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Health ImpactAssessment Guidelines

September 2001

PA6584 HIA guidelines cover1 12/6/01 3:30 PM

Health Impact Assessment

Guidelines

September 2001

ii Health Impact Assessment Guidelines

© Commonwealth of Australia 2001

ISBN 0642503656

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Note the document may be accessed electronically from: http://enhealth.nphp.gov.au/council/pubs/ecpub.htm

The enHealth Council, a subcommittee of the National Public Health Partnership, brings together top Environ-mental Health officials at the Federal and State/Territory level along with representation from the AustralianInstitute of Environmental Health, the environment and public health sectors, the Indigenous community andthe wider community. The Council has responsibility for providing national leadership, implementation of theNational Environmental Health Strategy, forging partnerships with key players, and the development andcoordination of advice on environmental health matters at a national level. The advice development process isstrongly based on collaboration and consultation.

Disclaimer

This document has been prepared in good faith, exercising due care and attention. However, no representationor warranty, expressed or implied, is made as to the relevance, accuracy, completeness or fitness for purpose ofthis document in respect of any particular user’s circumstances. Users of this document should satisfy them-selves concerning its application to, and where necessary, seek expert advice about, their situation. TheDepartment of Health and Aged Care and the enHealth Council shall not be liable to the purchaser or anyperson or entity with respect to any liability, loss or damage caused or alleged to have been caused directly orindirectly by this publication.

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 19

3.2 The Precautionary Approach 20

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

Health Impact Assessment Guidelines v

AcknowledgementsThe work of the Department of Health and HumanServices, Tasmania in developing the first draft ofthese guidelines is gratefully acknowledged.

All those who participated in public consultation onthe first draft of the Guidelines, either by writtensubmission or through attendance at one of thenational workshops, are sincerely thanked for theirefforts. These Guidelines draw heavily on the initialdraft Guidelines and the feedback received duringthe consultation. Brian Wall was responsible forconduct of the consultation workshops and much ofthe drafting during the latter stage, his assistance isgratefully acknowledged.

AbbreviationsABS Australian Bureau of StatisticsDOH Department of Health (UK)E&HIA Environmental and Health Impact Assess-

mentEIA Environmental Impact AssessmentEMPCA Environmental Management and Pollution

Control Act (Tasmanian)HIA Health Impact AssessmentHIS Health Impact StatementNHMRC National Health & Medical Research

CouncilPAH Polyaromatic hydrocarbonPCB Polychlorinated biphenylPHA Public Health AuthorityWHO World Health Organization

Glossary RiskThe probability that, in a certain timeframe, anadverse outcome will occur in a person, group ofpeople, plants, animals and/or the ecology of aspecified area that is exposed to a particular doseor concentration of a hazardous agent, i.e. itdepends on both the level of toxicity of the agentand the level of exposure.

Risk assessmentThe process of estimating the potential impact of achemical, physical, microbiological or psychosocialhazard on a specified human population or ecologi-cal system under a specific set of conditions andfor a certain timeframe.

Risk communicationAn interactive process involving the exchangeamong individuals, groups and institutions ofinformation and expert opinion about the nature,severity, and acceptability of risks and the deci-sions taken to combat them.

Risk managementThe process of evaluating alternative actions,selecting options and implementing them inresponse to health risk assessments. The decisionmaking will incorporate scientific, technological,social, economic and political information. Theprocess requires value judgements, eg. on thetolerability and reasonableness of costs.

Environmental healthA subset of public health which focuses on environ-mental conditions and hazards which affect, orhave the potential to affect, human health, eitherdirectly or indirectly. It includes the protection ofgood health, the promotion of aesthetic, social andeconomic values and amenity, and the preventionof illness and injury by promoting positive environ-mental factors and reducing potential hazards –physical, biological, chemical and radiological.

HazardThe capacity of an agent to produce a particulartype of adverse health or environmental effect.

Health Impact AssessmentThe process of estimating the potential impact of achemical, biological, physical or social agent on aspecified human population system under aspecific set of conditions and for a certaintimeframe.

Health Impact StatementThe report which presents the findings of a HealthImpact Assessment.

Health Impact Assessment Guidelines vii

Preface

The critical link between human health and oursurroundings is highlighted in the National Environ-mental Health Strategy (1999)1. In particular, it callsfor greater attention to the impacts of developments– “...health considerations should form part of anyimpact assessment for developments or decisionsthat could have health consequences.”

There is overwhelming evidence that developmentcan have a beneficial effect on health and wellbeing;through the creation of employment, promotion ofeconomic advancement and providing circumstanceswhich can improve living standards. Developmentcan also have adverse effects, however, throughproblems such as noise, water and air pollution, andincreased risks of injury and disease transmission.Development may also impact on the social andemotional status of individuals and communitiesthrough, for example, alienation and dis-empower-ment. Some community members may be particu-larly susceptible to both the physical and socialimpacts, such as children and the elderly.

Health Impact Assessment (HIA) is a process thatsystematically identifies and examines, in a balancedway, both the potential positive and negative healthimpacts of an activity.

These Guidelines specifically address the use of HIAwhen conducting Environmental Impact Assessment,further developing the National Health and MedicalResearch Council National Framework for Environ-mental and Health Impact Assessment (1994)6 inthe light of experience in implementing HIA inAustralia and overseas. In this planning context theoutcomes of HIA provide the ideal starting point forefforts to maximise positive health impacts andprevent or minimise negative impacts. Rectifyingproblems during planning is usually the preferredapproach; rather than having to deal with them oncea development is under construction or in place.

By ensuring that immediate and future human healthcan be protected, the possibility of sustainabledevelopment is strengthened by HIA.

In addition to health professionals, HIA involves anumber of other sectors, including planning, envi-ronment, social science, economics and the widercommunity. These Guidelines are intended to assistthese sectors to better understand the rationale forHIA and the processes involved. In particular, theGuidelines provide insight into the health benefitsthat can be derived from better health-based deci-sion making.

For proponents the Guidelines will assist under-standing of what needs to be done and promote amore balanced approach by ensuring positiveimpacts are given appropriate consideration. For thewider community HIA can help to ensure oursurroundings are best able to enhance health for allinto the future.

Maximising the economic and other benefits ofdevelopment while managing the adverse impacts isan important but often difficult balance to strike.These Guidelines are intended to assist with theachievement of that balance.

Executive summary

These Guidelines aim to promote and enhance theincorporation of Health Impact Assessment (HIA)into environmental and planning impact assessmentgenerally, thereby improving the consideration ofhealth issues.

In particular they seek to provide those involved inimpact assessment across all levels of governmentand developers, along with their advisers, with anintroduction to HIA and general guidance on the keysteps involved.

The intent of the Guidelines is to achieve thiswithout the addition of another layer of‘bureaucracy’ to the impact assessment processesalready in operation across Australia, through theintegration of HIA with the processes already inplace.

The current consideration given to human health inEnvironmental Impact Assessment (EIA) is oftenunstructured and confined to negative impacts. AnEIA may not properly recognise the positive effect onhealth that development can have, for examplefinancial status.

Health is determined by many factors includinggenes, age, a person’s social and economiccircumstances, lifestyle and access to services, aswell as environmental health factors such as air andwater quality, housing, etc. HIA seeks to ensure boththe positive and negative impacts on health (asviewed from a wider perspective than just physicalillness or injury) are effectively considered duringimpact assessment.

The HIA process shares the general frameworkcommonly used for impact assessment, as shown inthe diagram below:

Community Consultation

Screening

Health Impact

Statement

Profiling•Who is affected

•What is their current

health status

Report andRecommendations

(if any)

Scoping•Identify issues to be addressed•Level of appraisal - how comprehensive?

Informed

opinion

Evidence

available

Further investig-ation required

Health impacts well understood & control measures

routinely applied

Healthimpactsnegligible

Risk Assessment•What are the hazards

•What is their likelihood

of harm occurring

•Who might be exposed

Risk management•Prevention or minimisation of risk of harm•Managing any consequences•Specific risk communication

Monitoring and Evaluation(Processes and outcomes)

Decision making & on-going management

Project

Description

2 Health Impact Assessment Guidelines

The proponent’s role is to prepare a Health ImpactStatement (generally as part of a broader impactassessment) that addresses the issues identifiedduring scoping, and which includes assessment ofthe likely risks and benefits to health from thedevelopment, as well as management of the risks.

The health authority should provide its view on thehealth risks requiring attention (at the scoping stage)and ensure that the level of ameliorationrecommended is in proportion to the level of risk tohealth. The health authority may also advise on datarequirements and data availability and provide inputinto assessment of the Health Impact Statement.

The decision-making agency (Environment orPlanning) should ensure that human health isincluded in the issues to be addressed in thestatement of requirements issued to proponents, itshould refer assessments to the health authority forconsideration and forward monitoring and evaluationdata provided by the proponent or their agent.

A HIA will require much of the same data as neededfor a general impact assessment, but there will oftenbe additional data requirements. These include:

• demographic and health status data for local andother affected populations (eg. adjacent totransport routes), and details of any specialpopulations, eg. children, the elderly;

• environmental health data – potential impacts onair quality, soil, water and waste-water will be ofparticular relevance in health assessment; as areany potential impacts on the quality, availabilityor price of food or impacts on food producingland;

• additional demands on community infrastructure– such as sewerage, water supplies, wastemanagement services, schools, health and socialservices;

• transport issues, including the risk of injury,pollution and amenity. Both the positive andnegative aspects of transport changes may need tobe considered; and,

• social and economic impacts, where these mayhave an effect on health.

Assembly of these data into the Health ImpactStatement is usually the responsibility of theproponent, but advice can be sought from the healthauthority. The health authority also has the role ofproviding the decision-making agency with adviceand recommendations on the proposal.

These Guidelines and the related advice from thehealth authority should ensure a smooth, effectiveprocess that will more thoroughly address thepotential human health impacts of a development.

Health Impact Assessment Guidelines 3

1 Introduction

within the legislative framework that alreadyexists in each jurisdiction; and,

• assist agencies, communities and individuals whoare involved in the preparation of impactassessments with guidance on each of the keysteps of a HIA.

The Guidelines seek to strengthen and improve theconsideration of health issues within the context ofthe impact assessment processes currently inoperation across Australia. They do not call for anadditional evaluation process, nor to widen the scopeof the development assessment laws in anyjurisdiction.

HIA can be applied to the assessment of impacts inthe wider field of policies and programs, but that isnot the focus of these Guidelines.

These Guidelines do not address issues ofoccupational health and safety, as separate agenciesare specifically charged with this responsibility inmost jurisdictions. There are occasions where publicand occupational health issues overlap to such anextent that they are inseparable, eg. Legionellacontrol. In that case the Health Impact Statementwill need to address the issue.

1.3 Scope of health impactassessment

The UK Department of Health guidelines3 refer toHIAs as being ‘broad’ or ‘tight’ depending upon thescope of the activity under scrutiny and theapproaches used to assess the health impacts. Table1 describes the differences between theseapproaches. Notwithstanding the differences there isa common purpose – to optimise health impacts of aparticular policy, program or project (minimise thenegative and maximise the positive).

1.1 What is health impactassessment?

Health Impact Assessment (HIA) is defined bydifferent agencies in different ways, but there is ageneral consensus around a broad definition,published in 1999 as the ‘Gothenburg ConsensusPaper’ by the WHO Regional Office for Europe2. Thatdefinition is:

“a combination of procedures or methods by whicha policy, program or project may be judged as to theeffects it may have on the health of a population.”

HIA may thus include assessment of high level policyand programs as well as individual developments,and encompass the vast array of assessmenttechniques used for each.

In its broadest form, HIA seeks to predict the healthimpact of a policy, program or project (including adevelopment) usually before implementation, andideally early in the planning stage. It aims tofacilitate the reduction or avoidance of negativeimpacts on human health and enhancement of thepositive impacts, and in so doing promotingsustainable development (SD) – human health beingcentral to the concept of SD.

Internationally, HIA has become a key component ofinformed decision making and is being undertakenby governments world wide in a variety ofcircumstances and situations3,4,7.

1.2 Aim of the GuidelinesThe Guidelines are intended to provide anintroduction to HIA and general guidance on theassessment of proposed developments.

