Health impact assessment and health equity in sub-Saharan Africa: A scoping review

BackgroundNatural resource extraction projects can have positive but also negative effects on the health of affected communities, governed by demographic, economic, environmental, physical and social changes. Negative effects often prevail and these might widen existing health inequities. Health impact assessment (HIA) is a decision-support tool that aims at maximizing benefits and minimizing negative impacts on people's health. A core value of HIA is equity; yet, little is known about health equity in the frame of HIA, particularly in sub-Saharan Africa.MethodologyWe conducted a scoping review to determine whether and to what extent HIA in sub-Saharan Africa addresses health equity. We included peer-reviewed publications and guidelines pertaining to HIA, environmental impact assessment (EIA) and social impact assessment (SIA). Health equity was investigated by identifying (i) how health considerations were addressed and (ii) whether health was stratified by subgroups of the community.ResultsOut of 1′640 raw hits, we identified 62 articles (16 HIA, 36 EIA, one SIA and nine integrated assessments), 32 of which specifically addressed health. While 20 articles focused on a specific health topic, 12 articles used a more comprehensive approach to address health. In 15 articles there were specific subgroup analyses (e.g. mothers, children or marginalized groups) as a measure of health equity. Another 12 papers referred to the community in a more general way (e.g. affected). Without exception, health was an integral part of the nine included guidelines. HIA guidelines addressed health systematically through environmental health areas, risk assessment matrix or key performance indicators.ConclusionsWe found evidence that previously conducted HIA in sub-Saharan Africa and current guidelines address health equity. However, there is a need to stratify community subgroups more systematically in order to determine health differentials better. Future HIA should consider community heterogeneity in an effort to reduce health inequities by “leaving no one behind”, as suggested by the Sustainable Development Goals.     

Determining significance in social impact assessments (SIA) by applying both technical and participatory approaches: Methodology development and application in a case study of the concentrated solar power plant NOORO I in Morocco

One of the main objectives of impact assessments is to identify potentially significant impacts. However, determining this significance has received very limited attention as a procedural step in social impact assessments. Consequently, only limited research and documentation exists on approaches, survey tools and evaluation methods, especially with regard to participatory approaches and combined participatory-technical approaches. This study aims to address this research gap by developing and applying a joined participatory and technical impact significance evaluation. The approach is applied in a case study which analysed the livelihood impacts of the large-scale concentrated solar power plant NOOR_O I in Ouarzazate, Morocco.The analysis shows that although different approaches and significance criteria must be applied when involving both local stakeholders and experts, the linked analysis offers more robust results and an improved basis for decision-making. Furthermore, it was observed in the case study that impacts affecting the social, cultural and political spheres were more often considered significant than impacts affecting the physical and material livelihood dimensions. Regarding sustainability assessments of large-scale renewable energy plants, these findings underline the importance (as for other large-scale infrastructure developments) of placing greater emphasis on the inclusion of social aspects in impact assessments.     

The community cost of consultation: Characterising the qualitative social impacts of a wind energy development that failed to proceed in Tasmania,Australia

Energy developments affect communities in a range of ways. Impacts on communities can be caused by changes to landscape amenity and access, disruptions to community cohesion, increased or decreased income streams, effects on property values, and population changes. These changes are ideally captured in the social impact assessment (SIA) process, where proponents outline in a formal statement the balance of benefits and burdens on local communities, and measures that will be taken to minimise negative outcomes for the community. In SIA practice there is a tendency toward quantitative socio-economic impacts, such as changes to demographics, income, and land values, with some qualitative assessment of amenity impacts. While the academic literature promotes inclusion of changes to the community itself, such as impacts on community cohesion and social capital, these qualitative changes are not consistently evident in SIA practice. Additionally, SIA practice assesses the impacts of the project, i.e. how the development of wind turbines or other energy infrastructure will affect the community. Because the consultation process around a proposed project typically commences prior to the characterisation and assessment of any associated social impacts and the finalisation of the SIA process, the potential impacts of this consultation are rarely, if ever, evaluated. Here, we examine a case study of an Australian wind energy project that did not proceed to implementation. Through this case study we are able to analyse the anticipatory impacts of the proposal; those stemming from the consultative process rather than the development of the project itself. We present these qualitative social changes, and outline the pathways through which the social changes manifest in two overarching social impacts: a divided community and future development capacity. We discuss the implications of this analysis in the context of good engagement practice and energy governance.     

