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Appendix F Analysis of Health Effects under the National Environmental Policy Act In Chapter 4, the committee noted that the analysis of health effects under the National Environmental Policy Act (NEPA) has been limited. To date, nei- ther the Council on Environmental Quality (CEQ) nor federal agencies that comply with NEPA have produced guidance on the analysis of health effects. As discussed in Chapter 4, the lack of guidance on analyzing public-health effects does not diminish the legal requirement to consider health in an environmental impact statement (EIS). Agencies complying with NEPA, however, often lack public-health expertise, and the lack of guidance may be a disincentive to a more robust, systematic approach to health. Although there is no formal guidance, existing regulations and relevant guidance provide a foundation for improving the analysis of health effects in an EIS. To assist the agencies in conducting a more robust, systematic analysis of health impacts, this appendix addresses the following issues:  Determining when to conduct a systematic analysis of health effects in an EIS or environmental assessment.  Determining the appropriate scope of health problems to include in the analysis.  Determining what populations or communities are affected and describ- ing baseline conditions in them.  Analysis of health effects in a manner that is scientifically and legally defensible according to the requirements of NEPA.  Mitigation of identified effects on public health.  Responsibility and authority for public-health analysis under NEPA. 204

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205 Appendix F DETERMINING WHEN TO CONDUCT AN ANALYSIS OF HEALTH EFFECTS Health effects should be considered in complying with NEPA (40 CFR 1508.8). However, the CEQ also instructs agencies to “identify and eliminate from detailed study the issues which are not significant or which have been cov- ered by prior environmental review” (40 CFR § 1501.7(a)3). Agencies are thus obliged to consider health effects only when there is reason to conclude that they may be significant. Questions that agencies may wish to answer in determining significance include the following:  Were scoping comments on health submitted?  Are health concerns a major point of controversy (even if the concerns that have been raised are not likely to be supported by the analysis)?  Are there other significant impacts likely that are known to affect health? The effects of federal-agency actions subject to NEPA that may impact health include emissions of hazardous substances; changes in community demo- graphics; involuntary displacement of residents or businesses; changes in indus- try actions or practices, employment, government revenues, or land-use patterns; changes in modes or safety of transportation; reductions in access to natural re- sources; and changes in food and agricultural resources. Although environmental-justice guidance is intended to assist agencies in addressing the potential for disparate effects on low-income and minority-group communities, some of the principles also have relevance to health effects in the general population. The CEQ suggests that agencies should “consider enhancing their outreach” to public-health agencies and clinics (CEQ 1997). DETERMINING THE APPROPRIATE SCOPE OF HEALTH-EFFECT ANALYSIS CEQ regulations on implementing NEPA contain several statements that can help to guide an agency’s approach to scoping for health effects. First, agen- cies are instructed to consider direct, indirect, and cumulative effects associated with the proposed action and alternatives (40 CFR § 1508.8). Thus, agencies should not arbitrarily limit consideration to health effects that may be the most obvious or direct (such as those related to emissions or discharges) but should systematically consider the potential for direct, indirect, or cumulative health effects. Health determinants that might be considered and analyzed in the scope of an environmental impact assessment under NEPA would be the same as those considered in HIA and would include such factors as the quality and afforda- bility of housing; access to employment and government revenues; the quality

