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Consideration of health aspects in environmental impact assessments for roads

Karin Alenius

MSc Project Manager: Dr Bertil Forsberg Department of Public Health and Clinical Medicine, Umeå University.

Consideration of health aspects in environmental impact assessments for roads

Karin Alenius

MSc Project Manager: Dr Bertil Forsberg Department of Public Health and Clinical Medicine, Umeå University S-901 87 Umeå, Sweden

National Institute of Public Health, Sweden 2001:27 First edition, first printing (1­200) isbn 91-7257-113-6 · issn 1104-358x Graphic design: Original Et ab Print: Tryckcentrum i Stockholm ab, 2001

Abstract

The third Ministerial Conference on Environment and Health (London, 16­18 June 1999) for European Member States of the World Health Organization (WHO) held a meeting which among other things resulted in the Charter on Transport, Environment and Health. The Swedish National Institute of Public Health is the Swedish contact point for this Charter and the initiator of this study. The aim of the study was to evaluate how health issues were presented in environmental impact assessments for roads. The study included two parts. In the first part a protocol was produced that was to be used for examining environmental impact assessments in a standardized way. The protocol was based on a literature study with a main focus on community noise and air pollution. The second part of the study contained an examination of environmental impact assessments. These documents were collected from the Swedish Road Administration and from a few major municipalities. The results of the study showed that only a few of those who had written the documents had used help from experts on health issues. An almost exclusive way to show the consequences of health in the projects was by comparison with guidelines and limit values. Most of the environmental impact assessments did not include a presentation of the affected population. Many of the studied documents had a description of health related goals, but only a few presented how their project would meet these goals. Key-words: environmental impact assessment, human health, community noise, air pollution.

Summary

In 1999, the third conference of European environmental and health ministers for the member states of the WHO European Region was held in London. The conference resulted in the adoption of a Charter on Transport, Environment and Health. An important part of the work on achieving transport solutions that are sustainable from the standpoint of health is to pay greater attention to health aspects in the impact assessments which form the basis for decisions in transport issues. The National Institute of Public Health is the Swedish contact point for the WHO-coordinated European cooperation in this area, and is the initiator of this study. The aim of the study was to find, by examining environmental impact assessments for road projects, how the health aspects are treated and presented in a selection of such documents. The study is in two parts, in the first of which a check list was drawn up. This check list was then used in the second part of the study as the basis in examining the way health aspects were described in the collected environmental impact assessments. Use of this check list made it possible to scrutinise the environmental impact assessments in a uniform manner. The design of the check list was based on a study of the literature relating to this area. The emphasis in the literature study was laid on community noise and airborne pollution, since it was found during a brief examination of a number of environmental impact assessments that, in spite of their important role in this context, the treatment of these issues had evident shortcomings. The sample of the documents for examination consisted of environmenmtal impact assessments for road projects in urban environments from 1990 onwards. These were collected from the Swedish Road Administration regions and some of the major municipalities in Sweden. The results of the analysis showed that in only a few of the environmental impact assessments were experts consulted in regard to the health effects of the different projects. Descriptions of the health impacts of the projects were almost exclusively based on comparisons with current standard, guideline and limit values. In the majority of the examined environmental impact assessments, there was no description of the affected population. Several of the studied documents described the national health related goals, but in many cases they did not state how the projects met these goals. For only a few of the projects subject to the provisions of the Environmental Code regarding consideration of environmental aspects was there a description of the extent to which the project satisfied these provisions.

Contents

Abstract Summary Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The aim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Environmental impact assessment and its purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Environmental impact assessments according to the Road Act and the Planning and Building Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The process according to the Road Act. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The process according to the Planning and Building Act . . . . . . . . . . . . . . . . . . . . . Health in this context. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Definition of health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health in environmental impact assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 2 2 2 3 3 4 5 5 6 7 7 7 7 7 7 8 8 8 8 8 9 9 9 9 10 10 10 11 11 12 15 15 16 16 16 17 18 19

Material and method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arrangement and focus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Definitions and limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Traffic safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hazardous goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Airborne pollutants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Noise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Barrier effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Outdoor activities and recreation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Definition of effect and impact. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Studies of the literature and the basis for the production of a Check list . . . . . . . . . . . . . . Identification of relevant health effects and health impacts . . . . . . . . . . . . . . . . . . . . . . Description of the state of knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary of relevant regulations and goals and the conditions relating to these . . . . . . . The population and its exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calculations of health impacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health effects of airborne pollutants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calculation of health effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods for calculating concentrations/exposure . . . . . . . . . . . . . . . . . . . . . . . . . . Threshold limit values and environmental quality standards for airborne pollutants . Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The health effects of noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Effects of noise on humans and the present state of knowledge . . . . . . . . . . . . . . . . Calculation of health effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Guidance values and goals for noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The check list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis of the studied environmental impact assessment . . . . . . . . . . . . . . . . . . . . . . . . . Expertise and method used in identifying essential health aspects . . . . . . . . . . . . . . . . . Identified health effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Traffic safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hazardous goods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Barrier effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vibrations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Outdoor activities/recreation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Airborne pollutants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The population in these environmental impact assessments . . . . . . . . . . . . . . . . . . . . . Presentation of the population concerned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Description of health effects on the population concerned. . . . . . . . . . . . . . . . . . . . Methods of describing how the health of the population is affected . . . . . . . . . . . . . . . Effect-modifying factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Validation of calculation models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agreement with the stated goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Project goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20 21 21 21 21 21 22 22 22 22 22 22 22 22 23 23 23 24 24 24 24

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analysis of the studied environmental impact assessments . . . . . . . . . . . . . . . . . . . . . . . . . Expertise and method used in identifying essential health aspects . . . . . . . . . . . . . . . . . Identified health effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The population in these environmental impact assessments . . . . . . . . . . . . . . . . . . . . . Methods of describing how the health of the population is affected . . . . . . . . . . . . . . . Effect-modifying factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calculation models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Agreement with the stated goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Project goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cumulative effects and strategic decisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Important conclusions of the analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 25 25 25 26 26 27 27 27 27 28 28 28 28

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Elektronic references . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Introduction

Transport systems and transport solutions can have an essential effect on human health and wellbeing owing to their significance for air quality, noise levels, the risk of injuries, facilities for daily exercise and recreation and, in a longer perspective, for sustainable development without e.g. climatic changes (Dora, 1999). Airborne pollutants such as oxides of nitrogen and carbon monoxide in urban areas are today mostly produced by motor vehicles. Together with wood fires, traffic constitutes the most important local sources of particulates, volatile organic compounds (VOC) and polyaromatic hydrocarbons (PAH). Having previously been regarded as a problem of relatively low priority, the negative consequences of air pollution on humans have recently been re-evaluated (World Health Organisation [WHO], 2000b). A study from France, Switzerland and Austria that has attracted a lot of attention estimates that 6% of mortality is related to air pollution, half of which is caused by vehicle exhausts (Künzli et al, 2000). Transport is the greatest source of community noise in Europe, and motor vehicles the principal cause of exposure, with the exception of those living near airports and railway lines (Stanners & Bordeau, 1995). In Sweden about 9% of the population is estimated to be disturbed by road traffic noise. (National Board of Health and Welfare [SOS] et al, 2001). Cycling or walking can confer great health benefits. Even if the activity does not exceed 30 minutes over a day, the risk of developing heart disease and diabetes may be cut by half (US Department of Health and Human Services, 1996). The importance of making daily exercise possible, for instance by providing a safe cycle route to work, ought to be an important aspect in decisions concerning transport solutions (Maddison et al, 1997). The above points to a number of health related conditions that may be influenced by e.g. a road project. As more knowledge becomes available regarding the health impacts of road traffic, the need for information for decision makers and the public also increases. Environmental impact assessments are an important source of information as regards the impact of a project on human health and the environment. At present, however, it would appear that the emphasis in the information and discussion is often placed on the possible local effects of the project on the natural environment. At the conference of environmental and health ministers in London in June 1999, a Charter on Transport, Environment and Health was adopted (WHO, 1999). The goal is to achieve transport solutions that are sustainable from the standpoints of both environment and health, and this demands, inter alia, that greater weight is given to health aspects in decisions concerning transport and traffic issues. One point of high priority is that greater consideration should be given to health aspects in impact assessments that form the basis for decisions on such issues. The National Institute of Public Health is the Swedish point of contact for the WHO-coordinated European cooperation in this area, and it has initiated this Swedish study of how health aspects are considered in environmental impact assessments.

The aim

With the Charter on Transport, Environment and Health (WHO, 1999) as the point of reference, this study was initiated in order to throw a light on the way Swedish environmental impact assessments deal with health aspects. The aim of the study is to ­ examine and analyse the way health impacts are treated in environmental impact assessments for road projects and plans concerning traffic solutions, ­ place special emphasis on the way issues concerning the central aspects of airborne pollutants and noise have been described, ­ draw up, as a framework for this examination, a check list for health aspects in environmental impact assessments, ­ give an idea of how effects on air and noise should be described in an EIA.

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Background

Environmental impact assessment and its purpose

An environmental impact assessment, EIA, is both a document and a process. The document contains both an investigation of the environmental effects that may result from a planned measure or activity, and also, usually, descriptions of different ways of carrying out the planned measure or activity. The EIA process is the process which extends from the conceptual stage to a completed document. It contains a limitation of what should be included, collection of facts, scrutiny and analyses of these facts, and consultations so that the views of the authorities and the public may be considered. The purpose of an environmental impact assessment is to enhance knowledge and awareness of environmental and resource management issues and to provide a better basis for decisions (National Board of Housing, Building and Planning, 1996). An EIA must identify and describe direct and indirect effects on people, animals, plants, land, water, air, landscape and cultural heritage, as well as on economical management of land and water. It must describe the interaction between these factors and in this way provide a basis for an overall assessment of the impact that the measures will have on human health and the environment (Training Course for the Environmental Code, 1998).

History

Environmental impact assessments are used in many countries all over the world. Each country has developed its own system for dealing with EIA in the light of its planning and review process (National Board of Housing, Building and Planning, 1996). In the USA National Environmental Policy Act (NEPA), a requirement was imposed in 1969 on federal authorities that they should not make decisions concerning measures of major environmental impact before elucidating what this measure would involve from the environmental standpoint. The decision makers should also find out whether there is an alternative that is better from the environmental standpoint than the proposed measure. A decision must not be made until this has been done. This description of environmental impacts and alternatives was contained in a special document that was called an Environmental Policy Statement (EIS) (Westerlund & Swedish Society for the Conservation of Nature, 1992). Later on, other countries also introduced requirements and procedures for environmental assessment, and the internationally used term became Environmental Impact Assessment (EIA). The common denominator of these systems is that an investigation of environmental impacts must be made before a decision is made, alternative solutions to achieve a similar aim must be produced, and the process must facilitate active public participation (Westerlund & Swedish Society for the Conservation of Nature, 1993). In 1985, the EC Directive "On the assessment of the effects of certain public and private projects on the environment" was adopted. This directive is not as far reaching as the USA requirement concerning Environmental Impact Assessments (Westerlund & Swedish Society for the Conservation of Nature, 1992; National Audit Bureau, 1996). The directive is however formulated as a minimum directive, which means that individual countries can impose stricter requirements in their national legislations. In 1997 a new directive was issued which amended that from 1985. Among other things, this directive is adapted to the ESBO Convention treaty on transboundary impacts. Annexes 1 and 2 of the directive also contain a schedule of a large number of activity types that require an EIA. In Swedish legislation, environmental impact assessments were introduced gradually. In 1981 the Environmental Protection Act was amended to include regulations on environmental impact assessments in conjunction with reviews of permits, and in 1987 the Road Act was extended to include requirements for EIA in conjunction with road construction. The Bill "A good living environment", the aim of which was to introduce and develop EIA in Sweden, was proposed in 1991. The provisions of the Bill as to what an EIA must contain were at about the same level as the minimum requirements in the EC Directive, but the requirements concerning the circumstances in which an EIA could be demanded were stricter (Westerlund & Swedish Society for the Conservation of Nature, 1992). The Bill was passed and EIA was incorporated in Chapter 5 of the Natural Resources Act and also in a number of other acts. In the same year, Sweden signed the ESBO Convention on EIA in regard to transboundary impacts. Even though planning work has always comprised analyses of land use, it was not until 1994 that requirements as to

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Consideration of health aspects in environmental impact assessments for roads

what an EIA must contain were incorporated in the Planning and Building Act. The Environmental Code came into force in 1999. In this, the requirements concerning environmental impact assessments were extended and made more stringent. The opportunities for public participation were also enhanced. Chapter 6 of this Act contains clearer minimum requirements as to what an EIA must contain. There is also a requirement for the description of an alternative location for, and design of, the planned activity or measure. This description is important in order that environmental impact assessments should achieve their aims.

