Community-led Health Impact Assessment: Addressing Cross-border Pollution in Nan Province, Thailand.
- Specific Topics
- Air Quality
- Climate Change
- Coady Institute Graduates
- Scope of Influence
- Start Date
- End Date
- Time Limited or Repeated?
- A single, defined period of time
- Develop the civic capacities of individuals, communities, and/or civil society organizations
- Make, influence, or challenge decisions of government and public bodies
- Citizenship building
- Co-production in form of partnership and/or contract with private organisations
- Social mobilization
- Spectrum of Public Participation
- Total Number of Participants
- Open to All or Limited to Some?
- Open to All With Special Effort to Recruit Some Groups
- Targeted Demographics
- Indigenous People
- Low-Income Earners
- General Types of Methods
- Collaborative approaches
- Deliberative and dialogic process
- Research or experimental method
- General Types of Tools/Techniques
- Facilitate dialogue, discussion, and/or deliberation
- Plan, map and/or visualise options and proposals
- Facilitator Training
- Professional Facilitators
- Face-to-Face, Online, or Both
- Types of Interaction Among Participants
- Discussion, Dialogue, or Deliberation
- Information & Learning Resources
- Site Visits
- Participant Presentations
- Expert Presentations
- Decision Methods
- General Agreement/Consensus
- Communication of Insights & Outcomes
- Word of Mouth
- New Media
- Type of Organizer/Manager
- Academic Institution
- Health System Research Institute, Thailand
- Evidence of Impact
- Implementers of Change
- Lay Public
- Appointed Public Servants
- Formal Evaluation
The Lua ethnic people in Nan Ree Patana and Nan Chang Patana, Thailand used a community-led health impact assessment process to address concerns over cross-border air pollution from a Lao power plant and to advocate for a community-led monitoring system.
Problems and Purpose
The coal fired-power plant generated air pollution which can cross a border. The people who live along wind direction, both side Lao and Thailand, risk to impact on health and also agriculture farming. The environmental and health impact assessment is an important tool for decision-making. Base on the Impact assessment principle, all of the stakeholders have the right to participate in raising their concerns. But in an Asian country, there is no law and regulation for doing transboundary impact assessment. Regard to this situation, it lacks Thais participation because the EIA has done only in Lao PDR and also no monitoring system.
The purpose of the community-led impact and monitoring system is to empower communities to have the capacity for monitoring the impact of the dam on humans and the environment on their own, to then negotiate with policy-makers.
Background History and Context
Nam Ree Patana village and Nam Chang Patana villages are located in the Khun Nan Sub-district, Chaloem Phra Kiat District, Nan Province, Thailand, located on the Thai -Lao border. It is high altitude, and the water source comes upstream from a river. They are “Lua”, who are a minority ethnic and native people. They have their own language and spiritual belief systems. Their houses are made from bamboo and wood, and agriculture is the predominant economic driver. They grow rice, coffee, mulberry, lychee, and bananas. All drinking water comes from the mountain rivers directly, and there is no filtration system for contaminated water.
In 2016, the Lao PDR’s highest-capacity power plant became operational. It’s located in Hongsa and Muang Nguen Districts, Xayaboury Province, Lao PDR, which shares a border with the Nan Province in Thailand. The 1878 megawatt capacity power plant provides a sustainable source of energy for both Laos and Thailand.
The typical air pollutants associated with a coal plant, (PM 2.5, NOx, sulfur dioxide, heavy metal, mercury) have been linked with significant diseases. However, the Environmental Impact Assessment (EIA) has only been done in only Lao side and does not include those affected on the Thai side of the border. Therefore, there is no monitoring and mitigation for Num Ree Patana village and Nam Chang Patana village communities.
Dr.Lujisak Voradetwittaya, MD, and director of Chaloem Phra Kiat Community Hospital in Thailand, had concerns, so he developed a program to monitor the health impacts from Hongsa power plant, which focused on diseases such as respiratory syndrome and heart disease, to identify the at-risk population, and collect baseline data via physical health exam (EKG, Chest X-ray). However, due to limited budget and human resources, the monitoring program did not cover every at-risk person, and the Lua ethnic community who live far away from the district but near the power plant were excluded.
There are 4 contextual factors pertinent to the initiative:
- Air pollution from coal power plant contains heavy metal especially mercury that can be contaminated in ecology and to accumulate in a food chain.
- The risk to native people who live in a remote area, upstream river, and their livelihood depend on natural food.
- The risk is not only with native people but can expand to the others who live outside because this area produces food and export both to domestic and abroad.
- No monitoring system so communities cannot raise their concerns and give evidence to regulator and polluter directly.
Villagers don't know about the pollution or the risk and don't know how to protect themselves. Therefore, they need to be educated about the harmful effects of these pollutants and personal mitigating measures they can take. And also need a platform for working collaboratively with others for example medical doctor, local authority, an agriculture expert, engineer, etc. All of the stakeholders that villagers were mention have a common concern including policy sector especially the ministry of public health. So that it provided new opportunities for participation in policy change. And there is an opportunity to apply in another area in the Asian country that facing the same situation e.g. coal power plant in Shan state, Myanmar, gold mining in Cambodia, etc.
