IPIECA - IOGP - Health Impact Assessment

Health impact assessment
A guide for the oil and gas industry
Health
THE GLOBAL OIL AND GAS

INDUSTRY ASSOCIATION
FOR ENVIRONMENTAL
AND SOCIAL ISSUES
www.ipieca.org
IOGP Report 548
© IPIECA-IOGP 2016 All rights reserved.

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Health impact assessment
A guide for the oil and gas industry
The global oil and gas industry association for environmental and social issues
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International Association of Oil & Gas Producers

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Contents
Contents
Executive summary 3 Section 4: Project HIA 19
Section 1: Introduction 5 Types of HIA 20

Desktop HIA 20
Purpose of this Guide 6
Rapid appraisal HIA 20
Section 2: What is HIA? 7
Comprehensive HIA 21
Core Principles 8
Critical steps in the HIA process 24
National requirements and 8 Step 1: Screening 24
International Standards
Step 2: Scoping 25
International Financial Institutions (IFIs) 9
Step 3: Baseline data collection and reporting 30
and their role in HIA
Step 4: Impact assessment 33
Benefits of performing HIA 10
Step 5: Mitigation and enhancement 39
Limitations 11
Step 6: Monitoring and evaluation 41
Audience for this Guide 11
Stakeholder communication and consultation 43
The ESHIA process and other 11
impact assessments Management and resourcing 44
Cost and time management 44
Other health studies 13
The HIA process, including types of HIAs 14 Appendix 1: Interdependencies 45
Section 3: Strategic health impact 15 Appendix 2: Emerging infectious diseases 55

assessment (sHIA) and the extractive sector
Introduction to sHIA 16 Appendix 3: Ecosystem services in ESHIA 61
sHIA Actors 17
Appendix 4: Example of monitoring/ 71
sHIA principles 17 longitudinal data available from large
Geography and scale 17 oil and gas projects
(range of impacts/new area)
Appendix 5: Glossary 87
Collaboration (range of stakeholders) 18
Bibliography 93
Timing (as early as possible) 18
Results 18
2 — Health impact assessment: a guide for the oil and gas industry
Executive summary
OVERVIEW: THE IMPORTANCE AND VALUE OF STRATEGIC HEALTH IMPACT ASSESSMENT

HEALTH IMPACT ASSESSMENTS (sHIA)
Oil and gas companies need to consider and understand Strategic health impact assessment (sHIA) is a structured
the potential public health impacts of their projects and process to strengthen the role of health issues in strategic
operations in order to define their responsibilities with decision making and planning. Focusing on decision
regard to local communities and host governments. making, sHIA provides a technical document and a
strategic engagement process that can inform industry
A health impact assessment (HIA) is a structured planning strategic planning across multiple projects over a large
and decision-making process for analysing the potential geographical area. Often driven by governments and
positive and negative impacts of programmes, projects, international financial institutions, the sHIA process enables
and policies on public health. These can then be addressed industry to plan for, and manage, the human health
in a timely and appropriate manner to achieve positive impacts resulting from decisions made across a range of
outcomes and cost benefits while also enhancing levels, from regional to global. This strategic process can
sustainability. create a platform for engagement with government or
regulatory authorities and communities about human
This guide defines and outlines the purpose and value of health-related issues identified during the project planning.
health impact assessments within the oil and gas industry,
and details a six-step HIA implementation process. It Three core principles for conducting sHIAs inform the
revises and updates the 2005 guide, and includes ‘lessons process, and its outcomes and outputs: scale (of impacts);
learned’ and new HIA developments. collaboration; and timing. Outcomes of a sHIA are: a
technical report about strategic health impacts; improved
The guidance is intended as a technical resource for both definition of relationships with stakeholders; indicators for
subject matter experts and project staff who work on the ongoing project planning and assessment; and monitoring
potential health impacts of oil and gas projects. and evaluation.
INTRODUCTION PROJECT HEALTH IMPACT ASSESSMENT

The introduction explains the purpose of the document, Once the decision has been taken to conduct an HIA, it is
which is to create a common understanding of the basic vital to consider the level of effort needed to adequately
concerns, principles and practices of HIA for the oil and gas characterize potential project risks. While there is no
industry that would be relevant across a diversity of consistent or agreed terminology to describe the required
potential upstream, midstream and downstream projects. intensity of effort, this Guide defines three key types of
HIA: desktop; rapid appraisal; and comprehensive.
WHAT IS HIA? The type of HIA that is considered triggers different

While exploring the core principles of HIA, this section approaches to baseline data collection and stakeholder
locates the process within the broader context of national engagement.
requirements, international standards and the concerns of
financial institutions. It also reviews the benefits and limits A desktop HIA is a qualitative assessment most
of the assessment, looks at HIAs both as stand-alone appropriate for projects with few anticipated health
processes and components of broader environmental, impacts. It will usually be completed in 2 to 4 weeks, but
social and health impact assessments (ESHIAs), and may take longer if baseline data gathering is difficult.
outlines the different types of HIAs. Typically the HIA team will not pursue extensive external
stakeholder engagement, but any related data collected
should be documented. Internal business stakeholders and
close communication are critical. Desktop HIAs are often
Executive summary
implemented by company staff as an internal ‘exercise’ and 3. Collecting and reporting baseline data is a critical
are not made public. analytic task for the HIA. The scoping analysis and use
of the systematic methodology, such as the
A rapid appraisal HIA is site-specific and uses health environmental health area framework, should help
information that is already available or potentially guide and inform the data collection process. Initially, a
accessible without conducting new field survey work. Data large amount of data can be collected using published
sources for a rapid appraisal may include: peer-reviewed sources, e.g. peer-reviewed scientific papers, ‘grey
scientific literature; NGOs’ reports and data; and local, literature’ produced by the host country Ministry of
provincial and national health department databases. In Health, etc. Stakeholder input and local knowledge are
addition, if the current project under consideration is an critical and should be obtained and coordinated with
expansion scenario, information from previous impact the ESHIA team.
assessments should be consulted.
4. Impact assessment: after screening, scoping and
A comprehensive HIA is defined by its collection of new baseline analysis, the HIA team should rate and rank the
field study data to address data gaps identified during potential health impacts, their relative importance and
scoping. It may be appropriate for large, complex projects at what level they are expected to occur. Impacts can
involving some or all of the following: local community occur singly or in combination at various levels, i.e.
resettlement; potential for project-induced in-migration; individual, household, community/village, regional and
major disruption of livelihoods; significant impact for key national. The assessment needs to consider the
social determinants of health; information gaps related to a advantages and disadvantages of concentrating on one
well-known aspect of a project; greenfield oil or gas level versus another. It may be difficult to develop the
developments. database necessary to assess all levels or key units
simultaneously. Clearly defining the unit of assessment
is critical since it can help to focus studies and
CRITICAL STEPS IN THE HIA PROCESS concentrate resources as well as facilitate
The largest section of the guide describes six critical steps understanding of the linkages that exist between the
for the practical implementation of HIAs: different levels.
1. Screening is a preliminary evaluation of whether a 5. Mitigation and enhancement are measures that aim
project poses significant health questions, and helps to avoid, minimize, eliminate or remedy an adverse
determine whether an HIA is needed. All screening effect, or maximize a potential benefit. Outcomes of
discussions should answer the basic question: Is an HIA the impact assessment step can be used to both
appropriate and/or needed for this project? prioritize health impacts to be mitigated and to identify
opportunities for enhancing health benefits. The
2. Scoping underpins the HIA process. It is an early, open mitigation development process should reassess the
identification of likely significant impacts requiring effectiveness of the selected mitigation measures. Even
investigation, and can also facilitate identification and companies with strong reputations can lose credibility
assessment of alternative project designs/sites, the when mitigations fail to prevent or reduce health
gathering of local knowledge of site and surroundings, impacts and enhance positive impacts associated with
and the preparation of a plan for public involvement. a project.
Scoping results are frequently used to prepare HIA
terms of reference—providing focus when time and 6. Monitoring and evaluation help to determine whether
resources are usually limited—and to decide whether the selected mitigation strategies have been
the HIA will be a stand-alone document or part of an implemented and are effective. Monitoring is the
overall ESHIA. ongoing, methodical collection of data that provides
early indication of progress toward the desired goals.
Evaluation is periodic and primarily focused on
measuring long-term results and overall effectiveness of
the actions implemented. Effective management,
monitoring and evaluation depend on the identification
of key performance indicators.
Section 1
Introduction
This Guide defines and outlines the purpose and

value of Health Impact Assessments (HIAs)
within the oil and gas industry. The Guide is a
revision of the 2005 document and
incorporates both ‘lessons learned’ and new
developments within the HIA field.
Section 1
Introduction
PURPOSE OF THIS GUIDE addition to the execution of a project-specific HIA.

HIA is a useful and beneficial tool for business, Strategic HIA (sHIA) is a new and evolving concept that
communities and host country decision makers. is a parallel exercise to: (i) the strategic environment
Experience within the oil and gas industry suggests that assessment (SEA) for public plans and programmes; and
health is a critical issue, both for the project workforce (ii) the assessment of cumulative impacts for multiple
and the surrounding communities, as well as being a projects that often coexist in the same general
key component of project sustainability. The oil and gas geographical area, e.g. large offshore gas and oil
industry faces a complex agenda that increasingly development blocks with significant onshore processing
requires an evaluation of health, social, human rights and support facilities. The sHIA provides a potential
and environmental impacts throughout its operations. opportunity for companies to consider a higher-level
This concern is often present and felt in all phases of perspective on large, complex developments, (e.g.
upstream, midstream and downstream activity, i.e. onshore LNG projects), and to establish relationships
exploration, production, refining and marketing activities. with multiple stakeholders, such as the national health
authorities. Oil and gas companies need to understand
Historically, impact analysis has focused primarily on and consider the potential public health impact of their
environmental assessment and compliance; however, activities and projects on both local communities and
over the past several years, the industry’s ‘licence to the host government in order to understand, define and
operate’ has expanded to encompass both address their responsibilities appropriately.
environmental and social performance. While health and
safety issues have always received the highest priority The practice of HIA has gained substantial traction
for any project, the traditional focus was on worker within the oil and gas industry over the past 10 years,
health and safety within the geographical boundaries of and many companies have developed their own
a proposed project. The importance of HIA and public internal HIA guidelines and execution procedures. HIA
health has been rapidly absorbed by the oil and gas can be a separate process or can be integrated with
industry, and these are Tier 1 (Health Management the other components to become an environmental,
System) KPIs for IOGP members. Within the context of social and health impact assessment (ESHIA), but the
environmental and social issues, the oil and gas industry underlying principles remain the same. This HIA Guide
is increasingly asked to address problems that are is useful whether the HIA is part of an integrated
considered to be ‘outside the fence line’ and not assessment or is presented as a stand-alone report.
directly tied to a specific oil and gas project, i.e. Hence, this guidance is designed to present many of
problems that are considered responsibilities of the host the common practices and procedures that are
government. There is a difference between the potential occurring across the industry regardless of the final
health consequences of a project or production activity report format. The purpose of this guidance document
and the general voluntary health promotion outreach is to create a common understanding of the basic
activities supported by the companies. For example, concerns, principles and practices of HIA for the oil
many companies have a variety of local community and gas industry that would be relevant across a
health initiatives that are not directly related to diversity of potential upstream, midstream and
mitigating potential negative project-related impacts. downstream projects.
These voluntary contributions include vaccination
support, local health staff training, scholarships, etc. The
potential ‘blurring’ of the line between inside and
outside the fence line has led some companies to
consider the role and benefit of a ‘strategic HIA’ in
Section 2
What is HIA?
This section provides an overview of the core

principles of an HIA, and looks at the need to
consider national requirements and
international standards. The benefits and
limitations of HIA are discussed, and other types
of health studies are introduced. The section
closes with a summary of the steps needed to
conduct an integrated environmental, safety
and health impact assessment (ESHIA).
Section 2
What is HIA?
CORE PRINCIPLES also assist in the planning process for health and social
HIA is a structured planning and decision-making outreach programmes that extend beyond the fence
process for analysing the potential positive and negative line and into surrounding communities, e.g. capacity
impacts of programmes, projects and policies on public and institution building, health infrastructure support,
health. The HIA process is designed to: information education and communication, vocational
l provide a systematic methodology and process of training, safe water projects and small-scale business
how a project, policy or programme is potentially (trade markets) infrastructure support. All of these
generating human health impacts; programmes can provide positive and important health
benefits, both in terms of strengthening public health
l predict the consequences (positive, negative or
services and enhancing household-level health
both) and distribution of these impacts across
outcomes, the latter being strongly associated with
potentially affected communities, including
improved income generation.
vulnerable individuals or groups;
l identify positive health effects while prioritizing the
HIA seeks to identify and estimate lasting or significant
prevention of potential negative health effects; changes resulting from different actions on the health
l be multidisciplinary in approach and use information of a defined population. These changes can be positive
from many different health providers, disciplines or negative, intended or not, single or cumulative.
and allied technical fields, e.g. environmental, socio- Furthermore, the range of changes may or may not be
economics and human rights; evenly distributed across the population. The potential
l facilitate discussions across decision makers and key for uneven differences is a major concern for many
stakeholders; and impact assessment practitioners (including health) and
l generate detailed baseline information that can be
is generally referred to as the ‘assessment of equity’.
used to develop key performance indicators for The management and mitigation of potential health
future monitoring and evaluation. impacts is discussed in later sections of this guidance.
The integration and alignment of impact management
A comprehensive HIA is a participative and interactive across health, environment, social and human rights is
process with a broad range of stakeholders at every extremely important.
level within the host society. In addition, health analysis
is increasingly considered by national and international NATIONAL REQUIREMENTS AND
stakeholders (e.g. non-governmental organizations INTERNATIONAL STANDARDS
(NGOs) and financial institutions) as an essential part of
the overall impact assessment process. HIA can be used The HIA team should carefully evaluate and understand
at any stage of the industry life cycle, whether this is host government rules and requirements covering
new country entry, exploration and development, health. In any given setting, there is a range of
production, modification of an existing activity or regulations and standards addressing health issues that
closure of previous projects. should be considered during the development and
execution of an HIA. National laws regarding health can
HIA makes recommendations to avoid or mitigate be extremely variable and are often included in the
negative impacts and enhance health opportunities as a regulatory framework review typically addressed by the
core aspect of the oil/gas project design. The HIA can environmental and social impact assessment process,
Section 2
What is HIA?
e.g. with regard to land use, housing, and water and INTERNATIONAL FINANCIAL INSTITUTIONS
sanitation systems. Most countries have labour and (IFIs) AND THEIR ROLE IN HIA
workplace health and safety rules; however, these
IFIs are financial institutions that are established across
requirements are more commonly considered by ‘inside
more than one country and are subject to international
the fence line’ evaluations. In terms of community
law. IFIs include the World Bank Group (WBG), European
health, communicable disease reporting requirements
Investment Bank, Asian Development Bank, Asian
are extremely important, particularly as the number of
Infrastructure Investment Bank, European Bank for
serious emerging infectious diseases continues to
Reconstruction and Development, Development Bank of
increase worldwide. Relatively few countries require a
Latin America, African Development Bank and the Islamic
formal stand-alone HIA or its equivalent; however, host
Development Bank. These institutions have global reach
country and lender (financial institutions) requirements
and are critical partners for both host countries and oil
often trigger a formal and detailed health impact
and gas companies. One of the most influential IFIs is the
analysis above and beyond the level customarily
World Bank Group. Within the WBG, the International
considered in the environmental and social assessment.
Finance Corporation (IFC) is one of the most important
Many oil and gas companies have internal impact
actors in terms of impact assessment, particularly for
assessment guidelines and requirements. In addition,
private companies. The IFC is the largest global
IPIECA has developed a number of human rights
development institution focused exclusively on the
guidance documents that consider the role of health
private sector. The IFC has developed a series of eight
and well-being within this context, i.e. the ‘right to
Performance Standards (PS) that are ‘directed towards
health.’ Since the first edition of this IPIECA-IOGP HIA
clients, providing guidance on how to identify risks and
Guide was written in 2005, the number of member
impacts, and are designed to help avoid, mitigate, and
companies that require some level of community health
manage risks and impacts as a way of doing business in
impact assessment has increased.
a sustainable way, including stakeholder engagement
and disclosure obligations of the client in relation to
project-level activities.’ The PS were revised and updated
in 2012 and cover a range of social, environmental and
Section 2
What is HIA?
health and safety performance areas. Performance l Identifying factors, positive or negative, that
Standard 4, Community Health, Safety and Security and otherwise may not have been adequately assessed.
its associated ‘Guidance Notes’ directly address This process allows for timely project design and
community health. Many oil and gas companies have modifications in a cost-effective manner.
modelled their own impact assessment processes to be l Quantifying the positive and negative impacts more
aligned with the IFC Standards. precisely than would have otherwise been done.
l Clarifying the potential elements of project trade-
Private sector financial institutions have also embraced
offs. The HIA can become an effective risk
the need for benchmarking environmental, social and
management tool for all stakeholders.
health project risks, and have developed a risk
management framework known as the Equator l Describing the potential interactions and
Principles (EP). The EP are used for determining, relationships among the different environmental
assessing and managing environmental, social and health areas and sectors.
health risks in project financing. The EP have adopted l Allowing a clearer analysis of potential mitigation
the IFC PS and IFC Environmental Health, and Safety strategies for negative effects or enhancement of
Guidelines (EHS) Guidelines and applied them globally, positive benefits.
to all industry sectors, including oil and gas. l Making the overall project decision process more
transparent for key stakeholders.
BENEFITS OF PERFORMING HIA l Providing a structured environment for stakeholder
input and engagement in both new projects and
Many oil and gas projects occur on a large scale and in existing operations. This allows for early input into
diverse locations across the globe. The potential for the overall decision-making processes.
health impacts is affected by a combination of local
l Building consensus within stakeholder communities
environmental, cultural and social living conditions. The
so that mutual trust is developed and enhanced
HIA is a tool that helps decision makers and
during all phases of project development,
stakeholders to maximize the potential benefits for
construction, operations and decommissioning.
communities and minimize potential impacts that may
be triggered by the project. The HIA can be a vehicle for l Securing funding from IFIs.
documenting and delineating the roles, responsibilities l Specifying responsibilities between the project
and issues that are relevant for the host government, sponsors and the host government.
local communities and the project sponsor. The HIA can l Establishing an accurate and appropriate baseline for
assist in understanding the wider health issues and future comparison during the development,
trends that may already be occurring in the host operation and eventual closure of a project.
country or community. l Enhancing project benefits, as HIA can help to
provide the basis for large- and small-scale
A well-executed HIA can prevent new project delays by
investment and development plans in the health
anticipating, soliciting and appropriately incorporating
sector and other areas (for example, education) for
stakeholder concerns and suggestions into the overall
the benefit of the overall community.
project design. Similarly, existing operations can also
benefit by the timely assessment and evaluation of a l Contributing to overall health systems capacity,
broad range of impacts. One of the key benefits of the infrastructure and development including
HIA process for stakeholders is to enhance the preservation of traditional medicine, local health
awareness that health is a relevant and significant cross- providers and culturally important practices.
cutting issue. Additional benefits include:
Section 2
What is HIA?
LIMITATIONS THE ESHIA PROCESS AND OTHER

