The Importance of Health Impact Assessments

by Candice Youngblood

In October 2022, Comite Civico Del Valle held its 11th Environmental Health Leadership Summit at Imperial Valley College – the first in three years since the COVID-19 pandemic. Over 300 government leaders, academics, advocates, and supporters came together to discuss questions on equity in minerals extraction, recovery of the Salton Sea, and the future of “Lithium Valley.”1 In his opening remarks to the Summit, Comite’s Executive Director Luis Olmedo said, “This is a historic time . . . Lithium Valley, if it comes to pass, will mean our long-underrepresented home will have a real role in the fight against climate change by being the source of a safe and sustainable supply of a mineral critical to this nation’s future.”

Luis Olmedo – who sat on the Blue Ribbon Commission on Lithium Extraction in California3 – was not exaggerating. Lithium plays an important role in producing electric vehicles, portable consoles, and battery storage. Currently, only 1 percent of lithium is mined and processed in the United States,4 and the Imperial Valley’s abundance of geothermal brine at the Salton Sea has the potential to meet 40 percent of the world’s lithium demand.5 The Imperial Valley therefore has an opportunity to “become a global lithium producer and exporter and support Imperial Valley residents by creating new green jobs as well as clean economic development for the region.”6 Last year’s passage of Senate Bill 125 – which authorized the state to assist in developing Lithium Valley – makes this a truly historic time for their community.
I was invited to the 2022 Summit to provide legal context on the California Environmental Quality Act as a speaker on the panel “Importance of Health Impacts Assessments in Environmental and Land Use Decisions.”7 The ongoing opportunities for the public to participate in the Lithium Valley Specific Plan and Programmatic Environmental Impact Report and the Salton Sea Renewable Resource Health Impact Assessment processes made this conversation timely. It is my hope that attendees left that conversation feeling better equipped to wield the environmental laws at their disposal and make their voices heard in the future of “Lithium Valley.”

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Candice Youngblood, second from the left, speaking at the 11th Environmental Health Leadership Summit at Imperial Valley College, October 22, 2022. Photo: Victor Beas/Comite Civico del Valle

Health Impact Assessments

Health Impact Assessments (HIA) initially arose overseas in the early 2000s and have since become more popular in the United States as agencies and organizations seek to incorporate perspectives and expertise of community stakeholders in their health decision-making.8 The United States Environmental Protection Agency (EPA) defines a Health Impact Assessment as “a tool designed to investigate how a proposed program, project, policy, or plan may impact health and well-being and inform decision-makers of these potential outcomes before the decision is made.”9 Health Impact Assessments include both quantitative and qualitative analysis that aim to predict potentially significant health effects resulting from changes in the physical, social, and economic environment. They also include health-promoting recommendations.

A Health Impact Assessment typically comprises six steps:

1. Screening: The HIA team and stakeholders determine whether an HIA is needed, can be accomplished in a timely manner, and would add value to the decision-making process.
2. Scoping: The HIA team and stakeholders identify the potential health effects that will be considered and develop a plan for completing the assessment, including specifying their respective roles and responsibilities.
3. Assessment: The HIA team evaluates the proposed project, program, policy, or plan and identifies its most likely health effects using a range of data sources, analytic methods, and stakeholder input to answer the research questions developed during scoping.
4. Recommendations: The HIA team and stakeholders develop practical solutions that can be implemented within the political, economic, or technical limitations of the project or policy to minimize identified health risks and to maximize potential health benefits.
5. Reporting: The HIA team disseminates information – including the HIA’s purpose, process, findings, and recommendations – to a wide range of stakeholders.
6. Monitoring and evaluation: The HIA team and stakeholders evaluate the HIA according to accepted standards of practice. They also monitor and measure its impact on decision-making and health.10

Health Impact Assessments are often confused with the similarly named Health Risk Assessment (HRA). EPA defines a Health Risk Assessment as “the process to estimate the nature and probability of adverse health effects in humans who may be exposed to chemicals in contaminated environmental media, now or in the future.”11 Health Impact Assessments and Health Risk Assessments are different in important ways. First, Health Impact Assessments make evidence-based judgments on the health impacts of a decision and make health-promoting recommendations, while Health Risk Assessments only quantify the health risk from a change in exposure to a particular hazard. For example, a Health Risk Assessment may analyze the relationship between the pollutant diesel and the health outcome lung cancer. Second, Health Impact Assessments use a broad framework to predict all the potentially significant health effects that could result from changes in the physical, social, and economic environment. This can include analysis of many different impacts on the determinants of health, such as housing, transportation, employment and income, noise, air quality, access to goods and services, access to parks, and social networks. In contrast, a Health Risk Assessment typically does not consider existing health conditions or disparities in a community. In sum, a Health Impact Assessment is much broader than a Health Risk Assessment.

