HEALTH REQUIREMENTS FOR HEALTH IMPACT

ASSESSMENT (HIA) IN ENVIRONMENTAL IMPACT

ASSESSMENT (EIA)

Thematic Working Group (TWG) 7 – Health Impact Assessment

National Environmental Health Action Plan (NEHAP)
November 2021
 Table of Contents

Preamble .................................................................................................................... 3
Acknowledgments ...................................................................................................... 4
Abbreviations ............................................................................................................. 5
1.0 INTRODUCTION .................................................................................................. 6
1.1 Background and Legal Requirement ................................................................ 6
1.3 Purpose and Emphasis ..................................................................................... 6
1.4 Objectives and Goals........................................................................................ 6
1.5 Target Groups................................................................................................... 7
2.0 THE SCOPE......................................................................................................... 7
3.0 THE QUALIFIED PERSON .................................................................................. 7
4.0 REQUIREMENTS TO CONDUCT RISK ASSESSMENT IN HIA ......................... 8
4.1 HIA Process ...................................................................................................... 8
4.2 Existing Public Health Status of the Local Community ..................................... 9
4.3 Health Impact Assessment ............................................................................. 10
5.0 PROCEDURAL STEPS FOR REVIEWING HIA ................................................. 17
Afterword .................................................................................................................. 19
Appendix 1: Supporting Letter to DOE ..................................................................... 20
References and Selected Readings ......................................................................... 22

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 Preamble

Health is the state of being free from illness or injury both physical and psychosocial.
It refers to the individual as well as to the general population. Public health is a concern
of every nation contributes to prosperity and underlies national security. The World
Health Organisation (WHO) defines health as 'a state of complete physical, mental
and social wellbeing and not merely the absence of disease or infirmity' (WHO, 1948).

Public health impact is the measurable quantum that associate exposure factors and
health outcomes. HIA in EIA is a proxy closes to measure public health impact through
analysis of health determinants over seamlessly wide health spectrum in particular
enveloping both environmental and occupational factors. Although HIA in EIA in this
context refers to DOE legal requirements however MOH as the gatekeeper and
guardian to health is much aware of legal provisions for occupational health under
DOSH. MOH caution over health fragmentation and tunnel vision approach to health.
HIA in EIA provide legal and priority in the evaluation of risk by systematic identification
of intervention strategies. Prevention is the best strategy to avoid diseases and
injuries. The 3 levels of prevention in health encompasses the preventive, curative and
rehabilitative aspect, reflecting a wholesome and holistic approach.

The main intention when undertaking HIA is to provide information to support decision-
making with regards to EIA project proposal report. The potential health impacts of a
proposal both beneficial and harmful are put forth and suggestions ways to minimise
the harms and maximise the benefits. HIA evaluation offers decision-makers the
possibility of changing a proposal to protect and improve health, and to reduce
inequities, thereby achieving health gain maximally.

This booklet is intended to provide insights into enhancing and improving specifically
quality of HIA reports, as well as EIA reports in general. This booklet complement and
supplement available formal document namely the Guidance Document On Health
Impact Assessment (HIA) In Environmental Impact Assessment (EIA) (June 2012) by
the DOE.

Last but not least it is hoped that this booklet will be useful and stimulate HIA
practitioners to submit reports meeting the expectations and altruistic ideals of the
MOH.

