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Health Impact Assessment in Project and Policy Formulation

Health impact assessment is globally gaining widespread credibility and adoption in the policymaking process as it leads to a holistic view of healthcare and informs policy dialogue in a more coherent manner. But in India, this process has not yet begun. This paper looks at the viability and necessity of introducing HIA in policymaking. It also suggests an integration of HIA with environmental impact assessment in order to draw upon the strength of the latter and bring in an integrated approach to the issue of impact assessments and their monitoring.

Health Impact Assessment in Project and Policy Formulation

Health impact assessment is globally gaining widespread credibility and adoption in the policymaking process as it leads to a holistic view of healthcare and informs policy dialogue in a more coherent manner. But in India, this process has not yet begun. This paper looks at the viability and necessity of introducing HIA in policymaking. It also suggests an integration of HIA with environmental impact assessment in order to draw upon the strength of the latter and bring in an integrated approach to the issue of impact assessments and their monitoring.

ARTI AHUJA

I
ndia has nearly 17 per cent of the world’s population and a large proportion of the world’s poor, with poor health indicators. The health ministry implements various programmes to improve healthcare delivery, and consequently the health status of the people. The national disease control and other programmes are implemented nationwide. However, health impact assessment (HIA) does not form a part of policymaking in India. The approach thus far has been of looking at health as a stand alone factor, with diseases that can be prevented or cured by the health system. However, human health is not just a factor or outcome of decisions taken by the health department. Actions of other entities and agencies also cause substantial health effects. Unless this is recognised, the health sector will only be left to grapple with the adverse outcomes of other policies, with no ability to tackle the problem at its roots. What is needed is a review of how various programmes and policies of the government in other sectors can impact the health of people. It is thus time to look at the broader definition of health,1 encompassing the well-being of the people.

At the present juncture, India has a strong system of preparing environmental impact assessments (EIA). Although they cover some aspects of health, no substantial or thorough framework exists for assessing the health impacts of various large and small development programmes. While there are some assessments of the health impacts of large projects that involve resettlements, there is hardly any impact assessment for large projects without any displacement or small projects that affect the health of the people who live in the neighbouring area.

Internationally, countries are adopting and practising health impact assessments for their populations. But in India very little works have been done on this aspect. This paper examines whether HIA is a feasible option for India and what can be done to put it in place. In Section I, we provide a brief background of why India needs to put HIA in place. Section II discusses the viability of making HIA a tool of public policy. Section III looks at the existing practices in the field. Section IV examines whether we can draw lessons from the field of EIA for doing HIA in India. Section V examines various options for integrating HIA and EIA, and makes suggestions. Section VI concludes the discussion.

I Background

Joan Robinson said that “whatever you can rightly say about India, the opposite is also true” [Sen 2006]. On the one hand, India has seen an impressive economic performance, on the other hand it still has a large proportion of the population below the international poverty line of a dollar a day. The goals of health and development have often conflicted. While the government has undertaken initiatives for poverty amelioration and development, they have also adversely affected health outcomes.

Large projects such as the Narmada dam have caught media attention due to the human face of displacement and the economic and social problems associated with the loss of livelihoods and familiar habitats. However, the focus on health problems – of both the displaced and those who will continue living in the areas next to the dam – seems to be almost diffused in the public debate. Large and small dams not only cause displacement, but they also impact the health of the displaced as well as those who live in the vicinity. A good example can be found in Senegal where the construction of dams and the ensuing transmission through fresh water snails led to a massive outbreak of schistosomiasis [Gryseels et al 1994]. As there were no alternate sources, people were using the dam water for bathing, washing and even for drinking. In India too, such problems, though undocumented, are common. In Orissa, scabies due to bathing in village ponds is a major health problem. The media has also recently covered cases of disability among those living in the vicinity of the Uranium Corporation of India’s mines in Jaduguda.2 The infamous Bhopal gas tragedy, where leakage of methyl isocynite left thousands dead and hundreds of thousands injured, is a glaring example of lack of corporate and governmental responsibility in assessing and ensuring compliance with health impacts.3

However, project impacts on people’s health are often not as dramatic as were in Bhopal. They happen insidiously and over a period of time. A study showed that cases of malaria went up in the vicinity of a medium-sized dam after the construction was completed. Figure 1 shows that the numbers jumped up dramatically with the impounding of waters in the dam.

