I offer comments about the Enerdu proposal from a population health perspective. As has been suggested, the Enerdu proposal has potential effects on the environment, culture, and employment/income in the short and long term. This is therefore explicitly a population health issue, where one of the central principles in protecting or improving health is to have a positive influence on “upstream determinants of health and their interactions”. (It is hard to ignore the irony in this principle given the project type being debated … but I digress …)
Upstream determinants of health are the conditions in which people are born, grow up, live, work and age, including but not focused on the health system. In Canada, the Public Health Agency, through to the Ontario Ministry of Health and Public Health Units, recognize twelve key determinants that make Canadians healthy or unhealthy (1):
- income and social status,
- employment and working conditions,
- social environments,
- physical environments,
- personal health practices and coping skills,
- social support networks,
- healthy child development,
- education and literacy,
- biology and genetic endowment,
- health services.
It is also understood that these circumstances are in turn shaped by a wider set of forces (structural determinants) including economics, social policies, and politics. I am not going to discuss these here.
With respect to the twelve, we can identify how the Enerdu proposal and decision affects population health. These are brief comments about several of these topics and I recognize that a lot more could be done to complete a full assessment.
Regarding “income and social status” – clearly, wages will be lost and gained in both the short and long term – in existing jobs and shops, as well as for the construction/Enerdu workers and the company.
The effect on “Employment and working conditions”, for those with an existing business or working anywhere near the construction sites, is more than likely all negative for the duration of the construction and possibly during operations: the noise, dust, and potential loss in tourist appeal for the town of Almonte (and Mississippi Mills) (therefore related to income as well). On the other hand, employment prospects (and income) will improve for the workers involved in the project.
The “social environment” is described as the broader community, reflected in our institutions and organizations that may support values and create or maintain resources that foster better health. To date, it appears that our government sectors are not doing well in supporting this determinant of health. Perhaps if the MNR would act on the request to review the Mississippi River Water Management Plan, one environmental concern related to water levels associated with Enerdu operations would begin to be rectified (also see interrelated effect on the “Physical Environment”, next). We also await the MOE decision on the request for the Part II Order. Finally, the municipality has the role to play in upholding values and resources along the river corridor, through its formal and informal mechanisms related to the proposal. With respect to relevant non-government organizations that are part of our “social environment” as a determinant of health, I would include the work of the Mississippi RiverWatchers, the Mississippi Valley Field Naturalists, as well as the Chamber of Commerce. There are others.
The “physical environment” refers to both the built and natural environment in which we are born, grow, live, work and play. The effects are not inconsequential, where about 25% of global burden of disease has been linked to environmental health (although causes of illness vary around the world). Granted, for the most part, we are very lucky to be living where we do. However, the potential effects of the Enerdu proposal on both the natural and built environment have been described by others for both the construction and operating periods. The linked risks to health include at a minimum the noise and the stress.
The potential change in our physical environment as a result of this proposal is clearly interrelated with some of the above mentioned determinants, as well as our “coping skills”. This determinant can be affected both positively and negatively in how individuals respond/cope with challenges and solve problems. Coping skills may improve with the ongoing response to this project but may just as easily deteriorate and result in long-lasting negative impacts. As well, psychosocial change or stress can affect other illnesses, depending on genetic predisposition or existing health status. All sides likely agree that the proposal is affecting coping skills. Incidentally, I suggested to the MOE that psychosocial effects of the project be assessed through the Part II Order.
“Social support networks” refer to support found in relationships. A project such as Enerdu can have a positive effect as people join together and help each other through this process. Relationships can also be torn apart when friends and family have varied points of view.
Others have noted how our “culture”, as a determinant of health, is also being tested both with respect to the potential to curb our activities and the potential effect on the river aesthetic and our historic buildings. Gender is also a determinant, as women and men respond differently to life circumstances.
In sum, Enerdu is having and could continue to have an explicit effect on the determinants of health, and therefore the population health of our community. Unfortunately, there is no such thing as zero-risk to health.
Patricia Larkin, Population Health Risk Assessment specialist
Mississippi Mills, Ontario
(1) Public Health Agency of Canada. (2010). What makes Canadians healthy or unhealthy?