HIA Guidelines - Enhealth Australia - 2001

8/14/2019 HIA Guidelines - Enhealth Australia - 2001

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Health Impact

Assessment Guidelines

September 2001


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Health Impact Assessment

Guidelines

September 2001


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ii Health Impact Assessment Guidelines

Commonwealth of Australia 2001

ISBN 0642503656

This work is copyright. Apart from an y use as permitt ed under the Copyright Act 1968, n o part m ay be repro-

duced by an y process without prior written per mission from th e Common wealth available from Informat ion

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Copyright Services, Information Services, GPO Box 1920, Canberra ACT 2601 or by e-mail

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Telephone: 1800 020 103

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Note t he documen t may be accessed electronically from: h ttp://enh ealth.nphp.gov.au/council/pubs/ecpub.htm

The en Health Council, a subcommittee of the National Public Health Partn ership, brings together top Environ-

mental Health officials at the Federal and State/Territory level along with representation from the Australian

Institute of Environmen tal Health, the en vironm ent an d public health sectors, th e Indigenous comm unity and

the wider com mun ity. The Council has responsibility for pr oviding national leadership, implemen tation of the

National Environm ental Health Str ategy, forging partner ships with key players, and the development and

coordination of advice on en vironm ental health matt ers at a nat ional level. The advice development process is

strongly based on collaboration an d consultation.

Disclaimer

This document has been prepared in good faith, exercising due care an d atten tion. However, no representat ion

or warrant y, expressed or im plied, is made as to th e relevance, accuracy, completeness or fitness for purpose of

this documen t in respect of any particular u sers circumstan ces. Users of this document should satisfy them -

selves concerning its application to, and where necessary, seek expert advice about, their situation. Th e

Departm ent of Health an d Aged Care and the enHealth Council shall not be liable to th e purch aser or any

person or entity with respect to any liability, loss or damage caused or alleged to have been caused directly or

indirectly by this pu blication.


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Health Impact Assessment Guidelines iii

Contents

Glossary v

Acknowledgements v

Abbreviations v

Preface vii

Executive summary 1

1 Introduction 3

1.1 What is health impact assessment? 3

1.2 Aim of the Guidelines 3

1.3 Scope of health impact assessment 3

1.4 Why undertake health impact assessment? 4

1.5 What is meant by health and what are its determinants? 5

2 Principles 9

3 The HIA process and roles of those involved 11

3.1 The health impact assessment process 11

3.1.1 Community consultation and communication 13

3.1.2 Project Description 13

3.1.3 Screening 13

3.1.4 Scoping 14

3.1.5 Profiling 15

3.1.6 Assessing the health impacts (risk assessment) 15

3.1.6.1 Risk assessment using health-based guidelines and objectives 15

3.1.6.2 Quantitative risk assessment 16

3.1.6.3 Other methods of risk assessment 18

3.1.7 Managing the health impacts identified as being of significant risk 19

3.1.8 Decision making 19

3.1.9 Monitoring and evaluation 193.2 The Precautionary Approach 20


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iv Health Impact Assessment Guidelines

3.3 Roles and responsibilities 21

3.3.1 Responsibilities of the proponent 21

3.3.2 Responsibilities of the public health authority 21

3.3.3 Responsibilities of the decision-making agency (environment or planning) 21

4 Preparing a Health Impact Statement 23

4.1 Content of a Health Impact Statement 23

4.1.1 Details of the proponent and the development 23

4.1.2 Details of the affected or interested communities 23

4.1.3 Environmental health data 24

4.1.4 Social impacts 26

4.1.5 Economic impacts 26

4.1.6 Actual assessment of the health impact 26

5 Conclusion 29

Appendices

Appendix 1 The Australian Experience with Health Impact Assessment HIA in Tasmania 31

Appendix 2 The Australian Charter for Environmental Health 35

Appendix 3 The HIA Screening Tool developed by the UK Department of Health 39

Appendix 4 Community Consultation and Risk Communication 41

Appendix 5 Bibliography of Sources of Key Impact Assessment Information 43

Appendix 6 Health monitoring 47

Appendix 7 enHealth Council Membership and Terms of Reference 53

Appendix 8 enHealth Council Publications 55

References 57


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Health Impact Assessment Guidelines v

AcknowledgementsThe work of the Departm ent of Health and Human

Services, Tasman ia in developing the first draft of

th ese guidelines is gratefully ackn owledged.

All those who part icipated in pu blic con sultation on

the first draft of the Guidelines, either by written

submission or th rough attendan ce at one of the

national workshops, are sincerely than ked for th eir

efforts. These Guidelines draw heavily on the initial

draft Guidelines and the feedback received during

th e consultation . Brian Wall was respon sible for

conduct of the consultation workshops and much ofthe drafting during the latter stage, his assistance is

gratefully ackn owledged.

AbbreviationsABS Aust ra lian Bureau of Stat ist ic s

DOH Depar tm en t of Healt h (UK)

E&HIA Environmental and Health Impact Assess-

ment

EIA En vir on men tal Im pact Assessm en t

EMPCA Environmental Management and Pollution

Control Act (Tasmanian)

HIA Health Im pact Assessm en t

HIS Health Impact Statement

NHMRC National Health & Medical Research

Council

PAH Polyar om at ic h ydr ocar bon

PCB Polych lor in ated biph en yl

PHA Pu blic Healt h Au th or it y

WHO World Health Organiza tion

Glossary RiskThe probability that , in a certain timeframe, an

adverse outcome will occur in a person, group of

people, plants, animals and/or the ecology of a

specified area th at is exposed to a par ticular doseor concen tration of a hazardous agent, i.e. it

depends on both the level of toxicity of the agent

and the level of exposure.

Risk assessment

The pr ocess of estimating the poten tial impact of a

chemical, physical, microbiological or psychosocial

hazard on a specified hum an population or ecologi-

cal system under a specific set of conditions and

for a cert ain timeframe.

Risk communication

An interactive process involving the exchange

among individuals, groups and institutions of

information and expert opinion about the nature,

severity, and acceptability of risks and the deci-

sions taken to combat th em.

Risk management

The process of evaluating alternative actions,

selecting options an d implement ing them in

response to h ealth risk assessments. The decision

making will incorporate scientific, technological,

social, economic and political information. Theprocess requires value judgement s, eg. on the

tolerability and reasonableness of costs.

Environmental health

A subset of public health which focuses on environ-

ment al conditions and h azards which affect, or

have the poten tial to affect, hum an h ealth, either

directly or indirectly. It includes the protection of

good health, t he promotion of aesthet ic, social and

economic values and am enity, and the pr evention

of illness and injury by promoting positive environ-

ment al factors and r educing potential hazards

physical, biological, chemical an d r adiological.

Hazard

The capacity of an agent t o produce a par ticular

type of adverse h ealth or environmen tal effect.

Health Impact Assessment

The pr ocess of estimating the poten tial impact of a

chem ical, biological, physical or social agent on a

specified human population system un der a

specific set of conditions and for a certain

timeframe.

Health Impact Statement

The r eport which pr esents th e findings of a Health

Impact Assessment .


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vi Health Impact Assessment Guidelines


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Health Impact Assessment Guidelines vii

Preface

The critical link between hum an health an d our

surroundings is highlighted in the National Environ-

men tal Health Strategy (1999)1. In par ticular, it calls

for greater atten tion to th e impacts of developments ...health con siderations should form part of any

impact assessment for developmen ts or decisions

that could have health consequen ces.

There is overwhelming evidence th at development

can have a beneficial effect on health and wellbeing;

thr ough th e creation of employment, promotion of

economic advancement an d providing circumstan ces

which can improve living standards. Development

can also have adverse effects, h owever, thr ough

problems such as noise, water an d air pollution, an d

increased r isks of injury an d disease tran smission.

Developmen t m ay also impact on th e social andemotional status of individuals and com mun ities

thr ough, for exam ple, alienation and dis-empower-

ment. Some community mem bers may be particu-

larly susceptible to both t he ph ysical and social

impacts, such as ch ildren and t he elderly.