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 Acknowledgments

Mohd Zaharon Mohd Talha - ESD / TWG 7 (HIA) Chairman (until April 2021)
Ir. Jamilah Mahmood - Head of Secretariat NEHAP Malaysia
Bariah Bakri - Secretariat NEHAP Malaysia
Dr. Norlen Mohamed - DCD MOH/ Member of TWG 7
Dr. Thahirahtul Asma’ Zakaria - DCD MOH/ Member of TWG 7
Dr. Vickneshwaran Muthu - DCD MOH/ Member of TWG 7
Kamarulzaman Ab Ghani - SHD Perak / Member of TWG 7
Dr. Haidar Rizar Toha - SHD Johor / Member of TWG 7
Mastura Md Zahari - SHD Johor / Member of TWG 7
Dr. Rohani Mat Bah - SHD Sarawak / Member of TWG 7
Syed Masyhur Wan Mohd Yusop - SHD Sarawak / Member of TWG 7
Dr. Mohamad Iqbal Mazeli - Institute of Medical Research (IMR) / Member of TWG 7
Hazrina Salleh - DOE / Member of TWG 7
Sham Izuddi Mat Hussin - DOE / Member of TWG 7
Dr. Abdul Rahman Mahmud - DOE / Member of TWG 7
Dr. Zati Sharip - NAHRIM / Member of TWG 7
Dr. Bashirah Fazli - NAHRIM
Muhammad Azroie Mohamed Yusoff - NAHRIM
Siti Nor Azura Md Saad - DOE
Azlina Omar - DOE
Prof. Dr. Jamal Hisham Hashim - HIA Consultant
Prof. Dr Mazrura Sahani - HIA Consultant
Prof. Dr. Mohd. Hasni Ja'afar – HIA Consultant
Dr. Noor Artika Hassan - HIA Consultant
Niza Samsuddin - HIA Consultant
Zairul Ain Zulkaflli – Liaison Officer TWG 7 (HIA)
Dalila Farhana Baharuddin – Secretariat of TWG 7
Nur Iylia Hidayah Fahmi – Secretariat of TWG 7
Abdul Razif Abd Muthalib – Secretariat of TWG 7
Dr. Muhammad Amir Kamaluddin - Malaysian Association of Environmental Health (MAEH) /
Technical Proof Reader

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 Abbreviations

ATSDR Agency for Toxic Substances and Disease Registry

CAC Codex Alimentarius Commision
CDC United States Centre of Disease Control and Prevention Agency
DCD Disease Control Division (Bahagian Kawalan Penyakit) MOH
DOE Department of Environment
DOSH Department of Occupational Health and Safety
EIA Environmental Impact Assessment
EIS Environmental Impact Statement
EMP Environmental Management Plan
ESD Engineering Services Division (Bahagian Perkhidmatan Kejuruteraan) MOH
FDA United States Food and Drug Administration
HIA Health Impact Assessment
HI Hazard Index
HQ Hazard Quotient
HRA Health Risk Assessment
IRIS Integrated Risk Information System
KPAS Kesihatan Pekerjaan dan Alam Sekitar KKM
LADD Lifetime Average Daily Dose
LCR Lifetime Cancer Risk
MOH Ministry of Health
Mg/l Milligrams per litre
MSDS Material Safety Data Sheet
NAHRIM National Hydraulic Research Institute of Malaysia
NEHAP National Environmental Health Action Plan
OSHA Occupational Safety and Health Act
PIK Pusat Informatik Kesihatan KKM
PKD Pejabat Kesihatan Daerah
POP Persistent Organic Pollutants
RfC Reference Concentration
RfD Reference Dose
SHD State Health Department (Jabatan Kesihatan Negeri)
TWG Thematic Working Group
USEPA United States Environmental Protection Agency
WHO World Health Organization

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1.0 INTRODUCTION

1.1 Background and Legal Requirement

Environmental Impact Assessment (EIA) is an important tool to assess the impact of

prescribed activities developments on the environment. The EIA reports are evaluated
not only for new projects but also before any expansion or process changes
developments. In Malaysia, EIA is legally required for activities prescribed under the
Environmental Quality (Prescribed Activities) (Environmental Impact Assessment)
Order 2015, gazetted and enforced since 28 August 2015.

1.2 Importance and Justification

Health Impact Assessment (HIA) is a critical component in the EIA process. It is a tool
that systematically identify, using scientific methods, the public health consequences,
both adverse and beneficial health effects resulting from proposed projects. The
outcome of HIA provides the ideal platform to optimize positive health impacts and
minimized negative health impacts through recommendation of mitigation measures.
In addition HIA methods may also be used for post EIA management.

