Incorporating Community Health into Operations. Presented by Dr. Janis Shandro

Transcription

1 Incorporating Community Health into Operations Presented by Dr. Janis Shandro

2 The Business Case for Community Health Health concerns often underpin the social acceptance of a project Driver of occupational health risk Have a direct and significant impact on the bottom line Often are underappreciated and uncharacterized

3 Enabling a more Predictable Setting & Accountability Impact Assessment Risk Assessment Permitting Requirement Action Plans Management System Ability to Identify, prevent, mitigate or compensate impacts and risks effectively Reduce impact on communities Reduce risk to project Reduced risk of cost escalation

4 Comparison of Social Spending Vs. Project Impacts Item Cost of a typical community relations program Cost of a typical international standard resettlement program Cost of a typical strategic social investment program Cost of local employment training programs Typical of contributions in participation agreements Typical cost of local contractor programs Typical cost of road resurfacing Typical costs of large infrastructure (eg. dams) Cost $1-5M/yr $50k-$650k / HH $1-5M/yr $1-5 M overall $1-5 M / yr <$1 M overall $1 M/mile $100 M

5 Comparison of Social Spending Vs. Project Impacts Item Salaries of manpower idle (direct and contractor) Cost of services contracted through hiatus Cost of senior executive time focused on resolution Cost of delays in terms of penalties, debt finance, etc. Costs remedial measures (compensation, additional programs, Cost of additional security measures moving forward Cost Up to $250k/day Up to $250k/day $100sK - $1sM/day $1s - $10s of M/day $1s - $100s M Up to $10s M/yr Cost of reputational damage to company??? Additional future cost of raising capital??? Legal costs (contract reviews, law suits, permitting issues etc)???

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7 Social Management System: Best Practice Social Management System Impact & Risk Assessment Structure & Action Plans Organization & training Engagement & Grievances Monitoring & Reporting Dynamic continuous Commensurate with scale of impacts and risks Change through life cycle

8 What is Health? A complete state of physical, mental and social wellbeing, and not merely the absence of disease or infirmity (WHO 1946)..and the extent to which an individual or a group is able, on the one hand, to realize aspirations and to satisfy needs, and on the other, to change or cope with the environment (WHO 1984) and health is therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities (WHO 1986)

9 What is Health? A holistic model of health that supports the interconnectedness and importance of mental, spiritual, physical and emotional dimensions Mental Spiritual Emo5onal Physical

10 What Influences Health? Collective Determinants Individual Determinants Human Health Outcomes 10

11 DETERMINANTS OF HEALTH Individual Social Status Education Genetic Endowment Gender Personal Behaviour and Coping Skills Child Development Collective Social Support Networks Culture Physical Environment Employment and Working Conditions Health Services Conflict

12 PHYSICAL/ENVIRONMENTAL DETERMINANTS Photo: W. Eugene Smith (1971) Exposure to harmful substances

13 IMPORTANCE OF SOCIAL DETERMINANTS Range of Complex Health Outcomes CULTURAL DISLOCATION OF ABORIGINAL PEOPLE Youth Suicide Addiction Behavioural Disorders Endemic Violence

14 COMMUNITY HEALTH AND SAFETY BEST PRACTICE Avoid or minimize risk with particular attention to vulnerable groups. Requires a detailed understanding of affected communities. Standalone HIA or included in the ESIA.

15 COMMUNITY HEALTH & SAFETY OVERVIEW Locate and Identify Affected Communities Understand how these communities Experience Perceive & Respond To Risks and Impacts Stand Alone HIA Health incorporated into ESIA Baseline Conditions

16 Community Health " One of the more challenging topics to address " Why? Ø Community health is as complex as a mine conditions are context specific Ø Multiple factors influence community health (cumulative effects) Ø Companies often rely on external experts who often come from one discipline or another

17 EXAMPLES OF COMMUNITY HEALTH AND SAFETY ISSUES ADDRESSED IN A RISK/IMPACT ASSESSMENT Infrastructure and equipment design safety Hazardous materials management and safety Community exposure to disease (including communicable diseases associated with the influx of workforce such as HIV/AIDS and other sexually transmitted infections)

18 EXAMPLES OF COMMUNITY HEALTH AND SAFETY ISSUES Traffic Use of security personnel Emergency preparedness and response Ecosystem services

19 Opportunities To Incorporate Community Health Into Operations Inclusion of Health within the EA/EIA/SIA Standalone Health Impact Assessment Health Baseline Studies Management Plans Monitoring Programs