Similarly, dams are also likely to cause Japanese encephalitis, yellow fever and dengue [McCully Patrick 1996]. The building of an irrigation canal in the Thar desert of India brought about climatic changes, resulting in the formation of extensive mosquito breeding habitats, high vector densities and intrusion of new malaria mosquitoes earlier unknown in the region. As a result, the prevalence of disease in the desert, with several epidemics reported in the last 10 years, increased three to five times [Tyagi and Chaudhary 1997]. However, water bodies are not the only culprits in causing health problems in the catchments. Other

5000 4500 4000 3500 3000 2500 2000

1000 500

Figure 1: Health Problems in Bargi Dam Area

Malaria Outbreak in Bargi Dam Area in Narayanganj PHC, Madhya Pradesh

programmes. As with health, states play an important role in implementation of the environment programmes. The forest cover has been growing due to various programmes, including EIA, undertaken by the ministry,4 showing the positive impact of government programmes. In the present set-up the health ministry has no role in ensuring HIA as part of the EIA done by the ministry of environment and forests.

II

HIA as a Tool in Policy Formulation

HIA is commonly defined as “a combination of procedures,

methods and tools by which a policy, programme, or proj

ect may be judged as to its potential effects on the health of

Dam impounded Dam completed Malaria cases Pf cases

197919811983198519871989199119931995199719992001

Note: The Pf mentioned is plasmodium falciparum – the worst form of malaria.

Source: Singh, Mehra and Sharma 1999.

Figure 2: The European Policy Health Impact Assessment

Screening Scoping

Conduct assessment

Policy analysis Profiling of communities Qualitative and quantitative data collection

a population, and the distribution of those effects within the population”.5 HIA can be used to evaluate objectively the potential health effects of a project or a policy before it is built or implemented. It can provide recommendations to increase positive health outcomes and minimise adverse health outcomes. A major benefit of the HIA process is that it brings public health issues to the attention of persons who make decisions about areas that fall outside traditional public health arenas, such as transportation or land use.6

HIA can be applied to a programme, a policy or a project. The process is derived from the principles of EIA and constitutes the following: (1) Screening to filter our proposals that

Impact analysis Establish priority impacts

do not require HIA; (2) Scoping sets the boundaries and terms of reference of HIA; (3) Appraisal or risk assessment whereby health impacts, positive or negative are identified by stakeholders

Report on health impacts and policy options Monitoring Impact and outcome evaluation

and assessors; (4) Preparation of report and recommendations and testing them to ensure that they address the impact identified and interventions are effective; (5) Submission of report and recommendations to decision-makers; (6) Monitoring and evaluation comprising of process, impact and outcome evalu-

Recommendations developed Process evaluation

Source: European Policy Health Impact Assessment – A Guide.

[http://www.ihia.org.uk/ephia/guide/4.html ]

ation; and (7) Risk communication and management.

development programmes such as deforestation, mining, laying of electricity lines and oil pipelines, etc, also have an effect on the health of the populations living nearby. In the quest for development, the human health concerns of the people living in and around the affected areas are often ignored. There is a framework in place in India for rehabilitation and resettlement (if required) of the affected populations; however, as the recent conflict over the Narmada dam shows, even that is questioned by community-based organisations (CBOs) in terms of its efficacy. Amid the protests of the resettlement rights of the people, lie subsumed and underplayed their health rights.

Indian Health and Environment Systems

The Indian health system is administered by the health and family welfare ministry which supervises a state-funded, subsidised, universal healthcare system [World Bank 2001]. Starting from the primary level up, it provides curative and preventive care through a referral based system. Although in sheer numbers the presence of the public sector is huge, yet it falls below the world standards of ratios of manpower and hospital beds (ibid). Huge payments make healthcare inaccessible and expensive to the poor.