This Guide does not focus on ‘inside the fence line’
IMPACT ASSESSMENTS
occupational health issues that are typically covered by Human health outcomes are embedded in a myriad of
both host country’s rules and regulations and internal economic, social and personal issues. Theoretically,
company policies and procedures. The oil and gas there are potential benefits and synergies that could be
industry is a leader in occupational health and safety, derived by using a multidisciplinary team that utilizes a
and a range of IPIECA-IOGP publications are available single impact assessment approach integrating
which cover a wide variety of workplace issues. This environmental, social, human rights and health
guidance document addresses workplace ‘cross-over’ components. The resulting ESHIA could be fully
issues that could potentially affect household- and integrated and:
community-level health outcomes; examples include l avoid duplications;
emerging infectious diseases and changes in the level
l minimize overlaps;
of non-communicable diseases. In general, the Guide
l efficiently and cost-effectively obtain baseline
focuses on projects as opposed to general policy or
programme impact assessment. information;
l have a unified risk ranking system so that
environmental, social, human rights and health
AUDIENCE FOR THIS GUIDE impacts could be systematically rated and ranked
The Guide is intended as a technical resource for both using a common risk matrix;
subject matter experts and project staff who work on l better assess the pathways between environmental
the potential health impacts of oil and gas projects. exposure and health outcomes; and
Experience with the first edition of this Guide indicates l develop a unified risk registry with an integrated
that there are a variety of internal business stakeholders monitoring and surveillance system.
who want to understand and participate in the HIA
process, including:
l project managers;
l environmental, social, human rights and health

advisers;
l communications and external affairs personnel;
l HSE managers;
l construction and facilities managers;
l design engineers; and
l security professionals.
Many company decision makers are unfamiliar with HIA

and its close alignment and potential integration with
the environmental and social impact assessment
process. This Guide provides core technical information
and insight into the benefits of conducting an
appropriate, focused and integrated HIA. In addition,
external stakeholders (e.g. host country officials and
international financial institutions), including potentially
affected communities can use this guidance as both an
information source and as a mechanism for actively
participating in the HIA process.
Section 2
What is HIA?
The overlap across the different ESHIA disciplines is For example, long-haul truckers are considered an
illustrated in Figure 1. important ‘vector’ for HIV/AIDS transmission, and
changes in land use and/or in-migration may trigger
In general, the different disciplines (environmental, new disease emergence (emerging infectious diseases).
social, human rights and health) all use a similar These geographic areas or communities may not match
sequential impact assessment process. While an potentially affected areas identified in the social or
integrated impact assessment is theoretically ideal, environmental component of the ESHIA. The
there are many situations when a stand-alone HIA is epidemiology of disease transmission is generally not
created and is a preferred option. In many considered during the social impact assessment (SIA)
circumstances, there will be an overlap across the and may be evaluated in the environmental impact
potential social, health and environmental impact areas. assessment (EIA) only in relation to wildlife and habitat
However, many projects, particularly those that are large issues. Project-induced in-migration is likely to be
and have diverse linear features (e.g. pipelines, power considered differently by environmental, social, human
transmission corridors, canals and significant new-road rights and health professionals. Flexibility is critical as the
developments), may impact communities and overall impact assessment, whether integrated or stand-
geographical areas in ways that are specific to health. alone, should be fit for the intended purpose.
Disease vector Health

Floral and
faunal species Waste
management
Healthcare delivery services
Hazardous Air
Climate change
material quality
Ionizing/non-ionizing
Ecosystems Soil radiation Noise National health systems
quality
Protected areas Ecosystem services Communicable (and non-
Water communicable) diseases
Areas of quality Natural resources Public
biodiversity use and availability health
importance Land and Human rights Personal
marine use behaviour Nutrition
Public services
Landscape Employment
Habitat Working
Fishing and Agriculture condition
Education
hunting Energy Demography
Environment Indigenous
use
people
Economic
development
Community
Transparency
Cultural structure
mechanism
heritage
Social
Security
Figure 1
Key environmental, social and health issues
and their interrelationships
Source: eni E&P Standard Doc. No. 1.3.1.47, Environmental, Social
and Health Impact Assessment, 2010
Section 2
What is HIA?
Whether stand-alone or integrated, the HIA process can

work synergistically within the ESHIA process. For
example, baseline environmental health data such as
water and sanitation service levels in communities and
contaminant levels in media (i.e. soil, water, air,
subsistence foods) collected by the environmental team
is utilized in the HIA, thus avoiding duplication of efforts.
Typically, there are environmental and social studies that
generate data, which can be fed directly into the HIA.
These interdependencies are extremely important and
are shown in Appendix 1. Survey efforts should also be
coordinated to avoid survey fatigue among residents.
OTHER HEALTH STUDIES

As part of the project evaluation process, company
health professionals are often tasked with performing
three different types of assessments that can provide
critical input into the HIA:
l health risk assessment (HRA)
l health needs assessment (HNA)
l health facility assessment (HFA)
Health risk assessments classically address ‘inside the

fence line’ issues that focus on the workforce. These
assessments include the quantitative calculation of
incremental individual exposure risk to hazardous materials
in the environment or the assessment of exposure risks
encountered while working at the project facility, such
as chemical exposures, cold and heat exposures, or
safety hazards. There are cross-over considerations
when workers act as transmission agents for potentially
hazardous exposures (e.g. to chemicals or infectious
diseases) and transmit the exposure effects from the
worksite to their homes. These situations are typically
evaluated as part of an industrial hygiene/safety review
and should be carefully considered by the HIA team.
Health needs assessments (HNAs) involve a systematic

review of the health issues faced by a population, and
lead to agreed priorities, strategy identification/selection
and resource allocation that may concur to improve
health and reduce inequalities.
Health facility assessments (HFAs) function primarily as

a means of documenting the existing level of clinical
(including hospital and emergency healthcare) services
that are available, both in the host communities and the
country as a whole.
Section 2
What is HIA?
THE HIA PROCESS, INCLUDING TYPES OF HIAs

The steps necessary to conduct an integrated ESHIA are
illustrated in Figure 2. The sequence of basic steps, e.g.
screening, scoping, baseline, impact assessment,
mitigation planning and monitoring, is identical for a
stand-alone HIA. Stakeholder communication and
consultation is critical during all phases of the HIA.
Stakeholders (both internal and external) should have
an opportunity for input throughout the entire process.
ESHIA PHASES ACTIVITIES SCOPE OF CONSULTATION
High-level ESH impacts assessment Identification of relevant/

1. Screening based on secondary data key stakeholders
Definition of information and data gaps Identification of inputs

2. Scoping Focus on key ESH impacts and concerns from
STAKEHOLDER ENGAGEMENTÑCONSULTATION
Definition of methodology key stakeholders
Feedback on the results

3. Baseline Definition of baseline conditions of the baseline analysis;
of the area (including field surveys) identification of
community needs
Assessment of ESH impacts Validation of the findings

4. Impact assessment
(type and significance) of the assessment
Identification of mitigation measures Support in the identification

5. Mitigation and enhancement related to identified impacts in a and evaluation of options
comprehensive management plan for mitigation measures
Identification of monitoring measures

Support in the
6. Monitoring and evaluation related to identified mitigation
identification of
measures in a comprehensive
monitoring measures
management plan
Participation of stakeholders
IMPLEMENTATION AND
in the monitoring programme
FOLLOW-UP
and grievance mechanism
Figure 2
Critical activities that inform each step of the HIA
process are illustrated as arrows directed toward the
key decision making steps of the HIA process.
Source: eni E&P Standard Doc. No. 1.3.1.47, Environmental, Social and Health
Impact Assessment, 2010
Section 3
Strategic health
impact assessment
(sHIA)
A strategic health impact assessment can be
defined as ‘a structured process to strengthen the
role of health issues in strategic decision making
and planning’. Crucially, because of its focus on
decision making, sHIA provides a technical
document and a strategic engagement process
that can inform industry strategic planning across
multiple projects over a large geographical area.
Section 3
Strategic health impact assessment (sHIA)
INTRODUCTION TO sHIA potentially national scales. Impacts, both positive and/or

Strategic health impact assessment can be defined as ‘a negative, on a large geographical scale, may be beyond
structured process to strengthen the role of health the scope of single project assessments, and it may not
issues in strategic decision making and planning’. be possible to assess, mitigate and effectively manage
Crucially, because of its focus on decision making, sHIA such impacts without significant and ongoing
provides a technical document and a strategic involvement by the host country government. Strategic
engagement process that can inform industry strategic environmental assessments (SEA) offer a potential
planning across multiple projects over a large template for a similar strategic health assessment.
geographical area. Similarly, integration of health into an ongoing SEA
process could be considered. For example, the World
When there is potential for (i) large-scale industry activity Bank has recognized SEA as a key means of integrating
in a new geographical area and/or (ii) a number of environmental and social considerations into policies,
separate projects carried out by multiple organizations plans and programmes, particularly for sector decision
in a large geographic region, conducting a sHIA may be making, reform and sustainable development. The World
an important option to consider. Potential examples Bank has written that ‘SEA is a family of approaches that
include oil sands activities in Canada, oil and gas lie on a continuum. At one end, the focus is on impact
exploration and development in Greenland and analysis, at the other end, on institutional assessment.
Mozambique, and large onshore and offshore SEA incorporates environmental considerations across
development in Ghana. Multiple projects, typically different levels of strategic decision-making: plan,
conducted by different developers, have the potential to program, and policy.’ A similar perspective can be utilized
lead to a myriad of health impacts across a large for health, either as part of an integrated strategic
geographical area, i.e. at provincial, regional and assessment or, in some situations, as a stand-alone sHIA.
Section 3
TRIGGERS RESULTS
Geography and scale Plan for action

(range of impacts) and intervention
Timing Strategic Health

Impact Assessment Indicators
(as early as possible)
(sHIA)
Figure 3 Collaboration
Relationships
Triggers/dimensions (range of stakeholders)
of sHIA and its results
sHIA ACTORS Correspondingly, the outputs of a sHIA are: (i) a

technical report about strategic health impacts;
While governments and International Financial
(ii) improved definition of relationships with
Institutions could be major drivers of the sHIA process,
stakeholders; (iii) indicators for ongoing project planning
the sHIA approach allows for industry to plan for, and
and assessment; and (iv) monitoring and evaluation.
manage, the human health impacts of a range of
These outcomes are discussed, and compared and
decisions including macro-business models and
contrasted to a more typical project HIA.
approaches at a global and regional level. This strategic
process can lay the platform for engaging with
government or regulatory authorities and communities Geography and scale (range of impacts/new area)
about issues influencing human health that have been
sHIAs are concerned with large geographic areas, e.g.
identified through the project planning process.
national and regional. Strategic decisions at a large
scale are concerned with potential health impacts of
sHIA PRINCIPLES multiple similar projects, e.g. development of multiple
offshore platforms feeding different and geographically
There are three core principles for conducting sHIAs dispersed onshore LNG plants. Similar to the process
that inform the process as well as the results (see considered by the cumulative impacts assessment, the
Figure 3). The core dimensions underpinning these analysis also includes other non-project related
principles are scale (of impacts), timing and development activities and government priorities
collaboration. occurring in the region, e.g. transport infrastructure,
schools, markets, etc.
Section 3
Collaboration (range of stakeholders)

Strategic problems require discussion and collaboration
across a large and diverse set of stakeholders. sHIAs
provide the opportunity to proactively engage with a
wide range of stakeholders, including other companies
who are operating, or plan to operate, in the same
general geography, at an early stage of project planning
and development.
Timing (as early as possible)

sHIAs should occur at the earliest point of planning for
industry activity where ideas and options about multiple
activities at scale are forming. The purpose of a sHIA is
to identify and assess the range of potential health
impacts at a large scale and from multiple activities
before the traditional planning for individual activities
begins. Once a trigger has been established—in terms
of need for a sHIA to address a problem—a sHIA can be
rapidly initiated.
Results
The principle results from a sHIA include:
l Decisions are made about planning for actions and
interventions based on the size and type of health
impacts in new regions where industry will operate.
l Development of broad national or regional-level
indicators that can be used for monitoring, e.g.
population morbidity and mortality indicators.
l Strategic relationships allow implementation of
effective interventions.
Finally, the sHIA planned interventions should lead to

reduced impact on, and even improve, health in
communities which can be measured through
reduction in morbidity and mortality numbers.
Section 4
Project HIA
This section considers the different

types of HIA, and outlines six critical
steps in the HIA process:
l screening
l scoping
l baseline data analysis
l impact assessment
l mitigation and enhancement
l monitoring and evaluation
Section 4
Project HIA
TYPES OF HIA l legislative/regulatory review;

If a decision is made to conduct an HIA, it is extremely l scope of the HIA;
important to consider the level of effort needed to l brief project description including:
adequately characterize potential project risks. HIA (i) location;
practitioners often refer to different types of HIAs in (ii) site access (are new transport features needed?);
terms of the intensity of effort that will be required,
(iii) timing/schedule;
particularly in relation to the collection of new
community-level data, as well as the overall time (vi) type of project activity; and
needed to complete a document. At present, no (v) the number of persons involved in the project
consistent terminology is used to distinguish one type activity;
of HIA from another. In this Guide, the key terms used l potentially impacted areas (geography);
to describe the different types of HIAs are:
l potentially affected communities (if any);
l ‘desktop’;
l community and/or external stakeholder concerns or
l ‘rapid appraisal’; and
comments;
l ‘comprehensive’. l brief baseline analysis and preliminary identification
of whether critical data gaps are present;
The type of HIA that is considered triggers different
l impact analysis based on the standard
approaches to baseline data collection and stakeholder
environmental health area (EHA) categories;
engagement.
l mitigation analysis (if required, or if none, why not?);
and
Desktop HIA
l monitoring and evaluation analysis (if required, or if
The desktop HIA is a qualitative assessment and is most none, why not?) .
appropriate for projects with few anticipated health
impacts. The desktop HIA ideally requires 2 to 4 weeks
Rapid appraisal HIA
but may require longer if baseline data are difficult to
obtain. The HIA team typically does not pursue A rapid appraisal HIA is considered to be a site-specific
extensive external stakeholder engagement. However, HIA that uses health information that is already available
any external stakeholder input that is collected should or potentially accessible without conducting new field
be documented. Close communication with internal survey work.
business stakeholders is critical. Many desktop HIAs are
performed by internal company staff as an internal Data sources for a rapid appraisal may include: peer-
‘exercise’ and are not released for public review or reviewed scientific literature; NGO reports and data; and
comment. In a desktop analysis, the following elements local, provincial and national health department
should be covered: databases. In addition, if the current project under
l project background; consideration is an expansion scenario, information
from previous impact assessments should be consulted.
l internal company standards and guidance for impact
assessments;
Section 4
Project HIA
Comprehensive HIA
(ii) key informant interviews with health workers and
The hallmark of the comprehensive HIA is new field other community leaders/stakeholders; (iii) focus group
study data. Field studies address data-gaps identified discussions (FGDs), especially with vulnerable groups,
during the scoping process. A comprehensive HIA may such as women, elders, disabled persons, etc.; and
be appropriate for large, complex projects that involve: (iv) biomedical data, e.g. haemoglobin determination,
l resettlement of existing communities; malaria prevalence surveys, anthropometric surveys, etc.
l significant potential for project-induced in-migration; If an integrated environmental, social and health study is
foreseen, survey administration should be aligned with
l major disruption of livelihoods;
the timing of environmental and social surveys, and
l significant impact on key social determinants of
coordinated through the ESHIA team in order to avoid
health; survey fatigue among community members and to
l information gaps related to a well-known aspect of a make optimal use of project resources.
project; and
l large greenfield development, i.e. no previous oil or A summary of the levels and characteristics of the
gas projects. different types of HIAs is shown in Table 1.
Field data collection typically consists of a combination

of: (i) household level health-questionnaire surveys;
Table 1 Levels and characteristics of the different types of HIAs
TYPE OF HIA CHARACTERISTICS

l Broad overview
l Analysis of existing and accessible data
Desktop HIA
l No new data collection. Usually takes an experienced assessor 2–3 weeks to perform the
appropriate literature searches, analysis and write-up
l Provide more detailed information of possible health impacts

l Analysis of existing data
l Stakeholder and key informant analysis
Rapid appraisal HIA
l No new data collection
l Typically takes a team of two experienced assessors 10–14 days in the field, followed by 4–8
weeks of analysis and document preparation, with literature (desktop) searches performed prior
to the field work
l Provide a comprehensive assessment of potential health impacts

l Robust definition of impacts
l New data collection
Comprehensive HIA
l Participatory approaches involving stakeholders and key informants
l Requires approximately 2–4 weeks of fieldwork. Community survey may require a long pre-work
coordination time and its feasibility is highly dependent on local climate and accessibility.
Section 4
Project HIA
While no formal algorithm is used to select the level of l endemic disease profile—considers the likelihood of
HIA, Figure 4 suggests key factors for consideration and sexually transmitted infections including HIV/AIDS,
a schematic for decision making. communicable respiratory diseases including
tuberculosis, and other emerging infectious diseases,
The potential health impacts axis considers health issues etc.;
in the proposed project location, such as: l health systems and infrastructure—considers status
l exposure to hazardous materials—considers facility of existing public health infrastructure and potential
operation, and potential exposures to physical effects on direct clinical care services and resources;
(including noise and illumination), biological and l stakeholder concerns—considers critical community
chemical hazards, particularly potential impacts on issues, such as impacts on subsistence harvest,
subsistence resources through emissions, or water quality, crime rates, increased road traffic and
avoidance of an area due to noise or other physical accidents, noise, dust, etc.; and
hazard;
l social sensitivity—considers whether or not the
l resettlement, relocation, influx—considers whether project will significantly alter existing cultural,
or not the project will require the need for changes community, and household social relationships.
in the existing community configuration and social
structures;
Figure 4
Selecting an HIA type
Source: adapted from State of Alaska (2011),
Technical Guidance for HIA in Alaska
(‘Alaska HIA Toolkit’), 2011.
High
Comprehensive
POTENTIAL HEALTH IMPACTS SOCIAL SENSITIVITY

l Hazardous materials exposure l Socio-economic situation
l Endemic disease profile l Conflict

Rapid appraisal
l Health systems infrastructure l Human rights
status l Indigenous People
l Stakeholder concerns l Vulnerable subgroups
l Political factors
l Stakeholder concerns
Desktop
Low = Low High High =

¥ Good PROJECT FOOTPRINT ¥ Poor
¥ Precedent l Knowledge ¥ No precedent
¥ Short l Precedence ¥ Long
¥ Small l Timescale of impact ¥ Large
¥ Easy l Physical area, number of people impacted ¥ Difficult
l Complexity (workforce size, countries of origin; level
of inconvenience to quality of life, displacement,
potential impact on the use of natural resources;
in/out migration and access to healthcare; cultural
health impact; food/housing inflation)
Section 4
Project HIA
The social sensitivity axis gives special focus to some of l impacts on natural resources used by the
the social determinants of health such as gender, communities for subsistence, such as hunting and
ethnicity, cultural cohesion, physical or mental distress fishing, foraging, and water supplies for drinking;
due to cultural change, education levels, poverty or l physical displacement (resettlement or relocation of
economic disadvantage, and dependence on unique individuals or communities increases the project
natural resources. These topics are usually addressed in footprint);
the social impact analysis, so it is extremely important
l impact on community transportation infrastructure,
that the HIA team understands the SIA approach to
such as road improvements resulting in potential
social analysis.
positive and negative changes in the flow of goods
and services, such as alcohol and drugs (negative)
The project footprint axis applies to:
and delivery/restocking of medication (positive);
l the physical area, and number of communities
l potential of the project to lead to local violence or
affected by construction, operation and
other significant disruptions of community cohesion;
decommissioning: the health-specific project
footprint may extend beyond the immediate l Indigenous Peoples’ cultural health practices and
physical footprint, and a useful technique may be to access to health infrastructure and services; and
organize potentially impacted communities into l distortion of local prices, especially of food, property
geographic ‘zones of impact’ (e.g. ‘Zone 1’ and energy.
representing the most impacted proximate
communities; ‘Zone 2’ representing potentially
impacted but geographically distant communities,
and ‘Zone 3’ representing those with a low
likelihood of potential impact);
l inconveniences to the population’s quality of life
such as dust, noise and transportation congestion;
l changes in access to services (e.g. health clinics) or
livelihood activities due to re-routing of roads,
re-routing or damming of rivers, and positioning of
construction camps;
Section 4
Project HIA
CRITICAL STEPS IN THE HIA PROCESS
Step 1: Screening
Screening is a preliminary evaluation to decide whether A description and general knowledge of the project,
a project poses any significant health questions, and covering location, size, workforce, surrounding
helps to determine whether an HIA is needed. All communities, operations and likely exposures, is
screening discussions should attempt to answer the essential. This initial review will determine whether an
basic question: ‘Is an HIA appropriate and/or needed for HIA may be appropriate, and provides an indication of
this project?’ its potential complexity.
Table 2 Steps for screening

Source: adapted from State of Alaska (2011), Technical Guidance for HIA in Alaska (‘Alaska HIA Toolkit’).
1. Assemble the team