Health Impact Assessment (HIA) is a process that

systematically identifies an d examin es, in a balanced

way, both the potential positive an d n egative health

impacts of an activity.

These Guidelines specifically address the u se of HIA

when condu cting Environmen tal Impact Assessmen t,further developing the National Health and Medical

Research CouncilNational Fram ew ork for Env iron-

m ental and Health Im pact Assessm ent(1994)6 in

the light of experience in implementing HIA in

Australia and overseas. In t his planning context th e

outcomes of HIA provide th e ideal star ting point for

efforts t o maximise positive h ealth impacts and

prevent or m inimise negative impact s. Rectifying

problems during planning is usually th e preferred

approach; rath er than having to deal with them once

a development is under constru ction or in place.

By ensuring that immediate and future h uman healthcan be prot ected, th e possibility of sustainable

development is strengthened by HIA.

In addition t o hea lth p rofessionals, HIA involves a

num ber of other sectors, including planning, envi-

ronm ent, social science, economics and th e wider

commu nity. These Guidelines are int ended t o assistthese sectors to better un derstand th e rationale for

HIA and the processes involved. In particular, the

Guidelines provide insight into t he health benefits

that can be derived from bett er health-based deci-

sion making.

For proponen ts th e Guidelines will assist un der-

standing of what needs to be done an d promote a

more balanced approach by ensur ing positive

impacts are given appr opriate consideration. For the

wider comm unity HIA can h elp to ensure our

surroun dings are best able to enh ance h ealth for all

into the future.

Maximising the economic an d oth er ben efits of

development while m anaging the adverse impacts is

an imp ortant but often difficult balance to strike.

These Guidelines are in tended t o assist with the

achievement of that balance.


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Executiv e summary

These Guidelines aim to promote and enhance the

incorporation of Health Impact Assessment (HIA)

into environmen tal and planning impact assessment

generally, th ereby impr oving the consideration ofhealth issues.

In part icular they seek t o provide those involved in

impact assessment across all levels of government

and developers, along with their advisers, with an

introduct ion to HIA and general guidance on the key

steps in volved.

The int ent of the Guidelines is to achieve this

without the addition of anoth er layer of

bureaucr acy to th e impact assessmen t pr ocesses

already in operation acr oss Australia, through th e

integration of HIA with the processes already inplace.

The curr ent consideration given to human health in

Environmental Impact Assessment (EIA) is often

unstr uctur ed and confined to negative impacts. An

EIA may n ot properly recognise th e positive effect onhealth th at development can h ave, for example

financial status.

Health is deter mined by m any factors including

genes, age, a per sons social and econom ic

circumstances, lifestyle and access to services, as

well as environm ental health factors such as air and

water quality, housing, etc. HIA seeks to ensure both

the positive and negative impacts on h ealth (as

viewed from a wider perspective than just physical

illness or injury) are effectively considered during

impact assessment.

The HIA process shares the general framework

common ly used for impact assessmen t, as shown in

the diagram below:

Community Consultation

Screening

Health Impact

Statement

ProfilingWho is affected

What is their current

health status

Report andRecommendations

(if any)

ScopingIdentify issues to beaddressedLevel of appraisal -how comprehensive?

Informed

opinion

Evidence

available

Further investig-ation required

Health impactswell understood &

control measuresroutinely applied

Healthimpactsnegligible

Risk AssessmentWhat are the hazards

What is their likelihood

of harm occurring

Who might be exposed

Risk managementPrevention or minimisationof risk of harmManaging any consequencesSpecific risk communication

Monitoring and Evaluation(Processes and outcomes)

Decision making &on-going management

Project

Description


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2 Health Impact Assessment Guide lines

The pr oponents role is to prepare a Health ImpactStatemen t (generally as part of a broader impact

assessment ) th at addr esses the issues identified

during scoping, and which in cludes assessment of

the likely risks and benefits to h ealth from th e

development, as well as management of the risks.

The h ealth auth ority should provide its view on the

health r isks requiring atten tion (at t he scoping stage)

and en sure t hat the level of amelioration

recomm ended is in proportion t o the level of risk to

health. The h ealth auth ority may also advise on data

requiremen ts and data availability and p rovide input

into assessmen t of the Health Impact Statem ent.

The decision-making agency (En vironm ent or

Planning) should ensure that human health is

included in the issues to be addressed in th e

statemen t of requiremen ts issued to proponen ts, it

should refer assessments to t he h ealth auth ority for

consideration and forward mon itoring and evaluation

data provided by the proponen t or th eir agent.

A HIA will require much of the same data as needed

for a general impact assessment, but there will often

be additional data requirem ents. These include:

demographic and health status data for local and

other affected p opulations (eg. adjacent to

tran sport rout es), and details of any special

populations, eg. children, the elderly;

environmental health data potential impacts onair quality, soil, water and waste-water will be of

particular relevance in health assessment; as are

any potential impacts on the quality, availability

or price of food or impacts on food producing

land;

additional demands on community infrastructure

such as sewerage, water supplies, waste

management services, schools, health and social

services;

transport issues, including the risk of injury,

pollution and amen ity. Both the positive andnegative aspects of tran sport ch anges may need t o

be considered; and,

social and economic impacts, where these may

have an effect on health.

Assembly of these data int o th e Health Impact

Statemen t is usually the responsibility of the

proponen t, but advice can be sought from th e health

auth ority. The health au thority also has the role of

providing the decision-making agency with advice

and recommendations on the proposal.

These Guidelines and the r elated advice from thehealth auth ority should ensure a smooth , effective

process that will more t horoughly address the

potential hum an h ealth impacts of a development .


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Health Impact Assessment Guidelines 3

1 Introduction

within the legislative framework that already

exists in each jurisdiction; and,

assist agencies, communities and individuals who

are involved in t he pr eparation of impact

assessmen ts with guidance on each of the key

steps of a HIA.

The Guidelines seek to strengthen an d improve the

consideration of health issues within the con text of

the impact assessment pr ocesses curren tly in

operation across Australia. They do not call for an

additional evaluation process, nor to widen t he scope

of the development assessmen t laws in an y

jurisdiction.

HIA can be applied to the assessment of impacts in

the wider field of policies and programs, but that is

not the focus of these Guidelines.

These Guidelines do not address issues of

occupational health and safety, as separate agencies

are specifically charged with this responsibility in

most jurisdictions. There are occasions where pu blic

and occupat ional health issues overlap to such an

extent t hat t hey are inseparable, eg.Legionella

control. In that case the Health Impact Statemen t

will need to address the issue.

1.3 Scope of health impactassessment

The UK Departm ent of Health guidelines3 refer to

HIAs as being broad or tight depending upon the

scope of the act ivity under scru tiny and th e

approaches used to assess the h ealth impacts. Table

1 describes the differences bet ween these

approaches. Notwithstanding th e differences ther e is

a comm on pur pose to optimise health impact s of a

particular policy, program or project (m inimise the

negative an d m aximise the positive).

1.1 W hat is health impactassessment?

Health Imp act Assessment (HIA) is defined bydifferent agencies in different ways, but there is a

general consensus ar ound a broad definition,

published in 1999 as th e Gothenbu rg Consensus

Paper by the WHO Regional Office for Europe2. That

definition is:

a combin ation of procedur es or m ethods by w hich

a policy, program or project m ay be judged as to the

effects it m ay hav e on the health of a popu lation.

HIA may t hus include a ssessment of high level policy

and programs as well as individual developments,

and en compass the vast arr ay of assessmen ttechn iques used for each.

In its broadest form, HIA seeks to predict t he h ealth

impact of a policy, program or project (including a

development ) usually before implemen tation, an d

ideally early in the planning stage. It aims to

facilitate the reduction or avoidance of negative

impacts on hum an health and enhancemen t of the

positive impacts, and in so doing promoting

sustainable developmen t (SD) hum an h ealth being

centr al to the con cept of SD.

Intern ationally, HIA has become a key compon ent of

informed decision m aking and is being under taken

by governments world wide in a variety of

circumstances and situations3,4,7.

