Health Impact Assessment

HIA is defined as a combination of

procedures, Methods tools by which a project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.

Why HIA
An attempt to prevent the manifestations of health impacts that may emanate from a development project. Not Only help avoid unnecessary hardships due to negative health consequences, but also preventing a health effect is certainly less costly than treating it.

Definition of project type and location Retrieval of project experience Health hazard identification Initial Health examination

OUTPUT
Long list of hazards Short list of hazards with potentially significant health risks

Consult bank health specialist

Need HIA

No further Action

Initial Health Examination

TOR for HIA

Scope

Health Risk Assessment

Health impact Statement

Health Risk Management

Health monitoring data

Project benefit monitoring & evaluation

Evaluation report

Screening
The purpose of this first step in the HIA process is to screen the potential project for the need to conduct an HIA.

Scoping
To list the potential health impacts that may accrue from a proposed development project. The HIA Assessor should begin by listing the project activities. The project activities are usually classified into 4 phases, namely
site preparation phase, project construction phase, project operational phase project abandonment phase. (If needed)

Activity & Potential Health Impact

Description of Existing Public Health Status

Zone of Impact 5-10 km from the radius of area. Environmentally related disease cases should include respiratory, cardiovascular, waterborne, vectorborne, zoonotic diseases, and skin diseases, especially those due to atopy. Community Health Survey

Community Survey
The survey tool would be a health questionnaire. Assessments that should be included in the health questionnaire are
Respondents background information Household demographic information (age structure) Sanitation facilities (toilet, solid waste disposal and drinking water source) Household members morbidity profile of environment-related diseases

Health Risk Assessment

Prior to 1980s assumed that pollutants had a threshold level, below which they were harmless Increasing contradictory evidence, especially with carcinogens Initial approach was to demand zero levels Came to understand that zero not possible Led to development of field of environmental risk assessment

Definitions
Risk -- the probability of injury, disease or death under specific circumstance (EPA) Health a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity (WHO) Hazard the agent or means by which an adverse effect can occur in a particular situation

Definitions
Risk perception what people believe poses a risk or hazard Risk assessment quantifying the risk associated with a hazard Risk management evaluating whether real or perceived risks are acceptable, and if not, addressing them

Risk Perspectives

Risk Perspectives

Risk Perspectives

Health Risk Assessment

1.Hazard Identification
First indication that a hazard exists. Conventionally thought of as toxicological evidence. Can be more broadly viewed as any initiator
contaminant levels health concerns -- releases -- public outcry

2-A Dose-Response Assessment

Also termed toxicity assessment. Commonly presented as dose-response curve Generally produced in animal studies Assumes response of the population follows Gaussian statistics (normal distribution) Capable of detecting risks ~1%

2-A.Dose-Response Assessment

Carcinogens
EPA uses linear model risk decreases with dose but always some risk no matter how small the dose Calculates a potency factor or slope factor (SF) risk per unit dose, e.g. kgday/mg EPA maintains a data base of slope or potency factors

Potency Factor (Lifetime Risk)

Integrated Risk Information System (EPA)

Group A - Human carcinogen. This group is used only when there is sufficient evidence from epidemiologic studies to support a causal association between exposure to the agents and cancer. Group B - Probable human carcinogen. This group includes agents for which the weight of evidence of human carcinogenicity based on epidemiologic studies is "limited" and also includes agents for which the weight of evidence of carcinogenicity based on animal studies is "sufficient." The group is divided into two subgroups. Group B1 is reserved for agents for which there is limited evidence of carcinogenicity from epidemiologic studies. Group B2 is used for Agents for which there is "sufficient: evidence from animal studies and for which there is "inadequate evidence" or "no data" from epidemiologic studies. Group C Possible human carcinogen. This group is used for agents with limited evidence of carcinogenicity in animals in the absence of human data. Group D - Not classifiables as to human carcinogenicity. This group is generally used for agents with inadequate human and animal evidence of carcinogenicity or for which no data are available. Group E - Evidence of non-carcinogenicity for humans.This group is used for agents that show no evidence for carcinogenicity in at least two adequate animal tests in different species or in both adequate epidemiologic and animal studies.

2-B Exposure Assessment: Calculation of Chemical Intake

2-B Exposure Assessment

1. Identify significant pathways 2. Determine concentrations in environmental media that are contacted 3. Assign exposure factors 4. Calculate chemical intake OR Chronic Daily Intake (CDI)

Identification of Significant Exposure Pathways

Example Human Exposure Factors

Male Lifespan (yr) Body weight (kg) Residential exposure period (hr/d, d/yr) Food intake (wet g/day) Water intake (mL/day) Air intake (m3/day) 70 70 24, 365 1500 2000 20 Female 78 60 24, 365 8, 250 1500 2000 20

Occupational exposure period (hr/d, d/yr) 8, 250

Reference Exposure factors

Chronic Daily Intake-CDI

Exampl : I
C1 R1 CDI ! WB where C1 is the concentrat ion of chemical in water (mg/L) R1 is the ingestion rate (L/day) WB is the body weigh t (kg)

sti

f ri

at r

3.0 Risk Characterization

Last step in the risk assessment process Integrates first three steps
hazard identification toxicity assessment exposure assessment

determines probability of an adverse impact to individuals or to a defined population provides the basis for risk communication to stakeholders, determination of risk acceptability, and evaluation of risk management strategies

3.0 Characterizing Risk for Carcinogens

Incremental Lifetime cancer Risk = Chronic Daily Intake (mg/kg-day) v slope factor Example Aldrin
slope factor = 17 (mg/kg/day)-1 suppose CDI = 0.002 mg/kg-day Risk = (17)(0.002) = 0.034 = one in 29

3.0 Characterizing Risk for Carcinogens

Example - What dose would give a risk of one in a million?
CDI = Risk/slope factor = 10-6/17 (mg/kg/day)-1 = 6 x 10-8 mg/kg/day

Non-carcinogens
EPA approach is to calculate a reference dose, RfD Estimates the dose at which no appreciable risk is expected Obtained by dividing the no observed adverse effects level (NOAEL) by several safety factors

Hazard Index For Non Carcinogens

Hazard Index = Sum of Hazard quotients Hazard quotient = Average daily dose (mg/kg.day)/RfD Hazard Index>1 , significant toxicity,

Oral RfDs

4.0 Risk Management

Technological Solutions
elimination treatment isolation

Behavioral Solutions
exposure avoidance

Mitigation Measures/Emergency Response Plan

Health specific measures will have to be proposed for occupational diseases like noise-induced hearing loss and work accidents. As mentioned earlier, even with mitigation measures properly in place, something may still run amiss. An example would be an unexpected breakdown of the air pollution control equipment resulting in excessive release of air pollutants into the atmosphere. This calls for an emergency reaction to minimize the magnitude and severity of the health impacts. To assure that this will indeed happen, the Project Initiator needs to properly draft out an emergency response plan. The emergency response plan should have the following features : A detailed information on potential health hazards, health effects and their control (e.g. a material safety data sheet or MSDS). A plan to engage emergency stakeholders like the Department of Environment, Ministry of Health, District Office, local Village Development and Security Committee and others. A plan to engage security and emergency authorities like the private security firm, police, fire and rescue, District Hospital, District Health Office, and others.