Fracking and health – professionals speak out

On 28th January at the Killyhevlin Hotel, Enniskillen, the Fermanagh Fracking Awareness Network were delighted to host a presentation by Dr Eilish Cleary, Chief Medical Officer for Health, New Brunswick, Canada. As explained in our post of 11th December, Dr. Cleary has recently produced a report about the public health implications of shale gas development using fracking. Dr Cleary was on a family holiday to Ireland and very kindly agreed to speak about her report to medical professionals, elected representatives, and concerned residents in and around Fermanagh.


The large audience was welcomed by Dr. Carroll O’Dolan, the chair of FFAN, who thanked all who had been involved in making the event possible, especially Dr. Cleary herself and the owners and staff of the Killyhevlin Hotel. Carroll then introduced the first speaker, Gary McFarlane.

Gary was appointed as the Director for the Chartered Institute of Environmental
Health (CIEH) in Northern Ireland in late 2001 The CIEH is a national, professional, charitable organisation whose mission is to maintain, enhance and promote improvements in public health through knowledge, understanding and campaigning. As director he is involved in contributing to the development of healthy public policy, reestablishing the critical links between environment and health within the context of sustainable development and public health. Gary is also currently the co-chair of the Public Health Alliance, is a board member of Sustainable Northern Ireland and Northern Ireland Environment Link. He chairs the advisory board to the environmental
health undergraduate programme at the University of Ulster and has been appointed to the Safe Food Scientific Advisory Committee.

He spoke eloquently of his vision of health, as not simply the absence of disease but as a state of complete well-being; social, and emotional, as well as physical and psychological. Within this context, the lack of research into the health and environmental implications of fracking and shale gas exploitation is deeply worrying. The Environmental Protection Agency in the United States is at last now beginning to investigate the effects of fracking on groundwater, but it is also essential to consider its effect on soil and its indirect effects on tourism, agriculture etc. Only such a complete investigation can give anything like a full picture of the real results of fracking for human health.

The view of the Chartered Institute of Environmental Health is that the precautionary principle should be the foundation of policy in this, as in other areas. As such, any proposals for shale gas development should be carefully analysed not only by means of an Environmental Impact Assessment but also with a Health Impact Assessment. Furthermore, such a study should look particularly at the effects of the industry upon health inequalities and upon those in our society who are already the most vulnerable.

Dr Eilish Cleary, the main speaker of the evening, addressed the audience next. If there was one message, she said, that they should take away with them, it was the importance of asking questions. It is only by asking the right questions, and being determined to find answers, that we can keep ourselves and our communities safe and healthy.

Her presentation was divided into three parts: the first looking at the functions and principles of public health, the second at the shale gas industry and the third at the report which she, together with colleagues, produced in New Brunswick.

Public health as a discipline covers a wide range of functions including measuring and monitoring the health of individuals within society, preventing disease and injury, preparing emergency responses, and protecting the health of the public from the many hazards which assail it. The prerequisites for good health have been identified as peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity. If any of these are lacking, it becomes difficult or impossible for an individual or a community to achieve or maintain a truly healthy life. In common with other disciplines, public health recognises the ‘three-legged stool’ model of sustainability, that it depends upon environmental, social and economic factors, and that unless all these areas are nurtured, a society cannot be said to be sustainable.

In a complex world, much of public health work is necessarily concerned with risk management. When faced with potential or actual damage, disease or injury, there is a range of responses that may be taken. Earliest, most effective and least expensive is prevention, making sure that the damage does not occur in the first place. If this is not carried out, then less effective and more expensive paths must be taken; mitigation, response or recovery and remediation.

Within this context, Dr Cleary then went on to consider the risks to human health which are posed by shale gas development. There are several pathways by which humans can be exposed to contamination caused by the industry, principally inhalation (breathing in toxic substances), dermal contact (through the skin), ingestion (eating or drinking contaminated food or drink) and maternal (the exposure of an unborn child to contamination while in its mother’s womb). Each of these pathways can bring people into contact with different types of contamination. For example, machinery and vehicles involved in shale gas activities produce several different types of toxic emissions including particulate matter, carbon monoxide and nitric oxides.
The effects of the various types of contamination on health are wide-ranging, including reproductive, dermal (skin), and haemologic (blood) disorders. Full details of the pathways, types of potential contamination and their effects can be found in Dr. Cleary’s report here.

