Aaron Wernham, M.D., M.S. Director | The Health Impact Project

1. Health Impact Assessment: integrating health into the NEPA ProcessPresentation to TRBJan 23, 2011 Aaron Wernham, M.D., M.S.Director | The Health Impact Project 901 E Street, NW, Washington, D.C. 2004 p: 202.540.6346 e:awernham@pewtrusts.org www.healthimpactproject.org

2. Outline of talk • Legal foundations: how should agencies approach health in NEPA analyses? • Introduction to Health Impact Assessment (HIA), and its use in the context of NEPA • Applications of HIA to transportation decisions

3. Health analysis in NEPACurrent practice Survey of 45 EIS: No discussion of health in 83% In the remainder, discussion of health limited to single-substance cancer risk assessment Steinemann, A. 2000. Rethinking Human Health Impact Assessment. Environmental Impact Assessment Review 20: 627-645 Survey of NEPA professionals: Found little understanding, discussion, or analysis of health among EIS professionals Cole et al. 2004. Prospects for Health Impact Assessment in the United States: New and Improved Environmental Impact Assessment of Something Different? Journal of Health Politics, Policy, and Law 29 (6) 1153-1186

4. Health analysis in NEPATypical practice Assessment of air and water quality impacts is common: while health impacts are implied, they are rarely analyzed. Single-substance risk assessments are sometimes undertaken. Rare to look at the public health baseline or identify subgroups that are vulnerable to specific impacts. Rare to look at indirect or cumulative health effects.

5. The “Determinants of Health” • Graphical representation

6. “Get more exercise”...

7. “I never thought of this as a health issue” • Car-friendly communities have almost double the rate of obesity as pedestrian-friendly communities • Access to public parks and recreational facilities has been linked to reductions in crime and juvenile delinquency, and violent injury. • An E-Z Pass toll system reduced rates of premature birth.

8. NEPA and Human Health: Purpose The purposes of this Act are: … to promote efforts which will prevent or eliminate damage to the environment and biosphere and stimulate the health and welfare of man; to enrich the understanding of the ecological systems and natural resources important to the Nation; and to establish a Council on Environmental Quality NEPA Sec. 2 [42 USC § 4321]

9. CEQ Regulations and Guidance • 40 C.F.R. 1508.8 Effects: “Effects” includes ecological, aesthetic, historic, cultural, economic, social, or health, whether direct, indirect, or cumulative.” • 40 C.F.R. 1508.27 Significantly: (b) Intensity: includes “ The degree to which the proposed action affects public health or safety.” • “Agencies should recognize the interrelated cultural, social, occupational, historical, or economic factors that may amplify the natural and physical environmental effects of a proposed agency action.”CEQ (1997) Environmental Justice: guidance under NEPA

10. Congressional Intent…? “When we speak of the environment, basically, we are talking about the relationship between man and these physical and biological and social forces that impact upon him.  A public policy for the environment basically is not a public policy for those things out there.  It is a policy for people." Senator Henry Jackson. Hearings on S. 1075, S. 237, and S. 1752, Senate Committee on Interior and Insular Affairs, 91st Cong., 1st Session. 118 (1969)

11. Executive Orders Each Federal agency shall: • make achieving environmental justice part of its mission by identifying and addressing, as appropriate, disproportionately high and adverse human health or environmental effects of its programs, policies, and activities on minority populations and low-income populations in the United States Executive Order 12898: Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations (11 February 1994) • …make it a high priority to identify and assess environmental health risks and safety risks that may disproportionately affect children; and ... shall ensure that its policies, programs, activities, and standards address disproportionate risks to children that result from environmental health risks or safety risks. Executive Order 13045: Protection of Children from Environmental Health Risks and Safety Risks

12. HIA:Definitions A combination of procedures, methods and tools that systematically judges the potential effects of a policy, programme or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects. (IAIA, 2006) A practical approach for collaboration between health and other sectors, translating public health research into predictions and reasonable recommendations that policy makers can use to ensure that new public decisions contribute to healthier communities.