The ministry of environment and forests (MoEF) is the nodal agency for the planning, promotion, coordination and overseeing the implementation of environmental and forestry

A schematic representation of European policy health impact assessment (EPHIA) is given.

III Existing Global Practices

Networks

HIA is gaining ground as a strategy for defining policy formulation as well as a component of project and programme planning and monitoring. A number of initiatives led by multilateral organisations and private associations have pushed it to the forefront of public debate. The 1997 Jakarta declaration on “Health Promotion into the 21st Century” placed high priority on promoting social responsibility for health and identified equity focused HIA as a priority. This theme was again among the focal issues at the fifth Global Conference on Health Promotion held in Mexico in 2000.

Among the large multilateral agencies, the WHO has been moving in this direction with the health and environmental linkages initiative (HELI) in partnership with United Nations Environment Programme (UNEP). It provides tool kits and documents for HIA, and works with partners to build capacity for HIA and health policy development [Lehto J Ritsatakis 1999]. However, a caveat must be added here. The WHO is not in a position to implement, nor does it have a strong influence in

Economic and Political Weekly September 1, 2007

enforcing public health action plans with countries. At the most it can play an advisory role.

The international association for impact assessment (IAIA) was organised in 1980 and brings together researchers, practitioners and users globally. It has more than 2,500 members representing more than 100 countries. It seeks to develop approaches for comprehensive and integrated impact assessment, especially HIA. The International Health Impact Assessment Consortium (IMPACT) is another multi-agency that brings together a team of experienced and knowledgeable specialists working in the field of HIA. It is involved with the current growth of research and development in HIA, such as the health inequalities and integrated impact assessment. Another initiative is the Strategic Environment Assessment (SEA) protocol signed in May 2003 at Kiev by 36 United Nations Economic Commission for Europe (UNECE) member states and the EU, which lays down a framework for systematic treatment of environmental, including health concerns in SEA. Consideration of health is a key feature of the protocol [UNECE 2004].

A number of financial institutions have adopted the Equator Principles which mandate that projects should be financed only when certain guidelines have been met for categorisation of risk in accordance with environmental and social screening criteria. As part of this, protection of human health and culture, major hazards, occupational health and safety, community participation in formulation of projects, pollution control, etc, are considered. The borrowers have to comply with the environment management plan in the construction and operation of the project, and provide regular reports on the progress made. However, the primary mandate of the principles is environment although health does form a part of the principles.

The private companies seeking to establish long-run relationships with countries have also undertaken HIA in the past. An example is the Chad-Cameroon pipeline project which put in place a HIA in a five stage process. The notable aspect is a clear delineation of the project-associated health aspects and working out of the mitigation strategies in advance [Utzinger Jurg et al 2005].

Donor-led initiatives in HIA also stand out as best practices. For example, the Nam Theu 2 Dam in LAO PDR had a detailed HIA plan. The main components were categorisation of direct and indirect impacts and health assessment including disease burden, the existing system and cultural practices. Baseline data was collected from detailed household surveys and government records at the district and regional levels. Health issues were identified and an impact analysis was done for all affected areas. The plan identified the weaknesses in the existing health delivery system and sought to enhance the medical capacity. Disease prevention as well as curative services were put in place. Monitoring and surveillance were an integral part of the plan and they were adopted after involvement of all stakeholders including the communities. This was a good example of what strategies need to be followed when communities are being displaced.

Governments

It is estimated that by 1997, nearly 100 countries used EIA. In contrast, HIA is a nascent, though growing, practice globally. Among the countries practising it, the UK government has expressed its commitment in a white paper [Secretary of State for Health 1999]. The Acheson Report in UK also recommended that health inequalities assessment should be carried out [Department of Health, UK 1998]. The European Union Amsterdam Treaty commits that “a high level of human health protection shall be ensured in the definition and implementation of all commu nity policies and activities” [European Communities 1997]. New Zealand has integrated HIA with EIA. Australia, the US, Ireland, Scotland and Canada also follow HIA in their policy formulation.

