Health and Environmental Impact Assessment

An Integrated Approach

British Medical Association

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134067015
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This text shows why we need to develop an integrated approach to health and environmental impact assessment of development projects, and how this might be achieved. Case studies and examples are provided

Introduction

The British Medical Association

The British Medical Association (BMA) is a professional organisation representing all doctors in the UK. It was established in 1832 to promote the medical and allied sciences, and to maintain the honour and interests of the medical profession. The BMA Board of Science and Education supports this aim by providing an interface between the profession, the government, and the public. By undertaking research studies on behalf of the BMA, and through the publication of policy reports, the Board of Science and Education has led the debate on key public health and professional issues.

One major objective of the Board of Science and Education is to contribute to the development of better public health policies that affect the community, the state, and the medical profession. In order to do this, the Board appoints working parties and steering groups, combining medical and other specialist expertise to undertake investigations to examine the impact of various policies and activities on public health. The Board has published a number of reports over recent years, reflecting current concerns, such as pesticide toxicity, transport policy, complementary medicine, bloodborne infections, and the environmental and occupational risks of health care^1,2,3,4,5 and has developed BMA policy in a range of medico-sociological topic areas.

The Board is also responsible for developing educational initiatives. Some of the reports and video presentations published through the Board have been used in medical education programmes, in secondary schools and in higher education. The Board not only develops such educational materials, but also has an interest in educational policy, and has examined the education of doctors in clinical safety, multicultural health care, and other issues.

BMA policy on the environment

The BMA has produced a number of policy documents which focus on aspects of environmental health and pollution and which recommend policies for national action by government, other organisations and individuals, with specific recommendations affecting the medical and allied professions. In 1987 the BMA published Living with Risk,⁶ a comprehensive guide which explored the risks associated with the environment as part of a wide ranging investigation into how individuals perceive, manage and prevent risk. Pesticides, Chemicals and Health⁷ examined the current need for the use of pesticides, reviewed the literature concerning acute and chronic effects on human health, methods of control and surveillance, and alternatives to chemical pesticides. Hazardous Waste and Human Health⁸ provided an overview of the existing evidence relating to the adverse health effects due to exposure to hazardous waste. This evidence was presented in relation to the characteristics of hazardous waste, its origins, disposal methods and regulations governing the management of waste.

The BMA’s Board of Science and Education has considered air pollution caused by the internal combustion engine and recommendations for actions to reduce pollution were published in the report Cycling: toward health and safety.⁹ The report recommended the active promotion of cycling as an environmentally friendly means of transport, and suggested ways in which cycling could be made safer and more accessible. In a further report, Road Transport and Health¹⁰ published in 1997, the BMA highlighted the many ways in which transport policy can affect health, considering not only the more obvious effects such as accidents and pollution but also other consequences of transport policy such as the decline in public transport services, particularly in rural areas, the lowering of the quality of life in inner-city residents and the associated lack of physical activity leading to unhealthy lifestyles. In 1994 the Board of Science and Education reviewed the issues surrounding water disconnections and the effects on individual and public health.¹¹ Also in 1994 the BMA addressed concerns over the adverse effects of medical technology through publication of a report on Environmental and Occupational Risks of Health Care.¹² The report considered risks to health and the environment from chemicals, radiation, infectious agents and disposal of clinical waste as well as numerous other processes carried out as part of health care. Further guidance on clinical waste, storage and disposal has been given by the Association through its Code of practice for the safe use and disposal of sharps¹³ and the Code of practice for sterilisation of instruments and control of cross infection.¹⁴

Doctors, human health and the environment

The medical profession has an important role to play in exploring risks to human health so that hazards can be controlled, diminished or eliminated. A key practical recommendation that arose from the BMA’s work regarding the environment called for doctors to “play an active part in managing the environment in the interests of public health”.¹⁵

In recent years, with growing public interest in environmental issues, increasing concern has been shown over the environmental consequences of unrestrained environmental development. This has resulted in the introduction of new national and international legislation intended to safeguard the environment and promote sustainability. Environmental impact assessment is one such example which has been legislated for in many countries, to ensure that environmental effects are taken fully into account when planning new development. New development can have major implications for human health, both on a national, local and individual basis. The health and quality of life of people depend substantially on the physical, social, economic and commercial environment in which they live. This environment is increasingly compromised by human activity and there are few areas of the world left which are completely unaffected by the direct or indirect effect of humans. Much recent development has been enormously beneficial to human life and for many the quality of their built environment, their food and water supply and their employment and leisure activities bring them a quality and duration of life unmatched in history. Unfortunately, the increase in the population and the consumption of natural resources to achieve this are now widely recognised as unsustainable. As more and more parts of the world become industrialised and energy and material consumption increase, the problems will be aggravated. In an environment where scant regard is paid to the precautionary principle (see section 4.4.5) or to the desirability of some proposed development, and where its potential profitability is the dominant or sole consideration, market forces can have serious adverse effects on environmental and public health.

