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Health ImpactHealth Impact Assessment in CAFO
Permitting
I i i h lth i CAFOImagining health in CAFO permitting
Ellen Mee, JD Director of Environmental
Health Policy Ohio Environmental Council
A t 5 2011August 5, 2011
Health in all policies . . .
“(The) toxic combination of bad policies(The) toxic combination of bad policies, economics, and politics is, in large
ibl f th f t th tmeasure, responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible.” g y p
– Who Commission on Social Determinants of Health (2009)Health (2009)
Industrial Agricultureg
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 specializationTechnology/breeding/animal specialization
• Mechanization
• Pharmaceutical practice
Impact on communities & environment
PositiveLower 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 commodities
NegativeExcess manure stored or applied locally (3‐20 times human waste in U.S.)
Environmental impacts to water resources, aquatic life
l h d l f l lHealth impacts due to release of agricultural chemicals, pathogens, pharmaceuticals into air, water and soil
Quality of life‐social impacts
Stress
Power imbalance
h i i i i / i l h iChanges to community activities/social cohesion
Interference with daily activities, life‐style
Loss of local political control/authority
Increased large truck traffic
Infrastructure 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” activitiesDeeply 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
f fNo funding for health studies
Disconnect between health (science‐driven) and policy (economics, politics, public choicepublic choice
Right‐to‐farm laws
Building on the role of community health
Assessment:Assessment: Collecting and tracking public complaints InvestigationAssistance with monitoring (rodents, flies, well water)Monitor ER visits related to work environmentsMonitor ER visits related to work environments
Policy development:Some HDs may adopt limited health‐based regulations (but, Iowa regulations overturned)regulations overturned)
Advocacy & Education:Convene public meetingsEducate agency personnel on public health impactsEducate agency personnel on public health impactsEducate facility owners/managersPromulgate recommendations and regulations (limited)Work with producers/agency to promote mitigation strategies
Bridging the gap with health impact assessment
What is a health impact assessment?Set of procedures, methods, and toolsp , ,
Systematically judges the potential effects of a policy or project on the health of a population and distribution of those effects within the population
Goals?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 aspectsnegative aspects.
Many HIAs therefore overtly aim to influence the decision‐making process.
Make health impacts (broadly defined) more explicit
Goals
Primary GoalsAchieve changes in policies and proposals so that they support better health and reduce health inequalitiesand 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 explicitp ( y ) p
Secondary GoalsEngage & 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 conditionsAn evaluation of potential health impactsStrategies to manage identified adverse health impacts
Reporting Includes:Development of the HIA reportCommunication of findings & recommendations
Monitoring Tracks:Impacts on decision‐making processes and the decisionImpacts of the decision on health determinantsp
Screening Worksheet
Project and TimingHas a project, plan or policy been proposed?
Is there sufficient time to conduct an analysis before the final decision is made?
Health ImpactsHealth ImpactsDoes 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 theAre 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 CapacityHave public concerns about the health impacts of the decision been voiced or documented?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 theDo 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 decisionIs 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 buildingWhat 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 characteristics
Inequalities in health outcomes/impacts among subpopulations or places.
What is a significant health impact?
direction
magnitude
likelihoodlikelihood
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 investigations
When available, practitioners should utilize evidence from well‐designed andpeer‐reviewed systematic reviews
Previously published evidence, both supporting and refuting particular health impacts
The 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 monitoring
Ai li i iAir quality monitoring
OSHA complaints
Journals/web‐based reporting
SurveysSurveys
Documented complaints
Recommendations
The HIA should include specific recommendations to manage the health impacts identified, including:
Alternatives to the decision
Modifications to the proposed policy, program, or project
Mitigation measuresMitigation measures
Where needed, expert guidance should be utilized to ensure recommendations reflect current effective practices
Criteria
Developing 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 environment15 involved natural resources and the environment
6 agriculture and food policy
CAFO i i /i d i l i l 0 (Mi hi ?)CAFO permitting/industrial agriculture: 0 (Michigan?)
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
Resources
Health 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.org
Human 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‐resources
International 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. h // i i /http://www.iaia.org/
Questions?Questions?