Health involve cross-cutting issues in project development and a holistic approach is

presented. Advancing health agendas through recognition of cross cutting approaches
to health will add value to the system.

Although relevant official guidance documents are available for the conduct of HIA in
Malaysia there is always room for improvement. Hence this booklet complement and
supplement the available document namely the ‘Guidance Document on Health
Impact Assessment (HIA) in Environmental Impact Assessment (EIA)’ developed by
the DOE (2012).

1.3 Purpose and Emphasis

The purpose of HIA is to synthesize evidence based on science and provide

recommendation to decision-makers in order to prevent adverse health effects,
preserve community health and proposed practical health mitigation measures.
Recognizant of environmental health hazards and its potential health effects allow
hypothetical logical causal pathway through air, water and soil to be established.
Inappropriate assessment result in erroneous reporting of sensitive receptors.

1.4 Objectives and Goals

The primary objective of this booklet is to provide guidance and consideration to HIA
expert person under DOE registration system as well as to authorised HIA reviewers
under MOH.

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The objectives of this document are: -

i. To list health requirements for HIA study.

ii. To provide instructions to project proponents and relevant agencies on

procedural steps required for submission and review of HIA.

iii. To provide appropriate application of accepted methodologies complementing

Guidance Document on HIA in EIA (2012).

1.5 Target Groups

This document is intended to provide better understanding from MOH policy

perspectives and disease program priorities, to stakeholders as follows:

i. Project proponents;
ii. HIA Consultants;
iii. DOE Officers;
iv. Review Panel Members; and
v. Other relevant stakeholders.

2.0 THE SCOPE

This guide provide general requirements for conducting and reporting HIA within EIA
in Malaysia and taking into consideration health priorities of the day. This guide is not
a definitive and exhaustive reference. Recognizant that HIA within EIA is site and
project specific, it is thus not practical to provide specific methodologic details for each
project type. A range of useful guidance and tools has been developed by other
credible international body and should be referred to. Should there be a specific
requirement for assessing impact via any exposure route/pathway which is not
mentioned in this guide the subject consultant shall refer to methods developed and
published by international organisation of repute namely to mention a few, USEPA,
ATSDR, U.N and WHO.

3.0 THE QUALIFIED PERSON

A person qualified to conduct HIA is defined as a person registered with the EIA
Consultant Registration Scheme, DOE and designated subject specialist in HIA. The
subject consultant is expected to have profound knowledge and experiences in public
health applied to the field of HIA evaluation methods. As such a qualified person are
well versed in subject matter pertaining to disease prevention and control, workers
health and epidemiology with appropriate credentialing agreeable to DOE and MOH.

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4.0 REQUIREMENTS TO CONDUCT RISK ASSESSMENT IN HIA

4.1 HIA Process

The HIA process and methodology inclusive of discriptive epidemiology shall be in

accordance with the published guidelines or equivalents. Emphasis is on the used of
formal guidance documents namely the Guidance Document on HIA in EIA (DOE,
2012). Table 1 below summarized the HIA processes and expected outputs.

Table 1: HIA Processes and Key Outputs

STEPS KEY OUTPUTS
SCREENING All proposed project development under Schedule 1 and
Schedule 2, EIA Order shall be looked into the possible negative
impact on health of the local community.