More specifically the Guidelines aim to:

• improve consideration of the health impactsassociated with development by promoting andfacilitating the incorporation of HIA intoenvironmental and planning impact assessment,


Guidelines developed by the National Health andMedical Research Council (NHMRC)6, New Zealand7

and (to a lesser extent) Canada4 focus on healthimpact assessment of individual projects ordevelopments, not at the policy or program level.Nevertheless, this set of Guidelines, as well as thosementioned above, take a broad view of whatconstitutes health. In that respect they cannot beregarded as tight in their focus.

1.4 Why undertake healthimpact assessment?

HIA is undertaken to ensure explicit and balancedconsideration of the human health impacts ofpolicies, programs and (in relation to theseGuidelines) developments.

The importance of human health being moreexplicitly considered in relation to promotingsustainable development has already been discussed.

The costs of failure to protect and promote healthfall on governments, the community generally andindividual members of the public. These costs areunlikely to be borne by a proponent. Ensuring thatsuch costs are not incurred by non-beneficiaries isboth equitable and good economics.

Environmental Impact Assessment (EIA) has beenpractised in Australia and elsewhere since the early1970s. While aspects of the physical and naturalenvironment are central to EIA, the considerationgiven to human health has been generallyunstructured and confined only to the most direct,negative impacts.

The need for HIA to be conducted explicitly in anyenvironmental or economic decision-making processwas strongly endorsed by the NHMRC in 1992.

Table 1

Characteristics of broad and tight perspective Health Impact Assessment

In 1996, Tasmania became the first state to legislatefor HIA to be a formal requirement of the EIAprocess. Appendix 1 sets out some of the Tasmanianexperiences in the conduct of health impactassessment.

Traditional EIA often does not identify the positiveeffect on health that development may have. Forexample, as identified in Table 2, one of the keydeterminants of health is financial status. There isample evidence that poorer communities experiencepoorer health and that improving economiccircumstances can improve health status. HIA shouldexplicitly identify the positive effects on health thatdevelopment may have through, say, job creation, aswell as any negative effects.

Furthermore, traditional EIA has not alwaysmanaged identification and reporting of likely humanhealth effects in an optimum manner. For instance:

• the reporting of health effects may beunstructured, as most impact assessmentguidelines may not call for an explicit section onhuman health (even though relevant data mayappear throughout the document);

• the consideration of health issues may be toonarrow. As outlined in section 1.5, health isinfluenced by many factors and the lack of aspecific requirement to consider and report onhuman health impacts has sometimes seensignificant health issues overlooked; and/or

• regional environmental health considerations areoften not characterised in a way that enablesassessment of the incremental contribution adevelopment or activity may have upon them (eg.the contribution of pollutants to a regionalairshed or to dietary intake via the food chain).

BROAD PERSPECTIVE TIGHT 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


A sharper focus on health need not involve a greatdeal more work by the proponent or others, and canprevent significant adverse health outcomes. It mayalso prevent the need for costly late changes to adevelopment, or avoid adverse publicity fordevelopers, managers and others, at some later stage.

HIA is occurring at present – formally in onejurisdiction but also informally or on a discretionarybasis in others. It is not a whole new layer ofbureaucratic activity that needs to be added on towhat is currently occurring. Incorporation of theseGuidelines should ensure better consideration ofhealth issues, so that important health concerns areaddressed explicitly and comprehensively early on,preventing later adverse health events with attendantcost to individuals, industry and the community, andat the same time maximising any health benefits.

The Guidelines rely on, and assume, intersectoralcollaboration between health, planning andenvironmental agencies at all levels of Government –Commonwealth, State, Territory and Local.

1.5 What is meant by ‘health’ andwhat are its determinants?

It is useful when examining the scope of HIA ingeneral, and of these Guidelines in particular, toconsider what health is and what are itsdeterminants.

The WHO definition of health is:

‘a state of complete physical, mental and socialwell-being and not merely the absence of disease orinfirmity’.

This definition is very broad. While it helps toidentify what might be included as ‘health’ it is lesshelpful in setting boundaries around what should beconsidered and what may be ignored. A morespecific approach is to examine the keydeterminants of health and consider which aresusceptible to change and by what means (Table 2).

As outlined above, the approach described in theseGuidelines is sometimes referred to asenvironmental health impact assessment as itfocusses mainly on the environment (natural andbuilt) in attempting to improve and maintain health.

Nevertheless, HIA may also need to address otherissues, such as lifestyle, an important determinant ofhealth, which may be readily impacted upon bydevelopmental change.

Overall, it is important to note that health isinfluenced by a very broad range of factors.

Table 2

Examples of key factors that determine healthFixed Social and

economicLifestyle &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) Inset 1A


What constitutes a health impact?Anything which alters a determinant of health, suchas those listed in Table 2, may, as a consequence,have an impact on health.

A list of some possible health impacts, which mayassist in identifying likely positive or negativeimpacts, is provided in Box 1, below. Sensitivity ofindividuals is likely to be affected by age, sex,nutritional and pregnancy status, or a combinationof 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 physical 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 industry.

• Changes in social conditions (way of life) or demographic changes leading to health consequences eg. thelikelihood 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 that may 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.


In the past, potential health impacts wouldfrequently and perhaps automatically be thought ofas negative. A more balanced approach is needed – itis important that the likely positive health aspects ofdevelopments be properly recognised and capturedthrough the HIA process. Positive impacts can arisefrom increased employment, greater recreationalopportunities, new products and services that reducedisease, or a decreased health risk by, for example,improved road design.

During scoping the proponent can decide whichlikely impacts will be considered, usually afterdiscussion with the relevant health authority.

Health impacts that may continue tobe inadequately addressed

There are developments which have impacts onpublic health while having no environmental impact,such as locating a large liquor outlet in a communitythat may already have many of them and/or signs ofexisting problems from excessive alcohol access/consumption. The focus of this document, however,is on health impact in the context of traditionalenvironmental impact assessment.

i Tasmanian legislation includes the power to require health impact assessment be conducted on development proposals that are notsubject to the normal impact assessment processes.

Separate identification steps are required fordevelopments with a public health impact that arenot environmentally-orientedi.

Global health impacts are rarely if ever able to beaddressed effectively by a process that considersimpacts on a development-by-development basis.This is not to say that HIA does not have a place inassessing global health impacts – it can, whenapplied at the strategic and government policy level(this is outside the scope of these Guidelines). TheUK Department of Health (DOH) Guidelines3 are anexample of guidelines that are focussed more at thislevel.

HIA of individual developments often fails to identifyimpacts that arise from numerous small activities,each of which are, in themselves, too small towarrant assessment. For example, the installation ofwood-burning room heaters may, collectively, giverise to a high level of air pollution when installed inlarge numbers, particularly in non-windy areas. Eachheater alone clearly falls outside the limits of whatmight be considered under HIA. Non-point sourcepollution from farming activity is another example.


2 Principles

The WHO, in its report on Health and SafetyComponent of Environmental Impact Assessment8,established four basic principles to help fulfil thepotential for environmental impact assessment (EIA)to protect human health. They are:

• One of the fundamental considerations in theapproval of projects, policies and plans should bethe health of communities affected by them;

• Greater consideration should be given to theconsequences of development policies andprograms for human health;

• Environmental impact assessment should providethe best available factual information on theconsequences for health of projects, policies andplans; and

• Information on health impact should be availableto the public.

These principles have been developed into theguiding principles listed in Box 2– they expand onand clarify the application of the WHO Principles.

Attention is also drawn to the Charter ofEntitlements and Responsibilities for Individuals,Communities, Business and Government (theCharter) which, as part of the NationalEnvironmental Health Strategy 19991, has beenendorsed by the Australian Health Ministers’Conference on behalf of the Governments ofAustralia. The Charter sets boundaries for activities,in order to ensure the entitlements andresponsibilities of each sector are fulfilled andmaintained. A copy of the Charter is given inAppendix 2.


Box 2

Principles to be addressed when undertaking Health Impact Assessment

Overall

• The Charter of (Environmental Health) Entitlements and Responsibilities 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 the“environment” and rely on the quality 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 Assessment

• The scope and detail of the HIA should be in proportion 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 (oncethey have been identified as a possible concern). The additional financial cost is likely to be less for both industryand governments if action is taken at the design stage.

Integration of Health Impact Assessment and Environmental Impact Assessment

• HIA should be explicitly 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.

Monitoring and review

• 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.


3 The HIA process and roles ofthose involved

3.1 The health impact assessment processThe HIA process described in these Guidelines is based on that outlined in the National Framework forEnvironmental and Health Impact 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 NHMRC6

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 Implementation 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, environmental and health auditing, 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?


Community Consultation

Screening

Health Impact

Statement

Profiling•Who is affected

•What is their current

health status

Report andRecommendations

(if any)

Scoping•Identify issues to be addressed•Level of appraisal - how comprehensive?

Informed

opinion

Evidence

available

Further investig-ation required

Health impacts well understood & control measures

routinely applied

Healthimpactsnegligible

Risk Assessment•What are the hazards

•What is their likelihood

of harm occurring

•Who might be exposed

Risk management•Prevention or minimisation of risk of harm•Managing any consequences•Specific 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 and 2C)


3.1.1 Community consultation andcommunication

The NHMRC framework6 does not include a specificconsultation step, in the expectation thatconsultation will occur throughout the conduct ofthe HIA, as appropriate. Ideally consultation wouldoccur at every stage, at least for large projects.

What is appropriate depends on the size and type ofproject, as well as the legislative requirements forconsultation. These vary between jurisdictions. Thisdocument does not set out a particular consultationprocess, but assumes that jurisdictions will requireconsultation steps in accordance with their relevantlegislation and as appropriate for the project. Someproponents may wish to do more than the requiredminimum.

In general, one would expect public input to thescoping and subsequent steps, as shown in the abovediagram. In particular, there must be an opportunityfor stakeholders to comment on a proposal before adecision is made.

3.1.2 Project descriptionOne additional preliminary step to those proposed inthe earlier NHMRC framework6 is highlighted – theneed for a comprehensive Project Description at thebeginning of the HIA, so that the reader is clear whatthe intention of the project is and what, in generalterms, the impacts might be.

If the HIA is part of a wider impact assessmentprocess such an outline may already be specified, inwhich case no additional explanation may benecessary. Otherwise the Project Description willusually include:

• the rationale, objectives and goals of the project;

• a description of the project including theprocesses, materials and types of equipment to beused and the building layout;

• sufficient detail of the planning, designing,construction, operating, maintenance anddecommissioning phases;

• types and quantities of inputs (energy, water andchemicals used in the industrial process) andoutputs (products and waste materials) and abrief discussion of their treatment and disposal;

• expected infrastructure, local facilities andservices (eg., electricity, water, sewerage, roads);

• advantages and drawbacks associated with theproject;

• perceived impacts on health, positive or negative;and

• emergency procedures and response plans forincidents that have the potential to impact on thesurrounding population.

3.1.3 ScreeningScreening is the process of determining whether ornot a proposed development warrants impactassessment. It is commonly governed by statute.

Screening for health issues is carried out as anintegral part of the overall screening process. It isusually, if not invariably, undertaken by the agencyresponsible for determining whether a developmentneeds to be assessed, and if so, to what extent.

All proposed developments that are required toundergo EIA should be screened for possible healthimpacts, as well as for other impacts. While this maynot ensure every project likely to impact on health isdetected, it will identify most, if not all, of thoselikely to have health impacts that are significant.

If health authorities wish to apply HIA more broadlythey would need to make other arrangements outsidethis framework to identify the projects or issues ofsignificance.

Screening is, firstly, a process of filtering out thoseprojects that do not require HIA because:

• the health effects are expectewd to be negligible;or

• the health effects are well known and readilycontrollable though measures that are wellunderstood and routinely applied, and so requireno specific investigation or analysis.

Identifying these early in the HIA process allowsscarce resources to be applied to assessment of thoseprojects with the most significant likely healthimpacts.

In considering health issues, the UK Department ofHealth3 has developed a screening tool to provideobjectivity, transparency and consistency in itsprocesses. This tool may be of use to health and non-health authorities when considering human healthissues, and details of it are given in Appendix 3 forease of reference.


3.1.4 ScopingScoping is the process of identifying the particularissues that should be addressed in preparing a HealthImpact Statement.

Scoping is the link between identifying the need forHIA, for one or more reasons, (ie. screening) and theactual assessment of the risks and the consequentdevelopment of management, monitoring andevaluation strategies. Scoping therefore needs to setthe framework for the Profiling, Risk Assessment,Risk Management, Decision Making and Monitoringand Evaluation steps shown in Figure 1 above. It is akey step, if not the most important step, in the HIAprocess.