Faced with this type of problem, Dr. Cleary suggested that the conventional way of looking at the situation is fundamentally flawed. This traditional approach tends to begin with the industry and its processes, then considering its effect on the environment and finally upon public health. Suppose we instead began with the requirements for a healthy population, those factors identified earlier as including peace, social justice, a stable eco-system and sustainable resources? Then proposals for industrial activity could be more accurately assessed according to whether they contributed to, or destroyed, those fundamental building blocks of health.

Sadly, we are a long way from such an approach today. The situation that Dr Cleary was faced with in New Brunswick was that the government had already made the decision to go ahead with shale gas extraction. The question that she was faced with, therefore, was not whether or not such activities should be carried out – that one had already been answered by others – but what measures could push the situation in the direction of being a net benefit, rather than a loss, for the health of New Brunswick’s people.

Given both the constraints of this situation and the lack of research and evidence available, it was not possible for the New Brunswick report to be a complete overview of all the public health impacts threatened by shale gas development. Instead, it was more a survey of what is currently known upon the subject, and, perhaps more importantly, what is not known. There are a disturbing number of data gaps including the health status of affected populations, details of their exposure, information about the toxicity of chemicals used in the extraction processes and those contained in waste products, health impact assessments, forecasting and analysis of the cumulative and lifestyle impacts of the industry’s activities and their consequences. One of the most significant achievements of Dr. Cleary’s report is in identifying these gigantic holes in what is currently known about shale gas and human health.

A particular problem related to shale gas extraction is that the industry typically begins in any location on a very small scale but that development thereafter is extremely rapid. This speed of growth, and the inevitable implications for the health of local people, requires proper planning before the first development; it is not sufficient to rely upon ad hoc measures as the activity increases.

In line with the general pattern of absent information, there is little clear data from locations where shale gas extraction is already underway. There are, however, certain common themes which emerge from the evidence available. These are: physical accidents occurring on and off-site, air and water quality problems, a loss of community cohesion, the boomtown effect and mental health issues. It is important to note the breadth of these problems and that the difficulties related to shale gas exploitation are emphatically not only those of chemical toxicity.

To date, public health experts and officials have been largely absent from the discussions about fracking and therefore unable to present their concerns. These, in addition to the direct impacts, would include the inequitable distribution of risk and reward in the industry, and the potential risks to economic well-being, to governments, to the environment as well as those to public health. The life-cycle of the shale gas industry is not yet clear; there are widely varying estimates as to the length of time for which a well would be viable but it is likely to be short in the context of a community’s experience and the well-being of future generations.

Mistakes in this industry can be very large and very costly and it is therefore not enough simply to have rules which regulate its activities. Dr. Cleary’s recommendations to her government therefore included the setting up of various consultative and overseeing projects and groups, a genuine dialogue between communities, governments, academics and the industry, an effective role for local government, the public reporting of data and a balanced distribution of the risks and rewards.

She closed by emphasising that final decisions have to be made by the communities who would have to live with shale gas exploitation and its consequences.

Questions were invited from the audience and these were numerous and detailed, including issues of water contamination, the length of time needed before public health effects would be assessed, the unlikelihood of claims that fracking could be carried out ‘without chemicals’ and the implications of the industry’s exemption, in the United States, from key environmental legislation.

A statement was read on behalf of Dr. Geralyn McCarron, a GP originally from Fermanagh and now working in Australia, who has witnessed the severe health problems created by the shale gas industry in Queensland. Her statement was featured in our last post and is available here.

Further questions concerned the proposed study by the Irish Environmental Protection Agency into the feasibility and consequences of fracking in Ireland, and the absence from its draft terms of reference of any health impact assessment, the possibility of pilot projects, the need for, and general absence of baseline studies and the fact that, to date, the New Brunswick government have not implemented any of Dr. Cleary’s recommendations. There was some criticism of Dr. Cleary for her clear position, stated at the outset, that she would not enter into the political debate as to the general advisability of otherwise of shale gas exploitation, but that her role, as she saw it, was the provision of information.

Some criticism was also made of FFAN for discussing issues of regulation rather than simply calling for an outright ban on fracking. FFAN’s position is that shale gas exploitation using fracking is a dangerous and unnecessary activity which should not go ahead in Fermanagh or elsewhere. In order to achieve this end it is vital to inform the public and other decision-makers of all the issues and potential effects of the industry. Ultimately it is the responsibility of local people to decide whether or not they want fracking in Fermanagh. If they do not, each individual needs to speak out clearly to ensure that his or her voice is heard by those elected to represent us.

Finally, closing remarks were given by Dr John Graham, who is a retired public health physician who has moved back to Fermanagh having grown up there and trained at Queen’s. He was a health service chief executive in Germany and the Middle East and worked as a medical policy director in Whitehall. He commissioned a major international epidemiological research programme to investigate Gulf War Syndrome and worked in Washington DC for the White House in collaboration with the Institute of Medicine.

