Over the past half-decade, the US has seen a sharp increase in high-volume hydraulic fracturing — also called hydrofracking, or simply “fracking” — to extract natural gas from underground shale formations. States’ responses to fracking applications have varied, and in general public health concerns seem to have gotten far too little consideration.

The latest issue of the environmental and occupational health policy journal New Solutions is devoted to the issue of high-volume hydraulic fracturing (HVHF), and PDFs of all the articles are available for free online. It’s a great resource for anyone interested in learning more about the public health issues involved in hydrofracking, and I especially like the piece by Katrina Smith Korfmacher, Walter A. Jones, Samantha L. Malone, and Leon F. Vinci that describes how public health can contribute to the ongoing conversation on this issue. Here’s how they describe their big-picture view:

This commentary considers the entire life cycle of, and processes involved in, the expansion of HVHF, including site preparation, drilling and casing, well completion, production, processing, transportation, storage and disposal of wastewater and chemicals, sand mining, and site remediation. The rapid changes, scale of development, and pace of extraction made possible by HVHF could affect health directly or indirectly through changes in vehicular traffic, community dynamics, unequal distribution of economic benefits, demands on public services, health care system effects, impacts on agriculture, and increased housing costs. At the same time, economic growth resulting from HVHF may contribute to improvements in individual health status, health care systems, and local public health resources. The public health also requires assessing the long-term and cumulative impacts of this dispersed-site extractive industry, as well as the distribution of these impacts, particularly within low-income rural populations.

They describe potential public-health impacts, including:

• Contamination of surface and ground water, use of massive quantities of water that might be needed for other purposes, and the challenge of treating millions of gallons of of wastewater;
• Air pollution from drilling operations and from increased vehicular traffic;
• Noise and light contributing to stress among residents living near fracking operations;
• Strains on local healthcare and emergency response resources;
• Occupational health issues including high injury rates and exposure to hazardous chemicals;
• Increased exposure (for workers and communities) to respirable crystalline silica — which can cause lung disease — due to the dust produced by mining and transporting frack sand; and
• Greenhouse-gas-producing emissions from all stages of the process. (The authors write, “Natural gas is more efficient and clearn-burning than coal … However, some projections suggest that obtaining natural gas through HVHF actually produces more greenhouse gas emissions than does coal production and burning.”)

The authors then describe a public-health response to fracking, based on five perspectives from a framework described by Howard Frumkin and colleagues in 2008: Prevention, risk management, co-benefits, economic impacts, and ethical issues. A prevention-oriented approach includes steps such as requiring discolosure of chemicals used in fracking operations (not currently required under federal law), baseline monitoring of environmental and health quality, and conducting health impact assessments. Risk management includes considering cumulative impacts of HVHF over time. Co-benefits “result when actions yield benefits in multiple arenas,” such as water-quality monitoring that identifies non-fracking-related water issues that might not have been detected otherwise.

Consideration of economic impacts must account for the boom-and-bust cycle typical of energy developments and long-term as well as short-term costs, the authors urge. They remind us, “The history of environmental health includes many examples of long-term remediation costing more than prevention,” and note, “The distribution of costs and benefits from HVHF is highly variable.” This variability in costs and benefits informs their recommendations on ethical issues, which include considering the burden fracking will place on future generations, vulnerable populations, and communities that are already economically and geographically disadvantaged. They recommend “informed, ongoing, and meaningful participation by affected communities” to promote ethical decisions.

Of course, it’s much easier to employ a public health perspective to make ethical, prevention-oriented decisions when public officials call on public health practitioners before issuing permits for hydrofracking or any other activity with such far-reaching potential health impacts. A policy statement adopted by the American Public Health Association at least year’s annual meeting criticizes the limited involvement of public health in fracking:

[As] of 2012, public health professionals have had a limited role in policy-making, regulatory, and planning decisions regarding HVHF. Public health professionals should actively engage in the full range of decisions relevant to HVHF, from education of health care providers and local health departments to local land use policy, administrative and budgetary decisions, and state and federal air and water quality policies. Policies that anticipate potential public health threats, use a precautionary approach in the face of uncertainty, provide for monitoring, and promote adaptation as understanding increases may significantly reduce the negative public health impacts of this approach to natural gas extraction.

Also in 2012, the Institute of Medicine held a workshop on the health impacts of shale gas extraction, and many of us wished such a session had been convened before HVHF activities became as widespread as they are today.

It’s to the credit of the team behind this issue of New Solutions that the articles don’t just bemoan the problems with hydrofracking, but recommend steps we can take from now on to improve public health outcomes. (You can download all the articles here.) Getting states and the federal government to implement such steps will still be a challenge.