1 / HEALTH IMPACTS OF ENVIRONMENTAL POLLUTION IN ENERGY-DEVELOPMENT IMPACTED COMMUNITIES COPLEY INTERNATIONAL CORPORATION Economic Research • Marketing Research • Environmental Research • Management Services 7817 HERSCHEL AVENUE LA JOLLA, CALIFORNIA 92037 ------- / HEALTH IMPACTS OF ENVIRONMENTAL POLLUTION IN ENERGY-DEVELOPMENT IMPACTED COMMUNITIES Final Report Phase II Prepared for the Office of Energy Activities ENVIRONMENTAL PROTECTION AGENCY Region VIII Denver, Colorado 80203 Under Contract No. 68-01-1949 N. L. Hammer, Project Officer By COPLEY INTERNATIONAL CORPOPATION 7817 Herschel Avenue La Jolla, California 92037 November 1977 ------- PREFACE This report summarizes activities conducted during Phase II of a study on Health Impacts of Environmental Pollution in Energy- Development Impacted Communities. The work was performed by Copley International Corporation (CIC) under Contract No. 68-01- 1949 with the Office of Energy Activities, Environmental Protec- tion Agency (EPA), Region VIII, Denver, Colorado. The scheduled period of performance for this phase of the project was April 5, 1977 through November 5, 1977. Project Participants This project was conducted under direction of Melvin H. Goodwin, Jr., Ph.D., Epidemiologist, Director of Health Studies, Copley International Corporation. Other participants included the following: Jeri Dey, Manuscript Typist, CIC Marian 0. Doscher, M.B.A., Senior Industrial Economist, CIC R. David Flesh, B.S.E., M.S., M.B.A., Group Director, Environmental Sciences, CIC Julie Jensen, Manuscript Typist, CIC Victoria Jones, Research Analyst, CIC Catherine C. Le Seney, M.D., •M.P.H., Epidem- iology and Health Services Planning, Consultant Joyce Revlett, Project Coordinator, CIC Acknowledgmen ts Grateful acknowledgment is made to Mr. N.L. Hammer, Project ------- Officer for the Environmental Protection Agency, for his guidance and attention throughout the course of this work. Special thanks also are due to the individuals and organizations who provided information and reviewed material. The principal contributors are listed in the appendices. Many others, however, contributed time and effort to this study. This invaluable assistance is sincerely appreciated. ------- Eaaacaucacica" TABLE OF CONTENTS Page PREFACE ¦ ii SUMMARY v INTRODUCTION ' 1 METHODS AND PROCEDURES ' 4 OBSERVATIONS AND EVALUATIONS . 14 SELECTED REFERENCES 33 Appendices A. Handling Health Impacts — Suggestions for Communities Impacted by Energy Developments B. Narrative for Slides. Health Effects Associated with Energy Developments -iv- ------- SUMMARY A previous study of Health Impacts of Environmental Pollu- tion in Energy-Development Impacted Communities was extended to evaluate conditions in specific communities. The communities se- lected for study represented various conditions of impact, sizes, geographic locations, and extent of experience in dealing with health impacts. Information was obtained concerning the health- related problems that occurred in the study communities and the methods employed to cope with these problems. The most significant problems were related to rapid community growth and were not characteristic of either energy developments or geographic locations. The principal health issues were the provision of adequate municipal services and personal health services. Municipal services included water-supply, sewage dis- posal, solid waste disposal, and environmental services. The most prominent issues related to personal health services con-, cerned behavioral problems, mental health, preventive health pro- grams, and resources for treating disease and illness. In many communities the real or apparent need for physicians and hospitals was perceived as the most important problem. Communities that have coped successfully with health and other impact problems have done so through an orderly process of ------- planning. Communities that have failed to deal effectively with impacts have done no planning or inadequate planning. The most severely impacted communities, those among the first affected dur- ing the current surge of energy developments, had little opportun- ity for advance preparation to reduce impacts. Most of these com- munities have, however, made spectacular progress in alleviating undesirable conditions by concerted community effort. Many recent developments make the repetition of severe impacts unlikely, or at least unnecessary for other communities. Concepts of industry- community responsibility favor collaboration and foster mutual concern in avoiding undesirable impacts. State and local govern- mental, agencies have gained experience and support. Considerable forces have been mobilized to assist impacted communities. Assistance in dealing with health and other impacts is gen- erally available to all affected communities. Initiative in ob- taining such assistance and in instigating arrangement for effec- tive planning to do so must come from the individual communities. Most communities wish to initiate this process and are progres- sing in planning and implementation of programs. This project was designed to provide further assistance to communities concerned with alleviating health impacts resulting from energy developments. Three products were developed for this purpose: A report for use at the community level. "Handling Health Impacts—Suggestions for Communities Impacted by Energy Developments'.' A slide series, with narrative. "Health Effects Associated with Energy Developments" A collection of formats and protocols. "Procedures for Evaluating Health Impacts Resulting from Energy Development" -vi- ------- INTRODUCTION. Purpose of the Study The overall purpose of this study was to assist the Environ- mental Protection Agency in evaluating the environmentally re- lated health impacts in communities affected by the development of energy resources, The work was conducted in Federal Region VIII which includes the states of Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming. During the first phase of this study, conducted from January 5 through September 5, 1976, the following work was performed: Procedures were developed for appraising health im- pacts in affected communities and the relative ex- tent of impacts was determined. The scope and adequacy of pertinent health infor- mation available in state repositories were de- termined and readily available material was sum- marized and evaluated. The potential health impacts resulting from devel- opment of energy resources were identified and evaluated. Approaches and economic considerations in providing health services in communities affected by energy developments were defined. Formats and protocols were developed as a Procedures Manual for collecting and consolidating data needed for adequate planning to prevent or reduce adverse health effects related to energy developments. ------- Results of these activities were summarized in a report to EPA."*" Phase II was designed to extend the work accomplished in Phase I by obtaining more specific information from representa- tive impacted communities. This information was to serve as the basis for a report on community strategies for dealing with health impacts. The report was to be designed for use at the community level by elected officials, health professionals, and lay persons who were confronting or anticipating similar impact situations. The deliverable products initially anticipated were the report just mentioned and a series of 35mm slides to be used in oral pre- sentation of the substance of the report on community strategies. During the course of this work, a strong consensus was ap- parent concerning guidelines, suggestions, and other materials intended for use at the community, level, Most of the available material was regarded as forbidding because of length or complex- ity, or both. There was repeated expression from many sources indicating that information developed for local use should be brief enough to be read within 30 minutes and sufficiently straightforward to be easily understood \>y the intended audience. With these and similar considerations in mind, the report on com- munity strategies was prepared as a series of suggestions for dealing with health impacts. These suggestions may be used for training and orientation for a variety of groups. The slide ^Copley International Corporation. 