KINDER MORGAN and
PUBLIC HEALTH
The risks of Kinder Morgan’s pipeline in your community
TABLE OF CONTENTS ACKNOWLEDGEMENTS
3
EXECUTIVE SUMMARY
4
KINDER MORGAN AND PUBLIC HEALTH
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THE BIG PICTURE: CLIMATE CHANGE AND HEALTH
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LOCAL IMPACT: HEALTH EFFECTS OF BENZENE AND 1,3-BUTADIENE
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VULNERABILITIES WITHIN LOCAL POPULATIONS
8
FIRST NATIONS, MÉTIS, INUIT, AND INDIGENOUS PEOPLES
10
NOT IF, BUT WHEN: ACCIDENTS HAPPEN
11
MENTAL HEALTH AND TOXIC EXPOSURE
11
CASE STUDY: THE 2007 KALAMAZOO RIVER SPILL
12
RECOMMENDATIONS
13
COMPLETING A CUMULATIVE HEALTH IMPACT ASSESSMENT
13
REFERENCES
15
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ACKNOWLEDGEMENTS We sincerely thank the following physicians for their valuable input on this guide: Dr. Tim Takaro. Dr. Takaro is a Professor in SFU’s Faculty of Health Sciences, and a member of the Canadian Association of Physicians for the Environment (CAPE). In 2015, he was the primary author of a report submitted during the National Energy Board’s intervenor process for Kinder Morgan’s pipeline, which summarized key health impacts and risks of the proposal. Dr. Trevor Hancock. Dr. Hancock is a physician and Professor of Public Health and Senior Scholar at the University of Victoria. He is one of the three co-founders of CAPE, an
“The humanity of a society is judged by how well it protects and cares for its most vulnerable individuals… [Kinder Morgan’s pipeline] poses an unacceptable risk to the health of Burnaby and North Shore residents.” - Dr. Tim Takaro
Honorary Life Member of the Canadian Public Health Association, and was recently made an Honorary Fellow of the UK’s Faculty of Public Health. He has worked on issues of health and the environment for over 40 years. Dr. Courtenay Howard, MD, CCFP-EM. Dr. Howard is a born-in-BC Yellowknife ER doctor who is the Climate-health Board Lead for CAPE. She led the successful campaign to have the Canadian Medical Association divest from fossil fuels, coordinates MD-advocacy on climate-health across Canada, researches the health effects of wildfires, and helped CAPE become a founding board member of the Global Climate and Health Alliance during COP21 in Paris. Dr. Curtis Lavoie. Dr. Lavoie is an Ottawa-based Pediatric Emergency Physician who leads Environmental Sustainability Initiatives. Born in the Oil Patch, he has planted trees, worked rodeos, and pounded spikes across Western Canada. He did his medical studies in Calgary, “You have only one choice — [to] reject this proposal to expand Canada’s fossil fuel exports and further contribute to global warming.” - Dr. Trevor Hancock
Montreal, and Halifax, and practiced medicine in remote areas of every maritime province, plus Quebec. He also teaches Mindfulness, researches Outcome Feedback, enjoys crazy outdoor pursuits, and plays double bass with his wife and kids. Dr. Angela Brooks-Wilson. Dr. Brooks-Wilson is a Professor and research scientist in the Department of Biomedical Physiology and Kinesiology at Simon Fraser University.
We would also like to acknowledge the Stand.earth community. Our community helps us make the impossible possible. Without them, we wouldn’t be able to do hard-hitting advocacy work to establish strong environmental rights and a clean, safe future for this planet and its residents. Special thanks also to Cassandra Torok and Hayley Zacks for their efforts in producing this report.
