"Health Impact Assesment in Confirmed Animal Feeding Operations (CAFO) Permitting" presented by Ellen Mee, JD, at the Ohio Clean Water Conference 2011.

1. Health Impact
Health Impact
Assessment in CAFO
Permitting
Imagining h lth i CAFO
I i i health in CAFO
permitting
Ellen Mee, JD
Director of Environmental
Health Policy
Ohio Environmental Council
August 5, 2011
A t 5 2011

2. Health in all policies . . .
“(The) toxic combination of bad policies
(The) toxic combination of bad policies,
economics, and politics is, in large
measure, responsible for the fact that a
ibl f th f t th t
majority of people in the world do not
enjoy the good health that is
biologically possible.”
g yp
– Who Commission on Social Determinants of
Health (2009)
Health (2009)

3. Industrial Agriculture
g

4. Some characteristics
• Size (chickens 125,000; dairy 700 or more)
• D it
Density
• Concentration of facilities, related industry
• Vertical integration
• Corporate ownerships or control
• Technology/breeding/animal specialization
Technology/breeding/animal specialization
• Mechanization
• Pharmaceutical practice

5. Impact on communities & environment
Positive
Lower costs for meat, milk & eggs due to
more efficient feeding, housing
Larger facilities requiring less land
Increased employment
Increased tax revenue
Increased demand for local commodities
Negative
Excess manure stored or applied locally (3‐20
times human waste in U.S.)
Environmental impacts to water resources,
aquatic life
Health impacts due to release of agricultural
lh d l f l l
chemicals, pathogens, pharmaceuticals into air,
water and soil

6. Quality of life‐social impacts
Stress
Power imbalance
Changes to community activities/social cohesion
h i i ii / i l h i
Interference with daily activities, life‐style
Loss of local political control/authority
Increased large truck traffic
Infrastructure damage (roads, bridges) costs paid by local tax
revenue

7. Connecting health to CAFO policy – a few hurdles?
The EPA, DEQ, Agriculture Department, etc., are NOT health agencies
Deeply entrenched notions of independence of farming activities
Deeply entrenched notions of independence of “farming” activities
Power politics! Industry v. rural community
Weak regulatory systems at both state and local levels, few (no?) formalized
requirements for consideration of health impacts
Little understanding of health impacts (as opposed to nuisance)
Little understanding of “health” impacts (as opposed to nuisance)
Public health agencies largely removed from jurisdiction
No funding for health studies
f f
Disconnect between health (science‐driven) and policy (economics, politics,
public choice
public choice
Right‐to‐farm laws

8. Building on the role of community health
Assessment:
Assessment:
Collecting and tracking public complaints
Investigation
Assistance with monitoring (rodents, flies, well water)
Monitor ER visits related to work environments
Monitor ER visits related to work environments
Policy development:
Some HDs may adopt limited health‐based regulations (but, Iowa
regulations overturned)
regulations overturned)
Advocacy & Education:
Convene public meetings
Educate agency personnel on public health impacts
Educate agency personnel on public health impacts
Educate facility owners/managers
Promulgate recommendations and regulations (limited)
Work with producers/agency to promote mitigation strategies

9. Bridging the gap with health impact assessment
What is a health impact assessment?
Set of procedures, methods, and tools
p , ,
Systematically judges the potential effects of a policy or project on the health
of a population and distribution of those effects within the population
Goals?
Achieve changes in policies and proposals so that they support better health
and reduce health inequalities.
The recommendations of an HIA can include suggestions for enhancing positive
aspects of proposals, as well as recommendations to mitigate any potentially
negative aspects.
negative aspects
Many HIAs therefore overtly aim to influence the decision‐making process.
Make health impacts (broadly defined) more explicit

10. Goals
Primary Goals
Achieve changes in policies and proposals so that they support better health
and reduce health inequalities
and reduce health inequalities
Recommendations for enhancing positive aspects of proposals or mitigating
potentially negative aspects
Influence the decision‐making process (promote voluntary actions)
Make health impacts (broadly defined) more explicit
p ( y ) p
Secondary Goals
Engage & empower community
Emphasize everyday experience
Build consensus
Build relationships & collaborations

11. Key elements
Screening:
Determines the need and value of a HIA
Scoping :
Scoping :
Determines what impacts to evaluate, methods for analysis, work plan
Assessment Provides:
A profile of existing health conditions
An evaluation of potential health impacts
Strategies to manage identified adverse health impacts
Reporting Includes:
Development of the HIA report
Communication of findings & recommendations
Monitoring Tracks:
Impacts on decision‐making processes and the decision
Impacts of the decision on health determinants
p

12. Screening Worksheet
Project and Timing
Has a project, plan or policy been proposed?
Is there sufficient time to conduct an analysis before the final
decision is made?
Health Impacts
Health Impacts
Does the decision have the potential to affect environmental or social
determinants that impact health outcomes? If so, which determinants
and which health outcomes?
Would health inequities be impacted? In what ways?
Are the proposal s impacts to health likely to be significant in terms of the
Are the proposal’s impacts to health likely to be significant in terms of the
number of people impacted, the magnitude, breadth and/or immediacy of
impacts?
Do evidence, expertise, and/or research methods exist to analyze health
impacts of the decision?