1976. Heal.th impacts of en- vironmental pollution in energy-development impacted communi- ties. A report prepared for the Office of Energy Activities, Environmental Protection Agency, Region VIII, Denver, Colorado. 2 vols. (An Executive Summary is available.) -2- ------- series was cast in the same way arid complements the- suggestions. Care was taken to assure that the suggestions were compatible with procedures used or contemplated by the responsible official agencies concerned. The suggestions are included in Appendix A under the title "Handling Health Impacts--Suggestions for Commun- ities Impacted by Energy Developments." The slide series is pro- vided separately. • The narrative to accompany the slide series is provided in Appendix B. In addition to evaluating community experiences and develop- ing the suggestions for dealing with health impacts, Phase II also involved revision of the Procedures Manual developed during Phase I. This Manual was prepared to meet the clearly defined need of communities for formats and procedures that could be used to evaluate the extent of health impacts and the availability of resources to reduce them. Work conducted during Phase II was de- signed to assess the usefulness of the Manual to impacted commun- ities and to the official offices involved. The revised Manual is provided separately. Content of This Report On the following pages the approaches used in this study are described. Annotations are provided fo^ the'community strate- gies evaluated during the course of this work. Obviously effec- tive procedures are so identified. Programs available to assist the impacted- communities are listed and brief descriptions of selected programs are included with the Suggestions in Appendix A. -3- ------- METHODS AND PROCEDURES Obj ectives Three objectives were pursued to accomplish the purpose of the second phase of this study as outlined in the Introduction. These objectives were: To determine the nature and extent of health- related problems experienced by communities impacted by energy developments and to iden- tify. the measures undertaken to cope with them. To ascertain the usefulness of the Procedures Manual, developed during Phase I, and revise as necessary to assure maximum usefulness to communities in dealing with health-related problems. On the basis of results obtained in accomplish- ing the above objectives, to prepare suggestions for community actions to cope with adverse health effects. Work Plan Details of activities and the schedule of performance are outlined in a Work Plan prepared in support of this project. That Plan should be consulted for more specific information than is provided here. The following summary provides a general out- line of procedures. Local Participants and Contacts During the first phase of this study, the principal sources -4- ------- of information were identified and contacts were developed with persons primarily at the state and regional level. Since Phase II involved study of specific communities and planning areas, efforts were made to solicit participation of individuals, governmental agencies, and industries that worked directly with communities or had access to first hand information concerning them. The fol- lowing were identified as the primary source of community-specific data and information: Regional and multistate agencies - Environmental Protection Agency - Region VIII - Department of Health, Education, and Welfare Region VIII - Regional Center for Health Planning - Department of Interior - The Oil Shale Environ- mental Advisory Panel - Old West Regional Commission - Four Corners Regional Commission - Western Governors' Regional. Energy Policy Office State agencies - Planning offices or departments - Energy offices - Health departments - Health planning offices - Departments of community affairs - University institutes - Bureaus of business or economic development - Cooperative extension services Local agencies - Planning offices - Health systems agencies - Industrial councils - Public health agencies - Mental health agencies - Public assistance programs - Industrial organizations - Impact planners The specific organizations and representatives that participated in this work are included in .the list with Appendix A. -5- ------- Selection of Study Communities Criteria. Attention was given to selecting communiti'es rep- resenting various intensities of health impacts, as determined dur- ing Phase I. Other factors considered were: size of population, planning competencies, type of health effects, and length of ex- perience in dealing with health impacts. A limiting factor was the availability of information concerning the community. If data were not accessible, or could not easily be obtained, the community was not considered for study. Selection of Communities. On the basis of information avail- able earlier in the study, a list of candidate communities' was compiled and grouped by states. The list then was referred to one or more state planning offices for review. The reviewers were informed of the criteria for selection and requested to sug- gest revisions on the basis of their current familiarity with local situations. The list of.communities selected for study is shown in Table 1. Sources of Information Data and information were collected by three principal means as indicated below. The sources of information available for the study communities are indicated in Table 1. Literature. A thorough search was made of regional publica- tions pertinent to this study. In addition, local participants and contacts were asked to identify publications, reports, drafts, or data related to specific communities or sub-state regions. These requests were made by correspondence, by telephone, or -6- ' ------- Table 1. Communities Included in Study of Health Effects Associ ated with Energy Developments Colorado Utah Craig I, 0 Beaver R, I Grand Junction R, I, 0 Castle Dale R, I, 0 Meeker I, 0 Price R, I, 0 Rangley R> I, 0 Roosevelt R, I, 0 Rifle I", 0 St. George R, I, 0 Vernal R, I, 0 Montana Ashland R, I Wyoming Birney R, I Douglas I, 0 Circle R, I Evanston I Colstrip R, I, 0 Gillette R, i, 0 Decker R, I, 0 Hanna - Elmo I, 0 Forsyth R, I, 0 Kemmerer I, 0 Glendive I, 0 Medicine Bow I Hardin I, 0 Meeteetse I Miles City I, 0 Ranchester I, 0 Rawlings R, I, 0 North Dakota . Rock Springs - Green River R, I, 0 Beulah R, I, 0 Sheridan R, I, 0 Center R, I, 0 Wheatland R, I, 0 Hazen R, I, 0 Wright 0 Killdeer R, I, 0 (Reno Junction) I, Stanton R, I, 0 South Dakota Belle Fourche I, 0 Edgemont I, 0 Source of Information: R Reports or drafts I Key informants 0 Observations -7- ------- during personal visits. The list of Selected References follow- ing the body of this report indicates representative title.s per- taining to specific locations or problems. The material on specific communities was augmented by ac- counts of selected programs or techniques not necessarily devel- oped in the study communities. These citations, which can readily be identified in the list of Selected References, were provided as additional sources of pertinent information. Key Informants. Persons actually involved in dealing with impacts at the community level were the best source of detailed information concerning experiences in individual communities. Much relevant information has not been consolidated in formal re- ports for distribution. Consequently, individuals having knowl- edge of the location of essential data and information in minutes of meetings, proceedings, and similar forms must indicate the source of a great amount of essential material. Furthermore, the personal observations and impxpssions of informed local partici- pants are invaluable in assessing the types and significance of health impacts as perceived by the residents, and in identifying the basis for reactions by the community. These types of information were obtained by person-to-person discussions with individuals or small groups. In order that the persons visited could be well prepared,' appointments were made at least two weeks in advance of the meeting. Contacts usually were made by telephone to enable explanation of the purpose of • the meeting and to answer any questions the Informant might wish -8- ------- to ask. The majority of persons involved had worked with the project team during Phase I and were familiar with the pur.pose of the project. All were provided with a copy of the Executive Sum- mary . The discussions were unstructured and varied with each con- tact. The