Feature article
Rethinking human health impact assessment

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Abstract

Most EIA programs around the world require the consideration of human health impacts. Yet relatively few EIA documents adequately address those impacts. This article examines how, why, and to what extent health impacts are analyzed in environmental impact assessments in the U.S. An empirical study of 42 environmental impact statements found that more than half contained no mention of health impacts. In the others, health impacts were analyzed narrowly, if at all, using risk assessment to quantify the carcinogenic potential of a single substance over a single generation. This analytic focus overlooks other significant morbidity and mortality risks, cumulative and intergenerational effects, and broader determinants of health. This article investigates these problems and provides recommendations to improve human health impact assessment, using strategic environmental assessment, qualitative health data, health outcomes in addition to cancer, and a precautionary approach to risk.

Introduction

Humans affect the environment, and the environment affects humans. Recognizing this interconnection, the environmental impact assessment movement has sought to promote more environmentally sound and informed decisions for the sake of human welfare. Meanwhile, the public health movement has long considered the environment to be a primary determinant of human health. So it's not surprising that most EIA programs around the world encourage the consideration of human health impacts (Sutcliffe 1995). What is surprising, however, is that EIA documents often omit health impacts.

Even though, historically, the environment and human health have been linked in concept, they have been paradoxically separated in EIA practice in the U.S. Instead of analyzing health impacts, EIAs often just refer to an environmental standard. If health impacts are analyzed, the focus is typically narrow: a single health outcome (cancer), due to exposure to a single toxin, over a single lifetime, represented by a single number, calculated by a quantitative risk assessment methodology (e.g., NRC 1983; EPA 1984). But this focus misses a range of other significant health concerns, such as endocrine disruption (Colborn et al. 1994), neurotoxicity (Silbergeld 1990), chemical sensitivity (Ashford and Miller 1998), non-toxicological social impacts (Burge and Vanclay 1995), intergenerational genetic damage (Fan et al. 1995) and exposures to combinations of chemical, biological, or physical agents—the types of exposures that humans face.

This article investigates the role of EIA for reuniting the environment and human health, for preventing and reducing significant health risks, and for improving human health impact assessment (HHIA). It begins with an overview of human health impact assessment within EIA. It follows with the research approach and results from analyses of 42 environmental impact statements from the U.S. Then, drawing upon the empirical results and interviews with environmental and public health professionals, the article analyzes why human health impacts are often neglected in EIAs. Finally, the article discusses problems with traditional methods of HHIA, and provides recommendations to improve both HHIAs and our understanding of connections between environmental systems and human health. This understanding has an added benefit: showing how changes in the environment affect human health can create support for efforts to protect and promote environmental quality.

Section snippets

Evolution of human health impact assessment within EIA

The legislative origins and implementation of EIA in the U.S. provide insights into the role of human health impact assessment. Environmental impact assessment is required in more than half the countries around the world (Canter 1996). The U.S. National Environmental Policy Act of 1969 (NEPA) provided one of the earliest sets of EIA requirements, and many countries modeled their requirements after NEPA. NEPA grew from public concern that federal projects were significantly harming the

Research approach

A goal of this research was to investigate how, why, and to what extent EIA addressed human health impacts. To do that, a two-phase study was performed.9 The first phase involved a content analysis of 42 environmental impact statements produced in the U.S. under NEPA.10 The EISs were selected according to two main criteria: the proposed actions were likely to

Improving human health impact assessment

The results of this study suggest a need to take a harder look at human health impacts, and use EIA as an opportunity to prevent or reduce health risks. It's not enough to say, “Well, just do the analyses.” The needs are more than analytic. And more analyses do not necessarily mean better decisions. What is needed is a rethinking of human health impact assessments, and the ways they can improve environmental decision-making.

Recognizing significant health impacts—and sources of health impacts—is

Acknowledgements

I thank Janeane Gilbreath for her valuable research assistance. I am grateful to Richard Carpenter for his helpful comments, and to Dinah Bear and Ray Clark for their insights and direction. This research received support, in part, from the National Science Foundation, under grant CMS 9874391. Any opinions, findings or conclusions are those of the author and do not necessarily reflect the views of the National Science Foundation.

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