A Strategic Project Appraisal framework for ecologically sustainable urban infrastructure

Actors in the built environment are progressively considering environmental and social issues alongside functional and economic aspects of development projects. Infrastructure projects represent major investment and construction initiatives with attendant environmental, economic and societal impacts across multiple scales. To date, while sustainability strategies and frameworks have focused on wider national aspirations and strategic objectives, they are noticeably weak in addressing micro-level integrated decision making in the built environment, particularly for infrastructure projects. The proposed approach of this paper is based on the principal that early intervention is the most cost-effective and efficient means of mitigating the environmental effects of development projects, particularly macro infrastructure developments. A strategic overview of the various project alternatives, taking account for stakeholder and expert input, could effectively reduce project impacts/risks at low cost to the project developers but provide significant benefit to wider communities, including communities of future stakeholders. This paper is the first exploratory step in developing a more systematic framework for evaluating strategic alternatives for major metropolitan infrastructure projects, based on key sustainability principles. The developed Strategic Project Appraisal (SPA) framework, grounded in the theory of Strategic Environmental Assessment (SEA), provides a means of practically appraising project impacts and alternatives in terms of quantified ecological limits; addresses the neglected topic of metropolitan infrastructure as a means of delivering sustainability outcomes in the urban context and more broadly, seeks to open a debate on the potential for SEA methodology to be more extensively applied to address sustainability challenges in the built environment. Practically applied and timed appropriately, the SPA framework can enable better decision-making and more efficient resource allocation ensuring low impact infrastructure development.     

Coal mining and the resource community cycle: A longitudinal assessment of the social impacts of the Coppabella coal mine

Two social impact assessment (SIA) studies of Central Queensland's Coppabella coal mine were undertaken in 2002–2003 and 2006–2007. As ex post studies of actual change, these provide a reference point for predictive assessments of proposed resource extraction projects at other sites, while the longitudinal element added by the second study illustrates how impacts associated with one mine may vary over time due to changing economic and social conditions. It was found that the traditional coupling of local economic vitality and community development to the life cycle of resource projects—the resource community cycle—was mediated by labour recruitment and social infrastructure policies that reduced the emphasis on localised employment and investment strategies, and by the cumulative impacts of multiple mining projects within relative proximity to each other. The resource community cycle was accelerated and local communities forced to consider ways of attracting secondary investment and/or alternative industries early in the operational life of the Coppabella mine in order to secure significant economic benefits and to guard against the erosion of social capital and the ability to cope with future downturns in the mining sector.     

Liveability as determinant of health: Testing a new approach for health impact assessment of major infrastructure

Major urban infrastructure projects are intended to alter the built, human ecology for the better. Even when they are not labelled as health projects, arguably they should produce public health benefits that are commensurate with their scale, particularly when they are publicly funded. Health impact assessment (HIA) is an established method of evaluating major infrastructure projects using a determinants of health equity lens. HIA explicitly puts health front and centre to ask, ‘How should the proposed infrastructure project be altered to improve the determinants of health equity?’ There are well-established HIA protocols, but few provide a framework for scoping possible impacts. Given interest in the concept of liveability we introduce an exhaustive, evidence-based framework of 11 liveability domains for HIA. We then test the framework by scoping the impacts of the Upfield Level Crossing Removal (LXR) project in Melbourne, Australia to hypothesise its impacts on health. Scoping this case study suggests that many domains will be affected in complex ways, some positively and some negatively, exemplifying the potential for the framework to detect major infrastructures' pervasive impacts on determinants of health. The paper includes a plan to validate the liveability framework with empirical research in the HIA assessment stage. The paper concludes with a discussion of the contribution and usefulness of the liveability domains as a framework for structuring HIA and for building its profile, thus advancing the discipline, and helping to ensure that all major infrastructures constitute a prudent investment in public health.     

Effects of noise pollution over the blood serum immunoglobulins and auditory system on the VFM airport workers, Van, Turkey

Noise pollution is a common health problem for developing countries. Especially highways and airports lead to noise pollution in different levels and in many frequencies. In this study, we focused on the effect of noise pollution in airports. This work aimed measurements of noise pollution levels in Van Ferit Melen (VFM) airport and effect of noise pollution over the immunoglobulin A, G, and M changes among VFM airport workers in Turkey. It was seen that apron and terminal workers were exposed to high noise (>80 dB(A)) without any protective precautions. Noise-induced temporary threshold shifts and noise-induced permanent threshold shifts were detected between the apron workers (p?<?0.001) and terminal workers (p?<?0.005). IgA values of apron terminal and control group workers were approximately the same in the morning and increased in a linear manner during the day. This increase was statistically significant (p?<?0.001). IgG and IgM values of apron, terminal, and control group workers were approximately same in the morning. Apron and terminal workers IgG and IgM levels were increased until noon and then decreased until evening as compare to control group, but these changes were not statically significant (p?>?0.05). These findings suggested that the noise pollution in the VFM airport could lead to hearing loss and changes in blood serum immunoglobulin levels of airport workers. Blood serum immunoglobulin changes might be due to vibrational effects of noise pollution. Airport workers should apply protective precautions against effect of noise pollution in the VFM airport.     