subjects considered depended upon the extent of infor- mation acquired prior to the meeting and the role of the informant in working with the impacted communities. Efforts were made to encourage the informant to describe the experiences with health impacts as he or she perceived them. After receiving a general account, questions and ideas were exchanged concerning specific issues. Observations. The third means used for developing informa- tion was by direct observation of the communities. In most in- stances, informants suggested specific locations for examination or accompanied the observer, on a visit to selected sites. More than 60 communities were visited and inspected in varying detail during the course of this work. (Not all of these communities were studied during Phase II.) Review of Procedures Manual Further evaluation of the Procedures Manual was undertaken, although extensive reviews were made during the initial phase. The additional evaluations took into account the changes in planning organizations and the recent experiences of communities. As indicated by the list of reviewers in Table 2, a wide variety of planning and operating agencies at the Federal, State and -9-' ------- Table 2. Reviewers of Procedures for Evaluating Health Impacts Resulting from Development of Energy Resources Regional Agencies Environmental Protection Agency Office of Energy Activities, Region VIII Mr. N.L. Hammer Department of Health Education and Welfare Regional Office Mr. Michael Liebman, Liaison Officer National Center for Health Studies Mr. James E. Ver Duft, Chief Health Planning Branch PACT Health Planning Center Mr. H. Sterling Drumwright, Associate Director Colorado State Health Planning and Development Agency . Ms. Patricia L. Steuhler, Health Planner Western Colorado Health Systems Agency Mr. David Meyers, Executive Director Denver Research Institute Dr. Alma.Lantz, Research Psychologist Montana State Health Planning and Development Agency Mr. Wallace King, Hospital and Medical Facilities Division Montana Health Systems Agency Mr. Ralph Gilroy, Executive Director Montana Department of Community Affairs Mr. Jim Richards, Planning Division North Dakota State Health Planning and Development Agency Mr. Hiram T. Waterland, Assistant Director Division of Health Planning -10- ------- Table 2 continued North Dakota (continued) Western North Dakota Health Systems Agency' Mr. James R. Boyd, Plan Development Associate West Central North Dakota Regional Environmental Impact Statement Ms. Rebecca Lee, Community Affairs Specialist Basin Electric Power Cooperative Mr. Mike Zainofski Mr. Greg Gallagher North Dakota State Universtiy Mr. Don Peterson, Area Resource Develop- ment, Cooperative Extension Service ANG Coal Gasification Company Mr. John Clement South Dakota State Health Planning and Development Agency Mr. Donald Kurvink, Director South Dakota Health Systems Agency Mr. Donald Brekke, Executive Director Wyoming State Health Planning and Development Agency .Mr. Lawrence B. Bertilson, Program Plan- ning Manager, Department of Health and Social Services Wyoming Health Systems Agency Mr. Richard Neibaur, Executive Director Lincoln - Uinta Counties Planning Office Mr. Glenn Payne Sheridan Area Planning Agency Mr. Daniel E. Songer, Planning Engineer -11- ------- Table 2 continued Wyoming (continued) University of Wyoming Dr. George Piccagli, Director Health Planning Resource Center Dr. Keith Miller, Field Coordinator Wyoming Human Services Project Dr. JoAnn Shuriger Wzorek, Community Coordinator, Gillette Human Services Proj ect Missouri Basin Power Project Mr. Tim Rafferty, Impact Coordinator Utah State Health Planning and Development Agency Mr. Stewart C. Smith, Assistant Director Office of Planning and Research Department of Social Services Utah Health Systems Agency Dr. Paul J. Boumbulian, Executive Director Department of Social Services Dr. E. Arnold Isaacson, Deputy Director of Health Department of Community Affairs Mr. Christian P. Beck, Special Project Coordinator Five County Association of Governments Mr. Neal R. Christianson, Executive Director -12- ------- local levels participated in reviewing the Manual. There were two general purposes in this review. First, to solicit informed opinions as to the potential usefulness of the Manual in assessing health impacts at the community level. Sec- ond, to determine the compatibility of the suggested procedures with those employed or contemplated by the agencies responsible for evaluating impacts and for developing preventive or remedial health programs related to energy developments. In addition to evaluating these two aspects, reviewer's were asked to critique approaches and techniques. The resulting material provided the basis for revising the Manual. Preparation of Reports The data and information collected and compiled as outlined above provided the basis for the following: This Project Report for EPA "Handling Health Impacts - Suggestions for Commun- ities Impacted by Energy Developments" A slide series and narrative for oral presentation of the suggestions for communities Revision of "Procedures for Evaluating Health Im- pacts Resulting from Development of Energy Re- sources" -13- ------- OBSERVATIONS AND EVALUATIONS This chapter relates to the first objective of the study-- namely, to determine the nature and extent of health-related problems and the measures undertaken to cope with them. One basic point should be made at the outset. Health-related problems cannot clearly be differentiated from other types of problems ex- perienced by the impacted communities. Many of the manifest ad- verse effects have common causes and are interrelated, or are mutually dependent upon each other. Health-related prob.lems can- not adequately be evaluated or solved in isolation. These issues must be considered in the context of related conditions in the entire community. Consequently, in this discussion reference is made to some problems, or issues, that ostensibly are not the principal responsibility of health agencies or health practi- tioners . Types of Health-Related Problems The health-related problems experienced by the study commun- ities are not uniquely associated with energy developments. The problems generally are the same that occur in any community under- going rapid growth for any reason. In many of the study communi- ties the undesirable conditions noted did not appear coincidental with rapid growth--they were-there already. Several communities -14- ------- classified as "significantly impacted" during Phase I had not been involved, at that time, with energy developments. Yet, the data available indicated adverse situations with respect to health effects. Obviously, the causal factors were not related to impacts from energy development. There is no doubt, however, that rapid population growth intensifies, preexisting conditions that favor the occurrence of health problems. The issues faced by the impacted communities in removing health hazards and main- taining conditions favorable to health are essentially the same as those confronting any community. Kinds of Health Effects. As indicated in the report of work conducted during Phase I, two general types of health ef- fects were considered in evaluating the causal influence, of energy developments. Adverse effects resulting from the toxins and irritants generated by indiistrial activities. Undesirable conditions resulting from the rapid growth of communities that are conducive to the occurrence of adverse health effects. Data collected during Phase II corroborated the impression previously reported regarding health effects associated with in- dustrial processes. Namely, that no wide-spread adverse health effects are likely under existing conditions. Current programs for maintenance of environmental quality appear adequate to pre- vent occurrence of adverse health effects in the future. The most significant health impacts that have occurred, or that may be anticipated, are related to the rapid growth of communities. As previously indicated, these effects are of two types: -15- ------- Those that "impact community environmental services Those that have direct adverse effects on people. Community Environmental Services. The rapid influx of pop- ulation to a community creates precipitous need for housing. If an adequate number of dwelling units is not available to meet the requirements of newcomers, either temporary or long-term, improvisions