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Linking Waste Management and Health: Linking Waste Management and Health: A Community Health Impact Assessment ApproachA Community Health Impact Assessment Approach

James Edwin James Edwin andand

Steve ColtSteve Colt

Institute of Social and Economic Research, Institute of Social and Economic Research, University of Alaska AnchorageUniversity of Alaska Anchorage

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The Creation! that never had a day of restThe Creation! that never had a day of restIn the beginning there was In the beginning there was limited wastelimited wasteproduction. And man said it was Really Good. production. And man said it was Really Good. The The 11stst waste production and management.waste production and management.Then came Then came industrial revolutionindustrial revolution and waste and waste started to accumulate at industrial sites. But started to accumulate at industrial sites. But man said it was Good. The man said it was Good. The 22ndnd waste waste production and managementproduction and managementThen Then incomes increasedincomes increased, man bought lots of , man bought lots of stuff, adding to industrial waste. But man said stuff, adding to industrial waste. But man said it was Good. The it was Good. The 33rdrd waste production and waste production and managementmanagementThen waste started Then waste started driving man from homesdriving man from homesand neighborhoods. And man said, and neighborhoods. And man said, hmhm... it is ... it is Not Good. The Not Good. The 4th4th waste production and waste production and management.management.

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Then man said, now we need to make Then man said, now we need to make bins to collect wastebins to collect waste. Man looked at . Man looked at the bins and said, it was Good. The the bins and said, it was Good. The 55thth

waste production and managementwaste production and managementThen man said, now that we have bins Then man said, now that we have bins we need a helper for the bins. we need a helper for the bins. Incinerators, landfills and dumpsitesIncinerators, landfills and dumpsiteswere created. Man looked at this were created. Man looked at this creation and said it was good. The creation and said it was good. The 66thth

waste production and management.waste production and management.

But after all these creations, man Never Rested. Waste is being produced now more than ever before and continues to threaten human health if not properly managed.

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Waste Management in AlaskaWaste Management in AlaskaWaste Management Waste Management in Alaskain Alaska sets targets for increased prevention sets targets for increased prevention and reductionand reductionWaste reduction could be done through waste management Waste reduction could be done through waste management techniques:techniques:–– Source ReductionSource Reduction: In: In--plant steps taken to reduce or eliminate plant steps taken to reduce or eliminate

waste generated by a processwaste generated by a process–– RecyclingRecycling: reusing wastes as useful products in the process after : reusing wastes as useful products in the process after

they have been used by consumers they have been used by consumers –– CompostingComposting: an aerobic, biological process of degradation of : an aerobic, biological process of degradation of

biodegradable organic matter biodegradable organic matter –– TreatmentTreatment: wastes are treated after they are generated to reduce : wastes are treated after they are generated to reduce

their volume or toxicity their volume or toxicity –– Incineration: Incineration: a process of combustion designed to recover energy a process of combustion designed to recover energy

and reduce the volume of waste going to disposaland reduce the volume of waste going to disposal–– LandfillLandfill: the deposition of waste in a specially designated area: the deposition of waste in a specially designated area–– DisposalDisposal: wastes are taken to a conventional disposal facility : wastes are taken to a conventional disposal facility

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Waste management and public health are inextricably Waste management and public health are inextricably linkedlinkedAs such, there is inherent sense in assessing the potential As such, there is inherent sense in assessing the potential impact on health of any proposed method of managing impact on health of any proposed method of managing waste waste Such assessments can contribute to developing a greater Such assessments can contribute to developing a greater understanding of the relationship between various forms of understanding of the relationship between various forms of waste management and healthwaste management and healthMany studies have concentrated on the physical health Many studies have concentrated on the physical health outcomes, however a more holistic interpretation of health outcomes, however a more holistic interpretation of health would also include psychological and social wellbeingwould also include psychological and social wellbeing

Waste Management and HealthWaste Management and Health

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What Determines Our Health? What Determines Our Health?

(Whitehead & Dahlgren, 1991).