IV Lessons from EIA

The whole framework of HIA evolved with the EIA. The HIAs are similar in some ways to EIAs, which are mandated processes that focus on environmental outcomes such as air and water quality. However, unlike EIAs, HIAs can be voluntary or regulatory processes that focus on health outcomes. Pressure groups in environmental protection and subsequent developments have ensured that the main focus of EIA is environment protection and how it then affects human health. This leads us to the next section, i e, whether EIA has an adequate health component.

Most EIA programmes require some consideration of human health impacts. Yet, very few address it adequately. In a study of 42 environmental impact statements in the US, it was found that more than half contained no mention of health impacts. In others, health impacts were measured narrowly, using risk assessment to quantify the carcinogenic potential of a single substance on a single generation. They overlooked cumulative and intergenerational impacts and broader determinants of health [Steinmann A 2000]. Other studies have also found consideration of health impacts lacking in EIA [Sutcliffe J 1995].

EIA Framework in India

The MoEF in India is the nodal body for getting and monitoring EIAs. Under the Environmental (Protection) Act 1986, it promulgated a notification in 1994 making environmental clearance mandatory for expansion or modernisation of any activity or for setting up new projects. Now EIA is mandatory for 30 categories of developmental activities involving investments which can be broadly categorised under the sectors of industries, mining, thermal power plants, river valley, ports, harbours and airports, communication, atomic energy, transport (rail, road, highway) and tourism.

In 1997, public hearing was made mandatory for environmental clearance. It is conducted by the state pollution control boards before the proposals are sent to MoEF for obtaining environmental clearance (EC). A notification of September 15, 2005 of the ministry explains the process as follows: Screening: This phase facilitates decision-making about applicability of EC process. It provides guidance to decide whether the proposed project requires an EC from MoEF, the state department or the state pollution control board. Siting and EIA report preparation: Identifying the guidelines applicable to the project so as to select the right location for the proposed project. It also guides about the stage when detailed rapid EIA study can start. Public hearing: This phase facilitates screening the applicability of public hearing for the proposed project and what steps are to be followed for completion of public hearing. It also provides the legis lated time limit applicable to public hearing process and obtain ing no objection certificate (NOC) from pollution control board. Other approvals, recommendations and certifications: This phase provides direction for approvals/recommendation essential in case of utilities, handling of hazardous chemicals, etc. These requirements would necessitate approvals from the concerned government departments. Clearance from MoEF: This phase facilitates the steps of the EC process and time limits for its completion. Post-environmental clearance monitoring: This phase defines the monitoring requirement once a project has been accorded environmental clearance.

Overall, the EIA process in India is quite similar to the process suggested for the HIA. It also provides for post-environmental clearance monitoring, which is essential for HIA.

EIA in India and Its Health-Related Aspects

The EIA notification of 1994 stipulates that the application form will contain information on land use, climate and air quality, water balance, solid wastes and noise and vibrations, which impact human health tangentially. Specifically, the column for peak labour force to be deployed asks for details of endemic health issues in the area due to waste water/air/soil quality, etc, and existing and proposed healthcare system. In the subsequent notification of 2005, information is sought on health-related information pertaining to use of hazardous materials, changes in disease or disease vectors and vulnerable groups such as patients, elderly and children who could be affected by the project. Other environmental factors that affect human health such as solid waste, land use, pollution, noise and vibration, and risk of accidents are also included. The generic structure of EIA given in appendix II of the notification, however, does not specify clearly if any health impacts are included.

It is also pertinent that the expert committees for EIA do not include any public health experts, though experts on environmental health are included. Environmental health is one of the 11 Annexures of the EIA manual. Thus, health is definitely not a main focus of the EIA as it exists today. This is not surprising, since EIA is primarily for purposes of environment assessments and health is seen as an ancillary concern.

