National Academies Press: OpenBook

Improving Health in the United States: The Role of Health Impact Assessment (2011)

Chapter: Appendix F: Analysis of Health Effects under the National Environmental Policy Act

« Previous: Appendix E: Summary of Health Impact Assessment Guides
Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

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, neither 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 describing 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.

Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

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 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).

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, 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

Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

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, particularly 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 understanding 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 include 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 significant or which have been covered by prior environmental review (§1506.3), narrowing the discussion of these issues in the statement to a brief presentation of why they will not have a significant effect on the human environment or providing a reference to their coverage elsewhere.

In practice, a systematic approach to identifying health effects should help agencies 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 environment 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 relevant to the health impacts identified.

Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

Public-health data and statistics for describing the public-health environment will be drawn from a variety of sources. Federal, tribal, state, and local health departments maintain databases and surveillance on various health conditions; local hospitals and clinics may also have relevant data. There may be restrictions on accessing or publishing some statistics because health data are subject to legal requirements intended to protect privacy. Consultation with the appropriate health officials is a way for agencies to identify and access appropriate 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 significant 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 direct, 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 systematic, 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 statements. They shall identify any methodologies used and shall make explicit reference…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 implications, 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 effects, 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 assessed 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

Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

known but are ‘reasonably foreseeable’” and that “the agency has the responsibility 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 alternatives (40 CFR § 1502.14(f)) or in response to any significant effects identified in the analysis (40 CFR § 1502.16(h)). Some existing regulatory standards (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 project 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 mitigation.

Health mitigation measures may be implemented not only through regulations 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 specifically 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).

Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

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 participation 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 Concerning 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_questions.html [accessed July 12, 2011].

CEQ (Council on Environmental Quality). 1997. Environmental Justice: Guidance Under the National Environmental Policy Act. Council on Environmental Quality, Washington, DC [online]. Available: http://ceq.hss.doe.gov/nepa/regs/ej/justice.pdf [accessed July 12, 2011].

CEQ (Council on Environmental Quality). 2002. Cooperating Agencies in Implementing the Procedural Requirements of the National Environmental Policy Act. Memorandum 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/cooperatingagenciesmemorandum.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. Environmental Protection Agency. April 1998 [online]. Available: http://www.epa.gov/compliance/ej/resources/policy/ej_guidance_nepa_epa0498.pdf [accessed July 12, 2011].

Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×

This page intentionally left blank.

Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×
Page 204
Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×
Page 205
Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×
Page 206
Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×
Page 207
Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×
Page 208
Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×
Page 209
Suggested Citation:"Appendix F: Analysis of Health Effects under the National Environmental Policy Act." National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press. doi: 10.17226/13229.
×
Page 210
Improving Health in the United States: The Role of Health Impact Assessment Get This Book
×
Buy Paperback | $39.00 Buy Ebook | $31.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Factoring health and related costs into decision making is essential to confronting the nation's health problems and enhancing public well-being. Some policies and programs historically not recognized as relating to health are believed or known to have important health consequences. For example, public health has been linked to an array of policies that determine the quality and location of housing, availability of public transportation, land use and street connectivity, agricultural practices and the availability of various types of food, and development and location of businesses and industry.

Improving Health in the United States: The Role of Health Impact Assessment offers guidance to officials in the public and private sectors on conducting HIAs to evaluate public health consequences of proposed decisions -- such as those to build a major roadway, plan a city's growth, or develop national agricultural policies -- and suggests actions that could minimize adverse health impacts and optimize beneficial ones.

Several approaches could be used to incorporate aspects of health into decision making, but HIA holds particular promise because of its applicability to a broad array of programs, consideration of both adverse and beneficial health effects, ability to consider and incorporate various types of evidence, and engagement of communities and stakeholders in a deliberative process. The report notes that HIA should not be assumed to be the best approach to every health policy question but rather should be seen as part of a spectrum of public health and policy-oriented approaches.

The report presents a six-step framework for conducting HIA of proposed policies, programs, plans, and projects at federal, state, tribal, and local levels, including within the private sector. In addition, the report identifies several challenges to the successful use of HIA, such as balancing the need to provide timely information with the realities of varying data quality, producing quantitative estimates of health effects, and engaging stakeholders.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!