1. Battlement Mesa Health Impact Assessment and Exposure/Health Study Stakeholders Meeting Roxana Witter, MD, MSPH John Adgate, PhD, MSPH Lee Newman, MD, MA Colorado School of Public Health Feb 3, 2010

2. BM HIA BM EHAMS DISCLAIMER! Everything you hear is a work in progress Everything you hear is a work in progress Study proposals and designs are being planned as we speak Study proposals and designs are being planned as we speak You are part of the design process You are part of the design process We are here to hear you We are here to hear you Each step will inform the next Each step will inform the next

3. Battlement Mesa Concerned Citizens Health Study Request Battlement Mesa Concerned Citizens Health Study Request Baseline Health Study and Baseline Air and Water Quality Baseline Health Study and Baseline Air and Water Quality before drilling before drilling Air, Water, Soil Quality Monitoring Air, Water, Soil Quality Monitoring which is comprehensive and continuous which is comprehensive and continuous Medical Monitoring System Medical Monitoring System to detect changes from baseline to detect changes from baseline Full Disclosure of Drilling Materials Full Disclosure of Drilling Materials to health officials and scientists to health officials and scientists Test Buffer Zone Test Buffer Zone of 1000 feet of 1000 feet

4. TWO Proposed Studies Related yet separate (Not yet funded) BM HIA Battlement Mesa Health Impact Assessment BM EHAMS Battlement Mesa Environmental/ Health Analysis and Monitoring Study

5. TWO Proposed Studies- Related yet separate BM HIA Use existing data Use existing data Recommendations (before drilling) Recommendations (before drilling) Tied to permitting decision Tied to permitting decision Endpoints Endpoints –Inform decision-makers –Improve health

6. TWO Proposed Studies- Related yet separate BM EHAMS Exposure assessment Exposure assessment Health monitoring Health monitoring During drilling/production During drilling/production Not tied to decision Not tied to decision Fill data gaps with new sampling/monitoring Fill data gaps with new sampling/monitoring Endpoints: Endpoints: Document Document Exposure levels Exposure levels Health impacts Health impacts Information Improve health Information Improve health

7. Health Impact Assessment (HIA) Grant Pew Health Impact Project Pew Health Impact Project Funded by Robert Wood Johnson Foundation Funded by Robert Wood Johnson Foundation 15 Demonstration Projects 15 Demonstration Projects Primary investigators Primary investigators Colorado School of Public Health Colorado School of Public Health Partnership with Garfield County Environmental Health Partnership with Garfield County Environmental Health Stronger application demonstrates: Stronger application demonstrates: Stakeholder outreach Stakeholder outreach Stakeholder partnerships (Garfield County) Stakeholder partnerships (Garfield County) Strategy for implementation (COGCC, BOCC buy-in) Strategy for implementation (COGCC, BOCC buy-in) Institutionalization of HIA (HIA conference for state, local, regional health officials) Institutionalization of HIA (HIA conference for state, local, regional health officials)

8. HIA Process ScreeningScopingAssessmentAnalysisRecommendationsReportingImplementationEvaluation Health Impact Assessment

9. HIA Process Screening Potential to affect health Scoping Stakeholders/ Decision-makers/ Concerns Assessment Baseline exposures and health Analysis Anticipated health impacts Recommendations Minimize negative, support positive Reporting Draft, stakeholder input, Final Implementation Recommendations into action Evaluation Effective/ accepted

10. HIA Process Scoping Who are the Stakeholders? Who are the Stakeholders? What are your concerns? What are your concerns? Who are the Decision-makers? Who are the Decision-makers? Will decision makers consider the recommendations of the HIA? Will decision makers consider the recommendations of the HIA? What are the hazards? What are the hazards? Can people be exposed to the hazards? Can people be exposed to the hazards? What are the sicknesses that can happen? What are the sicknesses that can happen? What are the ways that the Antero project can help people be healthier? What are the ways that the Antero project can help people be healthier? We are here!

11. Battlement Mesa Exposure/Health Analysis and Monitoring Study Separate yet related to HIA Separate yet related to HIA Uses HIA information as beginning, builds on HIA Uses HIA information as beginning, builds on HIA Study design dependent upon HIA findings Study design dependent upon HIA findings We will develop study design this spring We will develop study design this spring Longer term (3-5 years) Longer term (3-5 years) Not tied to permitting decision Not tied to permitting decision Tied to gas drilling and production Tied to gas drilling and production

12. What is the fate and transport of hazardous substances? What is the fate and transport of hazardous substances? How and where can you be exposed? How and where can you be exposed? Is this sufficient to cause disease? Is this sufficient to cause disease? What Can an Exposure Study Tell Us ? EnvironmentalMedia Environment - Individual Interface Internal - Disease

13. BM EHAMS Study What are the HAZARDS that we are concerned about? What are the HAZARDS that we are concerned about? Are there routes of EXPOSURE? Are there routes of EXPOSURE? Are there HEALTH OUTCOMES that may result from sufficient EXPOSURE to a HAZARD ? Are there HEALTH OUTCOMES that may result from sufficient EXPOSURE to a HAZARD ?