Environmental impact assessments according to the Road Act and the Planning and Building Act

Under the provisions of Sections 14b and 15 of the Road Act, an environmental impact assessment is required when a road is constructed, and, under the provisions of Chapter 5 Section 18 of the Planning and Building Act, for detailed development plans which involve significant impacts on the environment, health or economical management of land, water or other resources. An EIA is also required in many other circumstances and according to other acts, but in this report it is these circumstances that will be discussed. Construction of a road is often a long process. It begins with an overall plan which establishes what construction is required in the country. This plan gives rise to national and regional road management plans. These plans serve as the basis for further planning (Swedish Road Administration [VV], 1995). What the continued planning process is like and what acts it complies with depends on the road management authority concerned. According to Section 4 of the Road Act, the term road management refers to the construction and operation of roads. For public roads in Sweden it is the State that is the road management authority. The municipality may be the road management authority inside the boundaries of the municipality if this promotes good rational road management. The State has delegated road management activity to the Swedish Road Administration, and it is also the Administration that supervises municipal road management. If there are plans for road construction, the Road Administration must for this process comply with the provisions of the Road Act, while the Municipality complies with the provisions of the Planning and Building Act. Depending on the environmental impact of the project, the process for constructing a road according to the Road Act and the Planning and Building Act may be slightly different. The following description of this process focuses on environmental work and the production of an environmental impact assessment.

The process according to the Road Act

The Road Act is closely related to the Environmental Code. In examining proposals according to the Road Act, the provisions of the Environmental Code regarding consideration of environmental aspects, resource management and environmental quality standards must be applied. As regards the procedure in drawing up an EIA according to the Road Act, the requirements in the Environmental Code must be applied. Planning of an individual road project according to the Road Act takes place in several stages. For each stage, a document is produced; the three principal documents are called preliminary study, feasibility study and land acquisition plan. In the preliminary study, the shortcomings and problems of existing roads are discussed. At this stage no road solutions are proposed; the purpose of the preliminary study is to elucidate the conditions for further work (VV, 1999a). When basic data have been produced, a consultative meeting is held. Consultations are entered into with the County Executive Board, the municipality and the affected public. After this consultation, the County Executive Board decides on the basis of the consultative process whether or not the project may be presumed to entail significant environmental impact. After this the regional road administration office decides how further work is to proceed. The next stage is the feasibility study. The objective of this study is to provide the basis for the choice of road corridor and road engineering standard. A road corridor is a wide strip along one or more possible road routes. At an early stage during this planning phase, consultations are held. If the County Executive Board has resolved that the project is presumed to entail significant environmental impact,

Consideration of health aspects in environmental impact assessments for roads

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extended consultations are held with the County Executive Board, municipalities, other authorities, affected organisations and the affected public. If, on the other hand, the project is not presumed to entail significant environmental impact, consultation is mainly confined to contacts with state authorities. After this cunsultative process, an environmental impact assessment is produced. This is an important part of the feasibility study since it determines what impacts the road project will have on the environment, and the contents of the EIA can therefore serve as the basis in choosing a road corridor. According to the Environmental Code, the environmental impact assessment shall contain 1. A description of the activity or measure, with data concerning location, design and scope. 2. A description of the measures that are planned in order to prevent, alleviate or remedy harmful effects. 3. The data that are needed for an assessment of the impact of the activity or measure on human health, the environment and economical management of land, water and other resources. 4. A description of alternative locations, if these are feasible, and a description of alternative designs of the activity or measure, together with the reasons for choosing a certain alternative and a description of the consequences due to the activity or measure not being carried out at all (zero option). 5. A non-technical summary of the above information. The County Executive Board decides whether to approve the EIA. If the project is presumed to entail significant environmental impact, the feasibility study together with its associated EIA is also put on public display. After this the regional office of the Road Administration chooses the road corridor. In the next stage, planning is transformed into design. In this phase, the most appropriate route inside the chosen road corridor must be decided on. The document which is produced is called land acquisition plan, and as in the feasibility study phase, consultations are held before the plan is drawn up. Consultations are held with the affected land owners, authorities and other interested parties. During this consultative process, the proposed road alignment and the contents of the EIA to be drawn up are discussed. The environmental impact assessment that is drawn up has the opportunity of being more detailed than that for the feasibility study, since at this stage of planning a specific alignment is to be decided on inside the chosen corridor. More detailed investigations of e.g. geological and hydrological conditions can be made. The County Executive Board must decide whether to approve the EIA for the land acquisition plan. The plan is put on display, and those affected are given the opportunity to make their observations on the plan. When these observations have been received, a final draft of the land acquisition plan is produced for the decision of the County Executive Board. The plan is then sent to the head office of the Road Administration for approval. If the County Executive Board and the regional office of the Road Administration disagree, the matter is referred to the government for a decision. The decision can be appealed against within three weeks, after which the land acquisition plan has legal effect and the road management authority has the right to occupy the land for road construction. Consideration of permissibility under the provisions of Chapter 17 of the Environmental Code A road project which, during its assessment by the County Executive Board regarding significant environmental impact, comes under the provisions of Chapter 17 Section 1 Clause 20 of the Environmental Code with regard to review of permissibility, shall be subjected to a legal review by the government. The head office of the Road Administration sends a discussion document on this matter to e.g. the affected state authorities. After this, it submits its own statement and the feasibility study to the government. The feasibility study serves as the basis for the review. If the government finds that the project may proceed, the regional office of the Road Administration draws up a land acquisition plan, and this is subjected to the procedure described above.

The process according to the Planning and Building Act

Municipal planning is carried out on several levels, from structure planning to more detailed planning for specific areas of municipal land. Under the provisions of Chapter 1 Section 3 of the Planning and Building Act, all municipal land must be covered by a structure plan. This plan must set out the use of land and water areas and the way

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Consideration of health aspects in environmental impact assessments for roads

in which public interests according to Chapter 2 of the Act and national interests according to Chapters 3 and 4 of the Environmental Code are to be catered for. Among other things, a structure plan shall serve as a control instrument for building development, infrastructure and environment in the municipality. It shall also provide guidance for the way in which built environments shall be preserved. In addition, the act serves as a basis for both further planning and detailed development planning. Detailed development plans are used to plan and regulate major changes in a certain area of municipal land. According to Chapter 5 Section 1 of the Planning and Building Act, the aim is to ascertain the suitability of the land for some kind of building development. Area regulations are yet another planning instrument for municipal land. Area regulations may be adopted in certain areas where the municipality wants to secure the purposes of the structure plan. The function of area regulations is approximately the same as that of detailed development plans, but they cover a smaller number of issues. Planning process in detailed development planning For the construction of a road in a municipal area where the municipality acts as the road management authority, a detailed development plan must be drawn up. A road project can be included as part of a detailed development plan. The road project may also be the reason that a detailed development plan is produced. In detailed development planning, both the normal and simplified approval procedure can be applied. The latter is applied when the proposal is of limited significance and has no interest for the public, and is compatible with the structure plan and the scrutiny report of the County Executive Board in this respect. Under the provisions of Chapter 5 Section 18 of the Planning and Building Act, the detailed development plan should be based on a programme that sets out the premises and goals of the plan. If the municipality is of the opinion that the plan may be presumed to entail significant impact on the environment, health or economical management of land, water and other resources, an EIA must be appended to the plan programme. When the draft detailed development plan is ready, the municipality must consult the County Executive Board, authorities, the affected municipalities, property owners and individuals who have an essential interest in the proposal. The aim of the consultation is to acquire information and to provide information for those affected and for interested parties. This results in an improved decision base, increases transparency and provides greater opportunities for public control. It is important that consultation should take place at an early stage in order that the planning process may be made more effective and satisfactory participation by the public ensured. During the period of consultation, the County Executive Board shall make available the planning documents, provide advice on the application of the public interests, ensure that national interests are safeguarded and that the environmental quality standards in Chapter 5 of the Environmental Code are observed, and shall coordinate intermunicipal interests. During the consultation, the reasons for the proposal, its consequences and alternative solutions, if any, should be discussed. The results of the consultative process must be set out in a consultation report. The next step is an announcement concerning public display, followed by public display of the detailed development plan and the environmental impact assessment. Observations on the planning proposal must be submitted to the municipality in writing during the period of display. After the period of display, the municipality must, under the provisions of Chapter 5 Section 27 of the Planning and Building Act, examine the observations received and issue a statement concerning these. This statement is sent to those whose observations have not been accepted. The County Executive Board must also be sent this statement. Finally, the municipal board adopts and approves the detailed development plan and the environmental impact assessment. Relationship between the Environmental Code and the Planning and Building Act The provisions of the Environmental Code regarding activities or measures that affect the environment and health apply parallel with the Road Act and the Planning and Building Act (, 1998). However, the relationship of the Code with these two acts differs in its scope. During preparatory work on the Code, the government stated that environmental impact

Consideration of health aspects in environmental impact assessments for roads

5

assessments for plans shall as far as possible perform the same function as environmental impact assessments in accordance with the Environmental Code. There are however some differences which may be important to point out. The Environmental Code describes in detail the aim of an EIA, the procedure in producing an EIA and the contents of an EIA. The Planning and Building Act contains no regulations concerning procedure and contents, but it directs when an EIA shall be drawn up (significant impact) and states its aims (to make an overall assessment possible). One of the reasons that the Planning and Building Act has not specified the procedure and contents is that detailed development plans are so different in their aims and degree of detail that it is difficult to lay down uniform requirements (National Board of Housing, Building and Planning, 2000). Another essential difference between environmental impact assessments for detailed development plans and for projects is that an EIA for a detailed development plan must describe the impacts inside the area for which the plan applies. There is thus a requirement for a description of the impacts due to maximum utilisation of the rights conferred by the plan, not only the impacts of an individual project.