2. Identify legislative and relevant corporate requirements
3. Gather and review relevant project information
4. Evaluate health context
a. Location b. Influx c. Culture/socio-economic
l Rural l Temporary l Social structure
l tribal/clan
l Urban l Permanent
l Level of wage/cash economy
l Peri-urban l Countries or locations l subsistence agriculture
of origins
5. Review project design

l Water bodies
l Waste management
l Roadways, pipelines
l Construction camps
l Operation facilities
l Source of potential exposure
l Transmission-line corridors
6. Review the possible health impacts using environmental health areas (refer to Table 4 on page 28)
7. Identify potentially health impacted geographic areas and potentially affected communities
8. Identify key stakeholders
9. Determine whether an HIA is needed
Section 4
Project HIA
Step 2: Scoping Scoping also starts the process of understanding the

regulations and standards that are pertinent to the
Scoping is an early and open activity to identify the
project and its setting. This is important since these will
impacts that are most likely to be significant and require
have considerable influence on the health performance
investigation during the HIA work. It may also be used to:
standards and the significance criteria that will be used
l identify alternative project designs/sites to be in assessing impacts.
assessed;
l obtain local knowledge of site and surroundings; and The scoping process:
l prepare a plan for public involvement. l gives a clear focus for which health issues will be
addressed in the HIA;
The results of scoping are frequently used to prepare the l considers the range of direct, indirect and
terms of reference for the HIA. A decision should be cumulative impacts on health issues;
made whether the HIA will be a stand-alone document
l identifies major external stakeholders and their likely
or part of an overall ESHIA. Scoping is one of the main
issues and concerns;
foundations of an HIA. If scoping is carried out well, the
l starts the process of understanding applicable host
HIA process has a significantly higher chance of
proceeding smoothly and efficiently; if carried out poorly, country regulations and standards and their
it is likely that important information will be missed, potential impact on the design of the HIA;
leading to unnecessary delays and costs. l determines whether compliance with IFC
Performance Standards will be required;
Scoping defines the limits of what is included in the HIA l considers the relevant company regulations and
and what it is not necessary to include. This is important standards, especially if the host country has a weak
because time and resources are limited when legal and regulatory system;
undertaking a HIA and it is necessary to invest them in l makes a provisional identification of the issues and
addressing the most important and relevant baseline potential impacts;
aspects and potential impacts (Table 3).
l considers what baseline information is required and
how to get it; and
l describes the impact assessment ranking and rating
methods to be used.
Table 3 Steps for scoping
1. Set the geographical time and population boundaries for the assessment
2. Determine the HIA approach
a. Comprehensive b. Rapid appraisal c. Desktop
l Significant influx concern l No new data collection l Limited review
anticipated within
l Resettlement/relocation
communities of concern
l Key social determinants of health
l Existing data source review
(SDH), e.g. income, employment
l Significant construction activity
l New linear features, including
transportation
l Large project in rural setting
l Potential subsistence impacts
l Community perceptions
Section 4
Project HIA
Important technical considerations during scoping are: l potential for economic change, including regional
l defining potentially impacted (affected) communities staging centres, e.g. port facilities or regional
(PICs) and vulnerable populations; transportation hubs;
l considering the potential extent and magnitude of l existing large burden of diseases or health
project induced in-migration; problems; and
l considering impacts across a suite of defined EHAs; l existing high level of exposure to an environmental
hazard.
l considering the availability of specific health defined
key performance indicators (KPIs); and
Project-induced in-migration (influx)
l assessing potential partners including the viability of
Project-induced in-migration (also generically known
community participatory epidemiology. as ‘influx’) is a critical consideration for the overall
impact assessment effort. The IFC has studied project-
Potentially impacted communities and populations induced in-migration associated with large
During the scoping process, the HIA team should define development projects, although these studies have
the PICs and be careful to identify vulnerable subgroups largely been performed in rural environments in
within these communities. Potentially impacted developing country settings.
populations may be grouped by variables such as age,
sex, ethnic group, education, income level and even According to the IFC, influx associated with economic
disease status (e.g. people living with HIV/AIDS). opportunity is a common phenomenon and involves the
movement of people into an area in anticipation of, or in
Population groups will differ in their vulnerability to health response to, economic opportunities associated with the
hazards. For instance, research has shown that, in development and/or operation of a new project. While
developed countries, chronic disease disproportionately primary employment is a critical driver, a wide range of
affects women and minority groups. In developing project-related economic opportunities serve to draw
countries, chronic disease rates have been rising rapidly, people into a project area, particularly in close proximity
most likely due to a complex mix of social, economic and to large workforce housing developments. As noted by
behavioural factors. Children are often more susceptible the IFC, this in-migration may ultimately benefit trade,
to communicable disease due to their lack of immunity. employment, infrastructure and services in the project
In addition, it should be noted that the composition of a area; however, there can also be negative consequences
community may change during the project’s life cycle. for host communities in terms of environmental, social
For instance, during a construction phase of a project, and health issues. The US Agency for International
there may be a greater proportion of adult men than
during other project phases.
A set of clear criteria often allows PICs to be identified in

a systematic way and facilitates the development of
zones of impact for the project. Some sample criteria
are communities with:
l close geographic proximity to the project;
l potential changes to water sources and quantities;
l locations in projected release areas for contaminants

of concern (e.g. plume);
l high likelihood of influx, resettlement or relocation;
l intense workforce recruitment potential;
l high likelihood for change in key subsistence

resources;
l high likelihood for change in transportation
infrastructure;
Section 4
Project HIA
Development (USAID) has developed an analysis and There is a continuous effort to link biomedical and
audit checklist of emerging infectious diseases (EID) that socio-environmental models and ecosystem services.
can be triggered by significant project-induced Policy-level HIA tends to utilize a broadly defined socio-
in-migration. More information on this critical topic is environmental model where significant emphasis is
presented in Appendix 2. placed on determinants of community health such as
poverty and income. In contrast, project level HIA is
The positive and negative impacts of influx are not often more narrowly focused on specific health
solely driven by the magnitude of in/out migration (i.e. outcomes, for example potential project-attributable
the ‘rate of influx’). The overall footprint, duration and changes in disease-specific rates for, say, malaria or
sustainability of in-migration, along with the resilience sexually transmitted infections (STIs). According to the
and absorptive capacity of the affected area, all IFC, ecosystem services include:
determine the significance of the consequences of l provisioning services: e.g. food, fresh water, timber,
in-migration for a given project. fibres, medicinal plants;
l regulating services: e.g. surface water purification,
HIA experience in international developing country
carbon storage, climate regulation, protection from
settings indicates that influx impacts are not evenly
natural hazards;
distributed across a defined study area, hence the
l cultural services: e.g. natural areas that are sacred
population growth rate and distribution cannot be
reliably assumed a priori. From an HIA perspective, influx sites, or important for recreation, aesthetic
is a significant potential source of impacts; however, HIA enjoyment; and
experience indicates that the ‘health issues’ are largely, l supporting services: e.g. soil formation, nutrient
but not exclusively, focused on the construction period. cycling, primary production.
Environmental health areas (EHAs) The World Bank has developed the scope of HIA for
Given the broad definition of ‘health’, HIAs can sub-Saharan Africa and other low human development
potentially have extremely wide scope and latitude. The index (HDI) settings within the context of environmental
underlying philosophical model of the HIA often drives health. The ‘environmental health’, perspective
the scope of the HIA. The two traditional models of encompasses the ‘human living environment’ and
health are biomedical and social or socio-environmental. emphasizes primary prevention through interventions in
The biomedical model of health focuses on disease and housing, sanitation, solid waste control, water, food,
illness, and related causal mechanisms. In contrast, the transportation and communication. The ‘environmental
socio-environmental model tends to focus on the health’ approach overlaps with some of the ecosystem
broader factors or determinants that shape and services concepts, e.g. food, water. The World Bank
influence health and well-being. Health determinants approach and scope emphasizes the potential linkages
are personal, social, cultural, economic and between infrastructure-related activities and overall
environmental factors that influence the health status of environmental health. Sectors defined by the World
individuals or defined populations. Examples include Bank are: housing; water and food; transportation; and
age, sex, genetic factors, air, water, housing conditions, communication and information management. This
income, employment and education. integration of health and infrastructure is compatible
with the design and execution of large, capital intensive
An additional perspective known as ‘ecosystem services’ oil and gas projects in low HDI settings.
has also been gaining traction, particularly with EIA
practitioners. The perspective received a substantial
boost as the 2012 IFC Performance Standards update
included specific language regarding ecosystem
services in Performance Standard 6, Biodiversity
Conservation and Sustainable Management of Living
Resources. An ecosystems framework that includes
health considerations is presented in Appendix 3.
Section 4
Project HIA
The environmental health perspective represents a shift and STIs. Hence, the EHA methodology provides several
from a disease-specific focus (e.g. malaria) toward an areas for discrete, focused consideration. The EHA
examination of the relationships between overall disease framework can be aligned with an ecosystems services
burden and infrastructure impacts. For example, the strategy as illustrated in Table 5.
assessment of potential malaria impacts is an important
consideration for many projects, and malaria Regardless of whether EHAs, the ecosystem services
management has an extremely strong environmental framework, or determinants of health are utilized, the
component. The first edition of the IPIECA-IOGP HIA critical objective is that the HIA utilizes a systematic
Guide generally promoted the EHA framework that was methodology that is compatible with environmental,
also utilized by the IFC ‘HIA Toolkit’ (2009). The EHA social and human rights impact assessment strategies.
framework has 12 specific defined areas (Table 4). This focus on compatibility is important to ensure that
the HIA is viewed as an integral and essential part of the
Many oil and gas projects are undertaken in settings overall impact assessment process, regardless of whether
where there is an extremely high underlying burden of the HIA is a stand-alone report or part of an ESHIA.
vector-borne, zoonotic diseases, respiratory illnesses
Table 4 Defined environmental health areas
ENVIRONMENTAL HEALTH AREAS (EHAs)

Vector-related diseases (VRDs): malaria, schistosomiasis, dengue, Japanese encephalitis, lymphatic filariasis, etc.
Housing and respiratory issues: acute respiratory infections (bacterial and viral), pneumonia, tuberculosis, respiratory
effects from housing, overcrowding and inflation of housing prices.
Veterinary medicine/zoonotic diseases, including zoonotic emerging infectious diseases, e.g. brucellosis, rabies, Ebola.
Sexually transmitted infections: HIV/AIDS, syphilis, gonorrhoea, chlamydia, hepatitis B.
Diseases related to soil, water, sanitation and waste: giardiasis, worms, etc.
Food and nutrition-related issues: stunted growth, wasting, anaemia, micronutrient diseases (including folate, vitamin A,
iron and iodine deficiencies), changes in agricultural practices, gastroenteritis (bacterial and viral) and issues relating to
inflation of food prices.
Accidents and injuries: traffic-related accidents, spills and releases, construction (home- and project-related) and drowning.
Exposure to potentially hazardous materials: pesticides, fertilizers, road dust, air pollution (indoor and outdoor, related to
vehicles, cooking, heating or other forms of combustion and incineration), landfill waste or incineration ash, any other
project-related solvents, paints, oils or cleaning agents and their by-products.
Psychosocial effects (social determinants of health): resettlement/relocation, violence, security concerns, substance
misuse (e.g. drugs, alcohol, smoking), depression and changes to social cohesion.
Cultural health practices: role of traditional medical providers, indigenous medicines and unique cultural health practices.
Understanding cultural practices and beliefs inside and outside communities that are health lowering and enhancing.
Health services infrastructure and capacity including programme management delivery: physical infrastructure, staffing
levels and competencies, technical capabilities of health-care facilities at district levels, systems for delivering and managing
health programmes, coordinating the project to existing national and provincial health programmes (for example, TB, HIV
and AIDS) and future development plans.
Non-communicable diseases: e.g. hypertension, diabetes, stroke and cardiovascular disorders.
Section 4
Project HIA
Table 5 Identifying the drivers of ecosystem change likely to be associated with the project
ECOSYSTEM SERVICE ENVIRONMENTAL

ECOSYSTEM DRIVER CATEGORIES HEALTH AREAS
CHANGE EXAMPLE IMPACTED IMPACTED
Change in local Changes in wildlife migration patterns Provisioning, regulating, Food and nutrition issues,
land use and cover and habitat use, land availability for cultural, supporting VRDs, zoonotic disease,
hunting, and/or agriculture, disease accident and injury,
vector and host/reservoir habit, cultural health practices
availability of medicinal plants,
culturally significant locations for
traditional healing practices
Harvest and Changes in availability of subsistence Provisioning, regulating, Food and nutrition issues,
resources fish and wildlife species, water cultural, supporting water and sanitation
consumption availability (WATSAN) diseases
Pollution Changes in water quality, water Provisioning, regulating, Exposure to potential

resources pattern cultural, supporting hazardous materials, food
and nutrition issues,
WATSAN diseases
Introduction of Changes in wildlife migration pattern Provisioning, regulating, Food and nutrition issues,
invasive species and habitat use, land availability for supporting VRDs, zoonotic disease,
hunting and/or agriculture, disease accident and injury,
vector and host/reservoir habit, cultural health practices
availability of medicinal plants, etc.
Demographic In-migration, resettlement Provision, regulating Housing and respiratory

change issues, WATSAN diseases.
food and nutrition issues
Economic Decreased dependency on water Regulating Accidents and injuries.

changes purification and waste treatment, soil VRDs, zoonotic diseases,
quality and diseases regulation, and WATSAN diseases
harvest and resources ecosystem
services
Socio-political, Decreased use of medicinal plants, Provisioning, cultural Cultural health practices
cultural, religious traditional healing practices
change
Scientific and Decreased dependence on water Provisioning, regulating WATSAN diseases, STIs,
technological purification and waste treatment, soil food and nutrition issues
change quality and diseases regulation,
ecosystem services, increased
efficiency of agriculture practices
Section 4
Project HIA
Considering the availability of health KPIs Assessing potential partners

During scoping, the need for monitoring and The impact assessment team should evaluate potential
evaluation (M&E) of potential health impacts should be host country health partners who could be involved
considered. This can potentially help to identify high- with the assessment process. Ministry of Health
priority health impacts specifically related to the authorities will almost always be involved as well as
project. These impacts will need to be considered health officials at the village, district, provincial, regional
within the context of available baseline data and future and national levels. Each entity has unique information
monitoring. For example, scoping may identify that about the project, the local environment, and cultural
increases in road traffic accidents and injuries might and traditional practices important for completing the
have a potential impact due to increased project- HIA and other assessments.
related vehicular traffic. Understanding the baseline
level of traffic (e.g. vehicle counts, etc.) including the
Step 3: Baseline data collection and reporting
current level of accidents and injuries becomes an
important piece of baseline data. Future monitoring Collecting and reporting baseline data is a critical
may follow the subsequent changes in underlying road analytical task for the HIA. The scoping analysis and use
traffic volume including accident and injury rates. The of the systematic methodology, such as EHA
number of road traffic accidents per vehicle kilometre framework, should help to guide and inform the data
travelled is an example of a key performance indicator. collection process. Initially, a large amount of data can
be collected using published sources, e.g. peer-reviewed
KPIs are used to evaluate impacts throughout scientific papers, ‘grey literature’ produced by the host
construction and operations. KPIs should be measurable country Ministry of Health, etc. Stakeholder input and
and, ideally, easy to monitor on a regular basis. Most local knowledge are critical, and should be obtained and
companies rely on the Global Reporting Initiative1 to coordinated with the ESHIA team (Table 6).
develop their annual sustainability reports and their
Communication on Progress (COP) for the UN Global The baseline literature review is likely to reveal whether
Compact2. An experienced HIA team will use the there are key data gaps that should be addressed
scoping period to consider which KPIs are appropriate through the collection of baseline field data (e.g.
for future monitoring in a manner consistent with the anthropometric and disease-specific (e.g. malaria
company’s already-existing commitments and reporting prevalence) surveys. The data collection efforts should
mechanisms. match the complexity and practical needs of the HIA,
and should not be allowed to devolve into an academic
exercise, i.e. the field effort should be ‘fit for purpose.’ It
Table 6 Steps for baseline data collection
1. Systematic literature review (e.g. by environmental health area)

2. Evaluation of existing country survey and research data
l Data validation
l Statistical analysis
3. Evaluation of data from key stakeholders; traditional and local knowledge

4. Evaluation of health data from existing project workers
1 Global Reporting Initiative (GRI): www.globalreporting.org

2 UN Global Compact: www.unglobalcompact.org
Section 4
Project HIA
is important to always think about why data needs to be The overall data establishes the baseline from which
collected, how it is relevant to the project, and how it estimated and actual project impacts on the community
relates to the overall final analysis of a project. can be measured. Interdependencies with other project
functions exist and may provide critical sources of
Before new data are collected, a series of relevant study baseline health data, e.g. hydrogeology, traffic and influx
questions should be carefully formulated. Data should studies. Interdependencies across the impact
be collected in a culturally sensitive and ethical manner assessment disciplines are quite common. Appendix 1
with a clear understanding of how it will be utilized in identifies these interdependencies as a function of EHA.
the HIA (for example in impact clarification or Table 7 (below) illustrates some of the standard baseline
characterization, or for baseline definition for data that are typically collected across environmental,
subsequent monitoring activities). Formal ethical review social and health disciplines.
and/or Institutional Review Board (IRB) approval from
the host country Ministry of Health is typically required Health status indicators
before fieldwork can begin. Once health statistics are collected, careful attention
should be given to what the statistics actually represent.
There are a wide variety of evidence and data collection There is often confusion regarding key public health
methods that can be selectively employed, including: terminology and definitions, e.g. incidence versus
l focused stakeholder interviews and discussions; prevalence rates. For example, incidence and prevalence
l key informant questionnaires and surveys of
rates are two commonly used measures of disease
frequency. A disease incidence rate refers to the rate at
knowledge, attitudes, beliefs and practices;
which new cases of disease occur in a population
l objective health screening surveys for certain
during a specified time period, whereas a disease
diseases or conditions, e.g. malaria, micronutritional prevalence rate refers to the proportion of the
deficiencies and disease-specific surveys including population that has the disease at a given point in time
consideration of seasonality (e.g. wet versus dry) as or over a specified time period. Appendix 5 presents a
this can be a critical confounding problem; brief glossary of important public health terminology.
l health needs assessment;
l demographic and health surveys; and
l food consumption and nutrition surveys.
Table 7 Some of the standard baseline data that are typically collected across environmental, social and health disciplines
Source: eni E&P Standard Doc. No. 1.3.1.47, Environmental, Social and Health Impact Assessment, 2010
ENVIRONMENTAL SOCIAL HEALTH

l Atmosphere l History and culture l National health concern
l Water l Demography and social determinants l Burden of diseases
l Soil and subsoil l Gender issues l Morbidity, mortality and disability
l Oceans, seas and coasts l Welfare l Community health determinants
(risk factors)
l Biodiversity l Facilities
l Responsiveness of public health systems
l Services l Political and institutional framework
l Responsiveness of private health
l Waste l Transparency and corruption
providers/traditional healers
l Energy l National and local economy
l Cooperation
l Human rights
Section 4
Project HIA
Health statistics should be analysed and presented in a

way that describes community health status in context.
Comparative analysis evaluates data on affected
communities relative to reference communities and
regional and national statistics. Trends analysis consists
of quantitative presentation of health indicators over
time (including graphical presentations), as well as
discussion of potential causes that may have influenced
the trends seen in the data (for example, a significant
change in a disease rate may be caused by a change in
case definitions, changes in healthcare access, changes
in surveillance/collection/reporting system, etc.).
Data quality and relevance will be an important