obviously will be made. The result has been, in the worst situations, "hobo cities" and clusters of tents with- out any provisions for essential environmental services such as water supply, sewage disposal, solid waste disposal, and commun- ity sanitation. Temporary arrangements that create less immedi- ate hazards to the public health are motor homes equipped with sewage holding tanks and water reservoirs or mobile homes in es- tablished areas with sanitational services. However, most small communities, less than 2,500 population, cannot accommo- date increases in population of more than 5 percent annually without overtaxing community services. Most of the communities involved in this study have experienced substantially higher rates of growth. It is not surprising that virtually all im- pacted communities report problems associated with public water supplies, waste water, solid waste disposal, and environmental sanitation. Such problems are, of course, attributable to in- adequate housing and basically to rates of population growth that are unusual for the communities affected. As indicated in the following section, there are no indications that diseases occurred as a result of inadequate environmental services. -16- ------- Direct Health Effects. Health impacts that have a direct effect on people also are of two types: Those that cause disease or illness among the affected population. Those that reduce the effectiveness of personal and public health services. Disease and Illness. The report for Phase I indicated some of the possible consequences resulting from environmental contain ination, such as increase in communicable diseases associated wi inadequate water supplies, sewage disposal, and solid waste dis- posal. Although environmental contamination did occur in some communities, there were no reports of increased incidence of dis ease. The potential occurrence of disease because of inadequate environmental services apparently was avoided by adequate enforc ment of existing laws, ordinances, and regulations. Health problems not directly associated with environmental services were quite a different matter. The rapid growth of com munities, especially the small ones previously without much in- dustrial activity, often caused considerable trauma among the initial residents. The newcomers, likewise, frequently exhibited problems associated with adjustment and acceptance. Stressful conditions experienced by both groups often were reflected in antisocial behavior. Alcoholism was the most prominent problem, with resulting increases in crime and accidents. Crowding, lack of recreational facilities, inadequate day-care facilities for children, social isolation, and related conditions were respon- sible for increase in instances of child abuse and mental illness -17- ------- School-age children in families new to the community frequently- had problems associated with transition and adjustment. The re- sult for the community was often more juvenile delinquency, in- cluding drug abuse. Personal and Public Health Services. Other effects of rapid population growth are reflected in overtaxing the capacity of available resources to provide personal and public health ser- vices. Many communities reported inadequacies of personnel to make inspections necessary to enforce sanitation regulation. Sim- ilar deficiencies were noted in services of public health nurses to provide immunization, maternal and child services, and home health care. Equally prominent as problems with housing and community environment services, were reports of inadequate medical ser- vices. More accurately, the problem was perceived as an inade- quate number of physicians and insufficient medical facilities. Summary. Health-related problems reported or observed in the study communities related to the following: Housing Environmental services - water supply - waste water treatment - solid waste disposal - sanitation Public health services - preventive services - health education - home health services Personal health service - therapeutic services -18- ------- There is certainly nothing new in this list of.issues facing boomtown communities. The effect of rapid community growth has been exhaustively, often tediously, reported. Further descrip- tive case-history studies that reiterate the obvious are unlikely to make further contributions to solutions. Situations in the impacted communities simply cannot be summarized as sharply de- fined, quantitated problems that can be associated with equally straightforward solutions. Much in the way of "how-to-do-it" information can. however, be developed from studying the ap- proaches undertaken in various communities. Community Approaches to Deal with Health Impacts In this section, the extent of health impacts and community experiences in dealing with them are summarized. The purpose in examining ways that communities dealt with health impacts was to develop some idea of an optimum approach,- or at least effective approaches. It was not anticipated that the ideal model would be found in a single community. However, some highly efficient and apparently effective programs have been organized. Efforts in selected communities are described briefly in Appendix A and are not included in this section. The following material provides details and critiques that are not appropriate for the Sugges- tions for Communities (Appendix A). Extent of Health Impacts. Wide variation was apparent in the intensity of health impacts among the study communities. Some of the communities that typify boomtowns, such as Rock -19- ------- Springs and Gillette, Wyoming were among the first areas to ex- perience precipitous impacts from energy developments. The col- orful account of Rock Springs, provided by former Mayor Paul.J. Wataha provides an insight to underlying causes of severe impacts that are representative of occurrences in many of the communities initially affected.^* Inaccurate data were available on projected employment. In- dustries estimated that in 1971 employment would be 385 persons and by May 1974, 920 persons would be employed. The actual em- ployment in 1973 was 3,000 persons. The population projected for 1990--26,000 persons—actually was reached in 1973 and 1974, 17 years ahead of schedule. Although the community leaders were comfortable with an annual rate of growth of about 5 percent, they were not prepared for the doubling of population in' less than four years. Examples of the extent of impact are numerous. For in- stance, in 1970 the City of Rock Springs permitted 78 sewer con- nections, 980 in 1973, and 1,220 in 1974. Police arrests were 1,460 in 1970 and 3,600 in 1974. During this period the police force increased from 15 to 35 and police fines from $34,000 to $114,700. The city budget increased from $671,000 in 1970 to $5,500,000 in 1975. Health-related problems are reflected in ¦these evidences of impact. More specifically, services at the emergency room at the local hospital were quadrupled. The sewer Hjataha, Paul J. Presentation to The 26th Annual Utah Eco- nomic Development Conference. Salt Lake City. August 20, 1975. -20- ------- system which was operating at 65 percent of capacity became in- adequate. All health facilities were "overrun." The Rock Springs experience is an example of, probably, the most intense type of impact. Other communities have similar ex- perience but the majority have been affected to a lesser degree. The magnitude of impacts seemed to have little relation to the type or effectiveness of community response. The question natu- rally arises as to why the impact was so severe in communities like Rock Springs and not as bad elsewhere. In the first place, Rock Springs and a few other communi- ties were among the first of the "present generation" of energy- development boomtowns. As indicated above, population esti- mates were grossly inaccurate. This was due, in part at least, to the fact that several major industries were undertaking de- velopments simultaneously but independently. Each development separately would significantly stimulate growth but the combined effect could not be assessed by anyone. Furthermore, in the early 1970s planning organizations, development councils, and other informational and regulatory offices at the federal, state, and regional levels were either not in place or had scant experi- ence in dealing with situations like Rock Springs. Industries too, were