Issue framing in the IEHIAS

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Issue framing represents the first stage in doing an integrated environmental health impact assessment. It is at this stage that we specify clearly what question we are trying to address, and who should be involved in the assessment.

By the end of the issue-framing stage, therefore, we should have defined the scope of the assessment, and the principles on which it will be done. In the process, we should also have resolved any ambiguities in the terms and concepts we might be using, so that everyone involved has a common understanding of what the results of the assessment will mean.

Issue-framing can rarely be done as a singular, one-off process. Considerable reiteration if often required to deal with new insights, as they emerge. The order in which issue-framing is done also needs to be adapted according to circumstance. Five main steps, can, however, be recognised:

1. Specifying the question that needs to be addressed;
2. Identifying and engaging the key stakeholders who need to be involved;
3. Agreeing an overall approach to the assessment and the scenarios that will be used;
4. Selecting and constructing the scenarios on which the assessment will be based;
5. Defining the indicators that will be used to describe the impacts.

For the sorts of complex (systemic) problems that merit integrated environmental health impact assessment, issue framing can be extremely challenging (see link to Challenges in issue framing, left). Care and rigour in issue framing are therefore crucial if the assessment is to be valid and useful: failure to give the necessary attention at this stage will almost certainly undermine the value of everything that follows.

Challenges in issue framing

Describing complex issues in a way that captures the interests of all the stakeholders concerned, yet can also form a sound and practicable basis for assessment, is inevitably difficult.

Difficulties arise both from the complexity and ambiguity of the issues that need to be assessed, and the multitude of stakeholders (often with different and conflicting interests) who are concerned. As a consequence, issue framing has to deal with several challenges:

• how to identify all the stakeholders who might have interests in the issue and engage them in the process;
• how to define the conditions (in the form of realistic yet relevant scenarios) under which the issue will be assessed;
• how to set practicable limits to the issue without unfairly excluding some stakeholders’ interests and thereby biasing the assessment;
• how to define and agree on a series of indicators that will adequately and fairly capture an describe the results of the assessment.

All four require that issue framing is done as a reiterative process, with each version of the issue being reviewed and debated to ensure that key elements or stakeholders have not been neglected. It also needs to be an open process, with additional stakeholders being invited to take part when new (and unrepresented) interests emerge.

This reiterative process of issue framing often involves a clear cycle, comprising:

• a phase of ‘complexification’, as new factors and relationships are discovered, and new interests taken into account;
• a phase of simplification, as the issue is paired down by eliminating redundant or irrelevant elements, in order to focus on what matters most.

Defining the question

All assessments are done in response to a ‘question’ or ‘concern’. This initial question is often not phrased specifically for the purpose of assessment, but instead to raise awareness and get attention. Even when an official body commissions an assessment, the question may not be clearly and fully described. In most cases, therefore, the issue of interest will need to be carefully considered and redefined.

The aim of doing so is to make sure:

• that it is unambiguous and clearly understood;
• that it really does reflect the issue about which people are concerned;
• that it can form the basis for a sensible and realistic assessment;
• that the rationale for doing an assessment is clearly recognised.

To achieve this the question needs to be phrased in a clear and structured way. Typically, this involves defining (at least in general terms):

• the causes (e.g. human activities, environmental stressors, agents) and/or types of health impacts of concern;
• the area or population of interest;
• the timescale of the concern.

Who defines the question?

Questions about potential health impacts from the environment may arise in different ways, and from different sources. For example:

• Policy-makers may ask ‘What will be the effects of this policy’, or ‘How well are our current policies working’?
• Scientific studies may suggest that specific substances or practices pose a risk to health, which merit investigation.
• Long-term monitoring of the environment or of health may show patterns or trends that give cause for concern.
• Practitioners (e.g. doctors), the media or members of the public may believe that they have observed anomalous patterns or trends (e.g. disease clusters or growing rates of illness) that imply some form of environmental threat to health.

Each of these may merit some form of impact assessment, and if the issues are complex or have wide-ranging implications then an integrated assessment may be appropriate. However, the opportunity actually to undertake an assessment may vary greatly. For example, while policy-makers usually have the authority to commission an assessment, and scientific evidence (if validated by repeated studies) are often powerful enough to motivate action, the costs and complexities involved may limit the ability of members of the public to have an issue assessed in any formal way. How the question originates may greatly condition the type of assessment that is done (and the sorts of issues that are addressed).

What types of questions can be assessed?