consideration in the health baseline assessment. Not only
is it important to have accurate and valid information to
correctly characterize the current situation of the area, it
is also critical for subsequent assessments that the
information is well specified and clearly defined.
Potential data quality problems may include: inaccurate Direct human health hazards from oil and gas
or incomplete information; definitional problems; rate or development projects may be related to the potential
ratio calculations that differ from international contamination of environmental media, e.g. air, water,
standards; poorly documented information sources; soil and biota, and subsequent human contact with
disease classification errors; definitional changes of those media. Establishing direct links between
disease classification; and biases in the system that environmental exposures and human health outcomes
might lead to over- or under-classification of certain is often very problematic for a number of reasons. For
diseases. When collecting data, the assessor should example, there are often long latencies between
evaluate the quality of data. For example, any unusual environmental exposures and disease (such as cancer).
aspects of the data should be noted (e.g. extreme Instead, environmental health indicators, i.e. direct
variation by month in the recorded numbers of deaths measures of environmental determinants of health, are
or births). The assessor should also collect information often used to assess the status of environmental health
about the data sources and collection methods as part factors.
of the quality evaluation.
Social factors
Environmental factors There is an extremely important set of baseline
Although the main focus of the health baseline is to household level social data that is strongly tied to health
describe health status, it is important to identify performance, e.g. income, consumption expenditure,
environmental factors that influence the exposure of costs of housing, food, fuel and household educational
communities and potentially vulnerable subpopulations attainment, etc. Household and community-level
to health hazards/issues. Current hazardous demography, e.g. household size, age pyramids and
environmental health factors should be identified, along structure, number of living/sleeping rooms, occupation,
with other factors that are likely to be associated with education, etc. is utilized by both social and health
future project stages. Most oil and gas projects have impact assessors. The HIA team should collaborate and
distinct phases, i.e. front-end engineering design (FEED), align with the social team in order to efficiently review
early works construction, major construction, operations and understand key baseline social data and avoid
and decommissioning. Potential hazards and exposures duplicate data collection.
are unlikely to be static and are likely to change over
the different project phases.
Section 4
Project HIA
Health system: infrastructure, human resources, Interpreting baseline data and reporting
programmes and policies Merely reporting factual baseline information is rarely
As part of the health baseline assessment, the local enough to allow impacts to be assessed and decisions
health support systems, agencies, supply chains to be made. The meaning of what has been observed
(especially for medications) and infrastructure are and measured should also be interpreted. For example,
considered. An assessment of the healthcare delivery clinical diagnoses of malaria should be interpreted
system is critical, and requires more than just cautiously, as experienced and peer-reviewed studies
performing a physical facility review and equipment have clearly demonstrated that malaria prevalence can
inventory. In a developing country context, experience be grossly overestimated in the absence of objective
indicates that carefully reviewing local staffing levels and testing. Interpretation provides a bridge between factual
qualifications is essential. Knowledgeable and baseline data and being able to assess the significance
experienced health professionals should perform this of impacts.
ground-truthing assessment. Example questions
assessing a community’s current health system capacity The baseline ‘chapter’ is an integral part of the HIA and
might include: is often the longest and most time-consuming section
l Are health services in line with national to prepare and write. In some instances, the baseline
policies/programmes and accessible to the various data collection exercise may result in development of a
population groups in a community? separate stand-alone report that is issued by the
project. In reporting the baseline, it is essential to
l Do healthcare diagnostic facilities exist? If so, are
identify critical data gaps in knowledge or areas of
they functional and quality controlled?
uncertainty. Certain data gaps may need to be
l Do healthcare centres have safe water supplies,
addressed by additional studies or as part of the
functional equipment, and effective waste implementation of the HIA findings.
management systems?
l Are there adequate supplies of essential drugs? Are
Step 4: Impact assessment
stock-outs common?
l Are health statistics routinely collected and shared After screening, scoping and baseline analysis, the HIA
between local and regional health facilities and team should rate and rank the potential health impacts,
agencies? their relative importance and at what level they are
l Are diagnoses (e.g. using rapid diagnostic testing kits)
expected to occur (Table 8). Impacts can occur singly or
subject to laboratory confirmation? in combination at various levels, i.e. individual, household,
community/village, regional and national. The
l Which governmental bodies have jurisdiction over
assessment needs to consider the advantages and
water supply, sanitation, etc. and what bodies have disadvantages of concentrating on one level versus
control over regulatory requirements?
Table 8: Impact assessment
1. Detailed description
l Use of map to brainstorm to identify risks
2. Assess impact significance l Extent

Impact l Perception of risks by potential affected communities
l Nature—direct, indirect or cumulative
l Magnitude
assessment
l Timing and duration l Frequency
3. Risk ranking
l Severity
l Probability
Section 4
Project HIA
another. It may be difficult to develop the database l Indirect—caused by an action and occurring later
necessary to assess all levels or key units simultaneously. in time or farther removed in distance, but still
Clearly defining the unit of assessment is critical since it reasonably foreseeable
can help to focus studies and concentrate resources as Indirect effects can be of equal or greater
well as facilitate understanding of the linkages that exist significance than the more observable direct
between the different levels. impacts that are related to accidents, injuries or
sudden releases of potentially hazardous
As part of the impact assessment process it is important materials. Indirect effects can include increases in
to consider the strength of cause-and-effect relationships community rates of certain communicable
and to assess, either qualitatively or semi-quantitatively, diseases that are associated with significant
the likelihood of potential impacts. One of the benefits of project-induced in-migration into local
the process is that it can facilitate the ranking of impacts communities by job seekers. In this situation, the
so that they can be addressed in a priority fashion. Many presence of a large project can lead to
companies perform an ‘assessment’ of the defined construction job seekers and service workers
impacts using a severity (consequence)–probability moving into local communities, which can
(likelihood) matrix. The definitions of severity and significantly alter the spread and transmission of
probability are company specific. If the health impact many diseases like influenza and sexually
rating process employs the same internal company transmitted infections (STIs).
system utilized for environmental and social, critical
l Cumulative—caused by an incremental impact of
internal and external stakeholders can evaluate the full
suite of impacts within a uniform framework. an action when added to other past, present and
reasonably foreseeable future actions. Impacts
In general, impacts exist in two broad categories: may be minor but collectively significant over a
(i) those that are within a project span of direct control period of time.
and are therefore amenable to technical (engineering) Cumulative effects analysis is complex and
and managerial control by a project; and (ii) those that often difficult to perform because the effects:
are external to immediate project control and often i. may arise on a human receptor at any scale;
require (a) actions by contractors and subcontractors ii. are triggered by multiple causes, e.g. interaction
and/or (b) host government involvement and of multiple health issues on one receptor
participation. For example, a project is directly (individual); and
responsible for worker activity on-site; however, when
iii. are generated by multiple impact pathways,
workers are off duty and away from the site, a project
e.g. air quality impacts attributable to multiple
has little or no control over personal behaviours. While
projects such that overall levels of individual
this manageability is considered within the risk
pollutants increase incrementally, with
dimension analysis, it is more crucial in the
subsequent changes in disease outcomes such
development of mitigation roles and responsibilities.
as asthma. Hence, the cumulative effects of an
activity/intervention may be either:
Dimensions of health impacts
Each potential health impact has several different (a) additive—incremental accumulation; or
dimensions, and most companies have defined the (b) synergistic—produced by the interaction or
dimensions relevant for them. These might include: combination of effects in the past, present and
reasonably foreseeable future.
l Nature: direct, indirect or cumulative, defined as:
l Timing and duration: when (in the project phase),
l Direct—caused by an action and occurring at the
i.e. construction, operations, decommissioning; and
same time and place. how long, i.e. days, weeks, months, years, etc.
A direct effect demonstrates a specific cause-
l Frequency: the overall rate of occurrence within the
and-effect relationship. For example, the presence
defined time duration.
of a project vehicle that subsequently has an
accident on a roadway in a local community l Extent: localities most likely to experience the
would be a direct cause-and-effect situation. projected impact (local, parish, regional).
Section 4
Project HIA
l Magnitude: intensity, particularly with regard to The impact assessment process rates and ranks
existing baseline conditions. potential project impacts. HIAs typically use a standard
l Significance: perception of risks by a potentially impact assessment methodology that includes:
affected community. l identification of potential health impacts;
l Manageability or ability to influence risk l description of the issue and impact;

responses (‘proactive’ or ‘reactive’): l risk analysis of the defined impacts, which considers
l High—within the control of the project the importance of potential health impacts based on
management team. Can control probability or a severity (consequence) and probability (likelihood)
impact (or both). risk matrix; and
l Medium—within the influence of the project l impact ranking, which can be performed using a
management team. Can influence probability or severity–probability matrix.

impact (or both).
l Low—outside the influence of the project While a ‘limitless’ number of potential impacts, positive
management team. Can only influence impact. and/or negative, can be imagined, experience indicates
that defining a realistic set of impacts based on a pre-
defined systematic framework such as EHAs is likely to
capture the most important impact issues. Table 9
illustrates a generic set of potential impacts by EHA.
Table 9 An illustrative example of potential impacts by EHA
ENVIRONMENTAL HEALTH AREA AND ASSOCIATED IMPACTS

Vector-related disease—malaria, leishmaniasis and ectoparasites, etc.
l Although incidence of malaria is currently low, 80% of the country’s territory is receptive to infection. Active infections are
currently reported in 23 districts of the country. Third-country national (TCN) imported malaria is a concern without
rigorous screening for TCN workforce entering the country.
l Leishmaniasis, Yersinia pestis and tularemia are endemic in the country, with most cases occurring in rural areas. Project
alteration of host habitat could impact the ecology of these diseases and thus transmission to humans.
l Scabies, a contagious skin rash caused by mites, is common in children in the country but outbreaks are also common
among adults in institutional/camp settings.
Housing and respiratory issues—acute respiratory infections (ARI) (bacterial and viral), pneumonias, tuberculosis;
respiratory effects from housing, overcrowding, housing inflation
l There will be a large rotating national workforce housed in project camps across the country; communicable respiratory
diseases are a significant concern; these include tuberculosis (TB), influenza and acute upper and lower respiratory
infections. The country has a high burden of TB including MDR-TB so this disease is of particular concern.
Zoonotic diseases—animal to human disease transmission; potential disease distributions secondary to changes in
animal migration patterns due to project-related activities or infrastructure, emerging infectious diseases
(See Appendix 2)
l Ebola, brucellosis, anthrax, rabies, echinococcus, and foot-and-mouth disease all occur within the project area.
Sexually transmitted infections—HIV/AIDS, syphilis, gonorrhoea, chlamydia, hepatitis B

l The project camps will be open allowing interaction with the local population.
l Long-haul truck drivers transporting materials/goods to the project camps from major cities are a potential concern.
l HIV transmission is currently on the rise in the country.
Continued …
Section 4
Project HIA
Table 9 Examples of potential impacts by EHA (continued)
ENVIRONMENTAL HEALTH AREA AND ASSOCIATED IMPACTS

Soil, water, sanitation and waste-related diseases—e.g. giardia, hook and pin worms, etc.
l WATSAN diseases are likely to be high among PICs as sewage and waste disposal infrastructure utilities are lacking.
l Abstraction of surface and/or groundwater could adversely impact water availability in PICs.
l Surface water impacts are possible in the event of a spill.
Food and nutrition related issues—changes in subsistence practices; stunting, wasting, anaemia, micro-nutrient
diseases (including folate, vitamin A, iron, and iodine), gastroenteritis (bacterial and viral); food inflation
l If large quantities of food are procured from any of the PICs, food price inflation may occur.
Accidents/injuries—road traffic related spills and releases

l The project will operate vehicles that have the potential to interact with and potentially impact inhabitants of the PICs, i.e.
road traffic accidents, releases/spills.
l The project will create numerous excavations and trenches that may pose a risk to community safety.
Exposure to potentially hazardous materials—road dusts, air pollution (indoor and outdoor related to industrial activity,
vehicles, cooking, heating or other forms of combustion/incineration), landfill refuse or incineration ash, any other
project-related solvents, paints, oils or cleaning agents and by-products
l The project is a potential incremental additional source of road dust.
l The project is a potential incremental additional source of noise.
l Project activities could result in leaks, spills or other releases of potentially hazardous materials.
Social determinants of health (SDH)—psychosocial, resettlement/relocation, violence and security concerns, substance
misuse (drug, alcohol, smoking), depression and changes to social cohesion
l The project will employ local area residents bringing increased wages and concomitant social issues.
l Tensions may arise over who is (or is perceived to be) benefitting more or less from the project.
Cultural health practices—the role of traditional medical providers, indigenous medicines and attitudes and beliefs
regarding health-enhancing and health-lowering practices
l The project will occur in an area endemic to medicinal plants of cultural importance.
l Certain cultural beliefs are likely to have an impact on the management of disease outbreaks.
Health services infrastructure and capacity—physical infrastructure, staffing levels and competencies, technical
capabilities of healthcare facilities
l A casualty event in the PICs related to project activities (e.g. road traffic, local accidents, the release of significant potentially
hazardous materials) could require local community response and interaction.
Programme management delivery systems—coordination and alignment of the project with existing national and
provincial level health programmes (e.g. TB, HIV/AIDS, non-communicable diseases (NCDs) such as diabetes and
hypertension), and future development plans
l The project has a positive opportunity to coordinate and contribute to ongoing health programmes.
Non-communicable diseases—hypertension, diabetes, stroke and cardiovascular disorders

l Indirect effects, i.e. individual changes in lifestyle and behaviours (diet, smoking, exercise, etc.) are likely with increased
income.
l A shift to NCDs is already under way in the country and is likely to increase with higher wages and rising standards of living.
Section 4
Project HIA
Risk assessment paradigm l Step 1—Hazard identification: examines whether a

Health regulatory agencies throughout the world have stressor has the potential to cause harm to humans
agreed on a conceptual framework and methodology and/or ecological systems, and if so, under what
for performing quantitative risk assessment. For HIA circumstances.
utilization, the risk assessment paradigm could be used l Step 2—Dose-response assessment: examines the
prospectively as a way to quantitatively assess the numerical relationship between exposure and
potential project, using the EHA ‘Potential Exposure to effects.
Hazardous Materials’, i.e. specific emissions such as fine
l Step 3—Exposure assessment: examines what is
particulate matter or volatile organics during
known about the frequency, timing, and levels of
construction and operations. The US Environmental
contact with a stressor.
Protection Agency (US EPA) has significantly expanded
the science and application of quantitative risk l Step 4—Risk characterization: examines how well
assessment over the past three decades, and has the data support conclusions about the nature and
established methodology and terminology that is extent of the risk from exposure to environmental
utilized globally. Human health risk assessment includes stressors.
four basic steps:
These steps are illustrated in Figure 5.
Hazard identification Dose-response assessment

What health problems are What are the health problems
caused by the pollutant? at different exposures?
Risk characterization
What is the extra risk of health
problems in the exposed
population?
Exposure assessment
How much of the pollutant
are people exposed to during
Figure 5
a specific time period?
The risk assessment process
How many people are
Source: US EPA (2015a):
www.epa.gov/risk/conducting-human-health-risk- exposed?
assessment#tab-2
Section 4
Project HIA
Figure 6
Risk assessment/risk management paradigm
Source: US EPA (2015b):
www2.epa.gov/fera/nrc-risk-assessment-paradigm
Risk assessment Risk management
Dose-response Control Legal

assessment options considerations
Hazard Risk Risk management

identification characterization decisions
Exposure
assessment Other economic
and social factors
As shown in Figure 6, the risk assessment methodology The application of innovative genomic technologies to
differs from risk management. Risk assessment provides toxicology has ushered in a new field known as
information on potential health or ecological risks, and ‘toxicogenomics’ where genotypes and toxicant-induced
risk management is the action taken based on genome expression, protein, and metabolite patterns
consideration of that and other information. can be used to: screen compounds for hazard
identification; monitor individuals’ exposure to toxicants;
New developments in toxicology track cellular responses to different doses; assess
New strategies and testing technologies have emerged mechanisms of action; and predict individual variability
for evaluating the hazards or risks associated with in sensitivity to toxicants. The proposed applications of
exposure to industrial and other chemicals. These toxicogenomics include: hazard screening; the study of
developments in toxicology will potentially have a toxicologic mechanisms of action; exposure assessment;
profound effect on the future practice of HIA. The US and characterizing variability in susceptibility.
National Research Council has published three Toxicogenomic technologies have the potential to affect
significant monographs on: Human Biomonitoring for decision making for both risk assessment and
Environmental Chemicals (NRC, 2006; Toxicity Testing in regulatory toxicology. Hence, it is inevitable that these
the 21st Century: A Vision and a Strategy (NRC, 2007a); newer technologies, particularly those related to
and Applications of Toxicogenomic Technologies to biomonitoring and biomarker surveys for community
Predictive Toxicology and Risk Assessment populations, will eventually be adopted by HIA
(NRC, 2007b). As the testing technology becomes practitioners.
cheaper, more portable and increasingly available, the
strategies for performing baseline community health
evaluations are likely to change profoundly.
Section 4
Project HIA
Figure 7 Process to develop management plans
Mitigation and Reassess

Predict Evaluate
enhancement impacts
impacts impacts
planning (as needed)
What could happen as Is it important? What can be done Do mitigations and

a consequence of what about it? enhancements
is proposed? address the impact?
Step 5: Mitigation and enhancement

Mitigations are measures that aim to avoid, minimize, l Engage local stakeholders. Stakeholders may identify
eliminate or remedy an adverse effect, or maximize a special community concerns and additional areas of
potential benefit. The project can use the outcomes of mitigation for the project team that ensure planned
the impact assessment step to: (1) prioritize the health mitigations will work for a particular community and
impacts for which mitigations will be developed; and local culture. In addition, local stakeholders can
(2) identify opportunities for enhancing health benefits. assist in developing additional and/or different
The process to develop mitigation measures, as shown measures that may be required to reach vulnerable
in Figure 7, should include a reassessment component groups (e.g. women and children or a
to ensure that the mitigation measures selected are disenfranchised ethnicity).
effective. Even companies that have a strong reputation
can risk losing their credibility when they fail to put Use of a multi-disciplinary team that includes both
systematic approaches in place to ensure effective subject matter experts, as well as stakeholders,
implementation of mitigation measures to prevent or facilitates consideration of a wider variety of mitigation
reduce health impacts and enhance positive impacts strategies than those solely related to health. For
associated with the project. example, for road transportation and infrastructure
impacts, health expertise is important (e.g. drug and
In developing mitigation and enhancement measures alcohol policy development), but traffic experts,
based on the identified impacts, the following construction managers and engineers, and local
framework is recommended: community members can all contribute to the design of
l Assess the regulatory requirements of the local
mitigation strategies.
jurisdiction and ensure measures meet local
regulations. Mitigation strategies are typically organized around
anticipating, recognizing and evaluating impacts.
l Evaluate options for design changes/engineering
Implementation plans focus on control strategies such
controls. This allows identification of opportunities to
as prevention, elimination and minimization.
prevent or reduce the impact. Elimination and
minimization strategies are more likely to be
Another important consideration when developing
successfully implemented, particularly where local
mitigation measures is to distinguish between
capacity is weak.
regulatory mitigations enforced by law (e.g.
l If the impact cannot be avoided, develop measures contaminants of concern, the transport of hazardous
via design changes/engineering controls. This materials) and negotiated or voluntary mitigations. Many
should be done in an interdisciplinary fashion with proponents have internal corporate policies that
environment, health, safety and social experts to prioritize attentiveness to negotiated or voluntary
address the remaining effects. mitigations. Listing of voluntary controls is a way to fully
Section 4
Project HIA
communicate a commitment to mitigate health Implementation—health management/action plan

impacts. After measures are developed for each impact, a health
management plan (HMP) is created that presents the
Mitigation should be designed to be specifically linked rationale for the selected mitigation strategies and the
to an impact. In most cases it should be clear that detailed methodology on how the mitigation strategies
mitigations aim to address a project impact, rather than will be implemented (Table 10). It is crucial that the
to simply improve social conditions among health management plan be integrated into the over-all
communities. management plan for the project to ensure health
mitigations are part of the entire project’s management
Nevertheless, the HIA team is in a unique position to system.
help proponents consider appropriate ways to improve
the local communities where they operate if the project The HMP includes:
wishes to make these types of investments. It is possible l the types of mitigations selected, including specific
to design a mitigation strategy that not only addresses and clear actions and approaches necessary to
the project impact but goes above and beyond the implement them, and timescales for implementation;
reduction of negative effects and creates a health
l roles and responsibilities of people/organizations
benefit for the community. While not always present or
responsible for all the actions planned;
strategically feasible, opportunities sometimes arise to
l identification of additional support and resources
use the information gathered as part of the HIA, and to
specifically use mitigation measures to generate health from external organizations that may be necessary
benefits. This work should be coordinated between to implement the action (i.e. construction contractor,
social investment specialists within the company and health institutions, local community organizations
the HIA team, as well as with other key project etc);
personnel. Input on mitigation and enhancement l methods that will be used for documenting,
measures from affected and other key stakeholders is monitoring and reporting on the selected
critical to developing practical measures that are locally mitigations/actions;
implementable. When engaging stakeholders on this l schedule for periodic review and update of the plan
topic it is important to clearly set out the expectation, (usually on an annual basis);
ahead of time, that not all suggested measures may be l a process for change management; and
adopted by the company; this can help to avoid adverse
l the cost of implementing the plan.
community reaction if not all of the mitigation measures
discussed with stakeholders are implemented.
Defining responsibilities is one of the most critical
As with Step 3 (Baseline data collection and reporting) a aspects of the HMP. The division of responsibilities
separate analysis of the mitigation requirement for each between the project, construction contractor and the
project phase is necessary to ensure that appropriate host government at local, regional and even national
mitigation measures are allocated to all impacts across levels is crucial. Specific and detailed division of
the various project phases. responsibilities should be considered and articulated. An
analysis of local, regional and national health
Table 10 Health management plan (HMP)
HEALTH ACTION PLAN MITIGATION APPROACH

l Action
Addressing
l Resource flows and responsibilities
identified
impacts l Timing (construction, operations, decommissioning)
l Collaborating organizations, if applicable
Section 4
Project HIA
infrastructure and management capacity is a key l use appropriate units for measuring change;
consideration during both the development of l be able to distinguish between inputs, outputs and
mitigation strategies and the HMP, as well as during the outcomes;
process of identifying mitigations that other parties
l measure effectiveness and efficiency; and
(outside the project) will be implementing. If there are
systematic weaknesses in the host country health l assess both qualitative and quantitative dimensions
systems, capacity considerations will become one of the of change.
most important issues. Capacity building is a long and
slow process. Close coordination and training of host
resources require long-term planning and commitment. Table 11 Monitoring and evaluation
The absorptive capacity of host institutions, at all levels,
is often the limiting factor for successful 1. Define key performance
implementation of the mitigation strategy. Indicators (KPIs)
Monitoring and 2. Determine the approach to
The assignment of responsibility includes project evaluation data collection
contractors, since day-to-day responsibility is often l Implement
devolved to prime contractors, particularly during the l Evaluate
construction phase of project. Contractor responsibilities
can be assigned by requesting specific and detailed
health implementation plans from each major
contractor or developing these with them depending on
their capacity and level of expertise in this area. These Key performance indicators
types of issues need to be anticipated early in the Effective management, monitoring and evaluation rely
project so that the proper contract requirements can be on the development of appropriate KPIs, which can be
developed and unplanned budget overruns can be defined once clear goals and objectives have been
avoided. Defining staffing levels also requires careful identified in the health action plan (HAP). Understanding
consideration since projects frequently underestimate and being able to distinguish between input, output and
the time and staffing levels required for implementation outcome indicators is a critical step toward identifying
and monitoring. the appropriate KPIs.
For a programme or project to achieve its goals, inputs