relatively inexperienced in working collectively with communities to allay the development of the type of conditions that did occur. Equally important is the fact that the communi- ties generally lacked both the experience and resources to antic- ipate the magnitude and implications of the development. Under -21- ------- the cicumstances then existing, timely and effective action by- the first of the modern boomtowns could hardly have been ex- pected. Conditions now, at the end of 1977, are quite different. Most everyone involved has had more experience and is sensitive to the need to minimize impacts. Furthermore, there is wide ap- preciation of .the advantages of doing so. Rather than reduce the efficiency of work forces by competitive hiring, industries col- laborate in projecting employment needs and in recruitment. Sit- ing laws for major facilities are in force in some states. Plan- ning and regulatory agencies are better prepared to anticipate impacts and to deal with them. The public generally is aware of the consequences of boomtown growth, both the negative and posi- tive aspects. Informed decisions now are easier and better founded, whether to oppose, accept, or exploit. In other words, there is a general awareness of options available to communities involved with energy developments. More objective and effective decisions can now be made, in terms of desired outcomes, regard- ing management of current impacts or in encouraging future growth. Under present circumstances, it is unlikely that situations such as those in Rock Springs or Gillette will again occur. At least such developments are not inevitable. This is not to imply that all problems of impact are solved or that remedial programs are in place everywhere that they should be. Certainly, there are and will be the potential for other boomtowns and there is the danger of severe impact in -22- ------- many other communities. The point is that mechanisms are avail- able which will enable communities to avoid or reduce undesirable effects of rapid growth. Obviously, these mechanisms must be mobilized and applied if undesirable effects are to be minimized. The experiences of communities in dealing with impacts provides indications of how this may be done, and with what results. Community Experiences in Dealing with Health Impacts As indicated previously, health impacts must be considered in the context of related impact problems. Discussion, in this summary, of general community approaches to impact alleviation includes the health-related problems. Specific references to health issues are applicable to other problems as well. It sim- ply is not possible to consider one type of impact alone. Also, generalizations must cautiously be evaluated. No two communities are alike. Each has unique physical conditions and population. Obviously, actions appropriate for one community ma}' not be ap- plicable in another. In examining the ways that impacts were handled, the com- munities may be considered in three groups: The "first generation" of severely impacted com- munities . "Intermediate" communities--those recently in- volved in energy developments. Communities that anticipate impact. Severely Impacted Communities. The first generation of severely impacted communities characteristically had little op- portunity to prepare. As indicated above, this may have been -23- ------- due to lack of adequate notice of the developments that were planned or already taking place. In other instances, the mechan- isms simply were not available to anticipate the extent of im- pacts or to evaluate the potential consequences. Local planning organizations generally were not in place and assistance from other levels of government was not available or not sought. In some instances there wasn't time to get help and in other cases its existence was not known. Communities where impacts developed precipitously, or ap- peared to do so, had little opportunity to do anything but react to emergencies or the most urgent needs. Means at that time were not available for immediate financing to expand facilities and services. Responsible officials had to make day-by-day decisions and often endure day-by-day criticism, simply to avoid disaster and minimize the number of crises. The realistic objective at that stage was to keep up. There was little opportunity for ad- vance planning. Gradually gains were made in reducing the frequency of emer- gency issues and more orderly processes began to evolve. Many factors contributed to these changes; community leaders acquired experience, assistance was obtained from state and Federal sources, and industrial organizations were formed. These develop- ments had the combined effect of realigning local governmental structure to handle impacts more effectively, acquire needed tech- nical personnel, and developing planning competencies. The plan- ning process involved establishing priorities for orderly -24- ------- corrective programs and preparing for future needs. The critical point is that this caine about through cooperative efforts of all levels of government, industry, and the general public. The ne- cessity of cooperation was learned the hard way in many places but the fact now is well established, although not always heeded. Problems of the severely impacted communities have by no means disappeared. In many places intense impact still exists and is anticipated for sometime to come.- But planning mechanisms are in place and gains are being made in reducing or eliminating problems. Uncertainties persist about sources of funds and many communities are skeptical about too much reliance on Federal guidelines or money. Recently Involved Communities.. Approach of communities in dealing with health impacts has been more varied among the re- cently involved communities than with the first, severely impacted communities. Developments did not occur so abruptly in the re- cently impacted communities. There generally was advance, usually ample, notice of planned industrial activity. Time was available for more deliberation and responses generally were more adequately considered. At least the opportunity was available to select a logically derived course of action. However, this was not always done. It is informative to consider some of the factors that in- fluence the effectiveness of communities to deal with impacts. - Size. Most small communities, those with a population of about 1,000 or smaller, do not have the capacity to handle the types of impact typically associated with energy developments. -25- ------- Generally there is no 'one around that: is knowledgable or who has been involved in the planning and developmental processes neces- sary to deal with the impacts, especially those related to tran- sient and temporary populations. There is probably no one locally who knows the entire scope of services that will be required by newcomers. Determining the magnitude of need depends upon accu- rate demographic data that usually have to be developed locally. Small communities are hard pressed to cope with Federal regula- tions. Even if appropriate assistance is sought and promtply re- ceived, it is unlikely that means would be available to address the most urgent needs within a year. But many communities don't know where help is available or how to ask for it. Probably the majority of communities want help. Those that don't probably don't want the responsibility. Size, of course, was not the critical .factor in influencing the extent of impact. Information, in many instances, had not been provided to communities concerning how to organize and how to get help to meet impacts. Some communities reported that in- formation available at the state level was not promptly sent to the affected communities. Many small communities relied on the state government: to solve local problems. When this didn't hap- pen, the feeling developed that faith in the state government had been misplaced. Often the easiest, and perhaps the most ob- vious, course was an appeal to industry for assistance. - Attitudes of Local Government and the General Public. Noth- ing appeared to have as much affect' on the intensity of impacts ------- experienced by the recently impacted communities as did local at- titudes about energy developments and community involvement. The factors associated with overt opposition to energy developments and the posture of complete detachment are not considered in