The UOGE moratorium reports for fracking and CBM were set within a clear structure and timetable to ensure outcomes, public consultation and parliamentary scrutiny and approval.
The process was carefully thought through and managed. The report findings would not bind decision-makers as we show in our diagram but would inform debate and consultation.
3.2.1. The Health Impact Assessment
Health Protection Scotland (HPS), a government agency, conducted a health impact assessment (HIA) of unconventional gas extraction including fracking. It is the most substantial enquiry of the six commissioned by the Scottish government, using input from international referees in a transparent manner, and a systematic literature review of peer-reviewed scientific publications. The conduct of the HIA in terms of setting out criteria for inclusion of research in the review, as well as how expert review of this material was organized, would appear to represent best practice. The very transparency of these processes enabled proper scrutiny of this HIA. Some of our detailed critique, particularly of the drift between the evidence base and the summary conclusions of the HIA, are only possible because the review was conducted with such a high degree of transparency.
HPS also organized several initial stakeholder events scoping public health issues related to UOGE as part of the wider HIA. There were three dedicated strands: (1) for community groups; (2) industry; and (3) public sector agencies and regulators who may have responsibilities in relation to UOGE. The organization of these events, and how they were to feed into the finding of the inquiry, was an issue of contention for community groups in particular who were dissatisfied with the conduct and framing of this phase of stakeholder engagement. They raised particular concerns over permissions for community groups to submit their own evidence, and disputes over how representative some invitees were of community concerns relating to UOGE. This understanding is based on correspondence between authors and community groups who participated in the stakeholder event and participant observation and is reflected in the official minute of this meeting [21
The published HIA found evidence for some fracking risks, identified established hazards including ones for workers and likely risks for air and water pollution along with inconclusive evidence for other risks and many data gaps [22
]. The report found inadequate evidence to determine whether shale oil and gas or coal bed methane development would harm public health. Based on the available evidence the report acknowledges the relevance of a cautious approach to fracking. Generally, the weighing of evidence is measured and balanced. However, some of the conclusions drawn appear to be optimistic readings of data and experience. For example, assessments of the ability of industry and regulators to control fracking effects on public health do not stand up to scrutiny [23
]. Potential resource and staffing problems for regulators and reliance on industry partnerships are noted. The overall thrust of the report on data gaps regarding epidemiological studies of the industry, worker hazards and problems with regulation nevertheless clearly contradicts the industry view that fracking will be safe and highlights potential impacts on densely populated geographical areas. The HIA could not decide on the effects on public health of fracking noise and seismic activity. The report briefly mentions climate change, economic and housing impacts as these are covered in separate enquiries but fails to explore several important studies on the adverse social impacts of fracking especially in terms of stress and well-being [27
The HIA report offers several conclusions that are not always supported by the evidence it reviewed. Specifically, it downplays some evidence and data gaps, and at times appears to conflate mitigation measures with the application of cautionary approaches rather than separate them in dealing with nation-wide approval of fracking. The available evidence indicates that mitigation through either regulation or good industry practice cannot be assured. Yet the drafting of the report’s conclusions suggests otherwise. Significant relevant literature from peer-reviewed and independent sources on regulation and industry practice is ignored in the HIA and this is a major weakness.
The terms of reference provided by the Scottish government to HPS for the HIA appear to have been changed by HPS. This effectively leads to a downplaying both of a holistic approach to health (which is a central tenet of the Scottish government’s own policies) but also a serious neglect of the literature on social impact assessments and related research and HIA literature that address questions of well-being and mental health. We are unclear to what extent the Scottish government was consulted and agreed these changes. While cumulative health impacts are touched upon in the report, linked to problems of assessing mixtures and interactions of substances, this important subject is still relatively neglected and plays directly into considerations about data gaps and precautionary policies in assessing UGE.
The downplaying of environmental and social justice issues appears to be another significant weakness of the report. Such questions cannot simply be bracketed out when addressing the hazards, risks, and public health impacts of UOGE. These issues should form an important element of policy consideration in the fracking debate.
The Scottish HIA provides an evidence base for public health concerns and data gaps that the Scottish government considered sufficient to support a decision not to proceed with fracking. To this evidence base one can add research published after the HIA (after 2016) and current knowledge about sustainable energy alternatives.
3.2.4. The Scottish Government UOGE Review in a Global Context
Shale gas and other oil and gas extraction by fracking occurs in several US states and in some Canadian provinces. It has been approved in England and is contested or banned in many other countries. In Australia, such fracking has been banned in Victoria, and there is a moratorium on conventional onshore gas exploration until 2020 [39
]. France has banned fracking due to an application of the precautionary principle [40
]. Before shale gas fracking, CBM and UCG projects are permitted it is usual in most states, or provinces and regions where UOGE is proposed for some sort of environmental and health-related impact assessment relating to planning controls to be conducted. These assessments may vary, and some authorities have also produced policies and guidance relating to shale gas extraction before projects are approved.