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EXECUTIVE SUMMARY The Kinder Morgan pipeline – a project that would triple the company’s existing pipeline capacity through British Columbia and increase tanker traffic 7-fold in the Salish Sea – comes with major global and local health risks. This guide reviews the research of health professionals in order to communicate those risks, and the gaps that still remain in our knowledge of them. Globally, the World Health Organization asserts climate change is the biggest human health threat of our time, but climate change was not considered in Kinder Morgan’s review process. This project would generate 14 to 17 megatonnes of carbon in upstream emissions alone. In context, this equals 100% of British Columbia’s 2050 emissions target and 25% of the current target. Overlooking the health impacts of climate change connected to this project demonstrates a dangerous gap between the health, environmental, and development arms of our governments. The Lancet Commission – a body of peer-reviewed, scientific work on global health – tells us that tackling climate change could be the biggest public health opportunity of our time. The former head of the UN’s Framework Convention on Climate Change, Christiana Figueres, told the world’s health ministers last spring that it represents our best preventative public health investment. Yet our national review processes continue to overlook this issue. The local health effects of the Kinder Morgan pipeline are also deeply concerning. Diluted bitumen (dilbit), the product this pipeline would transport to tidewater, contains two carcinogens: benzene and 1,3-butadiene. Both have no known safe threshold of exposure. The primary health concern from this project, childhood leukemia, can arise from benzene exposure due to the routine operations at Westridge Marine Terminal and from an oil spill. Other exposure-related health impacts include increased risk of cardiovascular and respiratory illness, reproductive disorders or defects (e.g., neural tube defects), cancers, and death. All of Greater Vancouver’s 2.3 million people are at potential risk from these effects, but there are certain populations that are more vulnerable to health decline in the event of an exposure incident – namely children, women of childbearing age, and the elderly. Furthermore, there are major health discrepancies between Indigenous and non-Indigenous Canadians that Kinder Morgan’s pipeline would deepen. Indigenous health is an emerging priority for medical professionals across the country, particularly in light of the Truth and Reconciliation Commissions’ 94 Calls to Action. Expansion of the Kinder Morgan pipeline represents a step backwards for reconciliation in Canada.
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Additionally, this project comes with a significant
The Canadian Government cannot fulfill their responsibility to safeguard the public – their health, their security, and their future – without knowing the breadth and depth of health risks this project would produce.
risk of accidents. How such events impact individual and community health is of critical importance to the Federal decision on this project. And Kinder Morgan’s existing pipeline is no stranger to accidents: 82 reported spills since 1961, which translates to over 6 million litres released into British Columbia’s environment.
If our Federal government approves this project, communities along the pipeline and tanker routes will face a triple-threat: first, they will be victim to the routine toxic emissions that come with oil and gas operations; second, there will be an increased risk of a major oil spill or fire that could devastate local health and environment; and lastly, climate change will continue to worsen and deteriorate public health for current and future generations. In 2012, the Canadian Medical Association passed resolution to support “a comprehensive federal environmental review process, including health impact studies, for all industrial projects” (CMA, 2016). The Canadian Government cannot fulfill their responsibility to safeguard the public – their health, their security, and their future – without knowing the breadth and depth of health risks this project would produce. For that reason, this report asks the federal government to complete an independent Cumulative Health Impact Assessment.
As of today, Kinder Morgan’s review process has not undergone a comprehensive assessment of its risks to public health.
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KINDER MORGAN AND PUBLIC HEALTH Kinder Morgan is a US energy company that proposes to build a second pipeline in Canada to follow a similar route to their existing Trans Mountain Pipeline — from just outside Edmonton, AB to Burnaby, BC (Kinder Morgan, 2014). This will result in a substantial increase in both their pipeline capacity — from 300,000 barrels of oil per day to 890,000 barrels — and tanker traffic in the Salish Sea — from 5
Climate change and our carbon-intensive energy system already cause 4.5 million deaths a year and cost the world over $1.2 trillion USD annually.
tankers per month to an estimated 35 (ibid.). Kinder Morgan’s pipeline would transport diluted bitumen or ‘dilbit’ (ibid. 75). Bitumen is a type of heavy crude oil from the Alberta tar sands. This product is highly viscous and dense, and must be diluted to be transported through a pipeline (Chang et al. 7). Dilbit also contains various toxicants. The condensate blends Two substances that are present within both crude and dilbit are benzene and 1,3-butadiene. Both are classified as Group 1 human carcinogens with no known safe threshold of exposure.
used to dilute bitumen contain volatile organic compounds (VOCs), which are airborne toxicants and endocrine disrupters (Eykelbosh 14). They have adverse cardio-, respiratory-, and reproductive impacts to humans and wildlife (Kim et al. 1; Chang 7). Two substances that are present within both crude and dilbit are benzene and 1,3-butadiene. Both are classified as Group 1 human carcinogens with no known safe threshold of exposure (IARC 333; ATSDR, 2007 16).