this report. Such reactions have been adequately, perhaps laboriously, treated in many of the descriptive reports. Representative ac- counts are cited in the list of Selected References included in this report. The following were among the factors, observed or reported, that appeared to have the most influence on impacts. --Recognition of Problems and Placement of Responsibility. Some communities have indicated attitudes of fierce independence. The local citizens desired to develop solutions without any as- sistance or interference from outside the community. Help was neither desired or' sought. This attitud.e often was accompanied by a tendency to ignore, or overlook, the existence of problems until a crisis developed. As indicated in the previous section, most small communities do not have the competence to handle im- pact problems without outside assistance. Another, less frequent, expression suggested that since industry was responsible for the problems, let industry handle it. This position ranged from complete detachment, "let them handle it and they better do it right" to presentation of ex- tensive lists of expectations to industry. In some instances these were tantamount to demands. --Willingness to plan. Further indications of independence is reflected in attitudes toward planning. There is, or has been, wide spread opposition among the small communities to adopt -27'- ------- any form of zoning or regulation of land use, "a man has a right to do what he wants with his land." Planning is suspect as another level of bureaucracy, something that is done in communis- tic countries. Although planning often has been resisted before, or in the early stages of impact, most communities generally come to accept the process when conditions get bad enough. In some cases, the responsible officials have sometimes directed the planners to accomplish specific tasks, not necessarily in the context of a community plan; for example, "get rid of the trailer parks." Such an approach often lead to development of effective community plans, but not necessarily so. Planners have not always been effective, even though they may have been adequately trained and competent. Many were young, recent university graduates who were unable to relate well to the community. This was especially true when the community was reluc- tant to accept them. In some instances elected officials pre- ferred to exercise intuitive judgement, regardless of evidence produced by planners, on the basis of long established concepts of value. This was not always either good or bad. Another very important aspect of planning is collaboration with other jurisdictions. Many problems, especially those re- lated to provision of health services, must be resolved on a regional basis. Yet there is a widespread preference among many communities to "go it alone." This has resulted, in some cases, in bitter competition among communities, especially among profes- sional segments of the community. 'For example, medical groups -28- ------- and hospitals have found cooperation difficult because of in- tensely competitive attitudes. Community pride (?) has resulted in constructing, or trying to, duplicate facilities beyond fore- seeable needs, "if they have a hospital we will have one too." --How Problems are Handled. Some elected officials and governing bodies prefer to deal with problems incrementally by making decisions on each issue as it arises. This often is done without guidance from an articulated plan. Each request for a building permit or business license is considered separately on the basis of the "merit" in each instance. Again, this process has not been all bad. Some decision makers have maintained a "hard line" and not permitted development that detracts from aesthetic and other societal values of the community, as per- ceived by the decision makers. One disadvantage of this process, which excludes substan- tial consistent input from the public, is that minor issues may displease a significant segment of the community. The ensuing uproar may be reflected in changes at the next election. The continuity of approaches and value judgements among elected bodies are tenuous, at best. The matter of involving the public in planning and de- cision-making processes is an issue in itself. Many officials point out' that attendance of citizens at important and well- publicized meetings is poor. For example, there has been con- siderable indifference to discussion of priorities for use of revenue-sharing funds or to review of building codes for land use -29- ------- plans. (Such indifference has not been apparent when tax issues were on the agenda!) In some instances advisory groups want to make heavy decisions without adequate information and experience. On balance, however, the participation of the general public, as well as governmental and industrial groups directly concerned, seems highly desirable. As discussed in Appendix A, effective mechanisms for orientation and training are readily available. There are, however, some communities that felt there wasn't enough time to go through a training process--too much to be done. --Effective Organization. Many communities appear to have dealt effectively with health and other impacts, judging by pres- ent conditions and attitudes of residents. In these communities the leaders and the processes used in meeting impacts can easily be identified. There is nothing obscure about the way that things were done. Those who should know are fully aware of the details. Assistance was sought from district and state planning agencies soon after the possibilities of impact were apparent. Someone or some organization, agency, political entity, or industry took the initiative to develop a group to initiate planning. The initiators include elected officials, representatives of industry, profes- sional organizations, civic groups, governmental programs, volun- teer agencies, and other types of organizations. The public was adequately informed and involved from the inception of the process. The process of organizing planning activities and details of the processes used in selected communities are given in -30- ------- Appendix A. The general consensus from the communities that had dealt with impacts most effectively indicate easy access to assis- tance, both technical and financial. Planning and implementing programs to minimize impacts obviously has maximum effect only when done collaboratively with participation of all levels of government. Communities Anticipating Impact. Some of the communities currently planning for anticipated impacts have developed effi- cient planning organizations and are in the process of implement- ing plans. On the other hand, there are communities for which impacts are equally imminent that are doing little if anything to prepare for them. Some outstanding examples of effective advance planning are described briefly in Appendix A. The activities in Wheatland, Wyoming and Mercer County, North Dakota are especially interesting. Detailed accounts of these and other activities are cited in the references included in Appendix A. Summary. Means for avoiding undesirable health impacts from energy developments are available to all communities in the Rocky Mountain-Prairie Region. Technical assistance and funds for ad- vance planning and for implementing remedial and preventive pro- grams generally are accessible. State agencies are sensitive to community needs and are prepared to collaborate in dealing with local problems. Industry, in by far the majority of cases, is a willing partner in community activities to alleviate impact. The initiative for community action must come from the com- munity. Timely action is essential to mobilize the resources -31- ------- that are available. Recent untoward effects from energy develop- ments usually have occurred because adequate information was not available to communities or because communities failed to appro- priately use resources that were available. -32- ------- cz i t-rsi-nja I1BDS SELECTED REFERENCES Multistate Briscoe, Maphis, Murray and Lamont. 1974. Oil shale tax lead time study. Prepared for Regional Development and Land Use Planning Subcommittee of the Governor's Committee on Oil Shale Environmental Problems. Denver. Briscoe, Maphis, Murray and Lamont. 