13. Health Impact AssessmentCurrent Applications: • Canada and Australia: considerable work, both within EIA and for other policies and projects. • European Union: HIA done for any major new policy • broad applications in policy-making, land-use, etc • variety of governance structures • Many other nations: Australia and New Zealand; Ghana; Thailand; Viet Nam

14. Health Impact AssessmentInternational business is starting to use it • World Bank and IFC: part of evaluation standards for large development loans (IFC Guidance Note 4:http://www.ifc.org/ifcext/enviro.nsf/Content/GuidanceNotes) • Equator Principles: ratified by the majority of large lending banks worldwide, the Equator Principles delineate ethical requirements for large development loans: they refer to IFC standards (http://www.equator-principles.com/principles.shtml )

15. Completed and In Progress HIAs 1999–2010: 119 WA 8 ME 1 MT 3 MN 6 OR 12 NH 2 WI 1 MA 4 PA 2 OH 1 NJ 1 IL 1 CO 4 CA 47 MO 1 MD 2 KY 1 NM 1 TN 1 GA 8 TX 1 FL 1 AK 7 Map Courtesy of A. Dannenberg, A. Wendel, CDC NCEH HI 1

16. The HIA Process Screening –is HIA feasible and likely to add value? Scoping – determine the important health effects, affected populations, available evidence, etc Assessment – analyze baseline conditions and the direct, indirect, and cumulative pathways through which health can be affected. Recommendations Reporting – disseminate the report to the public, stakeholders, solicit input Monitoring and Evaluation

17. HIA in NEPAFirst efforts occurred in Alaska • Tribal health department became cooperating agency with BLM and MMS on several EISs for oil and gas leasing completed HIAs that addressed a wide range of health issues: • Local air quality concerns for a sensitive population (high baseline rate of lung disease) • Influx of non-resident workers, culture change and risk of mental health problems, and drug and alcohol use, and STIs • Dietary impacts if whales, caribou or fish displaced • Current picture: • -BLM, MMS, USACE, EPA now using HIA commonly • -State of AK has developed its own HIA program, and will do HIA for any major natural resource development project.

18. HIA in NEPAStatus of national practice • EPA region IX commented in support of HIA for I-710 and Port of LA expansion • HIA non-profit is now contracted with local council of governments to do HIA of I-710 in conjuction with EIS • EPA region IX has MOU with CDC to work on HIA • Several HIAs completed and being integrated into transportation EISs: • I-5 Columbia River Crossing – HIA submitted as DEIS comment • Buford Highway redevelopment • Lake Oswego to Portland transit corridor EIS (OPHI and Metro)

19. Typical health considerations • Physical activity and related health concerns – obesity, diabetes, cardiovascular disease • Air quality – impact of roadway emissions on local residents, workers, indoor air quality – asthma, cardiovascular mortality, all-cause mortality • Accidents • Social cohesion – crime, violence, injury • Economic changes – life expectancy, many specific disease rates • Access to goods and services – health care, grocery stores, etc

20. Other transportation-related HIAs

21. Other transportation-related HIAs

22. Other transportation-related HIAs

23. Other transportation-related HIAs

24. Other transportation-related HIAs

25. Conclusion • NEPA requires an analysis of health effects • According to the basic NEPA process, this should include: • A description of the affected environment: for health, this includes baseline prevalence of any illness that could be affected, and a baseline description of any factors important to health that might be affected by the proposed action • A systematic analysis of the direct, indirect, and cumulative health effects: this should NOT be limited a priori to specific issues, such as contaminants or injury, but instead should include a discussion of any potentially significant direct, indirect or cumultaive health effect • Proposed recommendations to manage the identified effects • HIA provides a way to accomplish a well-done NEPA-compliant health effects analysis

26. Questions? Aaron Wernham Director, Health Impact Project The Pew Charitable Trusts Tel. 202-540-6346  awernham@pewtrusts.org