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Health Impact Assessment (HIA)Health Impact Assessment (HIA)HIA is a combination of procedures, methods and HIA is a combination of procedures, methods and decision making tools by which a policy, program decision making tools by which a policy, program or project may be judged:or project may be judged:–– as to its potential effects on the health of a population as to its potential effects on the health of a population –– the distribution of those effects within the population the distribution of those effects within the population

(health inequality). (health inequality). –– and it ensures that all groups within the population are and it ensures that all groups within the population are

considered, especially those identified as being considered, especially those identified as being vulnerablevulnerable

HIA assist decision makers to mitigate the harmful HIA assist decision makers to mitigate the harmful impacts of a proposal and enhance the beneficial impacts of a proposal and enhance the beneficial ones ones

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Why Conduct Health Impact AssessmentWhy Conduct Health Impact AssessmentTo have a comprehensive overview of specific To have a comprehensive overview of specific stages of a proposal so that actions associated with stages of a proposal so that actions associated with health impacts are consideredhealth impacts are considered

Allow stakeholders, especially the community, to Allow stakeholders, especially the community, to participate more meaningfully in the formation of a participate more meaningfully in the formation of a project, policy or program project, policy or program

To enable the decision maker to be aware of both To enable the decision maker to be aware of both positive positive and and negativenegative health impacts and the health impacts and the sizesize of of an impactan impact

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Why Conduct Health Impact AssessmentWhy Conduct Health Impact AssessmentTo make the decision making process more To make the decision making process more transparenttransparent

To extend the protection of human health and To extend the protection of human health and reduce the burden of ill health reduce the burden of ill health

To promote greater equity in healthTo promote greater equity in health

Documenting this evidence and making it freely Documenting this evidence and making it freely available can assist in addressing public concern available can assist in addressing public concern over potential health impactsover potential health impacts

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Conducting HIAConducting HIAIt may be conducted at various stages in the development It may be conducted at various stages in the development of an identified project, program or policy:of an identified project, program or policy:

–– ProspectiveProspective HIA is carried out in the developmental HIA is carried out in the developmental stage when findings and recommendations can stage when findings and recommendations can influence decision making influence decision making

–– ConcurrentConcurrent HIA is carried out when the identified HIA is carried out when the identified proposal is being implemented proposal is being implemented

–– RetrospectivRetrospectivee HIA is carried out after the proposal has HIA is carried out after the proposal has been implementedbeen implemented

HIA is carried out by progressing through a series of HIA is carried out by progressing through a series of steps which recognize the steps which recognize the positivepositive and and negativenegative health health impactsimpacts

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Stages in Conducting HIAStages in Conducting HIAGiven the proposed subject area of waste Given the proposed subject area of waste

management, a HIA could be conducted as management, a HIA could be conducted as follows:follows:

S SC A R ES SC A R EScreeningScreeningScopingScopingAppraisalAppraisalReportingReportingEvaluationEvaluation

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The Health Impact Assessment Process (Stages and Methods)The Health Impact Assessment Process (Stages and Methods)Screening

Evaluation

Scoping

Appraisal

Reporting &Recommendation

Is HIA required Screening Checklist

Not Sure Yes No

What level of HIA is most appropriate

The Health Lens Health Appraisal

Scoping Checklist

Use specific tools to•Assess Evidence•Establish Priority Impact

Evaluation of the impactof the HIA

Recommend and justifyoptions for action

More information

Adapted from http://www.phac.health.govt.nz/moh.nsf/pagescm/764/$File/guidetohia.pdf

Identify how to progress with policy, program or project

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Community Involvement in HIA Community Involvement in HIA ProcessProcess

Group ExerciseGroup Exercise

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These Materials at:These Materials at:

www.iser.uaa.alaska.eduwww.iser.uaa.alaska.edu

Thank You!Thank You!

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Rapid Community Health Impact Assessment: the case for Waste Management In the matrixes that follow is a list of possible stakeholders that a possible waste management proposal (e.g. landfill) might affect, the determinants of health and potential impacts of the proposal and decision making process. Feel free to add to the list in any matrix while completing this exercise. Stage I: Estimate Impact on key Stakeholders For this particular landfill project think of its potential impact on all stakeholders in the table. You may add to the list of stakeholders. Pleas circle/check the appropriate box in each row. Stakeholder group Positive Negative Note key points raised in your

discussion Children (6-12 years) 1 2 3 4 5 Not sure Adolescent (13-21 yrs) 1 2 3 4 5 Not sure Men 1 2 3 4 5 Not sure Women 1 2 3 4 5 Not sure Seniors 1 2 3 4 5 Not sure People with disability 1 2 3 4 5 Not sure Pregnant women 1 2 3 4 5 Not sure Stage II: Identification of Key Determinants of Health Which of the following determinants of health might be affected by the landfill, and will the impact be positive or negative? Circle/check the appropriate box for each row Determinant of Health