V Integrating HIA and EIA

There are at present two distinct schools of thought on the HIA. One stream sees HIA as a natural development of EIA, treating human communities as important components of the ecosystems to be protected. The EIA-based strand promotes the incorporation of health within project EIA. This approach is also called environ mental health impact assessment [Martin 2001]. Another stream has its origins in the notions of health and healthy public policy [Kemm 2003]. The health policy/health promotion strand promotes HIA as part of public policy and inequality impact assessment.

For poor countries, poverty reduction strategies are seen as a structured way of developing investment policies, and HIA seems an ideal way to integrate economic and social activities

Economic and Political Weekly September 1, 2007

with health concerns [Banken 2003]. Thus the recommendation for India seems to be a policy level initiative and not just having HIA as a part of EIA. However, the lessons to be learnt from the EIA are well-recognised; since HIA brings together and builds on methods of EIA [Lock 2000]. However, it also needs to be recognised that EIA is not the only precursor of HIA. The HIA also shares certain concepts and methods with social risk assessment and economic assessments [Mindell and Michael 2003], and thus can be easily incorporated in the policy framework.

Thus, the HIA is truly an integrative tool. It has much in common with and builds on EIA, and also the human rights impact assessment. It has the potential for enhancing recognition of social determinants of health and the inter-sectoral responsibility for health [Krieger N et al 2003]. But like health itself, HIA isnot value neutral. The processes determine the outcomes. An equityfocused approach implies participatory methods and openness at all stages of the process to public scrutiny. Some analysts believe that in the future, HIA may become as important as clinical trials are today, i e, a key influence of evidence-based health policy [Scott-Samuel 1998], and hence requiring public scrutiny.

Although there is no single blueprint for HIA that is appropriate for all circumstances, the key principles are that HIA should be systematic, involve decision-makers and affected communities; take into account local factors; use evidence appropriate to the impacts defined and make practical recommendations [Margaret et al 2001]. In order to involve policymakers fully and not have it done under an adversarial relationship with CBOs, it is suggested that the ideal state is for the policy proponent and regulatory authority to be in consonance [Kemm 2001], as is presently done for EIA in India.

Suggested Adaptation in India

The health ministry is the nodal agency for formulating and implementing health policy. The health policy lays down the path the health system has to traverse, but HIA does not figure there as a strategy. There is not much data or information available on the counterfactual, i e, what would have happened, if HIA had been done for major projects and policies. However, an analysis of the transport and land use policies in Delhi showed that decisions resulting from these policies penalised the least affluent groups and made it more difficult for them to get healthcare and services. The study posited that HIAs and indicators can provide the essential criteria for determining successes and failures of such policies [Tiwari 2003]. The studies cited earlier also point to the fact that HIA, if done, would have averted the diseases that followed in the wake of those projects.

The discussion in the previous section has, however, made it clear that HIA should not be done in isolation as the mandate of a particular ministry. It has to be integrative to be effective. Coming to the two streams of thought and which is more suited in the Indian context, it needs to be examined if HIA should be within the purview of the health ministry or should be integrated with EIA. There are drawbacks and advantages of both approaches, which I examine separately for each option. Option 1: HIA as a part of EIA: The pragmatic approach would suggest that since EIA is already well-established as a practice and its capacity exists to expand its scope to include HIA, the HIA should just be made a part of EIA. With that, it can easily draw on the existing framework and expertise of the EIA, as well-established mechanisms and institutional expertise exist in the environment field to easily adapt HIA into the framework. The Indian Environment Assessment Association, the Bombay Natural History Society, the Tata Energy Research Centre, the National Environmental Engineering Research Institute (NEERI) or the Environment Information Centre7 can be used by the government, NGOs and all stakeholders for EIA.

Thus not only can HIA fit into the framework, there will be other direct benefits such as reduced costs, less processing time for the projects as it can be done through a single mechanism or application, and exploitation of the existing capacity in the environment field without any significant start-up losses.