Step 6: Monitoring and evaluation
and processes, such as drugs, information materials,
The goal of monitoring and evaluation for the HMP is to training or staff time, etc. need to result in outputs, such
ensure that the mitigation strategies selected have been as the number of people reached by a particular service.
(1) implemented and (2) are effective at addressing the If these outputs are well designed and reach the
impact they were designed to mitigate. Monitoring can populations for whom they were intended, the
be thought of as an ongoing, methodical collection of programme or project is likely to have positive short-
data that provides early indication of progress toward term effects or outcomes, such as increased condom
achieving the desired goal. Evaluation, on the other use with casual partners, increased use of bednets, or
hand, is conducted periodically (often annually) and adherence to TB drugs. These positive short-term
focuses primarily on measuring long-term results and outcomes should lead to changes in the longer-term
the overall effectiveness of the actions implemented. impact of programmes, such as fewer new cases of HIV,
TB or malaria.
Effective management, monitoring, and evaluation
depend on the identification of key performance A visual representation of the different types of
indicators (KPIs). Effective performance measurement indicators is provided in Figure 8 on page 42. The
needs to: framework builds upon general principles on aid
harmonization and effectiveness as well as the IFC
guidance on strategic community investment
(IFC, 2010). As such it is consistent with the M&E
Section 4
Project HIA
Figure 8: Hierarchy of Indicators

Sources: SOS International, 2012 and WHO, 2010
INPUT AND PROCESSES OUTPUTS OUTCOMES IMPACT
l Financing
Indicator domains
l Health workforce
l Coverage of
l Training
l Services delivered interventions l Improved health
l Supply chain outcomes
l Information l People reached l Behaviour
change
l Medicines and
commodities
frameworks of all potential partners involved in the l be measurable;

health management/implementation plan, and enables l measure impacts on the community;
the tracking of both positive as well as negative impacts.
l detect both acute and chronic changes within
potentially affected communities (PACs)—acute
A combination of input, output and outcomes indicators
changes appear within weeks to months, such as
is often useful to monitor progress as well as to
acute disease-rate changes for respiratory infection;
measure the overall effectiveness of the HAP. Impact
chronic non-communicable disease-rate changes for
and outcomes are more powerful indicators because
diabetes or cardiovascular disorders evolve over a
they show not only that money is invested (staff hired)
much longer period of time; a well-selected set of
and properly used (mosquito nets distributed), but that
KPIs will detect both acute and chronic changes in
it is also making a real difference (the number of malaria
health status;
cases has gone down). However, obtaining data for
these indicators can be cumbersome. It can also be l be clearly linked to the project (monitoring and
difficult to determine the causal relationship of the evaluating community health changes unrelated
‘impact’ indicators. An ad-hoc approach to data to a project is important, but beyond the scope
collection can be influenced by a range of factors and of the HIA);
will require detailed analysis of the collected data. l capture both positive and negative health impacts
Careful consideration is therefore necessary when (for example, the alleviation of poverty will produce
choosing the appropriate outcome indicators, and both positive and/or negative changes across many
where health outcome indicators are chosen this is best health outcomes); and
done in coordination with, and/or relying on, data from l be drawn from existing host country health
government health surveillance systems. Where such information systems, where feasible.
data is not appropriate or available, or where the use of
certain health outcome indicators is too costly, proxy Appendix 4 presents a case study of a comprehensive
measures may also be used. monitoring programme developed by ExxonMobil PNG
for the Papua New Guinea (PNG) Liquid Natural Gas
Once the various input, output and outcome indicators (LNG) Project.
have been developed based on the goals of the HMP, it
is often useful to refine and test the chosen indicators Evaluation and verification
to make sure that they will be useful and can be Evaluation and verification of the effectiveness of the
feasibly implemented. From a practical perspective, the HMP and the selected KPIs is a critical and often
selected indicators should: overlooked step in the HIA process. The HIA team
should plan an evaluation and verification process at
least on an annual basis to review and update
management actions as well as to update the KPIs
selected to ensure a continual improvement process.
Section 4
Project HIA
This verification process is critical considering that, as STAKEHOLDER COMMUNICATION AND

the project activities change throughout each phase, CONSULTATION
new impacts will emerge; mitigation and KPIs will
Effective stakeholder engagement (Table 12) is an
therefore need to be continually updated.
essential component of an HIA. Stakeholders are
persons or groups, both internal and external to the
For most projects, it is unrealistic to begin the
project, who are affected by the project. Stakeholders
evaluation and verification process before the project
will have varying degrees of interest in a project and/or
has collected at least 6–12 months’ worth of
ability to influence its outcome. Stakeholders may
information. Target milestones are often created, for
include locally-affected communities or individuals, their
example vaccination rates, malaria incidence rates, etc.
formal and informal representatives, national or local
Auditing against these target goals and objectives can
government authorities, politicians, religious leaders, civil
be readily performed. These audits may be conducted
society organizations, special interest groups, the
internally and/or as part of an external and independent
academic community, or third-party businesses. The
auditing process, based on the goals of the project.
term ‘stakeholder’ has broadened over time to include
Audit systems should be integrated with, and not
any interested parties, regardless of their location or
duplicate, other environmental and social verification
their direct contact with the project.
systems.
Involving stakeholder input and participation in

Table 12 Steps for stakeholder engagement
monitoring and evaluation and the development of KPIs
is often a useful approach to add transparency to the
process and ensure that appropriate KPIs are selected, 1. Mapping of Stakeholders
especially when results are being measured based on 2. Transparent process
community perception.
3. Consultation
Stakeholder 4. Response/feedback for public
l A note on evaluation of contractor performance:
engagement comments
It is important to remember to include contractor
performance as a natural extension of project 5. Accountability, including
performance when developing and evaluating the consideration of participatory
HMP, in particular when contractors may be heavily monitoring/verification
l evaluate
involved in generating impacts during construction
and in implementing mitigations per the HMP.
Stakeholder communication has evolved rapidly into a

systematic process that is incorporated into the overall
impact assessment strategy such that an active and
integrated communication process has become an
essential part of conducting a stand-alone HIA or an
integrated ESHIA. The communication process is not
just a one-way exercise of information dissemination; it
includes consultation, active feedback and participation.
Ideally, the optimal timing for initiating a stakeholder
communication programme would be as early as
possible in the overall business project development
cycle. However, such a programme should be carefully
considered and planned in a coordinated and
systematic fashion that is responsive to overall business
objectives and coordinated with the other impact
disciplines, and particularly with the social impact team.
Section 4
Project HIA
The objectives of stakeholder engagement and public Areas of competency necessary for external consultants
participation include: include:
l obtaining public input on the nature of health risks l epidemiology, and a knowledge of diseases endemic
and benefits posed by the project, and possible to the area under consideration;
locally-relevant solutions; l health data analysis;
l ensuring that the analysis of potential impacts l occupational health (including relationships with
proceeds in a publicly transparent and unbiased industrial hygiene and safety);
manner;
l sanitation, including food, water and waste-related
l obtaining information regarding local and traditional issues and diseases;
knowledge, scientific data and other sources of
l public health planning at a community level;
information that may be available to contribute to a
l risk communication;
more complete HIA; and
l experience with infectious diseases such as
l building trust and collaboration between
stakeholders. tuberculosis and respiratory diseases;
l assessment (including modelling), prevention and
The public participation process should be coordinated planning for HIV/AIDS;
so that relevant health issues are integrated into the l knowledge, attitudes, practice, belief surveys;
overall environmental/social process. In general, effort l risk assessment—qualitative and quantitative
should be made to avoid duplicative community modelling and ranking;
meetings as stakeholders can experience ‘consultation
l surveillance system planning;
fatigue’ just as easily as ‘survey fatigue’. Health-specific
key informant and focus group interviews are more l insect and pest control;
likely to be successful if conducted by experienced l management of accidents, injuries and chemical

health professionals with knowledge of social science exposure-related risks;
research skills. In addition, sensitivity should be l assessment of existing health infrastructure
exercised surrounding cultural and health taboos and (systems analysis);
settings, e.g. separating men from women when
l assessment of psychological impacts and possible
discussing certain issues such as gender-based violence,
effects of relocation;
contraception/family planning, STIs, etc. Health sessions
l use of geographic information systems (GIS) for
that target specific groups (e.g. women) should be led
by an experienced and culturally acceptable facilitator. mapping of disease and impact areas; and
l community stakeholder facilitation.
MANAGEMENT AND RESOURCING

Cost and time management
Many companies have sophisticated medical
departments that can easily carry out the initial steps of Costs are largely a function of scope, schedule and final
the HIA process. However, for some projects, some level deliverable report. Clear terms of reference are a key
of specialist consulting support may still be required. In tool for managing both internal and external
addition, external consultants or an independent review consultants’ costs. The adequacy of baseline data is one
process may help to identify gaps or other issues not of the most important considerations. New data
fully considered by an internal team, and enhance collection takes time and money and is often an
validity and transparency. Clear terms of reference iterative process generating frequent travel and per
should be in place for managing the costs of consultants diem costs. In many areas of the world the available
from inside and outside the organization. For some support infrastructure is weak, and survey and health
extremely high-profile projects, the appointment of an data collection can be a difficult and slow process. The
independent advisory board may be appropriate, time required to complete a comprehensive HIA will
particularly where cultural sensitivities may conflict with depend on the scope of the project, availability of
the need to thoroughly assess certain diseases, for adequate baseline data and the complexity of the
example HIV/AIDS. stakeholder engagement and consultation process.
Appendix 1:
Interdependencies
The table in this Appendix, organized by
environmental health areas (EHAs), identifies
key indicators and disciplines that the HIA relies
on for data input.
Table A1 Interdependencies for the HIA (‘X’ indicates the key project discipline that typically collects data to feed into the HIA)
ENVIRONMENTAL KEY PERFORMANCE ENVIRONMENT AND PROJECT

HEALTH AREA DESCRIPTION INDICATORS ECONOMIC SOCIAL TRANSPORTATION PROPONENT HEALTH
Appendix 1
Social Conditions in which people are born, grow, Early childhood development X X
determinants live, work and age. These circumstances are
Interdependencies
of health shaped by the distribution of money, power, Mental health and suicide X X
(SDH) access, and resources at global, national,
Substance abuse/ X X
state, regional and local levels. The SDH are
binge drinking
mostly responsible for health inequities.
Domestic violence X X
Life expectancy X
Economic indicators: X
l household income
l employment status
l job growth projections
l job training opportunities
Tax revenue sharing X

targeting health
Applicant’s fees allocated for X
health mitigation
Educational attainment X X
Household Indicators: X X
l rent or own
l length of time there
l number of rooms
l water/sanitation
l household availability
l household inflation
Land use, parks, recreation, X X

zoning, aesthetics
Schools, locations, enrolment X
Mental health indicators X

Table A1 Interdependencies for the HIA (continued)

Appendix 1
Social School-based health and X X

determinants of social programmes
Interdependencies
health
(continued) Population forecasts X X
Hiring practices and X

work rotations
Transportation impacts X X
Changes in access to business, X

residence, community facilities
Regional impacts X X X
Population size X
Train volumes X
Number of crossings X
Demographic characteristics X X
Accidents and Health outcomes and determinants related Unintentional fatal and X
injuries to accidents and injuries. The key outcomes non-fatal injury rates
considered are increases and decreases in
intentional and unintentional injuries with Intentional fatal and non-fatal X
fatal and non-fatal results. injury rates
The key determinants in this category Road traffic accident rates X X

include items such as the presence of law
Traffic levels (road, air, X X
enforcement, traffic patterns, alcohol
rail, river)
involvement, distance to emergency
services, and the presence of prevention Traffic impacts X X
programmes.
Community alcohol policy X X
Presence of law enforcement X


Appendix 1
Accidents and Community public safety X X

injuries programmes
Interdependencies
(continued)
Anticipated changes in traffic X X
Time to emergency services X X X
Commute times X X
Number of workers/schedule X
for construction/operations
Materials deliveries for X

construction/operations
Exposure to Health outcomes and determinants that Asthma/COPDa prevalence X

potentially may arise from exposure to hazardous and exacerbations
hazardous materials.
materials Cancer rates X
The key health outcomes considered are
increases and decreases in documented Thyroid disorders X
illnesses or exacerbation of illnesses
Developmental delay X X
commonly associated with pollutants of
potential concern. These may be mediated Acute poisonings X
through inhalation, ingestion or physical
contact. Birth defects X
Soil quality/contamination X X
Existing contaminated sites X X
Air quality monitoring/ X X

modelling data (e.g. levels of
fine particulate)
Water quality monitoring data X X
Subsistence food contaminant X X

levels

Appendix 1
Exposure to Human biomonitoring data X

potentially
Interdependencies
hazardous Dust exposure in workers X

materials
Arsenic X X
(continued)
Mercury, lead, etc. X X
Bioaccumulation modelling X X X
(e.g. mercury in fish tissue)
Noise impacts X
Food and This category includes health outcomes and Rate of obesity/overweight X
nutrition determinants related to food security, dietary
choices and the consumption of subsistence Rate of hypercholesterolemia X
foods.
Child nutrition indicators X
The key health outcomes considered are
Diet composition X
nutrient levels, malnutrition or improvements
in nutrient intake, and the subsequent Subsistence food consumption X
increases or decreases in related diseases. The
key determinants include diet composition, Food security and food costs X X
food security and the consumption of
subsistence foods in rural settings. Traditional and local X X
knowledge
Vector-related Health outcomes and determinants that result Pneumonia rates X

diseases; from infectious diseases.
housing and Communicable respiratory X
respiratory; The key health outcomes include rates of diseases
sexually increase or decrease for a range of infectious
diseases, such as vector-borne diseases, STIs, Vector-related diseases, X
transmitted
blood-borne pathogens, respiratory illness or especially malaria
diseases (STIs)
skin infections. Important health determinants
TB infection (latency status) X
may include immunization rates, and the
and active illnesses
presence of infectious disease prevention
efforts, including vector management and STI rates (esp. gonorrhoea, X
control programmes. chlamydia, syphilis)

Appendix 1
Vector-related HIV rates X

diseases;
Interdependencies
housing and Reportable blood-borne X

respiratory; STIs infections
(continued)
Skin infections X
Immunization rates X
Housing costs, inhabitants per X X

household
STI education efforts/practices X
Worker housing plans X X
Worker numbers both locally, X X

regionally and nationally
Project occupational health X X
plan
Diseases Changes to access, quantity and quality of Source of water X

related to soil, water supplies.
water, Water quality—biologics, X
sanitation and Key determinants reviewed may include metals, etc.
waste distance to clean water, presence or
absence of latrines including type, adequate Potential for contamination of X X
volume of water resources. water source
Level of human waste X

management, e.g. latrines, etc.
Level/adequacy of water X
supply
Maintenance of water supply X
Household and community X

waste management

Appendix 1
Non- Health outcomes and determinants related Obesity/BMIb data X

communicable to chronic disease.
Interdependencies
diseases Diabetes rates X

Important outcomes include increases or
decreases in mortality and morbidity rates Cancer deaths by type X
of cancer, cardiovascular and
Cancer rates X
cerebrovascular diseases, diabetes,
respiratory diseases and mental health Most common cancer types X
disorders. Key determinants for chronic
diseases may include smoking rates, rates of Leading causes of X
alcohol and drug abuse, physical activity cardiovascular disease
levels, presence of recreation centres, as mortality
well as cancer screening rates.
% of residents with X
hypertension
% of residents with X
hypercholesterolemia
Heart disease mortality rates X
Rate of COPD (self reported) X
Cerebrovascular disease X
mortality
Chronic lower respiratory X

mortality
Cases of mental health X

disorders
Self-reported diagnoses: X
asthma, CHDc, heart attack,
diabetes, stroke, cancer
Self-reported indicators of X
good mental health

Appendix 1
Non- % of residents who are X

communicable overweight or obese
Interdependencies
diseases
(continued) Physical activity levels, X
recreation
Sweetened beverage X
consumption
Tobacco use X
Exposure to second-hand X
smoke
Drug use X
Health services Considers health outcomes and Medical evacuations X

capacity and determinants related to healthcare access
infrastructure and healthcare infrastructure. Health services X
Important outcomes include the increase or Health facility utilization X
decrease in the number of medical
Health expenditures X
evacuations, clinics or hospital visit trends,
health expenditures, and medication usage. Health staffing patterns X
Health determinants may include distance and capacity
to health facilities, medevac
facilities/aircraft, the presence of Available health services X
community health aides, and the frequency (regional/community-level
of physician visits to the area. assessment of existing health
care and public health services)
Description of emergency X
response system and staffing
Mode of travel to advanced X X

medical facilities; boat,
ambulance, etc.

Appendix 1
Health services Anticipated change in demand X X

capacity and for services (influx of
Interdependencies
infrastructure population; health benefits for

(continued) employees)
Zoonotic Health outcomes related to the New cases of zoonotic X X X

diseases transmission of diseases from animal to diseases
person, particularly related to animal
husbandry at the household and
community level. Changes in land use
including water sources, crop locations, etc.
can also have a significant impact.
This page is intentionally blank
Appendix 2:
Emerging infectious
diseases and the
extractive sector
Appendix 2
Emerging infectious diseases and the extractive sector
WHAT ARE EMERGING INFECTIOUS DISEASES?