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206 Improving Health in the U.S.: The Role of Health Impact Assessment and accessibility of parks, schools, and transportation services; neighborhood safety; exposure to environmental hazards; the quality and affordability of food resources; and the extent and strength of social networks. Moreover, agencies should be responsive to concerns raised by stakeholders during scoping, particu- larly when health concerns are a matter of controversy (40 CFR § 1501.7, 40 CFR § 1508.27(b)(4). Environmental-justice guidance (EPA 1998) discusses what is relevant to health effects in the general population and states the following: The EPA NEPA analyst should develop a full understanding of baseline demographic, socioeconomic, and environmental conditions so that a comprehensive assessment of the types of impacts that may be imposed upon all human and natural resources…can be conducted and an under- standing of how these impacts may translate into human health concerns can be developed. NEPA and CEQ regulations do not identify any category of health effect that is exempt from consideration under NEPA. Agencies are instructed to in- clude all effects that may be significant, whether direct, indirect, or cumulative. CEQ regulations (40 CFR § 1501.7(a)(3)) do, however, require that agencies do the following: Identify and eliminate from detailed study the issues which are not signifi- cant or which have been covered by prior environmental review (§1506.3), narrowing the discussion of these issues in the statement to a brief presen- tation of why they will not have a significant effect on the human envi- ronment or providing a reference to their coverage elsewhere. In practice, a systematic approach to identifying health effects should help agen- cies to ensure that potentially significant health effects are included. DETERMINING THE AFFECTED POPULATIONS OR COMMUNITIES AND DESCRIBING THE BASELINE The description of the affected environment in the regulations indicates the baseline with which impacts of the alternatives can be compared. For public health, the comparison should include a concise discussion of the health status and health determinants in the affected community. CEQ regulations clearly indicate that the EIS should focus on describing aspects of the affected environ- ment that are necessary for developing an understanding of the effects of the alternatives (40 CFR § 1502.15). For public health, therefore, the goal is not a comprehensive assessment of all health issues, but only the ones that are rele- vant to the health impacts identified.

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207 Appendix F Public-health data and statistics for describing the public-health environ- ment will be drawn from a variety of sources. Federal, tribal, state, and local health departments maintain databases and surveillance on various health condi- tions; local hospitals and clinics may also have relevant data. There may be re- strictions on accessing or publishing some statistics because health data are sub- ject to legal requirements intended to protect privacy. Consultation with the appropriate health officials is a way for agencies to identify and access appropri- ate data. Establishing cooperating agency relationships with the relevant health agencies may also be desirable (40 CFR § 1501.6). Determining what populations or communities may be affected requires an understanding of the pathways through which impacts may occur. The CEQ notes that the context of the decision is important for determining where signifi- cant effects would occur; for example, site-specific actions are more likely to have localized effects (40 CFR §1508.27). ANALYZING THE HEALTH EFFECTS As noted above, CEQ regulations require that agencies consider “the di- rect, indirect, and cumulative effects” of the proposed action and alternative and, as noted in Chapter 4, define health as one of the effects that should be included (40 CFR § 1502.16, 40 CFR § 1508.8). They also note that the analysis may include beneficial effects (40 CFR § 1508.8). Agencies are further directed to consider how “economic or social and natural or physical environmental effects are interrelated” (40 CFR § 1508.14). The regulations and available guidance do not identify specific methods that must be used in analyzing health effects or other effects more commonly included in an EIS. Instead, NEPA simply requires that agencies “utilize a sys- tematic, interdisciplinary approach which will insure the integrated use of the natural and social sciences and the environmental design arts” (Section 102(2)(A)). Agencies are required to “insure the professional integrity, including scientific integrity, of discussions and analyses in environmental impact state- ments. They shall identify any methodologies used and shall make explicit ref- erence…to sources relied upon for conclusions in the statement” (40 CFR § 1502.24). Thus, although the regulations on NEPA’s implementation do not provide specific guidance on methods that should be used to assess health impli- cations, they establish basic standards and expectations (as for all other effects considered in an EIS) regarding a broad-based, interdisciplinary, scientifically sound approach. Uncertainty of predictions is a common concern in analyzing health ef- fects, but this challenge is common to many effects considered in an EIS. In many cases, controlled studies of a scenario analogous to the action being as- sessed do not exist, and the agency must make judgments based on uncertain predictions. CEQ guidance addresses the question of uncertainty and states that “the EIS must…make a good faith effort to explain the effects that are not