SCOPING Key objectives

• Identify stakeholders and plan for engaging them.
• Identify sensitive receptors and their relevant exposure
pathways.
• Identify the main public issues and impact to be studied.
• Define the boundaries of the HIA study.
• Identify method for the study.
PROFILING OF The objective is to provide baseline informations on the health
EXISTING PUBLIC status and identify health determinants of the community prior to
HEALTH STATUS the construction and operation of the project. Sources of
information may include:
• Primary Data – Obtained through community health surveys.
• Relevant secondary health records from hospitals and
clinics.
• Relevant health survey reports among population within ZOI.
• MOH PIK Health informatics statistics for aggregated data.
ASSESSMENT OF • Predict the impact using qualitative and/or quantitative
HEALTH IMPACT methods depending on the type of hazard identified for
Preliminary Site Assessment (when required), Construction,
Operational and Abandonment phases of the project.
• Predict the impact for worst case scenario.
• Predict the impact for acute and chronic health impacts
• Predict the health impact for all sensitive receptors within
ZOI.
• Predict cumulative health impact.
• Utilise probability science in health risk modelling.
• Modelling worst case public health scenarios.
• Predict the significant positive health impacts (if any).

RECOMMENDATIONS Mitigation measures and levels of prevention.

REPORTING Submission of report to MOH for review by DCD, ESD and SHD.

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4.2 Existing Public Health Status of the Local Community
Profiling of the existing community health status is an integral part of HIA in EIA
framework. This may be described using primary and secondary data:

i. Primary data when acquired through community health survey should identify
all potential impacted communities and survey sample should be representative
of the community. Analysis of primary data provide baseline data of the relevant
health outcome of interest. Baseline health data is useful for understanding the
current health status of a community, and for identifying the relevant health
determinants for assessing the needs of the community. The questionnaire
used in the primary data collection should be attached in the appendices.

ii. Secondary data for relevant diseases are available from local health
clinics/hospitals and are requested through the State Health Department. MOH
has issued a supporting letter to DOE as in Appendix 1.

iii. Health data for trend analysis:

a. Communicable diseases require monthly data for at least 1 year or

aggregated annual data for at least 5 years.

b. Chronic non-communicable disease require annual data for at least 5

consecutive years.

iv. Relevant health data should include both communicable and non-
communicable diseases. The objective is to understand the current health
status of the community residing in the impact area. This include common
diseases/health problem that lead to utilization of healthcare services by the
community. In addition, a more relevant health data related to the specific
hazard produced by the proposed project, also need to be collected. However,
since the specific diseases depend on the type of project, hence, it is not
practical to specify the type of diseases that need to be collected as it varies by
the project type. However, as a general guide, below is a list of environmental
related diseases (non-exhaustive) that may be requested from the nearest
health facility;

a. Vector borne diseases (Dengue, Malaria, Chikungunya, Filariasis)

b. Food and water borne diseases (AGE, Cholera, Typhoid, Hepatitis A,
Food poisoning, dysentery)
c. Zoonotic diseases (Leptospirosis)
d. Acute respiratory infection (Upper respiratory tract infection, influenza
like illness, pneumonia)
e. Chronic Obstructive Respiratory diseases (Asthma, COPD)
f. Cardiovascular diseases (Hypertension, Ischemic Heart Disease,
stroke)
g. Other Non-communicable disease (Diabetes Mellitus)

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 h. Skin diseases
i. Birth defect
j. Cancer
k. Childhood focus groups; obesity, slow learners, autism, epilepsy

v. Data can be presented in the form of prevalence, incidence, health care

utilization rate and hospital admission rate, depending on the relevancy of the
situation.

4.3 Health Impact Assessment

i. Methodology of HIA should be in accordance to the published guideline, the

Guidance Document of Health Impact Assessment (HIA) in Environmental
Impact Assessment published by DOE Malaysia (2012) or equivalent
guidelines. Depending on the need for details assessment, if the method is not
available in the HIA Guideline (2012), subject specialist can refer to
methodology published by international body such as U.S EPA, ATSDR, ADB,
U.N, WHO or any equivalent methodology published by developed countries.