In Australia, Canada, USA, and England, for example, a variety of health impact assessments of fracking and CBM or related policy and health reviews have been conducted either by public health professionals, commercial consultants or academics who may be paid by local authorities, government, civil society bodies or industry. Some have looked at specific potential extraction sites and some have attempted to assess the UOGE industry as a whole. The table below lists several of the most influential or revealing of these assessments and related policy documents. While they cover many but not necessarily all the topics addressed by the Scottish government reports, none do so across the board in the depth of the Scottish exercise. The substantial public consultation built into the official Scottish policy deliberation process is very different from the typical public inputs via focus groups or panel surveys etc., run or commissioned by commercial consultants.
Some of the reports included in the table above offer a very cursory treatment of certain topics. Nonetheless we give recognition where and when the identified topic is at least touched on. In relation to processes around public engagement we acknowledge there are some issues of nomenclature here. In relation to HIA, effective and meaningful “public engagement at all levels should mean much more than simply minimal “stakeholder” involvement that is built into the health impact assessment methodology and sometimes planning requirements. Nor is it covered by “public pushback”, a term used in the USA relating to resistance to fracking proposals. As some of the outputs included for analysis on Table 2
are not strictly HIAs we have sought to capture public engagement as both a theme and practice in our ranking.
identifies and rates the key topics and processes involved in UOGE assessments. Our analysis below offers a qualitative assessment of the merits of each and adds some comparative commentary to give context to our assessment of the Scottish government moratorium reviews [33
The report of the Independent Expert Scientific Panel for the Scottish government in 2014 [18
] touched on some of the key topics in Table 2
. However, there were significant limitations in its coverage of public health, occupational health, regulation and industry practice and a lack of expertise in some of these areas. The panel was comprised of leading engineers, geo-scientists, chemists, and environmental scientists as well as former environmental regulators with considerable experience. This meant that issues related to extraction and production of shale gas were well covered. The panel was not tasked with carrying out public engagement work but significantly noted the importance of such efforts, recognizing “genuine public engagement on unconventional gas needs to include a consideration of social, political and ethical aspects of developments, both within the community and as a nation” [18
] (p. 63). The report does not address public health nor examine the related questions of effective enforcement of regulations. It does not adequately cover the issue of resources and staffing needed by regulatory agencies to effectively inspect and oversee the UOGE industry.
Finkel’s report [2
] covered most of the topics identified in Table 2
. The background of each chapter author/s was disclosed, and the book included contributions from industry and environmental groups. The book provided one of the most detailed assessments then available of fracking, climate change and public health linked to economic benefits and costs. It does not focus on “vulnerable populations” as such but contributors do cover a range of social determinants of health, economics and employment and endocrine disruptors that ensure the subject is addressed. The publication is unique in that it also has a chapter on impacts on animals in agriculture and the wider environment. It did not, however, pull together all the topics discussed to reach a conclusion about whether fracking should be approved. Nor was any public consultation exercise conducted as this was not relevant at the time to the book’s purpose.
The UK Task Force on Shale [41
] was funded by the fracking industry. It produced a series of reports on topics relating to fracking and then an overview document pulling together these disparate elements. A number of the specific reports drew on a range of expertise relevant to assessing the fracking industry. However, the analyses especially of industry practice and in places on regulation were superficial and the coverage of occupational health was deficient. The technical review supporting the final Task Force report does review studies that flag vulnerable populations, social determinants of health, and notes the absence of peer review on some papers. All these qualifications appear to vanish in the final report itself. The Task Force calls for a simplification of the regulatory structure and consolidation of agencies responsible for fracking with the creation of a bespoke regulator. This casts some doubt on whether the current regulatory system in the UK can deal effectively with the considerable health, safety and environmental challenges posed by fracking.
Werner et al. [42
] examined environmental health issues and found direct health outcome evidence on fracking and coal bed methane lacking especially regarding long-term studies. Hence possible health impacts could not be ruled out. The paper specifically addressed societal impacts and reviewed a wide range of papers on government and regulation in peer reviewed and grey publications, recognizing the significance of both subjects to fracking policy. In terms of process, there are considerable strengths in this work, particularly when dealing with uncertainty in scientific findings, and how this is translated in policy processes.