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208 Improving Health in the U.S.: The Role of Health Impact Assessment known but are ‘reasonably foreseeable’” and that “the agency has the responsi- bility to make an informed judgment” and “cannot ignore these uncertain, but probable, effects of its decision” (CEQ 1981). MITIGATATION OF IDENTIFIED EFFECTS ON PUBLIC HEALTH Agencies are required to consider mitigation measures as part of the al- ternatives (40 CFR § 1502.14(f)) or in response to any significant effects iden- tified in the analysis (40 CFR § 1502.16(h)). Some existing regulatory stan- dards (such as those established by the Clean Air Act and Clean Water Act) establish health-based thresholds that trigger actions to minimize exposure to specific pollutants. Many impacts included in an EIS—including some health effects—have no such thresholds or regulatory standards. In some cases, the mitigation measures identified may lie outside the jurisdiction of the lead agency or cooperating agencies. The CEQ (1981) has provided guidance on this situation and states the following: All relevant, reasonable mitigation measures that could improve the pro- ject are to be identified, even if they are outside the jurisdiction of the lead agency or the cooperating agencies, and thus would not be committed as part of the RODs [Records of Decisions] of these agencies. Sections 1502.16(h), 1505.2(c). This will serve to [46 FR 18032] alert agencies or officials who can implement these extra measures, and will encourage them to do so. Because the EIS is the most comprehensive environmental document, it is an ideal vehicle in which to lay out not only the full range of environmental impacts but also the full spectrum of appropriate mitiga- tion. Health mitigation measures may be implemented not only through regula- tions or requirements established by the lead agency but through actions taken by a cooperating agency, another government entity, or local, state, or tribal health department or through voluntary actions taken by a project proponent or another stakeholder. RESPONSIBILITY AND AUTHORITY FOR PUBLIC-HEALTH ANALYSIS UNDER THE NATIONAL ENVIRONMENAL POLICY ACT Ultimately, compliance with NEPA requirements is the responsibility of the lead agency. As noted previously, however, agencies are directed specifi- cally to use an interdisciplinary approach (40 CFR § 1502.6). CEQ guidance has emphasized the importance of soliciting cooperating agency participation to fulfill this requirement and ensure a complete, efficient analysis (CEQ 2002).

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209 Appendix F Finally, CEQ requires that the “disciplines of the preparers shall be appropriate to the scope and issues identified in the scoping process” (40 CFR § 1502.6). Thus, when health effects are to be included, agencies should solicit the partici- pation of public-health experts. Local, state, tribal, and federal health agencies often have adequate public-health knowledge and data but may lack familiarity with NEPA and will require orientation on the procedures and approach. REFERENCES CEQ (Council on Environmental Quality). 1981. Forty Most Asked Questions Concern- ing CEQ’s National Environmental Policy Act Recommendations. Memorandum for Federal NEPA Liaisons, Federal, State, and Local Officials and Other Persons Involved in the NEPA Process, from Nicholas C. Yost, General Counsel, Council on Environmental Quality, Washington, DC, March 16, 1981 [online]. Available: http://nepa.energy.gov/nepa_documents/TOOLS/GUIDANCE/Volume1/4-1-40_que stions.html [accessed July 12, 2011]. CEQ (Council on Environmental Quality). 1997. Environmental Justice: Guidance Under the National Environmental Policy Act. Council on Environmental Quality, Wash- ington, DC [online]. Available: http://ceq.hss.doe.gov/nepa/regs/ej/justice.pdf [ac- cessed July 12, 2011]. CEQ (Council on Environmental Quality). 2002. Cooperating Agencies in Implementing the Procedural Requirements of the National Environmental Policy Act. Memo- randum for the Heads of Federal Agencies, from James Connaughton, Chair, Council on Environmental Quality, Washington, DC. January 30, 2002 [online]. Available: http://ceq.hss.doe.gov/nepa/regs/cooperating/cooperatingagenciesmemo randum.html [accessed July 12, 2011]. EPA (U.S. Environmental Protection Agency). 1998. Final Guidance for Incorporating Environmental Justice Concerns in EPA’s NEPA Compliance Analyses. U.S. En- vironmental Protection Agency. April 1998 [online]. Available: http://www.epa. gov/compliance/ej/resources/policy/ej_guidance_nepa_epa0498.pdf [accessed July 12, 2011].

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