Scoping includes:

1. Identifying the potential health impacts that needto be addressed by:

• identifying all the potential health impacts;and

• assessing which impacts are likely to beimportant and thus need to be addressed inthe HIA and which are not important.

2. Setting boundaries eg:

• timescale;

• geographical boundaries; and

• population covered, including demarcation ofany populations of special concern because ofrisk factors such as age, pregnancy, etc.

3. Identifying stakeholders that need to be involved,particularly those that will not already beinvolved in the routine impact assessmentprocess.

4. Agreeing on details of the risk assessmentbetween the proponent, the health authority andother stakeholders.

Responsibility for these steps typically rests with theproponent but the health authority will generallywork with the proponent to identify the level ofdetail and effort required. This must be in proportionto the likely level of health risk, based on objectivecriteria.

Where the project is such that an actual risk appearsto be low but the community’s perception of the riskis high, the risk management strategy should addressthis aspect.

Within the limits of the local legislativerequirements, proponents may choose the precisedetails of the scoping process they believe to be themost appropriate. There are, however, some stepsthat are strongly recommended.

Where there is a high level of community interest,proponents should involve the community early, inparticular at the scoping stage. Also, an earlymeeting with the health authority may avoidunnecessary work, identify relevant data sources,and apprise the proponent of the health authority’sview of the significant and less significant likelyimpacts on health.

A suitable process usually involves:

• an early meeting between the proponent and thehealth authority to discuss issues that may be ofconcern to the health authority;

• the health authority providing advice on issues(including parts of these Guidelines and otherreference material) that the proponent shouldconsider addressing and the level of detailrequired;

• discussion between the health authority and theproponent on models and methods that can beused to address the identified issues, assumptionsthat will need to be made, the contributions thatthe health authority can make, and where expertopinion may be required;

• the opportunity or necessity for periodicconsultation with the health authority;

• identifying sources of health and demographicdata (which may be provided by the healthauthority, on a cost recovery basis if necessary).

• identifying significant health stakeholders whoshould be consulted in addition to those routinelyinvolved in the impact assessment process;

• discussion on the need for monitoring that maybe required on health grounds during any phaseof the development, or after completion; and

• identifying relevant standards that will providesome benchmarks for planning, consultation andHIA.

Public and stakeholder consultation may form part ofthe scoping exercise but will also take place duringor following the preparation of the proponent’s final


proposal, depending upon the precise arrangementsfor impact assessment in each jurisdiction.

Figure 1 shows consultation as an all-encompassingbackground to indicate that it should occur formallyat some key points (this may vary betweenjurisdictions and between projects), rather than as astrict requirement at every step.

Informal consultation with interested parties and thewider public, throughout the process, may also bebeneficial. Thus consultation is a wide-rangingprocess that should occur continuously throughout aproject, not just at those points formally required bylegislation.

Scoping should identify any special stakeholders thatneed to be consulted outside of those included in theusual impact assessment process.

Scoping may also identify health concerns for whichpublic input should be especially sought, to moreclearly establish the community’s values andattitudes.

Approaches to community consultation are outlinedin Appendix 4, and the bibliography (Appendix 5)provides links to relevant material.

3.1.5 ProfilingProfiling describes key aspects of the health statusand general make-up of the population, particularlyin relation to factors that are believed to besusceptible to change or that may act as indicators ofanticipated health impact(s). It enables theidentification of, and characterisation of, thepotential health effects on the community, byproviding a baseline against which possible healthimpacts can be assessed.

Information that may be collected includes:

• Characteristics of the population covered, forexample:

– size;

– density;

– distribution;

– age and sex;

– birth rate;

– ethnicity;

– socio-economic status; and

– identification of at-risk groups, eg. at aged carefacilities, schools.

• Health status of the population, particularly of at-risk groups, eg. from mortality, disability andmorbidity data;

• Levels of employment/unemployment;

• Health behaviour indicators, if relevant eg. ratesof alcohol use and alcohol-related harms;

• Environmental conditions of the populationcovered, eg.:

– air/water/soil quality and ability to increasecapacity eg. of a water supply or effluentdisposal;

– transport issues if relevant; and

– quality and quantity of affordable housing.

• Locations where at-risk groups may beconcentrated, eg. particular streets/areas, schools,nursing homes, etc.

Many of these data are routinely available from localgovernment or the relevant health authority or othergovernment agency, eg. the Australian Bureau ofStatistics (ABS).

3.1.6 Assessing the health impacts(risk assessment)

The risk assessment process should identify theimpacts that a proposed development is likely tohave on health. These effects could be negative,resulting from exposure to a hazard, or positive suchas improved recreational opportunities or jobopportunities. This is an aspect overlooked by thetypical assessment that does not fully considerhuman health, and is one reason to include abroader view of health in the impact assessmentprocess.

Assessment of risk may be done by assessmentagainst health-based guidelines, it may be aquantitative assessment, or use qualitativetechniques, or it may use a mix of these approaches.

3.1.6.1 Risk assessment using health-basedguidelines and objectives

Health-based guidelines and objectives assist inconsistently and reliably assessing health risks,ensuring safety in the situation to which they arerelevant. Guidelines and objectives have beendeveloped for environmental and occupationalhazards, including noise, pollutants, radiation andmicrobiological agents.


Guidelines are prepared by national and State/Territory agencies as well as international bodiessuch as the WHO. They provide a straightforwardmeans of predicting impacts, but they do not existfor every possible environmental health hazard.Ideally, predicted levels should have insignificant orlittle effect if they fall below the levels as specified bythe guidelines or objectives. Guidelines should,however, be used critically. Reasons for cautioninclude:

• most guidelines are developed to protect againstspecific types of health effects. They do notnecessarily guarantee protection from all types ofadverse effects, and reflect the science at the timeof publication;

• they do not necessarily address the social,community or psychological dimensions of healthand well-being effectively;

• they may apply to occupational exposure and arenot directly applicable to public health;

• they may not identify positive effects on health;and

• they may not fully account for factors such as theage and sex of a person. For instance, children,the elderly and pregnant women may be moresusceptible to some environmental healthhazards.

If no regulatory standards or objective criteria areavailable, other modes of evaluation are used. Otherapproaches that can be used to assess a project’spotential effects on health include risk-basedanalyses that may be quantitative or qualitative.

Whatever method is used will also need to addressthe concerns expressed by stakeholders and thepublic, as well as any other risks that are identified.

3.1.6.2 Quantitative risk assessment

The basic risk assessment process is set out in Figure2, which was taken from a draft of EnvironmentalHealth Risk Assessment – Guidelines for AssessingHuman Health Risks from Environmental Hazards9.

Given that positive effects are also to be included,risk assessment may not be the ideal term but it isused for the sake of uniformity with the 1994NHMRC publication6 and similar risk assessmentframeworks.

Environmental Health Risk Assessment9 provides amethodology for assessing risk from chemicalhazards in considerable detail; reference to thisdocument is recommended for those undertakingsuch assessments.


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

•

Risk

Characterisation

•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


3.1.6.3 Other methods of risk assessment

Often sufficient data are not available to allowquantitative risk assessment (QRA) to beundertaken, and alternative methods will need to beused. In some instances the alternative methods maybe used as an adjunct to QRA. Techniques usedinclude:

• expert opinion, such as a Delphi study orworkshop on the risks;

• views and perceptions of the community andother stakeholders; and

• other published material on analogous situations.

The Canadian Handbook on Health ImpactAssessment4 includes a table (see Table 3) forassessing impact significance which is a useful guideto non-quantitative risk assessment.

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 North, 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 repetitive?) If repetitive, then how often?

Cumulativeimpact

The potential impact that is achieved when the particular project’s 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 itbeen 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,regulatory, 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?


3.1.7 Managing the health impactsidentified as being of significantrisk

Risk management is the process of evaluatingalternative actions, selecting options andimplementing them in response to risk assessments.The decision making will incorporate scientific,technological, social, economic and politicalinformation. The process requires value judgements,eg. on the tolerability and reasonableness of costs.

Alternative actions may be identified by theproponent or through a community consultationprocess.

Once possible health impacts have been identifiedand assessed, desirable and undesirable impacts canbe sorted into those of significance and those thatare not.

Actions to maximise potential health benefits andminimise or prevent the potential risks to health areidentified.

Recommendations to the decision-making authoritymay be made by the health authority or by others, inaccordance with the regulatory or administrativearrangements in the particular jurisdiction.Recommendations may be to modify the proposal,consider alternatives where available, or imposeconditions on its implementation. One alternative,where the risks have not been, or cannot be,adequately addressed, may be not toproceed.

This stage may also involve a substantial publicconsultation element, including:

• how impacts identified during screening andscoping have been addressed; and

• demonstrating that impacts identified by thecommunity as being important to them have beenadequately considered and what action has beentaken.

3.1.8 Decision makingThe decision making process incorporates scientific,technological, social and economic information andmust take into account the community concernsidentified during consultation processes.

The decision-making capacityfor an impactassessment does not lie within the health authority.This does not matter so long as the health authorityis well linked in to the process and communicationbetween health and the decision-maker is adequate.The important issue is to have health impactassessment as part of the overall impact assessmentprocess.

Negotiation may occur between the environment,planning and health agenciesii to ensure acomprehensive, coherent and workable set ofchanges or conditions are applied to any proposal.

Recommendations and decisions, and the reasons forthem, should be publicly available.

3.1.9 Monitoring and evaluationThere are two types of monitoring and two types ofevaluation that may need to be undertaken.

Monitoring

• monitoring of the conditions applied to adevelopment.

Routinely undertaken for many developments, bothduring construction and after operation of thedevelopment commences.

• monitoring of the health impacts during and/orafter the development, as required.

This is an added requirement if, in fact, anymonitoring of health impacts is needed. Adversehealth impacts are often ‘designed out’ to the point ofpresenting negligible additional risk, in which casemonitoring is not required (beyond monitoring thatthe controls are actually implemented – see previouspoint).

If a particular risk to health cannot economically becontrolled to an extent that ensures no significantadditional public health risk, then monitoring ofhealth status, or indicators of the risk thereof (suchas noise or dust levels, rather than deafness orasthma) may be necessary.

Health monitoring is discussed in detail in Appendix 6.

ii Within a local government these three aspects may all be considered within the one agency if it has decision-making powers for thatdevelopment.

Evaluation

• evaluation of the efficiency of the HIA process.

The intent when dealing with risk should not be toreduce it at all costs or to reduce it to a negligiblelevel, but rather to balance the benefits and costs tothe community of reducing the risk10. There iseconomic cost to the proponent (money and time)and to the health authority (the opportunity cost ofthe assessment activity) and these should be offsetby the health or economic gains that result from theproject’s improved consideration of health issues.

• evaluation of the health outcomes – is the HIAprocess effective and are health outcomesimproved as a result of it?

This requires assessment of the actual healthoutcomes achieved (positive and negative) as a resultof undertaking HIA, with a view to evaluatingwhether the process is effective in maintaining orimproving the health status of the community.

Both of the evaluations mentioned above shouldideally be undertaken across a series of HIAs, sometime after they have been implemented (ie. once theoutcomes can reasonably be determined).

3.2 The precautionary approachThe NHMRC framework document6 suggests thatwhen the scientific basis for a risk assessment is stillin the early stages of development, decisions shoulderr on the side of caution. This is often referred to asa precautionary approach.

What is meant by the precautionaryapproach?

Definitions of the precautionary approach vary, butthe most widely internationally accepted is thatdescribed in Principle 15 of the Rio Declaration onSustainable Development (UNCED, 1992)11. Thisstates:

“In order to protect the environment, theprecautionary approach shall be widely applied byStates according to their capabilities. Where thereare threats of serious or irreversible damage, lackof full scientific certainty shall not be used as areason for postponing cost-effective measures to

prevent environmental degradation.”

In Australia, some jurisdictions have included thisconcept, variously referred to as the ‘precautionaryapproach’ or ‘precautionary principle’, in agreementsand legislation. In February 1992, the Inter-governmental Agreement on the Environmentincluded the following as part of a commitment tosustainable development:

“Where there are threats of serious or irreversibleenvironmental damage, lack of full scientificcertainty should not be used as a reason forpostponing measures to prevent environmentaldegradation. In the application of the precautionaryprinciple, public and private decisions should beguided by: (i) careful evaluation to avoid, whereverpracticable, serious or irreversible damage to theenvironment; and (ii) an assessment of risk-weighted consequences of various options.”