The Big Picture: Climate Change and Health The Director of the World Health Organization, Dr. Margaret Chan, states “climate change is the greatest threat to global health in the 21st century” (Chan, 2015). Linked to instability and social decline, climate change has and will continue to adversely impact the livelihood of billions well into the future (Costello 1693; WHO, 2016; D’Ippoliti 1, 3). The second edition of the Climate Vulnerability Monitor estimates that climate change and our carbon-intensive activities cause 4.5 million deaths a year and cost the world over $1.2 trillion USD annually (DARA 17). The reasons for these deaths are wide-ranging — from hunger to cardioand respiratory-disease to cancer – and will increase worldwide if anthropogenic climate change continues unmitigated (WGPHFC 1346; CPHO 16, 18).
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Climate change should not only be considered at a global scale. Its impact should also be localized to understand how these are experienced by our communities. Climate change is deeply tied to our energy systems, including the projects and policies we support. Thus, these systems are directly linked to health: “effects of energy systems alone exceed the global health impact of most other risk factors… [including] tobacco, alcohol, and high blood pressure” (Smith et al. 178). Energy-intensive projects such as Kinder Morgan’s pipeline will add to the world’s greenhouse gas emissions contributing to rising global temperatures, rising sea levels, and extreme weather events that are all driving further climate crisis (Takaro et al. 9; WHO, 2016). The health of Canadians is also threatened. Our Chief Public Health Officer states “Canadians remain vulnerable to the effects of climate change and its impacts on health” (CPHO 25).
Increased exposure to benzene, especially in the event of an oil spill, would increase the risk of Acute Myeloid Leukaemia, most significantly in children.
Local Impact: Health Effects of Benzene and 1,3-Butadiene Kinder Morgan’s local impact is connected to the transportation of dilbit. Exposure to benzene and 1,3-butadiene can produce severe health impacts, including potential death. Benzene. The most significant contributor to benzene in our environments is the petroleum industry (Takaro et al. 16). Benzene can enter our bodies through inhalation, ingestion, or through skin contact (ATSDR, 2007 216), but the majority of exposure occurs when the compound is inhaled (ATSDR, 2007). The health outcome of critical concern from benzene exposure is Acute Myeloid Leukaemia, a type of cancer that affects the blood stem cells in bone marrow (Takaro et al 7). Increased exposure to benzene, especially in the event of an oil spill, would increase the risk of Acute Myeloid Leukaemia, most significantly in children (Takaro et al. 5). 1,3-Butadiene. 1,3-butadiene predominantly enters the body through inhalation, but it can also “be absorbed through the skin or ingested” (ibid. 19-20). Human activity linked to butadiene emissions include construction and operation of pipelines, pump stations, and storage terminals; internal combustion; industrial production, specifically for plastics, petroleum, coal, and chemicals; incineration of waste or wood products; and cigarette smoking (Takaro et al. 18). The tables on the following page summarize the acute and chronic health impacts of both carcinogens. Acute health impacts “result from the immediate exposure to the toxicant and are generally severe and dangerous” (Takaro et al. 20), while chronic health impacts “result from the long-term exposure to a toxic substance” (ibid. 21).
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In the event of an oil spill in Burrard Inlet, modeling commissioned by Metro Vancouver predicts benzene and butadiene levels will not decrease below “acute inhalation exposure limits” (44) until at least five hours have passed, with the first hour of exposure posing the “greatest human health risk” from the spill. Dilbit can produce chronic health impacts as the cumulative or additive body burden in an individual increases, as well as the fact that there is high potential for oil and toxins to remain in the environment even after clean-up efforts have come to an end.
Table 1: Health Impacts of Benzene Exposure ACUTE HEALTH IMPACTS
CHRONIC HEALTH IMPACTS
Dizziness, drowsiness, rapid/irregular heartbeat, loss of consciousness, tremors, convulsions, and death
Immunotoxicity: toxicity to the immune system
Exposure to the eyes or skin will cause irritation, reddening, and blistering of the skin or damage to the cornea
Bone Marrow defects: aplastic anemia, chromosomal defects, and cancer (particularly Acute Myeloid Leukaemia, AML, in children)
Ingestion will cause vomiting, irritation of the stomach lining, sleepiness or staggering gait, or collapse and coma
Chromosomal damage, such as disruption or breakage of chromosomes leading to chromosome rearrangements, deletion or addition
Acute exposure to 7,500 ppm for 30 minutes or over 10,000 for less than 10 minutes presents a high risk of death
Reproductive effects, including decreased sperm count, irregular sperm, and birth defects including neural tube defects
*Both limits would be exceeded in the event of a major spill at First or Second Narrows in Burrard Inlet (Metro Vancouver, 2015).