Emerging infectious diseases (EIDs) are defined as responsible for Ebola and Marburg, Nipah and rabies
infections that have newly appeared in a population or viruses), rodents (Lassa, hanta and monkeypox viruses)
have existed previously but are rapidly increasing in and non-human primates (yellow fever viruses). As EIDs
incidence or geographic range (Morse, 1995). Between originate from animals, there has been a growing global
1940 and 2004, 335 EIDs have been reported globally, focus on the development of systems that focus on
concentrated in hotspots located mainly in low-latitude surveillance at the animal-human environment interface,
developing countries; these remain a significant threat to lending further support to what is known as the ‘One
global health and the global economy despite attention Health’ approach3. The One Health approach is defined
to their identification, surveillance, epidemiology, as a collaborative effort of multiple disciplines to attain
containment and prevention (Jones et al., 2008). optimal health for people, animals and the environment.
Nearly three-quarters of emerging infectious diseases Disease emergence can result from a number of factors
originate from wildlife. Three wild animal groups, which including genetic, biological, physical, environmental,
comprise approximately 70 percent of mammal species, ecological, social and political changes, as shown in
are considered most likely to spread new infections to Figure A1.
people: bats (coronavirus responsible for SARS; filovirus
Figure A1: Potential pathways

LAND-USE CHANGE associated with disease
Human encroachment, deforestation, habitat fragmentation, biodiversity loss, emergence and re-emergence
ecosystem changes, ecosystem services alteration, urbanization and industrial development Source: adapted from Heyman and Dixon, 2013
FOOD SYSTEM
Intensifying and expanding farming systems, greater livestock density and mixing patterns,
trade network, unregulated/irregular use of drugs and vaccines
EMERGENCE AND
RE-EMERGENCE
HUMAN BEHAVIOUR
Hunting/consumption practices, cultural patterns and processes, travel capabilities,
breakdown of governance, antimicrobial usage patterns
ENVIRONMENTAL SYSTEMS
Climate change, natural disasters, periodic climate oscillations
3 www.onehealthglobal.net/what-is-one-health
Appendix 2
Alterations in land use as a consequence of economic, 14% and 17% of Liberia’s and Sierra Leone’s GDP,
industrial and technological development are risk respectively. A World Bank assessment predicted
factors that are particularly relevant to the extractive shrinking economies for these countries in the second
industry. As a consequence of the industry’s activities, half of 2014, and a forgone income across all three in
these changes result in: increased contact with wildlife 2015 of about $1.6 billion. This is more than 12% of
through encroachment into previously uninhabited their combined GDP. Declining national output has
areas; changes in the distribution and abundance of translated into weaker revenues, while government
wildlife and their associated pathogens; increased spending needs have grown, weakening public finances.
movement of wildlife and livestock; population growth;
and ecosystem change (Morse, 1995; Smolinski et al.,
2003; Patz et al., 2004). THE ROLE OF HIA/EIA IN MANAGING EIDs
The extractive industry, particularly companies working
in previously unexplored areas in tropical latitudes, is
WHY EIDs ARE RELEVANT FOR THE aware that its workforce and surrounding communities
EXTRACTIVE SECTOR are susceptible to a range of adverse health effects
This phenomenon is amplified by the extractive industry exacerbated by its operations. In order to assess and
operating in areas recognized as EID ‘hotspots’. The mitigate these health-related risks, companies
extractive industry’s ability to asses and manage the risk commission HIAs, or EIAs incorporating a health aspect,
of EIDs is therefore crucial to prevent or mitigate the prior to commencing or expanding projects.
occurrence of such an emergence with potentially
global consequences. When these assessments are conducted, many
companies actively mitigate the potential adverse effects
Compared with other health risks such as malaria, EIDs of their operations on wildlife and promote biodiversity,
remain a low-probability but high-impact event in these but do not often consider the potential transmission of
areas. Approximately 2% of all EID events between 1940 zoonotic pathogens5. The USAID 2012 Guidelines for
and 2004 have occurred among workers in the natural Adding Zoonotic Diseases to Health Impact Assessments
resource industry and in their local communities. In provides steps for incorporating emerging infectious
2007, an outbreak of Marburg haemorrhagic fever diseases of zoonotic origin into an HIA.
occurred among miners in Kamwenge and Ibanda
District, Uganda. In 2004 in DRC, outbreaks of The determinants of emergence are risk factors that
pneumonic plague and leptospirosis occurred in a align in such a manner as to modify the equilibrium
miners’ camp. among and between three species: humans, animals,
and the infectious organisms carried by those animals.
Outbreaks of EIDs affect extractive sector operations. In Hence, the EIA/HIA needs to focus on all components
2013–2014 the most widespread outbreak of Ebola of an extractive project that can alter this equilibrium
known today occurred in West Africa. It is likely that this (see Table A2 on page 58).
began with a single human contact with bats in Guinea
in December, 2013; it then expanded in Liberia and
Sierra Leone and was finally declared a Public Health
Emergency of International Concern (PHEIC)4 by WHO in
August 2014. Prior to the outbreak, mining represented
4 Public Health Emergency of International Concern is a procedure introduced by the 2005 revision of the International Health Regulations (IHR).
www.who.int/ihr/9789241596664/en
5 A zoonotic disease is a disease that can be passed between animals and humans. Zoonotic diseases can be caused by viruses, bacteria, parasites and fungi.
These diseases are very common. Scientists estimate that more than 6 out of every 10 infectious diseases in humans are spread from animals.
Information available at www.cdc.gov/onehealth/zoonotic-diseases.html
Appendix 2
Table A2 Typical health impact issues associated with zoonotic disease transmission
Adapted from the USAID Guidelines for Adding Zoonotic Diseases to Health Impact Assessments, 2012
EMERGING INFECTIOUS DISEASE

ISSUES LEADING TO DISEASE
IMPACT ISSUES EFFECT TRANSMISSION RISK
Influx l Increases population l Increases person-to-person contact
(job seekers, family, service
l Stresses community infrastructure l Increases potential for evolution and/or
workers, camp followers)
amplification of disease
l Introduces an immunologically
susceptible immigrant population or l Immunological susceptibility altered
introduce carriers of diseases not
present in the area
Resettlement; relocation l Existing social/community l Increased in person to person contact

structures altered
l Immunological susceptibility altered
l Might shift hunting/gathering
l Increased proximity of animal and human
subsistence population to peri-
interaction
urban settlements
Water management l Insect-breeding habitat created or l Food and water storage containers
(including creation of new modified contaminated by nuisance wildlife and
water bodies, altering existing vectors
l Animal watering areas created or
water bodies, and changes in
modified. l Increases potential for shared use of water
drainage patterns)
between humans and wildlife, with
l Increases stress on or competition
associated contamination
for water resources
Linear features l Increased access to remote l Increases human-wildlife contact

(roadways; transportation undeveloped areas
l Potential consumption of nuisance wildlife
routes; transmission lines)
l Increased bushmeat hunting meat and their fluids
l Modifies existing wildlife habitat
Infrastructure facilities l Attracts nuisance wildlife due to l Increases potential human-wildlife or

(including on-site housing sewage, water and food containers vector contact if buildings are not
catering facilities, housing sufficiently wildlife/vector proofed
l Increases habitat for rodents and
and laundry, sewage
bats
treatment plants (STP),
surface-water run-off control,
dams and containment
facilities)
Habitat fragmentation; l Modifies existing wildlife habitat l Increase human-wildlife contact

edge effect; biodiversity loss
l Wildlife may search for food and
(due to human population
shelter in nearby human
influx, construction of linear
settlements and labour camps
features, and construction of
facilities and labour camps)
Agricultural production l Modifies existing wildlife habitat l Increases human-wildlife contact

(including nuisance wildlife,
l Provides food source for wildlife l Increases wildlife-domestic animal contact
land clearing for agriculture,
and food and waste storage) l Increases potential for wildlife-livestock
disease transmission
Appendix 2
Table A2 highlights critical project components that can The IPC measures implemented by the companies also
alter the pre-project baseline. The USAID guidelines included health programmes to promote worker and
identify appropriate and internationally recognized community health (outside the fence line) for diverse
management measures. Most of the measures are not a problems such as HIV/STIs, malaria, and
direct ‘health action’; close coordination among several water/sanitation and hygiene. Nevertheless, companies
departments and project teams is therefore required were still vulnerable to disease outbreaks originating
and illustrates the interdependency between health and from host communities where the chance of disease
the environmental and social assessments. spread was increased due to weak public health
infrastructure, underdeveloped hygiene/sanitation
systems and low levels of household education.
THE IMPORTANCE OF UNDERSTANDING
‘OUTSIDE THE FENCE LINE’ DETERMINANTS Most international oil and gas producers have either
AND RISK FACTORS general emergency response plans or detailed outbreak
EIDs become a significant health issue when there is a response plans. However these plans are often not
disease breakout, i.e. when existing prevention shared with the national health system, and joint
mechanisms have failed. When dealing with outbreaks, exercises are not carried out. In case of an EID outbreak,
two aspects are usually considered: (i) the modality of the company needs to collaborate with the national
transmission of the disease, and (ii) the severity of the health system and other critical stakeholders in order to
disease and its capacity to kill those infected. maximize the efforts required for response and control.
An early engagement with the national health system
Transmission of EIDs occurs in given set of political, can influence the capacity of surveillance and early
social and economic conditions. This context further detection as well as the development of an integrated
facilitates the control and/or spread of the infection. response plan that includes companies operating in the
However, within these conditions, operating companies country.
have no immediate direct control; hence, ‘manageability’
is a significant concern. From an HIA perspective, the Overall, important components that address EIDs in the
critical ‘conditions’ are external to the project; therefore, HIA/EIA include:
any mitigation measures are likely to require l assessment of land-use change and change in
coordination and/or partnerships with other actors. ecosystem services;
l assessment of population influx;
A study (Llamas et al., 2014) conducted within mining
l assessment of the national public health system
companies in a known EID hotspot area found that all of
capacity to conduct surveillance, prepare and
the companies had strict infection, prevention and
respond to outbreaks;
control (IPC) measures in place. The ‘inside the fence
line’ measures were, in general, primarily designed to l community subsistence strategies and husbandry
limit contact between humans, wildlife and domestic practices; and

animals. For example, workers’ accommodation and l community attitudes and practices toward infectious
camp facilities were kept clean, rubbish was collected diseases in animals and humans.
regularly and food was kept in locked containers to
avoid attracting nuisance animals (e.g. rats). Safe food
and water were available in camp, kitchen staff were
regularly tested for infectious diseases, and hunting was
strictly forbidden, while adequate nutrition for workers
was ensured and efforts were made to preserve the
existing biodiversity in the locality. All companies were
proactive with health prevention and promotion
outreach for both the workforce and adjacent
communities.
Appendix 2
REFERENCES
Heymann, D. L. and Dixon, M. (2013). The value of the
One Health approach: shifting from emergency
response to prevention of zoonotic disease threats at
the source. In Microbiology Spectrum 1 (1):
OH-0011-2012
Jones, K. E., Patel, N. G., Levy, M. A., Storeygard, A., Balk, D.,
Gittleman, J. L., and Daszak, P. (2008). Global trends in
emerging infectious diseases. In Nature, Vol. 451,
No. 7181), pp. 990-993.
Llamas A., Buckley, E., Mathewson, S., Viliani, F., Edelstein,

M. and Dar, O. (2014). Exploring attitudes within the
mining industry towards emerging infectious disease
control interventions. IDRAM Qualitative Study.
Morse, S. S. (1995). Factors in the emergence of

infectious diseases. In Emerging Infectious Diseases,
Vol. 1, No. 1, pp. 7-15.
Patz, J. A., Daszak, P. et al. (2004). Unhealthy landscapes:

Policy recommendations on land use change and
infectious disease emergence. In Environmental Health
Perspectives, Vol. 112, Issue10, pp. 1092-1098.
Smolinski, M. S., Hamburg, M. A. and Lederberg, J. (eds)

(2003). Microbial threats to health: emergence, detection,
and response. Committee on Emerging Microbial Threats
to Health in the 21st Century. Board on Global Health.
Institute of Medicine of the National Academies, The
National Academies Press, Washington D.C.
The World Bank (2015). The Economic Impact of Ebola

on Sub-Saharan Africa: Updated Estimates for 2015.
World Bank Group, Washington D.C.
United Nations, The World Bank, European Union,

African Development Bank (2015). Recovering from
Ebola crisis: A summary Report.
USAID (2012). Guidelines for Adding Zoonotic Diseases to

Health Impact Assessments. www.usaid.gov/what-we-
do/global-health/pandemic-influenza-and-other-emerging-
threats/programs/extractive-industry-engagement
Appendix 3:
Ecosystem Services
in ESHIA
Appendix 3
Ecosystem services in ESHIA
The 2012 International Finance Corporation (IFC)

Performance Standards (PS) have incorporated
LNG Expansion Project
ecosystem services in order to improve the
environmental, social and economic sustainability of its
projects. These new IFC PS, which have been adopted OVERVIEW OF POTENTIAL PROJECT
by the Equator Principles Financial Institutions, require HEALTH IMPACTS
clients to ‘maintain the benefits from ecosystem
Introduction
services’ and ‘conduct a systematic review’ to identify
those services on which the project is directly IFC Performance Standard 4 (PS 4) recognizes that
dependent on for its operations. This is different from project activities, equipment and infrastructure, can
looking at impacts on the beneficiaries of ecosystem increase community exposure to risks and impacts (IFC
services (ES) because it considers project feasibility in PS4, 2012). The Project’s direct and indirect impacts on
terms of whether or not its reliance upon an ES may be ecosystem services may result in adverse health
unsustainable from an ecological standpoint. The PS impacts and safety risks to affected communities (IFC,
also consider whether or not there is a viable alternative PS6, 2012). The diminution or degradation of natural
to the project’s reliance on ES. resources, such as adverse impacts on the quality,
quantity and availability of fresh water, for example, may
ESHIA practitioners have identified a lack of guidance as result in health-related risks and impacts (IFC PS4,
a major barrier to wider use of the ES approach in ESHIA. 2012). IFC Performance Standard 3 (PS 3) recognizes
The World Resources Institute (WRI), a major proponent that increased economic activity and urbanization often
of the ES methodology has issued guidance in order to generate increased levels of pollution to air, water and
address this concern (www.wri.org/publication/ land, and consume finite resources in a manner that
ecosystem-services). The use of the ES framework up may threaten people and the environment at the local,
front in scoping can potentially reveal ‘hidden issues’. regional and global levels (IFC PS 3, 2012).
This includes asking stakeholders/ecosystem
beneficiaries what their view of ‘well-being’ is as well as HIA practitioners could identify high-level potential
carrying out the proscribed scoping steps. project health impacts on ecosystem beneficiaries by
environmental health area (EHA). EHAs are a standard
The following is an oil/gas industry example of using the set of health effects categories that have been
ES approach for HIA. This example is created for developed by the oil and gas industry and international
illustration purposes only. multilateral lending institutions, which have been
developed to capture a variety of determinants of
health (IPIECA, 2015; IFC, 2008). Table A3 provides an
overview of direct and indirect drivers of ecosystem
change identified in the exercise, and lists the
associated ecosystem service categories and the EHAs
in which these potential impacts are anticipated to
occur. The sections that follow describe these potential
impacts in detail.
Table A3 Identifying the drivers of ecosystem change likely to be associated with the project
ECOSYSTEM SERVICE ENVIRONMENTAL HEALTH

DRIVER DETAILS DRIVER EXAMPLE CATEGORIES IMPACTED AREAS IMPACTED
Appendix 3
Direct drivers of Change in local land use and Changes in: wildlife migration patterns Provisioning, regulating, cultural, Food and nutrition issues, VRDs,
ecosystem cover and habitat use; land available for supporting zoonotic disease, accidents and injury,
change hunting and/or agriculture; disease cultural health practices
vector and host habitat; availability of
medicinal plants; culturally significant
locations for traditional healing practices
Harvest and resource Changes in: availability of subsistence Provisioning, regulating, cultural, Food and nutrition issues, water and
consumption fish and wildlife species; water availability supporting sanitation (WATSAN) disease
Pollution Changes in: water resource quality; water Provisioning, regulating, supporting Exposure to potentially hazardous
resource use patterns materials, food and nutrition issues,
WATSAN disease
Introduction of invasive species Changes in: wildlife migration patterns Provisioning, regulating, cultural Food and nutrition issues, VRDs,
and habitat use; land available for zoonotic disease, cultural health
hunting and/or agriculture; disease practices
vector and host habitat; availability of
medicinal plants, etc.
Indirect drivers Demographic change In-migration, resettlement Provisioning, regulating, Housing and respiratory issues, WATSAN
of ecosystem disease, food and nutrition issues,
change accidents and injury, VRDs, zoonotic
disease
Economic change Decreased dependence on: water Regulating Food and nutrition issues,
purification and waste treatment; soil WATSAN disease
quality and disease regulation; and
harvest and resource ecosystem services
Sociopolitical change Decreased use of medicinal plants, Provisioning, cultural Cultural health practices
traditional healing practices
Cultural and religious change
Decreased dependence on: water Provisioning, regulating WATSAN disease, STIs, food and
Scientific and technological purification and waste treatment; soil nutrition issues
change quality and disease regulation;
ecosystem services; increased efficiency
of agricultural practices
Appendix 3
Changes in the well-being of ecosystem beneficiaries relocated to a vector habitat. Housing design measures
can affect direct as well as indirect drivers of ecosystem can be taken to reduce risk of exposure to VRDs.
service change (Landsberg et al., 2011). In addition,
changes in human well-being can affect community- Direct drivers of ecosystem change (change in
driven impacts on ecosystems. HIA practitioners are local land use and cover, introduction of invasive
concerned with assessing the impact of ecosystem species)
change upon the well-being of ecosystem service l Change in local land use and cover leads to change
beneficiaries (as described above). In addition, the HIA in vector habitat use, resulting in community
will also identify some impacts that are independent of exposure to VRDs.
ecosystem services. These impacts typically concern the
l Changes in land available for hunting leads
built environment (i.e. project infrastructure such as
community members to utilize new areas, resulting
camps, landfills, etc.). These impacts are described in the
in VRD exposure.
third section of each EHA following a description of
l Changes in land available for agriculture leads
direct and indirect drivers.
community members to utilize new areas, resulting
Many drivers for ecosystem change are inherently in VRD exposure.
interconnected, which can create an overlap among l Introduction of invasive species leads to changes in
impacts. Here, drivers with overlapping impacts are vector habitat use, resulting in community exposure
described separately in an effort to illustrate that to VRDs.
multiple pathways can lead to the same impact. For
example, water-related diseases are often strongly Indirect drivers of ecosystem change
related to the absolute per capita volume of water (resettlement)
available for personal hygiene, e.g. bathing, hand
l Community members are resettled into vector
washing, etc. Thus, a water shortage or the use of an
habitat, resulting in exposure to VRDs.
alternate (unsafe) water source due to a contamination
l Community members are resettled into an area
event can both lead to a surge in water and sanitation
(WATSAN)-related diseases. In this example, Non- adjacent to vector habitat that is used for hunting
communicable diseases (NCDs, see EHA 12), is not and other provisioning services, resulting in exposure
considered separately within the ES framework but is to VRDs.
largely covered under EHA 6, Food and nutrition-
related issues. Project to community health impacts
(built environment)
l Design of housing (e.g. inclusion of screens) for
Environmental health resettled community members reduces exposure to

