1. HEALTH IMPACT ASSESSMENT: WHAT WE SHOULD DO IN MEXICO JULIETA PISANTY-LEVY

2. IAIA'07 Seoul, Korea Julieta Pisanty-Levy2 CONTENTS Introduction Health in Mexico Environmental Impact Assessment in Mexico – what we do Environmental Impact Assessment in Mexico – what we don’t do and what we should do Conclusions

3. IAIA'07 Seoul, Korea Julieta Pisanty-Levy3 INTRODUCTION Health Impact Assessment (HIA), a definition* “…. a combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, program or project on the health of a population and the distribution of those effects within he population. HIA identifies appropriate actions to manage those effects” (adapted from World Health Organization, 1999). *Quigley, R., et al in their article entitled “Health Impact Assessment International Best Practice Principles”

4. IAIA'07 Seoul, Korea Julieta Pisanty-Levy4 INTRODUCTION Health Impact Assessment (HIA)* Human health and the physical and social environment are intricately linked Development planning is typically conducted outside the health sector It’s the health sector that must cope with development-induced health problems *Quigley, R., et al in their article entitled “Health Impact Assessment International Best Practice Principles”

5. IAIA'07 Seoul, Korea Julieta Pisanty-Levy5 HEALTH IN MEXICO Every person is entitled to health protection* Every person is entitled to an environment adequate for development and well-being* Means and basis by which all may obtain health services♣ *Article 4. Political Constitution of the United States of Mexico ♣ General Health Law

6. IAIA'07 Seoul, Korea Julieta Pisanty-Levy6 HEALTH IN MEXICO Faculties of the Ministry of Health Federal Commission for Protection against Sanitary Risks (COFEPRIS in Spanish) Main activities performed by COFEPRIS: 1. Prevention and handling of sanitary risks arising from exposure to chemical, physical and biological factors 2. Epidemic surveillance and control

7. IAIA'07 Seoul, Korea Julieta Pisanty-Levy7 HEALTH IN MEXICO National Strategy for Better Health Promotion and Prevention (2007-2012) Measures will be adopted to avoid or decrease health risks and dangers due to lack of basic sanitation and environmental pollution control Health depends, among other factors, upon the existence of stable ecosystems and favorable environments

8. IAIA'07 Seoul, Korea Julieta Pisanty-Levy8 HEALTH IN MEXICO Article 4. Political Constitution of the United States of Mexico doesn’t clearly establish the link between health and environmental quality. It doesn’t make reference to programs or development projects whose activities could fall upon the health of the population involved.

9. IAIA'07 Seoul, Korea Julieta Pisanty-Levy9 HEALTH IMPACT ASSESSMENT (HIA) Should HIA be implemented in Mexico, it would be necessary to consider: The objectives Entities Working methodologies Types of evaluation Stakeholders

10. IAIA'07 Seoul, Korea Julieta Pisanty-Levy10 ENVIRONMENTAL IMPACT ASSESSMENT IN MEXICO – WHAT WE DO Thirty years of experience General Ecological Equilibrium and Environmental Protection Act Environmental Impact Assessment Regulation Environmental Impact Assessment Proceedings at the Federal level Ministry of Environment and Natural Resources (SEMARNAT in Spanish) Department of Environmental Impact and Risk Assessment (DGIRA in Spanish)

11. IAIA'07 Seoul, Korea Julieta Pisanty-Levy11 ENVIRONMENTAL IMPACT ASSESSMENT PROCEEDINGS AT THE FEDERAL LEVEL Environmental Impact Statements of development projects are presented, reviewed, approved or rejected. DGIRA requests technical opinions from groups of experts or other federal public administration entities which provide additional support to facilitate resolutions. There are guidelines to help project proponents write the EIS but don’t contemplate evaluation of health impacts on the population

12. IAIA'07 Seoul, Korea Julieta Pisanty-Levy12 ENVIRONMENTAL RISK STUDIES The main objective is to assess extremely risky activities. They must include the necessary programs to prevent accidents or risks to society and the environment. Provide external plans to respond to possible emergencies.

