The complexity of these issues may appear daunting, for impacts arise not as a product of individual risks, operating in isolation, but as the result of different environmental agents, media and policy domains, working in combination, and often over long time periods. Health effects can also be caused not only by the environment per se, but by the wide range of policies that affect the environment. Moreover, the magnitude of these effects varies depending on how sensitive people are to these hazards, and their ability to adapt to them either by changing the environment or their own behaviours and lifestyles.
In the face of these complexities, traditional methods of risk assessment reach their limits. Assessment cannot be done by looking at individual hazards or issues in isolation, nor only immediate, primary impacts. Instead a much more integrated approach is required that can assess the full range of effects, over the population and over time, and sum these in a meaningful way. Developing and applying such an approach is not easy. Gaps in knowledge, data and tools hamper the process of assessment; the need to co-ordinate action across different policy areas and to take account of different types of impact, poses challenges for policy. The rewards of an effective methodology for integrated environmental health impact assessment (IEHIA) are, however, enormous: not only in terms of improved human health but also through more cost-effective policies.
The INTARESE (Integrated Assessment of Health Risks of Environmental Stressors in Europe) project aimed to help make this possible. By bringing together scientists from a range of disciplines (epidemiology, environmental sciences, biosciences) it developed the theory, tools and data for assessment, and demonstrated their use through a number of case studies. Imperial College London (United Kingdom) coordinated this project, which was funded by the European Commission under the Sixth Framework Programme (FP6). Throughout the research, was run in close collaboration with its sister project HEIMTSA.
The project was structured into several inter-dependent components. The foundations for the approach were laid by agreeing a conceptual framework for integrated environmental health impact assessment, then translating this into a clear, yet flexible, practical procedure. This highlighted the importance of careful issue-framing as the starting point for any assessment. The analytical tools needed for integrated assessment (e.g. for managing an assessment, for exposure assessment, for determining relevant dose-response functions, and for aggregating the effects into an overall measure of impact) were also identified and evaluated, and where necessary new tools were developed. Detailed reviews of the data (data analysing) required to use these tools, were conducted, in order to determine the sufficiency of existing data, and identify areas where improvements in monitoring or reporting were needed. A series of seven, thematic case studies was carried out – covering different environmental media and policy domains – to demonstrate how the approach could be applied, and the benefits to be gained. In addition, a large, multi-factorial study was undertaken, exploring the health effects of policies targeted at combating climate change in the European Union.
Finally, all the outputs and resources of the project were gathered into an on-line IIEHIA System. This provides both the guidance needed to design an integrated environmental health impact assessment, and links to the various data sources and tools that might be needed. It also includes numerous case studies illustrating what is involved in doing an assessment, and what form the results might take. One example of these is the assessment of environmental health impacts of waste management of municipal solid waste (MSW). The system has been thoroughly tested and evaluated with data corresponding to real environmental problems. The technology readiness level can therefore be estimated as 9 on the TRL scale.