Health Impact Assesment in Permitting for "Factory Farms"
Health Impact Health ImpactAssessment in CAFO Permitting Imagining h lth i CAFOI i i health in CAFO permitting Ellen Mee, JD Director of Environmental Health Policy Ohio Environmental Council August 5, 2011 A t 5 2011
Health in all policies . . . “(The) toxic combination of bad policies (The) toxic combination of bad policies, economics, and politics is, in large measure, responsible for the fact that a ibl f th f t th t majority of people in the world do not enjoy the good health that is biologically possible.” g yp – Who Commission on Social Determinants of Health (2009) Health (2009)
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 specialization Technology/breeding/animal specialization • Mechanization • Pharmaceutical practice
Impact on communities & environmentPositive Lower 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 commoditiesNegative Excess manure stored or applied locally (3‐20 times human waste in U.S.) Environmental impacts to water resources, aquatic life Health impacts due to release of agricultural lh d l f l l chemicals, pathogens, pharmaceuticals into air, water and soil
Quality of life‐social impactsStressPower imbalanceChanges to community activities/social cohesion h i i ii / i l h iInterference with daily activities, life‐styleLoss of local political control/authorityIncreased large truck trafficInfrastructure 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 activities Deeply 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 No funding for health studies f f Disconnect between health (science‐driven) and policy (economics, politics, public choice public choice Right‐to‐farm laws
Building on the role of community healthAssessment: Assessment: Collecting and tracking public complaints Investigation Assistance with monitoring (rodents, flies, well water) Monitor ER visits related to work environments Monitor ER visits related to work environmentsPolicy development: Some HDs may adopt limited health‐based regulations (but, Iowa regulations overturned) regulations overturned)Advocacy & Education: Convene public meetings Educate agency personnel on public health impacts Educate agency personnel on public health impacts Educate facility owners/managers Promulgate recommendations and regulations (limited) Work with producers/agency to promote mitigation strategies
Bridging the gap with health impact assessmentWhat is a health impact assessment? Set of procedures, methods, and tools p , , Systematically judges the potential effects of a policy or project on the health of a population and distribution of those effects within the populationGoals? 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 aspects. negative aspects Many HIAs therefore overtly aim to influence the decision‐making process. Make health impacts (broadly defined) more explicit
Goals Primary Goals Achieve changes in policies and proposals so that they support better health and reduce health inequalities and 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 explicit p ( y ) pSecondary Goals Engage & 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 conditions An evaluation of potential health impacts Strategies to manage identified adverse health impacts Reporting Includes: Development of the HIA report Communication of findings & recommendations Monitoring Tracks: Impacts on decision‐making processes and the decision Impacts of the decision on health determinants p
Screening Worksheet Project and Timing Has a project, plan or policy been proposed? Is there sufficient time to conduct an analysis before the final decision is made?Health ImpactsHealth Impacts Does 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 the Are 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 Capacity Have public concerns about the health impacts of the decision been voiced or 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 the Do 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 decision‐ Is 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., building What 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 characteristicsInequalities in health outcomes/impacts among subpopulations or places.
What is a significant health impact? direction magnitude likelihood 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 investigationsWhen available, practitioners should utilize evidence from well‐designed andpeer‐reviewed systematic reviewsPreviously published evidence, both supporting and refuting particular health impactsThe 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 monitoringAir quality monitoring Ai li i iOSHA complaints Journals/web‐based reporting SurveysDocumented complaints
Recommendations The HIA should include specific recommendations to manage the health impacts identified, including:Alternatives to the decisionModifications to the proposed policy, program, or project Mitigation measuresMitigation measuresWhere needed, expert guidance should be utilized to ensure recommendations reflect current effective practices
CriteriaDeveloping 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 environment 15 involved natural resources and the environment 6 agriculture and food policy CAFO permitting/industrial agriculture: 0 (Michigan?) CAFO i i /i d i l i l 0 (Mi hi ?)
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
ResourcesHealth 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.orgHuman 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‐resourcesInternational 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. http://www.iaia.org/h // i i /