14. BM EHAMS Study Exposure Assessment Exposure Assessment Fill data gaps Fill data gaps Ambient and personal exposure Ambient and personal exposure Air, water, soil Air, water, soil Consider biomarker study Consider biomarker study Collect blood/urine samples to measure exposure Collect blood/urine samples to measure exposure

15. BM EHAMS Study Health Monitoring and Analysis Health Monitoring and Analysis Which health effects? Which health effects? Exposures Exposures Population size Population size Current level of disease Current level of disease Prospective (vs Retrospective) Prospective (vs Retrospective) Possible designs include Possible designs include Hospital/ ER/ clinic discharge and diagnosis data Hospital/ ER/ clinic discharge and diagnosis data Clinic records review Clinic records review Resident survey Resident survey Each design had advantages and disadvantage Each design had advantages and disadvantage

16. Conclusion Two Studies Two Studies Related- yet separate Related- yet separate Scientifically based Scientifically based Designed to answer as much of your concerns as possible Designed to answer as much of your concerns as possible Open process Open process Thank you for your help!

17. HIA Process Reporting/ Implementation/ Evaluation A draft report that is shared with all stakeholders A draft report that is shared with all stakeholders A revised report based upon input and release a final report A revised report based upon input and release a final report Advocate for implementation Advocate for implementation How effective was the HIA? How effective was the HIA? Were the recommendations implemented? Were the recommendations implemented? Was the process accepted by all stakeholders? Was the process accepted by all stakeholders? Did the HIA improve health? Did the HIA improve health?

18. HIA Process Assessment Who is the project going to affect? Who is the project going to affect? How healthy are the people now? How healthy are the people now? What things influence the health of the population? What things influence the health of the population? Are there groups that may be more susceptible to chemicals or other influences? Are there groups that may be more susceptible to chemicals or other influences?

19. HIA Process Assessment Are there current sources of exposures? Are there current sources of exposures? How do these affect the health of the community now? How do these affect the health of the community now? Are there people collecting information about exposures? Are there people collecting information about exposures? Do we need to collect more information? Do we need to collect more information?

20. HIA Process Analysis Are there other scientific or medical studies that tell us Are there other scientific or medical studies that tell us how much of a chemical (or another hazard) there is? how much of a chemical (or another hazard) there is? how people are exposed to a chemical (or a hazard)? how people are exposed to a chemical (or a hazard)? how peoples health can be affected? how peoples health can be affected? Can we use computer models to help us understand the risk? Can we use computer models to help us understand the risk? Using the best available scientific data Using the best available scientific data What do we Predict the potential health effects may be? What do we Predict the potential health effects may be?

21. HIA Process Screening Does the project have the potential to affect health? Does the project have the potential to affect health? Are there chemicals or other influences that can affect health? (HAZARDS) Are there chemicals or other influences that can affect health? (HAZARDS) Will an HIA add value? Will an HIA add value? Will it provide new information? Will it provide new information?

22. What can we do to minimize What can we do to minimize the hazard? the hazard? the exposure? the exposure? the health effect? the health effect? What are the positive health effects? What are the positive health effects? How can we increase the positive health effects? How can we increase the positive health effects? Are we making recommendations specific enough? Are we making recommendations specific enough? HIA Process Recommendations

23. Limitations of Studies May not be able to document May not be able to document –All exposures –All health outcomes May not be able to separate all exposures May not be able to separate all exposures Some health outcomes may be due to combination of exposures, including personal life-style Some health outcomes may be due to combination of exposures, including personal life-style

24. Battlement Mesa Health Impact Assessment Timeline: APPROXIMATE Screening and Scoping (currently ongoing) Screening and Scoping (currently ongoing) –4 weeks Assessment and Analysis Assessment and Analysis –8-12 weeks Recommendations/ Implementation Recommendations/ Implementation –4 weeks Reporting and Evaluation Reporting and Evaluation –4-12 weeks

25. BM EHAMS Study Timeline: APPROXIMATE Phase 1: Design/Feasibility/Budget Phase 1: Design/Feasibility/Budget 2-6 months 2-6 months Phase 2: Study Phase Phase 2: Study Phase 2-5 years 2-5 years Annual Current Health Status Report Annual Current Health Status Report Phase 3: Analysis and Dissemination: Phase 3: Analysis and Dissemination: 1 year 1 year

26. Battlement Concerned Citizens Request Qualifier Health Project Data Baseline health study before any drilling HIAExisting Baseline monitoring of air and water before any drilling HIAExisting Air, water, and soil quality monitoring comprehensive and continuous, all well sites during all phases EHAMSNew Medical monitoring systemany changes in baseline data EHAMSNew Full disclosure of materials used in drilling and fracturing to health officials and scientists XXX Test buffer zoneone thousand feet between any well operation and any residence, business, or public building EHAMSExisting/Ne w