EDITORIALS

Risks to health, risk management and environmental health impact assessment When we think of the environment and its effect on health we tend to think in terms of cliches; perhaps the squatter with weathered face waiting for the rains to come, or the smog cloud over large cities. The environment is ‘out there’, not in our homes, neighbourhoods and workplaces, and we tend to restrict environmental health concerns to extreme and well-publicised examples, such as chemical plant fires or toxic sites. But the environment is a more pervasive and personal factor and our health is critically interdependent with the immediate per- sonal as well as global environment in which we live. As John Last noted in Public health and human ecology

Ecology is concerned with the healthy interaction of living creatures in a closed system. Human ecology includes humans in this system. Humans interact with each other as well as with other living creatures and these interactions can have impor- tant effects on the health of all partners in the complex closed ecosystem of our planet. We ignore this reality at our peril.’

A major concern of environmental health risk assess- ment is to express possible risks to environment and population health in ways that can be understood and evaluated on a personal level. Development brings jobs, economic benefits and amenities which can be readily appreciated at the personal level. Risks accompanying development expressed as sta- tistical possibilities on a population scale are not so readily appreciated or assessed. Although risk assess ment is implicitly a major part of any government public health and regulatory activity (Should we do this, should we not? What are the chances our action will ameliorate the problem or cause a bigger one?), many would agree that the process of explicit risk assessment is not as well understood or as well imple- mented as it should be.

Risk assessment is often controversial. It often involves analysing incomplete data, or extrapolating from data that refer to other systems (for example, data on carcinogenesis obtained from rats or even mutation rates in bacteria). Sometimes the risk assessment will be used for regulatory or corrective purposes, and the outcome of the assessment may be challenged in the courts (for example, the effect of an industrial emission on health). At other times, the assessment will be used for educational purposes (for example, the health effects of dietary fat), and sometimes it serves both sets of purposes (for exam- ple, passive smoking).

Explicit assessment of health risks is surprisingly only recently (and sometimes reluctantly) incorpe rated into the process of environmental impact assessment. Perhaps this is a reflection of our inabil- ity or unwillingness to deal with the uncertainty and controversy which necessarily accompany the process of making ‘best guesses’ about human health. It is now accepted in Australia that environ- mental impact assessments should have a health component built in as an integral component.

Environmental impact assessment was first for-

mally established in the United States in 1969, with the US National Environmental Policy Act. This Act referred to federal agencies, but the extensive debate and legal testing that has followed over the years has shaped our current understanding of what we should expect of our environmental manage- ment processes. For instance, in the famous case concerning the Chesapeake Environmental Protec- tion Association’s claim that the Atomic Energy Commission did not adequately consider the effects of its proposed nuclear power plants on water qual- ity, it was ruled that assessment had to go beyond mere compliance with standards to look at the wider implications of its effects on the environment.

Australia was one of the first countries outside the United States to legislate for environmental impact assessment (in the Envirunmentul Proteclion (Impact of Proposals) Act 1974, amended in 1987 by the Environment Protection (Impact of Proposals) Administrative Procedures. The states and territo ries have their own legislation, set up between 1971 and 1993. Concern has been expressed about Australia’s procedures, which some claim allow excessive powers to governments to bypass assess ments, smooth the path of pro osals and restrict the standing of interest groups! Following concern about the differences in procedures between states, the Australian and New Zealand Environment and Conservation Council produced A national approach and a background paper on environmental impact assessment in 1991.5 The national approach included proposals for integrating economic and ecological impacts, considering cumulative and long-term impacts, early public participation and postdevelopment auditing. After the Inter-govern- mental Agreement on the Environment, national guidelines on the need for and the extent of the assessment process have been produced.

In New Zealand, the Resource Management Act 1991 established procedures for the ‘assessment of effects on the environment’ in a manner that safeguards health and safety.

In Australia, the National Framework for Environmental and Health Impact Assessment has provided guidance on how to do it.’ The national framework has attracted attention from a number of countries and organisations, and provided a step for- ward in the international evolution of environmen- tal and health impact assessment. A noteworthy feature was the inclusion of social and economic fac- tors into the assessment process: hitherto, the ten- dency was to consider only catastrophe (for example, explosion) or toxicity in such assessments. Social effects were largely the preserve of sociole gists and anthropologists, divorced from the impact assessment process.

New Zealand has built on this and produced a clear and simple guide for resource management agencies, public health services and applicants on health impact assessment as part of environmental a s s e ~ m e n t . ~ The need for consultation is stressed, with regard to sustaining the environment and a proper recognition of the principles of the Treaty of Waitangi (between the Maori and the British colonising power in 1840).