ii. Approaches to health risk assessment can be qualitative or quantitative

depending on the type of health hazard identified. Qualitative health risk
assessment involves listing and describing the probable change in health
outcomes or endpoints that would be realized due to the proposed project. For
example, inappropriate waste handling during the construction stage may lead
to potential breeding of pests like rodents and disease vectors like mosquitoes
and flies. However, the quantum of increased in the populations of rodents or
mosquitoes or the subsequent increased in the prevalence of diseases
associated with them, are difficult to quantify and is a recognised limitation.

iii. Quantitative health risk assessment generates a risk value on the potential
adverse health effects of human exposures to environmental hazards.
Quantitative methodology of HIA should be in accordance to the Guidance
Document of Health Impact Assessment (HIA) in Environmental Impact
Assessment published by DOE Malaysia (2012) or equivalent guidelines.

iv. Assessment of health impact should include acute, chronic health effects and
lifetime cancer risk when applicable, AND should address both communicable
and non-communicable diseases.

v. Assessment of health impact should be conducted for all phases of project

development namely Preliminary Site Assessment (when required),
Construction, Operational and Abandonment phases.

vi. Considerations and examples during the construction phase of common health
hazards include:

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 a. Respiratory effects from exposure to gaseous and particulate pollutants
such as PM10, PM2.5, SO2, and NO2 from on-sites fuel combustion
machineries.

b. Vector-borne and zoonotic diseases at construction sites or living

worker’s quarters (example dengue fever, caused by poor housekeeping
fostering breeding sites and leptospirosis due to rodent infestation)

c. Food and Water borne diseases like cholera, typhoid and hepatitis A due
to improper sewage and solid waste disposal in the worker’s camp area.

d. Physical injuries due to work accidents, road traffic accidents, noise

induced hearing impairment from exposure to vehicle or machinery
noises.

vii. During Operation: In addition to relevant situation above, accidents from falling
objects or projectiles and hazards from explosion from mishandling highly
flammable materials on site (pipelines, storage tanks etc.) should be considered
and adherence to safe practice and use of PPE should be noted.

viii. During Abandonment phase: relevant examples need to be highlighted and

accounted for.

ix. For relevant hazards identified, their dose response abilities to cause cancer
should be clearly stated in the report. The weight of evidence for cancer and
their mode of action either mutagenic or non-mutagenic mode of action should
be reported.

x. For carcinogen based on WHO IARC Classification, Group 1, Group 2A, lifetime
cancer risk assessment must be conducted for all receptors with completed or
potential exposure pathways.

xi. Carcinogen with mutagenic mode of action, lifetime cancer assessment must
consider early life exposure. Aged dependent adjustment factor (ADAF) need
to be applied for assessing cancer risk from carcinogen with mutagenic mode
of action. For details, information on methodology for assessing early life
exposure to carcinogen can be referred to the guideline produced by the U.S
Environmental Protection Agency [EPA/630R-03/003F (2005) entitled
“supplemental guidance for assessing susceptibility from early-life exposure to
carcinogens”].

Aged dependent adjustment factor (ADAF):

(a) Risk during the first two years of life ADAF =10
(b) Risk for age years through < 16 years old, ADAF = 3, and
(c) Risk for age 16 – 70 years, ADAF = 1

Total lifetime cancer risk equal to (a) + (b) + (c).

For a non-mutagenic carcinogen, no ADAF is needed.

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xii. The consultant should identify, characterize and assess pollutants that have
potential multiple pathway including activity, fate and transport phenomena.
Site-specific information should be used to determine which exposure
pathways to evaluate in the risk assessment. Five elements of exposure
pathway are described in Table 2.