1.2 Aim of the Guidelines

The Guidelines are intended to provide an

introduct ion to HIA and general guidance on the

assessmen t of proposed developments.

More specifically the Guidelines aim to:

improve consideration of the health impacts

associated with development by prom oting andfacilitating the incorporat ion of HIA into

environment al and plann ing impact assessment ,


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Guidelines developed by the National Health and

Medical Research Council (NHMRC)6, New Zealand7

and (to a lesser extent) Canada 4 focus on health

impact assessment of individual projects or

development s, not at t he policy or p rogram level.

Neverth eless, this set of Guidelines, as well as those

mentioned above, take a broad view of what

constitutes health. In that r espect they cann ot be

regarded as tight in th eir focus.

1.4 W hy undertake healthimpact assessment?

HIA is undertaken to en sure explicit an d balanced

consideration of the h uman health impacts of

policies, programs an d (in r elation t o these

Guidelines) development s.

The importan ce of hum an health being more

explicitly considered in relation to pr omoting

sustainable development has already been discussed.

The costs of failure t o protect an d promote health

fall on governm ents, t he commu nity generally and

individual member s of the pu blic. These costs ar eunlikely to be borne by a proponen t. Ensuring that

such costs are n ot incurr ed by non -beneficiaries is

both equ itable and good economics.

Environm ental Impact Assessment (EIA) h as been

practised in Australia and elsewhere since th e early

1970s. While aspects of the ph ysical and n atural

environment are cent ral to EIA, the con sideration

given t o hum an h ealth has been generally

unstructured and confined only to the most direct,

negative impacts.

The need for HIA to be conducted explicitly in anyenvironment al or econom ic decision-making process

was strongly endor sed by t he NHMRC in 1992 .

Table 1

Characteristics of broad and tight perspective Health Impact Assessment

In 1996, Tasmania became the first state to legislate

for HIA to be a formal requirement of the EIA

process. Appendix 1 sets out some of the Tasmanian

experiences in the con duct of health impact

assessment.

Traditional EIA often does not ident ify th e positive

effect on h ealth th at developmen t may h ave. For

example, as identified in Table 2, one of the key

determ inants of health is finan cial status. Ther e is

ample evidence that poorer com mun ities experience

poorer health an d that impr oving economiccircumstan ces can impr ove health status. HIA should

explicitly identify the positive effects on health that

development may h ave through, say, job creation, as

well as any negative effects.

Furth ermore, traditional EIA has n ot always

man aged ident ification and reporting of likely hu man

health effects in an optimu m m ann er. For instance:

the reporting of health effects may be

unstructured, as most impact assessment

guidelines may not call for an explicit section on

human health (even though relevant data mayappear th roughout th e document);

the consideration of health issues may be too

narrow. As outlined in section 1.5, health is

influenced by m any factors and t he lack of a

specific requirement to consider and report on

human health impacts has sometimes seen

significant health issues overlooked; and/or

regional environmental health considerations are

often n ot charact erised in a way that en ables

assessment of the incremen tal contribution a

development or activity may h ave upon them (eg.the contribut ion of pollutan ts to a regional

airshed or to dietary int ake via th e food chain).

BROAD PERSPECTIVE T IGH T PERSPECTIVE

View of health Holistic Emphasis on defined and observable aspects

Disciplinary roots Sociology Epidemiology; toxicology

Ethos Democratic Technocratic

Quantification In general terms Towards measurement

Types of evidence Key informants; popular concern Measurement

Precision Low High

Source: UK DOH 2000. (3) Inset 6A


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A sharper focus on h ealth need not involve a greatdeal more work by the proponen t or other s, and can

prevent significant adverse health outcomes. It m ay

also prevent the need for costly late ch anges to a

development, or avoid adverse publicity for

developers, managers and ot hers, at some later stage.

HIA is occurr ing at presen t form ally in on e

jurisdiction but also informally or on a discretionary

basis in ot hers. It is not a whole new layer of

bureaucr atic activity that needs to be added on to

what is curren tly occurring. Incorporation of these

Guidelines should ensure bet ter con sideration of

health issues, so that important health concerns areaddressed explicitly and compreh ensively early on,

preventing later adverse health events with atten dant

cost to individuals, industr y and th e comm unity, and

at th e same time m aximising any health benefits.

The Guidelines rely on, and assum e, intersectoral

collaboration between health, plannin g and

environmental agencies at all levels of Government

Commonwealth, State, Territory and Local.

1.5 W hat is meant by health andwhat are its determinants?

It is useful when examin ing the scope of HIA in

general, and of these Guidelines in particular, to

consider what health is and what are its

determinants.

The WHO definition of hea lth is:

a stat e of comp lete phys ical, men tal and social

w ell-being and not m erely the absence of disease or

infirm ity.

This definition is very broad. While it helps toident ify what might be included as health it is less

helpful in setting boundaries aroun d what shou ld be

considered and what m ay be ignored. A more

specific approach is to examine th e key

determ inants of health and con sider which are

susceptible to ch ange and by what mean s (Table 2).

As outlined above, the approach described in th ese

Guidelines is sometimes referred t o as

environmental health impact assessmen t as it

focusses mainly on the environmen t (nat ural and

built) in attem pting to improve and maintain health .

Nevertheless, HIA may also need to address other

issues, such as lifestyle, an import ant determ inant of

health, which may be readily impacted u pon by

development al ch ange.

Overall, it is import ant t o note th at health is

influenced by a very broad range of factors.

Table 2

Examples of key factors that determine health

Fixed Social andeconomic

Lifestyle &Behaviours

Access toservices

Environment

Genes

Sex

Ageing

Poverty

Employment

Socialexclusion

Communitystructure andinfrastructure

Diet

Physical activity

Smoking

Alcohol

Sexualbehaviour

Drugs

Coping skills

Education

Health services

Social services

Transport

Leisure

Air quality

Noise

Housing

Water quality

Social environment

Risk of injury

Sun exposure

Disease vectors eg.mosquitoes

Source: Adapted from UK DOH (3) In set 1A


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W hat constitutes a health impact?Anyth ing which alters a deter minan t of health, such

as those listed in Table 2, may, as a consequence,

have an impact on health.

A list of some possible health impacts, which mayassist in ident ifying likely positive or n egative

impact s, is provided in Box 1, below. Sensitivity of

individuals is likely to be a ffected by age, sex,

nut ritional and pregnan cy status, or a combination

of these factors3.

Box 1

Examples of potential health impacts that may need to be consideredduring HIA

General environmental aspects that may impact on health:

Increased demand and/or improvements to public infrastructure (water supply, sewerage, waste management,health, education, other government services).

Altered risk from acute hazards, eg. fires, spills during transport or handling of materials.

Altered motor vehicle traffic leading to changed risk of injury or air pollution.

Damage to vulnerable ecosystems that are of importance to human health.

Impact on health or amenity through changes to odour, noise, dust, insects, shade, vibration, light spill, etc(including what are historically referred to as environmental health nuisances).

Encourage/discourage healthy forms of physical activity eg. walking or cycling.

Potential impacts on ph ysical health: Communicable/infectious diseases (eg. spread of STDs, mosquito-borne disease).

Non-communicable diseases cardiovascular disease, cancer, asthma, etc.

Exacerbation of existing conditions.

Injury, eg. from trauma.

Social impacts which have a health effect:

Employment opportunities created/lost.

Effect on local government revenues.

Spin-off effects on local industr y.

Changes in social condit ions (way of life) or demographic changes leading to health consequences eg. the

likelihood of changes to alcohol consumption in an area. Mental and emotional wellbeing of a community (eg. is the development likely to cause or allay stress, anxiety,

nuisance, discomfort).

Altered (improved or decreased) opportunity for recreation or socialisation.

Increased or decreased isolation of individuals.

Shifts of population into or out of the affected area and the health impacts of such shifts.

Special populations th at m ay need to be considered include:

the elderly;

the disabled;

persons of low socio-economic status;

children born and unborn;

Persons with a non-English speaking background;

Indigenous Australians;

Specific examination of the demography of the area under consideration may reveal other groups to be considered.