Rape fields may exacerbate pollen allergy

In addition to the health impact assessment of development projects, there is a need to assess the health impacts, both positive and negative, of policies. One example is agricultural policy which can have a health impact through food standards, access to food, and nutritional status of the population, as well as other implications such as the planting of rape seed which may have an adverse health impact for those who are allergic to pollen.

Government departments, other organisations or agencies often send consultation documents to the BMA for consideration and comment on the medical/health aspects of the document. This consultation exercise could be considered to be a preliminary health impact assessment. Issues may arise from this preliminary review which could indicate that a detailed health impact assessment needs to be carried out. A full health impact assessment may be a very detailed piece of work, and at present the methodology is at an early developmental stage. The BMA believes that a framework for regulation is required to enable the assessment of development projects and public policies to be undertaken within a wider strategic set of objectives which contribute to the overall goal of sustainability, and maintenance of health.

Human health is determined by a number of factors including genetic predisposition, lifestyle, nutrition, socio-economic status, access to adequate health care, and the environment. The multidimensional nature of human health was emphasised in 1995 by the BMA report Inequalities in Health¹⁶ which noted that the quality of the environment affects all sectors of society, especially those in deprived groups. The continuing availability of environmental resources — air, water, food and shelter — as well as appropriate climatic and socio-economic conditions, is a prerequisite for health and survival. Environmental conditions are not always optimal however, and populations may be exposed to a variety of environmental factors that may adversely affect their health and wellbeing. These environmental hazards may result from natural causes and/or human activities. Healthy environments and healthy populations are therefore interdependent.

Despite this clear interdependence, the protection of human health and the environment have traditionally been addressed separately, through the provision of health care services and public health legislation on the one hand, and through environmental protection measures on the other. At various times, especially since the 1970s, references have been made to the importance of relationships between the environmental and health sectors, but in practice little progress has been made towards their integrated assessment and regulation. In 1996, however, the professional body which represents Environmental Health Officers, the Chartered Institute of Environmental Health, established an Environmental Health Commission in collaboration with the Royal Environmental Health Institute of Scotland, and the city councils of Edinburgh and Oxford. The conclusions of that Commission were published in July 1997.¹⁷ The Commission concluded that human beings can only be healthy in a healthy environment, and provided a set of detailed recommendations for institutional and policy reforms, including the need for local authorities to develop techniques for integrated environmental health impact assessment. These recommendations can be expected to contribute to improving both environmental and public health.

At the BMA Annual Representative Meeting in 1994, there was a debate on impact assessment in the UK. A resolution was passed calling upon the BMA Board of Science and Education to review the methods for health impact assessment of environmental projects, and then press the government to undertake them for all major projects affecting the environment. As a result of this debate, a preliminary report was prepared for the Board of Science and Education by Dr D Osborn of the Natural Environment Research Council (NERC) which formed the basis for discussion at an informal round table meeting held in June 1995. Following the meeting, a formal BMA working party was established to examine the degree of emphasis given to the dynamic relationship between human and environmental health in the light of existing public health legislation, health care provision and formal environmental assessment procedures. The outcome of this study and recommendations formed the basis for this report.

Aims, scope and structure of the report

This present report further develops the BMA’s policies on health and the environment. One of its aims is to challenge the way people think about impact assessment both at a national/strategic and local/project level and to set out what is known, and what remains to be learnt about the process of environmental impact assessment (EIA), and to show how this might be enhanced.

The report considers actions that could potentially affect the environment and human health. Such actions may be individual development proposals submitted for planning consent, or proposals for plans, policies or programmes. For terminological convenience the text will refer primarily to ‘projects’, although policies, programmes and plans are included, except where otherwise stated. The environmental impacts of these are addressed through project-level environmental impact assessment (EIA) and strategic environmental assessment (SEA) respectively. The assessment of health impacts may be addressed through health impact assessment (HIA) with respect to either project-level EIA or strategic-level SEA. These various forms of assessment are described in detail in Chapter 3.

Provisions for the assessment of health impacts within EIA vary between countries. Mandatory provision for SEA is in place in a relatively small number of countries, but there is ongoing consultation on a European SEA Directive.¹⁸ This report refers primarily to existing EU and UK legislation, but also summarises experience from developing countries. Drawing on this experience, together with some UK examples and case ...

Table of contents

• Cover
• Half title
• Title Page
• Copyright Page
• Table of contents
• List of figures and tables
• Editorial Board
• Board of Science and Education
• Working Party
• Acknowledgements
• Chapter 1: Introduction
• Chapter 2: Management of the environment to safeguard human health: the background
• Chapter 3: Environmental impact assessment: development and current UK provision
• Chapter 4: The inclusion of human health in the environmental impact assessment process
• Chapter 5: Wider social and economic issues
• Appendix 1: The evolution of public health legislation
• Appendix 2: Duties of a doctor in occupational medicine
• Appendix 3: Recommended target maximum levels for pollutants listed in the UK National Air Quality Strategy
• Appendix 4: Life-cycle assessment
• Appendix 5: Environmental impact assessment: the global scene
• Appendix 6: Coverage of impacts on human health in UK environmental impact statements: a review
• References
• Index