VRDs.
area analysis
ENVIRONMENTAL HEALTH AREA 1: ENVIRONMENTAL HEALTH AREA 2:
VECTOR-RELATED DISEASE HOUSING AND RESPIRATORY DISEASE ISSUES
(malaria, dengue, Chikungunya, lymphatic filariasis, (acute respiratory infections (bacterial and viral),
tick-related diseases and ectoparasites, etc.) pneumonias, tuberculosis, including multidrug-
resistant TB (MDR-TB); respiratory effects from
New exposure to vector-related disease is facilitated by housing, overcrowding, housing inflation,
landscape change and project infrastructure that immunization coverage)
promotes vector breeding (e.g. standing water). Change Housing and respiratory issues are primarily impacted
in local land use and cover and the introduction of by demographic shifts and crowding at worker camps,
invasive species can drive VRD impacts directly however these effects are not driven by changes in
through a variety of pathways as described below. ecosystem services but by infrastructure. For example,
Resettlement is an indirect driver when people are living area allocation per worker and living area
Appendix 3
ventilation specifications are drivers for the occurrence l Introduction of invasive species leads to changes in
of respiratory events at project camps, which can then wildlife migration patterns or habitat utilization
be transmitted back to the community. Similarly, resulting in community exposure to zoonotic disease.
crowding within homes due to in-migration and/or
failure to design resettlement homes with adequate Indirect drivers of ecosystem change
ventilation can lead to a surge in respiratory disease. (resettlement)
The in-migration to communities of disease-carrying or
l Community members are resettled into zoonotic
non-immune job seekers and workers at camps can
disease host habitat resulting in exposure to
spark a surge in respiratory disease prevalence.
zoonotic disease.
l Respiratory disease can be transmitted from in-
l Community members are resettled into an area
migrating (job seeking) non-locals to the community.
adjacent to zoonotic disease host habitat that is
l Undersized/under-designed and inadequately-
used for hunting and other provisioning services,
ventilated worker housing can generate an increase resulting in exposure to zoonotic disease.
in respiratory disease, which may be transmitted to
the community.
l Resettlement housing that is not properly designed ENVIRONMENTAL HEALTH AREA 4:
to accommodate indigenous cooking practices can SEXUALLY TRANSMITTED INFECTIONS (STIs)
lead to respiratory disease via exposure to (HIV/AIDS, syphilis, gonorrhoea, chlamydia, hepatitis B)
particulate matter generated in the combustion of
cooking fuels. STI impacts are independent of ecosystem services and
largely driven by the influx of project workers and an
increase in income. For example, long-haul truckers are
ENVIRONMENTAL HEALTH AREA 3: a well-known ‘vector of spread’ for STIs. This is a
ZOONOTIC DISEASE common occurrence in most countries. If worker camps
(potential disease distributions secondary to changes are ‘open’, workers residing in camps located in nearby
in animal migration patterns due to project-related communities can interact with locals. Individuals
activities or infrastructure) originating from areas outside the potentially affected
areas (PACs) where STI prevalence is higher may
New exposures to zoonotic disease can occur with ‘import’ these diseases to PACs, which could inflate the
community and wildlife land-use pattern change. This overall prevalence of STIs in a given community.
may occur directly via changes in local land use and l Project long-haul logistical support stops along the
cover that can facilitate impacts through a variety of transport route could give rise to short-term mixing
pathways as described below, and via the introduction between drivers and locals, resulting in an increase
of invasive species. Resettlement may be an indirect in STI prevalence.
driver of ecosystem change that results in adverse
l Local girls may engage in risky behaviour in order to
health impacts if people are resettled into habitat for
zoonotic disease hosts. attract men with money, placing themselves at risk
of contracting STIs.
Direct drivers of ecosystem change (change in local
land use and cover, introduction of invasive species) ENVIRONMENTAL HEALTH AREA 5:
l Change in local land use and cover leads to change SOIL, WATER AND SANITATION (WATSAN)-
in wildlife migration patterns or habitat utilization RELATED DISEASES
resulting in community exposure to zoonotic disease. (melioidosis, cholera, protozoan parasites,
l Changes in land available for hunting leads e.g. giardia, cryptosporidium; and geohelminths,
community members to utilize new areas resulting e.g. hook and pin worms, etc.)
in exposure to zoonotic disease.
HIA practitioners identified high-level potential project
l Changes in land available for agriculture leads
impacts on soil, water and sanitation (WATSAN)-related
community members to utilize new areas resulting
diseases, within an ecosystem services framework. As
in exposure to zoonotic disease.
Appendix 3
described below, the HIA found: potential for pollution Indirect drivers of ecosystem change
and water resource consumption as direct drivers of (demographic shifts, technological change)
ecosystem change, and demographic (i.e. in-migration Indirect drivers of ecosystem change include
and resettlement) and technological change (i.e. demographic shifts due to resettlement and in-
improved water and/or sanitation facilities) as indirect migration that may affect services such as water
drivers of ecosystem service change that may result in purification and waste treatment, as well as regulation
adverse health impacts for ecosystem service of soil quality and regulation of diseases. There are
beneficiaries. For example, pathogen pollution of a also potential project-to-community WATSAN impacts
community drinking or bathing water supply as a result that do not involve ecosystem services. These impacts
of a project sewage treatment plant is a direct driver of typically result from the built environment, and are
ecosystem change, which can adversely impact the independent of ecosystem change.
health of ecosystem beneficiaries via exposure to
WATSAN-related diseases. An example of an indirect In-migration
driver is in-migration, resulting in increases in open- l Overburdening of sewage lagoons leads to overflow,
defecation practices leading to a rise in prevalence of resulting in community water-related diseases.
soil-transmitted helminthes and WATSAN-related
l Increased demand on local latrines (if present)
diseases. Potential project impacts fall under the
creates increases in soil-transmitted helminthes and
categories of provisioning, regulating and supporting
potential increases in WATSAN-related diseases.
ecosystem services.
l Increases in community open defecation practices
Direct drivers of ecosystem change (pollution, creates increases in soil-transmitted helminthes and
water resource consumption) potential increases in WATSAN-related diseases.
l Overcrowded housing with poor personal hygiene
Direct drivers of ecosystem change that may result in
WATSAN impacts include contamination of fresh water leads to increases in skin-related diseases.
drinking and bathing resources. l Outbreaks of cholera and other diarrhoeal diseases
l A spill of hazardous materials contaminates drinking are associated with in-migration and changing
water, resulting in community use of an alternative, population locations.
unsafe source, which leads to a change in WATSAN-
related diseases. Resettlement
l Bathing facilities omitted from resettlement housing
l A spill from the project sewage treatment plant
contaminates drinking or bathing water supply with design creates exposure while bathing in streams
pathogens, resulting in a change in community containing pathogens.
WATSAN-related diseases. l Underdesign of latrines in resettled communities
contaminates soil and/or water, leading to WATSAN
Direct drivers of ecosystem change that may result in disease.
WATSAN impacts include project water resource
consumption. Technological change
l Changes in surface water flows and quality: potential l Improvements in water and/or sanitation facilities
groundwater drawdown leads to decreased water and infrastructure may decrease dependence on
resource availability for personal hygiene, leading to water purification and waste treatment, soil quality,
changes in WATSAN-related diseases. disease regulation and ecosystem services.
l Increased prevalence/incidence of water-related
diseases due to altered hydraulic regime or Project-to-community health impacts
vegetation/habitat and consequential development (built environment)
of additional/expanded locations for water bodies. Camps
l Increased prevalence of skin and foot conditions
among project workers residing in villages, with poor
laundry/personal hygiene, that are transmitted to
household members while on leave.
Appendix 3
Waste management important subsistence resources (hunting, fishing,

l Community-based project landfill accessed by local harvesting of wild plants).
population results in exposure to hazardous l Project workers compete with community members
materials and/or WATSAN-related diseases. for important subsistence resources, thereby
reducing the availability of important subsistence
Linear features resources (hunting, fishing, harvesting of wild plants).
l Inadequate disposal of human waste by construction
workers during short-term rolling fieldwork. Indirect drivers of ecosystem change
(in-migration, resettlement)
Resettlement housing design l In-migration leads to over-harvesting (hunting,
l Resettlement housing provides improved water and fishing, wild plants) reducing the availability of
sanitation access reducing community exposure to subsistence resources.
WATSAN-related disease. l Resettlement leads to adverse impacts on keystone
species, with community utilization of new areas for
hunting and/or fishing, reducing the availability of
ENVIRONMENTAL HEALTH AREA 6: important subsistence resources.
FOOD AND NUTRITION- RELATED ISSUES l In-migration or resettlement leads to a reduced
(changes in subsistence practices; stunting, wasting, availability of land for agriculture.
anaemia, micro-nutrient diseases (including folate,
l Increased income generated via project
Vitamin A, iron, iodine), gastroenteritis (bacterial and
viral); food inflation) employment and/or the increase in local
procurement of goods and services, facilitates the
Food and nutrition impacts may be driven directly by purchase of food items thereby decreasing
changes in local land use and cover, harvest and community dependence on harvest and resource
resource consumption, pollution and introduction of consumption ecosystem services.
invasive species. These impacts may also be driven l Project-provided science or technology leads to
indirectly via demographic change, economic more sustainable harvest and resource consumption
change and scientific change. There may also be practices.
impacts on food costs that are not mediated through
ecosystem services. Project-to-community health impacts
l Project procurement of food locally generates
Direct drivers of ecosystem change (change in inflation of food prices adversely impacting food
local land use and cover, harvest and resource security for community members.
consumption, pollution and introduction of
invasive species)
l A change in local land use and cover leads to a ENVIRONMENTAL HEALTH AREA 7:
change in wildlife migration patterns or habitat ACCIDENTS/INJURIES
utilization, resulting in impacts on the availability (road traffic-related spills and releases, construction
(increase or decrease) of important subsistence (home and project related) and drowning)
resources (hunting, fishing, harvest of wild plants).
l A hazardous materials release event leads to reduced
Risk of accident and injury is mainly driven by project-
availability (via a mass mortality event, an incremental driven landscape changes, infrastructure (including
increase in morbidity, impacts on forage and/or linear features such as roadways) and increased volumes
habitat, etc.) of important subsistence resources. of traffic due to population influx. With the exception of
landscape change, these are project-to-community impacts
l A hazardous materials release event contaminates
that are not mediated through ecosystem services.
irrigation water supply, reducing the community’s
capacity for agriculture. Unimproved roadways in remote, rural areas, with
l The introduction of invasive species leads to a difficult terrain and extreme weather events, are
change in availability (increase or decrease) of
Appendix 3
particularly vulnerable. Increased income can be used to Direct drivers of ecosystem change (pollution)
purchase vehicles, resulting in an overall increase in the l A spill of hazardous materials contaminates drinking
number of vehicles on the road. These factors, or bathing water, leading to exposure of the
especially in combination with a lack of local knowledge community to contaminants.
regarding roadways and vehicle safety, drives a high l Project emissions adversely impact air quality
potential risk of accidents. The focus of this EHA is on regulating services, leading to exposure of the
project-related, road traffic-related injuries and community to contaminants.
accidents, and transportation-related releases of
l Project emissions or release event contaminate
potentially hazardous materials outside the fence line.
The release event aspect of this risk is covered in EHA 8: harvest resources (hunting, fishing, wild plants),
Exposure to potentially hazardous materials. thereby compromising ecosystem regulating and
supporting services which leads to exposure of the
community to contaminants.
Direct drivers of ecosystem change
(change in local land use and cover)
l The creation of landscape features, such as borrow
Project-to-community health impacts
pits, bodies of water, etc. can increase the risk of fall l A release event associated with a road traffic
injuries and drowning. accident outside the fence line results in community
exposure to potentially hazardous materials.
l Community members access the project landfill,
Project-to-community health impacts
resulting in community exposure to potentially
l The project builds new unimproved roads in areas of
hazardous materials.
difficult terrain, leading to increased risk of road
traffic accidents involving community members l Project generation of fugitive dusts during
(vehicle operators, passengers, pedestrians). construction and on roadways increases community

exposure to particulate matter.
l Increased traffic volumes on existing roadways due
to population influx (worker and job seekers)
increases the risk of road traffic accidents. ENVIRONMENTAL HEALTH AREA 9:
PSYCHOSOCIAL/SOCIAL DETERMINANTS OF
ENVIRONMENTAL HEALTH AREA 8: HEALTH (SDH)
EXPOSURE TO POTENTIALLY HAZARDOUS (psychosocial, resettlement/relocation, violence,
MATERIALS security concerns, substance misuse (drug, alcohol,
smoking), depression and changes to social cohesion)
(road dusts, air pollution (indoor and outdoor, related
to industrial activity, vehicles, cooking, heating or
Social determinants of health include, but are not
other forms of combustion/incineration), landfill
exclusive to, resettlement/relocation, violence, security
refuse or incineration ash, any other project-related
concerns, substance use (drug, alcohol, tobacco),
solvents, paints, oils or cleaning agents, by-products)
depression and communal social cohesion. SDH impacts
are largely independent of ecosystem services. For
Direct drivers of ecosystem change that may adversely
example, households often perceive a disparity between
impact ecosystem beneficiaries include pollution of
the ‘haves’ versus the ‘have nots’, with regard to jobs and
provisioning services such as fresh water and harvest
housing, that may trigger resentment and increased
resources as well as regulating and supporting
demands for ‘across-the-board’ compensation. Gender
ecosystem services. Drivers that are not mediated
violence may also be a concern but is difficult to assess
through ecosystem services include: road traffic
accurately. Psychosocial impacts related to the stress of
accident spills outside the fence line (as described in
newcomers moving into the town at accelerated rates
EHA 7), infrastructure such as landfills and fugitive dust
during construction, and then leaving at the end of the
from construction and roadways.
project, may also be of concern.
l Compromise of community cohesion due to in-
migration of job seekers.
Appendix 3
l Conflict between the ‘haves’ (those employed by, project burden on local services and infrastructure via
and/or have been compensated by, the project) and accident/injury and in-migration, and also by removal of
the ‘have nots’. healthcare workers from the community due to
l Increased wages and/or psychosocial stress lead to employment by the project. Positive impacts can occur
an increase in substance misuse. if the project contributes to the improvement of local
services and capacity.
l A community casualty event that occurs due to the
ENVIRONMENTAL HEALTH AREA 10: project, including road traffic accidents, spills or
CULTURAL HEALTH PRACTICES releases, could require local medical services/
(role of traditional medical providers, indigenous infrastructure response and interaction.
medicines and unique cultural health practices) l Local clinics are not equipped to handle a major
industrial release event and/or fire/explosion and/or
Direct drivers of ecosystem change that can impact a mass casualty event (e.g. involving multipassenger
cultural health practices include changes in local land vehicles or multiple vehicles).
use and cover and the introduction of invasive
l Increased demands on the local healthcare
species. Cultural and religious change can have
indirect impacts via modification of, or discontinuation infrastructure and services, as a result of in-migration
of, cultural health practices involving local ecosystem and potential increases in accidents.
services such as medicinal plants. l Construction traffic could potentially delay access to
treatment.
Direct drivers of ecosystem change l Healthcare workers obtain jobs at the project,
(change in local land use and cover, reducing local capacity.

introduction of invasive species) l The project provides/supports or enhances local
l Project-induced change in local land use and cover infrastructure, services or skills related to healthcare.
can potentially impact the availability of plants
and/or geographic locations utilized for cultural Coordination and alignment of the project to
health practices. existing national and provincial-level health
l Invasive species can outcompete native species for programmes (e.g. TB, HIV/AIDS, malaria) and
food and habitats, and impact the availability of future development plans
plants, etc. utilized in cultural health practices. Impacts on programme management delivery systems
occur independently of ecosystem services. These
Indirect drivers of ecosystem change impacts are driven by the project’s coordination and
(cultural and religious change) alignment with existing public health authority
l Project-induced change in cultural health practices programmes and reporting requirements for
can decrease utilization of provisioning services such communicable and non-communicable disease.
as wild plants. l Health authorities will receive an influx of data when
new employees are screened (and turn up positive)
for reportable diseases.
ENVIRONMENTAL HEALTH AREA 11:
l Project-mediated increases in NCDs may necessitate
HEALTH SERVICES INFRASTRUCTURE AND
establishment or enhancement of existing NCD
CAPACITY INCLUDING PROGRAMME
programmes.
MANAGEMENT DELIVERY
(physical infrastructure, staffing levels and
competencies, technical capabilities of healthcare ENVIRONMENTAL HEALTH AREA 12:
facilities, immunization programmes) NON-COMMUNICABLE DISEASES (NCD)
This is largely covered under EHA 6 and not separately
Impacts on health services infrastructure and capacity analysed in this ecosystem services example.
are mediated independently of ecosystem services.
Adverse impacts on this EHA are driven by the potential
Appendix 3
REFERENCES
International Finance Corporation (2012).
IFC Performance Standards on Environmental and
Social Sustainability.
International Finance Corporation (2008). Introduction

to Health Impact Assessment. Washington D.C.
IPIECA (2015). A Guide to Health Impact Assessments in

the oil and gas industry.
Landsberg, F., Ozment, S., Stickler, M., Henninger, N.,

Treweek, J., Venn, O. and Mock, G. (2011). Ecosystem
Services Review for Impact Assessment: Introduction
and Guide to Scoping. WRI Working Paper. World
Resources Institute, Washington DC.
www.wri.org/publication/ecosystem-services-review-
impact-assessment
Appendix 4:
Example of monitoring/
longitudinal data
available from large oil
and gas projects
Appendix 4
Example of monitoring/ longitudinal data

available from large oil and gas projects
As operator of the PNG LNG Project in Papua New BACKGROUND

Guinea, ExxonMobil PNG Limited (EMPNG), the local
EMPNG established a Community Health Impact
affiliate of ExxonMobil Corporation in Papua New Guinea,
Management Programme to include Project worksites
recognized the importance of establishing effective
and community-based health initiatives designed to
partnerships with government, universities, and
prevent potential adverse health events related to
international and local non-governmental organizations
Project activity. Worksite health initiatives are guided by
to support sustainable population health benefits and
the PNG LNG Project’s Health Risk Assessment (HRA),
health sector improvements. The objectives were to:
Project Health Plan, Health Project Design Specification:
(1) accurately characterize and track the Project area (PA)
Minimum Health Requirements for Project Execution,
socio-economic indicators of health status and compare
and PNG LNG Environmental and Social Management
to similar control communities; (2) reliably diagnose and
Plan. Community-based health initiatives support
track disease occurrence in communities of interest;
activities identified in the PNG LNG Project’s Community
(3) implement specific intervention programmes to
Health Impact Assessment (2008), the International
promote health sector improvements and prevent
Finance Corporation’s guidance on community health,
adverse health outcomes in PA communities; and (4) to
safety and security, and the PNG LNG Environmental
create a robust and sustainable integrated health and
and Social Management Plan.
demographics surveillance system (iHDSS) to collect and
analyse community health data to inform the Project
team, provincial and national governments and non-
governmental organization regarding priorities for future
health improvement objectives and investments.
Strategic focus: the Partnership in Health Project (PiHP)
l Scientific and educational capacity building

l Establish demographic surveillance systems for longitudinal monitoring and evaluation
l Strengthen diagnostic capabilities for emerging infectious diseases (including construction of National Infectious Disease
Diagnostic and Research Laboratory—partners are the PNG Institute of Medical Research (PNGIMR) and the University of
Papua New Guinea (UPNG) School of Medicine and Health Science
l Sustainable scientific efforts for communicable disease (TB) at local level (adjacent to Project operations)
l Research in how to improve healthcare delivery and system performance
l Enhance quality of project management and financial stewardship
The PiHP was validated by an independent Science Advisory Panel composed of internationally recognized tropical disease
and demographic experts.
Appendix 4
Example of monitoring/longitudinal data available from large oil and gas projects
RECENT DEVELOPMENTS
The Community Health Programme was developed and Following the publication of the first two PNGIMR
implemented in partnership with the PNG Institute of reports, EMPNG and the National Department of Health
Medical Research (PNGIMR). A key component is the (NDoH) co-hosted a workshop to review key findings
Integrated Health Demographic Surveillance System and how data can better inform public policy
(iHDSS) that provides a platform to systematically development and implementation. The summary sheets
collect objective health and population data at key developed for the workshop are reproduced on pages
Project locations and matched control sites. It also 74–85 of this guidance.
provides timely response to disease outbreaks that
could potentially disrupt Project operations through the
placement of clinicians at selected health facilities along
the Project areas. Results from the iHDSS baseline and
follow-up health and social demographic data
demonstrate the absence of negative community impacts
and the presence of positive community health trends
and improvements potentially related to Project activity.
Partnership with the PNGIMR and the University of

