Information Gathered from Outside Authoritative

Information Gathered from Outside Authoritative

Organizations, Public Health Experts, and Formal

Health Impact Assessments

Information Gathered from Outside Authoritative

Other information sources were sought to provide additional background information on
public health risk of HVHF for the Public Health Review. Former Commissioner Shah,
Acting Commissioner Zucker, and DOH staff held multiple discussions and meetings
with public health and environmental authorities in several states to understand their
experience with HVHF. Former Commissioner Shah, Acting Commissioner Zucker, and
DOH staff also engaged in a number of discussions and meetings with researchers from
academic institutions and government agencies to learn more about planned and
ongoing studies and assessments of the public health implications of HVHF. Input was
sought from three public health expert consultants regarding the potential public health
risk posed by HVHF activities. And, health impact assessments conducted by other
state, provincial and international governments were reviewed for any additional insights
regarding HVHF public health concerns.

Health Impact Assessments

A health impact assessment (HIA) is a decision tool that uses a structured assessment
approach to identify impacts of an activity or policy decision and recommend ways to
lessen or prevent adverse public health impacts under alternate decision options. The
results of these assessments tend to be based on qualitative judgments when decision
alternatives being considered involve large-scale, complex issues such as HVHF. HIAs
that examined public health risks of HVHF have recently been conducted by

governments or academic institutions in Maryland (University of Maryland, 2014),
Michigan (University of Michigan, 2013), North Carolina (Research Triangle
Environmental Health Collaborative, 2013), Nova Scotia (Wheeler, 2014), the National
Institute of Environmental Health Sciences (NIEHS; Penning et al, 2014), the Institute of
Medicine (IOM, 2014), and the European Commission (Broomfield, 2012).
The European Commission, which is the executive body of the European Union,
published a report (Broomfield, 2012) on the results of a preliminary screening of
potential public health and environmental risks related to HVHF in Europe, along with
risk management recommendations. For each risk identified by the Commission, the
preliminary risk screening approach combined a subjective adverse event probability
classification ("rare" to "frequent/long-term definite") with a subjective hazard
classification ("slight" to "catastrophic") to develop a risk classification ("low" to "very
high"). Using this approach, the Commission determined that HVHF in Europe will entail
"high" cumulative risks of groundwater contamination, surface water contamination,
depletion of water resources, releases to air, increased noise, and increased traffic.
A 2011 Executive Order Issued by Maryland Governor Martin O’Malley established the
Maryland Marcellus Shale Safe Drilling Initiative.23 The Initiative is jointly administered
by the Maryland Department of the Environment and the Maryland Department of
Natural Resources. The Executive Order also established a Marcellus Shale Safe
Drilling Initiative Advisory Commission composed of a variety of governmental,
community, environmental and industry stakeholders. According to the Executive Order,
the purpose of the Initiative is to:

“… assist State policymakers and regulators in determining whether and
how gas production from the Marcellus shale in Maryland can be
accomplished without unacceptable risks of adverse impacts to public
health, safety, the environment and natural resources.”
As part of the Maryland Initiative, the Maryland Department of Health and Mental
Hygiene (MDHMH) announced in September, 2013, two public meetings to receive
public input on a study of potential public health impacts associated with possible
development of the Marcellus Shale in Western Maryland.24 MDHMH then oversaw the
study, which was performed by the University of Maryland School of Public Health’s
Maryland Institute for Applied Environmental Health. The final study report, entitled
“Potential Public Health Impacts of Natural Gas Development and Production in the
Marcellus Shale in Western Maryland,” was published in July 2014.25 The report
identifies largely the same types of potential health impacts of HVHF activity as those
identified in other HIAs. The report presents a hazard evaluation summary of eight
potential adverse impacts, rating four (air quality, healthcare infrastructure, occupational
health, and social determinants of health) as having a high likelihood of negative public
health impact. Three potential impacts (cumulative exposures/risks, flowback and
production water-related, and noise) were rated as moderately high, and one
(earthquakes) was rated as low.
In 2013 the University of Michigan’s Graham Sustainability Institute released several
technical reports on HVHF in the State of Michigan that were intended to provide
information for decision makers and stakeholders, as well as to help inform the
Institute’s “Hydraulic Fracturing in Michigan Integrated Assessment,” which will evaluate
policy options.26 Faculty-led and student-staffed teams provided reports on the following
topics: Technology, Geology/Hydrogeology, Environment/Ecology, Human Health,

Policy/Law, Economics, and Public Perceptions. The Institute noted that its technical
reports should not be characterized as final products of the integrated assessment, and
that the reports do not provide a scientific risk assessment for aspects of HVHF.
In its Public Health technical report, the Institute preliminarily identified 18 possible
public health issues related to HVHF, with “plausibility scores” reflecting qualitative
assessments of the evidence suggesting that each issue could be considered a
potential public health hazard.27 Of the 18 issues enumerated, eight were given the
highest plausibility score, reflecting the Institute’s determination that “scientific evidence
exists and is strong (e.g., many studies, good design, causality).” These eight issues
were silica exposure, intentional-use chemicals, by-product chemicals, transportation,
air quality, water quality, habitat and wildlife (impacts on recreational opportunities,
cultural/spiritual practices), and public perceptions (causing, e.g., increased anxiety,
family quarrels, depression).
The Institute discussed several “challenges and opportunities” with regard to HVHF in
Michigan, beginning with Michigan’s lack of a public health tracking system. The
Institute also called for complete disclosure of chemicals injected during HVHF, noting
that disclosure has thus far been minimal in Michigan, with only a few facilities reporting
upon a small number of drilling events out of more than 12,000 wells that have
undergone HVHF. The Institute additionally recommended more public health outreach
and education in Michigan, particularly in potentially-impacted communities, similar to
recommendations in our review. Finally, the Institute indicated that a health economist
should be enlisted to help describe risks and benefits of HVHF compared with
alternative energy sources.

In response to state legislation allowing the use of horizontal drilling and hydraulic
fracturing in North Carolina, a summit meeting was convened in October, 2012, by the
Research Triangle Environmental Health Cooperative (EHC). A report presenting
recommendations from the summit was released in 2013.28 According to the report,
summit participants represented diverse stakeholder groups including industry,
nonprofits, governmental organizations and academia. The report stated that:
“The EHC summit aimed to create a neutral space in which to share ideas
and experiences to identify gaps in the current knowledge of, and
preparations for, the potential impacts of hydraulic fracturing on public
health in North Carolina. The summit recommended actions and potential
policies to safeguard the health of North Carolinas citizens and
environment if hydraulic fracturing occurs in the state.”
Three working groups were formed as part of the summit – exposure pathways, health
impacts, and social impacts – and each working group made relevant recommendations
for developing new components or strengthening existing components of the state’s oil
and gas program. While each working group developed extensive specific
recommendations, major themes that were common to the working group
recommendations included:
• Collect baseline data prior to oil and gas drilling. This includes data on water
quality, hydrogeological information, hydrocarbon characterization, air quality,
ecosystem information, and population health statistics.
• Develop a comprehensive water and wastewater management plan that
addresses how water is allocated among users and how oil and gas drilling
wastewater will be managed through treatment, reuse/recycling and disposal.