Influence of spatial resolution on assessing channelization impacts on fish and macroinvertebrate communities in a warmwater stream in the southeastern United States

The choice of spatial and temporal scale used in environmental assessments may influence the observed results. One method of assessing the impact of stream habitat alterations involves the comparison of response variables among treatment categories (i.e., impacted and unimpacted sites). The influence of spatial resolution on patterns of response variables among treatment categories in assessments of stream channelization and other types of habitat alterations has not been evaluated. We examined how patterns of 10 community response variables among channel types and our interpretations of channelization impacts on fish and macroinvertebrate communities differed among three spatial resolutions in a warmwater stream in Mississippi and Alabama. Four fish and three macroinvertebrate community response variables exhibited different patterns among channel types at different spatial resolutions. Our interpretations of the impacts of channelization on fish and macroinvertebrate communities differed among spatial resolutions. Channelization had a negative influence on fish communities either with or without evidence of potential community recovery in one channel type. Channelization impacts on macroinvertebrate communities ranged from a negative influence to no effect. Our results suggest that spatial resolution can influence the observed results and interpretations derived from assessments of stream habitat alterations.     

Building capacity for Health Impact Assessment: Training outcomes from the United States

BackgroundDespite the continued growth of Health Impact Assessment (HIA) in the US, there is little research on HIA capacity-building. A comprehensive study of longer-term training outcomes may reveal opportunities for improving capacity building activities and HIA practice.MethodsWe conducted in-depth interviews with HIA trainees in the United States to assess their outcomes and needs. Using a training evaluation framework, we measured outcomes across a spectrum of reaction, learning, behavior and results.ResultsFrom 2006 to 2012, four organizations trained over 2200 people in at least 75 in-person HIA trainings in 29 states. We interviewed 48 trainees, selected both randomly and purposefully. The mean duration between training and interview was 3.4 years. Trainees reported that their training objectives were met, especially when relevant case-studies were used. They established new collaborations at the trainings and maintained them. Training appeared to catalyze more holistic thinking and practice, including a range of HIA-related activities. Many trainees disseminated what they learned and engaged in components of HIA, even without dedicated funding. Going forward, trainees need assistance with quantitative methods, project management, community engagement, framing recommendations, and evaluation.ConclusionsThe research revealed opportunities for a range of HIA stakeholders to refine and coordinate training resources, apply a competency framework and leverage complimentary workforce development efforts, and sensitize and build the capacity of communities.     

Open-source methods for estimating health risks of fine particulate matter from coal-fired power plants: A demonstration from Karachi,Pakistan

Environmental impact assessments (EIAs) effectiveness and accessibility by the public is determined by local environmental enforcement and regulation. Massive energy infrastructure projects like China's Belt and Road initiative (BRI) could accentuate social and economic costs, as regulation is deferred to host countries with varying levels of domestic enforcement. To fill major gaps in the public evaluation of EIA practices and results, our objective here is to present an open-source approach for evaluating localized air pollution health impacts for BRI-financed coal-fired power plants. This analysis focuses on one specific problem, additional attributable mortality from stroke, ischemic heart disease, and chronic obstructive pulmonary disease for adults ages 25–84 from fine particulate matter (PM_2.5), known to be major risk factor for premature deaths globally. As a concrete example, we examine the case of the Port Qasim power plant located near Karachi, Sindh Province, Pakistan. We present results for two main scenarios: a base case, assuming fully operational pollution control technologies, in particular electrostatic precipitators (ESP); and an alternative case without ESPs. All material and methods for replicating this analysis for the case study and for other projects are available in our institutional open repository. Our approach can be applied immediately to virtually any source location in the world, due to the public and global availability of input data.SynopsisWe present an open-source approach for evaluating localized health impacts due to fine particulate matter emitted from coal-fired power plants.     

