APPENDIX G 

 ____________________________________

EXAMPLES OF PUBLIC HEALTH 

MITIGATION STRATEGIES 
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Appendix G: Public Health 

Mitigation Measures 

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Appendix G: Public Health 

Mitigation Measures 

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Appendix G 

Examples of Public Health Mitigation Strategies 

The following are examples of strategies for mitigating the impacts of industrial 

development on public health using the “social determinants of health” framework which 

have been implemented successfully elsewhere. This discussion is provided by BLM and 

NSB as a guide to measures which could be adapted for use in the North Slope. The 

measures included do not represent an exhaustive list. Instead, they are intended as 

pertinent examples of measures that might be successfully adapted to meet the needs of the 

affected North Slope communities, in order to mitigate impacts discussed in this IAP/EIS. 

Economic and sociocultural conditions are among the most powerful drivers of health and 

health disparities, particularly in minority and indigenous communities. Internationally, 

this principle has become a central focus in industrial development and finance efforts. The 

following organizations have taken a leading role in advocating for a model of development 

planning which takes full account of the socioeconomic and health effects of development on 

indigenous and ethnic minority communities, and have published guidelines addressing 

these issues: 

• The World Bank – Operational Policy 4.10, “Indigenous Peoples,” at 

http://wbln0018.worldbank.org/Institutional/Manuals/OpManual.nsf/tocall/0F7D

6F3F04DD70398525672C007D08ED?OpenDocument

• The International Association of Oil and Gas Producers – “A Guide to Health 

Impact Assessments in the Oil and Gas Industry,” at 

www.ipieca.org/downloads/health/hia/HIA.pdf

• Royal Dutch/Shell Health, Safety, and Environment Panel – “Impact 

Assessment” 

• The signatories to the Equator Principals, at 

www.equator-principles.com/

• International Association of Impact Assessment – “Health Impact Assessment: 

International Best Practice Principles” 

http://www.iaia.org/modx/assets/files/SP5.pdf

The principles and measures outlined here could be adapted, through a process of 

community consultation, to meet the goals of a “Healthy Neighbors” plan, thus creating a 

comprehensive and effective strategy for long-term management of the sociocultural, 

economic, and public health changes discussed in this IAP/EIS. 

1. Infectious Disease Prevention: 

Examples/Precedents: 

a. Shell Camisea1Project: Shell’s initial oil exploration program in the 1980s was 

heavily criticized in large part because of epidemics of infectious diseases that 

 

1 May P, Dabbs A, et al (1999) Corporate Roles and Rewards in Promoting Sustainable Development: 

Lessons Learned from Camisea. Energy and Resources Group, U.C. Berkeley. Berkeley, CA. 

Accessed online on March 23, 2007 at http://socrates.berkeley.edu/erg/documents/camisea.pdf
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Mitigation Measures 

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occurred in the indigenous communities after contact with outside oil workers. 

As a result, Shell consulted with a highly qualified team of scientists and 

developed a number of interventions to prevent infections. Interventions used 

included: 

• Construction of camps which were physically segregated from the indigenous 

communities. 

• Strict controls on when and how employees were allowed to enter Native 

villages. 

• A requirement for a “health passport,” in which employees were extensively 

vaccinated and routinely screened for communicable diseases. 

• Roadless construction, to prevent entry to the communities by other outside 

groups or individuals; and strict monitoring and control of employee contact 

with the indigenous community. 

b. Chad-Cameroon Pipeline: a Health Impact Assessment of this project, done as a 

requirement for financing set out by the World Bank, revealed the potential that 

truckers from an area of high-prevalence HIV would trigger an epidemic of HIV 

in a region of low-prevalence HIV. An intervention involving a relay system, in 

which workers would drive within their own geographic regions, and relay trucks 

to drivers in the next region, was designed to prevent transmission.2

2. Interaction between outside workforce and local indigenous community: 

Recognizing that a large influx of outside workers into a small indigenous community 

may lead social and cultural conflict and tension (related to issues including 

acculturation, tensions between work and subsistence, intra-generational conflicts as 

children adopt modes of behavior and communication mirroring the outside society, and 

importation of drugs and alcohol), developers in other regions have developed protocols 

to control interaction between workers and the community. Measures include 

restricting entry by industry employees to local communities, building camps and 

facilities separate from communities, and banning or restricting the construction of 

roads into communities. See Shell’s Camisea project and the Chad-Cameroon Pipeline 

as examples. 

3. Support of subsistence: 

Substantial impacts to subsistence – both harvest amounts and dietary intake – are 

possible under development scenarios resulting from leasing in the planning area. 

Subsistence foods constitute the primary protection against diabetes and metabolic 

syndromes (epidemic problems in other American Indian Tribes), food insecurity and 

hunger. Furthermore, subsistence activities form the foundations of cultural stability 

and therefore important protections against social pathology. Suitable “replacement 

foods” are not available: there is no nutritionally equivalent food available for purchase 

 

2 Leonard L (2003) Possible illnesses: assessing the health impacts of the Chad Pipeline Project. 

Bulletin of the World Health Organization 2003; 81: 427-433. Accessed online on March 24, 2007 at 

http://www.hiagateway.org.uk/media/hiadocs/HIA_Leonard.pdf. 