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In th e past, potential health impact s wouldfrequen tly and perh aps automatically be thought of

as negative. A more balanced approach is needed it

is important that the likely positive health aspects of

development s be properly recognised and capt ured

through the HIA process. Positive impacts can arise

from incr eased employmen t, greater r ecreational

opportun ities, new products and services that reduce

disease, or a decreased health risk by, for example,

improved road design.

During scoping the pr oponent can decide which

likely impacts will be considered, u sually after

discussion with t he r elevant h ealth auth ority.

Health impacts that may continue to

be inadequately addressed

There ar e development s which h ave impacts on

public health while having no environmen tal impact,

such as locating a large liquor outlet in a commu nity

that may already have many of them and/or signs of

existing problems from excessive alcohol access/

consumpt ion. The focus of this document , however,

is on health impact in t he cont ext of traditional

environmental impact assessment.

i Tasman ian legislation includes the power to require health im pact assessm ent be condu cted on developmen t proposals that are not

subject to the norm al imp act assessment processes.

Separate ident ification steps are required fordevelopment s with a public health impact th at are

not en vironm entally-oriented i.

Global health impacts are rarely if ever able to be

addressed effectively by a process that considers

impacts on a development-by-development basis.

This is not to say that HIA does not have a place in

assessing global health impacts it can, when

applied at the strategic an d governm ent policy level

(this is outside the scope of these Guidelines). The

UK Departm ent of Health (DOH) Guide lines3 are an

example of guidelines th at ar e focussed m ore at this

level.

HIA of individual developments often fails to iden tify

impacts th at arise from nu merous sm all activities,

each of which are, in themselves, too small to

warrant assessmen t. For example, the installation of

wood-burnin g room h eater s may, collectively, give

rise to a h igh level of air pollution when installed in

large n umber s, particularly in non -windy areas. Each

heater alone clearly falls outside the limits of what

might be considered under HIA. Non-point source

pollution from farming activity is another example.


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2 Princip les

The WHO, in its report on Health an d S afety

Com ponent of Env ironm ental Imp act Assessm ent8,

established four basic principles to help fulfil the

potent ial for en vironm ental impact assessmen t (EIA)to protect human health. They are:

One of the fundamental considerations in the

approval of projects, policies and plans should be

the h ealth of comm unities affected by th em;

Greater consideration should be given to the

consequences of development policies and

programs for hum an health;

Environmental impact assessment should provide

the best available factual information on the

consequences for h ealth of projects, policies and

plans; and

Information on health impact should be available

to the pu blic.

These principles have been developed into the

guiding prin ciples listed in Box 2 they expand on

and clarify the application of the WHO Principles.

Atten tion is also drawn t o th e Charter of

Entitlem ents and Respons ibilities for Ind ivid ua ls,

Communities, Business and Government(the

Charter ) which, as part of the National

Env ironm ental Health Strategy 19991

, has beenendorsed by the Australian Health Ministers

Conference on beh alf of the Governm ents of

Australia. The Ch arter sets boun daries for activities,

in order to ensure the en titlements and

respon sibilities of each sector ar e fulfilled an d

maintained. A copy of the Charter is given in

Appendix 2.


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10 Health Impact Assessment Guidelines

Box 2

Principles to be addressed when undertaking Health Impact Assessment

Overall

The Charter of (Environmental Health) Entitlements and Responsibilit ies for Individuals, Communities, Businessand Government will be observed throughout the HIA process (NEHS 19991).

The Community

Community consultation is a critical and integral part of the HIA process. People and communities are part of theenvironment and rely on the qualit y of the environment for their survival and maintenance of good health andwellbeing.

The public has a right to know the actual or potential effects of a proposed activity on their health and theirenvironment, and should be consulted on the management of risks.

The community is also a rich source of local information that can only be tapped through its involvement.

The protection and, where possible, the improvement of public health should be fundamental to HIA.

Scope, relevance and timeliness of the Health Impact Assessmen t

The scope and detail of the HIA should be in propor tion to the scale of the potential health impacts of a pro-posed development. Scoping should identify only those impacts which have significant potential to occur. The levelof risk assessment should be in accord with the nature, scale and significance of the actual or potential effects ofthe proposed activity. Where there is insufficient information or uncertainty about the risks to health, this shouldbe clearly stated.

Both positive and negative health impacts should be considered. Human health should be safeguarded ie. likely health problems should be remedied before they can occur (once

they have been identified as a possible concern). The addit ional financial cost is likely to be less for both industryand governments if action is taken at the design stage.

Integration of Health Impact Assessmen t an d Environmen tal Impact Assessmen t

HIA should be explicit ly integrated into the assessment of effects on the environment (ie. into EIA) to ensure thatany actual or potential impacts or risks to public health are adequately addressed in the development approvalprocess.

Monitor ing and r eview

Where appropriate, monitoring should be carried out to assess whether modification to the proposal has actuallybeen implemented, evaluate the HIA process, and assess the outcomes, ie. whether anticipated or unanticipatedhealth impacts have occurred.

Environmental and health controls, as conditions in approvals, should be reviewed regularly.


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3 The HIA process and roles ofthose inv olv ed

3.1 The health impact assessment process

The HIA process described in th ese Guidelines is based on th at outlined in the National Fram ew ork for

Env ironm ental and Health Im pact Assessment6

. The general process is outlined in Box 3.This process is shown in flow chart format in Figure 1.

Box 3

Summary of a proposed framework for HIA (adapted from NHMRC 6

p.xxii)

Step 1 Screening

Should the project be subject to Health Impact Assessment?

Step 2 Scoping

What issues must be addressed in the Health Impact Assessment?

Step 3 Profiling

What is the current status of the affected population and the local environment?

Step 4 Risk assessment

What are the risks and benefits?

Who will be affected?

Step 5 Risk management

Can risk be avoided or minimised?

Are better alternatives available?

How can benefits and risks be evaluated and compared? How can differing perceptions of cost and benefit, nature and magnitude be mediated?

Will predictions of future health risk be robust enough to withstand legal and public scrutiny?

Step 6 Implementat ion and decision-making

Does the assessment provide sufficient, valid and reliable information for decision-making?

Is there a conflict to be resolved?

How will conditions be enforced?

How and by whom will impacts be monitored?

How will post-project management be resourced?

Step 7 Monitoring, environm ental an d h ealth au diting, post-project evaluation

Is the project complying with its conditions? How well is the E&HIA process as a whole achieving its aims of protecting the environment and health?


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Community Consultation

Screening

Health Impact

Statement

ProfilingWho is affected

What is their current

health status

Report andRecommendations

(if any)

ScopingIdentify issues to beaddressedLevel of appraisal -how comprehensive?

Informed

opinion

Evidence

available

Further investig-ation required

Health impacts

well understood &control measures

routinely applied

Healthimpactsnegligible

Risk AssessmentWhat are the hazards

What is their likelihood

of harm occurring

Who might be exposed

Risk managementPrevention or minimisationof risk of harm

Managing any consequencesSpecific risk communication

Monitoring and Evaluation(Processes and outcomes)Decision making &on-going management

Project

Description

Figure 1

Flow chart of the health impact assessment process

(Adapted from UK DOH (3), Insets 2A an d 2C)


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3.1.1 Community consultation andcommunication

The NHMRC framework6 does not include a specific

consultation step, in th e expectation that

consultation will occur th roughout the con duct of

the HIA, as appropriate. Ideally consultation would

occur at every stage, at least for large projects.

What is appropriate depend s on the size and type of

project, as well as the legislative requirements for

consultation. These vary bet ween jurisdictions. This

documen t does not set out a particular consultation

process, but assum es th at jurisdictions will requireconsultation steps in accordance with their r elevant

legislation an d as appr opriate for t he project. Some

proponents may wish to do more than the required

minimum.

In general, one would expect pu blic input to th e

scoping and subsequen t steps, as shown in the above

diagram. In particular, ther e must be an opportu nity

for stakeholders to comm ent on a pr oposal before a

decision is m ade.