Neurological, psychological, and behavioural abnormalities
Table 2: Health Impacts of 1,3-Butadiene Exposure ACUTE HEALTH IMPACTS
CHRONIC HEALTH IMPACTS
Irritation of the eyes, nasal passages, throat, and lungs
Carcinogen, known to cause leukemia and cancer of haemolymphatic organs
Blurred vision, fatigue, headache, and vertigo
Cardiovascular disease
Dermal sensation of coldness followed by burning sensations
Damage to central nervous system
(Source: Takaro et al. 20-25; ATSDR, 2007 12-20; Huff et al. 133)
Vulnerabilities within Local Populations All populations have individuals that are more vulnerable to health risks than others, and a robust review process should identify those groups (CPHO 20). Vulnerabilities may involve gender, ethnicity, age, race, sexual orientation, and socioeconomic status (AMJC, 2006). The local body
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burden should also be understood to know how existing toxins within the environment – like lead, mercury, and polychlorinated biphenyls (PCBs) – combine with new exposures to worsen intra- and inter-generational health decline (Takaro et al. 34). This project would place the entire population of Greater Vancouver at increased risk of health decline – over 2.3 million people. However, the three groups most vulnerable to health risks are children, women of childbearing age, and older adults (Health Canada, 2011), which together comprise roughly 50% of two Lower Mainland communities directly affected by Kinder Morgan’s pipeline: the City of Burnaby and the District of North Vancouver (Statistics Canada, 2011).
This project would place the entire population of Greater Vancouver at increased risk of health decline – over 2.3 million people
Children. Children are more vulnerable to toxins, particularly air pollution, due to “their physical size, immature organs, physiology, behavior and lack of knowledge” (Health Canada, 2011). Their activities differ significantly from adults as they are often more active and thus typically have increased “ventilation rates” (ATSDR, 2007 206). Their smaller height can also increase exposure to “heavier contaminants such as lead, particulates, [and] pesticides” (Health Canada, 2011). Women of Childbearing Age. The chance women of childbearing age – between 20 and 39 years old – have for birthing a healthy child is at risk from toxic exposure due to the pathways between toxins and an unborn fetus. These “may cause developmental abnormalities” (Health Canada, 2011), which pose serious consequences for both the fetus and mother (Health Canada, 2011). Adults Over the Age of 65. Older adults, especially those with chronic health conditions, are more vulnerable to environmental hazards because their bodies can “contain a lifetime worth of environmental contaminants” (Health Canada, 2011). Increased toxic exposure, coupled with an existing body burden or “general susceptibility to disease puts older adults at increased risk” (Takaro et al. 8). Certain members of the elderly population also suffer from mobility issues, making it more difficult for them to be evacuated in the event of an emergency.
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FIRST NATIONS, MÉTIS, INUIT, AND INDIGENOUS PEOPLES Historical injustices towards Indigenous Peoples have meant these communities experience more impact from resource development, toxic exposure, and other environmental health detriments than any other population in Canada (Shandro et al. 8; Health Canada, 2011). The Kinder Morgan pipeline continues this historical and appalling trend. 61 First Nations oppose this pipeline through the Treaty Alliance to Oppose Tar Sands Expansion. Some nations are already taking legal action against this pipeline’s approval as it represents a violation of land rights and cultural practices integral to their communities’ wellbeing, health, and security. Reducing health disparities between Indigenous and non-Indigenous Canadians has been recognized as an emergency priority b the Canadian Medical Association in wake of the Truth and Reconciliation’s Calls to Action (CMA, 2016). Health Canada lists various environmental health concerns for these communities, “including adequate housing that is free of environmental contaminants, safe and secure water supplies and traditional foods, and a variety of effects related to climate change” (2011). BC’s First Nations Health Authority also stresses these concerns (2016). Specific to Kinder Morgan’s impact on Indigenous Peoples are the concerns of “marine pollution that taints harvested species and adversely affects the health of First Nation communities” (Chang et al. 8)
Decisions regarding resource development, energy policy, and climate change, amongst others, must respect the rights and title of these communities and incorporate the valuable traditional ecological knowledge they possess.