Health in this context Definition of health

The concept of health is not unambiguously defined or self evident, and different definitions are used. The preamble to the Environmental Code states that the Act shall be applied so that "human health and the environment are protected against damage and adverse effects ..." Chapter 9 Section 3 of the Environmental Code defines the term adverse effects on human health as "disturbance which, according to medical or hygienic judgment, may adversely affect health and which is not slight or purely temporary". The intention of the Act is that people shall not be exposed to disturbances that produce a negative health effect, and directs attention to traditional environmental hygienic risk factors (such as airborne pollutants, noise, radiation etc). The preamble to the Planning and Building Act states that the provisions of the Act concerning planning "have the aim, while paying due regard to the freedom of the individual, to promote a societal development with equal and good social living conditions, and a good living environment, sustainable in the long term, for people in today's society and for future generations". The intention of the Act is thus to create a good living environment in a broad sense.

Health in environmental impact assessments

One of the five cornerstones of the Environmental Code is that "human health and the environment shall be protected from damage and adverse effects". Information regarding effects on human health must therefore be included in an EIA. In recent years, health impact assements (HIA) have become an established concept. The aim of health impact assessments is to elucidate the health impacts of a decision or a change. A proposal for the way in which an HIA may be carried out has been produced by the Swedish Association of Local Authorities and the Federation of County Councils (Federation of County Councils, 1999). To sum up, it may be said that an environmental impact assessment shall when this is relevant include a health impact assessment, and that its formulation is some extent prescribed by legislation regarding EIA. The same regulations regarding procedure and documentation do not exist for health impact assessments as such.

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Consideration of health aspects in environmental impact assessments for roads

Material and method

Arrangement and focus

This study may be seen as consisting of two parts. A check list was first of all drawn up for use later in examining a sample of environmental impact assessments. This was based on a section (see "Studies of the literature ­ production of check list") which gave reasons and examples of knowledge and methods that are relevant for health aspects in environmental impact assessments relating to roads and traffic schemes. In the light of what has been discussed above, the section and the proposals are based not on any specific legal provisions regarding content, but on a subjective appraisal of what would be possible and appropriate to describe. An outline examination of a few environmental impact assessments indicated that community noise and airborne pollutants, in spite of their evident significance for human health, tend to be treated as technical aspects; the health effects of airborne pollutants, in particular, appear to have received little attention. For this reason, the section focused on the present state of knowledge concerning the health effects of airborne pollutants and noise. The second part of the study comprises an examination of a sample of environmental impact assessments. The sample was taken from environmental impact assessments for road projects in urban areas from 1990 onwards, with special attention to those drawn up after Environmental Code came into force. Material for scrutiny was requested by writing to the seven regional offices of the Swedish Road Administration and by ringing five major municipalities. A total of 33 environmental impact assessments were received; of these, 28 agreed with the selection criteria and were used in the analysis.

Definitions and limitations

Traffic safety

The factor which is primarily associated with the impact of road traffic on human health is traffic accidents. A traffic accident often has direct and measurable consequences such as physical and mental damage and death. Since accidents are the dominant and most evident health effect, a separate impact assessment is often made for this area (VV, 1995). The issue of traffic safety will not receive closer attention in this study, the reasons being that traffic safety may be examined in separate impact assessments which are outside the documents sampled for this study, and because this is largely a freestanding and long established area.

Hazardous goods

The term hazardous goods is a comprehensive term for substances and products that have such hazardous properties that they may damage humans and the environment unless they are handled correctly while being transported (National Rescue Services Board et al, 1998). Examples of such substances are explosive, flammable, toxic and infectious substances. If an accident involving hazardous goods occurs, its immediate health impacts depend on the quantity and type of substance released, the number of people in the vicinity of the site of accident, and the characteristics of these people, e.g. age and mobility. Effects of a more long-term nature on human health may result from contamination of groundwater and water sources. This study will not deal in greater detail with hazardous substances since the National Rescue Services Board, on behalf of the government, is engaged on extending the level of knowledge regarding risk analyses in physical planning, which includes transport of hazardous goods by road. (National Rescue Services Board, 2000).

Airborne pollutants

Airborne pollutants due to road traffic primarily originate from vehicle exhaust gases, and also from particles generated by the wear of vehicles and the carriageway and the raising of dust. The substances and compounds in exhaust gases that are of primary significance for human health are particles, oxides of nitrogen, carbon monoxide, PAH, alkenes and benzene (Forsberg & Bylin, 2001). Health effects may also

Consideration of health aspects in environmental impact assessments for roads

7

arise due to ground level ozone and secondary particles formed by atmospheric action, e.g. particles containing sulphates, which are directly associated with vehicle exhaust but may affect areas a long way from the points of discharge. Knowledge in this area may be said to be good enough for a meaningful description and even quantification of the impacts.

Noise

Noise is defined as unwanted sound and may cause damage and disturbance to humans (Swedish Government Official Reports [SOU], 1993:65). Traffic noise is one of the most serious sources of disturbance for humans and is thus an essential health aspect that must be considered in an environmental impact assessment.

Vibration

Vibration results from the propagation of compression waves in a medium. Road traffic can give rise to vibration in the ground that may be have a disturbing effect on humans. Such vibration is mainly caused by heavy traffic and in areas with soft soils (Jonasson & Göransson, 1995). Vibration due to road traffic is not subject to any regulations at present, but threshold limit values are applied in judging comfort in buildings. In Sweden there is some lack of agreement as to what methods of measurement and quantities shall characterise vibration. Since there are no clear guidelines, there is no in-depth analysis in this report of the way vibration is described.

Barrier effects

The term barrier effects refers to the effect of traffic on the mobility and safety of pedestrians and cyclists and the consequential effects on safety, travel habits and contact patterns. An example of the primary barrier effect is the increase in walking distances and waiting times when crossing roads carrying a lot of traffic. Secondary barrier effects are effects on travel habits and contact patterns. One example may be that parents dare not allow their children to cycle to school. Tertiary barrier effects occur, for instance, when a shop is closed down because the customer base is reduced due to a barrier that has cut an area in two or when a neighbourhood is split up so that social patterns are disrupted. Knowledge of more direct health effects caused by barrier effects is not so well developed, and at present it is therefore difficult to quantify health effects. The way barrier effects are described will not therefore be subjected to in-depth analysis.

Outdoor activities and recreation

Nature may have a healing effect on different forms of stress (SOU, 2000:91). Humans today have a great need to recuperate through rest and recreation, and therefore Nature, parks and green spaces are needed in human proximity. Outdoor activities are perceived by many to have great significance for health and the quality of life, and outdoor activities may therefore be a health factor of increased importance. However, for the same reason as for barrier effects, lack of knowledge of how the health effects can be described, no in-depth analysis is made as regards the description of effects on outdoor activities and recreation.

Definition of effect and impact

In the context of EIA, the National Board of Housing, Building and Planning (2000) has defined effect as the directly measurable effect on the environment, health or economical management of natural resources, and impact as an assessment of the effects through analysis and evaluation. However, depending on the context and time frame, the terms effect and impact may vary. Since it is difficult to make a clear distinction between these terms, no endeavour to do so will be made in this study.

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Consideration of health aspects in environmental impact assessments for roads

Results

Studies of the literature and the basis for the production of a check list

In the first section of this part of the study, an endeavour will be made to set out what aspects of a road project should be considered, what scope there is for doing this, and what procedure should be applied in describing the health effects of a road project. This is followed by a section at greater depth on the methods and knowledge available regarding airborne pollutants and noise. It is in the light of this that the check list was produced. Finally, the results of the analysis in which the check list is used as the template are described. The list of scrutinised documents and a summary of the results of the scrutiny have been given in a background document for this report (Alenius, 2001). Before deciding what should be described and how this should be done, the question arises what general requirements there are as to how an environmental impact assessment should be formulated. The Planning and Building Act contains no direct requirements as to what an EIA shall contain. The reason is that the aims and goals of detailed development plans are highly variable, and it is therefore difficult to draw up uniform requirements (National Board of Housing, Building and Planning, 2000). Chapter 6 Section 7 of the Environmental Code lays down requirements as to what an EIA must contain, but it does not state what procedure should be applied to satisfy these requirements. The legal text lays down instead the scope of the contents of an EIA. For projects that are presumed to entail significant environmental impact, the Code specifies a minimum requirement, and for projects that are not presumed to entail significant environmental impact, the requirement shows what is needed to satisfy the aim of an EIA (Training Course for the Environmental Code, 1998). It is thus seen that the legal text (and preparatory work) does not actually define what the requirements are for an EIA. The five headings set out below are therefore based more on a subjective judgment of what are the health aspects which it is desirable that environmental impact assessments should examine.

Identification of relevant health effects and health impacts

It is important from the standpoint of health that an EIA should describe what health effects and risks will result from the project and how great an impact these may be expected to have on people. In identifying the health effects, the point of departure should be the project in question. Depending on the design and nature of the project, the effects and impacts which it is important to describe will vary. This is a form of limitation of the contents of the environmental impact assessment. Examples of what may be affected by a new road are road accidents, accidents due to hazardous goods (including air and water pollution), air pollution, noise, vibration and barrier effects. Apart from these there may also be factors that have an indirect effect on people, e.g. leakage of heavy metals from road construction materials, and effects on crops in the vicinity of roads. The impacts that may result from these effects may be of different types. It is important to provide a written description of the way the different effects and impacts were determined, and their relevance for the project in question. The names of the person or persons who made the assessments should also be given.

Description of the state of knowledge

When the health effects have been identified, the state of knowledge regarding their impact should be described. This description should place special emphasis on critical effects (which occur at the lowest dose/exposure), dose-response relationships, sensitive groups and effect-modifying factors. This is needed in order that a better description may be given of the effect on the population. The statement regarding the state of knowledge should also set out shortcomings and gaps in knowledge. Effect-modifying factors are those which modify the effect of an exposure. With regard to airborne pollutants, these may be e.g. interaction between different kinds of pollutants, interaction with the weather or with the state of health of individuals. The existence of specially sensitive groups may also be a cause of effect modification. If it is ambient concentrations which constitute the measure of exposure,

Consideration of health aspects in environmental impact assessments for roads

9

then activity patterns, for instance the length of time which people spend indoors and outdoors, may be an effect-modifying factor. As far as noise is concerned, the effect may be modified by the composition of the population; children, the elderly, the sick and shift workers are population groups that are sensitive to noise effects. Another example of effect modification is where noise interacts with vibration. This gives rise to a greater perception of disturbance than if these factors act on their own. There are also results which suggest that air pollution load and the noise level may have interaction effects with regard to disturbance (Klæboe, 2000).

Summary of relevant regulations and goals and the conditions relating to these

A description of regulations and goals should form part of the review of available knowledge. Regulations are in the form of environmental quality standards and other standard, guidance and limit values. Sometimes there are also recommendations and advisory notes to refer to. In addition to these there are also proposals for new regulations, e.g. new environmental quality standards, which should be described. All these rules and regulations differ in their legal effects. For instance, environmental quality standards are legally binding in conjunction with applications for permits, since under the provisions of Chapter 16 Section 5 of the Environmental Code a permit cannot be granted for an activity where an environmental quality standard will be contravened. Threshold limit values have the character of limits for remedial action, which implies that when a limit value is exceeded, remedial action must be taken. Finally, recommendations and advisory notes are a help in deciding at what level discharges/exposures should occur. It is a common feature of all these regulatory forms that they are laid down on the basis of human sensitivity to the exposure factors concerned. The possibility of laying down a requirement has also been taken into consideration in varying degrees. Where there are relevant international, national, regional or local goals, these should be presented together with a description of how the planned activity measures up to such goals, for instance whether a project will contribute to social development in accordance with local goals. National and regional environmental goals and the associated targets are examples of what may be relevant to consider. In addition to setting out in an EIA the relevant environmental quality standards and the other standard, guidance or limit values, and goals, reliable calculations of the values that the activity will result in, for instance air pollution levels expressed in the same way as in the environmental quality standards, should also be produced.