Whilst the Inter-governmental Agreement on theEnvironment is aimed at environmental protection,the Rio Declaration, within the context ofsustainable development and Agenda 21, makes itclear that the concept is equally applicable to humanhealth and wellbeing.

The precautionary approach is not intended to be adevice to inhibit development. However, proponentsmay need to consider and discuss health risks thatare uncertain as well as those that are well defined,including an indication of the degree of uncertaintyand where the uncertainty is thought to lie.

A precautionary approach is limited in its utility bythe uncertainty as to its meaning and application.Caveats that apply to its use includeiii:

• Implementation of a precautionary approachshould start with an objective risk assessment,identifying at each stage the degree of scientificuncertainty;

• All the stakeholders should be involved in thestudy of the various management options thatmay be envisaged once the results of the riskassessment are available;

• Regulatory measures taken should beproportionate to the risk which is to be limited oreliminated;

iii Adopted from Health Canada. 2000. Therapeutic Products Programme Strategic Framework for 1999-2002.

• measures based on a precautionary approachshould be able to establish responsibility as towho should furnish the scientific proof needed fora full risk assessment; and

• measures based on a precautionary approachshould always be of a provisional nature, pendingthe results of scientific research performed tofurnish the missing data and performance of amore objective risk assessment.

3.3 Roles and responsibilities3.3.1 Responsibilities of the

proponentThe proponent should satisfy the requirements of theimpact assessment process set out in the relevantjurisdiction.

This process should include the need to explicitlyaddress potential impacts on human health. TheseGuidelines are intended to assist proponents to dothis.

If proponents are in any doubt as to what to do theyshould contact the relevant health authority.Proponents are also encouraged to contact the healthauthority as soon as they identify a potentiallydetrimental human health impact, to discussacceptable means of preventing or ameliorating theimpact.

3.3.2 Responsibilities of the PublicHealth Authority

The health authority will facilitate development ofthe health impact statement (HIS) by the proponentthrough:

• discussing the HIA process, methodology, specifichealth concerns, sources of data, resources andcost recovery (if applicable) as required – a keyfocus being to ensure that the overall level ofeffort is in proportion to the level of risk;

• providing or identifying potential sources ofrelevant health and demographic data, whereavailable;

• participating in the screening and scopingprocesses, including visiting the site of thedevelopment if practicable;

• reviewing the health components of the draftimpact assessment report;

• providing advice to the proponent when theyaddress the concerns raised during publicconsultation. The HIS may need to be modified,extended or otherwise changed and monitoringconditions imposed to address the communityconcerns (depending upon the process used tomanage public comments in the jurisdiction);

• making recommendations to the approvingauthority concerning the potential health impactsof a developmentiv;

• participating in the health monitoring andevaluation, as appropriate;and

• liaising with the decision-making agency.

3.3.3 Responsibilities of the decision-making agency (environment orplanning)

The managing agency should:

• include human health as an issue to be addressedin the guidelines and standards that prescribe anddescribe the impact assessment process;

• encourage proponents to make contact with thepublic health authority early in the process;

• refer development applications requiringassessment to the health authority forconsideration in a timely fashion;

• provide the health authority with the results ofmonitoring and evaluation related to publichealth, when they are provided by the proponentor other agency;

• provide feedback to the health authority on HIAprocedures as they impact on the overall impactassessment processes; and

• liaise with the health authority as required.

iv Most jurisdictions tend to have one decision-making authority, which may be a Minister, a Board or the Chief Executive of therelevant planning or environment agency. The precise relationship between the health authority and the decision maker needs tobe considered. The purpose of this paper is not to say what they should be – that will depend upon the laws and administrativearrangements in each jurisdiction.


4 Preparing a Health ImpactStatement

This section provides supplementary and additionalinformation and ideas on how to undertake asuccessful HIA (and in so doing, prepare asatisfactory Health Impact Statement).

While the basic steps have been described and theessential content of each outlined, actuallyundertaking a HIA will still involve a great deal oflearning. Successfully undertaking a HIA will requirepractice and may be difficult at first for bothproponents and health authorities.

4.1 Content of a Health ImpactStatement

In preparing a Health Impact Statement it isnecessary for the proponent to consider what dataneed to be included. The level of detail and the rangeof issues canvassed will depend upon the healthimpacts identified during the scoping stage.

This section attempts to provide guidance on issuesthat might be considered. It is not expected thatevery issue outlined here should be covered, nor is itnecessary that there be an explanation of why issueslisted here are not covered.

4.1.1 Details of the proponent andthe development

Certain details will be required under the statutoryimpact assessment framework in each jurisdictionand it is unlikely that this will need to be added tofor health purposes. If only a HIA is necessary, thesesame requirements are likely to provide sufficientinformation and may be used as a guide byproponents.

Details of the development, its site(s), site history,and site climate should be covered in the standarddetail provided.

4.1.2 Details of the affected orinterested communities

The size of the local population, particularly thatliving close to the site, and details of that communityare essential to the HIA.

Profiling is the first step of the appraisal andinfluences the risk assessment and resulting riskmanagement and communication strategies.

The local population that is relevant may be definedin many ways. If the community is small it maysimply be the whole community, or it may be acommunity not near the site but on a transport routeto it, or it may be some other community that self-defines itself as having an interest. In the latter casewhile communication must be maintained, healthprofiling may not be necessary. The basis of choice ofthe boundaries should be explained by theproponent.

4.1.2.1 Demographic data

Demographic data should correspond as closely aspossible to the defined community, however suchdata may be difficult to obtain for small areas exceptby direct survey. The cost of a survey would only bejustified in exceptional circumstances. An alternativemay be to discuss with key informants anydifferences between the data for the larger areacovered by the demographic (usually ABS) data andthe area itself. For example, an industrial area mayhave very few residents, and therefore few ABSsurvey respondents, while having a large populationin workplaces during the day. Furthermore, any datainvolving small populations, however obtained, maylack epidemiological power, ie. lack ability to reliablydetect significant health effects.

4.1.2.2 Health data

Health (or illness) data may be similarly difficult toobtain. Morbidity data collections usually cover wideareas (eg. to postcode level) and usually reflectillness rather than health. The health of the relevant


population may, therefore, also require inference ofhealth status from data available on the regionalpopulation. Very local health data, if available, maybe subject to confidentiality requirements as it maybe identifying. There will be ethical andconfidentiality constraints on the use of any suchdata and it may only be accessible to the State/Territory health authority.

Health data collected might include crude andstandardised mortality data, morbidity data fordiseases related to potential health impacts, eg.mosquito-borne disease notification rates, or datameasuring the prevalence of chronic diseases ofconcern.

4.1.2.3 Special populations

The data collection may need to identify specialpopulations who may be at greater risk of adversehealth effects. For example a ‘top end’ Indigenouspopulation may have substantial outdoor exposureand would therefore be more at risk of an increase inmosquito-borne disease, such as Murray Valleyencephalitis, from a new dam. Other groups thatmay need to be considered include the young, theelderly, and the poor.

Some facilities may be significant in terms of riskexposure. These include child care centres, schools,aged care facilities (domiciliary or day care). Theproponent needs to consider the existence of anysuch facilities and the health impacts that may bemore significant for such groups (which may be assimple as road-crossing being more/less dangerousdue to altered traffic flows).

Notwithstanding the difficulties, profiling should bepossible with sufficient accuracy to obtainrepresentative data on the age structure, socio-economic status and health status of a population.Provided special local factors such as child care oraged care centres are taken into account, areasonably clear picture of the population should bepossible. Should this not prove to be the case theproponent should discuss with the health authoritythe level of detail required for the profiling step.

4.1.3 Environmental health dataA range of environmental factors affect health,notably food, water and air quality, and wastedisposal (solid, liquid and hazardous wastes if any).It is easier, more sensitive and usually more useful tomeasure the hazard directly, rather than measure illhealth.

Indicators must be chosen that reasonably reflectboth the health impacts that were identified as beingof importance during the risk assessment andmanagement steps (see Box 3, steps 4 and 5), andthe effectiveness of their amelioration (or not).

Indicators of health need to be:

• available at reasonable cost;

• valid and reliable reflections of the actualsituation;

• closely linked to actual health outcome;

• timely – ie. rapidly reflect change when a healthimpact occurs;

• able to be acted upon directly, without furtherdelay or further data collection; and

• readily understood by non-technical people.

4.1.3.1 Air quality

One key area of health concern is indoor andoutdoor air quality. If a development is likely to haveany influence on either indoor or outdoor air qualitythen likely health impacts should be assessed.

Changes in indoor air quality may arise from a widerange of factors, eg. construction materials orequipment used in a building, from outdoor dustcreation, from environmental tobacco smoke, orthrough the entrapment of other pollutants due toinadequate ventilation.

Outdoor air may be affected by the handling of dustymaterials, such as ores or grains, by the emission ofgases such as sulfur dioxide or other smokestackemissions, including particulates or dioxins, andvehicle emissions.

Whatever the source of pollution, it requires carefulestimation of the area likely to be affected, theintensity and duration of the effect and the level ofhealth impact (actual health effects) on the at riskpopulation. Modelling of the dispersion of airbornematerials is a specialist task, as is the estimation ofhealth effects once the dispersion model isdeveloped.

4.1.3.2 Food

If there is the possibility of a development having animpact on the quality, quantity or the price of foodthis should be noted and discussed in the HIS.


Impact on food production or on food producing landor water would almost certainly be addressed by anEIA but these data would be of interest to the HIA aswell.

4.1.3.3 Water (not including wastewater)

The use of local water by a proposed developmentand the likely impact on the surface, ground waterand drinking water is a fundamental health concern.It is also an environmental concern and so will beaddressed to a significant extent, if not fully, by theEIA process. However, there may be some aspectsthat require specific attention from a healthperspective.

The proponent should provide a detailed descriptionof the local water supplies, including non-potablewater, and any beneficial uses which the water is, orcould be, put to. Particular attention should be paidto any impacts on the potable water supply.

Impacts might be from additional consumption thatdepletes reserves or reduces access, chemicalcontaminants (nutrients, heavy metals, etc)microbial contaminants, loss of amenity of lakes orother surface water, impact on fish used for food, etc.

4.1.3.4 Wastewater

The disposal of wastewater can have health impacts,whether or not the wastewater contains sewage.Improper disposal of stormwater can lead to loss ofamenity and may be hazardous. Disposal of sewagemay be a problem in that control of nutrients andmicrobes can be difficult or expensive; it typicallyrequires a considerable area of land well away fromhousing and most other forms of development, andimproper disposal quickly becomes a health hazard.

Industrial wastes pose differing hazards, dependingupon their constituents. They often require furtherspecialised treatment before discharge to sewer or tothe local effluent disposal system. These details willbe required for any health assessment.

If wastewater is to be produced in any quantity andis not simply discharged to sewer, full information onits expected volume, content and method of disposalis likely to be required (note that this informationmay be included in existing impact assessmentprocedures now). These details could include:

• the biological oxygen demand;

• heavy metal content;

• pH;

• concentration of nutrients – nitrogen, phosphoruscompounds;

• pathogens of special significance, eg. Giardiawhich 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 orincreased access or cost would be likely to result in ahealth impact. If large enough such possible impactswould warrant inclusion in the Health ImpactStatement.

Some developments may enhance communityinfrastructure through directly funding the provisionor upgrading of services or though the payment ofrates which enable improved community services.These have the capacity to improve health directlyor indirectly and should be included in the HIAprocess.

4.1.3.6 Transport

One issue that may have significant health impactbut which is not usually considered in a healthcontext (except in relation to injury) is transport,both public and private.

Improved public transport may have the effect ofimproving equity, improving access, reducingisolation and increasing opportunities for work andsocial activity. Use of public transport can evenincrease exercise through walking to the bus or trainstop. Cycleways provide an environmentally friendly,healthy way to travel. Improving road systems canreduce (or increase) noise, pollution, and the rate ofinjury to motorists and pedestrians. Areas of loadingor unloading can be problematic because of noiseand because of materials that may be hazardousbeing handled there.

HIA for a development that directly or indirectlyaffects means of transport or traffic levels to asignificant extent, needs careful consideration. Itshould entail description of existing services andtraffic levels related to either movement of people ormaterials (particularly hazardous materials), theanticipated or planned changes to those services andassessment of their positive or negative effects onhealth and amenity. Links to examples of HIAs ofmajor public transport schemes overseas are given in


the bibliography (Appendix 5). The UK hasundertaken a number of such HIAs.

