If we’re not doing impact assessments to protect human health and well-being for current and future generations, why are we doing them at all? Really. If impact assessments are of any use, don’t they have to give us tools primarily to predict and mitigate impacts on human health and well-being?
That’s one of the fundamental questions that came up for me during the recent International Association of Impact Assessment’s (IAIA) annual conference in Calgary, Canada. It arose as I was thinking about what is being recognized as a divergence between three main impact assessment streams: environmental, social and health, along with calls for streamlining, integration, improvement and sharing of practice between the three “disciplines”. Those deeply engaged in the health discipline are questioning how health impact assessments (HIAs) and their intended outcomes to protect human health can be better integrated into the environmental impact assessment (EIA) or social impact assessment (SIA) fields that dominate the impact assessment realm, particularly when proponents are trying to permit large-scale extractive projects.
For me, the lack of attention to health within other impact assessments is not an integration issue but one of philosophical framing. Despite the depth and detail of these studies, we need to remember how and why they emerged to begin with.
For instance, we say we undertake EIAs to understand and mitigate environmental consequences of particular projects. This dates back to the 1960s, when concern about and appreciation of environmental health linkages started to trickle into mainstream society (Rachel Carson’s novel Silent Spring played an important role in this movement). The importance of environmental health was reinforced from devastating cases of Minamata disease and later from incidents like Chernobyl, both providing strong visual reminders of why we need to understand and mitigate environmental impacts.
In SIAs we review and recognize the importance of a project’s impacts on society and a community’s delicate social fabric. Community health topics such as impacts on health services are now starting to emerge within SIAs as they are recognized as an essential part of how a community functions. SIAs also consider impacts to education, income, and social support networks, which represent important social determinants of health.
So, although health is starting to emerge as a focus within EIAs and SIAs, I think it is time to raise a flag and ask a pointed question: Why aren’t IAs being framed to bring health front and centre?
Those engaged in doing EIA’s recognize impacts to human health from a toxicology perspective and capture impacts to the environmental determinants of health (although this is a challenging field, and especially when approaching the topic of cumulative effects). Those engaged in doing SIAs need to take impact assessments one step further and draw the line between social impacts – or, in other words, impacts to the determinants of health important to a given society/community – and human health consequences.
Impacts to the social determinants of health are less visual when compared with some environmental health consequences. For example, it’s hard to identify people who have stress-mediated disease, although most people recognize that developing a large natural-resource project can be challenging and stressful for community members. There is, however, a growing body of research that links the social determinants of health and health outcomes. Those of you interested in this topic should follow this link (http://www.mdpi.com/2075-163X/1/1/30) to a recent publication that describes the relationship in 29 resource-based communities between community-level exposure to changes in economic conditions and the incidence and prevalence of mental disorders and cardiovascular disease.
I think industry, communities and regulators agree that the impact assessment process is arduous and time consuming. Although the current drive to integration may offer a way to simplify things, we need to remind ourselves why we undertake these studies to begin with: don’t impact assessments serve to protect human health and well-being for current and future generations? If this is the case, perhaps EIAs and SIAs should be reframed under a Health Impact Assessment umbrella. Rather than HIA practitioners working hard to ‘integrate’ with other IA disciplines, EIA and SIA practitioners need to engage with health experts to make sure they’ve ‘got it right’.
To hear Janis discuss this topic in more detail on CBC’s Daybreak North Radio Show (September 6, 2013) click here.