20 Inclusion Of Health Within EIA/SIA " Generally one small section within an EIA/SIA " Poorly done " Focus is on health service delivery or regional health data " Generally accomplished by non-specialists in this area (either environmental scientists or social scientists)

21 Health Impact Assessment " A dedicated field of practice " International guidance available " HIA s are becoming more frequent, especially in developing nations " Often takes a western medical approach

22 Health Impact Assessment Road Map Project Concept Feasibility studies; project planning Project Cycles Construction Operations Downsizing, decommissioning; divestment REVIEW Legislation & Project Information Hazard Types, Health Hazard ID Modeling & Ranking Significance Criteria Define Roles and Responsibilities Effectiveness Screening Scoping Risk Assessment, Assessing Impact Decision Making, Establishing Priorities, Reporting Implementation & Monitoring Evaluation Health Context Define TOR Baseline Data Health Management Plan Surveillance System Audit Stakeholder Communication and Consultation

23 Health Impact Assessment Advantages of an HIA þ Give you a very accurate representation of clinical baseline conditions (health outcomes) þ Can identify community health priority areas þ Can clearly identify health risks to workforce and operations (TB, HIV, Malaria)

24 Health Impact Assessment Challenges of an HIA þ Ethics requires consent þ Contingency plan for positive diagnoses þ Methods fail to incorporate Indigenous health models or determinants þ Recommendations are often weak accomplished by those lacking a technical or financial understanding of the business in addition to insight into the local context

25 Health Impact Assessment Level Voluntary Regulatory Na5onal or subna5onal Interna5onal Countries having policies that support HIA but do not require it: many European countries USA (through the NEPA) increasing # of Asian countries (e.g. China and Mongolia) Interna5onal ins5tu5ons recommending HIA as important: WHO Regional development banks European Union ICMM, IPIECA Different legisla5on and requirements at na5onal or subna5onal level: certain states of Australia and New Zealand some Asian countries Requirement that health be considered according to IFC PS4: loan agreement with IFC loan agreement with EPFIs Adapted from Winkler et al., 2013

26 Health Impact Assessment " Reality is: HIA s are often not required by IFI s or nations " In Canada the inclusion of an HIA into the EA process is highly unlikely in the near future

27 Health Baseline Studies: Approach Mul5- method Approach Need to know baseline condi5ons to: Fully understand the social context in which you are opera5ng To address project risk of health impact allega5ons Informs the development of numerous management plans

28 PRINCIPLES OF A HEALTH BASELINE Contextual Data Background information Quantitative Data Health statistics Qualitative Data Interviews with health care professionals National/Provincial/ Regional level reports/statistics Health Outcome/ Status Data Focus groups with community members

29 Case Study: Health Baseline Asian country for large scale extractive project ($9 Billion) pre-construction

30 Health Baseline Studies (3 WEEKS) (2 DAYS) (3 WEEKS) Desktop Literature Review country context Na5onal/Regional Data Collec5on Mee5ng with Na5onal ministry of health officials and leading na5onal health NGO s Country specific context (desktop) APPROACH Local Data Collec5on Mee5ngs with local health leaders Survey to community health experts Follow up one on one interviews with village prac55oners deeper understanding of the context Collec5on of health records (quarterly) Supplemented by self- reported health survey for affected popula5ons

31 Management Plans Community Health information will often inform a standalone MP and/or will intersect with other MPS Ø Influx MP Ø Communicable Disease MP Ø Traffic MP Ø Emergency Response MP Ø Workers Accommodation MP Ø Health and Safety MP Ø Hazardous Material/Waste MP Action orientated Mitigation measures Roles and Responsibilities Budget Timeline

32 Management Plans Easy to develop More challenging to implement Especially when EPC s and subcontractors are involved Can be assisted by both internal and external monitoring

33 Health Monitoring Programs Internal and External Monitoring is optimal Internal assist with implementation efforts and to ensure company activities mitigate negative impacts to community health External Can health identify potential health risks to project activities and impacts a project may be having on communities

34 Internal and External Monitoring Internal have we met our health commitments; does our workforce understand our commitments; critical health issues and risks; is our workforce receiving health training and coverage? External what are the current health conditions in the community? Do they hold risk for our workforce? What do we have to do to ensure the risk does not elevate? Conditions are elevated now what!?

35 INDICATORS FOR CH&S Leading ac5onable effec5veness Inputs and condi5ons Influence Proac5ve Evolves Lagging retrospec5ve failures Outcomes No influence Reac5ve Sta5c

36 THANK YOU!!!