13. Screening Worksheet
Stakeholder Interest and Capacity
Have public concerns about the health impacts of the decision been voiced or
documented?
Who are the stakeholders and interest groups involved in the decision‐making
process?
Do stakeholders have the interest to participate in the HIA?
Do stakeholders have the capacity (resources, skills, etc.) to participate in the
Do stakeholders have the capacity (resources skills etc ) to participate in the
HIA?
Would stakeholders use the HIA to inform or influence the decision‐making
process? How?

14. Screening Worksheet
Potential Impact of HIA Findings
Is health already being considered in the proposal or as part of the decision‐
Is health already being considered in the proposal or as part of the decision
making process?
Are the links between the proposal and health or health determinants clear?
Is the decision‐making process open to the HIA and /or recommendations for
changes to design, mitigations and/or alternatives?
If applied, would HIA findings and recommendations potentially improve the
impact that the proposal has on health?

15. Screening Worksheet
Potential Impact of the HIA Process on secondary goals?
What are the potential impacts of the HIA process? (e.g., building
What are the potential impacts of the HIA process? (e g building
relationships, empowering community members, voluntary intervention,
demonstrating how health can be used in decision making)

16. Starting at the beginning
Document baseline conditions, including –
Population health vulnerabilities based on the population
characteristics
Inequalities in health outcomes/impacts among
subpopulations or places.

17. What is a significant health impact?
direction
magnitude
likelihood
distribution within the population
permanence

18. Using the best available evidence
Assessments of health impacts should be based on a synthesis of the best
available evidence.
Existing data, empirical research, professional expertise, and the products of
original investigations
When available, practitioners should utilize evidence from well‐designed and
peer‐reviewed systematic reviews
Previously published evidence, both supporting and refuting particular health
impacts
The expertise and experience of affected members of the public (local
knowledge), whether obtained via the use of participatory methods, collected
via formal qualitative research methods, or reflected in public testimony, is
potential evidence.

19. Community data collection
Water quality monitoring
Air quality monitoring
Ai li i i
OSHA complaints
Journals/web‐based reporting
Surveys
Documented complaints

20. Recommendations
The HIA should include specific recommendations to manage
the health impacts identified, including:
Alternatives to the decision
Modifications to the proposed policy, program, or project
Mitigation measures
Mitigation measures
Where needed, expert guidance should be utilized to ensure
recommendations reflect current effective practices

21. Criteria
Developing recommendations and mitigation –
Responsive to predicted impacts
Specific
Technical feasible
Enforceable
Within the authority of decision‐makers or
Recommendations may include those for monitoring,
reassessment, and adaptations to help manage uncertainty in
impact assessment.

22. Using HIA process
HIA identified (self) in the U.S.
100 – 120 HIAs in process or completed in U.S.
15 involved natural resources and the environment
15 involved natural resources and the environment
6 agriculture and food policy
CAFO permitting/industrial agriculture: 0 (Michigan?)
CAFO i i /i d i l i l 0 (Mi hi ?)

23. Using HIA to move up the ladder
Can health impact assessment
help rural communities “move up
the ladder?
Arnstein S. 1969. Ladder of citizen participation.
JAIP 35 (4): 216‐224
JAIP 35 (4) 216 224

24. Resources
Health Impact Project
Robert Wood Johnson Foundation and The Pew Charitable Trusts
National initiative designed to promote the use of health impact assessments (HIAs)
as a decision‐making tool for policymakers.
http://www.healthimpactproject.org
Human Impact Partners
Offers policymakers, project leaders, public agencies, community groups and
advocacy organizations the support they need to conduct HIAs and use the results to
make informed choices
http://www.humanimpact.org/hips‐hia‐tools‐and‐resources
International Association for Impact Assessment (IAIA)
International Association for Impact Assessment (IAIA)
organized in 1980 to bring together researchers, practitioners, and users of various
types of impact assessment from all parts of the world. IAIA involves people from
many disciplines and professions.
http://www.iaia.org/
h // i i /

25. Questions?