Four years of sustainability impact assessments accompanying the implementation of improved cooking stoves in Tanzania

Development projects and innovations are often implemented based on scientific recommendations and do not incorporate local knowledge and demand for interventions. In this paper, we demonstrate the successful engagement of local stakeholders in the implementation and evaluation process of improved cooking stoves; a technology that improves food security in two climatically contrasting regions in Tanzania.The Framework for Participatory Impact Assessment tool was used to conduct impact assessments on firewood-based improved cooking stoves to evaluate their contribution to food security at local stakeholder level. Between 2014 and 2017, four annual impact assessments were conducted with local stakeholders in four villages in the semi-arid Dodoma and the sub-humid Morogoro regions to assess the impact of improved cooking stoves on locally defined nine food security criteria. The Framework for Participatory Impact Assessment was used to (i) ex-ante identify the expected impact, and (ii) to ex-post assess the experienced impact of improved cooking stoves on the nine food security criteria. The impact assessments showed that the perceived contribution of improved cooking stoves towards the food security criteria was positive throughout all assessments. In particular, improved cooking stoves addressed relevant food security criteria such as social relations, food availability, and market participation. The Framework for Participatory Impact Assessment tool supported continuous knowledge exchange between scientists and local stakeholders, thus improving communication and co-learning; while identifying merits and demerits of the improved cooking stoves that could be addressed during the project lifetime.     

Evaluating cumulative effects of small scale hydropower development using GIS modelling and representativeness assessments

Assessing cumulative effects are a vital task for strategic environmental assessments (SEA) but lack of consistent methodology has hampered the development and implementation of useful tools. We present a model for GIS and multivariate analysis to assess the effects on a valued ecosystem type at a regional scale based on the sum of impacts of local projects. We demonstrate application of the model by assessing how hydropower developments would generate cumulative impacts on river gorges for a county in northern Norway. We use principal component analyses (PCA) of spatially-explicit variables from the region to describe the diversity of river gorge ecology with a mathematical low-dimensional bioclimatic space. We then calculate cumulative effects of hydropower development as the proportions of subspaces of the multidimensional bioclimatic PCA that are affected by either existing infrastructure or planned and possible hydropower developments. The results showed that adding development of all potential sites for small-scale hydropower would have substantial impacts on over half of all bioclimatic segments where gorges were registered and more than 70% of all segments with forested river gorges. By demonstrating these possible cumulative effects we can illustrate the need for caution in hydropower planning to avoid reducing river gorge representativeness and diversity. The method can be applied for other types of development projects and other valued ecosystems, provided the assessed ecosystems and development installations can be mapped or modelled over a sufficiently large area.     

An integrated modelling framework to assess long-term impacts of water management strategies steering soil subsidence in peatlands

Around the world many peatlands are managed unsustainably. Drainage of the peat causes soil subsidence and a range of negative societal impacts. Integrated strategies are required to ensure more sustainable long-term settings, based on impact assessment models that simulate the interrelated dynamics of water management and soil subsidence, and determine the spatial and temporal range of societal impacts. This paper presents an integrated modelling framework that meets these requirements. We used the framework to assess the impacts of a range of water management strategies in Dutch peatlands. Average soil subsidence rates were shown to range from 0.6 to 4.5 mm·y^− 1, resulting in marked differences in societal impacts that affect stakeholders unequally. Moreover, the impacts on real estate damage and water system maintenance revealed inverse trends that result in increasingly unbalanced cost-benefit ratios. The generated insights led the regional water authority to change their current water management strategy, preventing unsustainable future developments. We find the results relevant for improving stakeholders' awareness of long-term impacts of management strategies, and making negotiation processes on goals, means, and possible future pathways more transparent.     

Adapting social impact assessment to address a project's human rights impacts and risks

We address the weaknesses inherent in the social risk assessments undertaken for business, especially in the extractive industries. In contrast to the conventional approach that considers consequence to the company rather than to impacted communities, conformance with the United Nations Guiding Principles on Business and Human Rights requires that consequence to affected communities has precedence. In order for social risks to be properly assessed, we consider that: companies need to know and understand the human rights impacts of their activities; contemporary approaches to project impact and risk assessment need to be adapted to consider human rights; and environmental impact assessment (EIA) and social impact assessment (SIA) methods need to be adapted to give greater attention to impacts on human rights. Using an example from the mining, oil and gas sector, we provide a method that differentiates social risks from business risks, and we position impact assessment as an instrument that actively facilitates the improved identification, analysis and management of social risks. Practical adaptations to SIA activities and risk assessment processes are provided. Taking human rights impacts into account and using the dimensions of gravity, extent, vulnerability and remediability, we nominate criteria to assess the significance of negative social impacts.     