1977. Action handbook for small communities facing rapid growth. Prepared for the U.S. Environmental Protection Agency. . Denver. (Draft) Bronden, Leonard D. et al. 1977. Financial strategies for allev- iation of socioeconomic impacts in seven western states. Western Governors' Regional Energy Policy Office. Call, Richard D. and Mark J. Howard. 1976. Rural health - a three-pronged approach. Clinical Medicine. 583:9-13. Drumwright, Sterling. 1977. The role of the federal government in health planning for (energy) impacted communities. Mim- eographed. The Center for Urban and Regional Analysis Institute for Policy Research. 1977. Socioeconomic longitudinal monitoring project. First year progress report. Vol. 1 - Summary report. Old West Regional Commission. Christiansen, B. and T. H. Clack, Jr. 1976. A western perspec- tive on energy: a plea for national energy planning. Science. 194:578-584. Gilmore, John S. 1976. Boomtowns may hinder energy development. Science. 119:535-540. Gold, R. L. 1974. A comparative case study of the impact of coal development on the way of life of people in the coal areas of eastern Montana and northeastern Wyoming. Institute for Social Science Research, University of Montana. Missoula. Health Systems Research Institute. Rural health care delivery system The new world in rural practice Community health care -33- ------- Multistate (Cont'd) Mountain West Research, Inc. 1975. An application of a procedures manual for assessing the socioeconomic impact of the con- struction and operation of coal utilization .facilities in the old west region. Denver. Mountain West Research, Inc. 1975. Construction worker profile. Denver. Separate issues as follovjs: User's guide to data Summary report Final report Radcliff, Kathryn E. 1977. Some effects of "boom town" growth. Northeastern Colorado Council of Governments Four Corners Regional Commission Project. Rapp, D.A. 1976. Western boomtowns: part .1. A comparative anal- ysis of state actions. Western Governors' Regional Energy Policy.Office. Denver. Socioeconomic Program Data Collection Office. 1977. Regional pro- file energy impacted communities. A report. Federal Energy Administration, Region VIII. Stenehjem, Erik J. 1975. Forecasting the local economic impacts of energy resource development: a methodological approach. Regional Studies Program, Argonne National Laboratory. Studt, Ward B., Jerald G. .Sorensen, and Beverly Burge. 1976. Medicine in the intermountain west. Olympus Publishing Co. Salt Lake City. -34 - ------- Colorado Mueller, Heinz F. 1971. Colorado health consumer survey, a re- gional analysis. Colorado-Wyoming Regional Medical Program. Noak, Mary. 1977. Health services area description and analysis. Western Colorado Health Systems Agency. Western Colorado Health Systems Agency. Health systems analysis. (Draft) Western Colorado Health Systems Agency. 1977. An assistance guide. Western Colorado Health Systems Agency, Study Group on Disease Prevention and Health Promotion, Plan Development Committee. 1977. Health promotion and protection. (Draft) Western Colorado Health Systems Agency, Study Group on Disease Prevention and Health Promotion. 1977. Personal responsi- bility for health plans. (Draft) Western Colorado Health Systems Agency, Study Group on Public Health 'Services. 1977. Organization, financing, and delivery of public health services in western Colorado. -35- ------- Montana Clearmont City Council and the Citizens of Clearmont. 1976. Clearmont comprehensive plan. Dayton Town Council and the Citizens of Dayton. 1976. Dayton comprehensive plan. Economic Development Association of Eastern Montana. 1975. East- ern Montana area-wide health plan. Gold, Raymond .L. 1977. A case study of social and socioeconomic effects of thermal power plant development at Colstrip, Montana. To be published in the Journal of the Air Pollution Control Association. Henningson, Durham and Richardson, Inc. 1976. State solid waste management strategy. Johnson, Maxine C. and Randle V. White. 1976. Coal development, population growth, and local government finance: a handbook for local officials. Prepared for Montana Energy Advisory Council and Custer National Forest, USDA. Montana Bureau of Business and Economic Research, University of Montana. Missoula. -36- ------- North Dakota Cooperative Extension Service, North Dakota State University, Fargo. Slide-tape sets: Prime farmland Extension's community development program Coal development and its impact on the community of Washburn, North Dakota Dorow, Norbert et al. North Dakota's state and local taxes and coal development. Cooperative Extension Service. North Dakota State University. Dorow, Norbert A. 1976. A comprehensive land use and public affairs educational program for the coal development areas of North Dakota. Progress report, January 1 to June 30. North Dakota State- University. Dorow, Norbert A. 1976. A comprehensive land use and public affairs educational program for the coal development areas of North Dakota. Progress report, July 1 to December 31. North Dakota State University. Johnson, A. William. 1976. The REAP economic-demographic model-1: user manual. North Dakota Regional Environmental Assessment Program. Ludtke, Richard L. 1977. Human impacts of energy development. A survey study of Dunn, McLean, Mercer and Oliver Counties in North Dakota. Social Science Research Institute, University of North Dakota. Luken, Ralph A. 1974. Economic and social impacts of coal devel- opment in the 1970's for Mercer County, North Dakota. Old West Regional Commission. National Biocentric, Inc. 1977. Analysis of the human environ- ment. Antelope Valley Station. Volume II. Query, Joy M.N. 1975. Human environment impact assessment of coal gasification in the Dunn County area of North Dakota. The Health Delivery System. North Dakota State University. Mimeographed. Rude, R. Joseph and Janet Kelly. 1976. The social impact of coal development. Slide-narrative set. Department of Sociology, University of North Dakota. Grand Forks; Voelker, Stanly W. et al. 1976. The taxation and revenue system of state and local government in North Dakota. U.S. Environ- mental Protection Agency. -37- ------- South Dakota Follartd, Sherman. 1976. Health needs and resources in South Dakota: a source book. Health Manpower Planning and Linkage System. Pierre. Health Manpower Planning and Linkage System. 1977. Nursing com- ponent of the health manpower plan. Pierre. Office of State Health Planning and Development, South Dakota State Department of Health. 1976. The health status of South Dakotans: a preliminary profile. Office of State Health Planning and Development, South Dakota State Department of Health. 1977. Health facilities and services in South Dakota. Office of State Health Planning and Development, South Dakota State Department of Health and South Dakota Health Systems Agency, Inc.' 1976. South Dakota policy statement for plan develop- ment for health systems plans/state health plans. Pierre and Vermillion. Mimeographed. -38- ------- Utah Hester, Herschel G. , III. 1977. Planning and zoning administra- tion in Utah. Bureau of Community Development, University of Utah and Utah League of Cities and Toms. Olsen, Lyman J. 1973. Utah health profile. Utah Center for health statistics, Utah State Department of Health. Roosevelt City Community Development Committee. 1977. Summary reports. University of Utah, College of Medicine, Department of Family and Community Medicine. 1976. Physician shortage special project, progress report. Weber Basin Health Planning Council. 1975. Health plan (Chapters 1 and 2). -39- ------- Wyoming Allen, Robert, Timothy Keaveny, George Piccagli, and William Sawaya. 1977. Health planning models for physicians in energy impacted areas. Research Paper No. 197. Institute for Policy Research, University of Wyoming. Bell, William. 1975. Data base book -for Sheridan County. Sheri- dan Area Planning Agency. Big Horn Planning Advisory Board. 1977. Community development plan, Big Horn, Wyoming. Cooke, William P. 1976. The utilization of health services: rates, factors, and impact of future conditions. Health Plan- ning Resource Center, University of Wyoming. •Dempsey, John and Associates. 1975. Comprehensive plan update, city of Rock Springs, Wyoming. Gillette Human Services Project. 