Potential Public Health Impacts of Natural Gas Development and Production in the Marcellus Shale in Western Maryland July 2014 Maryland Institute for Applied Environmental Health School of Public Health University of Maryland, College Park Prepared for the Maryland Department of the Environment and the Maryland Department of Health and Mental Hygiene 1 ACKNOWLEDGEMENTS Research Team Donald Milton, MD, DrPH Amir Sapkota, PhD Professor and Director Associate Professor Maryland Institute of Applied Environmental Health Maryland Institute of Applied Environmental Health University of Maryland, College Park University of Maryland, College Park Sacoby Wilson, MS, PhD Thurka Sangaramoorthy , MPH, PhD Assistant Professor Assistant Professor Maryland Institute of Applied Environmental Health Department of Anthropology University of Maryland, College Park College of Behavioral and Social Sciences University of Maryland, College Park Chengsheng Jiang, PhD Research Assistant Professor Meleah Boyle Maryland Institute of Applied Environmental Health Graduate Research Assistant University of Maryland, College Park Maryland Institute of Applied Environmental Health University of Maryland, College Park Laura Dalemarre, MPH Program Associate Maryland Institute of Applied Environmental Health University of Maryland, College Park Contributors Keeve Nachman, PhD, MHS Kim Stinchcomb Assistant Scientist Graduate Student Johns Hopkins School of Public Health Maryland Institute of Applied Environmental Health University of Maryland, College Park Liz Ducey, MPS Geographical Information Systems Support Carly Brody Undergraduate Student Kelsey Babik University of Maryland, College Park Graduate Student Maryland Institute of Applied Environmental Health Harihar Batal University of Maryland, College Park Undergraduate Student University of Maryland, College Park Amelia Jamison Graduate Student Christian Jenkins Department of Anthropology Undergraduate Student University of Maryland, College Park University of Maryland, College Park Josh Trowell Undergraduate Student University of Maryland, College Park ii 2 TABLE OF CONTENTS 1 ACKNOWLEDGEMENTS ...................................................................................................... ii 2 TABLE OF CONTENTS ......................................................................................................... iii 3 LIST OF TABLES .................................................................................................................. vii 4 LIST OF FIGURES ................................................................................................................. ix 5 GLOSSARY OF TERMS ....................................................................................................... xii 6 EXECUTIVE SUMMARY .................................................................................................... xv 6.1 Baseline Health Assessment ........................................................................................... xvi 6.1.1 Vulnerable Populations ............................................................................................ xvi 6.1.2 Physical Determinants of Health ............................................................................. xvi 6.1.3 Social Determinants of Health ................................................................................ xvii 6.2 Impact Assessment .......................................................................................................... xix 6.2.1 Hazard Evaluation Methods and Summary ............................................................. xix 6.2.2 Air Quality ................................................................................................................ xx 6.2.3 Flowback and Production Water-Related ................................................................ xxi 6.2.4 Noise ....................................................................................................................... xxii 6.2.5 Earthquakes ............................................................................................................. xxii 6.2.6 Social Determinants of Health ............................................................................... xxiii 6.2.7 Occupational Health ............................................................................................... xxiii 6.2.8 Healthcare Infrastructure ....................................................................................... xxiii 6.2.9 Cumulative Exposures/Risk ................................................................................... xxiv 6.3 Recommendations .......................................................................................................... xxv 6.3.1 Comprehensive Gas Development Plans (CGDP) .................................................. xxv 6.3.2 Disclosure of Well Stimulation Materials ............................................................... xxv 6.3.3 Air Quality ............................................................................................................. xxvi 6.3.4 Flowback and Production Water-Related ............................................................. xxvii 6.3.5 Noise ..................................................................................................................... xxvii 6.3.6 Earthquakes .......................................................................................................... xxviii 6.3.7 Social Determinants of Health ............................................................................. xxviii 6.3.8 Healthcare Infrastructure ....................................................................................... xxix 6.3.9 Cumulative Exposure/Risk .................................................................................... xxix 6.3.10 Occupational Health ................................................................................................ xxx iii 7 INTRODUCTION .................................................................................................................... 1 7.1 Health Impact Assessment Process and the Public Health Study ...................................... 1 7.2 Natural Gas Development & Production ........................................................................... 2 7.2.1 Conventional vs. Unconventional Natural Gas ........................................................... 2 7.2.2 The Marcellus Shale ................................................................................................... 2 7.2.3 Terminology ................................................................................................................ 3 7.2.4 Unconventional Natural Gas Development (UNGD) ................................................. 3 7.2.5 Unconventional Natural Gas Production (UNGP) ...................................................... 5 8 SCOPING UPDATE ................................................................................................................. 6 9 BASELINE HEALTH ASSESSMENT .................................................................................... 8 9.1 Introduction ........................................................................................................................ 8 9.2 Overview of Allegany and Garrett Counties ..................................................................... 8 9.3 Demographics .................................................................................................................... 8 9.4 Vulnerable Populations ...................................................................................................... 9 9.5 Health Indicators ................................................................................................................ 9 9.5.1 Environmental Health ................................................................................................. 9 9.5.2 Physical Health Indicators ........................................................................................ 10 9.5.3 Major Causes of Morbidity and Mortality ................................................................ 11 9.6 Social Determinants of Health ......................................................................................... 12 9.7 Healthcare Infrastructure ................................................................................................. 13 10 IMPACT ASSESSMENT ....................................................................................................... 15 10.1 Overview of Key Determinants of Human Exposures to UNGDP Related Hazards ...... 15 10.1.1 Overview of Exposure Assessment Methods for UNGDP Related Hazards ............ 16 10.1.2 Linking Exposure to Hazards with Adverse Health Outcomes ................................ 18 10.2 Methods............................................................................................................................ 19 10.2.1 Overview of Data Collection .................................................................................... 19 10.2.2 Identification of Hazards of Concern to Western Maryland Communities .............. 19 10.2.3 Ranking of Hazards ................................................................................................... 20 10.2.4 Identifying Chemicals of Concern ............................................................................ 23 10.3 Community Impacts ........................................................................................................