4.1.3.7 Storage, handling and disposal ofhazardous materials

Hazardous materials storage and handling is a goodexample of a health issue that is typically welladdressed by current impact assessment processesand it is unlikely that further basic data would needto be provided for a HIA. The organisation of thematerial might need to be more focussed on humanhealth, however, which may only require better crossreferencing within the proponent’s impactassessment.

4.1.4 Social impactsSocial impact assessment is important to HIA in thatthe health and social impacts are inextricablyintertwined. While these can overlap, health impactand social impact require different analytical skillsand need to be assessed separately.

Where social impacts are of importance to healththey should be addressed by the HIA. As discussedabove, the level of intervention needs to beproportional to the degree of risk and potentialimpact of that risk.

4.1.5 Economic impactsAs for social impacts, the HIA process should notbecome an economic assessment process. Economicimpacts need only be mentioned where they are alsoimportant health impacts; their analysis should beindependent from the HIA.

4.1.6 Actual assessment of the healthimpact

The list of health impacts developed by Canter(given in Table 3, p.18) provides a useful set ofcriteria against which to evaluate a proposal. It givesthe proponent a guide as to the types of impact thatmay be required to be addressed by a healthauthority.

From these criteria a set of weightings might be givento the positive and negative health effects and wherethere are substantial negative effects that are capableof amelioration or mitigation, a health authority canconsider recommending conditions be applied to theapproval. A list of possible mitigating actions is givenin Box 4 below.

If negative impacts are substantial but not capable ofamelioration, the fate of the proposed developmentneeds to be seriously considered against the healthand other benefits identified for it.


Box 4

Possible means of mitigating the unacceptable health impacts of adevelopment

• Alter processes or the design or choice of structures, equipment or other details to reduce the risk, or adverse health impact,experienced by the population. This could include changing the process/chemicals used, installation of pollution controlequipment, safety equipment, altering speed limits, providing training, providing remote siting for a hazardous facility, etc.

• Enhance operational safety by requiring that staff be provided with appropriate training.

• Monitor to reduce the likelihood of adverse health impacts during and after site operations.

• Establishment of public health surveillance systems to monitor health effects of the development during and afterimplementation.

• Ensure that potential problems are detected early and that contingency measures are in place to facilitate early response.

• Ensure that emergency procedures and response plans are in place in the event of an acute exposure or major incident.

• Modify land use planning to ensure that the development is not placed near nor becomes close to sensitive areas.

• Modifications to infrastructure to reduce the adverse health impact.

• Remove the risk and restore the environment at any stage of the development but especially at the close of operations (eg siteremediation).

• That procedures, structures or other aspects of the development can be altered in the future in response to monitoring results(includes any monitoring of health, biological or environmental indicators that reveals an increased or unexpected risk to healthdue to the development).

• Ensure that services are available to deal with any potential adverse health events including training of health personnel whererequired.

• Consider the special needs of workers and any at-risk groups in the affected populations.

• Undertake measures aimed at building public confidence and trust in the approach taken by project management.

• Compensation payments to affected populations (financial or other contributions to groups or individuals). Any compensationshould be paid in a way that optimises the mitigating effects of the compensation.


5 Conclusion

In seeking to improve consideration of health issuesassociated with development activity theseGuidelines have outlined the importance of HealthImpact Assessment as part of the overallexamination of a proposal and described the mainsteps involved in the drafting of a Health ImpactStatement.

In particular, HIA at the planning level can be a veryuseful tool, as it can:

• facilitate maximisation of positive health impacts;

• facilitate minimisation of negative health impactsbefore they occur; and

• strengthen the likelihood of sustainabledevelopment.

The likely general roles of the proponent andgovernment agencies, and some of the key healthconcerns that may need to be considered whenundertaking a HIA, have also been discussed.

Importantly, the Guidelines call for HIA to be betterintegrated into the assessment processes already inplace across the country; they do not advocate thecreation of new evaluation processes. Neither havethe Guidelines tried to be too prescriptive about howto conduct a HIA, this being largely precluded by theextent of variation across jurisdictions. Anyimportant additional details will need to be factored-in by the key agencies in each jurisdiction wheninvolved in a HIA.

Health and wellbeing are intimately linked to thestate of our surroundings, better understanding theselinks can lead to benefits for all.


Appendix 1: The AustralianExperience with Health ImpactAssessment – HIA in TasmaniaThe need for HIA was strongly endorsed by theNHMRC in 1992. Although other Australian statesrequire some form of HIA, to date Tasmania is theonly Australian jurisdiction to have introducedlegislation requiring formal HIA. The incorporationof HIA in the resource management and planningsystem in Tasmania was a major initiative resultingfrom the review of public health legislation inTasmania.

The Environmental Management and PollutionControl Act, 1994 (EMPCA), was proclaimed inJanuary 1996, and empowers the Director of PublicHealth to require that an Environmental ImpactAssessment include an assessment of the impact ofan activity on public health. The power of theDirector of Public Health to require HIA applies to allactivities which by law require EnvironmentalImpact Assessment (EIA). HIA is fully integratedwith EIA processes, in accordance with theprinciples identified in the National Framework forEnvironmental and Health Impact Assessment6. Inpractice, all activities requiring an EIA now alsomust have a HIA.

Since 1996, HIA in Tasmania has been based on draftGuidelines for Health Impact Assessment preparedby the then Tasmanian Public and EnvironmentalHealth Branch, in accordance with the broadprinciples identified in the National Framework forEnvironmental and Health Impact Assessment.

Legislative backgroundSubsection 74(5) of the EMPCA provides for theDirector of Public Health to direct that an EIAinclude a HIA. HIAs are required to be conducted inaccordance with the EIA Principles contained in theEMPCA Section 74.

It is intended that HIA be fully integrated with theoverall EIA process. Applicants, in preparingEnvironmental Impact and Health ImpactStatements, are not required to repeat general

material or address shared issues separately, unlessaddressing such issues or material independently isthe most effective way to represent them accurately.The Tasmanian draft HIA guidelines are used inconjunction with the Environmental ImpactAssessment Manual produced by the TasmanianDepartment of Environment and Land Management.

EMPCA establishes 3 categories of proposeddevelopments or activities, based on their potentialto cause environmental harm, which is defined verybroadly in the legislation. The categories are:

• Level 1 activities, which are likely to cause minorenvironmental harm;

• Level 2 activities, which are more significant(examples are outlined in a schedule); and

• Level 3 activities, which are of “statewidesignificance”.

The Environmental Assessment Manual distinguishesEIA as carried out by the Board of EnvironmentalManagement (the Board) for Level 1 referredactivities and Level 2 activities, from environmentalassessment as carried out by planning authorities forLevel 1 activities. In a similar manner, HIA is carriedout by the Director of Public Health for Level 1referred activities and Level 2 activities and, whererelevant, health assessment should be carried out bya planning authority for Level 1 activities.

When assessing health impacts it is important toconsider the immediate effects of foreseeable eventsupon the health of the community and to alsoconsider the effects of events and increased demandsupon existing and planned community, health andemergency services.


Criteria for activities likely torequire HIA or health assessment

Assessment (either HIA or health assessment) shouldbe required for activities which exhibit any of thefollowing characteristics:

• the possibility of substantial change to thedemographic or geographic structure of acommunity;

• potential exposure of individuals to hazardousproducts and processes, including substances thatare clinical or infectious;

• changes to the environment that may impact ondisease vectors or parasites;

• the potential to render recreational facilities orwater resources unsafe;

• potential impact on land productivity forhorticultural and/or pastoral activities;

• impact on the microbiological or chemical safetyof food chains and food supplies;

• substantial increase in the demands on publicutilities;

• increased traffic flow with increased risk of injuryor significant increase in the release of pollutants;

• generation of a high level of public interest inand/or concern about public health issues;

• identified ecosystems which are vulnerable, anddamage to which may cause health effects;

• potential exposure of the public to contaminants;

• potential impacts on the incidence of illness orinfection in the community, especially in relationto populations such as children and the aged.

Process for HIALevel 1 activities can be “called in” to the EIA/HIAprocess, if the Director of Public Health is concernedabout potential health impacts.

All level 2 and 3 activities are subject to EIA and HIA(the EMPCA requires that all EIAs include explicitHIA).

HIA and EIA are undertaken in accordance withvarious principles detailed in the legislation:

• the level of assessment should be consistent withthe health and environmental significance of theactivity, and the likely public interest;

• the Director of Public Health can specifyrequirements for the contents of a proposal;

• the Director of Public Health should provide theproponent with guidance on potential healthimpacts/issues of concern, and the level ofassessment required;

• there must be public consultation during theassessment; and

• information on health and environmental impactsshould be publicly available.

In Tasmania, the sequence of events in undertakinghealth impact assessment is essentially the same asdescribed in the body of these guidelines.

Perspectives arising from HIA inTasmania

1. HIA is not a separate discipline but a focussing ofmany existing disciplines on particular issues andprojects.

HIA involves using a range of public health andrelated skills in new ways, rather than being anew discipline itself. It is also more of an exercisein lateral thinking involving health concepts thanfollowing checklists.

It is helpful if those carrying out HIA have a broadexperience with health, environment, regulatory,and land use planning issues so that as manyissues as possible are considered in the screening/scoping process. For some larger projects specialexpertise in a particular discipline may be sought.

2. HIA is a decision support tool and not a decisionmaking tool.

Because HIA is part of the EIA process, healthauthorities reviewing the HIA will not usuallyhave any statutory power of veto over adevelopment. Health authorities will provideadvice and recommendations to whateverstatutory body is ultimately responsible. Othercomponents of the EIA will need to be consideredby the community and the decision-makingauthority, along with HIA, in deciding whether adevelopment proceeds or has special conditionsattached to it.


3. Consult widely before calculating deeply.

There are detailed tools available for numericalassessment of human health risks fromcontaminants in ground, water and air. The basedata and resources to use such tools may not beavailable or appropriate for smaller projectswhich have a HIA component. Screening andscoping are always required to ensure thatimportant health issues are not overlooked beforecarrying out such calculations.

In practice, it seems that the most usefulinformation more often comes from the screeningand scoping rather than from the calculations.

Appropriate local consultation is important. Forexample, most municipal council environmentalhealth officers have a wealth of experience andknowledge about the history of particular areas,industries and local health problems and localattitudes. This form of consultation should bestandard practice, even where it is not formallyrequired by legislation.

4. Scoping is the essence of HIA.

The possible health consequences, direct andindirect, of a development may be numerous. Inthe preparation of HIAs it is usually preferable toscope the significant health issues and to have thebulk of the HIA related to assessment of theseissues. If not, the HIA may be dominated by along list of possible health issues which are oflittle consequence. It is important to show thatother issues were considered however, and thismight be done in association with anyenvironmental checklists in the rest of the EIA,where there would be some overlap. Communityinvolvement in scoping is also highly desirable.

5. Consult early with the proponent.

This will enable consideration of alternatives andmodifications so that the likely impacts areminimised. In practice this has been found to beimportant by reducing time delays and extracosts, if changes are requested later in theassessment process. It is important that thissequence of consultation, be it with governmentor the public, together with any projectmodification, is described in the HIA.

In some cases consultation may involve the PHAassisting the proponent to undertake the HIA

component of the EIA. This assistance hasgenerally been appreciated and to date there havebeen no major problems or objections to arequirement for HIA.

6. Consider positive impacts on health also.

Environmental impact assessments often focus onnegative effects or risks. However, there may besignificant positive health impacts and it isimportant that these be effectively assessed.

For example, a new sewage treatment plant wouldlead to better water quality downstream from thedischarge point and this would affect health inrelation to the suitability of the water forswimming or possibly drinking purposes.Increased employment and income in acommunity would also have beneficial healthimpacts.

7. HIA does not add greatly to the cost of developingEIA.

The experience so far has been that HIA does notincrease greatly the size or cost of an EIA. Almostalways the consultant preparing the EIA has beenable to prepare the HIA component, with someassistance, and has not needed to engageadditional consultants. However, as acceptance ofHIA and further evolution of the methodologyoccurs, HIA may become more detailed and theremay also be a greater role for specialist HIApractitioners.


Appendix 2: The AustralianCharter for Environmental Health

Australians are entitled to live in a safe and healthyenvironment. The Charter identifies the basicentitlements and responsibilities required tomaintain and improve the quality of health for allAustralians.