Table 2: Evaluating Exposure Pathways (EP)

Exposure Pathways (EP)
Source EP1 - is there a source of contamination or release?
Environmental medium EP2 - Does contamination migrate through a medium?
Point of exposure EP3 - Does contamination reach an exposure point?
Route EP4 - Is there a possible route of human exposure?
Receptor EP5 - Are there potential exposed populations
Source: www.atsdr.cdc.gov/hac/phamanual/ch6.html

xiii. Exposure pathway analysis should be conducted for all receptors and
summarize the exposure pathway analysis outcome into three exposure
categories as follows:

a. Completed exposure pathways: all five elements of a pathway are

present.

b. Potential exposure pathways: one or more of the elements may not be

present, but information is insufficient to eliminate or exclude the
element. Potential exposure pathways indicate that exposure to a
pollutant could be occurring currently, or could occur in the future.

c. Eliminated exposure pathways. One or more elements is absent.

xiv. For a scenario with eliminated exposure pathway, no assessment of health

impact is required. However, HIA should be conducted for receptors with
completed or potential exposure pathway.

xv. Exposure data should be based on Malaysian population whenever available.

Below are examples of sources for exposure data that can be used for HIA:

a. Food consumption data for Malaysia:

http://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2014-
MANS-VOLUME-3-FoodConsumptionStatisticsofMalaysia.pdf

b. Adult Average Body weight for Malaysia: 66.48kg (Table 9.1, Page 287)
http://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2014-
MANS-VOLUME-2-SurveyFindings.pdf

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 xvi. The location of highly vulnerable receptors such as schools, health care
facilities, aged care facilities, source of water intake must be identified and the
distance from the project site must be clearly stated. Use of GPS to record
coordinates for important sites is a must.

xvii. Multiple chemical exposure: cumulative and aggregate health risk assessment
should be conducted for both cancer and non-cancer risk assessment.
Aggregate health risk assessment combined exposures to a single stressor
across multiple routes and multiple pathways. Cumulative health risk
assessment evaluates combined exposure to multiple stressors via multiple
exposure pathways that affect a single biological target.

xviii. The specific vulnerable receptors such as schools, health care facility, aged
care facilities, source of water intake must be identified, and the distance from
the project site is clearly stated. Permanent workers housing within compound
should be consider as sensitive receptors.

xix. It is important synthesize and document plausible Exposure Pathways.

Example Exposure Pathways as per Table 3.

Table 3: Guide to Document the Exposure Pathways

DISTANCE
EXPOSURE PATHWAY ELEMENT
OF
ENVIRONMENTAL POINT OF ROUTE OF RECEPTOR
SOURCE RECEPTORS TO THE
MEDIUM EXPOSURE EXPOSURE
SOURCE

Emission of
air pollution Air Ambient air Inhalation Community A 500 – 1000 m
from chimney

Drinking
Receiving water water Community A,
body [to be Ingestion 30 km
Water Intake B, C
specified] Point
Effluent of Need to specify Contact with Dermal, Recreational
wastewater the water intake 2 km
river water ingestion lake
point downstream
& the distance
Eating
from the source Ingestion Aquaculture 10 km
aquatic life

Contaminated soil
via deposition of
Locally
air pollutants Agriculture
Soil produced Ingestion 500 m
[applicable for a area
food
few pollutants
only]

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 xx. In area with high possibility of intake from locally produced food/ vegetables,
deposition of the air pollutants to the soil need to be assessed. The consultant
need to engage the air quality expert for conducting air dispersion and
deposition modelling and health risk via intake of contaminated locally produced
food should be carried out. (namely for POP chemicals, heavy metals)

xxi. In area with high possibility of intake from farming/ aquaculture activities,
concentration of pollutant in downstream water and uptake by biota need to be
assessed.

xxii. Multiple chemical exposure

a. Cumulative and aggregated health risk assessment should be
conducted for both cancer and non-cancer risk assessment. Aggregated
health risk assessment combined exposures to a single stressor across
multiple routes and multiple pathways.

b. Cumulative health risk assessment evaluates combined exposure to

multiple stressors via multiple exposure pathways that affect a single
biological target.

c. For chemicals impact on similar target organ, Hazard Index should be

calculated by combining each relevant HQ of individual pollutant.