3.1.2 Project description

One additional preliminary step to th ose proposed inth e earlier NHMRC fram ework6 is highlight ed the

need for a compreh ensive Project Description at th e

beginning of the HIA, so that the reader is clear what

the int ention of the project is and what, in general

term s, the impacts might be.

If the HIA is part of a wider impact assessment

process such an outline may already be specified, in

which case no additional explanation m ay be

necessary. Otherwise the Project Description will

usually include:

the rationale, objectives and goals of the project;

a description of the project including the

processes, mater ials and types of equipment t o be

used and the building layout;

sufficient detail of the planning, designing,

construction, operating, maintenance and

decommissioning phases;

types and quantities of inputs (energy, water and

chem icals used in the industr ial process) and

outputs (product s and waste mater ials) and a

brief discussion of their treatm ent and disposal;

expected infrastructure, local facilities and

services (eg., electricity, water, sewerage, roads);

advantages and drawbacks associated with theproject;

perceived impacts on health, positive or negative;

an d

emergency procedures and response plans for

incidents that have the potential to impact on the

surroun ding population.

3.1.3 Screening

Screening is the process of determining wheth er or

not a proposed development warrants impact

assessmen t. It is common ly governed by statut e.

Screening for h ealth issues is carried out as an

integral part of the overall screening process. It is

usually, if not invariably, undertaken by the agency

responsible for det ermining whether a development

needs to be assessed, and if so, to what extent .

All proposed development s that are requ ired to

undergo EIA should be screened for possible health

impacts, as well as for other impacts. While this may

not en sure every project likely to impact on h ealth is

detected, it will identify most, if not all, of th ose

likely to have h ealth impacts that are significant.

If health authorities wish to apply HIA more broadly

they would need to make oth er arran gement s outside

this framework to ident ify th e projects or issues of

significance.

Screen ing is, firstly, a process of filtering out t hose

projects that do not r equire HIA because:

the health effects are expectewd to be negligible;

or

the health effects are well known and readily

contr ollable th ough m easures th at are well

under stood and routinely applied, and so require

no spec ific investigation or an alysis.

Ident ifying these early in th e HIA process a llows

scarce resources t o be applied to assessmen t of those

projects with the most significant likely health

impacts.

In considering health issues, th e UK Departm ent of

Health3 has developed a screening tool to provide

objectivity, tran sparency an d consistency in its

processes. This tool may be of use to h ealth and n on-

health authorities when considering human health

issues, and deta ils of it are given in Appen dix 3 for

ease of reference.


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3.1.4 ScopingScoping is the process of identifying the particular

issues th at should be add ressed in prepar ing a Health

Impact Statement.

Scoping is the link between identifying the need for

HIA, for one or more reasons, (ie. screening) and the

actual assessment of the r isks and th e consequent

development of man agemen t, mon itoring and

evaluation strategies. Scoping therefore needs to set

the framework for th e Profiling, Risk Assessmen t,

Risk Management , Decision Making an d Monitor ing

and Evaluation steps shown in Figure 1 above. It is akey step, if not t he most import ant step, in th e HIA

process.

Scoping includes:

1. Identifying the potential health impacts that need

to be addressed by:

identifying all the potential health impacts;

an d

assessing which impacts are likely to be

important and thus need to be addressed in

the HIA and which are n ot importan t.

2. Setting boundaries eg:

t im escale;

geographical boundaries; and

population covered, including demarcation of

any populations of special concern because of

risk factors such as age, pregnancy, etc.

3. Identifying stakeholders that need to be involved,

particularly those that will not already be

involved in t he r outine impact assessmen t

process.

4. Agreeing on details of the r isk assessment

between th e proponent, the h ealth authority and

other stakeholders.

Responsibility for these steps typically rests with the

proponent but t he h ealth auth ority will generally

work with t he pr oponent to identify the level of

detail and effort r equired. This must be in pr oportion

to th e likely level of hea lth r isk, based on ob jective

criteria.

Where t he project is such that an actu al risk appears

to be low but th e comm unitys perception of the riskis high, th e risk man agemen t str ategy should address

this aspect.

Within th e limits of th e local legislativerequirements, proponents may choose the precise

details of the scoping process they believe to be the

most appr opriate. There ar e, however, some steps

that are strongly recommended.

Where ther e is a high level of commu nity inter est,

proponen ts should involve the com mun ity early, in

particular at the scoping stage. Also, an early

meeting with th e health aut hority may avoid

unn ecessary work, identify relevant data sources,

and apprise th e proponent of the h ealth auth oritys

view of th e significant and less significant likely

impacts on health.

A suitab le process usually involves:

an early meeting between the proponent and the

health aut hority to discuss issues that m ay be of

concern to the h ealth auth ority;

the health authority providing advice on issues

(including parts of these Guidelines and other

reference material) that the proponent should

consider addressing and the level of detail

required;

discussion between the health authority and theproponent on models and methods that can be

used to address th e identified issues, assumptions

that will need to be made, the contributions th at

the h ealth authority can make, and where expert

opinion may be required;

the opportunity or necessity for periodic

consultation with the health authority;

identifying sources of health and demographic

data (which may be provided by the health

auth ority, on a cost r ecovery basis if necessary).

identifying significant health stakeholders who

should be consulted in addition to th ose routinely

involved in t he impact assessment process;

discussion on the need for monitoring that may

be required on h ealth grounds dur ing any phase

of the development , or after com pletion; and

identifying relevant standards that will provide

some bench marks for planning, consultation and

HIA.

Public and stakeh older consultation m ay form par t of

the scoping exercise but will also take place duringor following the p repa rat ion of the pr oponen ts final


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proposal, depending upon the precise arran gemen tsfor impact assessment in each jur isdiction.

Figure 1 shows consultation as an all-encompassing

background to indicate th at it should occur formally

at some key points (t his may vary between

jurisdictions and bet ween projects), rather th an as a

strict requirement at every step.

Informal consultation with int erested parties and t he

wider public, throu ghout the process, may also be

beneficial. Thus consultation is a wide-ranging

process that should occur continuously throughout a

project, not just at those points formally required bylegislation.

Scoping should identify any special stakeholders that

need t o be consulted outside of those included in th e

usual impact assessment process.

Scoping may also identify health concerns for which

public input should be especially sought, t o more

clearly establish the comm unitys values and

attitudes.

Approaches to comm unity consultation are out lined

in Appendix 4, and the bibliography (Appendix 5)

provides links to relevant mater ial.

3.1.5 Profiling

Profiling describes key aspects of the health status

and general m ake-up of the population, part icularly

in relation to factors that ar e believed to be

susceptible to chan ge or th at m ay act as indicators of

anticipated health impact( s). It enables the

identification of, and ch aracterisation of, the

potent ial health effects on th e comm unity, by

providing a baseline against which possible health

impacts can be assessed.

Informat ion that may be collected includes:

Characteristics of the population covered, for

example:

size;

den sity;

d ist ribut ion ;

age an d sex;

bir th r at e;

et hn icit y;

socio-economic status; and

identification of at-risk groups, eg. at aged care

facilities, schools.

Health status of the population, particularly of at-risk groups, eg. from mor tality, disability and

morbidity data;

Levels of employment/unemployment;

Health behaviour indicators, if relevant eg. rates

of alcohol use and alcohol-related harms;

Environmental conditions of the population

covered, eg.:

air/water/soil quality and ability to increase

capacity eg. of a water supply or effluent

disposal;

transport issues if relevant; and

quality and quantity of affordable housing.

Locations where at-risk groups may be

concent rated, eg. particular street s/areas, schools,

nur sing homes, etc.

Many of these data are routinely available from local

government or the relevant health authority or other

government agency, eg. the Australian Bureau of

Statistics (ABS).

3.1.6 Assessing the health impacts(risk assessment)

The r isk assessment process should identify th e

impacts th at a proposed development is likely to

have on health. These effects could be negative,

resulting from exposure to a hazar d, or positive such

as improved recreational opportun ities or job

opportun ities. This is an aspect overlooked by the

typical assessment that does not fully consider

hum an health , and is one reason to include a

broader view of health in the im pact assessment

process.

