Health and environmental impact assessment: an integrated approach
May 1998
The way ahead
The ability to recognise, characterise, estimate and ameliorate adverse environmental health impacts is likely to be amongst some of the most pressing challenges facing national governments, industries and the public into the next century. Governments should be aiming to implement revised and enhanced procedures, rather than maintaining the status quo. Further investments in research and development are required to improve monitoring technology and early warning diagnostics. Similarly, planners, geographers and ecologists should try to refine their methods for environmental monitoring. Both community groups and public officials should try to ensure that there is effective public participation in the planning and development policy-making processes. Particular attention will need to be paid to monitoring the impacts which could be attributed to projects once development has been permitted. This should help establish whether mitigation measures are being implemented and how effective they turn out to be.
There will continue to be an important role for environmental and occupational health professionals and for the medical profession, particularly public health and occupational physicians. Environmental and occupational diseases encompass a wide range of human illness and are amongst the most important causes of disability and death in modern society. The full nature and extent of the health burden resulting from occupational and environmental exposure remains to be elucidated, but our understanding would benefit from improved links between toxicology and epidemiology. This will enable our knowledge about the possible effects, particularly of low level exposures to asbestos, benzene, organic dusts, radon, solvents, lead, and to pesticides and other agents, to expand. Building upon those developments, health economists will have a valuable contribution to make in quantifying health impacts.
Medical practitioners, however, may be inadequately prepared to respond to the growing need for clinical services that address the real and perceived problems of environmentally related illness. Physicians are one of the most trusted, but possibly less well informed, sources of information about the risks of chemical exposure. This gap between trust and knowledge must be narrowed and although this is now being addressed by some undergraduate courses, further changes in medical education are needed both at the undergraduate and postgraduate level, particularly for those in the fields of occupational, environmental medicine and risk assessment. Public health physicians have an important role which could be enhanced by further training, including specialisation in environmental issues. These topics were addressed in the 1995 Annual Report of the Chief Medical Officer who commented: “Infections and environmental hazards, procedures, investigations or drug treatments do carry risks. Some people may not wish to take any risks in spite of the possibility of real benefit. Others will take a chance, even when the benefit is likely to be very low. The problem for decision makers is not when the evidence is clear, but when it is weak or incomplete. In such instances there is a need for openness and sharing of information, and the establishment of trust between those who make policy and the public at large”. The British Medical Association concurs firmly with this view and will continue to work closely with the Department of Health, and other appropriate government departments, in ensuring that priority is given to this issue.
Looking forward to the 21st century, the 1992 United Nations Conference on Environment and Development established 'Agenda 21', which sets out what nations need to do to achieve sustainable development in the medium term (see Appendix 5). This has provided a basis for placing environmental considerations high on the public policy agenda. There has not yet, however, been a sufficiently widespread recognition of the importance of the relationship between public health and the state of, and changes to, the environment.