The population and its exposure

In reality, the exposure to which people are subjected is seldom in the form of an "either/or situation" where effects appear above a certain level (standard, guidance or threshold limit value etc) and not below this level. In order that a realistic picture of the project may be given, the way the exposure of the population will be affected must be described. Irrespective of how well the relationships between exposure and human effects are documented, an EIA will be more realistic if it is the exposure of the population concerned, rather than the concentrations in a certain area, which is described. Information on the geographical distribution of the population must be utilised, and it is best to describe both the overnight (resident) population and the daytime population in relation to the exposure levels. Where there are sensitive groups and/or effect-modifying factors, the project concerned must be elucidated with reference to these, e.g. the existence of sensitive population groups (e.g. children, the elderly and the sick) and their geographical locations.

Calculations of health impacts

A number of endeavours have been made to formulate requirements and recommendations as regards quantification of dose-response relationships for impact calculations (Hasselblad, 1994; Krzyzanowski, 1997; Scott-Samuel, 1998; WHO, 2000a). The most specific example is the WHO report that was drawn up in order to develop the methodology used when experts summarise the results of epidemiological investigations as the basis for health impact calculations.

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Consideration of health aspects in environmental impact assessments for roads

The aim of the calculations is to quantify the expected changes in the number affected by different health effects. The uncertainty in these calculations may be highly variable, depending on circumstances, the unreliability of exposure data and dose-response relationships, and the extent to which long term effects can be judged. An analysis of calculations should therefore at all times include a discussion of the uncertainty due to the assumptions made and the limitations in the available data. To a great extent, health effects due to long term exposure to environmental factors such as noise and air pollution are quantified with a lower accuracy than short term effects. This is not due to the importance of these effects from the standpoint of health, but to the greater difficulties and higher costs of studying exposures and their effects over a long period. One essential issue in calculating health impacts is to decide what dose-response relationship is to be used for the type of effect concerned. Sometimes it is possible to choose between using relationships based on aggregated analyses of many studies from a number of countries, or the results of a single local, Swedish or Nordic study. This choice is complicated by the fact that the local relationships may be different from those presented by the aggregated analyses, which may be greatly influenced by studies from entirely different environments and populations. At the same time, it must be borne in mind that the risk of random deviations from real conditions is greater in single studies, which also means that the magnitude of the statistical uncertainty (confidence interval) is also greater. When such a choice must be made, the results of the local (Swedish, Nordic etc) study should be chosen in preference to those of the aggregated analysis if there is a statistically significant difference in the relationships between the different environments. A significant variation in these relationships (variation in addition to the expected random variation) may be due to effect modification, i.e. factors that influence the effect of exposure. These factors may be related to factors such as the health of the population, access to medical care, standard of living, activity patterns or climate, and the load due to other environmental factors. With regard to reactions to disturbance, for instance to noise, attitudes and frames of reference may also be significant.

Health effects of airborne pollutants Background

Airborne pollutants in exhaust gases Road traffic emits a large quantity of different substances and compounds. A significant proportion originates from the exhaust gases of motor vehicles, but emissions may also arise from tyres, brakes and the carriageway. Refuelling and evaporation of unburnt fuel also cause emissions. Exhaust gases are generated when fuel is burnt. Complete combustion of organic matter in the presence of air produces mainly carbon dioxide, nitrogen oxide and water. Combustion in the internal combustion engines of today is incomplete, which means that the exhaust gases contain a large quantity of different chemical compounds. It is estimated that there are as many as 10,000­15,000 chemical compounds in vehicle exhausts, and only a few of these have been identified (Westerholm & Egebäck, 1994). In this study the emphasis is placed on a few chemical compounds which can affect human health and act as indicators of harmful pollutants. Health effects Air pollution can give rise to different effects in people, such as discomfort due to unpleasant smells, irritation of the mucosa of the respiratory passages, acute respiratory effects such as increased breathlessness in asthmatics, effects on the heart and circulatory system inclusive of increased mortality, and the incidence of chronic lung diseases and cancer (WHO, 2000b; SOS et al, 2001). Exposure of the airways to airborne pollutants may also cause a decrease in the protection against infections and possibly an increased risk of developing allergy (WHO, 2000b; Forsberg & Bylin, 2001; SOS et al, 2001). Depending on the properties of the airborne pollutants, different parts of the airways are affected. Gaseous pollutants that are easily dissolved in water attack the upper airways, while the gases that are less readily water soluble penetrate further. The same applies for large and small (<10 mm) particles; large particles settle in the upper airways while the smaller ones penetrate further down. Fractions with an aerodynamic diameter of 10 mm or smaller (PM10) are sometimes referred to as "respirable particles".

Consideration of health aspects in environmental impact assessments for roads

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The groups of people who are counted among those particularly sensitive to exposure to airborne pollutants are asthmatics and others with chronic respiratory diseases, people with cardiac-circulatory diseases, elderly people whose health status has been impaired, and children. (WHO, 2000b; Forsberg & Bylin, 2001; SOS et al, 2001; VV, 1999b). The compounds most often mentioned in connection with effects on the airways are ground level ozone, particles and nitrogen dioxide, while cardiac-circulatory complaints are most often associated with particles and carbon monoxide. For cardiac and circulatory diseases, the oxidants nitrogen dioxide and ozone may also be significant. Particles and oxidants are assumed to cause inflammation in the airways, with consequent effects on the coagulation of blood. Carbon monoxide reduces the ability of the blood to take up oxygen, and this may affect the cardiac and circulatory system. It is estimated that air pollution gives rise to ca 100 cases of lung cancer and 100­1000 cases of all types of cancer in Sweden annually (SOU, 1984; SOS et al, 2001). Cancer is influenced by several factors, among them factors related to life style such as smoking habits, dietary habits, etc. The airborne pollutants which are primarily implicated in the incidence of cancer are PAH, alkenes, benzene and probably also small combustion-related particles (WHO, 2000b; SOS et al, 2001).

Calculation of health effects

As far as the air situation is concerned, it is possible to describe in an impact assessment the number who would be affected by contents or changes in content of a certain level, or to calculate how the average and total population exposure will be changed. The calculations presuppose that content calculations can be related to information regarding the population. In many cases, data relating to buildings and thus the population in the municipalities are already coordinate-referenced on digital maps which can be used together with dispersion models for air pollution calculations. The concentration of vehicle exhaust gases in the ambient air can often be described with different correlated indicators such as NOX, NO2, CO, soot/particles and benzene. Epidemiological studies sometimes describe the same relationships between exposure and effect, but with different exposure variables (Forsberg & Bylin, 2001). In practice, because of the complex composition of exhaust gases, an indicator compound of some kind is always used to describe the effect of vehicle exhausts. If dose-response relationships for the same effect are described for closely related indicators (from different studies), these should not be treated as independent and the calculated effects should be added in health impact calculations. Correlated airborne pollutants may however have causal relationships with different effects, and are therefore used in the same health impact assessment, for instance the significance of particles for asthma, but also of hydrocarbons for cancer. Important quantifications of health effects as a function of the concentrations of particles and nitrogen dioxide (WHO, 2000b; WHO, 2000c) are plotted in the next section. Using calculation models, it should be possible to estimate the significance of traffic and changes in traffic for the concentrations of (exposure to) these substances, and calculations of health impacts are therefore also possible. Particles and daily mortality In many investigations, fairly direct effects have been associated with the change in particle concentration. Taken together, the studies indicate that the increase in particle concentration has a greater percentage effect on respiratory mortality than on cardiac-circulatory mortality. Since mortality due to cardiaccirculatory diseases is so much higher, however, most of the "extra" mortality will occur in this category (Forsberg & Bylin, 2001). According to the World Health Organisation (WHO, 2000b), the average daily respiratory mortality increases by 1.2% and the average daily cardiac-circulatory mortality by 0.8% per 10 µg/m3 increase in the concentration of particles measured as PM10. The total mortality per day increases by 0.7% (see Fig. 1). If the particle concentration is expressed as the "fine" fraction, PM2.5 (of up to 2.5 mm aerodynamic diameter), the increase in total mortality is given as 1.5% per 10 µg/m3, and for sulphate particles as 6% per 10 µg/m3 increased concentration. Since the assumed relationships for daily values of PM10 are based on results with concentrations within 20­200 µg/m3, WHO states that the relationships cannot be assumed to be valid outside this

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Consideration of health aspects in environmental impact assessments for roads

25 increased daily mortality 20 increased daily hospitalisation for respiratory problems increased symptoms in asthmatics 10 reduced peak expiratory flow rate 5

Per cent

15

0

0

20

40

60

80

100

120

PM10 concentration i µg/m3

Fig. 1. Dose-response curves for particles measured as PM10. Percentage changes in different health effects as a function of the change in PM10 concentration.

range. It is considered that the dose-response curves are fairly linear from low concentrations up to ca 100 µg/m3 of PM10, above which they flatten out for greater average daily concentrations. Since it does not appear that a lower threshold level (below which the daily concentration is not significant) could be identified, WHO is of the opinion that a threshold limit value for particles cannot be proposed. It is suggested instead that the dose-response relationship should be assessed on the basis of daily mortality and indicators for respiratory diseases (see the following section). Naturally, as more studies become available, assessment of what these curves are like may change. Particles and hospitalisation According to the World Health Organisation (WHO, 2000b), the average daily number of those hospitalised for respiratory diseases increases by 0.8% per 10 µg/m3 increase in particles measured as PM10 (see Fig. 1), by 5% if the particle concentration is expressed as PM2.5, and by 6% for sulphate particles per 10 µg/m3 increased concentration. As for daily mortality, it is considered that the curves may be assumed to be linear from low daily concentrations up to ca 100 µg/m3. In the WHO programme AirQ (WHO, 2000c), intended for calculation of health impacts due to airborne pollutants, the assumption is made that the number of those hospitalised for cardiac diseases increases by 0.9% per 10 µg/m3 increased concentration of PM10, but this relationship is not substantiated to the same extent as for hospitalisation for respiratory diseases. Particles and airways symptoms/medication As for daily mortality and hospitalisation, WHO has published data for the assumed shape of the doseresponse curves for symptoms and medication. The incidence of coughing, asthmatic complaints and the use of bronchodilators is assumed to increase by 3­5% per 10 µg/m3 increased daily concentration of PM10 (see Fig. 1). Particles and lung function According to the WHO Air Quality Guidelines (2000c), it may be assumed that lung function expressed as PEF (peak expiratory flow rate in l/min) decreases linearly by an average of 0.13% per 10 µg/m3 increase in PM10 concentration, which is so small that it does not appear particularly problematic (see Fig. 1). Not everybody is affected, and an analysis based on seven studies in the Netherlands found that 100 µg/m3 increase in daily PM10 concentration produced, on average, 31% higher risk that PEF would drop by more than 10%. (Forsberg & Bylin, 2001).