Jobin, W (2003) Health and Equity Impacts of a large oil project in Africa. Bulletin of the World 

Health Organization. 81: 420-426 

 
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in local or regional stores. Furthermore, studies have documented the generally poor 

nutritional value of store-bought foods available in rural Alaskan villages. 

Examples/Precedents: 

A variety of programs have been used to support subsistence lifestyles and diets, and 

healthful alternate foods in northern indigenous communities facing the impacts of 

industrialization 

a. Hunter Support programs: in general, these programs provide financial support 

for hunters, in return for efforts to hunt for the community. Programs have 

taken many forms, including support for poor families to purchase gas and 

equipment, and financial compensation for time spent hunting for community 

members3

b. Community freezers: the construction of community freezers would facilitate 

storage of harvested resources for longer periods of time, allowing a more even 

supply of foods available to the community.

c. Work Schedule modifications: flexible work schedules, subsistence leave, and 

job-sharing options may facilitate continued active participation in subsistence 

while allowing communities to reap the benefits of employment opportunity. 

4. Healthy Diet interventions: 

If development results in declining intake of subsistence foods (either because of impacts 

to the availability of resources, more difficult hunting conditions, or because of 

sociocultural change), North Slope communities will be at increased risk for diabetes, 

hypertension, hypercholesterolemia, and the resultant increases in cardiovascular and 

cerebrovascular diseases. The nutritional value of foods in northern village stores is 

generally quite poor, and people often chose “junk” foods such as chips, sweets, and soft 

drinks because of the relatively lower cost of these caloric sources. There are evidencebased measures which can support healthy dietary choices with regard to store-bought 

foods. 

Examples/Precedents 

a. Johns Hopkins Healthy Stores Program: employs community-directed 

participatory research to identify barriers to healthy eating, and creates 

incentives for local stores to stock better food choices. This program has been 

extensively validated in several indigenous communities, and is currently being 

piloted with encouraging initial results in Nunavut, Canada.4

b. Food Mail: the government of the Northwest Territories reduced the postage 

rate for “Nutritious Perishable Food” to encourage families to utilize regional 

sources of more nutritious store-bought foods.5 

 

3 Chan H, Fediuk K et al. Food Security in Nunavut, Canada: Barriers and Recommendations. 

International Journal of Circumpolar Health. 65(5) 416-431 

Aarluk Consulting Inc (2006) A consultation-based review of the harvester support programs of the 

Government of Nunavut and NunavutTunngavik Inc. 

4 Ho L, Gittelsohn S et al. Development of an integrated diabetes prevention program with First 

Nations in Canada. Health Promotion International 21(2) 88-97 

5Indian and Northern Affairs Canada. Food Mail Program Brochure. Online at http://www.aincinac.gc.ca/ps/nap/air/1brofoomai_e.html

Indian and Northern Affairs Canada. Backgrounder: Food mail program. Online at 

http://www.ainc-inac.gc.ca/nr/prs/s-d2001/01253bk_e.html
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5. Economic Sustainability and Sociocultural Impacts: 

The “boom and bust” economic cycle (rapid and dramatic economic growth followed by 

economic depression) that may accompany natural resource development in indigenous 

communities can create large-scale social and cultural change, and worsen social 

pathology such as alcohol and substance abuse, domestic violence, and suicide. 

Examples/Precedents 

a. Sakhalin II development: Indigenous Minorities Development Plan: 

A plan which assessed the likely socioeconomic effects of planned development on the 

local indigenous community, and developed and funded a mitigation package 

targeted at minimizing adverse social and economic outcomes, maximizing potential 

benefits, and promoting sustainable economic development. Based in part on World 

Bank OD 4.20 (an older version of OP 4.10). It provides a portfolio of interventions 

including: 

• Business training, start-up support for local businesses 

• Health services funding 

• Education support, including scholarships for professional training, 

stipends for low-income students 

• Financial support for cultural activities 

• Leadership capacity-building: training seminars, computer equipment 

 

b. Economic sustainability through “sustainable savings and investment programs”: 

for example, Canada’s National Roundtable on the Environment and Economy 

reviewed resource development in northern indigenous communities and 

recommended the creation of savings and investment programs specifically targeting 

long-term fiscal stability for the impacted communities, as well as equitable 

distribution of the economic benefits of development within the communities such 

that projects do not create or exacerbate “have and have-not” problems within 

indigenous communities.6

 

c. Shell Camisea – development plan focused on sustainable development through 

building and supporting social capital: 

• In partnership with a regional NGO, developed a socio-economic assessment 

and plan for sustainable development. 

• Shell engaged the Smithsonian Institution’s Conservation Biology Institute 

to prepare a biodiversity assessment and monitoring plan, and committed 

resources to ongoing monitoring, which drove an adaptive management 

strategy. 

• Investment strategy: strengthen existing local organizations (e.g. ‘Mother’s 

Clubs’) which were able to fund and administer local projects. 

 

Lawn J, Harvey D (2001) Change in nutrition and food security in two Inuit communities, 1992-

1997. Minister of Public Works and Government Services Canada. Ottawa, Canada. 

6 National Roundtable on the Environment and the Economy (2005). Aboriginal Communities and 

Non-renewable Resource Development. Online at www.nrteetrnee.ca/Publications/PDF/SOD_Aboriginal_E.pdf