Assessment of risk m ay be don e by assessment

against health-based guidelines, it may be a

quant itative assessment, or use qualitative

techn iques, or it may use a m ix of these approach es.

3.1.6.1 Risk assessment using health-basedguidelines and objectives

Health-based guidelines and objectives assist in

consistently and reliably assessing health risks,

ensuring safety in th e situation to which th ey are

relevant. Guidelines and objectives have been

developed for en vironm ental and occupationalhazards, including noise, pollutants, radiation and

microbiological agents.


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Guidelines are prepared by n ational and State/Territory agencies as well as international bodies

such as the WHO. They provide a straightforward

means of predicting impacts, but t hey do not exist

for every possible en vironm ental h ealth h azard.

Ideally, pred icted levels should h ave insignificant or

little effect if they fall below the levels as specified by

the guidelines or objectives. Guidelines should,

however, be used cr itically. Reasons for caut ion

include:

most guidelines are developed to protect against

specific types of hea lth effects. Th ey do not

necessarily guarantee protection from all types ofadverse effects, and r eflect the science at t he t ime

of publication;

they do not necessarily address the social,

community or psychological dimensions of health

and well-being effectively;

they may apply to occupational exposure and are

not directly applicable to public health;

they may not identify positive effects on health;

an d

they may not fully account for factors such as theage and sex of a person. For instan ce, children,

the elderly and pregnan t women may be more

susceptible to some en vironm ental health

hazards.

If no r egulatory standar ds or objective criteria areavailable, other modes of evaluation are used. Other

approaches t hat can be used to assess a projects

potential effects on health include risk-based

analyses that may be quant itative or qualitative.

Whatever method is used will also need to address

the concer ns expressed by stakeholders and the

public, as well as any other risks that are ident ified.

3.1.6.2 Quantitative risk assessment

The basic risk assessment pr ocess is set out in Figure

2, which was taken from a dr aft ofEnvironmental

Health Risk Assessm ent Guidelines for Assessin gHum an Health Risks from Env ironm ental Hazard s 9.

Given that positive effects are also to be included,

risk assessment m ay not be th e ideal term but it is

used for t he sake of uniformity with t he 1994

NHMRC publication 6 and similar risk assessmen t

frameworks.

Env ironm ental Health Risk Assessment9 provides a

methodology for assessing risk from chemical

hazards in considerable detail; reference to th is

document is recommended for those undertaking

such assessments.


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Figure 2

Risk assessment model (adapted from enHealth Council , p.5).

Issue identification

Identification of key

issues amenable to

risk assessment

Exposure Assessment

Analysis of hazard locations

Identification of exposedpopulations

Identification of potential exposurepathways

Estimation of exposure concentrationfor pathways

Estimation of contaminant intakesfor pathways

Uncertainty analysis for exposureassessment step

RiskCharacterisation

Characterise potential for

adverse health effects to occur

Evaluate uncertainty

Summarise risk information.

Risk Management

Define the options and evaluate

the environmental health, economic,social & political aspects of theoptions

Make informed decisions Take actions to implement thedecisions

Monitor & evaluate the

effectiveness of the action taken.

Engage the Stakeholders, Risk Communication, & Community Consultation

Hazard Assessment

Hazard

Identification

Collection &

analysis of

relevant data.

Uncertainty

analysis for the

hazard ident-

ification step

Dose-Response

Assessment

Collection &

analysis of

relevant data.

Uncertainty

analysis for the

dose-response

assessment step

Reviewandrealitycheck

Reviewandrealitycheck

9


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3.1.6.3 Other methods of risk assessmentOften sufficient data are not available to allow

quant itative risk assessment (QRA) to be

under taken, an d alternative methods will need to be

used. In some instances th e alternative methods may

be used as an adjunct t o QRA. Techn iques used

include:

expert opinion, such as a Delphi study or

workshop on the risks;

views and perceptions of the community andother stakeh olders; and

other published material on analogous situations.

Th e Canadian Handbook on Health Impact

Assessment4 includes a table (see Table 3) for

assessing impact significance which is a useful guide

to non-quan titative risk assessmen t.

Table 3

Criteria for Assessing Impact Significance (adapted from Canter, 1986cited in ref. 4)

Nature of theImpact

Definition

Magnitude The probable severity of each potential adverse impact, in the sense of degree, extensiveness or scale.How serious is the impact?Does it cause a large change over baseline conditions?Does it cause arapid rate of change large changes over a short time?Will these changes exceed local capacity toaddress or incorporate change?Does it create a change which is unacceptable?Does it exceed arecognized threshold value?

Geographicallimits

This is the extent to which the potential impact may eventually extend (e.g., local, regional, national,global), as well as to geographical location (e.g., far Nor th, reserve, etc.)

Duration &frequency

Length of time (day, year, decade) for which an impact may be discernible, & the nature of that impactover time (is it intermittent and/or repetit ive?) If repetit ive, then how often?

Cumulativeimpact

The potential impact that is achieved when the particular projects impact(s) are added to impacts ofother projects or activities that have been or will be carried out. The purpose being to predictwhether or not a threshold level is surpassed.

Risk The probability of an impact occurring. For many socio-economic impacts, qualitative assessmentswould be appropriate (high, medium, low).

Socio-economicImportance

The degree to which the potential effects may (or may be perceived to) impact on local economies orsocial structure.

People affected How pervasive will the impact be across the population?This criterion addresses the portion of thepopulation affected and the extent to which it will affect different demographic groups, particularly at-

risk groups (eg. children, elderly, pregnant women, etc.).Local sensitivity To what extent is the local population aware of the impact?Is it perceived to be significant?Has it

been a source of previous concern in the community?Are there any organized interest groups likelyto be mobilized by the impact?

Reversibility How long will it take to mitigate the impact by natural or human means?Is it reversible, and, if so, canit be reversed in the short or long-term?

Economic costs How much will it cost to mitigate this impact?Who will pay?How soon will finances be needed toaddress this impact?

Institutionalcapacity

What is the current institutional capacity for addressing the impact? Is there an existing legal,regulator y, or service structure?Is there excess capacity, or is the capacity already overloaded?Can theprimary level of government (e.g., local government) deal with the impact or does it require otherlevels or the private sector?


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3.1.7 Managing the health impactsidentified as being of significant

risk

Risk man agement is the process of evaluating

alternative actions, selecting options an d

implementing them in response to risk assessment s.

The decision making will incorporate scientific,

technological, social, economic and political

information. The pr ocess requires value judgements,

eg. on the tolerability and reasonableness of costs.

Alternative actions may be identified by the

proponent or through a community consultationprocess.

Once possible health impacts have been identified

and assessed, desirable and u ndesirable impacts can

be sorted in to th ose of significance and those th at

are not.

Actions to m aximise potential health ben efits and

minimise or prevent the poten tial risks to health are

identified.

Recommendations to th e decision-making auth ority

may be made by the h ealth author ity or by others, in

accordance with th e regulatory or adm inistrativearran gemen ts in the particular jurisdiction.

Recommendations m ay be to m odify the proposal,

consider alternatives where available, or impose

conditions on its implemen tation. One altern ative,

where the risks have not been, or cannot be,

adequately addressed, may be not toproceed.

This stage may a lso involve a substan tial public

consultation elemen t, including:

how impacts identified during screening and

scoping have been addressed; and

demonstrating that impacts identified by the

commu nity as being importan t to them have been

adequately considered and what action has been

taken.

3.1.8 Decision making

The decision m aking process incorporates scientific,

techn ological, social and econom ic informat ion an d

must take into account the commu nity concerns

identified du ring consultation processes.

The decision-making capacityfor an impactassessmen t does not lie within th e health aut hority.

This does not matter so long as the h ealth auth ority

is well linked in to th e process and commu nication

between health and t he decision-maker is adequate.

The importan t issue is to have health impact

assessmen t as par t of the overall impact assessment

process.