John drew upon his own experience in relation to Gulf War Syndrome to emphasise the vital importance of obtaining firm evidence before irrevocable decisions are made and in particular the necessity for the Irish EPA and any other reporting body to include health impact assessments in their analysis.

The evening was a valuable opportunity for people in Fermanagh and beyond, especially those concerned with public health, to discover more about the potential side-effects of shale gas development. In particular, Dr. Cleary’s presentation encouraged the audience to become more aware of the gaps in our current knowledge and the need for comprehensive analysis of medical, environmental, social and economic factors before potentially disastrous decisions are made. FFAN are grateful to Dr. Cleary for giving up her valuable personal time, while on holiday, to speak on this subject, to the other speakers, the Killyhevlin Hotel and to all who attended the event.

NB Chief Medical Officer for Health’s visit

As we mentioned way back in December 2012 (well, it feels like a long time ago),  we’re delighted to host a presentation by Dr. Eilish Cleary, Chief Medical Officer for Health for New Brunswick in Canada.  She will be visiting Enniskillen on Monday 28th January and speaking at the Killyhevlin Hotel at 8pm about her recent report on fracking and its effects on public health.

This will be a fascinating insight into the realities of fracking, of importance to all local people and particularly health professionals and public servants.  Invitations to the event have been sent to local GPs, elected representatives and to Chief Medical Officers throughout the UK and Ireland.  Members of the public are also of course warmly invited and we look forward to seeing as many of you as possible on the 28th.

Click on the link below to download a poster which can be printed and displayed or emailed to other interested groups.

CMOHNB poster 28.01.2013



Fracking and health: a unique opportunity

DR EILISH CLEARY, Chief Medical Officer of Health for New Brunswick, Canada has recently released a report into the Public Health aspects of shale gas development using fracking. This ground breaking report covers many important issues and we at Fermanagh Fracking Awareness Network are incredibly fortunate to host Dr Cleary for a presentation here in Enniskillen. She will be addressing many of the topics raised in the New Brunswick report and this will be of relevance to us all, whether Fermanagh residents, health professionals or the government. Dr Cleary’s presentation is on Monday 28th January 2013 at 8.00pm in the Killyhevlin Hotel, Enniskillen and all are very welcome to attend.

As a taster, here is a synopsis of her report, prepared by Dr. Carroll O’Dolan, chair of the Fermanagh Fracking Awareness Network:

New Brunswick Report into Public Health & Shale Gas Development [Fracking]. 2012

The Chief Medical Officer of Health [CMOH] for New Brunswick, Canada, Dr Eilish Cleary, commissioned and published a report, in September 2012, into Shale Gas Development and its impact on Public Health. The report is very perturbing reading with regards to the risks we face with fracking.

Shale Gas Development is better known by the name Fracking or more correctly High Volume Hydraulic Fracking [HVHF] and has only recently become available to the oil and gas industry. HVHF is very different from the traditional fracking which has been used by the industry for the last sixty years. The scale and intensity of the new operations, combined with the vastly increased amounts of water required, has led some states in the USA and other Countries to consider this a new and unproven industry.

New Brunswick [NB] and the Northwest of Ireland share many similarities; notably both have many rural communities and small towns. Both areas also depend on the viability of their agriculture and tourism industries to sustain and underpin their local communities and towns now and into the future.

The NB report is divided into four main parts:

Guiding Principles for the Protection of Public Health.
What We Know Now and What We Don’t Know Now.
Recommendations for the Protection of Public Health.

The Executive Summary states that:

‘unless proper controls are put in place there is a risk of spoiling any benefits from economic gains through adverse health outcomes’.

It goes on to say that

‘Government needs to take targeted and strategic actions aimed at prevention and mitigation of negative health impacts, which includes building capacity in local and provincial services and infrastructure. These will need to be put in place prior to further development as the current infrastructure, capacity, processes and legislation are not adequate to meet these needs. In addition, as this industry is new and evolving, monitoring of the health of the population will be important on an ongoing basis to detect adverse impacts. This will allow for modifications, if warranted, a slow down or halting of further development.’

Many aspects of Public Health that will be impacted by Fracking are dealt with in the report, one of which is the “Boomtown Effect”.