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EDITORIAL

Those are the frameworks for environmental and health impact assessment. It is clear that we still need to develo tools capable of describing the con-

people can understand. A good example of the limitations of an environ-

mental impact assessment process that does not address health and social effects is the develo ment

recognised for years that the limits of runway capac- ity would soon be reached, and the two solutions canvassed were either to add a third runway or build a new airport 70 km to the west in Badgery’s Creek. Because the pro onent was a Commonwealth

national assessment procedures were used. Several options were considered, including no action, no third runway but development at Badgery’s Creek, development of both the third runway and (later) Badgery’s Creek, altered traffic management, and different spacings of the third runway from the exist- ing north-south runway.

The draft environmental impact statement (1990) considered capacity, cost, noise, aircraft crashes, operations, market trends, timing etc., but provided only a limited analysis of the effect on residents. Durin a three-month review period, there was con-

that the public cared deeply about the additional noise that the runway would create. A final environ- mental impact statement was prepared, reviewed by the Department of Arts, Sport, the Environment, Tourism and Territories (DASETT, responsible for all Commonwealth environmental impact assess ment procedures), and in 1991 a decision to con- struct the third runway was taken. Now (1995) it is in operation and attracting vocal criticism and protest action from residents.

Health considerations, in the original statement, did not play a very prominent part, and the effects of repetitive excessive noise on wellbeing and the quality of life were considerably underestimated. Part of the problem, in retrospect, seems to be that we lacked adequate tools for assessing effects on wellbeing. We can assess the risk of deafness from continued noise, we can make an informed stab at the risk of a piece of aeroplane falling on us, but we are not good at measuring psychological or social effects. We also lack good tools for measuring out- rage, the sense of indignation that gives punch to our protests. Part of the problem also was the lack of early consultation; for practical urposes, the con-

occurred at a time when many people suspected that all the important decisions about Sydney airport had already been taken.

The article by Dunt, Abramson and Andreassen in this issue of the journal (000-000) on the assessment of future impact of a proposed freeway development is an excellent example of method development, simplicity and communication. The problem was to estimate the effect on health of an inner suburban freeway in Melbourne. The way in which the authors a proached the problem was first to estimate the

They used current statistics to estimate the changes in injuries (a reduction after the motorway was con- structed). Knowing the emission from an average

sequences of B evelopment on people in ways that

of a third runway at Sydney airport. It ha a been

authority (the Fe B eral Airports Corporation), the

sidera % le public controversy, and it became clear

sultation period lasted only t f ree months and

c R anges in traffic flow resulting from the freeway.

car, they estimated the changes in airborne pollu- tants and the changes in expected noise levels. Summing it all up, they reckoned that the overall effect of freeway construction would be a reduction in adverse effects, outweighing the effect of an increase in atmospheric pollution. Their methods are simple and understandable, and they wrote their whole paper in plain English.

Some situations are more complex, and we could, with advantage, enlarge our horizons by studying the excellent how-to-do-it book by Armstrong, White and Saracci, Ainciplar of ex@suw 7nasu-t in epi- dcmiology..s The problem of exposure measurement is at the heart of epidemiology, and this book covers the major methods. There are many sources of infor- mation available on specific problems: for instance, the Environmental Protection Agency in the United States has a comprehensive series of risk-assessment guidelines, and the ongoing Integrated Risk Infor- mation System (IRIS), which can be accessed through the National Library of Medicine MEDLARS system.

A complex and healthy society needs effective assessment of the potential effects of the environ- ment on health. A healthy environment needs an ecological perspective on human activity. Neither is possible without an informed public and a skilled workforce. A continuing, and growing, active involvement by public health professionals and researchers in ecology and our interactions with the environment, as well as an ability to communicate that interest in scientific and public forums, is vital to a healthy future.

Dennis Calvert and Christine E m University of WouongOng

References 1. Last JM. M l i c heah and human ccologp East Norwalk, CT.

Appleton and Lange, 1987. 2. Formby J. The Australian government’s experience with

environmental impact assessment Envimn Impact Ases.s Rm

3. Australian and New Zealand Environment and Conservation Council. Enurnmental impact arrcrrmcnt; a ~n’onal approach; badrgroundpap~ b the national appwch. Canberra: Australian Government Publishing Service, 1991.

4. National Health and Medical Research Council. National fratnmd fm muironmental and health impact asscsnnmt. Canberra: Australian Government Publishing Service, 1994.

5. Public Health Commission. Guide b health impact aucssnrmf. Guidetinu fm public health Smnm and TCSM(TCC manognnnt agm& and consent applicants. Wellington NZ Public Health Commission, 1995.

6. Armstrong BK, White E, Saracci R Nnciplw ofrrposun ma- sumncnt in +dmiology. Oxford: Oxford University Press, 1992.

1987; 7 207-26.

Health outcomes, health promotion and improved public health in Australia The current attention being given to health out- comes by the healthcare system offers an unprece- dented opportunity for us to reorient the direction of health policy in Australia towards the achieve- ment of improved public health.

So far, the two major initiatives in Australia-at national level through the National Health and Medical Research Council (NHMRC) Quality of

326 AUSTRALIAN JOURNAL Of WBUC HEALTH 1995 v a . 19 NO. 4