Developing a Modified Conceptual Model for Health and Environmental Impact Assessment

1. Developing a Modified Conceptual Model for Health and Environmental Impact Assessment within Ecological Public Health LE Fleming, S Reis, G Morris, S Beck, M Austen, M Depledge, T Taylor, M White • Affiliations: European Centre for Environment and Human Health, University of Exeter Medical School, Truro Cornwall, TR1 3HD; Centre for Ecology & Hydrology, Bush Estate, Penicuik, EH26 0QB; NHS Health Scotland, Directorate of Public Health Science, Elphinstone House, West Regent Street, Glasgow G2 2AF; Plymouth Marine Laboratory, Prospect Place, The Hoe, Plymouth, PL1 3DH, United Kingdom; Comments to Professor George Morris at geomorris55@hotmail.co.uk; Professor Lora Fleming lora.fleming@pcmd.ac.uk • Website: www.ecehh.org; funding provided in part by: CONTEXT – Shaping a new Approach for Public Health Public health has been uniquely challenged over recent decades to translate emerging socio-ecological thinking on health and its determinants into effective policy and action. Various conceptual models have been developed to portray the complex interaction of social, behavioural, environmental and genetic factors in creating and destroying health. The modified Drivers-Pressures- States- Exposure-Effect-Action [DPSEEA] (mDPSEEA) model (Morris 2006) (Figure 1) reflected such perspectives in environment and health policy, and has been exploited in Scotland for issue framing, to support stakeholder engagement, and to underpin more holistic and crosscutting approaches in environmental health. Figure 1 mDPSEEA maps from high level cultural, political etc. Drivers to the Pressures which modify the environment to produce an environmental State with defined characteristics with human Exposure and on to health Effect, all enclosed by Context to reflect the influence of demographic, social, cultural, etc. factors on both exposure and health effect. The model allows Actions to be directed to any point on the chain or context. Figure 1 mDPSEEA, Morris et al, 2006 DRIVING FORCES:Economic, social, political PRESSURES ACTIONS STATE SOCIAL DEMOGRAPHIC ECONOMIC BEHAVIOURAL Includes perception of environment EXPOSURE EFFECT Ecological Public Health Concerns over sustainability and the breach of planetary boundaries for human existence make evident that humans are not distinct from natural ecosystems, but rather, actually integral to them. Humans interact dynamically with other parts of those ecosystems. Human activity, including economic activity, is a direct and indirect driver of changes in ecosystems on which they rely for many services critical tor health and wellbeing. Recognising that public health must embrace and operationalize this integration of social relationships with the ecology of the natural world, Rayner and Lang (2012) have called for a new “Ecological Public Health” built on the core idea that “human health depends on the coexistence of the natural world and social relationships.” Ecosystem Services The concept of Ecosystem services has its origins in the desire of environmental science to integrate the natural and the physical with social economic and other anthropocentric concerns. Ecosystems underpin all human life and activities, and “Ecosystem Services” are benefits which people obtain from them. The following categories of ecosystem services, each important for human life, have been identified: Provisioning Services are products obtained from the ecosystem (e.g. fresh water, food, timber, fibres, fuels, genetic resources, natural medicines,pharmaceuticals); Regulating Services govern issues such as air quality, climate, rainfall, pollination, the spread of disease, the purification of water, the filtration and breakdown of organic waste; Cultural Services encompass non-material ways in which people benefit from ecosystems, ranging from benefits such as Cultural Diversity (significantly influenced by the diversity of ecosystems) to inspiration (e.g. for art or architecture to the opportunity for Recreation or Eco-Tourism); Supporting Services underpin the production of all other ecosystem services (e.g. soil Formation, photosynthesis, nutrient cycling, etc). Figure 3 eDPSEEA Case Study - Oil spill in coastal/estuarine waters: Ecosystems and Human Health Drivers Carbon Economy;Extraction and transport of fossil fuels by tanker and pipeline PressurePresence of contaminating oil from leaking pipes /ruptured vessel tanks in coastal/estuarine environment impacting supporting services in Marine Ecosystems Supporting Services: Primary Production, Nutrient Cycling, Ecosystem Health Regulating Services Cultural Services Provisioning Services Purification and filtration Processes overwhelmed Marine ecosystem unable to support coastal communities and cultural diversity. Marine Ecosystem unable to produce safe food in sufficient quantities Figure 2 “The Ecosystems Enriched DPSEEA” (eDPSEEA) Model” CONTEXT: Social, Economic, Political, Environmental Material MinimaPhysical Environment Ecological Public Health and Ecosystem Services : A Convergence We identify significant convergence between Ecological Public Health, with its calls for the acknowledgement in policy and action of the integration of social and natural ecology, and the concept of Ecosystem Services, particularly to express the connectivity of planetary ecosystems and human health/wellbeing. Experience in using mDPSEEA to integrate socio-ecological perspectives in environmental health policy - to frame complex issues in a policy relevant way and, especially to support stakeholder engagement, implies a new conceptual model which can also help communicate and operationalize Ecological Public Health. We believe integration of the process simplifications represented by Figure 1 (mDPSEEA) can provide the basis for such a model. In Figure 2 (Ecosystems Enriched DPSEEA or “eDPSEEA”), we offer a prototype; and in Figure 3,weexplore its utility by applying it to the public health and environmental repercussions of an oil spill which contaminates the food chain and bathing water. Enforced disruption of social, recreational and economic activity Security Freedom of Choice Social Relations Market uncertainty/Impact Deviation resources for clean up Disruption/Re-evaluation of fuel/Energy supply Social Disruption Family disruption Migration Damage to recreation, leisure and tourism Contaminated/depleted seafood resource Reduced biodiversity Spoiled coast/animal deaths Damaged aesthetic/ecosystems Exposure/Experience Psychological , Physical, Toxic Stress PHYSIOLOGIC EFFECTS GENO/ENDOCRINE EFFECTS PSYCHOLOGICAL EFFECTS ECOSYSTEM EFFECTS Disturbances from the Clean up Indirect and Direct PAH effects Multi-generational impacts Headaches Eye/Throat Irritation Tiredness Cancer Risk Lung Function Injury Perceived Health Effects Acute Solvent Intoxication Depression Anxiety Disorder Post Traumatic Stress Disorder PAH etc in food chain - Hepatic Effects Reproductive Effects Cancers As well as for the ecosystems, Exposure and Health Risk are potentially greater initially for personsinvolved in clean up/wildlife rescue, but there are long term effects on both the residents and the ecosystems; ACTIONS can take place throughout eDPSEEA