The US Institute of Medicine [43
] published a HIA on shale gas extraction based on a workshop they convened with industry, academics, and government agencies. It did not involve community or worker groups or non-governmental organizations. The publication that arose from that workshop provided information on geographic footprints and one of the most detailed explorations of occupational health and community impacts available at that time. In addition to the necessary sections on air and water pollution, the report also covered sustainable energy and future research. The process used to generate the analyses offered in the report, primarily dominated by scientific and governmental experts in their field has much to commend it. It was not part of the brief to carry out public or community consultation but given the remit and participants it appears it might have been possible to involve health and safety advisors from trade unions directly in the workshop.
Ben Cave Associates [44
] published a HIA that focused on UOGE planning applications in Lancashire county council in the UK. While the focus of this work is at the smallest scale of the studies we have included in Table 2
it merits inclusion as an exemplar of a relatively detailed, careful, and locally sensitive health impact assessment report prepared on fracking. It is generalizable in many respects. The authors were commercial consultants contracted by an English local authority to carry out an assessment determined by planning laws and guidelines that required decisions about fracking mitigation and not whether a fracking proposal should or should not be approved. With relatively limited resources, the process used in preparing this report and handling the evidence available has much validity. The assessment involved 2 community engagement workshops attended by 110 people—for a small scheme, this exceeded the engagement achieved by the Scottish government HIA stakeholder workshop and in the Maryland State report. Also, the Cave report covers several of the key areas either mentioned briefly or missed by better funded outputs. It is especially strong on recommendations for meaningful community input which links with the need for public engagement and trust, and input from the local authority Director of Public Health which links with climate change, environmental justice, and social determinants of health.
The University of Maryland [45
] assessment of potential public health impacts associated with UOGE in the Marcellus Shale in Western Maryland is one of two substantial US reports looking at proposal for fracking in part of a state. The authors were all academics and the report was externally peer reviewed. It was prepared for Maryland State Environment and Health Departments. The authors engaged in a scoping exercise with communities which involved two quite small public stakeholder engagement meetings, underpinned by the publication of a draft scoping report as well as contacting industry and local business bodies. The scoping activity is similar to that conducted by the Scottish government exercise and is relatively limited. It also lacks the large public consultation stage that occurred in Scotland.
The report pays particular attention to vulnerable populations, social as well as physical determinants of health, and worker health and safety issues along with discussions of the US and state regulatory landscape. The process used is, within the relevant setting, rigorous and quite comprehensive.
The HIA produced by Public Health England (PHE) on UOGE in the UK [3
] was conducted partly because various national and local agencies requested advice on the matter. The 2013 draft version was produced following statements by UK government ministers supporting fracking with appropriate caveats about the industry being properly regulated and following good practice. PHE is a government executive agency of the UK Department of Health. Although it states it has operational autonomy in 2015 it was criticized in the BMJ as being “nominally independent, (but) appeared to be serving the policy agenda of a government promoting the potential of fracking…to provide the UK with greater energy security, growth and jobs” [51
]. The PHE review excluded consideration of climate change and greenhouse gas emissions, sustainable use of water resources, nuisance issues, traffic (apart from vehicle exhaust emissions), occupational health, visual impact and the socioeconomic benefits and impacts of shale gas extraction. A BMJ commentary on the report noted that “a focus on mostly hypothetical regulatory and engineering solutions may mistake best practices for actual practices and supplants the empirical with the theoretical” [23
]. The report has some but limited relevance in informing a comprehensive policy process to assess fracking in 2018. Despite several key weaknesses including neglect of mental health, no consideration of cumulative exposures and little analysis of industry practice under different regulatory regimes [5
] (pp. 26–29) the PHE report has been politically significant and has been cited repeatedly by politicians and industry to claim that fracking can and will be conducted safely in the UK.
The public health review of high volume UOGE conducted by the New York State Department of Health [46
] is a relatively detailed and lengthy assessment of the subject. It was conducted drawing on a wide range of staff with extensive expertise in the fields of public health, science, and medicine. The resources devoted to this report exceeded those made available for example in the Scottish government public health report of 2017 although in some respects the scope was more limited. There is relatively little detail on industry practice. Like other reports, it highlights gaps in knowledge about impacts and adopts a cautionary approach. Such an approach is not obvious in several other reports we reviewed. Most other studies reviewed here do not display this range and level of detail. Its strength lies in the interrogation of research methods and assumptions built in to research designs. Skepticism and rigor are hallmarks of the evaluation of results and the methods that produced those results (including interpretation of secondary data analysis and whether data warrant some of the respective authors’ conclusions). The report is very relevant to the policy-making process and contains transferable examples of good practice.