For threshold contaminant. Single pathway = HQ. Multiple pathways = HI (sum

of all HQ)

xxiii. For each toxicological information, health reference values used in HRA must
be properly cited in the report for evaluation purpose.

xxiv. Formula used in HRA should be clearly written in the report for the purpose of
evaluation.

xxv. A suggested checklist for conducting risk assessment is as in Table 4 below.

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 Table 4: Checklist for Conducting Risk Assessment in HIA
No. Requirement Yes No Remarks
1. Existing public health status
1.1 Data from health facilities
1.2 Community survey for health status
2. Environmental sanitation status
3. Methodology of HIA should be in accordance
with the published guideline
4. Health Assessment completed for :
4.1 Acute health impact
4.2 Chronic health impact
4.3 Life time cancer risk
5. Lifetime cancer assessment include early life
exposure
6. Exposure pathway element is documented for all
chemicals of concern according to given labelled
Table
7. Vulnerable groups / locations such as schools,
aged care facilities, healthcare facilities, water
intake point was clearly identified

8. Cumulative health risk assessment conducted

9. Aggregated health risk assessment conducted

10. Reference for health reference

values/toxicological information of chemical of
concern is included
11. Formula used in HRA clearly written for
evaluation
12. Questionnaire for community survey is attached

14. Other public health concerns such as:

14.1 Communicable / Vector borne diseases
14.2 Food and water borne diseases
14.3 Workers’ camp / living quarters
14.4 Risk of communicable diseases from
foreign workers
14.5 Odour
14.6 Noise
14.7 Conflict
14.8 Impact on aborigine forest, source of food
and social problem
14.9 Work place Injury
14.10 Traffic injury

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 No. Requirement Yes No Remarks
15. Other determinants of health as relevant
(positive and negative). Will the project affect
quality, proximity, or access to park of public
spaces which is important for physical activity
and quality of life
16. Have the potential positive health impacts been
identified and discussed?
16. Mitigation measures
17. Monitoring and evaluation:
17.1 Location of monitoring station to monitor
environmental quality at the sensitive
receptor? (e.g school)
17.2 Water quality at workers base camp
/ living quarters.
17.3 Vector breeding at project site.
17.4 Foreign workers health certificate.

4.4 Positive Health Impacts

Development projects can potentially provide positive health impact to the population.
The development proponents should propose the positive health impact assessment
of the project before, during and abandonment especially phase the positive benefits
can be inherited by the surrounding population. The distribution of those positive
effects can be classified into six scopes of benefits. Those scopes are infrastructure
development, workforce development, revenue, healthcare service and health
improvement, nutrition plus social and quality of life.

Some of the examples of positive health impacts from the development projects are
infrastructure development such as new roads for rural health services will increase
the public access to local healthcare services and workforce development can be
improved by the influx of occupational health professionals in the surrounding area.
Healthcare services can also increase the health of the local population with the
coming of the development as new healthcare facilities and better health services can
be accessed by the population. These will encourage establishment and advancement
to healthcare services. Health improvement and better nutrition and better water
supply will lead to prevention and control of communicable diseases to the community.
The assessment also has to consider if the development can have positive healthy
lifestyle to the surrounding community. Thus, in turn, the overall benefits will increase
the quality of life of the population as a whole.

In addition, the introduction of green technology, open spaces for healthy lifestyle
activities and maintaining natural surroundings that can be preserved for public use
should also be considered as potential positive health impacts of the development by
the project proponents in their proposal.

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The above scopes are applied across the board to the following prescribed i.e.
agriculture, fisheries, forestry, industry, land reclamation, mining, petroleum, ports,
power generations, waste treatment and disposal, construction of a dam,
transportation and radioactive materials and wastes. However, the above scope is not
final and can change from time to time according to the prescribed activities given by
DOE. The development proponent has to give their positive health impact evaluation
for pre-development phase, during project development and during abandonment
phase.

4.5 Monitoring and Evaluation

Monitoring and evaluation of HIA for existing project are often done overseas but not
locally. However, in future without prejudice to cost, it need to be considered as and
when current priority needs are relevantly important.

