INTERNATIONAL POLICY CONFERENCE
“COMPETITIVENESS & DIVERSIFICATION:
STRATEGIC CHALLENGES IN A PETROLEUMRICH ECONOMY”
Health Challenges in a Petroleum Rich Economy
Daniel Kertesz
1 | Oil, health, and development
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Health Challenges in a Petroleum Rich
Economy
Daniel Kertesz
WHO Representative in Ghana
World Health Organization
Key messages
 Health is vital for successful growth of oil and gas
sector and for development of region
 Health impacts associated not only with environmental
risk factors
 Opportunity through health, to make sure that this oil is
good for development
 Health system a key partner
 Many tools and good practice examples of how to do
this
3 | Oil, health, and development
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Overview
1. Why is it important for people to be healthy?
2. What are the specific health concerns when
considering the oil and gas industry?
3. Who is affected
4. Why can’t we deal with these?
5. How can stronger health systems mitigate effects
6. Introduce the idea of Health Impact Assessment (HIA)
4 | Oil, health, and development
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Why is it important for people to be
healthy?
 Human health is very easy to relate to – intuitively we all
know and appreciate good health and understand the
impact of bad health
 Loss of health can have catastrophic consequences for
individuals and for families
 Development progress is measured with health indicators
(e.g. MDGs)
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… healthy population is vital for local
economic development…
 Labour pool
– Higher costs - non-wage labour
costs
– Reduced performance and
productivity of workers
– Longer term, due to reduced
educational attainment, less
qualified local labour pool
Less attractive
investment climate
 Heavy burden of disease
–
–
–
–
Tuberculosis
Alcoholism
HIV/AIDs
Malaria
Less competitive
 High health insurance costs
 Catastrophic costs of disease
for families
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…..also for industry…
 Liability for pollution and
environment and health damages
 Impact of projects on disease and
impacts of diseases on projects
– Disease transmission
social licence to
operate
cost of doing
business
 Disease and well-being affects
linkages with communities
– Perceptions, expectations and
reactions to business
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reputational
risks
Oil and gas extraction: Direct impacts on
health
 Pollution:
– Air emissions - NOx, SOx, PM, dust
– Soil and ground water contamination
– Vibration and noise pollution
 Degradation:
– Change in soil quality
– land use changes, damage to ecosystems, loss of biodiversity
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Direct impacts on health
 Operation of equipment and machinery
– Road traffic accidents
– Construction
– Fires, explosions
 Exposure to hazardous substances
– Chemicals,
– heavy metals
 Heat stress, exposure to UV radiation
 Ergonomic injuries
9 | Oil, health, and development
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Indirect impacts on health
 Changing patterns of communicable diseases
– Tuberculosis, HIV/AIDS, Malaria
– Respiratory infectious diseases
– Sexually transmitted infections
 Food and waterborne illness
– Local service / infrastructure are overwhelmed
 Increase in non communicable diseases
– “Boom town” effect: more money, more food of poorer quality, less
exercise, more obesity, more heart disease
– Violence, alcohol abuse, mental health problems
– Stress, anxiety and social tensions
10 | Oil, health, and development
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rapid development
example pathways to health outcomes
Stress, mental
well-being
Diet (quality)
and lifestyle
Alcoholism
Cardiovascular
disease
Nutritional status
Diabetes
Change in
spending patterns
Levels of physical
activity
Access to
motorized
transport
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Road traffic
accidents
Obesity
Respiratory
disorders
Injury or death
Why can’t we deal with these?
 Underestimation of health impacts by governments
– Inadequate consideration of all implications, lack of awareness
 Institutional barriers dividing sector functions
 Weak national/local health systems not equipped to
identify or manage impacts
–
–
–
–
Strain on access to limited services
Procurement and supply of commodities
Inadequate quantity/quality of human resources for health
Poor surveillance, information management
12 | Oil, health, and development
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Who is affected?
 Outbreak of mass
poisoning from sodium
bromide - 458 cases in
Luanda, Angola
 sodium bromide used
widely in oil and gas
industry
 Entered the local market
and was mistaken for
table salt
13 | Oil, health, and development
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What is a health system?
 All organizations, people and actions whose primary
interest is to promote, restore or maintain health
 Has 6 building blocks:
–
–
–
–
–
–
Service delivery
Health workforce
Information
Medical products, vaccines, technologies
Financing
Leadership and governance
14 | Oil, health, and development
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How good health systems can mitigate
impact
 Identification of health risks (and benefits)
– And interventions to address them using simple, low cost public
health interventions
 Monitoring, reporting and evaluation