13. IAIA'07 Seoul, Korea Julieta Pisanty-Levy13 ENVIRONMENTAL RISK STUDIES Guidelines to facilitate the presentation of diverse levels of environmental risk studies. The word “health” is not mentioned at all. None of the guidelines requests the description of the potential human population that could be affected by the project, although the developer must report potential radii of affectation.

14. IAIA'07 Seoul, Korea Julieta Pisanty-Levy14 ENVIRONMENTAL IMPACT ASSESSMENT IN MEXICO – WHAT WE DO NOT DO HIA is not an integral part of traditional environmental impact statements. Strict application of some environmental standards (like the one that protects wetlands and mangroves), could lead to differences of opinion among environmental an health authorities.

15. IAIA'07 Seoul, Korea Julieta Pisanty-Levy15 ENVIRONMENTAL IMPACT ASSESSMENT IN MEXICO – WHAT WE DO NOT DO Social impact assessments are not conducted either. Potential negative or positive impacts over a population don’t regularly fit into the decision making process. Some rather large projects have been seriously questioned by public opinion. A number or groups of civil society consider potential health impacts to be very significant.

16. IAIA'07 Seoul, Korea Julieta Pisanty-Levy16 QUESTION Should health impact assessment be an integral part of the environmental assessment, or should it be conducted separately ?

17. IAIA'07 Seoul, Korea Julieta Pisanty-Levy17 ENVIRONMENTAL IMPACT ASSESSMENT IN MEXICO – WHAT WE SHOULD DO Through the EIA proceeding, the Department of Environmental Impact and Risk Assessment could solicit technical opinions from state governments and other organisms on epidemiologic themes, potential risks and health impacts Through trans-sector or multi-sector collaboration agreements with the Federal Commission for Protection against Sanitary Risks (for example), the identified impacts could be minimized or avoided

18. IAIA'07 Seoul, Korea Julieta Pisanty-Levy18 ENVIRONMENTAL IMPACT ASSESSMENT IN MEXICO – WHAT WE SHOULD DO Adapt or modify the existing guidelines regularly used to perform risk studies and EIA Public consultation could be another means to include health aspects in project evaluations

19. IAIA'07 Seoul, Korea Julieta Pisanty-Levy19 ENVIRONMENTAL IMPACT ASSESSMENT IN MEXICO – WHAT WE SHOULD DO Health professionals could analyze qualitative and quantitative data in order to identify and assess health impacts Health government entities could intervene. Current administrative procedures would have to be adapted to facilitate coordination between different sectors

20. IAIA'07 Seoul, Korea Julieta Pisanty-Levy20 ENVIRONMENTAL IMPACT ASSESSMENT IN MEXICO – WHAT WE SHOULD DO Appropriate level at which to apply the HIA would be necessary Work methodologies will be needed in case the HIA becomes part of the current EIA proceedings or is conducted separately

21. IAIA'07 Seoul, Korea Julieta Pisanty-Levy21 CONCLUSIONS Advances in EIA in Mexico are significant, in spite of the fact that social and HIA should also be carried out EIA in Mexico is a discipline governed by administrative law in which the functions of environmental authorities are established in a rigidly, defined fashion that does not allow for evaluation of health impacts upon the population

22. IAIA'07 Seoul, Korea Julieta Pisanty-Levy22 CONCLUSIONS The Mexican judicial framework foresees the existence of coordination and cooperation agreements that might constitute a means of providing for participation between the health and environmental sectors in order to prevent health risks and impacts.

23. IAIA'07 Seoul, Korea Julieta Pisanty-Levy23 CONCLUSIONS In the event that health impact assessments should be carried out, it would also be necessary for the Federal Commission for Protection against Sanitary Risks (COFEPRIS), to be endowed with the functions and administrative procedures necessary to penalize the proponents whose projects could cause health impacts in the population

24. IAIA'07 Seoul, Korea Julieta Pisanty-Levy24 CONCLUSIONS The objectives of the HIA should be clearly established; appropriate guidelines must be created; work methodologies have to be proposed; levels of application and participating entities must be defined; and means of public participation in the evaluation process must be determined