The National Environmental Health Strategy(1999)1 emphasises that people share responsibilityfor securing good health with their government, andcannot merely depend on others for their ownprotection. No single organisation has the capacity tofulfil the Charter’s objectives. Recognisingenvironmental health as an entitlement helpsencourage stakeholders to become involved in thecooperative management of problems.

Although not all of the entitlements can be met atthis stage, it should be the aim of the Australianpeople that strategies are developed to ensure that allaspects of the charter are eventually met.

Environmental health entitlements cannot beabsolute, as the total absence of risk is not possible.The entitlements spelt out in this charter onlyextend to what can be practically achieved. Theprinciples that underpin this charter and guideactions arising from the Strategy are shown in Box 1on the following page.


Box 1

The Australian Charter for Environmental Health’s Guiding Principles(NEHS 1999)1

• Protection of Human HealthProtect human health by identifying threats posed by environmental hazards as early as possible and by introduc-ing appropriate safeguards. Ideally, these should be sustainable and cost-effective.

• Interrelationship between Economics, Health and EnvironmentEconomic development, human health and environmental protection are inextricably linked. Economic develop-ment should proceed hand-in-hand with measures to protect the environment and promote high standards ofenvironmental health.

• Sustainable DevelopmentFuture human health requires that development meets the needs of the present without compromising the abilityof future generations to meet their own needs.

• Local and Global InterfaceChanges to local and global environments are interactive and have a significant ability to impact on human health.Environmental health programs need to take into account that global environment protection requires localaction and that local actions impact globally.

• PartnershipPlanning, implementing and evaluating environmental health programs requires that all involved work together:the general public, Commonwealth, Local, State and Territory governments, industry and business, non-govern-ment agencies, and the health and scientific communities. This cooperation should extend to include policies andprograms that are not environmental health specific, but which have an environmental health component orimpact.

• Risk-based management

Risk assessment and management are tools used to address existing or potential environmental threats to humanhealth and the adverse effects on people, communities and economic interests. It includes assessing the likelyimpact of these threats and the development and implementation of strategies for their prevention, minimisationor removal.

• Evidence-based decisionsDecisions and deliberations must be based on a careful analysis of available scientific evidence about potentialenvironmental risks to human health. However, absence of conclusive evidence is not an excuse for inaction.

• EfficiencyImproving the delivery of environmental health services, encouraging innovation, and careful examination of howenvironmental health services are provided – including the relative costs and benefits of each alternative – areimportant considerations for optimal environmental health outcomes.

• EquitySocioeconomic status and other social factors such as access to community networks, family support andeducation, are key determinants of health. Providing all Australians with access to appropriate environmentalhealth services will help reduce the gaps in health status between different population groups.


Charter of Entitlements andResponsibilities for Individuals,Communities, Business andGovernment (NEHS, 1999)1

1 Individuals and CommunitiesEntitlements – Individuals and communities areentitled to live in a safe and healthy environment.This includes:

• safe and adequate supplies of water;

• safe and nutritious food;

• safe and adequate sanitation;

• clean air;

• safe and sustainable shelter;

• urban and housing designs that promoteenvironmental health;

• environmental management systems that protectenvironmental health;

• safe occupational environments and workpractices;

• safe and adequate recreational facilities,including water;

• information about environmental health issues;and

• being consulted on plans, decisions, and activitieslikely to affect both the environment and health,and to open and transparent decision making onthese issues.

Responsibilities – Individuals and communities areresponsible for:

• ensuring their own actions contribute to theprotection of the environment in the interests oftheir own health and the health of others;

• participating in decision-making processes onmatters likely to affect both the environment andhealth; and

• ensuring their environmental health services aredelivered to a high standard.

2 Business and IndustryEntitlements – Business and industry are entitled to:

• Management systems (legislative, regulatory andother) that:

– promote health and the environment whilerecognising business interests;

– recognise industry capacity for self-management in a co-regulatory environment;

– provide access to appropriate support, adviceand information on environmental health; and

– provide information on environmentalhazards.

• Consultation on environmental health decisionsthat affect business; and

• Guidelines and standards which:

– place a reasonable regulatory burden onindustry;

– support industry capacity to manageenvironmental health;

– are developed transparently; and

– are consistently and fairly applied.

Responsibilities – Business and industry areresponsible for ensuring that they:

• use opportunities and practices that minimiseadverse impacts on human health;

• seek and use alternatives to hazardous agents andpractices wherever possible;

• reduce levels of pollution and waste whereverpossible;

• maintain a high level of occupational health andsafety;

• ensure consumer and product safety;

• have a contemporary knowledge of the potentialenvironmental health risks arising from theirprocesses; and

• recognise that they are an integral part of thecommunity and therefore have communityobligations.


2.3 GovernmentResponsibilities

While the charter recognises the responsibilities ofindividuals, communities and business, governmenthas an obligation to make a major contribution toprogressing this Charter. Government has been andremains responsible for most of the investment inthe infrastructure that underpins the delivery ofenvironmental health services.

Government at all levels is responsible for providingdirection and leadership in environmental healthpolicy and management through:

• setting clear management standards that areconsistent across governments;

• ensuring effective mechanisms for linkagesbetween agencies to achieve improvedenvironmental health outcomes;

• ensuring appropriate environmental healthinfrastructure and services are available andeffective;

• ensuring seamless transition betweenjurisdictions and agencies, especially inmanagement of environment and environmentalhealth issues;

• ensuring that planning and regulatory decisionsrecognise that the integrity and sustainability ofthe ecosystem must be maintained;

• transparent and consultative decision-makingprocesses;

• development of consistent legislation, standards,and approaches to enforcement;

• planning, preparing and responding toenvironmental health challenges;

• aiding community involvement; and

• facilitating investment in strategic environmentalhealth research.


Appendix 3: The HIA ScreeningTool developed by the UKDepartment of HealthThe screening tool comprises four parts:

1. Examines the parameters of the proposal. Itshould be used to reach a provisional decisionabout whether a proposal has sufficientorganisational/partnership significance (withinthe parameters outlined) to justify an appraisal.

2. Considers the potential health impacts. It shouldbe used to qualify the provisional decision, toensure that those proposals which seem to haveinsufficient organisational /partnership

importance, but nevertheless have potentialnegative impacts of some import, are passedthrough screening to appraisal.

3. Should be used to qualify or confirm theprovisional decision made about which type ofappraisal to use (when applying the first part ofthe tool).

4. Focuses on the organisation/partnership capacityto conduct the HIA.

Screening tool: Part 1

Investigating the parameters of the proposals

Important parameters to consider are listed below.

For each parameter it is recommended that officers identify a set of levels or thresholds for the following situations:

(1) do not conduct HIA;

(2) conduct a rapid appraisal;

(3) conduct an intermediate appraisal;

(4) conduct a comprehensive appraisal.

As HIA becomes a regular feature of decision-making, and processes and outcomes are monitored and evaluated, it willbe possible to develop screening guidelines relevant to, and appropriate for, the type of proposals an organisation/partnership regularly implements.

Parameters for all types of proposal (policies, programs or projects):

• The relative importance of the proposal within the organisation’s/partnership’s priorities;

• The extent of the population affected by the proposal;

• The existence of at-risk groups within the population affected (because of age, nutritional status, etc);

• Stage of development of proposal (i.e. the potential to make changes).

Parameters for proposals about programs and projects:

• The size of the proposal;

• The cost of the proposal;

• The nature and extent of the disruption to the population affected.

3



A checklist of questions about the nature of potential health impacts

Bias towardsHIA To your knowledge:

Bias againstHIA

Yes/don’t know Are the potential negative health impacts likely to be serious? NoYes/don’t know Are the potential negative health impacts likely to be disproportionately

greater for some groups in the population, eg. because of age?No

Yes Are there community concerns about potential health impacts? No

No/don’t know

No/don’t know

Is there a robust evidence/experience base readily available to support:• appraisal of the impacts?

• the recommendations that could be made to ameliorate those impacts?Yes

YesYes/don’t know Could any of the actions to ameliorate the potential negative health impacts

of the proposal actually have a negative effect on health?No

No/don’t know If allowed to occur, could the potential negative health impacts be easilyreversed through current service provision?

Yes

Yes Is there a need to increase social capital in the community or populationaffected?

No


A checklist of questions about the circumstances in which the HIAmust be conducted

Bias towardsrapid appraisal To your knowledge:

Bias towardsintermediate orcomprehensive

appraisal

Yes Is there only limited time in which to conduct a HIA? No

Yes Is there only limited opportunity to influence the decision? No

Yes Is the timeframe for the decision-making process set by external factors beyondyour control?

No

Yes Are there only very limited resources available to conduct a HIA? No


A short checklist of questions about the capacity within an organisation orpartnership to conduct the HIA

Bias towardscommissioningthe assessor(s)

To your knowledge:

Bias towardsappointing an

internalassessor(s)

No Do personnel in the organisation or partnership have the necessary skillsand expertise to conduct the HIA?

Yes

No Do personnel in the organisation or partnership have the time to conductthe HIA?

Yes


Appendix 4: CommunityConsultation and RiskCommunicationHealth can encompass many quality of life and well-being issues that cannot always be effectivelycaptured in public health statistics and projections.It is essential to consult with the community toidentify these factors (eg. social and cultural needs).

Consultation is not only important to allaycommunity concerns but may also lead toimprovements in the development proposal. It isessential that communication be just that, ie. a twoway process with a willingness to listen to and actupon community views, not simply informing thecommunity what decisions have been made or justgoing through the motions of meeting the minimumlegislative requirements because one has to.

Health impact assessment is a part of impactassessment more generally and therefore thelegislative requirements for HIA will be those ofimpact assessment in the particular jurisdiction. Theproponent may have already consulted with thecommunity, or have plans to consult with thecommunity during the process, in addition to anystatutory requirements. Proactive communityconsultation is encouraged irrespective of theminimum legislated requirements of environmentalor health impact assessment.

Some of the key principles of effective riskcommunication9 are:

• accepting and involving the public as a partnerand stakeholder;

• carefully planning and evaluating the nature andcontent of the risk communication undertaken sothat it is relevant and understandable;

• listening carefully to the public’s concerns andacting on them. Trust, credibility, competence,fairness and empathy are often as important tothe community as statistics and scientific details.Trust and credibility are very difficult to regain iflost (experts do not command automatic trust);

• being honest, realistic and open;

• appreciating that intentional communication isoften only a minor part of the message actuallyconveyed. The manner of delivery and its tonemay be more important than its content;

• ensuring that information is accurate, consistentbetween agencies, and not speculative;

• effectively communicating with the media;

• acknowledging the concerns of the public and theeffects on the community; and

• focusing on issues and processes rather thanpeople and behaviours.

The extent of community consultation will largelydepend on the nature of a proposed development.Large developments that may generate considerablecontroversy will generally require a greater degree ofcommunity consultation than smaller developments.

Community and health authority input duringscoping, if sought, may augment the proponent’s ownideas about the degree and form of the health impactassessment.

Benefits of community consultation and publicparticipation include:

• better decision-making, by obtaining input fromthe community as to its values, priorities andconcerns, including matters known only to localresidents;

• identifying and addressing public concerns beforethey become significant issues in the reviewprocess;

• providing useful local information and knowledgefor completing the required impact assessmentstudies;

• identifying ways to avoid or mitigate adverseimpacts (a key element of the review process);


• avoiding or minimising unnecessary delays in theproject review and permitting processes;

• preparing local communities and residents formanaging the social, economic and land-useimpacts of a project;

• preparing workers and suppliers for training,employment and business opportunities related tothe project; and

• developing overall community and publicunderstanding of the project.

Community consultationmethodology

The extent of community consultation should beconsistent with the size and potential impact of adevelopment.

The methods used for community consultation willvary according to the size of the project, withparticular statutory requirements for some projecttypes, and with the preferences and experience ofthe proponent. However, as a minimum it isrecommended that consultation involve:

• informing the community of the proposeddevelopment details, the nature and likelymagnitude of both potential and possible impactsand their associated risks and benefits;

• allaying concerns by correctingmisunderstandings; and

• providing the opportunity to comment in a waythat ensures the comments are taken intoaccount when finalising the proposal, bymodifying it if necessary.