However, it is doubtful if the environment ministry and the other agencies/groups in the environment field will have owner ship of the HIA. Even if health ministry representatives are part of the committees involved in EIA, they may not be able to have their agenda pushed through satisfactorily. The enforcement and inspection would also be subsumed within the EIA without direct supervision of the health ministry. Currently, EIA is more focused on projects, and not policy. It is feared that HIA may suffer the same limitation if it is simply made a part of HIA. Option 2: Have HIA done separately by the health ministry: Having the health ministry as the primary enforcer of the HIA makes logical sense. It will, like the MoEF for EIA, have ownership and legitimacy to enforce the HIA, which may get diluted in the first option.

However, the disadvantages are that this will make a delay in time as health sector capacity may not exist at the same level as it does in the environment sector for impact assessment. In fact, often barriers such as lack of relevant skills and experience, resources, or conflicting priorities are cited by the policymakers for implementation of HIA (WHO-HIA and policymaking).8 Although this can be overcome by technical inputs from the resources available in the field, the real concern in the practical arena is creating one more “hurdle” to be crossed or clearance to be obtained for the projects. This could lead to further delays as well as project cost inflation. For a country on the path of deve lopment, this is likely to create more ill-will than appreciation. Option 3: Create a special purpose vehicle or authority to do an integrated assessment: Given the problems of the first two options, it appears that a holistic approach is required. This would mean making a truly integrated impact assessment and enforcement organisation or agency that takes within its fold both the impact assessments for health and environment and also adds on the social impacts of the development projects. This is only possible through an inter-ministry and an interdepartmental coordination.

There could be possible disadvantages of such a body. Interdepartmental coordination could be difficult to achieve as turf wars between different wings of the government are not uncommon. However, examples of interdepartmental coordination have often yielded spectacular results. The rice field malaria eradication in China was possible due to the coordination between agriculture and health ministries. In India, examples of such coordination already exist in the AIDS control programme, and the newly created National Disaster Management Agency which brings together a number of ministries. In the field, the unified command9 has shown that when decisions are taken thus in a coordinated manner, it reduces both costs and effort.

From the agency’s point of view, site visits, monitoring, etc, can all be done at one go instead of multiple times by different agencies. When enforcement and inspection are done by one agency that represents common interests, it will be more efficient. More importantly, every department’s interest will be adequately and equally represented, without the assessment being coopted by one big brother.

From the perspective of the client, this will be a one window clearance and will bring efficiency in disposal. A unified assessment will also be able to pull in various stakeholders from the NGOs; whether they act as disparate or unified pressure groups, will end up pushing forward the cause as a whole. Thus the health aspect will get a fillip even if only environmental groups press for the integrated impact assessment and vice versa. This will create a synergy in getting the assessments done, and the integrated assessment will get a boost.

An umbrella organisation or agency will also be able to involve grassroots organisations and elected panchayati raj members10 or urban local bodies in the assessment and implementation process. This is an often forgotten component of EIA today, but is very relevant for all-environment, health and social impact assess ment. For example, the People Assessing Their Health (PATH) project in Canada was undertaken in a geographically isolated region to increase public understanding and empower citizens to play an active part in decisions influencing their health. It demonstrated how low-technology HIA done by local people can show how programmes can support or weaken public health [Mittelmark 2001]. If it can be done in coordination with the panchayati raj institutions, it can bring a dramatic change in the feeling of owner ship of the projects in the communities. If people are involved at all stages, they will feel less agitated and helpless in the crisis. Decentralisation has already taken root in the Indian policy formu lation and implementation. Hence, involving communities in this endeavour will not involve heavy cost or effort investments. Costs: The new authority or agency will be formed as a unified agency, with resources pooled in from the environment, health, and possibly social injustice ministries – the latter for social impact assessment. At present, funds exist within the environment ministry for EIA. Within the health ministry as well, there are resources for IEC activities as well as for implementing programmes. The resource constraints can be overcome, and pooling of funds from all ministries can also be done. Organisational structure: The new organisation will have to be set up as an independent agency outside the ministries. As discussed, models that serve as a liaison among the private sector, the NGOs and the government already exist. Broadly, the proposed agency would have the following structure:

  • A secretariat, headed by a senior officer for handling the day-to-day operations.
  • Committees comprising experts from the field of health, environment and social justice for the process of screening, public hearing and monitoring after the projects are underway.
  • However, many projects will have an impact only some years after their grounding, especially on the health aspects, the committees will also be empowered to carry out inspections after the projects are grounded. For this, the set-up on the lines of the pollution control boards could be followed, as they have a recurring mandate to ensure pollution standards. Likely opposition: There could be possible resistance to an integrative assessment from the corporate sector. They may feel that they have an additional responsibility or requirement which is not warranted in their opinion. However, it has to be understood that not only is such an assessment important for those who are affected

    Economic and Political Weekly September 1, 2007

    by the projects, but it is also a necessity for the corporates as they too need to build long-term relations with local communities for the success of their own projects.11 Such an arrangement is also likely to give rise to greater social responsibility as the project authorities will be pressed to look at the overall effects of their project rather than looking at it in a piecemeal way or appeasing only certain vocal and active pressure groups or sections.

    The ministries could also have initial resistance to an integrated and unified agency which could encroach on their established domains and lead to some turf wars. However, it is important to establish the tenets and delineate clear lines of responsibility a priori so that such situations can be anticipated and provided for. Similarly, the activists and pressure groups in both the environment and health fields could be opposed to their respective agendas by being clubbed with another. In fact, the already grounded environment lobby could be more vocal in their objections, having taken an active role in establishing EIAs. Their objections will have to be met through a series of public meetings explaining the necessity for an integrated assessment that is more holistic and looks at all aspects: not just of a project’s deve lopment, but also in policy formulation.

    VI Conclusion

    There is no doubt that the woeful health indicators, especially for the poorest, get exacerbated when development intrudes into the habitat of the poor. Development is necessary and required, and so should the health of the vulnerable be protected. Both do not need to be antithetical to each other. As the EIA mechanism has shown in India, given the public will, judicial activism,12 legislative foresight and pressure from stakeholders, measures like the EIA benefit the society as a whole. However, the health of the affected people often gets neglected in this quest. The answer can be found in the HIA. As discussed in the paper, it is suggested that given the expertise of the environment sector and the special, individual-based need of the health sector, an agency that combines both EIA and HIA will be most appropriate. Not only that, it could also include social assessment as part of its agenda. Such an agency will tide over interdepartmental hegemonies, resolve conflicting concerns and bring about efficiencies in cost, effort and operations. It will present a single window to the clients and also foster a culture of holistic development and social responsibility.

    EPW

    Email: ahujaarti@lbsnaa.ernet.in

    Notes

    1 Health is a state of complete physical, mental and social well-being

    and not merely the absence of disease or infirmity [WHO 1946].

    2 BBC India, Whitaker Mark, May 4, 2006.

    3 Sanjay Kumar, ‘Bhopal Disaster’, TED Case Studies, Number 233,

    http://american.edu/ted/Bhopal.htm

    4 A comparison of forest cover assessment of 2001 with that of 1999

    reveals that there is an overall increase of or 6.0 per cent (State of

    Forest Report 2001).

    5 Gothenburg consensus statement, www.who.dk/document/PAE/Gothen

    burgpaper.pdf

    6 Centre for Disease Control, http://www.cdc.gov/healthyplaces/hia.htm

    7 An initiative of the MoEF, India. It is a professionally managed clearing

    house of environmental information.

    8 WHO-HIA and Policymaking – Barriers cited to using HIA in Govern ment

    Policymaking http://www.who.int/hia/policy/barriers/en/index.html

    9 Mostly to combat insurgency and terrorism in the border areas of the

    north-east and Kashmir. It has shown positive results in its years of

    operation. The analogy can be extended to social sector as well.

    10 The PRIs have of late gained ground as strong local organisations, with mechanisms for ensuring grassroot democratic decision-making.

    11 As was seen in the Chad-Cameroon pipeline project, and as should have been done in the Union Carbide plant in Bhopal.

    12 Supreme Court Order dated February 21, 2005 WP (Civil) No 460 of 2004, Goa Foundation versus UOI, http://envfor.nic.in/divisions/iass/supremecourtorder.htm

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