Questions about possible impacts of environment on health can take many forms – and they can relate to the positive as well as the adverse effects. Nevertheless, not all these questions merit an integrated assessment. Some may be relatively simple and be better addressed by other means (see IEHIA in relation to other forms of assessment). Others may be too general or vague to be capable of assessment.

Integrated environmental health impact assessment is most appropriate, therefore, for relatively complex issues that have the capability to affect large areas and large numbers of people. These are sometimes described as systemic – in that they typically involve a range of different causes, deriving from different environmental, social, economic, political or technological sectors, and have many different health (and other) impacts. Systemic issues are perhaps increasingly common in the modern world, not least because of the increased scale of technology and the ever larger imprint of society on the environment. Obvious examples include climate change, food security and many aspects of environmental pollution.

As this implies, relevant questions are often related to government (or inter-governmental) policies. These are not restricted either to environmental policies, or to policies directly concerned with health. Many other forms of policy (e.g. on energy, transport, agriculture, urban development) also have the capacity to affect health, albeit unintentionally, and thus merit integrated assessment. Moreover, policies are not the only drivers for integrated assessments; other forces for change (such as technological developments, natural environmental changes or hazards, or demographic change) are equally relevant. Any one of these can thus act as the motivation for assessment.

Consulting with stakeholders

A wide range of stakeholders may have interests in integrated assessments. These include not only people (or organisations) with statutory responsibilities for the issue under consideration, but also all those who might be affected either by the issue itself, or by actions taken to address it.

A key step in developing any assessment is to consider who these stakeholders might be, and how they might be involved. In doing so, it is useful to recognise the different roles that the stakeholders might have (see link to left) both because this may help to identify stakeholders who would otherwise be ignored, and because it can help to work out what their specific concerns might be, and how best to involve them.

It also needs to be recognised that any individual may fulfil more than one of these roles (e.g. as victim and manager) both at the same time, and over time as events play out. ‘Stakeholdership’ is thus not a fixed condition, but emerges out of any issue or event. For this reason defining stakeholders is not always easy, and the full range of stakeholders may only become evident as the issue is fleshed out. Wherever possible, it is therefore important to keep an open mind about who the stakeholders are, and to be prepared to involve additional people or organisations as new aspects of the problem emerge.

Types of stakeholder

Stakeholders may be classified in many different ways. Often, the main distinction tends to be between policy-makers and the public. This, however, ignores the subtle, and often overlapping, roles that stakeholders may play in environmental health issues. The consequence may also be that the variations in perceptions and interest (e.g. within the general public) are not recognised. The table below gives a more detailed breakdown of the different types of stakeholder that might need to be considered in an integrated impact assessment. Examples of the range of stakeholders who can be involved in specific issues and assessments are given via the links below.

Category	Explanation
Perpetrators	Individuals or groups who are responsible for generating the events or motivating the changes that ultimately cause the health impacts.
Purveyors	Individuals or groups who may deliberately or accidentally act to transmit the effects throught the wider population (e.g. carries of a disease; distributors of contaminated foodstuffs).
Victims	People and organisations who will bw involuntarily affected by the issue (e.g. subject to the risks); usually members of the public.
Beneficiaries	People and organisations who stand to benefit from the issue, or from its management (e.g. Commercial organisations who can sell their services as a result).
Informants	People and organisations who provide information on the issue and its associated consequences (e.g. Scientists, monitoring agencies, risk assessors, media).
Managers	People and organisations responsibilities for managing the issue and/or its consequences (e.g. Policu-makers, regulators, planners, emergency services, health services).

References:

Briggs, D.J. and Stern, R. 2007 Risk response to environmental hazards to health – towards an ecological approach. Journal of Risk Research 10, 593-622.

Engaging stakeholders

Engaging stakeholders in integrated impact assessments is not easy, especially if consultation is to be active and effective, and particularly where there are a large number of potential stakeholders, from different areas of the world.

A wide range of methods for stakeholder consultation exist (see link to left). Which of these is most appropriate will depend on the character of the issue under consideration, the scope and purpose of the assessment, the resources available, and the social and geographic context.

In general, however, more effective consultation is likely to occur when effort is devoted to gaining the trust of the stakeholders, and in engaging those concerned in a sustained dialogue, as many previous studies have shown (see references below). This can rarely be achieved quickly, for trust has to be earned. The most successful approaches to stakeholder consultation are therefore usually those that provide the basis for sustained involvement, and which give stakeholders the opportunity to influence what is done, how it is done and how the outcomes are used.