Consideration of health aspects in environmental impact assessments for roads

13

Nitrogen dioxide and daily mortality In a European project, the effects of variations in nitrogen dioxide concentration in six cities were analysed (Touloumi et al, 1997). Daily mortality increased with nitrogen dioxide concentration in all cities, and significantly in the cities with the highest soot concentrations (Athens, Barcelona and Rome). Taken together, the results indicate that an increase in maximum one-hour value during a day by 50 µg/m3 increases mortality by an average 1.3%. When the effect of soot was at the same time considered in the analysis, the effect was only half as large. The results were also added for three cities in Switzerland, and the aggregate effect was an increase by 1.5­1.8% per 50 µg/m3 increase in maximum one-hour value during a day; soot was however not considered. In the WHO calculation program AirQ for the health impacts of airborne pollutants, daily mortality is assumed to increase by 0.3% per 10 µg/m3 increase in the daily mean value of nitrogen dioxide (see Fig. 2).

6 5 Per cent 4 3 2 1 0 0 20 40 60 80

3

Increased daily mortality

Increased daily hospitalisation for respiratory problems

100

120

NO2 concentration i µg/m

Fig. 2. Percentage change in daily mortality and daily hospitalisation for respiratory problems as a function of changes in daily mean NO2 concentration.

Nitrogen dioxide and hospitalisation In cases where in studies of hospitalisation for respiratory complaints an attempt was made to distinguish the effect of nitrogen dioxide from the effect of particles, an increase in risk, which was at times statistically substantiated, was usually found for nitrogen dioxide. In the aggregate, the effect appears to be approximately 0.4­0.5% increase in the number of cases per 10 µg/m3 increase in daily mean nitrogen dioxide concentration (Forsberg & Bylin, 2001). In the European project comprising six cities with data on nitrogen dioxide concentration and hospitalisation, it was found that emergency hospitalisation for chronic obstructive lung disease increased by 2% per 50 µg/m3 increase in daily mean value (Touloumi et al, 1997). The WHO calculation program AirQ for the health impacts of airborne pollutants assumes that different categories of hospitalisation for respiratory complaints increase by 0.20­0.58% per 10 µg/m3 increase in daily mean nitrogen dioxide concentration (see Fig. 2). The studies were mainly made in cities with mean nitrogen dioxide concentrations of ca 45­55 µg/m3, and in spite of the assumption regarding linearity, the shape of the dose-response curve is not particularly well documented. Nitrogen dioxide and respiratory symptoms/medication There are diary studies in which a relationship was found between increased nitrogen dioxide concentration (usually the daily mean concentration) and deterioration of asthma, as well as the incidence of respiratory symptoms and also the duration of these symptoms. The arrangements of these studies are however very different, and it is difficult to make comparisons (Forsberg & Bylin, 2001). Such relationships have also been documented in Sweden for mean values of 22 µg/m3 during the study period (Forsberg et al, 1996; Forsberg et al, 1998). Nitrogen dioxide has also been used as an air quality indicator in studies of perceived general

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Consideration of health aspects in environmental impact assessments for roads

discomfort, but without coupling to any specific day. Studies from Sweden, Norway and Switzerland have described the correlation and dose-response relationships between the mean concentration of nitrogen dioxide in different areas and the population's perception of the air as unpleasant. In a study of more than 6000 Swedes from 55 different areas, it was found that the proportion who find the air as irritating etc correlate with the mean winter concentration of nitrogen dioxide in the immediate vicinity, which in the study was 9­32 µg/m3 (Forsberg et al, 1997). When there was an increase in concentration by 1 µg/m3 the relative risk of perceiving the air in the housing area as daily or almost daily irritating increased by ca 1.06 (ca 6%). The average proportion was 5%, with 14% as the highest value in an area.

Methods for calculating concentrations/exposure

By means of measurements and calculations of pollution concentrations, values can be obtained for the assessment of effects on humans. These two methods are complementary. Measurements provide direct information on the air situation at a measurement point over time, which can serve as the basis for calculations (VV, 1999b). Calculations can explain how the air pollution concentration varies in time and space, and provide predictions and estimates of what the air situation is like in places for which there are no measurements available. There are a large number of different calculation models. One of the reasons that there are so many is that they describe different processes. The transport and dispersion routes of airborne pollutants are complicated and cannot be summarised in a process. To obtain a credible result, the correct calculation model must be chosen. For road traffic there are models for pollutants in the street space and near roads, for point sources, for towns and for regions. When a model is selected it is also important to consider the purpose of the calculation, since it is not self evident that the most complicated model need be chosen to get an answer to the question posed. Models for calculation of pollution in the street space are simplified in comparison with the very complex flow and dispersion conditions that prevail. There is a large variation in the way the buildings surrounding the street space are constructed, but the typical model for the street space assumes that there are symmetrical buildings on each side. The assumption in the case of road traffic models is that the road is open in flat country. Calculation models for point sources can be used in connection with road traffic, for instance to describe the emission from an exhaust tower for tunnel ventilation and to compare the pollution concentrations from road traffic with the contributions of other types of sources. The models that calculate the pollution concentrations due to road traffic in a regional perspective can take into consideration the effect of the terrain on wind and turbulence. A landscape comprising hills, valleys, land and water will exert a great influence on wind and turbulence, and in order that this may be calculated, simulations are made with numerical meteorological models. These models have output data for a large number of typical weather situations in the area concerned which are applied in calculating dispersion.

Threshold limit values and environmental quality standards for airborne pollutants

One of the essential objectives of controlling air pollution is to protect people against illhealth. It is stated that i in specifying Swedish threshold limit values for airborne pollutants, consideration has been given to particularly sensitive groups in society such as asthmatics, allergic persons and persons with other types of hypersensitivity. The intention is that air pollution below the threshold limit value shall cause no or insignificant effects. It has however been found that effects can arise even below the limit value (see e.g. "Particles and daily mortality".). The limit values for air quality apply in urban areas. They also apply for places frequented by people such as school yards, sports stadia and footways outside buildings where people live and work. The substances which are controlled by threshold limit values are NO2 and soot. (Statistics Sweden, 2000). There is also a guidance value for CO and evaluation criteria for PM10 (which will be replaced by environmental quality standards according to the minimum requirements in an EC Directive).

Consideration of health aspects in environmental impact assessments for roads

15

Environmental quality standards have been drawn up by the National Environmental Protection Agency and shall serve as a tool in Swedish environmental work. The standards are intended as a least acceptable environmental quality for human health and the environment. The environmental quality standards serve both as a control instrument owing to their function as a kind of target in achieving an acceptable environmental standard, and, as mentioned before, they are also obligatory since, under the provisions of the Environmental Code, they must be taken into consideration in decision making (review, supervision, regulations) (National Environmental Protection Agency, 1998). Sweden is obliged to incorporate EC Directives into national legislation. The existing environmental quality standards and the proposed new environmental quality standards therefore conform to the EC framework directive on ambient air quality assessment and management and its ensuing directives. Standards have so far been drawn up for sulphur dioxide, nitrogen dioxide and lead (Swedish Code of Statutes [SFS], 1998:897). According to the National Environmental Protection Agency, in principle it is already possible to comply with the standards for sulphur dioxide and lead. It is believed that the standard for nitrogen dioxide can be complied with on the basis of decisions already made and in the course of planning within EU, and with regard to emissions from vehicles and machine tools. The environmental quality standard for nitrogen dioxide has been specified mainly to protect human health. To protect plants and the cultural heritage, even lower concentrations may be required, and this may result in a revision of the standard. The National Environmental Protection Agency has drawn up draft environmental quality standards for benzene and carbon monoxide; draft standards shall also be drawn up for particles (National Environmental Protection Agency, 1998; National Environmental Protection Agency, 2001). In a longer term, the Agency intends to analyse and evaluate the opportunities for standards for additional carcinogenic/allergenic airborne pollutants.

Goals

The policy objectives of the measures required to achieve sustainable development are governed by goals. There are a large number of international, national, regional and local goals to do with air pollution. Examples of national goals which may be mentioned are the traffic policy goals formulated in accordance with the Bill "Transport policy for a sustainable development" (1997/98:56). This goal comprises one overriding goal and five targets. The targets concerning air quality are as follows: ­ emission of oxides of nitrogen should by 2010 have been stabilised at the 1990 level; ­ emission of volatile organic compounds should decrease by at least 60% by the year 2005 in relation to the level in 1995; ­ emission of carcenogenic substances shall be halved by the year 2005 in relation to 1990, and in the long term shall decrease by 90%. As part of the Swedish MaTs collaboration (Environmental Transport System), the National Environmental Protection Agency has drawn up emission goals for the traffic sector (National Environmental Protection Agency, 1996a). The traffic policy goals were adopted as short term staged goal until 2005, and the long term goals until 2020­2050 for airborne pollutants are that emissions of NOX shall decrease by 85%. In the Bill "Environmental policy for a sustainable Sweden" (1997/98:145), the government set out 15 environmental goals and associated targets to be achieved within a generation, i.e. by ca 2020­2025. Construction of a road may affect many of these goals. Goals that deal with the effect of airborne pollutants on health are "fresh air" and "good built environment". In its final report, the Environmental Goal Committee set out proposals for further targets for the 15 environmental goals (SOU, 2000:52). The intention is to make provision for the revision of the goals as new facts and opportunities for improvement arise. This is also one of the reasons that the targets have time frames within which they must be achieved. Examples of targets for fresh air are: ­ The specified annual concentrations of sulphur dioxide (5 µg/m3) and nitrogen dioxide (20 µg/m3) shall be achieved by the year 2005 and 2010 respectively; ­ In all municipalities, the concentration of ground level ozone shall not exceed 120 µg/m3 as an 8-hour mean by the year 2010;

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Consideration of health aspects in environmental impact assessments for roads

­ By the year 2010 the emissions of VOC in Sweden, with the exception of methane, shall have decreased by 55% from the 1995 level to 2200 tonnes; ­ No later than by the year 2005, a staged goal for PM2.5 shall be specified. By the same time, a first revision of the generational goals for air quality shall have been carried out. Regional work is also subject to the environmental goals. The county executive boards have been charged by the government with the duty of developing regional goals which must be commensurate with the national goals.

The health effects of noise Background

Definition of sound and noise Sound is generated by mechanical oscillations in an elastic medium and is propagated as wave motion in air or in other media. From a physical standpoint there is no difference between sound and noise, but to people the difference is clear. Noise is defined as unwanted sound, and it is a sound source that gives, or can give, rise to negative effects on human physical and mental health (WHO, 1995). Units of measurement for sound pressure level and noise In air, sound consists of more or less rapid and more or less powerful compression wave variations (SOU, 1993:65). The rate of these variations is expressed in terms of frequency, and the power of the variations is expressed as sound pressure. Since sound pressure can vary over a wide and relatively intractable scale, it is measured in decibels (dB) on a logarithmic scale and is referred to as sound pressure level. Experiments, first performed in 1933, showed that when the loudness level is the same for sound of different frequencies, the sound pressure level can vary both upwards and downwards. This demonstrates that the ear has variable sensitivity to combinations of different frequencies and sound pressure levels. The ideal way of establishing sound levels would be to present the results of measurements with a sound pressure meter in terms of phon, where phon is the sound pressure level at 1000 Hz (WHO, 1995). Since this is a very complicated way of describing sound level, a simpler method has been decided on, namely different weighting curves which resemble the perception of the human ear. The A, B and C filters are intended to represent the way the human ear perceives low, medium and high sound levels respectively. The filters must attenuate the lower frequencies since the human ear has inferior sensitivity for low frequencies. The A filter is the one most commonly used, and the A-weighted sound pressure level, LA with the unit dB(A), is measured with this. In calculating and measuring sound, the time aspect is usually included. In measuring and calculating e.g. road traffic noise, the unit equivalent sound level LAeq is primarily used. This is the mean level over a certain period, mostly 24 hours (National Environmental Protection Agency, 1996b). A maximum level LAmax can also be used in measuring and calculating road traffic noise. This value can be of interest mainly overnight when noise disturbance may be due to a few vehicles and thus give rise to a number of noise peaks, peak levels. Noise is judged to be more disturbing overnight than during the day (SOU, 1993:65). One unit that takes this into consideration is Ldn which is a weighted equivalent continuous noise level for 24-hour exposure, with overnight noise given a weight 10 dB higher than daytime noise. Noise from road traffic Noise from road traffic is due to noise emitted by vehicles. Noise emissions depend on traffic flow, speed, the proportion of heavy vehicles, but also on topography, distance from the noise source, etc. At low speeds it is the design of the engine that is the dominant noise source. When speed exceeds 40 km/h, the properties of the tyres and carriageway are of greater significance. A narrow tyre emits less noise than a wide one, and a carriageway of normal surfacing emits less noise than one with coarse surfacing. The character of noise can also be altered by the character of the environment along the road. A hilly landscape can cause an increase in noise emission due to a changed driving pattern, but also a reduction in noise since rock can impede the spread of noise.