and the economic costs that come with oil spills, leaks, and other accidents that would affect any communities’ ability to sustain itself. The fact that Indigenous communities have cultural and economic systems deeply embedded within the natural environment must be recognized and respected. These communities have “physical, mental, spiritual, and emotional connections to traditional land and natural resources” (Shandro et al. 8) that should be protected for generations to come.
It is crucial within Canada that we make a serious and urgent transition away from these historic trends that undermine First Nations, Métis, and Inuit communities. To do so, decisions regarding resource development, energy policy, and climate change, amongst others, must respect the rights and title of these communities and incorporate the valuable traditional ecological knowledge they possess.
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NOT IF, BUT WHEN: ACCIDENTS HAPPEN Kinder Morgan is no stranger to accidents. Their existing Trans Mountain pipeline has experienced 82 spills since 1961. 11 of these have occurred in the past decade (Kinder Morgan, 2014). The greatest concerns in the BC Lower Mainland are the risk of a fire in the tanker farm and the risk of a marine-based oil spill. Studies have shown that accidents within the oil and gas industry have a wide range of adverse effects on residential populations, including an increase in “headaches, eye and throat irritations, breathing difficulties, The greatest concerns in the BC Lower Mainland are the risk of a fire in the tanker farm and the risk of a marine-based oil spill.
nausea, vomiting, and skin rashes,… asthma and negative mental health experiences” (Takaro et al. 9). Diluent, benzene, and 1,3-butadiene are also extremely flammable (ATSDR, 2007, 2012). The risk of fire is especially relevant in the City of Burnaby due to its proximity to Kinder Morgan’s tank farm and the fact the city boosts almost 1,500
acres of forested park land. Climate change is increasing the local risk of a forest fire as local climate trends towards longer and hotter dry periods (Takaro et al 26). Doubling the number of tanks in Kinder Morgan’s tank farm within the same area “can lead to a scenario involving a potential explosion resulting in toxic fumes and molten crude rolling towards residents and a nearby school” (ibid.). Furthermore, the daily operation of Kinder Morgan’s existing pipeline already emits “benzene, 1,3-butadiene and other volatile carcinogenic compounds [that have] no safe risk threshold” (ibid. 13). During Kinder Morgan’s review, the National Energy Board rejected the provincial government’s demand to fully disclose Kinder Morgan’s emergency management plans (ibid. 26). So, not only would the approval of this project come with increased daily emissions of known carcinogens and increased probability of leaks, spills, and fires, but also it would come with no publically accessible and independently reviewed emergency response plan.
Mental Health and Toxic Exposure There is a well-established link between toxic exposure and a decline in social fabric (Brown and Mikkelsen, 1990). Health experts have coined a new term to describe this decline: ‘solastalgia.’ This term reflects the “attack of one’s sense of place… [and] sense of belonging…, and a feeling of distress” (Albrecht 45) that comes when one’s home becomes the site of an industrial disaster.
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From oil spills specifically, the short-term mental health impacts include an increase in anxiety, depression, and post-traumatic stress disorder (Lyons 310; Kim et al. 7). Studies even show that oil spills are more psychologically stressful than natural disasters (Chang et al. 5). The inflow of outsiders, clean-up crews, and government officials, as well as disruption to typical daily structures or behaviours, can lead to community decline (ibid. 5). Moreover, the stress of the event – threatened livelihood, financial costs, inversion of the home – has been associated with social breakdown, such as higher levels of alcohol and drug consumption, and higher rates of domestic violence and crime (ibid. 22).
