Health and Hydrofracking Katrina Smith Korfmacher, PhD Department of Environmental Medicine University of Rochester

1. Health and HydrofrackingKatrina Smith Korfmacher, PhDDepartment of Environmental MedicineUniversity of Rochester

2. Current engagement in issue • Local networking re: information/education • National COEC network/UPenn “network” • 3-state “Information Needs Assessment” • OH, NC, NY • 45 interviewees • Perspectives on information sources, health issues, and research needs • Local health dept. capacity building

3. Goals • (How) can public health professionals, researchers, and perspectives help? • NOT to describe health effects or concerns

4. What is the evidence on health effects of hydrofracking? Depends on… • What is ‘hydrofracking’? • What is a ‘health effect’? • What counts as ‘evidence’?

5. 1:What is ‘hydrofracking’? • Industrial practice of injecting fluids into shale • All activities at well site (drilling, fracking, flaring, storage of water/chemicals) • Physical processes associated with unconventional shale gas extraction (trucks, compressor stations, pipelines) • Changes in communities and economies resulting from shale gas development

6. Horizontal hydraulic hydrofracturing. Courtesy www.propublica.org/special/hydraulic-fracturing

7. Filling a hydrofracturing reservoir. Courtesy of www.shaleshock.org

8. Photo (c) 2010, Sally S. Howard A Hydrofracking Tank on double tractor trailer – Rt 15 near Trout Run, PA Nov, 2010

9. Oct 1, 2009 about 20 miles south of Elmira, NY and 35 miles north of Williamsport, PA. Total disturbed area: 105.1 acres. The reservoir holds 14,841,128 gallons of hydrofracking flowback water. The tan area near B is being cleared for a 8,515,651 gallon reservoir. Water for the site will be withdrawn from the Fallbrook and Fellows Creeks. A wetland exists immediately south of this site; the effects are unknown. Courtesy of www.PaForestCoalition.org

10. 2. What is a ‘health effect’? • Health impacts/symptoms directly caused by hydrofracking • Changes in incidence of disease associated with increased hydrofracking • Changes in environmental quality or animal health that could affect humans • Well-being/quality of life (stress, conflict, wealth, sense of belonging/community)

11. Worker health and safety • Exposure: occupational • “Typical” industrial/mechanical injuries (falls, accidents) • Chemical burns/exposures • Air emissions • Silica sand

12. Surface water and health • Exposure: fish/game consumption, air, contact recreation, farm animals • Fracking chemicals/flowback water • Spills • Waste water disposal • Changes in water quantity/flow displacing other uses (agriculture, wildlife, etc.)

13. Ground water and health • Exposure: private drinking water wells • Methane • Fracking chemicals • NORM (Naturally Occurring Radioactive Materials) • Naturally occurring heavy metals • Chemical interactions

14. Air quality and health • Exposure: inhaled by workers, neighbors, regional communities • Diesel engines (trucks, compressors, etc.) – particulates, ozone precursors • Fugitive emissions from wells • Evaporation from storage ponds • Aggregate/cumulative impacts (18% of ozone due to gas development by 2020)

15. …Climate change and health • Health effects of heat • Indirect impacts through: • Flooding/drought • Insects • Agriculture • Air quality

17. Disasters, accidents and health • Flooding may wash chemicals into local waters/contaminate soil • Earthquakes associated with injection wells • Explosions/spills may cause injury or contaminate environment

18. Community health • Noise and light pollution • Stress and mental health (environmental concerns, economic change, conflict) • Population/community change (workers) • Impacts on health services (visits to emergency room, disaster/spill response, new disease concerns) • Increased housing costs/demand • Benefits from improved economy

19. 3: What counts as ‘evidence’? • Stories/reports from affected citizens, health care providers, or organizations • Newspaper articles • Evidence of past impact? • Predictions of future impacts? • Government agency reports • Peer-reviewed publications

20. Does uncertainty trump knowledge? • What will be the extent of drilling, where, over what time? • What engineering practices, control systems, and mitigation will be used? • What chemicals are used, released, how much, where, when? • What are the health effects of exposures? • Accidents, spills, natural disasters…

21. Can decisions be ‘science-based’ despite uncertainty? • “More research is needed” • Precautionary principle • Regulate, monitor and manage • Pilot test (adaptive management) • Uncertainty will persist • Latency of health impacts • Variation in geography/technology • Long-term processes • Unpredictable events

22. “Perspectives of public health” • Prevention • Risk management • Co-benefits • Economic impacts • Ethical issues H. Frumkin et al., "Climate Change: The Public Health Response," American Journal of Public Health 98 (3) (2008): 435-445

23. Prevention • Baseline monitoring of environmental and human health • Modeling cumulative impacts • Ongoing monitoring and adaptation • Emergency preparedness planning

24. Risk Management • Systematically identifying, assessing, and mitigating multiple risks • Life cycle analysis • Health Impact Assessment (HIA)

25. A special note on HIA • …NOT ‘science’ or ‘research’ • Applying existing health knowledge to non-health decisions • Process: • Scoping key health issues • Assessing using existing quantitative and qualitative data • Involves stakeholders • Makes recommendations to decision makers • www.healthimpactproject.org

26. Co-benefits • Increased environmental/health monitoring • Develop GIS/analysis capacity • Forge new community partnerships • Emergency response capacity/training

27. Economic impacts • Timing matters (net present value) • Prevention pays • Distribution of costs/benefits affects health (see “ethics”) • Cost effectiveness includes internalizing external (and future) costs

28. Ethics • Reducing health disparities • Environmental justice • Focus on vulnerable populations (children, asthmatics, pregnant women, etc.) • Public participation/community based research • Implications of long latency / intergenerational effects for equity

29. Tapping into public health • Beyond “environment versus economics” • Public health professionals as a resource: • Communication networks • Access to health data/analysis • Local monitoring/management • Body of experience includes: • Disaster response (Gulf Oil, flooding) • Emerging disease • Surveillance/epidemiology

30. American Public Health Association “The public health perspective has been inadequately represented in policy processes related to HVHF. Policies that anticipate potential public health threats, require greater transparency, use a precautionary approach in the face of uncertainty, and provide for monitoring and adaptation as understanding of risks increases may significantly reduce negative public health impacts of this approach to natural gas extraction.” Policy statement 20125 “The Environmental and Occupational Health Impacts of High-Volume Hydraulic Fracturing of Unconventional Gas Reserves” is publicly available in the APHA policy statement database. Here is the direct link: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1439

31. Public health resources • Health care providers (doctors, nurses…) • Health interest groups (APHA, ANHE, HSA, communities, insurance agencies) • Local health departments (NACCHO) • State/federal agencies (DOH, CDC…) • Medical associations • Academics (epidemiology, toxicology, health behavior/education) • Foundations and funders

32. Horizontal Hydrofracturing Rig, November 2009 in Moreland, PA. Wikipedia Commons – photo by Ruhrfisch