Papua New Guinea (UPNG) School of Medicine and
Health Sciences led to the funding by EMPNG of the
construction and outfitting of the National Infectious
Disease Diagnostic and Research Laboratory. This state-
of-the-art facility is managed by PNGIMR and is used to
advance important biomedical research in tropical
medicine and emerging and neglected infectious
diseases such as cholera and tuberculosis.
The Community Health Programme has improved

village-level capacity to accurately diagnose disease,
with PNGIMR clinicians visiting community clinics to
share good clinical procedures and diagnostic tools to
assess various illness rates. Examples of this include:
fever studies using rapid diagnostic testing (RDT) for
malaria diagnosis; passive and active TB surveillance;
and diagnosis of sexually transmitted disease and non-
communicable disease (e.g. cancer, diabetes). As a
result of the data collected, provincial and national
health authorities will be able to effectively plan and
implement health services.
Appendix 4
Appendix 4
Appendix 4
Appendix 4
Appendix 4
Appendix 4
Appendix 4
Appendix 4
Appendix 4
Appendix 4
Appendix 4
Appendix 4
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Appendix 5:
Glossary
Appendix 5
Glossary
Anthropometric surveys Anthropometry is the study of the measurement of the human body in terms of the
dimensions of bone, muscle and adipose (fat) tissue.
The word ‘anthropometry’ is derived from the Greek word ‘anthropo’ meaning
‘human’ and the Greek word ‘metron’ meaning ‘measure’.
The purposes of anthropometric surveys are to: characterize overall nutritional status
of population groups and variations by demographic and socio-economic
characteristics, e.g. age, sex, location, income; monitor trends in nutritional status;
evaluate the impact of changing health and socio-economic conditions; assess the
impact of intervention programmes; and increase awareness of nutritional problems
and define appropriate policies and programmes for addressing them.
Baseline health survey Process of systematically identifying and assessing the current environmental and
infectious health hazards and risks facing the local community and developmental
workforce.
Biomonitoring Biomonitoring is the measurement of chemicals (or their metabolites) in a person’s

body fluids or tissues, such as blood or urine. It tells us the amount of the chemical
that actually gets into people from all sources (for example, from air, soil, water, dust
and food) combined.
Biomonitoring can therefore provide useful information on how much exposure to
toxic chemicals a person has had.
Birth rate The birth rate (also known as crude birth rate) is the annual number of live births per
1,000 people at mid-year. When calculating the crude birth rate, the age structure of
the population is not taken into account. If a large portion of a population is of
childbearing age, the birth rate will automatically be relatively high. The crude birth
rate is an important measure of a country’s population growth.
Community A group of individuals broader than the household, who identify themselves as a
common unit because of shared locality or recognized social, religious, economic or
traditional government ties.
Communicable or Communicable or infectious diseases are caused by pathogenic microorganisms,

infectious diseases such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or
indirectly, from one person to another.
Zoonotic diseases are infectious diseases originating from animals.
Demography The study of changes (such as the number of births, deaths, marriages and illnesses)
that occur over a period of time in human populations.
Appendix 5
Glossary
Demographic and Demographic and health surveys (DHS) are nationally representative household
health survey (DHS) surveys that provide data for a range of monitoring and impact evaluation indicators in
the areas of population, health and nutrition. DHS have large sample sizes (usually
between 5,000 and 30,000 households) and typically are conducted every five years, to
allow comparisons over time.
The Demographic and Health Survey (DHS) Program6 is currently funded by USAID.
DHS reports, methodology and data are available online at www.dhsprogram.com.
Environmental impact Part of project management concerned with identifying, through a formal written
assessment (EIA) technical evaluation, the likely impact (positive and negative) of a proposed
development or activity on the natural and man-made environment. A process
whereby the assessment is used in reaching a consensus on acceptable levels of
change, defining the means by which agreed standards of operation and procedure will
be achieved and establishing management procedures to ensure that these objectives
are achieved and maintained.
A formal, written, technical evaluation of potential effects on the environment
(atmosphere, water, land, plants and animals) of a particular event or activity.
Emerging infectious An emerging disease is one that has appeared in a population for the first time, or that
diseases may have existed previously but is rapidly increasing in incidence or geographic range.
Endemic diseases The constant presence of diseases or infectious agents within a given geographic area
or population group. May also refer to the usual prevalence of a given disease with
such an area or group.
It includes holoendemic and hyperendemic diseases. A holoendemic disease is one for
which a high prevalent level of infection begins early in life and affects most of the child
population, leading to a state of equilibrium such that the adult population shows
evidence of the disease much less commonly than do children (malaria in many
communities is a holoendemic disease). A hyperendemic disease is one that is
constantly present at a high incidence and/or prevalence rate and affects all groups
equally.
Equator Principles The Equator Principles is a risk management framework, adopted by financial
institutions, for determining, assessing and managing environmental and social risk in
projects, and is primarily intended to provide a minimum standard for due diligence to
support responsible risk decision-making.
Equity Equity is the absence of avoidable or remediable differences among groups of people,
whether those groups are defined socially, economically, demographically or
geographically.
Environment, social ESHIA is also defined as ‘integrated impact assessment’ as it assesses a project in a
and health impact comprehensive manner, and includes an assessment of the interactions among
assessment (ESHIA) impacts. ESHIA requires multidisciplinary teams to evaluate environmental, social and
health impacts and risks, and to develop subsequent management plans and a
monitoring and evaluation framework.
Appendix 5
Glossary
Front end engineering FEED is the basic engineering which comes after the conceptual design or feasibility
design (FEED) study. FEED focuses on the technical requirements as well as on the investment cost
for the project.
FEED can be divided into separate packages covering different portions of the project.
The FEED package is used as the basis for bidding the execution phase contracts (EPC,
EPCI, etc.) and is used as the design basis.
Health A state of complete physical, mental, social and spiritual well-being and not merely the
absence of a disease or infirmity.
Health determinants The range of personal, social, economic and environmental factors that determine the
health status of individuals or populations.
Health impacts A health impact can be both, positive and negative. It refers to changes in community
health that are attributable to a policy, programme or project.
Health impact A combination of procedures, methods and tools that systematically judges the
assessment (HIA) potential, and sometimes unintended, effects of a project on the health of a population
and the distribution of those effects within the population. An HIA identifies appropriate
actions to manage those effects.
Health inequality Health inequalities are the differences in health status or in the distribution of health
determinants between different population groups.
Health needs A systematic method of identifying unmet health and healthcare needs of a
assessment population and making changes to meet these needs.
Health promotion Health promotion is the process of enabling people to increase control over, and to
improve, their health. It moves beyond a focus on individual behaviour toward a wide
range of social and environmental interventions.
Health outcomes Health outcomes are measurable changes in the health status of an individual, group or
population that can be attributed to an intervention or series of interventions.
Health system A good health system delivers quality services to all people, when and where they need
them. The exact configuration of services varies from country to country, but in all
cases requires a robust financing mechanism; a well-trained and adequately paid
workforce; reliable information on which to base decisions and policies; and well
maintained facilities and logistics to deliver quality medicines and technologies.
Human development Human development index is a composite index measuring average achievement in
index three basic dimensions of human development: a long and healthy life; knowledge; and
a decent standard of living.
Human rights Human rights are rights inherent to all human beings, whatever their nationality, place
of residence, sex, national or ethnic origin, colour, religion, language or any other status,
without discrimination. These rights are all interrelated, interdependent and indivisible.
Human rights are codified internationally by Conventions and Covenants and nationally
by Constitutions and other legal frameworks.
Appendix 5
Glossary
Information, IEC refers to a public health approach aiming at changing or reinforcing health-related
education and behaviours in a target audience, concerning a specific problem and within a pre-
communication (IEC) defined period of time, through communication methods and principles
Institutional Review An IRB is a committee established to review and approve research involving human
Board (IRB) subjects. The purpose of an IRB is to ensure that all human subject research is
conducted in accordance with all federal, institutional and ethical guidelines.
Multidrug-resistant TB Multidrug-resistant TB (MDR-TB) is defined as the resistance to the two most commonly
(MDR-TB) used drugs in the current four-drug (or first-line) regimen, isoniazid and rifampin.
WHO treatment standards require that at least four drugs be used to treat TB in order
to avoid the development of further resistance.
Non-governmental A non-governmental organization, also often referred to as a ‘civil society organization’

organization (NGO) (CSO) is a not-for-profit group, principally independent from government, which is
organized on a local, national or international level to address issues in support of the
public good.
Task-oriented and made up of people with a common interest, NGOs perform a variety
of services and humanitarian functions, bring public concerns to governments, monitor
policy and programme implementation, and encourage participation of civil society
stakeholders at the community level. Some are organized around specific issues, such
as human rights.
Primary healthcare Affordable and practical methods of delivering essential healthcare that are scientifically
sound and socially acceptable.
Primary prevention Primary prevention seeks to prevent the onset of specific diseases via risk reduction, by
altering behaviours or exposures that can lead to disease, or by enhancing resistance to
the effects of exposure to a disease agent. Examples include smoking cessation and
vaccination. Primary prevention reduces the incidence of disease by addressing disease
risk factors or by enhancing resistance.
Public health Public health refers to all organized measures (whether public or private) to prevent
disease, promote health and prolong life among the population as a whole. Its activities
aim to provide conditions in which people can be healthy and focus on entire
populations, not on individual patients or diseases. Thus, public health is concerned
with the total system and not only the eradication of a particular disease.
Sexually transmitted Sexually transmitted infections (gonorrhoea, chlamydia, syphilis, etc.). These infections
infections (STIs) increase the risk for the transmission of the HIV virus.
Social impact The processes of analysing, monitoring and managing the intended and unintended
assessment (SIA) social consequences, both positive and negative, of planned interventions (policies,
programmes, plans, projects) and any social change processes invoked by those
interventions.
Subsistence The minimal resources that are necessary for survival.
Appendix 5
Glossary
Sustainable Meeting the needs of the present in such a way that the benefits will be capable of
development being sustained for the future without excessive external support.
Surveillance Surveillance is the continuous, systematic collection, analysis and interpretation of

health-related data needed for the planning, implementation and evaluation of public
health practice.
Traditional Traditional medicine (TM) refers to the knowledge, skills and practices based on the
medicine (TM) theories, beliefs and experiences indigenous to different cultures, used in the
maintenance of health and in the prevention, diagnosis, improvement or treatment of
physical and mental illness. Traditional medicine covers a wide variety of therapies and
practices which vary from country to country and region to region. In some countries, it
is referred to as ‘alternative’ or ‘complementary’ medicine.
Bibliography
Bibliography
The HIA practice is constantly changing and evolving. Aside from peer-reviewed published papers,
many countries, regulatory agencies, development agencies and international financial
institutions have issued HIA practice guidelines and toolkits. The HIA practitioner should always
review the standard published literature and any host country guidelines that may be applicable
for a given project.
Equator Principles
l www.equator-principles.com
International Association for Impact Assessment (IAIA)

l International Best Practice Principles 5: www.iaia.org/publicdocuments/special-publications/SP5.pdf
l HIA FasTips 8: www.iaia.org/publications-resources/pdf/ Fastips_8%20Health.pdf
International Finance Corporation (IFC)

l IFC Performance Standards: www.ifc.org/wps/wcm/connect/c8f524004a73daeca09afdf998895a12/
IFC_Performance_Standards.pdf?MOD=AJPERES
l Health Impact Assessment Toolkit: www.ifc.org/wps/wcm/connect/a0f1120048855a5a85dcd76a6515bb18/
HealthImpact.pdf?MOD=AJPERES
l Project Induced In-Migration: www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_
site/ifc+sustainability/learning+and+adapting/knowledge+products/publications/publications_handbook_in
migration__wci__1319576839994
l Stakeholder Engagement: www.ifc.org/wps/wcm/connect/938f1a0048855805beacfe6a6515bb18/
IFC_StakeholderEngagement.pdf?MOD=AJPERES
l Environmental Health, and Safety Guidelines—industry-specific and covering oil/gas offshore and onshore:
l Onshore: www.ifc.org/wps/wcm/connect/4504dd0048855253ab44fb6a6515bb18/Final%2B-
%2BOnshore%2BOil%2Band%2BGas%2BDevelopment.pdf?MOD=AJPERES&id=1323153172270
l Offshore: www.ifc.org/wps/wcm/connect/f3a7f38048cb251ea609b76bcf395ce1/FINAL_Jun+2015_
Offshore+Oil+and+Gas_EHS+Guideline.pdf?MOD=AJPERES
Pew Charitable Trust

l HIA portal: www.pewtrusts.org/en/projects/health-impact-project/health-impact-assessment
Bibliography
Society of Practitioners of Health Impact Assessment (SOPHIA)

l www.hiasociety.org
United Nations Environment Programme

l EIA process including mitigation:
l Environmental Impact Assessment and Strategic Environmental Assessment: Towards an Integrated
Approach: www.unep.ch/etb/publications/EnvImpAss/textONUBr.pdf
United Nations Development Programme (UNDP)

l HIV inclusion in EIA:
l Guidelines for Integrating HIV and Gender-Related Issues into Environmental Assessment in Eastern and
Southern Africa: www.undp.org/content/dam/undp/library/hivaids/English/Guidelines_for_Integrating_
HIV_and_Gender_related_Issues_into_Environmental_Assessment_in_Eastern_and_Southern_Africa.pdf
University HIA Websites

l Monash University (Australia): www.monash.edu
l A simple guide to choosing a ‘Health Impact Assessment’ tool:
www.apho.org.uk/resource/view.aspx?RID=84266
l University of New South Wales, Research Centre for Primary Health Care and Equity (Australia):
http://hiaconnect.edu.au
l University of Liverpool, Institute of Psychology, Health and Society (UK):
https://www.liverpool.ac.uk/psychology-health-and-society/research/impact/about/
l University of California Los Angeles, Health Impact Assesment Project (USA):
http://www.ph.ucla.edu/hs/health-impact
l University of Birmingham (UK): www.birmingham.ac.uk
l A Training Manual for Health Impact Assesment: http://www.apho.org.uk/resource/view.aspx?RID=44927
US Agency for International Development (USAID)

l Emerging Infectious Diseases (EID):
l Audit Checklist For An Operating Facility Emerging Infectious Diseases, June 2012:
www.usaid.gov/sites/default/files/documents/1864/Audit-Tool.pdf
US Centers for Disease Control (CDC)

l www.cdc.gov/healthyplaces/hia.htm
WHO/European Centre for Health Policy/Public Health of England

l Health Impact Assessment: Main Concepts and Suggested Approach. Gothenburg Consensus Paper, 1999:
www.apho.org.uk/resource/view.aspx?RID=44163
continued …
Bibliography
World Health Organization (WHO)

l Health Impact Assessment portal: www.who.int/hia
l WHO Statistical Information System: www.who.int/whosis

l Country-specific health reports: www.who.int/countries
l Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies,
2010. www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf
l Managing the public health impacts of natural resource extraction activities, 2015.
http://commdev.org/wp-content/uploads/2015/06/WHO-Managing-the-public-health-impacts.pdf
l Social determinants of health (WHO website), www.who.int/social_determinants/en
Others
l eni (2010). Environmental, Social and Health Impact Assessment, 2010. eni E&P Standard Doc. No. 1.3.1.47.
l Global Reporting Initiative: www.globalreporting.org

l SOS International (2012). Health Indicators for Sustainability Reports. www.sos.eu/resources/business-
images/13.0005-Sos-rsrapport_ENGELSK_WEB_FINAL_01.pdf
l Inter-American Development Bank (2011): Community Health and Safety, Recommendations and Tools. IADB,
Environmental Safeguards Unit (VPS/ESG) TECHNICAL NOTES No. ESG-TN-325:
https://publications.iadb.org/bitstream/handle/11319/5495/ESG_TN-325_Community-Health-%26-
Safety.pdf?sequence=1
l IFC (2009). Introduction to health impact assessment (‘IFC HIA Toolkit’). International Finance Corporation (IFC),
Washington D.C.
www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/ifc+sustainability/learning+and+ada
pting/knowledge+products/publications/publications_handbook_healthimpactassessment__wci__1319578475704
l IFC (2010). Strategic Community Investment: A Good Practice Handbook for Companies Doing Business in
Emerging Markets. International Finance Corporation (IFC), Washington D.C.
http://www.ifc.org/wps/wcm/connect/topics_ext_content/ifc_external_corporate_site/ifc+sustainability/learni
ng+and+adapting/knowledge+products/publications/publications_handbook_communityinvestment__wci__1
319576907570
l State of Alaska (2011). Technical Guidance for HIA in Alaska (‘Alaska HIA Toolkit’), 2011 (updated in 2015).
http://dhss.alaska.gov/dph/Epi/hia/Documents/AlaskaHIAToolkit.pdf
l United Nations Global Compact: www.unglobalcompact.org
l US EPA (2015a). United States Environmental Protection Agency, Health Risk Assessment website.
www.epa.gov/risk/conducting-human-health-risk-assessment#tab-2
l US EPA (2015b): United States Environmental Protection Agency website: ‘The NRC Risk Assessment Paradigm.’
www2.epa.gov/fera/nrc-risk-assessment-paradigm
Bibliography
Key textbook references

l Kemm, J. (2013), Health Impact Assessment: Past Achievement, Current Understanding, and Future Progress.
Oxford, Oxford University Press.
l Birley, M. (2011) Health Impact Assessment: Principles and Practice. Routledge.
Toxicology references
l US National Research Council (NRC):
l Human Biomonitoring for Environmental Chemicals (2006):
www.nap.edu/catalog/11700.html
l Toxicity Testing in the 21st Century: A Vision and a Strategy (2007a):
http://nap.edu/11970
l Applications of Toxicogenomic Technologies to Predictive Toxicology and Risk Assessment (2007b):
http://www.nap.edu/catalog/12037.html
Key journals that publish HIA-focused papers

l Environmental Impact Assessment Review (EIAR): www.journals.elsevier.com/environmental-impact-assessment-review
l Environmental Health Perspectives (EHP): http://ehp.niehs.nih.gov

l Journal of Epidemiology and Community Health (JECH): http://jech.bmj.com/
l The Lancet: www.thelancet.com
l British Medical Journal: www.bmj.com/thebmj
IPIECA is the global oil and gas industry association for environmental and social issues. It
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improve its environmental and social performance, and is the industry’s principal channel of
communication with the United Nations.
Through its member-led working groups and executive leadership, IPIECA brings together
the collective expertise of oil and gas companies and associations. Its unique position
within the industry enables its members to respond effectively to key environmental and
social issues.
IOGP represents the upstream oil and gas industry before international organizations
including the International Maritime Organization, the United Nations Environment
Programme (UNEP) Regional Seas Conventions and other groups under the UN umbrella.
At the regional level, IOGP is the industry representative to the European Commission and
Parliament and the OSPAR Commission for the North East Atlantic. Equally important is
IOGP’s role in promulgating best practices, particularly in the areas of health, safety, the
environment and social responsibility.
IPIECA
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Health impact assessment

A guide for the oil and gas industry

THE GLOBAL OIL AND GAS

© IPIECA-IOGP 2016 All rights reserved.

International Association of Oil & Gas Producers

Executive summary 3 Section 4: Project HIA 19

Section 1: Introduction 5 Types of HIA 20

Section 3: Strategic health impact 15 Appendix 2: Emerging infectious diseases 55

OVERVIEW: THE IMPORTANCE AND VALUE OF STRATEGIC HEALTH IMPACT ASSESSMENT

INTRODUCTION PROJECT HEALTH IMPACT ASSESSMENT

WHAT IS HIA? The type of HIA that is considered triggers different

This Guide defines and outlines the purpose and

PURPOSE OF THIS GUIDE addition to the execution of a project-specific HIA.

This section provides an overview of the core

LIMITATIONS THE ESHIA PROCESS AND OTHER

l environmental, social, human rights and health

l construction and facilities managers;

l design engineers; and

Many company decision makers are unfamiliar with HIA

Disease vector Health

Whether stand-alone or integrated, the HIA process can

OTHER HEALTH STUDIES

l health needs assessment (HNA)

l health facility assessment (HFA)

Health risk assessments classically address ‘inside the

Health needs assessments (HNAs) involve a systematic

Health facility assessments (HFAs) function primarily as

THE HIA PROCESS, INCLUDING TYPES OF HIAs

ESHIA PHASES ACTIVITIES SCOPE OF CONSULTATION

High-level ESH impacts assessment Identification of relevant/

Definition of information and data gaps Identification of inputs

Definition of methodology key stakeholders

Feedback on the results

Assessment of ESH impacts Validation of the findings

Identification of mitigation measures Support in the identification

Identification of monitoring measures

Strategic health impact assessment (sHIA)

INTRODUCTION TO sHIA potentially national scales. Impacts, both positive and/or

Geography and scale Plan for action

Timing Strategic Health

sHIA ACTORS Correspondingly, the outputs of a sHIA are: (i) a

Collaboration (range of stakeholders)

Timing (as early as possible)

Finally, the sHIA planned interventions should lead to

This section considers the different

l baseline data analysis

l mitigation and enhancement

l monitoring and evaluation

TYPES OF HIA l legislative/regulatory review;

Field data collection typically consists of a combination

Table 1 Levels and characteristics of the different types of HIAs

TYPE OF HIA CHARACTERISTICS

l Provide more detailed information of possible health impacts

l Provide a comprehensive assessment of potential health impacts

POTENTIAL HEALTH IMPACTS SOCIAL SENSITIVITY

l Endemic disease profile l Conflict

Low = Low High High =

CRITICAL STEPS IN THE HIA PROCESS

Table 2 Steps for screening