Organizing, Supporting, and Funding Entities
The initiative was started by an environmental lawyer who was working on the transboundary impacts in an Asian country, who then raised their concern with Dr. Darunee Paisanpanichkul, a law professor of Chiang Mai University. Health impact assessment practitioner, Somporn Pengkam was brought on board alongside Dr. Tanaphon Phenrat, an environmental engineer and associate professor of Narasuan university . The project proposal was sent to the Health System Research Institute (HSRI) of Thailand and got funding for the 1st phase. The time frame for the initiative was 1 year (2017). The initiative was supported by the Foundation for Environment and Natural Resources, the Enlaw Foundation, and the Community-led Impact Assessment Institute. All have a common interest in human rights, equality, and sustainable development.
Participant Recruitment and Selection
Working on a borderland is quite sensitive, so we used the health issue as an entry point. A field researcher was sent to the following communities; Nam Ree Patana village, Khun Nan Sub-district, Chaloem Phra Kiat, Nan province. She stayed at a primary health care center in the community for 2 months. Her duties were building trust with community members and knocking on the door of each house, explaining the project and inviting everyone to join the workshops. The field researcher was a team member of community-led impact assessment institute who has 5 years experiences working on CHIA, public health background and to be able to work in a remote area. Due to this project, she working for full-time and got a salary from the project.
All of the community members were invited to participate in the monitoring program meetings. No one was neglected. The voices of elderly, sick people and poor of the poor people were prioritized.
However, demographic groups that were targeted for the workshops and discussions were health volunteers, youth, the elderly, and the agricultural community.
Methods and Tools Used
Community-led Health Impact Assessment (CHIA) is a form of health impact assessment approach. It is a joint learning process by local communities to equip themselves with sound information and evidence in order to make healthiest decisions on policies, projects, or development activities. Its ultimate goal is to ensure social justice and health equity.
In southeast Asia, the concepts and procedures of CHIA have been continuously developed over the past decade, starting from Thailand and expanding to Myanmar, Bhutan, and the Philippines.
CHIA integrates three concepts in its process:
- Health - emphasizes the holistic promotion of health and well-being by recognizing social factors
- Education - strengthens community capacity on lifelong learning skills
- Public policy - enhances the participatory process in public policy, balances the decision-making power, ensures accountability.
There are 6 steps of CHIA :
- Knowing Community Core Value - This step is about data collection. Mapping is a great tool to show relationships between natural resources and community cultural ecology. Creating a timeline of significant changes that occurred in the past helps the community to predict the future. The community is the main entity in this step.
- Knowing Policy/Project - The community has to find out about the policy or project. What are the reasons and necessity of this policy/project? Who initiates the policy/project? Where is the money coming from? What does the production process look like? What will be the impacts? Experts will also play an important role in this step. Experts will share scientific and technical knowledge to the community. In return, the community and the experts jointly learn and integrate their knowledge in order to make a comprehensive impact assessment.
- Knowing Community Right and Policy Procedure - It is important for the community to know policy procedure (e.g. EIA, permission process for power plants and/or mining) in order to know when and how they can engage, present their information, comment and involve in the decision-making. Legal experts are involved in this step to assist the community in legal and technical terms.
- Appraisal - Community joint learning process and information on the policy/project help draw the framework of the impact assessment and questions needed to predict the impacts. Risk mapping helps to visualize the framework and concerning issues to be more apparent. After that, it would be easier to rank the importance and design of further data collection for additional potential impact assessment. Collaborations with experts are highly suggested for complex issues such as pollution problems. After the study, there must be a process for the community to collectively review for accuracy and comprehensiveness.
- Influence Policy Decision Making - CHIA assists the community in generating information for various decision-making levels. It may be used when the community wants to inquire opinions within the community, to ensure informed decision at the local administrative level, to guarantee community involvement in environmental and health impact assessments. The CHIA result is also used as evidence for government agencies to review in parallel with information submitted by policy/project proponents. More importantly, this information reflects the core values of the community and can be used to determine their future.
- Monitoring of the project/programme after the assessment
What Went On: Process, Interaction, and Participation
Villagers have been worried about impacts since the plant started operating. Especially when they saw a haze in the sky and something abnormal occur in farming such as burnt rice leaves, and yellow mulberry leaves with a black spot, but it cannot be explained. Being ethnic people living in the borderland, they felt powerless, and wanted information but had no idea how to get it. Therefore, they very active when learning process comes in.
Initial deliberations in the community were conducted by a field researcher. The field researcher organized a core group of community stakeholders, which consisted of youth, health volunteers and local authority members. When there was a plan to hold a workshop, the field researcher would first meet with the core group, and they would communicate and coordinate with other people in the community. The community leader would also make an announcement and the local health officer would inform people when they visited patients home. There were many groups represented in the local workshops, including villagers, farmers, local authorities, health officers, a health volunteer, youth, and teachers. Majority of people who participated had some kind of concern about the impacts of the power plant and observed something abnormal with their farm.
