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 covered 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 demographics; involuntary displacement of residents or businesses; changes in industry actions or practices, employment, government revenues, or land-use patterns; changes in modes or safety of transportation; reductions in access to natural resources; 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).


CEQ regulations on implementing NEPA contain several statements that can help to guide an agency’s approach to scoping for health effects. First, agencies 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 affordability of housing; access to employment and government revenues; the quality

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