx of non-resident workers, culture change and risk of
mental health problems, and drug and alcohol use, and STIs
– Dietary impacts if whales, caribou or fish displaced
Current picture:
-BLM, MMS, USACE, EPA now using HIA commonly
-State of AK has developed its own HIA program, and will do HIA for
any major natural resource development project.
HIA in NEPA
Status of national practice
• EPA region IX commented in support of HIA for I-710 and
Port of LA expansion
• HIA non-profit is now contracted with local council of
governments to do HIA of I-710 in conjuction with EIS
• EPA region IX has MOU with CDC to work on HIA
• Several HIAs completed and being integrated into
transportation EISs:
– I-5 Columbia River Crossing – HIA submitted as DEIS comment
– Buford Highway redevelopment
– Lake Oswego to Portland transit corridor EIS (OPHI and Metro)
Typical health considerations
• Physical activity and related health concerns – obesity,
diabetes, cardiovascular disease
• Air quality – impact of roadway emissions on local
residents, workers, indoor air quality – asthma,
cardiovascular mortality, all-cause mortality
• Accidents
• Social cohesion – crime, violence, injury
• Economic changes – life expectancy, many specific
disease rates
• Access to goods and services – health care, grocery
stores, etc
Other transportation-related HIAs
Other transportation-related HIAs
HIA Name
Policy, plan, program or project
Columbia River Crossing
Project to replace a 5-mile section of highway and bridge
with a new bridge, expanded highway, and light rail
I-280 Freeway and
Still/Lyell Channel/
Excelsior District
HIA examines health effects from past highway
construction project
SR 520 Bridge
Replace aging highway bridge across Lake Washington;
HIA mandated by state legislature
Atlanta Beltline
Transit, trails, parks and redevelopment of brownfields
and greyfields
Baltimore Red Line
14-mile transit line through residential areas and
downtown district
Policies to reduce greenhouse gas emissions & VMT in a
proposed state law
Oregon Vehicle Miles
Traveled (VMT)
Legislation
21
Other transportation-related HIAs
HIA Name
Policy, plan, program or project
Redirection of California
Transportation Spillover
Funds
Reallocate approximately revenue from gasoline tax
that had been set aside for funding transit programs
Sacramento Safe Routes to
School Program
Policy of encouraging children to walk to school, and
street improvements project
Transportation Policies in
the Eugene Climate and
Energy Action Plan (CEAP)
Transportation recommendations within a Climate
and Energy Plan
City of Decatur Community
Transportation Plan
Plan for city-wide multimodal transportation system
City of Spokane Downtown
Plan Update
Policies that support bike and pedestrian
connections, found in the 2008 Spokane Downtown
Plan Update
County-level bicycle and pedestrian master plan
Clark22County Bicycle and
Pedestrian Master Plan
Other transportation-related HIAs
HIA Name
Policy, plan, program or project
East Bay Greenway
Project to build 12 miles of walking and biking paths
under elevated rail transit tracks
Santa Monica Airport
(SMO)
Existing policy at small airport for takeoff procedures
that increases idling of jets and other small airplanes
Treasure Island
Community
Transportation Plan
Redevelopment plans for Treasure Island
Port of Oakland
Plan to expand major port
Buford Highway
Redevelopment
Project of highway redevelopment and policy of
changed priority uses of road corridor
Other transportation-related HIAs
HIA Name
Policy, plan, program or project
Clark County Highway
99 Sub-Area Plan
Project to redevelop urban/suburban corridor through
an area approx. 4 square miles
Salmon Creek Sub-area
Plan
A sub-area plan to redevelop urban/suburban corridor.
Lowry Corridor Project
Project of redevelopment of blighted urban corridor
into mixed-use, pedestrian-friendly area
Bloomington Alternative
Transportation Plan,
Xcel Corridor
Citywide plan to increase walking/biking trails; HIA
completed for only the section of trail that would pass
through corridor with high voltage power lines
Boxers' Trail
Project to restore 3.8 miles of nature trail through
under-served neighborhoods in north Philadelphia
Conclusion
1. NEPA requires an analysis of health effects
2. According to the basic NEPA process, this should include:
a. A description of the affected environment: for health, this includes
baseline prevalence of any illness that could be affected, and a
baseline description of any factors important to health that might be
affected by the proposed action
b. A systematic analysis of the direct, indirect, and cumulative health
effects: this should NOT be limited a priori to specific issues, such
as contaminants or injury, but instead should include a discussion of
any potentially significant direct, indirect or cumultaive health effect
c. Proposed recommendations to manage the identified effects
3. HIA provides a way to accomplish a well-done NEPA-compliant health
effects analysis
Questions?
Aaron Wernham
Director, Health Impact Project
The Pew Charitable Trusts
Tel. 202-540-6346
awernham@pewtrusts.org
26