Consideration of health aspects in environmental impact assessments for roads

17

To sum up, there are several factors that influence noise emission. Measures taken in the area concerned can give rise to significant reductions in noise. As regards vehicles, a lot of work has been done to lower emissions from the engine, by e.g. silencing the engine compartment and fitting better silencers (SOU, 1993:65). It is believed that further efforts by vehicle makers will prduce only marginal reduction in noise. On the other hand, development of tyre manufacture and alternative road surfacings might result in considerable reduction in noise level. Tyre design is closely associated with speed and safety. If speed limits are lowered, tyres can, in contrast to the present position, be made narrower and of softer rubber, and would thus generate less noise. Many experiments have been made on road surfacings, with notable noise reductions as a result. It is however difficult to find a surfacing that has a long life. One advantage of the increased dominance of tyre and carriageway noise is that the noise source is near ground level and can thus be effectively reduced by screening and ground damping.

Effects of noise on humans and the present state of knowledge

Noise is a factor that most of the population in industrial countries is exposed to. The reason for this is e.g. more intensive traffic, increased use of ventilation installations and the use of motorised implements. Noise from road traffic is the most common noise source, and it is estimated that in Sweden ca 1.5 million people are exposed to an equivalent noise level higher than 55 dB(A) (SOS et al, 2001). Noise causes different kinds of negative effects on people. Loud noise can give rise to hearing loss which can, in turn, cause difficulties in communication, isolation and depression (SOU, 1993:65). Damage can occur both on short term high exposure and long term lower exposure (Edling et al, 2000). At a noise level of 85 dB(A), the risk of ear damage is ca 10%. The risk of damage increases with increasing noise level, the time spent in the noisy environment, and the character of the noise. At LAeq,24h of 70 dB(A) and lower, however, it is not considered that there is any risk of permanent hearing loss. The sensitive groups in this respect are mainly children and people who are sensitive to noise for hereditary reasons. The most common effect of noise is disturbance. Disturbance is defined as a feeling of discomfort directed towards something in the environment that one knows, or believes, to have a negative effect on health and wellbeing. Noise can disturb sleep, speech communication and learning, and give rise to psychosocial and psychosomatic effects (SOU, 1993:65, Appendix No 4; WHO, 1995). The most common source of noise disturbance is road traffic. Road traffic noise can be perceived disturbing because it emits an intermittent sound with large variations between background and peak levels, for instance motorcycles that can emit sound with high peaks and lorries that can generate low frequency noise. In addition, road traffic noise is unpredictable, and this can be perceived as highly disturbing. Sleep disturbance because of noise can give rise to negative effects such as taking a longer time to fall asleep, waking episodes and disruptions in the distribution of the stages of sleep (proportions of sleep in different EEG stages), and an acute increase in pulse rate. The consequences of disturbed sleep are manifested as different aftereffects (SOU, 1993, Appendix No 4; WHO, 1995). The aftereffects comprise, inter alia, increased fatigue and deterioration in performance as a result of subjectively impaired sleep quality. Particularly sensitive groups are the elderly, the sick, shift workers and people who consider themselves to be sensitive to noise. In order that there should be no disturbance while falling asleep and sleeping, the maximum sound level must not exceed 45 dB(A), and the equivalent sound level must not exceed 30 dB(A) indoors. Deterioration in speech communication implies that noise makes it difficult to understand speech. In order that speech may be heard indoors at a distance less than 1 m, the ambient sound level must be lower than 45 dB(A) (WHO, 1995). However, the requirement concerning sound level varies with the characteristics of the individual such as age, acuity of hearing and mother tongue, and the configuration of the room. In teaching premises it may be necessary for noise level to be as low as 25­30 dB(A) for speech communication to be possible. Noise can cause a deterioration in productivity and learning, since important information is masked. Masking of information such as warning signals can also increase the risk of accidents. Noise is also a known stress factor which, in interaction with other stress factors, can give rise to psychosocial and psychosomatic disorders. Irritability, fatigue and headache are known disturbance effects.

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Consideration of health aspects in environmental impact assessments for roads

Investigations have also demonstrated that noise can result in a reduction in wellbeing. One example of this is an investigation performed in Göteborg where it was found that a higher proportion of people living on a street carrying traffic were depressed than those living in a quiet control area. Wellbeing was also shown to have a significant relationship with road traffic (SOU, 1993:65, Appendix No 4). There are investigations which show that noise can cause a temporary elevation of blood pressure. Babisch (1998) showed in a study that "there is some epidemiological evidence of an increased risk of ischaemic heart disease in traffic noise exposed subjects above 65 LAeq (RR 1.1­1.5)". There are however differences of opinion whether noise causes permanent increases in blood pressure, since there are lot of other factors that exert an influence, such as dietary habits, smoking habits and age (WHO, 1995). More studies are neded to elucidate the relationships. Further studies are also needed to achieve greater understanding of long term effects, such as stress factors caused by road traffic noise.

Calculation of health effects

Dose-response relationships Since traffic noise is one of the greatest sources of disturbance for people, it is of interest to try and ascertain at what level disturbance occurs. Many dose-response relationships have been calculated for noise and disturbance. The WHO report (1995) presents investigations where the percentage of those disturbed is related to the disturbance level in Ldn. The results show that the proportion of those highly disturbed at Ldn<55 dB is about 10%. Miedema and Vos (1998) have in an investigation demonstrated the relationship between disturbance and traffic noise (road, rail and air traffic). In order to do this, they compiled data from many international studies and entered these into a database. Here the percentage of people highly disturbed is related to a day and night equivalent level Ldn. For all types of traffic noise it was found that the percentage of those highly disturbed in the population is zero below 40­45 dB and then increases with increasing Ldn. This result indicates a lower threshold limit value than that in the WHO report, which also demonstrates the complexity of noise as a disturbing factor. WHO is laying down guidance values for noise, and in the later WHO report from 2000 the guidance level for situations where people are highly disturbed is 55 dB(A), and where they are moderately disturbed it is 50 dB(A).

Guidance values and goals for noise

The guidance values for noise do not have the function of binding standards, but provide a guide in assessments. According to the Bill "Infrastructure for future transport" (1996/97:53), the intention is that these guidance values should be seen as long term goals. In setting the guidance values consideration was given to the risk of people being damaged and disturbed. In contrast to the guidance values for airborne pollutants, those for noise are based on the sensitivity of the normal population. In addition, these guidance values do not signify an absolute limit below which no effects will occur. For instance, at the existing guidance level there is a 10% risk of ear damage. According to the government bill, the guidance values for traffic noise "shall not normally be exceeded during new housing construction or during new construction or substantial alteration of traffic structures". The bill also presents staged goals. These are set with the aim of attaining the guidance values within the period 1998-2007. According to the goals regarding traffic noise, it is primarily existing buildings which are exposed to an outdoor noise level of 65 LAeq or higher from road traffic that shall be given remedial treatment. In addition to the guidance values there are several publications which contain regulations for noise levels. Examples that may be mentioned are the general recommendations of the National Board of Health and Welfare for noise indoors and high sound levels (1996:7), the Building Regulations of the National Board of Housing, Building and Planning (1998:38) and the WHO Guidelines for community noise (2000d). The regulations in these publications are slightly different from the adopted guideline values. For instance, the National Board of Health and Welfare recommends that the maximum noise indoors should be 35­45 dB(A); the lower level is based on subjective disturbance which can in some cases constitute a public health hazard, and the higher is intended as protection against e.g. difficulties in falling asleep, waking episodes and the aftereffects of disturbed sleep. This can be compared with the guidance value of 45 dB(A) for maximum noise indoors during the night.

Consideration of health aspects in environmental impact assessments for roads

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"Good built environment" is one of the 15 national environmental goals. This states, inter alia, that people must not be exposed to harmful noise disturbance. One of the targets is that traffic noise in urban areas should be reduced so that it falls below current guidance values. In the final report of the Environmental Goal Commission (SOU, 2000:52) there are proposals in which these goals are further defined. For a good built environment, a sustainable building structure must be developed for the housing and leisure environment outdoors and indoors, so that it satisfies exacting requirements concerning freedom from e.g. noise. The target regarding noise is as follows: ­ The number of people who are exposed to traffc noise disturbance in excess of the guidance values laid down by the Riksdag for noise in dwellings is to decrease by 10% by the year 2010 and by 80% by the year 2020, compared with 1998. Proposals have also been drawn up for national goals for public health (SOU, 2000:91). These comprise 18 overriding goals and associated targets. For instance, the goals emphasise the importance of noise-free open spaces near human dwellings, since it has been found that this is an important part of human recreation. Municipalities often draw up local goals for specific areas. One example of local/regional goals is the proposed environmental programme for Stockholm, according to which the long term goal is that the equivalent sound level from road and tram traffic shall not exceed 55 dB(A) outdoors and 30 dB(A) indoors (Stockholm Environmental Administration, 1996). The peak level shall not exceed 70 dB(A) outdoors. The goal during the programme period 1996­2001 is to reduce the peak level indoors due to road and tram traffic to 45 dB(A) between 1900 and 0700 hours.

The check list

The aim of the check list is to provide a template for uniform examination/presentation of the health aspects in environmental impact assessments. The points in the check list are based on the foregoing subsections which set out what should and can be included in an EIA with regard to health, with the headings "Identification of relevant health effects and health impacts", "Description of the state of knowledge", "Summary of relevant regulations and goals", "The population and its exposure" and "Calculations of health impacts". In these sections, the text in italics represents important points for the check list. The sections on airborne pollutants and noise serve as an aid in identifying what is the level of knowledge in these areas. With this as the point of departure, the check list is set out as follows: 1. What method/expertise has been used in deciding what health effects and impacts are important in this project? a) b) c) d) Own experience Consultation with experts Literature (scientific, descriptions of similar projects/environments) Others

2. What risk factors/causes and health effects are identified in the environmental impact assessment? Examples: Injuries (due to an external agency, i.e. accidents) Acute effects for those sensitive to air pollution, e.g. asthmatics Discomfort due to smelly/irritant compounds Disturbance due to noise or vibration Chronic effects (due to long term exposure) Significance for rest, recreational and exercise facilities a) b) c) Safety Hazardous goods Airborne pollutants

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Consideration of health aspects in environmental impact assessments for roads

d) e) f) g) h)

Noise Vibration Outdoor activities/recreation Barrier effects Others

3. Is there a description of the population that is affected by the project? Examples: Size, age distribution Sensitive groups Daytime and night time population 4. Is any consideration given to the population concerned when the risk of health effects is described, or is there an explanation why the population is not considered? Examples: No sensitive groups represented Predominantly daytime population 5. What "methods" are used in describing how the health and health risks of the population are affected? a) b) c) d) e) f) Comparison with guidance and threshold limit values, EIA and future standards Comparison with exposure to/conditions for/effects of similar projects Comparison with exposure to/conditions for/effects of the zero option Other comparison Scenario calculation (quantifications) of effects on the basis of dose-response relationships Calculations of probability

6. Is there a description of effect-modifying factors? a) If health effects were quantified, was consideration given to effect-modifying factors?