Accounting for intracultural variability in first nation environmental knowledge: A requisite for environmental monitoring and impact assessments

In many environmental monitoring and impact assessment processes, Indigenous communities are treated as intellectually homogenous and intracultural variation in environmental knowledge often goes unaccounted for. This not only poses obvious risks to the effectiveness of environmental impact assessments but also gives standing to those who question the credibility of traditional ecological knowledge and its contribution to environmental monitoring and assessment programs altogether. In this paper we describe the steps that were taken to account for intracultural variability in First Nation knowledge of fish and the potential impacts associated with the Peace River oil sands development in Alberta, Canada. Involving the delivery of a household survey to 1,127 First Nation households in 11 Peace River communities, our approach was successful in identifying regional, community, and household variability in fishing activity, and has allowed us to differentiate novice from expert knowledge holders. This research demonstrates the need to account for intracultural variability in First Nations environmental knowledge in order for traditional ecological knowledge to make meaningful contributions to environmental monitoring and assessment programs.     

Analysis of the invasion rate, impacts and control measures of Prosopis juliflora: a case study of Amibara District, Eastern Ethiopia

The tree Prosopis juliflora, introduced to Ethiopia in the 1970s to curb desertification, is imposing significant ecosystem and socioeconomic challenges. The objectives of this study are therefore to analyze the dynamics and associated impacts of the P. juliflora invasion over the period 1973–2004 and to evaluate the effectiveness of the management measures implemented to date. This required the analysis of Landsat images, field surveys, the use of structured questionnaires, and interviews. P. juliflora was found to invade new areas at an average rate of 3.48 km²/annum over the period 1973–2004. The high germination nature of the seed, mechanisms of seed dispersal, and its wide-range ecological adaptability are the main drivers for the high invasion rate. By the year 2020, approximately 30.89 % of the study area is projected to be covered by P. juliflora. The expansion has affected human health, suppressed indigenous plants, and decreased livestock productivity. The management measures that have been implemented are not able to yield the desirable results because of the limited spatial scale, cost, and/or improper planning and implementation. Therefore, the formulation of a strategy for management approaches that include the engagement of the community and the limiting of the number of vector animals within the framework of the current villagization program remain important. Moreover, risk assessment should be completed in the future before an exotic species is introduced into a certain area.     

The institutional dynamics behind limited human health considerations in environmental assessments of coal mining projects in New South Wales,Australia

Coal extraction remains supported in many countries despite a global context challenging the industry. A large evidence base links coal with negative consequences for human health. Environmental assessments (EAs) are regulated in nearly every country to assess and set conditions for large industry projects, including coal mines, but tend to exclude health impacts. This study investigated the institutional dynamics surrounding the inclusion of health in coal mining EAs in New South Wales, Australia. Semi-structured interviews with varied stakeholders were supported by a review of legislation, relevant case law and media analysis. Using insights from theories on power and institutions the findings show how EA practice is influenced by the politicization of coal mining that excludes potentially negative narratives surrounding the known human health impacts of coal. Poor EA practice is compounded by legislative ambiguity and lack of conceptual understanding about assessing health. EA's legislative purpose of approving projects undermines confidence that a balanced assessment of impacts has been made. EA is seen as a pro-industry process that disempowers those with dissenting voices. The research explains how the institutional dynamics of a policy process like EA challenge its potential to meaningfully engage with the impact of coal mining on human health.     

Derivation and Use of Sediment Quality Guidelines for Ecological Risk Assessment of Metals and Radionuclides Released to the Environment from Uranium Mining and Milling Activities in Canada

The Screening Level Concentration (SLC) approach was used to derive Lowest Effect Level (LEL) and Severe Effect Level (SEL) concentrations for nine metals (As, Cr, Cu, Pb, Mo, Ni, Se, U and V) and three radionuclides (²²⁶Ra, ²¹⁰Pb, and ²¹⁰Po) released to the aquatic environment during the mining and milling of uranium ore. This method was chosen because it allowed for the best use of the considerable historical and current data collected for diverse purposes in the uranium mining and milling regions of Canada (20,606 data points used in the analysis). Except for Cr, all the LELs derived in this study using the weighted method and published sediment quality guidelines (SQGs) were highly reliable (> 85%) in predicting sites unimpacted by uranium mining/milling defined as sites where reductions in the abundance and species richness of benthic invertebrate communities were < 20%. The derived SEL values and corresponding published SQGs (with the exception of Ni) were not reliable predictors (≤60%) of severe impacts on benthic invertebrate communities when severe impacts are defined as a reduction in abundance and species richness ≥40%. Most of the severely impacted sites had sediment contaminant concentrations well below the SEL values. It is concluded that LELs derived using the weighted method can reliably be used in ecological risk assessments as concentrations below which adverse effects on benthic invertebrate communities are not expected. In contrast, it is recommended that SELs not be used in assessments of uranium mining/milling activities as concentrations above which adverse effects are anticipated.