Using Health Impact Assessments in Environmental and Land Use Decisions

A Health Impact Assessment can be helpful for environmental and land use decisions, and they dovetail nicely with the National Environmental Policy Act (NEPA) and California Environmental Quality Act (CEQA). NEPA and CEQA are two of the most powerful legal tools that frontline communities can use to find out what projects are happening in their neighborhoods, what the impacts of those projects will be, and what the government plans to do to minimize the harm those projects will have on them.
NEPA – popularly known as “The People’s Environmental Law” – requires federal agencies to prepare an environmental impact statement (EIS) for major federal actions significantly affecting the quality of the human environment. An EIS must analyze direct, indirect, and cumulative health effects of a project. While this environmental review is most often done on an individual project level, an agency will sometimes prepare a programmatic EIS to evaluate the effects of broad proposals or planning-level decisions, which may include several individual projects, decisions implemented over a long timeframe, or decisions implemented across a large geographic area.
After NEPA was enacted in 1965, California enacted its own state version in 1970. CEQA requires state agencies to similarly prepare an environmental impact report (EIR) for state agency actions. While there are some key distinctions between the statutes – including that some argue CEQA has “more teeth” than NEPA – the important distinction is that NEPA applies to federally funded projects and CEQA applies to state-funded projects.
Both statutes are designed to involve the public in the agency’s decision making at multiple steps. The public is invited to participate when the agency issues a notice of intent to prepare its EIS/EIR, during EIS/EIR scoping, when a Draft EIS/EIR is published for public review and comment, when a Final EIS/EIR is made publicly available, and when monitoring the implementation of the proposed action and the effectiveness of any associated mitigation.
While Health Risk Assessments are sometimes conducted as part of an EIS/EIR, Health Impact Assessments can be more powerful in many ways. When the agency is scoping potential direct, indirect, and cumulative health concerns during the EIS/EIR scoping stage, the stakeholder meetings that are inherent in Health Impact Assessment scoping can ensure thoroughness and tap into community knowledge and experience. After health concerns are identified during scoping, a Health Impact Assessment can decide which concerns should be prioritized. This could entail producing new analyses, such as analyzing impacts not previously analyzed because of the expanded scope; extensions of existing analyses; and developing potential mitigation measures to address significant health impacts. Finally, a Health Impact Assessment can be useful for reporting, receiving, and responding to public comment on (1) baseline health conditions and determinants of health, (2) the analysis of health impacts, and (3) potential mitigation measures proposed in the Draft EIR/EIS.12

The Salton Sea Renewable Resource Health Impact Assessment

Among other things, SB 125 provides funding for developing a Lithium Valley Specific Plan and Programmatic Environmental Impact Report (PEIR). The Lithium Valley Specific Plan and PEIR are intended to map out and expedite the development and permitting of additional power plants, mineral recovery, lithium battery manufacturing, and other renewable industries within an approximately 51,786-acre area adjacent to the Salton Sea.13 The goal of expediting development and permitting is achieved by producing a programmatic EIR instead of project-level EIRs. “In the absence of an exhaustive California Environmental Quality Act process for every proposed project planned for the Salton Sea, the agreement was that a detailed health impact assessment was to be the trade-off. It’s not a perfect arrangement, but it’s the devil you know,” says Luis Olmedo.14 “With the health impact assessment, potential effects on people will be studied that could potentially result in policy and programs to remediate concerns.”15
The Imperial County Public Health Department is leading the Health Impact Assessment process, which was projected to begin in April 2023 and run for twelve to fifteen months. According to its latest Request for Proposals,16 the Salton Sea Renewable Resource Health Impact Assessment’s stated goals are to
a) provide an in-depth, comprehensive analysis of the potential health impacts of lithium extraction for all projects being evaluated under the Imperial County Lithium Valley Specific Plan and Programmatic Environmental Impact Report;
b) address social determinants of health;
c) explore, collect, and analyze baseline data and conditions; and
d) identify findings that will be used to inform decisions, influence policy development, support decision-making, as well as offer practical and evidence-based recommendations for ways to minimize risks and support opportunities to maintain and/or improve health in all Lithium-focused plans and programmatic Environmental Impact Reports (EIRs).17
Throughout this process, it will be critical to make sure impacted community members are fully engaged to understand all aspects of the “Lithium Valley” effort. Stakeholders who are interested in learning more and participating in the HIA process should follow Comite Civico Del Valle – which facilitates the Lithium Valley Community Coalition, a group of local stakeholders18 – and the Imperial County Public Health Department on social media for updates.
I am grateful to have been in community with Comite at the 2022 Environmental Health Leadership Summit, to point attendees to some legal tools in their toolbox, and to learn from the leadership of the Imperial Valley’s environmental justice community. Comite’s founding principle is an important reminder of this conversation’s significance: “Informed People Build Healthy Communities.” It will be exciting to see Imperial Valley’s residents leverage opportunities like the Health Impact Assessment process to shape this rising lithium industry and ensure it serves their health and economic interests.

Based in Los Angeles, Candice Youngblood is an attorney at Earthjustice. Her experience working with environmental justice communities on NEPA and CEQA advocacy includes supporting their written and oral public comments and representing them in federal and state court.

2) id.
4) according to the U.S. Geological Survey.
5) Footnote to RFP and California Energy Commission.
15) id.
17) id.