Case Study: The 2007 Kalamazoo River Spill The 2007 Kalamazoo River spill represents a recent and related example to the risks posed by Kinder Morgan’s pipeline. 3.2 million litres of dilbit was released into the Kalamazoo River, upstream from Lake Michigan, after an Enbridge-owned pipeline ruptured. Populations deemed directly affected by the spill saw an immediate increase in reported health concerns; 58% of individuals within these communities had “one or more new or aggravated ill health effects post-spill” (Eykelbosh 9-10). Residents along the river claim their neighbourhoods are dramatically changed “with many of the residents having moved away” (Takaro et al. 27). During the initial reaction to the spill, “over 100 residents were displaced and relocated in response to air quality (benzene) concerns… [and] the county health departments issued a drinking water advisory for water wells located within 200 feet of the affected waterways” (Dollhopf and Durno 6). Furthermore, the Kalamazoo clean-up cost an
The Kalamazoo River oil spill represents one twenty-fifth of the carrying capacity of the tankers Kinder Morgan will be loading with diluted bitumen.
estimated $1.2 billion USD (ibid. 1; Ellison, 2014): $550 million for emergency response, $230 million for environmental consultants, and $430 million in professional, regulatory, and other expenses (Takaro et al. 28). And yet, despite these resources, 700,000 litres of dilbit was deemed irretrievable from the local water systems (Ellison, 2014), which warrants long-term study on potential chronic health impacts to Kalamazoo residents. ! This spill represents one twenty-fifth ("# ) of the carrying capacity of the tankers Kinder Morgan
will be loading with dilbit at Westridge Marine Terminal for transport through the Salish Sea.
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RECOMMENDATIONS The 2009 Lancet Commissions – authored by a collaboration of experts on global health and climate change – states that “a need exists to improve access to secure, clean, reliable, affordable, and sustainable sources of energy that can provide essential services for a healthy, productive, and safe life” (Costello et al. 1706). With each passing year, this need for a renewable, healthy future becomes more urgent. The Trudeau-led Canadian delegation in Paris promised immediate and real action on climate change. The World Health Organization called the Paris Agreement “the most important health agreement of the century” (Chan, 2015). With one decision, the Trudeau Government could
The World Health Organization called the Paris Agreement “the most important health agreement of the century.”
go back on its promise in Paris. Kinder Morgan is a climate change bomb that has conclusive and devastating health risks for British Columbians and communities around the globe. Added to climate change-related health risks are the immediate and adverse impacts posed by the constituents of diluted bitumen. Prime Minister Trudeau’s Government must complete a With one decision, the Trudeau Government could go back on its promise in Paris.
Cumulative Health Impact Assessment for Kinder Morgan’s pipeline. By doing so, the Federal Government would signal to our communities that they place greater value in long-term public health than short-term corporate interests.
Completing a Cumulative Health Impact Assessment A Cumulative Health Impact Assessment is a peer-reviewed process that considers social, economic, and environmental drivers of health on all scales to determine whether a project is in the public interest. This tool reflects the Canadian Medical Association’s call for “full-cost accounting” of health impacts for large, industrial projects (CMA, 2016). Kinder Morgan submitted only a narrowly scoped assessment of health risks for review to the National Energy Board. Additionally, they refused to release all relevant information on their project – citing proprietary rights – and thus their submission could not be adequately peerreviewed (Takaro et al., 2015). As of yet, the Federal Government has not corrected this flaw in their review process.
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Our communities deserve better. They deserve to have their health and the health of future generations protected in the long-term. Kinder Morgan’s pipeline must undergo a Cumulative Health Impact Assessment that
No decision can be made to approve or reject this pipeline until a full Cumulative Health Impact Assessment has been completed.
reflects the evidence presented by physicians, biochemists, environmental health experts, and those members of the public that have experienced exposure to dilbit. Kinder Morgan’s pipeline is all risk and no reward. Overall, a Cumulative Health Impact Assessment for Kinder Morgan’s pipeline must include:
• Local population data and distribution, including population density, vulnerable groups, and existing body burdens; • Full consideration of the health risks that are increased from this specific project, especially the additive impact to local body burden and the expected increase in Acute Myeloid Leukemia in children in the event of a major exposure incident: • Modeling that takes into account worst-case scenarios within the directly affected and dense populations along the pipeline and tanker route, which was not included in the Kinder Morgan assessment process (Kinder Morgan, 2014); and • Additive and cumulative impacts that include consideration of other large-scale resource developments in the bioregion, intergenerational effects of dilbit exposure, and the health impacts climate change inflicts on today’s and future populations. No decision can be made to approve or reject this pipeline until a Cumulative Health Impact Assessment has been completed. If such an assessment cannot be done, then Kinder Morgan’s pipeline should be rejected.