When consulting with the community a number ofparticular issues may require consideration,including:

• benefits, risks and other adverse effectsassociated with a proposed development areunlikely to be evenly distributed across thecommunity;

• the ability of individuals to voice concern orrecognise issues may not be evenly distributed inthe community;

• communities should be informed about thereasons for consultation;

• non-negotiable aspects of the consultationprocess should be identified early in the process;

• communities are likely to lose faith in theconsultation process if it appears that they haveno power to affect unwelcome outcomes of aproposed development;

• using methods that encourage responses fromright across the community; and

• targeting those who are most likely to beadversely affected.

Communication of complex issues such as risk canbe difficult. The community’s understanding of riskis likely to be affected not only by the actualmagnitude of the risk but also by factors such as thenature of the danger and who will be subject to therisk. In communicating an appreciation of risk to thecommunity care should be taken to use the mosteffective methods.

Proponents may have consulted with the communityoutside of the impact assessment process, especiallywhere the development is likely to be controversial,in an effort to achieve the best possible outcome forboth the community and the development. Earlyconsultation has the benefit of:

• encouraging community trust;

• identifying problems earlier in the process; and

• assisting investigation of health issues associatedwith concerns raised by the community.

In addition to community consultation prior to adevelopment proceeding, ongoing consultation islikely to be required; this could involve:

• periodic meetings between the proponent andcommunity;

• information presented via the media; and/or

• visible acknowledgment of, and response to,comments and concerns from the public.


Appendix 5: Bibliography ofSources of Key Impact AssessmentInformationLists mainly electronic sources of information andthe key impact assessment websites for eachAustralian jurisdiction. Not all relevant sites arelisted, but many sites give links or references toother sites (eg. the UK papers give numerous links toother UK work).

Australian LegislationCommonwealth legislation is at:http://scaleplus.law.gov.au

Legislation for most States and Territories is at:http://www.austlii.edu.au

Health Impact Assessment incomparable countries – key sitesCanada

http://www.hc-sc.gc.ca/ehp/ehd/oeha/hia

New ZealandGeneral site at www.moh.govt.nz and search forHealth Impact Assessment or go to:

http://www.moh.govt.nz/moh.nsf/wpgIndex/Publications-Online+Publications+Contents (then to1998 and go through the list).

United Kingdomhttp://www.doh.gov.uk/london/healthia.htm

(Section 7 of the Resources for Health ImpactAssessment provides numerous other UK webaddresses including the well known University ofLiverpool site).

WHO (Gothenburg Consensus Paper)http://www.who.dk/hs/ECHP/index.htm

Impact Assessment in Australia –government sitesQueensland

http://www.env.qld.gov.au (search for impactassessment and/or integrated planning act).

New South Waleshttp://www.duap.nsw.gov.au

See also http://www.epa.nsw.gov.au

ACThttp://www.palm.act.gov.au/planning_and_development/environmental_planning/eia.htm

Victoriahttp://www.doi.vic.gov.au/doi/internet/planning.nsf

(see Impact Assessment under Environment in theA–Z index).

and http://www.epa.vic.gov.au

Tasmaniahttp://www.dpiwe.tas.gov.au/env

South Australiahttp://www.planning.sa.gov.au

See also http://www.dehaa.sa.gov.au/epa

Northern Territoryhttp://www.lpe.nt.gov.au/enviro/EIAinNT.htm

Western Australiahttp://www.environ.wa.gov.au

Commonwealthhttp://www.ea.gov.au/epbc/


Australian Environmental ImpactAssessment network

http://www.ea.gov.au/assessments/eianet

International Impact Assessmentwebsites

The Environmental Impact Assessment PreliminaryIndex of Useful Internet Web Sites

http://www.iaia.org/eialist.html

International Association for ImpactAssessment

http://www.iaia.org/


Community Consultation and RiskCommunication

Ewan C, Young A, Bryant E, Calvert D. (1994)National Framework for Environmental and HealthImpact Assessment. NHMRC, pp 81-87.

EnHealth Council. (2001). Environmental HealthRisk Assessment: Guidelines for Assessing HumanHealth Risks from Environmental Hazards (in press).enHealth Council: Canberra. Once published will beavailable at: http://enhealth.nphp.gov.au/council/pubs/ecpub.htm

Rutgers University Center for EnvironmentalCommunication, Publications List, June 1999 At:http://www.cook.rutgers.edu/~cec/PUBS/publist.html

Connor, D. (1997) Public Participation – A Manual –How to Prevent and Resolve Public Controversy.Connor Development Services Ltd, Victoria, BC,Canada. At: http://www.islandnet.com/connor/

Chapple, K. (1997) From conflict management toconflict resolution, The Tongariro Way, A pathwayfor the working party concept. Royal Forest & BirdProtection Society. Paper presented to the 24thHydrology and Water Resources Symposium,November 1997, Auckland. (details conflicts resolvedby the introduction of a consultative processinvolving two projects in New Zealand).

Peter Sandman publications (http://www.psandman.com):

• Responding to Community Outrage: Strategies forEffective Risk Communication.

• Risk = Hazard + Outrage: A Formula for EffectiveRisk Communication (Video).

• Quantitative Risk Communication: Explaining theData (Video).

• Implementing Risk Communication: Overcomingthe Barriers (Video).

ATSDR A Primer on Health Risk CommunicationPrinciples and Practices, USA Department of Healthand Human Services, Agency for Toxic Substancesand Disease Registry. At: http://www.atsdr.cdc.gov/and search for Health Risk Communicator.

Covello VT, McCallum DB, Pavlova MT. (1989)Effective Risk Communication, The Role andResponsibility of Government and Non-governmentOrganisations. Contemporary issues in risk analysis.Plenum Press, New York and London.

Covello, Vincent T., Peter M. Sandman, and PaulSlovic, (1988) Risk Communication, Risk Statisticsand Risk Comparisons: A Manual for Plant Managers.Chemical Manufacturers Association: Washington,DC.

Covello, Vincent T., Detlof von Winterfeldt and PaulSlovic, (1986) Communicating Scientific InformationAbout Health and Environmental Risks: Problemsand Opportunities from a Social and BehavioralPerspective. The Conservation Foundation:Washington, DC.

Ruckelshaus, William D. (1987) Risk, Science andDemocracy: Part 1. Chemtech, November 1987, pp.658-662; Part 2 Chemtech, December 1987, pp. 738-741.


Appendix 6: Health monitoring

• responding to results; and

• reviewing monitoring procedures and the need tocontinue monitoring.

Administrative considerationsMonitoring should be:

• undertaken or paid for by the proponent;

• performed transparently and reliably (on time,using standardised equipment, trained operator,etc);

• reported publicly, including advice to localresidents. Communities should be involved in asmany aspects of the monitoring as possible,including planning, sampling, analysis andinterpretation; and

• conducted efficiently. It is important thatmonitoring costs be in proportion to the scale of aproposed development (which includesminimising required monitoring) and that it beconducted as efficiently as possible.

Individuals and organisations overseeing monitoringshould have adequate technical expertise and be(and be seen to be) independent.

It is assumed that monitoring will be overseen by thedecision-making agency in most cases. Where adevelopment could potentially have a significantimpact on health, the public health authority (PHA)may wish to be directly involved in overseeing themonitoring (eg as a member of a monitoringcommittee).

The PHA should review and assess the results ofmonitoring on a regular basis (eg. yearly). Should theresults suggest the potential for an adverse healthimpact in excess of that described in the HealthImpact Statement, the PHA should alert thedecision-making authority and initiate action toreduce the risk. Such action should involve

Generally, the potential health risks posed by adevelopment will be controlled to the extent thathealth monitoring of the public is unnecessary.However, in a small number of instances suchmonitoring may be required.

It may, of course, be more necessary for workers asthey may receive much higher exposure than amember of the public. Occupational health has notbeen explicitly considered in these Guidelines butthere may be areas where the public andoccupational health issues overlap. In suchcircumstances the issue needs to be addressed,possibly in collaboration with other agencies.

Monitoring health impact, and the difficulties it maypresent, is also extensively discussed in section 8 ofthe Environmental Health Risk Assessment:Guidelines for Assessing Human Health Risks fromEnvironmental Hazards9.

Monitoring programs are necessary only whendevelopments are known to be, or likely to be,associated with ongoing health impacts of concern. Itis essential to define in advance what action will betaken if the indicator being monitored reaches acertain pre-defined point. If no specific action isnecessary or possible, then there is no point inmonitoring. Similarly, monitoring is only of use if theregulatory authority has the power and will to act onthe results in order to protect health.

The indicators that require monitoring need to beoutlined at or before the time of approval.

Key steps in monitoring include:

• identifying parameters to be monitored anddefining the correlation between thoseparameters and effects on health;

• developing monitoring protocols;

• ensuring monitoring is conducted;

• receiving and assessing results regularly;


consultation with stakeholders, particularly theproponent and decision-making authority.

It may be appropriate that a committee ofstakeholders (including community representation)oversee the monitoring of some developments,particularly those with a significant potential foradverse health impact or where the development iscontroversial.

General guidelines for monitoringParameters to be included in a monitoring programshould:

• be of reasonable cost;

• be technically reliable;

• be scientifically valid, with high sensitivity andspecificity;

• be easily interpreted;

• provide reassurance to the population;

• assist with undertaking protective responses; and

• provide timely indication of a problem.

Periodic review may indicate that a more modestmonitoring program would be adequate. If amonitoring program is to be scaled-down it isimportant that this be done in such a way as topreserve the comparability of the new and oldmonitoring data (if those data continue to becollected).

Monitoring indicators of healtheffects or health effectsthemselves?

It is often much easier, more economic and effectiveto measure indicators of health effects rather thanhealth effects themselves.

Health effects may be difficult to assess on apopulation-wide basis, incidence/prevalence mayfluctuate independently of environmental changes,there can be time lags between event and outcome,and one does not want to wait until harm is donebefore taking action.

As the WHO Guideline Evaluation and use ofepidemiological evidence for environmental healthrisk assessment (WHO, 2000.) states,“epidemiological studies that report associations

between measures of health of populations and thepresence of hazardous factors in the environmentare difficult to interpret”. Nevertheless, epidemiologydoes have a place in monitoring and in health riskassessment generally.

Measuring environmental or biological surrogates forhealth effects also has its difficulties. It may bedifficult, for example, to demonstrate an actualcorrelation between the indicator and a specifichealth outcome, even when one is expected toclosely follow the other in time, such as asthma fromairborne dust or gases such as sulfur dioxide.

Monitoring the health of small populations can be aconsiderable task, involving significant technicaldifficulties. The following should be considered whendeveloping a methodology:

• health monitoring using epidemiological toolsmay be possible where the affected population islarge enough to yield reasonable confidenceintervals and the geographic boundary of thepopulation coincides with that of the statisticallocal area(s);

• monitoring should commence as early as possibleso as to optimise the likelihood of recognisingtrends. Ideally, monitoring would commencebefore a development proceeds, thus providing abaseline against which to compare resultsobtained during (and possibly after) thedevelopment activities;

• it may be practical for only a small number ofparameters to be monitored. Parameters can behealth conditions (eg diseases) or bio-indicators(eg blood lead concentrations or antibodies) orenvironmental parameters (eg concentration ofpolychlorinated biphenyls in biota, concentrationof phosphates or dissolved oxygen levels inwater). An ideal parameter is one where easilymeasured changes in its value indicate smallchanges in health impact;

• the number of parameters to be monitored willdepend upon the potential likelihood andmagnitude of the health impacts and should be nomore than is consistent with providing adequateprotection of public health;

• every effort should be made to ensurecomparability of results of sampling and analysisover the whole monitoring period (eg. byretaining the same method, or parallel running of


new methods of obtaining samples, samplinglocations, analytical technique);

• monitoring of health impacts with long latencyperiods may not be effective in preventingadverse health outcomes eg. although cancer ratemonitoring may be worthwhile in the future,monitoring of biological or environmentalmarkers would be more effective in predictingincreased risk and preventing higher cancer rates(although the emission of a known carcinogen islikely to be approved only in very special caseseg. extremely low levels of benzene or apolyaromatic hydrocarbon);

• the collection and analysis of human biologicalsamples (blood, urine, hair etc) can be used as amarker to detect concentrations of contaminantsin people. While it may be ethically or sociallyunacceptable to routinely collect such samples, itmay be possible to sample opportunistically fromreasonably representative groups who are beingotherwise tested. It may also be practical to test asensitive sub-population (eg all pregnant mothersor school children, or perhaps to collect samplesfrom sensitive animal populations). Collectionand analysis of samples should be done withethical approval, confidentially and with the leastpossible disruption and discomfort to thoseproviding the samples;

• environmental samples (water, soil etc) andsamples of animal or plant tissue may be used aseffective markers of environmental contaminationand as such can be used as predictors of somehealth impacts;

• while environmental parameters or biologicalmarkers may be the most efficient and timelymeans of assessing negative health impacts,whether actual or likely, the community may bemore interested in whether health is beingdirectly affected and therefore may be interestedin periodically being advised about healthindicators for the area; and

• indicators of social, economic and cultural changecould also be monitored.