7. If calculation models have been used, what are they? a) b) Are these models validated in relation to the existing environment? Who has made the calculations?

8. Is there any description of how the project agrees with different goals, and if so, which? 9. Is there any description of plans to monitor the EIA? Example: Outcome compared with calculations. 10. Other aspects of interest in the EIA.

Analysis of the studied environmental impact assessments

Expertise and method used in identifying essential health aspects

Five of the 28 scrutinised environmental impact assessments state who have worked on health related issues. These issues are noise, vibration, airborne pollutants and safety. Usually there is no direct description of how the health aspects which are essential have been identified. The document merely sets out the health effects. In order to present the health aspects relevant to the project, two of the above five EIA made use of scientific literature, while all referred to statutes and standard values regarding the health issues concerned.

Consideration of health aspects in environmental impact assessments for roads

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Three of the 28 EIA consulted experts in some way in judging the possible health effects of the project. Of these three, one consulted scientific literature, and all three referred to statutes and standard values. Eight of the 28 EIA quoted facts regarding health effects from scientific literature, and 27 of the 28 referred to statutes and standard values as the means of protection against health effects.

Identified health effects Traffic safety

21 of the 28 environmental impact assessments contain a section on traffic safety. 20 of the 28 describe traffic safety with reference to the risk of traffic accidents. Of these 20, 14 also describe the health effects in the form of changes in the number of injuries to persons which a change in the traffic situation caused by the project is expected to result in. Injuries are expressed in terms of fatalities, severe injuries or slight injuries.

Hazardous goods

22 of the 28 EIA contain a section on hazardous goods. In 13 of the 28 there is a description of health effects by stating the hazardous nature of the goods concerned. The goods may be flammable/explosive, toxic or corrosive. In eight EIA the health effects of hazardous goods are described in terms of the fatalities or injuries which would occur in the event of an accident.

Airborne pollutants

In all the investigated environmental impact assessments, airborne pollutants are referred to in some form. The fact that feelings of discomfort can arise due to airborne pollutants is described in three of the 28 EIA. Five of the 28 describe that airborne pollutants can give rise to acute effects, and the same number describe that airborne pollutants can give rise to chronic effects.

Noise

All the investigated EIA contain a section on noise. In 16 of the 28 EIA, the health effect of noise is described as a disturbance. In eight of these 16 there is a more detailed description of the disturbance effects noise may give rise to. These may be disturbed sleep, communication and concentration. It is also stated that noise can increase stress and adversely affect comfort.

Vibration

Vibration is referred to in 24 of the 28 EIA. In 19 of the 28, the health effects of vibration are described as a disturbance, and 5 of these 19 give a more detailed description of the effect of vibration on humans. These effects are described in one EIA as "stress reactions and other subjective feelings of discomfort". Outdoor activities/Recreation 27 of the 28 environmental impact assessments discuss the aspects outdoor activities and recreation. 17 of the 28 refer to the effect of the project on recreational facilities, and five of these give a more detailed exposition of the significance of recreation for people. This is done, for instance, by describing the facilities for rest, relaxation and enjoyment of nature. One EIA calculates the area of parkland per inhabitant in the part of the city affected by the project. This is compared with the average for the whole city. Barrier effects 22 of the 28 EIA use the term barrier effect in some form. 12 of the 28 describe a physical barrier effect resulting from a change in accessibility and/or safety. In addition, eight describe the barrier effect more as a social effect due to reduced security, changes in movement patterns and/or contact patterns. These descriptions are given without any attempt to quantify the effects.

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Consideration of health aspects in environmental impact assessments for roads

The population in these environmental impact assessments Presentation of the population concerned

In 13 of the 28 EIA there is a description which discusses the population in the affected area in some way. Nine of these 13 describe sensitive groups in the population concerned in some form. It is chiefly children and their safety in traffic that is described. The problems that the barrier effect of traffic can cause for children are one example; in one EIA these are described as "particularly serious for children aged 10 to 12". The elderly and physically impaired are also mentioned in connection with safety and accessibility. Generally, however, there is no information as to what proportions these population groups constitute of the population in the areas concerned. Day and night time populations are described in one of these 13 EIA. It states how the population inside the hazard distance from an accident involving hazardous goods increases during the night. In nine of the 13 there is also a general description of the size of the population in the area affected by the project.

Description of health effects on the population concerned

23 of the 28 EIA have in some way considered the population, groups in the population or housing areas in describing the relevant health effects of the projects. The way the health effects will affect specific groups of the population is described in 9 of the 28 EIA. It may be a matter of stating that grade separated crossings must be provided in which the needs of the physically impaired are catered for, or that the route to school must be made safer for the children who go to a school affected by the project. It is however not evident what proportion these population groups constitute of the specific population. By means of geographical distribution, 21 of the 28 describe how the different subareas will be affected by different health effects. This distribution does not describe the composition of the population, but there is often an approximate indication of the number of persons in the different areas.

Methods of describing how the health of the population is affected

In 27 of the 28 investigated environmental impact assessments, the effect of the project on human health is evaluated with reference to the standard, guidance and threshold limit values and future requirements of this type. These evaluations are made on the basis of noise and air pollution conditions. In six of the 28 EIA the project concerned is compared with similar projects and/or situations in order to describe the expected impact on the health of the population. An example where a comparison is made is a tunnel construction project where the planned design is compared with the design of existing tunnels. If the designs are comparable, the results of measurements of air quality in existing tunnels can be used. 18 of the 28 EIA compare the proposed project with the zero option in describing the impact on the health of the population. In such comparisons, the way the new construction will alter existing exposure conditions is often described. For instance, the alignment of a road may take it further outside a community than before, and the exposure of the population to e.g. noise and airborne pollutants will thus be reduced. In 25 of the 28 documents there are also other types of comparisons to describe how the impact on the exposure and health of the population may be altered. These comparisons often take the form of assumptions based on accepted theories, for instance that the expected increase in traffic will result in an increase in noise, traffic accidents, accidents involving hazardous goods and barrier effects. As regards airborne pollutants, concentrations are generally expected to drop in spite of an increase in traffic volume. This is explained by the fact that the envisaged stock of vehicles contains a higher proportion of more recent vehicles and that the expected stricter emission requirements will result in better purification by catalytic converters. In none of these EIA are there calculations of impact with reference to expected changes in exposure and dose-response relationships. Probability calculations are made in six of the 28 EIA to describe the risk of health impacts. The calculations are set out only in connection with accidents involving hazardous goods; for instance, the calculations show the risk of being killed in such an accident, the probability that a vehicle carrying hazardous goods will be involved in an accident, the probability that a petroleum accident will occur on a specific road with the expected number of accidents/year, and the

Consideration of health aspects in environmental impact assessments for roads

23

expected time between accidents, etc. The risk analysis shows how the number of accidents and their consequences change over time.

Effect-modifying factors

The presence of medical/biological effect-modifying factors associated with individuals in the affected areas, e.g. that the proportion of children, the elderly or asthmatics is unusually high and will result in more serious effects due to changes in air quality, is not shown in any of the environmental impact assessments. What the effect-modifying factors are for air pollution effects is not dealt with in any of the EIA. On the other hand, in a number of the EIA it is possible to find a kind of "effect-modifying factor" in the form of the sound insulation capacity of buildings.The fact that the functionally impaired, the elderly and children may have a higher acccident risk and may be particularly affected by barrier effects is mentioned only in general terms, without any descriptions of the sizes of these groups or their distributions in the affected areas.

Calculation models

19 of the 28 documents state what calculation models have been used. Two of the 28 do not do so, but nevertheless set out the calculations. Seven of the 28 do not include any calculations. In such cases data may have been collected from other EIA, municipal measurements or something similar. Five of the 22(??) which have made calculations have validated these, and 11 of the 28 state who has carried out the calculations.

Agreement with the stated goals General goals

21 of the 28 environmental impact assessments set out different health related national, regional or local goals. Eight of the 28 describe the degree of agreement with the different goals. Six of these eight examine agreement with the Swedish environmental goals, mainly the goals regarding fresh air and good built environment. Three of the eight examine agreement with local goals, which are environmental programmes or environmental and traffic policies adopted by the municipality. Two of the eight examine agreement with the rules laid down in the Environmental Code regarding consideration of environmental aspects. Two of the eight also examine agreement with the traffic policy goals. In this study, the way the traffic safety and accessibility goals are satisfied is of interest. In one of the eight EIA there is a description of the attainment of the zero vision (no fatalities or serious injuries in traffic), and one of the eight considers compliance with the Swedish Road Administration publication "Special plan for environmental and traffic safety". This publication is of interest since it discusses the conditions of the inhabitants, vulnerable road users, children and those with functional impairment. There are 13 enviromental impact assessments written after 1 January 1999 when the Environmental Code came into force; four of these give no description at all of goals.

Project goals

One EIA has set up internal goals for the road project concerned. The description of the goals also indicates how well the goals of the project can be satisfied.

Monitoring

11 of the 28 environmental impact assessments contain a section on monitoring the project. Eight of these 11 describe monitoring of both the construction and operational phases. Three of the 11 are plans, two of the 11 are at the feasibility study stage, and the remainder at the land acquisition plan stage. According to the EIA, the purpose of monitoring is to verify compliance with environmental goals and to take corrective action in the event of non-compliance. It is also the aim to provide experience for the future. During monitoring, a check is made to see whether the calculated values agree for e.g. noise, vibration and airborne pollutants.

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Consideration of health aspects in environmental impact assessments for roads

Discussion

Method

In selecting the environmental impact assessments, some were picked from lists supplied by the regions of the Swedish Road Administration, but in most cases the regions and the municipalities suggested which EIA might, with reference to the criteria, be of interest for the study. It is therefore possible that in this study the EIA which are "better" performed are overrepresented and that this might affect the final result. If the selection of the environmental impact assessments is not fully representative, then it is likely that the health aspects have received worse treatment overall than in the examined documents. In order that a guaranteed representative picture of EIA may be obtained, the selection should have been made only by sampling from register systems with reference to the predetermined criteria. As mentioned before, there are no regulations in Swedish legislation as to how an environmental impact assessment should be formulated. Such regulations might result in constraints and limitations on the documents since there is constant development in this area. This study presents current knowledge in this area, with the focus on airborne pollutants and noise, and this knowledge has been used in drawing up the check list. This implies that the underlying documentation in particular, and the check list also, are not a permanent aid in scrutinising environmental impact assessments, but they will have to be expanded as new knowledge and issues arise. The check list, however, has been formulated with open-ended questions which gives it a somewhat longer life. Yet another reason for the use of open-ended questions is that these provide the opportunity to capture all types of impacts. If, for instance, answers to the check list were to be made in a multiple choice format, there is a risk that project-specific impacts might be overlooked unless just the right question were asked. However, to achieve lucid presentation of the results of a scrutiny, answers to the check list must be grouped, which gives results similar to those of a multiple choice list. However, the advantage of open-ended questions is that one can return to the check list and take a closer look at individual projects.