– Epidemiological and health indicators for baseline
– Early warning and monitoring of unintended impacts
– Measuring net "social" benefits or losses generated as a result
of growth of the petroleum industry
15 | Oil, health, and development
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How good health systems can mitigate
impact
 Responding to community concerns and
perceptions of risk
– Health sector experienced with risk communication and can
engage in dialogue on community concerns about health risks
 Emergency preparedness and response
– Public health response to chemical incidents
– Recognition and accurate diagnosis of chemical exposure
 Responding to health issues
– Delivery of medical services to workers and to communities
16 | Oil, health, and development
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Key messages
 Health is vital for successful growth of oil and gas
sector and for development of region
 Health impacts not only associated with environmental
risk factors
 Opportunity through health, to anticipate to make sure
that this oil is good for development
 Health system a key partner
 Many tools and good practice examples of how to do
this
17 | Oil, health, and development
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Thank you
Daniel Kertesz
World Health Organization Representative
Ghana
kerteszd@gh.afro.who.int
18 | Oil, health, and development
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Extra slides
Example: Alberta, CANADA (2010)
 "boom town"– virtual doubling of
population in less than a decade
 Community health status lower in
oil sands areas than in other
regions - inequity
 Individual and family pressures
– Inflation (rent, food prices)
– Housing and labour shortages
Fort McMurry and the Oil Sands, Photo: Gord Mckenna
 Infrastructure pressures
– Investment in health infrastructure
not as fast as population growth
 Increased crime, alcohol
and drug use, family stress
Source: RSC Expert Panel, Environmental and Health Impacts of Canada's Oil Sands Industry, Dec 2010
20 | Oil, health, and development
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Health impacts of oil and gas
extraction activities
Health impact assessment (HIA)
 Health impact assessment
– is a key tool/process/platform to facilitate the integration of
health considerations into development policies, plans, and
projects
 The use of HIA can enable the upstream
assessment/identification of
– potential health impacts associated with a particular policy,
plan
– opportunities to address those impacts.
HIA can enable foresight to help ensure that the legacy is positive.
22 | Oil, health, and development
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How does HIA work?
 Analysis of activities to determine potential health
impacts
 Determination of baseline of health status and
assessment/estimation of potential health impacts
 Generates recommendations on intervention options
 Framework for monitoring and evaluation
 Process and platform for systematically engaging all
stakeholders in decision-making process
23 | Oil, health, and development
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Onshore facilities
The footprint of oil and gas activities is much bigger
than just the well.
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Ancillary facilities and infrastructure
Requires construction of pipelines, transport corridors,
sometimes ports, and power and water infrastructure.
25 | Oil, health, and development
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HIA procedure
Policy, programme , or
project development
phase for prospective
assessments.
Screening
Quickly establishes "health
relevance" of the policy or project.
Is HIA required?
Scoping
Identifies key health issues &
public concerns, establishes ToR,
sets boundaries.
Rapid or in-depth assessment of
health impacts using available
evidence – who will be affected,
baseline, prediction, significance,
mitigation.
Appraisal
Reporting
Policy or project
implementation phase
Monitoring
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Conclusions and recommendations
to remove/mitigate negative
impacts on health or to enhance
positive.
Action, where appropriate, to
monitor actual impacts on health to
enhance existing evidence base.
HIA can be easily integrated into other IAs
Strategic Environmental Assessment
1. Establishing the context for the SEA





Scoping (in dialogue with stakeholders)
Collecting baseline data
Identifying alternatives
Identifying how to enhance opportunities and
mitigate impacts
Quality Assurance
Reporting
3. Informing and influencing decision making


Monitor decisions taken on the proposal
Monitor implementation of the proposal
Evaluation of both the SEA and the proposal
DAC Guidance on SEA in Development Cooperation, OECD 2006
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Scoping – where health relevance exists, identifies
questions to ask and defines boundaries for the
assessment

Appraisal

Reporting – development and communication of
– assessment of health impacts using
available evidence
conclusions and recommendations to remove/mitigate
negative impacts on health or enhance positive impacts
Making recommendations
4. Monitoring and evaluating



 Screening – to establish health relevance of the proposal
Screening
Setting objectives
Identifying stakeholders
2. Implementing the SEA




Health impact assessment (HIA)

Monitoring – action, where appropriate to monitor
actual impacts on health to enhance existing evidence
base
WHO, 2003