Potential Impact

Note key points raised in your discussion and/or source of evidence

Positive Negative

Lifestyle Factors Diet 1 2 3 4 5 Not

sure

Physical activity 1 2 3 4 5 Not sure

Smoking 1 2 3 4 5 Not

sure

Alcohol 1 2 3 4 5 Not sure

Sexual behavior 1 2 3 4 5 Not

sure

Social and Community Networks Population 1 2 3 4 5 Not

sure

Fear of crime 1 2 3 4 5 Not sure

Lack of local 1 2 3 4 5 Not

sure

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community facilities Experience of harassment

1 2 3 4 5 Not sure

Access to Services, Local Environment Education 1 2 3 4 5 Not

sure

Health Services 1 2 3 4 5 Not sure

Businesses 1 2 3 4 5 Not

sure

Transport 1 2 3 4 5 Not sure

Housing 1 2 3 4 5 Not

sure

Community Safety 1 2 3 4 5 Not sure

General Socioeconomic, Cultural and Environmental

Conditions and Policies

Poverty 1 2 3 4 5 Not sure

Employment 1 2 3 4 5 Not

sure

Air quality 1 2 3 4 5 Not sure

Water quality 1 2 3 4 5 Not

sure

Hazardous waste 1 2 3 4 5 Not sure

Stage III: Assessing the confidence level of your work so far How confident are you that you have enough information and knowledge to assess whether further health appraisal is needed? Please circle the response below which most closely reflects your opinion Response Self-assessment

(a) We feel completely confident that we have had enough information and knowledge to feel confident with the estimations we have made

(b) While there are some areas of uncertainty in the knowledge and information we have used , we feel confident enough with the estimations we have made

(c) There are several uncertainties about the information and knowledge we have used and we need more information to be confident with the estimations we have made

If you answered (a) or (b) continue to stage IV If you answered (c) stop now and consider what you need to do to gain the information and knowledge you require to continue. You may for instance, need to gather further information on:

1. The aims, objectives, and intended outcomes of the policy, program or project 2. The evidence relating to health impacts that might arise in relation to the policy,

program or project 3. The results of HIA on similar policy, program or project

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Stage IV: Summarize your findings: Do we need further health impact assessment? Summarize your findings so far by answering the questions below. For each question in the first column, check the appropriate box

Favor/not favor further appraisal

Question YES NO Don’t know

Does the landfill project affect, in a negative (4 and 5) way, any of the stakeholder groups?

For some of the determinants of health, are some of the effects of the landfill project unknown (not sure)?

Does the landfill project have any negative effects (4 or 5) through any of the determinants of health?

If you answered ‘Yes’ to two or more questions, then you favor further appraisal under the HIA process. If you answered ‘No’ to two or more questions then you do not favor further appraisal under the HIA process. Circle/check the appropriate decision box

Favor further appraisal Not favor further appraisal Stage V: The Decision Making: Where do we go from here? Read the main options and courses of action summarized below. Which actions identified do you need to take? Check as appropriate

□ In favor of health impact assessment , which should include community participation, time to influence the decision making process, explore resources available and who needs to be involved. You might also need to consider key points that have been noted while undertaking the screening of the waste management policy, program or project and identify how to progress.

□ Not favoring further health appraisal. However, you might want to consider any

key points that have been noted while undertaking the screening of the waste management policy, program or project and identify how to progress

o Either because the potential health impact of implementing the waste

management policy, program or project are judged to be negligible, that is nether positive nor negative

o Or because the potential health impacts are judged to be well known, as

are the ways in which negative impact can be eliminated or ameliorated, and /or positive impacts can be enhanced

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Stage VI: Evaluating the HIA process If you do not favor further appraisal, complete the following:

1. Record who was (were) responsible for screening the waste management policy, program or project and the documents that were used during the process.

2. Ensure that a completed copy of the screening is kept with the document along with any report and a completed HIA if carried out.

3. Outline how the impact of the waste management policy, program or project will be monitored and evaluated as it progresses.

4. Provide a cover page to the report, similar to the one below.

Health Impact Assessment: Rapid Appraisal Title of project: ………………………………….. Geographic area:………………………………… Name of Person/Group Reporting:……………………………..