Health Impact Assessment – Ambler Road, Alaska Contents Executive Summary .................................................................................................................................... 1 Affected Environment Summary ............................................................................................................... 1 Environmental Consequences Summary .................................................................................................. 2 Road Impacts ........................................................................................................................................ 2 Mining, Access and other Indirect and Cumulative Impacts ................................................................. 4 Recommendations .................................................................................................................................... 6 1. Introduction and Project Overview ................................................................................................... 7 1.1. Legal, Administrative and Legislative Requirements for Health Impact Assessment ................... 7 1.2. HIA Framework and Methodology................................................................................................. 8 1.2.1 HIA Definition ........................................................................................................................ 8 1.2.2 HIA Methods .......................................................................................................................... 8 1.2.3 HIA Scope ............................................................................................................................. 8 1.2.4 Areas Outside the Scope of the HIA ..................................................................................... 8 1.2.5 HIA Limitations ...................................................................................................................... 8 1.2.6 Alaska HECs ......................................................................................................................... 9 2. Potentially Affected Communities (PACs) ...................................................................................... 10 2.1. Background ................................................................................................................................. 10 2.2. Demographic Summary of PACs ................................................................................................ 12 2.3. Geographic Profiles ..................................................................................................................... 12 2.4. Stakeholder Engagement and Concerns – Health ...................................................................... 12 2.4.1 Issues and Concerns by HEC ............................................................................................. 12 3. Affected Environment – Health ........................................................................................................ 16 3.1. Background ................................................................................................................................. 16 3.2. Key Sources of Information ......................................................................................................... 17 3.3. Demographic and Socioeconomic Profiles of PACs ................................................................... 18 3.4. Overview Morbidity and Mortality ................................................................................................ 18 3.5. Health Effect Categories (HECs) ................................................................................................ 19 3.5.1 HEC 1: Social Determinants of Health (SDH) ..................................................................... 19 3.5.2 HEC 2: Accidents and Injuries ............................................................................................ 47 i 3.5.3 HEC 3: Exposure to Potentially Hazardous Materials ......................................................... 54 3.5.4 HEC 4: Food, Nutrition, and Subsistence Activity ............................................................... 60 3.5.5 HEC 5: Infectious Diseases including STIs ......................................................................... 65 3.5.6 HEC 6: Water and Sanitation .............................................................................................. 72 3.5.7 HEC 7: Non-Communicable and Chronic Diseases ........................................................... 75 3.5.8 HEC 8: Health Services Infrastructure and Capacity .......................................................... 88 3.6. Boom and Bust: Lessons Learned from the Development of Large Energy and Mining Projects ........................................................................................................................................ 92 3.6.1 Bakken Concerns ................................................................................................................ 93 3.6.2 Pennsylvania Marcellus Shale Surveys 2010 ..................................................................... 96 3.6.3 Lessons Learned from Recent U.S. Extractive Industry Projects ....................................... 98 4. Environmental Consequences ...................................................................................................... 100 4.1. Rating and Ranking ................................................................................................................... 100 4.2. Road Impact Analysis ............................................................................................................... 106 4.2.1 No Action Alternative ......................................................................................................... 107 4.2.2 Impacts Common to All Action Alternatives ...................................................................... 107 4.2.3 Alternative C ...................................................................................................................... 108 4.3. Other Indirect and Cumulative Impacts/Indirect and Cumulative Impacts of Growth Impact Analysis ................................................................................................................................................. 108 4.3.1 Impacts Common to All Action Alternatives ...................................................................... 108 4.3.2 Alternative C ...................................................................................................................... 110 4.4. Understanding Impact Ratings .................................................................................................. 110 4.4.1 Impacts Common to All Alternatives HECs #1-8 .............................................................. 112 4.4.2 Alternative C Road Direct Effects ...................................................................................... 116 4.5. Other Indirect and Cumulative Impacts/Indirect and Cumulative Impacts of Growth (Mining Development Scenario) ......................................................................................................................... 116 4.5.1 Impacts Common to All Alternatives HECs #1-8 .............................................................. 116 4.5.2 Alternative C Impacts ........................................................................................................ 121 5. Recommendations .......................................................................................................................... 122 5.1. Approach ................................................................................................................................... 122 5.2. Management Recommendations .............................................................................................. 122 5.3. Impact Management Summary ................................................................................................. 123 References ............................................................................................................................................... 132 ii Figures Figure 1. Prevalence of Selected Risk Factors, by Education Level (2012)* .............................. 22 Figure 2. Adequate Prenatal Care by Alaska Native Status, 1991–2013 ................................... 28 Figure 3. Adequate Prenatal Care by Tribal Health Region, 2009-2013 .................................... 29 Figure 4. Infant Mortality Rate 1981-2013 .................................................................................. 32 Figure 5. Alaska Native Infant Mortality Rates by Tribal Health Region, 2009-2013 .................. 33 Figure 6. Child Maltreatment, All Alaskans and the U.S. (2007-2015) ....................................... 34 Figure 7. Suicide Mortality Rate per 100,000 Population, All Ages, All Alaskans, Alaska Natives, and U.S. (2000-2017) .......................................................................................................... 37 Figure 8. Suicide Mortality Rate per 100,000 Population, by Age Group and Sex, All Alaskans, (2003-2017 [15-year average]) ............................................................................................ 38 Figure 9. Percentage of Adolescents (grades 9-12) Who Have Not Smoked Cigarettes, Cigars, or Used Chewing Tobacco, Snuff, or Dip on One or More of the Past 30