‘This effect occurs when a rapid change in population, industrialization and economic prosperity also leads to a host of social ills that impact community health. These can include increased rate of crime, drug and alcohol abuse. Sexually transmitted infections[STIs] and domestic violence; inadequate supply of quality housing; increased cost of living; increased community dissatisfaction; increased mental and social services case loads; increased hospital admissions; insufficient infrastructure; insufficient capacity in public services, including policing, local government, social services and health care. The Boomtown Effect is thought to be more intense for small communities with a traditional way of life that did not previously involve the industrial sector responsible for the boom.’

The assumed positives of the “Boomtown Effect” don’t always occur, the report says:

‘One could expect that as a result of economic gains due to increased income, energy and employment, there would be an indirect positive benefit in health status as a result of this industry, however clear evidence to support this was not found in the course of this review’.

The CMOH report covers all the areas of known and unknown risk relating to Fracking and this very fact that it is an evolving industry with a very short track record means that the  precautionary principle and burden of proof considerations must be paramount.

Precautionary Principle: when an activity or occurrence raises threats of serious or irreversible harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.

Burden of Proof: the burden of proof that an activity is not harmful falls on those undertaking the activity rather than on Public Health authorities to prove that the activity is harmful.

There are many recommendations in the report; all are common sense, mostly relating to the gathering and monitoring of various markers, both direct and surrogate, of pollution and health. The very first recommendation states that equitable distribution of risks and rewards is required. Other recommendations refer to protection of health relating to changes in social and physical environments, protection of future generations and implementation and overseeing and monitoring of the industry.

All these recommendations will take time and money and the report states that much of the costs should be absorbed by the industry; however proper oversight is required to ensure genuine independence between the industry and the regulators.

There are so many aspects to Fracking that impact on Public Health that much more detailed investigation is warranted before we make the ‘dash for gas’. The United States Environmental Protection Agency (USEPA) is currently investigating the impacts of fracking on drinking water and ground water; the full report is due out in 2014.

The CMOH report states:

‘Although this [USEPA]  will probably be the most definitive study ever regarding potential impacts on water, it is not designed to assess all the possible public health risks and as such is not a comprehensive Health Impact Assessment’

The report continues;

‘The public discussion on shale gas has been dominated to date by chemical toxicity concerns and has focused on water and hydraulic fracturing chemicals; while these are important, there is a risk of overlooking other potentially more problematic considerations, such as community health issues and the potential for physical injury. The scientific literature and medical literature has not widely reported or studied factors such as potential impacts to community health, mental health and socioeconomic wellbeing but rather also has been focused on issues surrounding potential environmental toxicants’

The report lists these environmental toxicants as including petroleum, heavy metals [mercury, cadmium, lead] radioactive waste and highly saline flow back fluid that all carry the risk of entering the surface or ground water. Also present are risks to air quality, noise, vibration, continuous illumination and physical hazards due to extensive heavy truck use.

Public Health Departments need to be involved in the investigation of Fracking, yet to date they have not been, as the report states:

‘ Although Health concerns are often noted as an important preoccupation among the public, there has been a notable lack of participation of Public Health agencies in many of the ongoing initiatives to regulate the industry elsewhere. This may be due to a general lack of understanding about the potential impacts on health, little precedent to draw on for learnings or plans that could be followed, a narrow scope of what “health” means, and/ or a belief that engineering controls and regulators can mitigate all of the potential impacts’.

This CMOH report by Dr Cleary and her team is a timely reminder and warning that we should not take High Volume Hydraulic Fracking as a proven and safe industry. Fracking may well cost our communities dearly in health and health care expenditure if we do not assess all the risks properly.

‘Ultimately this simply translates to, what is the cost of being wrong about estimating risk? If we believe the risks are moderate and acceptable and can be mitigated but we are wrong, what is the worst that can happen? If we believe the risks are extreme and unacceptable and we are wrong, then what?’

The above quote is a chilling message. This assessment of risk comes from a reliable and truly independent source whose job it is to protect Public Health. We must insist that the Government take heed and await the proper evaluation of Fracking by a comprehensive Health Impact Assessment. At present the Northern Ireland Government is planning only an Environmental Impact Assessment which entails a more superficial view of Health than is required. What is becoming apparent is that only a truly comprehensive Health Impact Assessment by trained Public Health Doctors can fully investigate the long term consequences for Public Health. Geologists, Engineers and Environmental Scientists all have their specific skills in the assessment of HVHF but none can properly assess Public Health. If the risks, once assessed, for our communities are deemed too high then fracking must not proceed.

Dr Carroll O’Dolan.
Member of the Royal College of General Practitioners
& Chairperson of Fermanagh Fracking Awareness Network

Dec.  2012.

Read Dr Cleary’s report in full here.



Fermanagh Fracking Awareness Network (FFAN)