Bianchi Fabrizio, Ancona Carla, Bisceglia Lucia, Forastiere Francesco, Ranzi Andrea
Istituto di fisiologia clinica, Consiglio nazionale delle ricerche (CNR), Pisa;
Istituto per la ricerca e l'innovazione biomedica, Consiglio nazionale delle ricerche, Palermo.
Epidemiol Prev. 2021 Jan-Apr;45(1-2):117-121. doi: 10.19191/EP21.1-2.P117.046.
Environmental Impact Assessments (EIAs) often conclude with a "low" or at least "negligible" final health impact assessment (HIA) of the industrial plant under assessment. We explore the reasons for this - often simplistic - conclusion and offer suggestions on how to extend the assessment focus from just the plant to an appropriate impact area. For many assessments, the conclusions are easily predictable: the application of available risk functions to modest increases in pollution, in the presence of numerically small populations in the areas of greatest fallout and considering rather rare health outcomes, can only result in quantitatively modest health impacts. This is the classic situation of low sensitivity of the observation system due to the impossibility of containing the type II error (false negatives) since we cannot increase the exposed population at will. The risk is to give the green light to an industrial plant in which the apparently null or very limited damage is simply not properly detectable. There is hardly any trace of these elements in the HIA scoping phase. In environmental complex territories, the renewal or authorization of a new plant should consider not only the impact of the individual plant, but also the health profile of the population concerned and the context in which the industrial project is located. An 'HIA area' is therefore configured, aimed at the complex of environmental pressure factors that insist on the same area of impact of the plant. Epidemiology focuses on the exposed population, considers the 'current' state of health, hazard, and risk information from toxicology, and estimates individual exposure and the effects of exposure. The 'HIA area' can assess the impact of the complex of persistent emission sources, considering in the analysis the health status of the exposed population and the presence of specific vulnerabilities. The proposal is in line with what is already foreseen in the Essential levels of care and Environmental technical performance of the National Health Service.A basic condition is the establishment of functions dedicated to integrated environmental and health surveillance to update the health profile and carry out the 'HIA area' as an accompanying tool for local strategic planning. On these issues, the Italian Environment and Health Network (RIAS) has opened a discussion within the network and with any Italian regions.
环境影响评估（EIA）往往以对被评估工业工厂的“低”或至少“可忽略不计”的最终健康影响评估（HIA）作为结论。我们探究了得出这一通常较为简单化结论的原因，并就如何将评估重点从工厂本身扩展到适当的影响区域提出建议。对于许多评估而言，结论很容易预测：在污染增加幅度不大、受影响最大地区人口数量较少且考虑的是相当罕见的健康结果的情况下，应用现有的风险函数只会导致在数量上适度的健康影响。这是观测系统灵敏度较低的典型情况，因为无法控制II类错误（假阴性），因为我们不能随意增加受影响人群。风险在于对一个工业工厂开绿灯放行，而其表面上零或非常有限的损害可能根本没有被正确检测到。在健康影响评估的范围界定阶段几乎没有这些因素的踪迹。在环境复杂的地区，新工厂的更新或授权不仅应考虑单个工厂的影响，还应考虑相关人群的健康状况以及工业项目所在的背景。因此，一个“健康影响评估区域”得以构建，目标是针对施加于工厂同一影响区域的环境压力因素复合体。流行病学关注受影响人群，考虑健康的“当前”状态、危害以及毒理学方面的风险信息，并估计个体暴露情况和暴露影响。“健康影响评估区域”可以评估持久性排放源复合体的影响，在分析中考虑受影响人群的健康状况和特定脆弱性的存在。该提议与国家医疗服务体系的基本医疗水平和环境技术性能中已经预见的内容一致。一个基本条件是建立专门用于综合环境与健康监测的职能，以更新健康状况并开展“健康影响评估区域”工作，作为地方战略规划的辅助工具。关于这些问题，意大利环境与健康网络（RIAS）已在网络内部以及与意大利各地区展开了讨论。