There were 3 workshops held in the community. The 1st workshop talked about community core values. The 2nd talked about coal-fired power plant project and its impact. The 3rd was about the impact on community, concerns and monitoring initiative. There was also a meeting with the governor and the community stakeholders. Participation of men and women was encouraged.
Workshops were facilitated by the field researcher and health impact assessment practitioner. Together, they designed and facilitated the workshops to promote active participation from community members. Dr.Tanaphon Phenrat, an associate professor of engineer faculty, Naresuan University, also presented academic information to the villagers. Community leaders provided facilities for the workshops.
A community map and timeline method were used for interaction between villager and academics. They shared knowledge and discussed risks based on experiential knowledge and evidence from the community. This method sought to bring together academic/scientific knowledge, as well as the experiential lived experiences of community members.
Because environmental degradation has long term effects, the biggest concern of villagers was economic, as agriculture is their main source of income. Air pollution from the coal power plant can generate acid rain, which negatively impacts farmland. When yield is down, income decreases and adults will be forced to move to urban regions for work, leaving the elderly and children in the community. Unfortunately, as a migrant worker away from home, some of them may become poor or homeless in urban areas.
After the workshops, villagers made a decision to initiate community-led monitoring. They had met with the governor and representatives of the coal company. The law faculty of Chaing Mai University called a meeting at Governor hall of Nan province to present the community concerns, as well as the laws and regulations which related to the issues as well as make recommendations to set up the monitoring system. The meeting was chair by the vice governor.
The vice governor recognized the community concerns and the company explained more about the monitoring system of the project, willing to share information and also invite community members and the academic team to visit the plant.
Community members had the courage to raise concerns and propose their needs. Academics who presented information about the impacts of the coal plant were key influences. No one was left out during the workshop.
The community-led monitoring system has not yet been implemented. It’s on the process of being developed and adopted.
Influence, Outcomes, and Effects
The intended outcome was achieved as the process has provided an opportunity for the Lua ethnic people to become active citizens. Villagers decided to store their own self-surveillance data without the need to rely only on experts and government agencies.
The dialogue between community members and government representatives held space for ‘experts’ to recognize villagers knowledge as crucial components of community led-monitoring system.
There were positive unexpected outcomes which are 1) inspiration to other countries with similar problems and 2) it can contribute to the working cooperation of experts from a various university in Thailand.
Analysis and Lessons Learned
Community-led impact assessment process gave villagers have a chance to review their own livelihood through community mapping and community changes from the past to the present. Community members were able to learn about the power plant and the risk of power plants from the engineering professor, making them more confident to speak their truth with power and inspire them to build self-monitoring systems and cooperate with various agencies. When locals gained some literacy on the subject, it changed the relationship from vertical to more horizontal and gave them more power for negotiation.
The community-led health impact assessment is a learning process. The co-production of knowledge among experts and lay knowledge gave locals literacy and capacity to communicate and negotiate with the relevant authorities to discuss the problem appropriately. However, it remains a challenge to work in the border area to prevent the impact of pollution. In particular, the source of pollution is in foreign countries where the Thai government has no authority to regulate it. Therefore, it is a common issue associated with international relations. There needs to be a platform for both countries to share information and make decisions together. To evaluate the success of this project, there is a collaboration to extend the system, not just two villages, but should be covered Nan province.
The most important experience and lessons from this work are the learning process together between a variety of experts, villagers and government agencies. Working carefully in fragile areas is not only aimed at solving pollution problems because it may affect the relationship and the border economy, thus designing a delicate process of listening deeply, which is necessary.
The main difference in this work is how to make a tribe of clans living in the border area, be aware of and open up the channel to participate in project-level decisions and the policy of a developing country. The current world is facing a complicated problem such as climate change. It cannot be solved by only one sector or only one type of knowledge. The co-production and co-creation of knowledge are needed to work together to solve these complex problems.
Somporn Pengkam, Revitalizing Thailand's Community Health Impact Assessment(Online: National Health Commission Office, Thailand, 2012), https://en.nationalhealth.or.th/wp-content/uploads/2017/11/2012_Revitalizing-Thais-Community-HIA.pdf
Hongsa Power Plant and Mining Project: https://earthrights.org/what-we-do/extractive-industries/hongsa-power-plant-and-mining-project/
Health Impact Assessment: https://www.who.int/hia/conference/poster_kessomboon.pdf?ua=1
Lead image: Health Impact Assessment Coordinating Unit, Thailand National Health Commission Office, http://bit.ly/2D8RV6r
Other images courtesy of Somporn Pengkam.
The first submission of this case was produced by a graduate of the Coady International Institute at St. Francis Xavier University with the support of its staff, Julien Landry and Rachel Garbary.