Negotiation may occur between th e environmen t,

planning and h ealth agenciesii to ensure a

compreh ensive, coheren t and workable set of

chan ges or conditions are applied to an y proposal.

Recomm endations an d decisions, and th e reasons for

them, should be publicly available.

3.1.9 Monitoring and evaluation

There are two types of monitoring and two types of

evaluation that may need to be undertaken.

Monitoring

monitoring of the conditions applied to a

development.

Routinely under taken for man y development s, both

during construction an d after operat ion of thedevelopment commences.

monitoring of the health impacts during and/or

after t he development, as required.

This is an added requirem ent if, in fact, any

monitoring of health impacts is needed. Adverse

health impacts are often designed out to the point of

presenting negligible additional risk, in which case

monitoring is not requ ired (beyond monitoring that

the controls are actu ally implemented see previous

point).

If a part icular risk to health cann ot econom ically becontrolled to an exten t th at ensur es no significant

additional public health r isk, then monitoring of

health stat us, or indicators of the risk thereof (such

as noise or dust levels, rath er th an deafness or

asthm a) may be necessary.

Health monitoring is discussed in detail in Appendix 6.

ii Within a local governm ent these three aspects m ay all be considered w ithin the one agency if it has decision-mak ing powers for that

development.


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Evaluation evaluation of the efficiency of the HIA process.

The inten t when dealing with risk should not be to

reduce it at all costs or to reduce it to a negligible

level, but rath er to balance t he ben efits and costs to

the com mun ity of reducing the risk10 . There is

economic cost to the proponent (money and time)

and to th e health authority (the opportunity cost of

the assessmen t act ivity) and these should be offset

by the h ealth or economic gains th at result from the

project s improved consider ation of health issues.

evaluation of the health outcomes is the HIAprocess effective and are h ealth outcom es

improved as a result of it?

This requires assessmen t of the actual health

outcomes achieved (positive and negative) as a result

of under takin g HIA, with a view to evaluatin g

whether the process is effective in maint aining or

improving the h ealth status of the comm unity.

Both of the evaluations m entioned above should

ideally be under taken ac ross a series of HIAs, some

time after th ey have been implemen ted (ie. once th e

outcomes can reasonably be determined).

3.2 The precautionary approach

The NHMRC fram ework documen t6 suggests th at

when the scientific basis for a risk assessment is still

in the early stages of development, decisions should

err on the side of caution. This is often referred to as

a precautionary approach.

W hat is meant by the precautionary

approach?

Definitions of the precautionar y approach vary, but

the m ost widely inter nationally accepted is thatdescribed in Principle 15 of the Rio Declaration on

Sustainable Development (UNCED, 1992)11. This

states:

In order to protect the env ironm ent, the

precautionary ap proach sha ll be wid ely app lied by

States a ccording to their capa bilities. Where there

are threats of serious or irreversible dam age, lack

of full scientific certaint y shall not be used a s a

reason for postponin g cost-effective m easur es to

prevent environm ental degradation.

In Australia, some jurisdictions h ave included th is

concept, variously referred t o as th e precautionar y

approach or precautionary principle, in agreements

and legislation. In Februar y 1992, th e Inter-

government al Agreemen t on th e Environm ent

included th e following as part of a comm itment to

sustainable development :

Where there are threats of serious or irreversible

env ironm ental dam age, lack of full scientific

certainty should not be used as a reason for

postponing m easures to prevent environm entaldegradation. In the application of the precautionary

principle, public and private decisions should be

guided by: (i) careful ev aluation to av oid, wh erever

practicable, serious or irreversible dam age to the

environm ent; and ( ii) an assessm ent of risk -

w eighted consequences of v arious options.

Whilst the Inter-governm ental Agreemen t on the

Environm ent is aimed at environm ental protection,

the Rio Declaration, within th e context of

sustainable development and Agenda 21, makes it

clear that the concept is equally applicable to hum an

health and wellbeing.

The precaut ionary approach is not intended to be a

device to inhibit development. However, proponents

may need t o consider and discuss health r isks that

are un certain as well as those th at are well defined,

including an indication of the degree of uncert ainty

and where th e uncert ainty is thought to lie.

A precautionar y approach is limited in its ut ility by

the u ncert ainty as to its meaning and application.

Caveats th at apply to its use include iii:

Implementation of a precautionary approach

should start with an objective risk assessmen t,ident ifying at each stage the degree of scient ific

uncertainty;

All the stakeholders should be involved in the

study of the various man agemen t options th at

may be en visaged once t he r esults of the risk

assessment are available;

Regulatory measures taken should be

proportionate t o the r isk which is to be limited or

eliminated;

iii Adopted from Health Canad a. 2000. Therapeutic Produc ts Programm e Strategic Fram ework for 1999-2002.


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measures based on a precautionary approachshould be able to establish responsibility as to

who should furnish the scientific proof needed for

a full risk assessment; and

measures based on a precautionary approach

should always be of a provisional nature, pending

the results of scientific research performed to

furn ish the missing data and performan ce of a

more objective risk assessment.

3.3 Roles and responsibilities

3.3.1 Responsibilities of theproponent

The proponen t should satisfy the req uiremen ts of the

impact assessment process set out in th e relevant

jurisdiction.

This process should include the need t o explicitly

address potential impacts on human health. These

Guidelines are intend ed to assist proponent s to do

this.

If proponent s are in any doubt as to what to do th ey

should contact th e relevant h ealth author ity.

Proponents are also encouraged to contact th e healthauth ority as soon as th ey identify a poten tially

detrimental human health impact, to discuss

acceptable mean s of preventing or ameliorating the

impact.

3.3.2 Responsibilities of the PublicHealth Authority

The health auth ority will facilitate development of

the health impact statement (HIS) by the proponent

through:

discussing the HIA process, meth odology, specific

health concer ns, sources of data, resources and

cost recovery (if applicable) as required a key

focus being to ensure that the overall level of

effort is in p ropor tion t o the level of risk;

providing or identifying potential sources of

relevant h ealth and dem ographic data, where

available;

participating in the screening and scopingprocesses, including visiting the site of the

development if practicable;

reviewing the health components of the draft

impact assessment report;

providing advice to the proponent when they

address the concern s raised during public

consultation. The HIS may need to be m odified,

extended or oth erwise changed and monitoring

conditions imposed to address the commu nity

concern s (depending upon th e process used to

man age public comm ents in th e jurisdiction); making recommendations to the approving

authority concerning the potential health impacts

of a development iv;

participating in the health monitoring and

evaluation, as appropriate;and

liaising with th e decision-making agency.

3.3.3 Responsibilities of the decision-making agency (environment or

planning)

The managing agency should:

include human health as an issue to be addressed

in the guidelines and standards th at prescribe and

describe the impact assessment pr ocess;

encourage proponents to make contact with the

public health author ity early in the p rocess;

refer development applications requiring

assessmen t to the h ealth author ity for

consideration in a timely fashion;

provide the health authority with the results of

monitoring and evaluation related to pu blic

health, when th ey are provided by the proponen t

or other agency;

provide feedback to the health authority on HIA

procedures as th ey impact on th e overall impact

assessmen t pr ocesses; and

liaise with the health authority as required.

iv Most jurisdictions tend to hav e one decision-m ak ing authority, which m ay be a Minister, a Board or the Chief Executiv e of the

relevant planning or environment agency. The precise relationship between the health authority and the decision maker needs to

be considered. The purpose of this paper is not to say w hat they should be that w ill depend u pon the laws and adm inistrative

arrangements in each jurisdiction.


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4 Preparing a Health Imp actStatement

This section provides supplementary an d additional

information an d ideas on how to undertake a

successful HIA (and in so doing, prepa re a

satisfactory Health Impact Statem ent).

While the basic steps have been described and the

essential content of each outlined, actually

un dert aking a HIA will still involve a great deal of

learn ing. Successfully under takin g a HIA will requir e

practice and may be difficult at first for both

proponents and health authorities.