Analysis of the studied environmental impact assessments

Expertise and method used in identifying essential health aspects

It is only five of the 28 environmental impact assessments which state who was responsible for various parts of the document. It is very probable that the health sections of the other environmental impact assessments were written by consultants or the staff of the municipality. In all the environmental impact assessments, it is difficult to ascertain what has been done to determine which are the health aspects that are essential for the project. When there are statutory instruments and standard values to refer to, or there is a "tradition" to consider a certain aspect, it seems that a section concerning the aspect is included as a matter of course. The way health is treated in environmental impact assessments is probably directly related to the demands the decision making authorities place on the document when this comes up for approval. If the demands of the authorities on the EIA as a decision base were to be sharpened with regard to presentation of the health aspects, then it is likely that the help of experts would be needed more and that scientific literature would be utilised to a greater extent, since in this way more specific answers would be obtained concerning the impact on the health of the population in question.

Identified health effects

In selecting the environmental impact assessments, an endeavour was made to find projects in which a road affects housing areas etc. This would make it relevant for effects on human health to be included in the document. However, none of the analysed EIA deal with all the previously mentioned health aspects. Traffic safety is represented in 21 of 28 EIA, hazardous goods are mentioned in 22, barrier effects in 22, outdoor activities/recreation in 27 and vibration in 24. As far as traffic safety is concerned, the absence of a description may be due to the fact that a separate impact assessment is sometimes performed in this

Consideration of health aspects in environmental impact assessments for roads

25

area (VV, 1995). The explanation for the others may be that the effect is not considered relevant for the project, for instance a recreational area is perhaps not near enough to be affected by the project. However, it has not been possible in this report to make an assessment of what the various environmental impact assessments ought to have identified as relevant effects, since this would have required an in-depth scrutiny of each individual case and environment. In order to arrive at a greater understanding of the impacts of these effects on people, it is of interest to describe the character of these effects. This has been done with highly varying results. One example that may be mentioned is description of the impact due to airborne pollutants; it is only three of the 28 documents which state that airborne pollutants can cause subjective discomfort such as smells and irritation of the airways even though the threshold limit values are not exceeded, and only five of the 28 that airborne pollutants can give rise to acute and chronic effects. The effects of air pollution on humans may appear less obvious than the disturbance effects noise can give rise to. In spite of this, noise is described as a disturbance in 16 of the 28 environmental impact assessments. There may be many reasons for the scant description of the different health effects, for instance the impacts may be thought improbable in view of the threshold limit values, they may be considered self evident, or they may be thought too complicated to describe, and a description is therefore omitted. It is not possible to judge from the studied EIA why the health aspects have been given so little space.

The population in these environmental impact assessments

A description of the population affected by the project is very important in order that the way in which the health of the population is affected may be ascertained. In the studied environmental impact assessments, the population has been commented on in 13 of the 28, in nine cases by giving the number of those affected by the project. It would for instance be of interest to see if it is predominantly families with children that live in an area. This would give rise to additional "sensitivity" to noise, airborne pollutants and traffic safety. It may also be of interest to find if a road goes past a school or a care institution, which are also sensitive environments. Consideration to sensitive population groups is given in 9 of the 28 EIA. A usual way of describing how the population concerned is affected by the road is to state in a geographical presentation where the population will be affected by a certain environmental change. This may be a good starting point for a description of the impact on the population, but a further step might be to describe the composition of the population in the areas concerned. On the basis of such a description, the proportion of the population that will be affected by the project can be determined with greater reliability.

Methods of describing how the health of the population is affected

There are many ways to describe how a project changes conditions and thus to state what the effect will be on human health. Under the provisions of Chapter 6 Section 7 Clause 4 of the Environmental Code, environmental impact assessments must contain a zero option. This zero option must describe the impacts that will ensue if a project is not carried out, i.e. it serves as a basis of comparison for the different solutions of the project. In 18 of the 28 environmental impact assessments, the zero option is used in comparing the health impacts of the project. The conditions that are compared with the zero option are usually equivalent and maximum noise levels, concentrations of nitrogen dioxide, etc. The predominant way of comparing the health effects of the project is to relate these to the current and future standard, guidance and limit values. This has been done in 27 of the 28 EIA. Standards etc are thus used instead of describing the impact, the implication being that if such values are not exceeded, changes in the environment have no effects on human health. This approach is unscientific and does not accord with present knowledge concerning e.g. the effects of exhaust gases. Standards have limited ability to describe the health impacts for the population concerned since they are an expression of the level at which it was considered that the limit for unacceptable disturbance and effects on people could be set when the standard value was ratified. Standards, threshold limit values and similar are also altered in stages, subject to considerable delay in relation to the constant increase in knowledge. It is for instance proposed that the Swedish long term standard for black smoke should be lowered from 40 to 10 µg/m3

26

Consideration of health aspects in environmental impact assessments for roads

in one step. When the assessed level is 8­10 µg/m3, it is naturally of great importance whether it is 10 or 40 µg/m3 that is considered to be the limit for what is acceptable. Research results, also from Sweden, have in this case shown for a long time that a dose-response relationship for e.g. asthmatic complaints exists much below a mean concentration of 40 µg/m3 (Forsberg et al, 1993). The magnitude of health effects due to an expected increase in traffic also depends on other external conditions. 25 of the 28 EIA describe how the health effect depends on other conditions, such as the composition of vehicles in the future.This type of comparison is useful since it is mostly easy to understand, but it should at all times give a calculation or explanation, and the sources of these theories should be quoted. To write, for instance, that air pollution will decrease in future as a result of the change in the vehicle fleet is not a sufficient description. Probability calculations and quantifications based on dose-response relationships are poorly represented in the studied EIA. Use of probability calculations as a calculation method appears to be most common in relation to hazardous goods. No quantifications have been made with reference to the expected air pollution or noise levels. If there is information available concerning the population in question, these methods may be very useful in describing how people will be affected by a project, for instance with regard to changes in exposure to airborne pollutants and noise; this may form the basis for quantifying the health impacts. As regards barrier effects, the effects on recreation and exercise etc, only qualitative and general comments are made.

Effect-modifying factors

Description and consideration of effect-modifying factors is chiefly of interest when the health impacts of e.g. airborne pollutants are to be quantified and assumptions must be made concerning the dose-response relationships that apply in the case concerned. Since these types of calculations are not used at all in environmental impact assessments, the information is not important. The most likely effect modification that will be stated is that, in relation to accident risks, there are certain forms of sensitive groups, e.g. children.

Validation of calculation models

Only a few of those who have performed calculations have validated these in relation to the environment concerned. This has mostly been done to describe the uncertainty in the calculations, which is a good way of quickly forming an idea of the reliability of the calculations. Owing to local conditions such as meteorology, volume of traffic etc, the models may not work well for the location in question.

Agreement with the stated goals General goals

Goals are often of an overriding and general character. Reference to general goals in a real decision situation enhances understanding of their purpose and the conditions that will be affected if the goal is satisfied. A large proportion of the studied environmental impact assessments, 21 out of the 28, contain a description of the national, regional and local goals, but only eight describe how the project concerned agrees with these goals. When projects comprise only a description of the goals, they perform the analysis only partially. A parallel can be drawn with the way the projects compare their results with the standard, guidance and limit values. 27 of the 28 show what the levels are estimated to be in relation to the stated requirements; in this case the analysis is thus carried through to its completion. The national environmental goals must be used as a guide in applying the regulations of the Environmental Code (Training Course for the Environmental Code, 1998). The goals gradually acquire a clearer shape as more targets are presented, and it is hoped that this will make them more usable in the future. Six of the eight EIA which describe the degree of agreement with the goals also examine how the national environmental goals are satisfied. This demonstrates that these goals are well known and are being increasingly applied. The general rules regarding consideration of environmental aspects shall be complied with at all

Consideration of health aspects in environmental impact assessments for roads

27

times for all cases covered by the provisions of the Environmental Code (Training Course for the Environmental Code, 1998). These rules must also form the basis in reviewing permits and exercising supervision in accordance with other Acts, where this is specifically stated in the Act. In Section 3a of the Road Act, it is stated that Chapter 2 of the Environmental Code shall be applied. Seven of the eight EIA which contain a section concerning agreement with the stated goals were projects covered by the provisions of the Road Act. These were made in 1999­2000 when the provisions of the Environmental Code began to come into force. In spite of this, five of these seven do not say how the rules on consideration of environmental aspects are complied with.

Project goals

The purpose of the proposed project, and in most cases also its goal, is stated in the environmental impact assessments. Assessment of how the project agrees with the stated goals gives a clear picture of how its purpose is satisfied, and it should be an important and interesting issue later on in finding how the completed project actually satisfies these goals. This type of follow-up is presented in only one EIA. Cumulative effects and strategic decisions Environmental impact assessments are associated with a final stage of the decision making process, and because of this it is often too late to perform strategic impact assessments (EU, 2000). The effects in an EIA are in most cases associated with impact assessments of a more technical nature, such as standard, guidance and threshold limit values. These assessments are not as far-reaching as the long term strategic assessments. Overall, the individual projects with environmental impact assessments give rise to cumulative effects which may have the result that the long term goals are exceeded or not attained. It is therefore important in producing major national, regional or local plans, policies or programmes to make a strategic assessment; this will make it possible to prevent the cumulative effects so that they do not go beyond the long term goals.

Monitoring

Monitoring of a project can produce a number of different benefits. One benefit in this context is the knowledge gained that can be applied in future projects. Another benefit is that greater control is achieved over the work, which may make it easier to comply with the appropriate legal requirements. This control of the work may be even more important in future when, for instance, environmental quality standards begin to apply. Legislation concerning EIA does not state that they must contain a section on monitoring. This section may however be important when a permit for the work is granted. Monitoring may also be specified when the process is already at a late stage. Nine of the 11 studied EIA which had a section on monitoring were at the last stage of the road construction process. The other two were EIA which had been produced quite recently. It would be beneficial if an EIA contained a section on monitoring, since this sets out the effect of the project during the construction stage and also describes how the expected health effects will be monitored.

Important conclusions of the analysis

The following conclusions are drawn regarding the presentation of health aspects in the examined documents: · It is only in a few environmental impact assessments that experts are consulted in identifying and describing the health effects of a project. There is usually little reference to the identification phase. · The majority of the studied EIA do not describe the population affected by the project, its composition, the presence of sensitive groups, etc. · The health impacts of the project are compared to a much greater extent with the current standard, guidance and limit values than with the zero option concerned. · The authors of EIA appear to assume that contents and levels below the standard, guidance and limit values do not have any effects on human health, and do not quantify changes in exposure or health effects.

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Consideration of health aspects in environmental impact assessments for roads

· Only a few of the projects which must observe the provisions of the Environmental Code regarding consideration of environmental aspects state how the project complies with these provisions. · In spite of the fact that many of the studied documents describe the national health related goals, most do not state how the projects agree with these goals. Because of this, the cumulative effect of a number of similar projects is not touched upon.

Consideration of health aspects in environmental impact assessments for roads

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Consideration of health aspects in environmental impact assessments for roads

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