Monitoring that relies on the provision of datawithout financial reward (eg sentinel datacollections) may fail unless those collecting the dataare rewarded in some way, including being linkedinto the process and/or kept informed about thetrends indicated by the data being collected.

Monitoring health indicatorsMonitoring of health indicators will usually beconfined to large developments and should beconsidered if:

• the potential effects are likely to be significantand obvious;

• the potentially affected population is large enoughto yield reasonable confidence intervals for rates;

• data pertinent to the area can easily be compiled,collected or obtained;

• there are few or no other means of indirectlymonitoring an important potential health impact;and

• the community demands reassurance that theirhealth will be unaffected by the development andthe monitoring methods are adequate.

Identifying a change in community health status willrequire knowledge of the population being assessed,particularly the baseline health status. Identifying anincrease in the number of cases of asthma forexample, without an understanding of changes in thepopulation, may lead to incorrect conclusions. A lackof baseline health status data diminishes the value ofmonitoring.

Disease rates which may be influenced by age orgender are best standardised against a referencepopulation (eg. the Australian population), unless itis clear that the age and sex structure of thepopulation in the area has remained largelyunaltered (in which case crude rates may beacceptable).

Additionally, it should be borne in mind that manyindicators are likely to relate only to specificdiseases, so they will only give a narrow picture ofthe health status of a population.

Some strategies for monitoringhealth

Monitoring of health can be achieved by:

• using standard data collections such as AustralianBureau of Statistics mortality data, midwives datacollection, cancer registries and other datacollections to track disease incidence over time.As mentioned above, one of the severaldisadvantages in using these data for health


monitoring is that the data are frequently old andimpacts may only become apparent some timeafter exposures occur;

• establishing sentinel data collections involvinglocal clinicians tracking particular diseases ortheir markers (confidentiality and continuityissues may be a problem);

• a series of surveys over time to track theindicators of health status and/or the prevalenceof disease, conditions or markers. This method ofmonitoring will frequently require significantfunding;

• routine health checks of sections of thepopulation which may be accepted as indicatorsof community health (eg workers, school childrenetc). Alternatively, testing of high riskpopulations, such as pregnant women or the frailelderly;

• monitoring specific incidents, for exampleinjuries involving vehicles or equipmentassociated with a large development. These datacould be provided through workers’ compensationdata, hospital data, or police and/or transportauthority data; and

• the public health authority notifiable diseasedatabase may be useful for monitoring infectiousdiseases. While this database may provide timelydata, isolating the data for small areas is generallydifficult and complicated by confidentialityissues.

Guidelines for monitoringbiological indicators

Often it will be impractical to monitor health.Monitoring of biological indicators may be apreferable alternative and can be more effective inprotecting health, especially where an indicatorreveals damage is occurring (eg blood leadconcentrations) or the potential for damage (egvaccination status), as opposed to damage actuallydone (eg impaired neurological function or cases ofmeasles).

Measuring blood lead levels is an example ofmonitoring a biological indicator; the health impactof most interest being impaired neurologicalfunction. Monitoring of blood lead concentration is amore feasible approach and a much earlier indicatorof people at risk, compared to assessing neurological

function – the results being more useful if concernarises that lead contamination may be a problem.

Biochemical and/or microbial assessment of blood,urine, hair, teeth and other tissue can provide usefulindicators. Monitoring could include analysis ofsamples:

• collected during one-off surveys conducted atregular intervals (eg 5 yearly);

• collected for other tests eg. blood collected forother tests could, with consent, be analysed forcontaminants of interest; and/or

• collected during routine screening of populationsubgroups (eg screening of school populations,workers or other populations which areperiodically screened).

When designing a monitoring program usingbiological indicators consider:

• is funding adequate to ensure the program willcontinue for as long as necessary;

• is the indicator a good measure of the healthimpact of interest;

• are there possible biases in the selection ofindividuals providing samples, and if so, in whatway will the bias operate and will the results stillbe useful;

• is the analysing laboratory accredited and does ithave a good reputation for analysing the samplesfor the contaminant or material of interest;

• will relevant standards be followed in samplecollection and analysis;

• has contamination been considered andprevented (eg. contamination of skin, collectionequipment and sample storage equipment); and

• are the collection and analysis methodologieswell-defined. Changing these methodologies canrender comparisons over time invalid or difficult(thus possibly masking trends) and may rendercritical information useless, possibly to thecommunity’s disadvantage.

Guidelines for health indicatorsAs discussed, it will often be unacceptable or difficultto monitor community health status and/or humanbiological samples. Consequently it will often bemore appropriate to monitor aspects of the physicalor social environment.


When (time of day, season and how often, etc) andwhere (geographical location, depth, altitude etc)samples are collected, the method of sampling andanalysis and who is to collect and analyse thesamples are issues that may require consideration bythe community, the proponent, the health agency,the environmental agency and other keystakeholders.

Frequency of sampling and spatial distribution ofsampling points can be critical for the success of amonitoring program. Measurement of contaminantsassociated with ill health may be undertaken in soil,water, air, dust or other organisms.

It may also be necessary to measure non-biologicalindicators of health to assess the impact of a largedevelopment on a community – the health impactmay be positive and/or negative, and the justificationfor a development may have been dependent uponone or more of these health determinants improving.

Some measurable indicators of health include:

• proportion of people of working age who are inwork;

• indicators of success in tackling poverty andsocial exclusion;

• people in employment working long hours;

• working days lost through illness, work fatalitiesand injury rates;

• index of Local Deprivation;

• long term unemployment;

• qualifications at, say, age 18;

• expected years of healthy life;

• people without qualifications;

• health inequalities;

• health indicators for heart disease, cancer,accidents, mental health;

• respiratory illness;

• hospital waiting lists;

• road traffic measures such as average journeylength by purpose;

• homes judged unfit to live in;

• temporary accommodation; and

• household and population growth.

Monitoring employment andproponent commitments

During an environmental impact assessment processa proponent may make commitments by way ofmitigation, for example, of compensation,employment, modifying the development andcontinuing community consultation. It may benecessary to monitor the undertaking of thesecommitments.


Appendix 7: enHealth CouncilMembership and Terms ofReferenceThe enHealth Council is the premier advisory bodyon environmental health in Australia. It providesnational leadership on environmental health issues,sets priorities, coordinates national policies andprograms and provides a pivotal link betweeninternational for a and environmental healthstakeholders in Australia. It is also responsible forimplementation of the National EnvironmentalHealth Strategy and is a sub-committee of theNational Public Health Partnership.

MembershipChair – Professor Christine Ewan, Pro Vice-Chancellor (Education), University of WesternSydney.

MembersState and Territory Health Departmentrepresentatives:

Australian Capital Territory – Manager HealthProtection Service

New South Wales – Director Environmental Health

Northern Territory – Program DirectorEnvironmental Health

Queensland – Manager Environmental Health

South Australia – Director Environmental Health

Tasmania – Director Environmental and PublicHealth

Victoria – Manager Environmental Health

Western Australia – Director Environmental Healthservice

New Zealand – New Zealand Health Ministry

Commonwealth Dept. of Health and Aged Care –Director of Environmental Health

Australian Institute of Environmental Health –National President

Environment Australia

Public Health Association of Australia

Australian Consumers’ Association

National Indigenous Environmental Health Forum

SecretariatServices provided by the Environmental HealthSection of the Commonwealth Department of Healthand Aged Care.

Terms of Reference1. Provide national leadership on environmental

health issues by:

i) coordinating and facilitating environmentalhealth policies and programs;

ii) establishing strategic partnerships betweenenvironmental health stakeholders;

iii) setting priorities for national environmentalhealth policies and programs;

iv) providing an open consultative system forpolicy development; and

v) facilitating cost effective use of environmentalhealth resources.

2. Drive the implementation of NationalEnvironmental Health Strategy;

3. Advise the Commonwealth, States andTerritories, Local government and otherstakeholders on national environmental healthissues;

4. Coordinate the development of environmentalhealth action plans at local, state and nationallevels;

5. Promote and develop model environmental healthlegislation, standards, codes of practice,guidelines and publications;


6. Strengthen the national capacity to meet currentand emerging environmental health challenges;

7. Provide a pivotal link between international foraand environmental health stakeholders inAustralia and strengthening Australia’scollaboration with countries in the Asia-Pacificregion.


Appendix 8: enHealth CouncilPublications

(N.B. Any monographs published before 1999 wereproduced by the National Environmental HealthForum which the enHealth Council has replaced)

Foundation DocumentsThe National Environmental Health Strategy 1999

The National Environmental Health StrategyImplementation Plan 2000

Human-Environment InterfaceWater Series

1. Guidance for the control of Legionella (1996)

2. Guidance on water quality for heated spas (1996)

3. Guidance on the use of rainwater tanks (1998)

Soil Series1. Health-based soil investigation levels, 3rd edition

(2001)

2. Exposure scenarios and exposure settings, 3rdedition (2001)

3. Composite sampling (1996)

Metal series1. Aluminium, 2nd edition (1998)

2. Zinc (1997)

3. Copper (1997)

Air series1. Ozone (1997)

2. Benzene (1997)

3. Nitrogen Dioxide (1997)

4. Sulfur dioxide (1999)

General series1. Pesticide use in schools and school grounds

(1997)

2. Paint film components (1998)

3. Guidelines for the control of public health pests –Lice, fleas, scabies, bird mites, bedbugs and ticks(1999)

Exposure series1. Child activity patterns for environmental

exposure assessment in the home (1999)

Counter Disaster Series1. Floods: An environmental health practitioner’s

emergency management guide (1999)

Environmental Health JusticeIndigenous Environmental Healthseries

1. Indigenous Environmental Health No. 1(1999)

2. Indigenous Environmental Health No. 2(2000)

Environmental Health Systems1. National standard for licensing pest management

technicians (1999)

2. Environmental Health Risk Perception inAustralia (2000)

You can obtain copies of these publications from:[email protected]

or ph. 1800 020 103.

OR VISIT THE ENHEALTH COUNCIL WEBSITEhttp://enhealth.nphp.gov.au/council/pubs/ecpub.htm


References

1 EnHealth Council. (1999). The EnvironmentalHealth Strategy. enHealth Council: Canberra. Alsoat: http://enhealth.nphp.gov.au/council/pubs/ecpub.htm

2 European Centre for Health Policy (1999) Healthimpact assessment: Main concepts and suggestedapproach. The Gothenburg Consensus Paper,December 1999. WHO Regional Office for Europe.

3 Department of Health, UK. (2000). A resource forHealth Impact Assessment. http://www.doh.gov.uk/london/healthia.htm

4 Health Canada. (2000). The Canadian Handbookon Health Impact Assessment (3 vols). http://www.hc-sc.gc.ca/ehp/ehd/oeha/hia/

5 Scott-Samuel A, Birley M, Ardern K. (1999).Merseyside Guidelines for Health ImpactAssessment. http://www.liv.ac.uk/~mhb/publicat/merseygui/index.html

6 Ewan C, Young A, Bryant E, Calvert D (1994)National Framework for Environmental andHealth Impact Assessment. NHMRC Australia.

7 Ministry of Health (1998) A Guide to HealthImpact Assessment: Guidelines for public healthservices and resource management agencies andconsent applications. Wellington, New Zealand.

8 World Health Organization (WHO). (1987).Health and Safety Component of EnvironmentalImpact Assessment. Environmental Health SeriesNo 15. Copenhagen: WHO, Regional Office forEurope.

9 EnHealth Council. (2001). Environmental HealthRisk Assessment: Guidelines for Assessing HumanHealth Risks from Environmental Hazards (inpress). enHealth Council: Canberra. Oncepublished will be available at: http://enhealth.nphp.gov.au/council/pubs/ecpub.htm

10 Office of Regulation Review. (1998). A guide toregulation. Second edition, p.E28. Canberra:AGPS.

11 United Nations Environment Programme. (1992).Rio Declaration on Environment andDevelopment. UNEP Nairobi, Kenya.

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