4.1 Content of a Health ImpactStatement

In preparing a Health Impact Statem ent it is

necessary for the proponen t to consider what dat aneed t o be included. The level of detail and t he r ange

of issues canvassed will depend upon the health

impacts identified during the scoping stage.

This section attem pts to pr ovide guidance on issues

that might be con sidered. It is not expected th at

every issue outlined h ere should be covered, nor is it

necessary th at th ere be an explanation of why issues

listed here ar e not covered.

4.1.1 Details of the proponent and

the development

Certain details will be required under the stat utory

impact assessment framework in each jurisdiction

and it is un likely that th is will need to be added t o

for health pur poses. If only a HIA is necessar y, these

same requiremen ts ar e likely to provide sufficient

information and m ay be used as a guide by

proponents.

Details of the development, its site(s), site history,

and site climate sh ould be covered in th e standard

detail provided.

4.1.2 Details of the affected or

interested communities

The size of the local population, particularly thatliving close to t he site, and det ails of that commu nity

are essential to the HIA.

Profiling is the first step of the appraisal and

influences the risk assessmen t an d resulting risk

management and communication strategies.

The local population th at is relevant may be defined

in man y ways. If the commu nity is small it m ay

simply be the whole comm unity, or it may be a

community not near the site but on a transport route

to it, or it may be some other com mun ity that self-

defines itself as having an inter est. In t he latter case

while commun ication must be maintained, health

profiling may not be necessary. The basis of choice of

the boun daries should be explained by th e

proponent.

4.1.2.1 Demographic data

Demographic data should correspond as closely as

possible to th e defined commu nity, however such

data may be difficult to obtain for small areas except

by direct survey. The cost of a survey would only be

justified in exceptional circumstances. An alternative

may be t o discuss with key informan ts any

differences bet ween the data for the larger ar eacovered by the demographic (usually ABS) data and

the area itself. For example, an industr ial area may

have very few residen ts, an d th erefore few ABS

survey respondents, while having a large population

in workplaces during the day. Furth ermore, an y data

involving small populations, however obtained, may

lack epidem iological power, ie. lack ab ility t o reliably

detect significant health effects.

4.1.2.2 Health data

Health (or illness) data m ay be similarly difficult to

obtain . Morbidity data collections u sually cover wide

areas (eg. to postcode level) and usu ally reflect

illness rather th an h ealth. The health of the relevant


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population may, therefore, also require inference ofhealth stat us from data available on th e regional

population . Very local health data, if available, may

be subject to confidentiality requiremen ts as it may

be identifying. There will be ethical and

confidentiality constraints on the use of any such

data and it may only be accessible to th e State/

Territory h ealth aut hority.

Health data collected m ight include crude an d

standardised mor tality data, morbidity data for

diseases related to potential health impacts, eg.

mosquito-borne disease n otification rates, or data

measuring the prevalence of chronic diseases ofconcern.

4.1.2.3 Special populations

The data collection m ay need t o identify special

populations who m ay be at greater risk of adverse

health effects. For example a top end Ind igenou s

population m ay have substantial outdoor exposure

and would therefore be more at risk of an incr ease in

mosqu ito-borne disease, such as Murr ay Valley

encephalitis, from a n ew dam. Other groups th at

may need t o be considered include th e young, the

elderly, and the poor.

Some facilities may be significant in terms of risk

exposure. These include child care cen tres, schools,

aged care facilities (domiciliary or day care). The

proponent needs to consider the existence of any

such facilities and th e health impacts th at may be

more significant for such groups (which may be as

simple as road-crossing being more/less dangerous

due t o altered tr affic flows).

Notwithstand ing the difficulties, profiling should be

possible with sufficient accuracy to obtain

represent ative data on the age struct ure, socio-

economic status an d health status of a population.

Provided special local factors such as child care or

aged care centr es are taken into account , a

reasonably clear pictur e of the population should be

possible. Should this not prove to be the case the

proponent should discuss with th e health auth ority

the level of deta il required for the p rofiling step.

4.1.3 Environmental health data

A range of environmental factors affect health,

notably food, water and air quality, and waste

disposal (solid, liquid and hazardous wastes if any).

It is easier, more sensitive and usually more useful tomeasure the hazard directly, rather than measure ill

health.

Indicators must be ch osen that reasonably reflectboth th e health impact s that were identified as being

of importan ce during the risk assessment and

man agemen t steps (see Box 3, steps 4 and 5), and

the effectiveness of their am elioration (or not).

Indicators of health n eed to be:

available at reasonable cost;

valid and reliable reflections of the actual

situation;

closely linked to actual health outcome;

timely ie. rapidly reflect change when a health

impact occurs;

able to be acted upon directly, without further

delay or furth er dat a collection; and

readily understood by non-technical people.

4.1.3.1 Air quality

One key area of health concern is indoor and

outdoor air quality. If a developmen t is likely to have

any influence on either indoor or outdoor air quality

then likely health impacts sh ould be assessed.

Changes in indoor air quality may arise from a wide

range of factors, eg. construction materials or

equipment used in a building, from out door dust

creation, from environment al tobacco smoke, or

through the entrapment of other pollutants due to

inadequate ventilation.

Outdoor air may be affected by t he h andling of dusty

mater ials, such as ores or grains, by th e emission of

gases such as sulfur dioxide or other smokestack

emissions, including particulates or dioxins, and

vehicle emissions.

Whatever t he source of pollution, it requires careful

estimation of the area likely to be affected, the

intensity an d dur ation of the effect an d th e level of

health impact (actual health effects) on th e at risk

population . Modelling of the dispersion of airborne

mater ials is a specialist task, as is t he estimation of

health effects once the dispersion m odel is

developed.

4.1.3.2 Food

If there is the possibility of a development having an

impact on the quality, quant ity or th e price of food

this should be noted and discussed in the HIS.


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Impact on food production or on food producing landor water would almost cer tainly be addressed by an

EIA but these data would be of interest to the HIA as

well.

4.1.3.3 W ater (not including wastewater)

The use of local water by a proposed development

and t he likely impact on t he sur face, ground water

and dr inking water is a fundam ental health concer n.

It is also an environment al concern and so will be

addressed to a significant extent, if not fully, by the

EIA process. However, there may be some aspects

that require specific attention from a health

perspective.

The pr oponent should provide a det ailed description

of the local water supplies, including non-potable

water, and any beneficial uses which the water is, or

could be, put to. Particular atten tion should be paid

to any impact s on th e potable water supply.

Impacts might be from additional consumption th at

depletes reserves or reduces access, chemical

contaminants (nutrients, heavy metals, etc)

microbial contaminants, loss of amenity of lakes or

other surface water, impact on fish used for food, etc.

4.1.3.4 W astewater

The disposal of wastewater can have health impacts,

whether or not the wastewater contains sewage.

Improper disposal of stormwater can lead to loss of

amenity and may be hazardous. Disposal of sewage

may be a problem in that cont rol of nut rients and

microbes can be difficult or expensive; it typically

requires a considerable area of land well away from

housing and m ost other forms of development, and

improper disposal quickly becomes a h ealth h azard.

Industrial wastes pose differing hazards, depending

upon their constituents. They often require furtherspecialised treatm ent before discharge to sewer or to

th e local effluen t disposal system. These de tails will

be required for any health assessment.

If wastewater is to be produced in an y quant ity and

is not simply discharged to sewer, full information on

its expected volume, cont ent an d met hod of disposal

is likely to be requ ired (note t hat this informat ion

may be included in existing impact assessment

procedures now). These details could include:

the biological oxygen demand;

heavy metal con tent ;

pH;

concentration of nutrients nitrogen, phosphoruscompounds;

pathogens of special significance, eg. Giardia

which produces hard-to-kill cysts; and

odour, colour, etc.

4.1.3.5 Government-controlled infrastructure

Changes to the capacity of utilities (gas, electricity,

water) or public facilities (education, public housing,

health and social services) which lead to reduced or

increased access or cost would be likely to result in a

health impact. If large enough such possible impacts

HIA Guidelines - Enhealth Australia - 2001

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