5.0 PROCEDURAL STEPS FOR REVIEWING HIA

At the national level, ESD and DCD of MOH will review and prepare written feedback
of EIA document (Second Schedule) to DOE. Meanwhile, at the state level, the written
feedback of EIA document (First Schedule) are reviewed by Unit Kejuruteraan and
Unit Kesihatan Pekerjaan dan Alam Sekitar (KPAS).

The EIA Consultant / HIA Expert Person are encouraged (optional) to arrange
stakeholder engagement with MOH during screening and scoping process to facilitate
the preparation of Terms of Reference (TOR). Figure 1 shows the procedural steps
for reviewing HIA in EIA for MOH at national and state level.

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FIGURE 1: FLOWCHART TO PROCEDURAL STEPS BETWEEN MOH AND DOE

Procedure Responsibility

Engagement with MOH during

screening & scoping (optional)
EIA Consultant

Follow Environmental
Impact Assessment
Guideline in Malaysia
(EGIM)

ESD/DCD/ SHD

ESD/DCD/ SHD

ESD/DCD/ SHD

TOR/EIA
Revise ESD/DCD/ SHD/ EIA
Endorsement
Consultant

Approve

Legend of Figure 1
ESD – Engineering Services Division, MOH (Bahagian Perkhidmatan Kejuruteraan, KKM)
DCD – Disease Control Division, MOH (Bahagian Kawalan Penyakit, KKM)
SHD – State Health Department (Jabatan Kesihatan Negeri)
TOR – Term of Reference
TORAC – Term of Reference Adequacy Check 18
 Afterword

The right to health a fundamental right as embodied in WHO constitution. A

precondition to physical development is ensuring health protection, security and health
maintenance from cradle to grave enshrined in national development policy cross-
cutting all ministries. The Implementation of National Environmental Health Action
Plan Malaysia (NEHAP) was Approved by the Malaysian Cabinet on December 2012.
The MOH is the lead Ministry addressing issues in environmental health and HIA is
viewed holistically from the standpoint of heath. Although the concept of HIA in EIA
primarily serve within the sphere of DOE’s legal perspective, other ministries also have
legal provisions that contribute to health. HIA practitioners should be aware of this and
be conscientious enough to submit useful and practical reports that serve to address
overall health concerns.

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Appendix 1: Supporting Letter to DOE

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21
 References and Selected Readings

Guidance Document On Health Impact Assessment (HIA) In Environmental Health

Impact Assessment (EIA); DOE June 2012.

Health Impact Assessment Evaluation Guide for A Proposed Development Project

Within Environmental Impact Assessment in Malaysia - Guidance for Health
Profession; MOH 2015.

A Practical Guidance On Evaluating EIA/DEIA Document for Public Health Engineers;

MOH 2016.

Malaysia Ambient Air Quality Standard Interim 2020; DOE 2013

Malaysia Air Pollution Index (API) Health Status; DOE

Abdullah S., Ismail M., Ahmed A.N., Abdullah A.M. Forecasting particulate matter
concentration using linear and non-linear approaches for air quality decision support.
Atmosphere. 2019;10:667. doi: 10.3390/atmos10110667.

National Water Quality Standards for Malaysia; DOE

https://www.doe.gov.my/portalv1/wp-content/uploads/2019/05/Standard-Kualiti-Air-
Kebangsaan.pdf

Malaysian Ground Water Quality Standards

https://www.doe.gov.my/portalv1/wp-content/uploads/2020/07/Indeks-Kualti-Air-
Tanah.pdf

National Standard for Drinking Water Quality; MOH revised January 2004

Occupational Safety and Health Act 1994

Notification of Accident, Dangerous Occurrence, Occupational Poisoning and

Occupational Disease) Regulations 2004.

Notifiable occupational diseases are listed in the Third Schedule of the Regulations
2004

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