The Bloomfield AEA plc report for the European Commission [47
] is an extensive, careful, and cautious study done by commercial consultants for the European Commission. It drew heavily on North America information where fracking was already underway but set its findings in the context of European regulatory and legislative environment. Serious potential risks with fracking are identified and discussed, which stands in contrast to the apparent exclusion of this type of consideration by the UK government. The report emphasized and drew strongly on peer reviewed scientific reports, though there is little or often no peer reviewed literature to support judgements about regulatory effectiveness and industry good practice in fracking. These topics may have been considered marginal to the main focus of the report. In this context, the publication has limited value to the “process” of producing comprehensive assessments of the industry. There is some recognition of fracking impacts on local populations through “operators working cooperatively with regulatory agencies and other stakeholders to promote best practices and improve communication with local communities” [47
] (p. 138). However, this does not relate to community participation in fracking approvals. The report therefore has both strengths and weaknesses in informing the policy process.
The recommendations of the Office of the Chief Medical Officer of Health in New Brunswick [48
] is a relatively concise report reviewing the scientific literature on hazards and health impacts assessments of shale gas production. It was prepared by the Chief Medical Officer to identify both the state of knowledge and gaps in knowledge of shale gas with relevant recommendations. It is, therefore, similar in some respects to the APHA policy statement [49
] and in terms of “process” does not fall neatly into a category where a template could be devised. However, several principles it draws on and applies in its recommendations on health protection would be central to an effective assessment process. These are present in other reviewed reports but not necessarily highlighted in the same way or emphasized so strongly. They include discussion of health equity, transparency and community participation, vulnerable populations especially children linked to protecting future generations and, in a Canadian context, First Nations peoples. In Scotland such groups would include those in former mining communities and heavily populated polluted de-industrialized manufacturing areas that are not often perceived as containing vulnerable populations at all by industry. The emphasis in the report on ethical consideration, values, and principles to “guide all actions to improve, promote and protect health” [48
] (p. 4) is surprisingly missing in several of the other documents we reviewed. These should be guiding principles in the process adopted to assess fracking and its impacts.
The North American Public Health Association (APHA) [49
] policy statement on Environmental and Occupational Health Impacts of High-Volume Hydraulic Fracturing of Unconventional Gas Reserves ranges over the whole fracking process including site preparation, drilling, and casing, well completion, production, transportation, storage and disposal of wastewater and chemicals, and site remediation. It additionally includes occupational health and safety, climate change and economic aspects. Other reports have sometimes had a much narrower focus on well construction and immediate production. It identified a wide range of short-, medium-, and long-term risks to a range of populations. While the statement lacks some of the depth of other reports listed in Table 2
, the process used and the comprehensive nature of the topics covered may be recommended. The APHA highlight the importance of cumulative health impacts and good quality base line health data to inform policy and flag the necessity of involving public health professionals in regulatory assessments and decision-making processes.
Witter et al. [50
] prepared a substantial HIA for Battlement Mesa, Garfield County, a local shale gas proposal within Colorado. It was one of the earliest documents on this subject. The HIA runs to over 110 pages with appendices and was partly supported by Garfield County and by two charities. Unlike several more limited UK reports at the time on similar subjects, shaped by the narrow planning requirements and often commissioned by industry, the process used in this HIA ensured a comprehensive assessment of the proposed industry development. The scoping exercise conducted by the team included meetings with citizens, the industry, regulators, and the state health department. Seven stakeholder meetings were held over a six-month period. The assessment used its own 2008 Community Health Risk Analysis of the Oil and Gas Industry report relating to Garfield County. This had already collected baseline air monitoring data for the area that it noted even then increased risks of negative health effects on citizens. The process used by the Witter team, drawing on these detailed baseline pollution and health data, is a model for future assessments that was often never followed. It contained considerations of vulnerable populations, social determinants of health, community wellness and social cohesion—very often neglected elsewhere in other reports—and economic impacts. The process finally threw up recommendations on tighter pollution prevention and better monitoring, public safety, boomtown problems, tougher regulation and guarantees of transparency. The report provides an excellent template to inform the policy process.
Our assessment of the relative strengths of these reports leads us to conclude that the process underpinning the Scottish government public health review has much to recommend it. For example, time spent on the review, the range of evidence included, the resources devoted to the individual strands of evidence gathering, as well as the very significant commitment to public consultation, together clearly show the Scottish approach is more comprehensive and integrated and de facto “better” than other approaches to date. We base this judgement on our reading of the available policy reports under the criteria we have outlined in Table 2
. This framework highlights scope and coverage but does not discriminate in terms of depth or efficacy, beyond the simple ranking we have offered. While we think that the criteria we have foregrounded in Table 2
are helpful to policy makers and stakeholders interested in UOGE, judgements about how well individual reports and assessments meet these criteria are not easily scored or translated into agreed metrics. As such we have devoted some space to adding some description of the reports selected to give readers a clearer sense of how we developed our analysis and warranted our claims about the deliberative processes that have informed Scottish policy.