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Health Canada, 2009. Web. http://www.hc-sc.gc.ca/ewhsemt/climat/impact/index-eng.php
Agency for Toxic Substances and Disease Registry (ATSDR). “Toxicological Profile for 1,3-Butadiene.” US Department of Health and Human Services, 2012. PDF.
Health Canada. “Environmental and Workplace Health: Vulnerable Populations.” Health Canada, 2011. Web. http://www.hc-sc.gc.ca/ewhsemt/contaminants/vulnerable/index-eng.php
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Huff, J. E., et al. “Multiple-Site Carcinogenicity of Benzene in Fischer 344 Rats and B6C3F Mice.” Environmental Health Perspective, 82 (1989): 125-163. PDF.
American Journal of Managed Care (AJMC). “Vulnerable Populations: Who Are they?” American Journal of Managed Care, 11 (2006). PDF.
International Agency for Research on Cancer (IARC). “1,3Butadiene.” Chemical agents and related occupations. IARC Working Groups, 100F (2012). Web. https://monographs.iarc.fr/ENG/Monographs/vol100F/m ono100F-26.pdf
BC Ministry of Environment (MOE). “Burnaby Oil Spill, July 24, 2007.” Past Spill Incidents, 2014. Web. http://www2.gov.bc.ca/gov/content/environment/airland-water/spills-environmental-emergencies/spillincidents/past-spill-incidents Brown, Phil, and Edwin Mikkelsen. No Safe Place: Toxic Waste, Leukemia and Community Action. Berkeley: University of California Press, 1990. Text. Canadian Medical Association (CMA). “Resolutions Adopted.” CMA General Council 2016, 24 Aug 2016. Web. https://www.cma.ca/Assets/assetslibrary/document/en/GC/Resolutions-adopted-Aug-2-242016-e.pdf#search=general%20council%20resolution
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Chan, Margaret. “Climate change and human health: WHO calls for urgent action to protect health from climate change.” World Health Organization, 2015. Web. http://www.who.int/globalchange/globalcampaign/cop21/en/
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Lyons, R.A., M. Temple, D. Evans, D. Fone, and S. Palmer. “Acute health effects of the Sea Empress oil spill.” Journal of Epidemiol Community Health, 53 (1999): 306-310. PDF.
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Shandro, Janis, Mirko Winkler, Laura Jokinen, and Alison Stockwell. “Health impact assessment of the 2014 Mount Polley Mine tailings dam breach.” First Nations Health Authority, January 2016. PDF.
DARA. “Climate Vulnerability Monitor: A Guide to the Cold Calculus of a Hot Planet.” 2nd ed. DARA and Climate Vulnerable Forum, 2012: 16-23.
Statistics Canada. Census Program, 2011. Web. http://www12.statcan.gc.ca/census-recensement/indexeng.cfm
D’Ippoliti, Daniela, et al. “The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project.” Environmental Health, 9.37 (2010):1-9. PDF.
Smith, Kirk, et al. “Energy and Human Health.” Annual Review of Public Health, 34 (2013): 159-88. PDF.
Dollhopf, R, and Mark Durno. “Kalamazoo River\Enbridge Pipeline Spill 2010.” 2011 International Oill Spill Conference, 17 Mar 2011. PDF. Ellison, Garret. “New Price Tag for Kalamazoo River Oil Spill Clean Up.” Michigan Live News, 5 Nov 2014. Web. http://www.mlive.com/news/grandrapids/index.ssf/2014/11/2010_oil_spill_cost_enbridge_1. html Eykelbosh, Angela. “Short- and long-term health impacts of marine and terrestrial oil spills.” Vancouver Coastal Health, August 2014. PDF.
Takaro, Tim, et al. “Major Human Health Impacts of the Kinder Morgan Trans Mountain Pipeline Expansion.” May 2015. PDF. Working Group on Public Health and Fossil-Fuel Combustion (WGPHFC). “Short-term Improvements in Public Health from Global-Climate Policies on Fossil-Fuel Reduction.” The Lancet, 350 (1997): 1341-49). PDF. World Health Organization (WHO). “Climate change and health: Fact Sheet.” WHO, June 2016. Web. http://www.who.int/mediacentre/factsheets/fs266/en/
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