1976. Campbell County human services program. Organization profiles. Gilmore, John S. and Mary K. Duff. 1975. Boomtown growth manage- ment; a case study of Rock Springs-Green River, Wyoming. Westview Press. Boulder. Holloway, Jill. Progress of the Piatt County impact alleviation task force. Wheatland, Wyoming. Howes, Douglass K. et al. The determination of medical trade areas with special reference to Wyoming. Health Planning Resource Center, University of Wyoming. Joehnk, Michael D. et al. The financial and economic implications of family practice residency programs: a benefit-cost eval- uation procedure (Part I of a Study). Health Planning Resource Center, University of Wyoming. Keaveny, Timothy J. A health manpower planning model for Wyoming: physician job family. University of Wyoming. Keaveny, Timothy J. Present and future requirements for dental laboratory technicians in Wyoming. Health Planning Resource Center, University of Wyoming. Keaveny, Timothy J. 1976. A health manpower planning model for Wyoming: dental job family. Health Planning Resource Center, University of Wyoming. Keaveny, Timothy J. 1976. A health manpower planning model for Wyoming: pharmacists. Health Planning Resource Center, University of Wyoming. -40- ------- Wyoming (Cont'd) Keaveny, Timothy J. and Roger L. Hayen. A health manpower planning model for Wyoming: introduction. Keaveny, Timothy J. and Roger L. Hayen. A health manpower planning model for Wyoming: nurse job family. Health Resource Center, University of Wyoming. Miller, Keith A. 1976. Gillette human services project. Annual report, 1976. University of Wyoming. Laramie. Piccagli, George and James Thompson. ¦ 1977. Sources of error in environmental impact statements. Research Paper No. 203. Institute for Policy Research, University of Wyoming. Piccagli, George et al. 1977. Energy impact research policy and concerns in energy impacted areas of the west. Research Paper No. 204. Institute for Policy Research, University of Wyoming. Platte County Joint Planning Office. 1976. Wheatland impact area comprehensive plan. Sheridan Area Planning Agency. 1976. Population study. Sheridan City Planning Commission. 1977. Community development plan, Sheridan, Wyoming. Sheridan County Commissioners and the Sheridan County Planning Commission. Sheridan County needs survey results. Sheridan County Planning Commission. 1977. A comprehensive plan for Sheridan County, Wyoming. Spielman, Bernie. 1977. Population update for Sheridan County, Wyoming, and the communities of Big Horn, Clearmont, Dayton, Ranchester, Sheridan, and Story, Wyoming. Sheridan Area Planning Agency. Story•Planning Advisory Board. 1977. Community development plan, Story, Wyoming. Uhlmann, Julie M. 1977. The delivery of human services in Wyoming boomtowns. Manuscript. University of Wyoming, Institute for Policy Research. 1977. Health planning models for physicians in energy impacted areas. Research Paper No. 197. University of Wyoming, Health Planning Resource Center. 1975. Wyoming health professional liability training workshop. -ZlI - ------- Wyoming (Cont'd) Wataha, Paul J. Presentation of Mayor Paul J. Wataha, Rock Springs, Wyoming. The 26th Annual Utah Economic Development Conference. August 20, 1975. Salt Lake City. Mimeographed. Wyoming State Department, of Health and Social Services. 1978. Wyoming state plan for mental health. Wyoming State Land Use Commission. 1976. Statewide goals, policies, and guidelines for local land use planning. -42- ------- APPENDIX A HANDLING HEALTH IMPACTS SUGGESTIONS FOR COMMUNITIES IMPACTED BY ENERGY DEVELOPMENTS ------- HANDLING HEALTH IMPACTS Suggestions for Communities Impacted by Energy Developments U.S. Environmental Protection Agency Office of Energy Activities Denver, Colorado 1977 ------- What this is all about... These Suggestions were designed to help communities, especi- ally small ones, to deal with health impacts associated with energy- developments in the Rocky Mountains - Prairie Region. These are not directions for handling specific problems. They are indications of some ways that citizens can go about deciding what kinds of actions are best for their own community. They are "how-to-do" sugges- tions rather than "what-to-do" directions. Efforts were made to provide practical suggestions for communities that are already deal- ing with impacts as well as for communities that expect impacts in the future. Some of the types of assistance that a community may need are outlined, together with sources of help and how to get it. You won't find in these Suggestions a list of clearly defined "problems" and equally straightforward "solutions." The situations faced by impacted communities are just not that simple. The problems that develop must be handled in ways which are appropriate for the specific community where they occur. The technological approaches may be the same for every community but local decisions have to be made as to what is acceptable to the community, how much the citizens are willing to pay, and many other factors. Such determinations require an orderly process. The purpose of these Suggestions is to indicate some ways that this may be done. As indicated later on, a community cannot deal with health problems in isolation. A variety of other issues -- education, recreation, law-enforcement -- must be considered at the same time. -2- ------- If you have not already done so, you will want to read the Action Handbook for Small Communities Facing Rapid Growth^. This Handbook is a "how to manage" manual for impacted communities. These Suggestions are designed to complement the portions of the Action Handbook relating to health and medical services. Another aid that you also may want to use at the outset is a slide series, with narrative, entitled "Health Effects Associated With Energy Development." This is available from the U.S. Environ- mental Protection Agency, Office of Energy Activities, Denver. These Suggestions are based on a study, extending over more than 18 months, of health impacts experienced by communities and how they were handled. From first hand accounts, direct observa- tions, and reading many reports, an effort has been made to provide a brief summary of what was done in the communities, and what worked and didn't work. Many persons requested that these Suggestions be brief and readable in one short period that might be available to busy people. Requests were made to eliminate details that could be obtained else- where -- just give an overview and sources of information. An attempt has been made to follow this sound advice. Briscoe, Mephis, Murray and Lamont. 1977. Action Handbook for Small Communities Facing Rapid Growth. Prepared for the U.S. Environmental Protection Agency. (Contract 68-01-3579). -3- ------- What to Expect Residents of communities impacted by energy developments are fully aware of the undesirable conditions that may occur. Rapid population growth may quickly exhaust the resources available for providing personal and government services. If the annual rate of growth is much over five percent, most small communities (less than 1,500 persons) have difficulties in providing for the newcomers; that is, unless adequate preparations for them are made in advance. As many new people move in, available housing is quickly oc- cupied. The new residents then must make temporary arrangements for housing in the community or commute to nearby towns. The tem- porary arrangements may result in tent cities, mobile home areas, trailer parks, and various types of improvised housing. If not carefully managed by the community, possibilities develop for the occurrence of unsanitary conditions that may have serious effects on the health of everyone -- initial residents and newcomers alike. A variety of personal services may also be affected. Recreational facilities soon may become overcrowded. The number of doctors and other health personnel may not be adequate to take care of the additional population. Such shortages create additional threats to health. The citizens of a community are the..only persons who can pre- vent such undesirable 1 conditions or eliminate- them if they already have developed. Let's now look at some of the ways this can be done. -4- ------- What Can Be Done Several courses of action are available to communities in dealing with health impacts: A community can do nothing and let events take care of themselves. The decision makers can deal only with emergency situations. The responsible officials can consider each issue as it is presented and make a decision on their evaluation of each individual case. Planners can be employed to advise the responsible official concerning each issue. A program can be developed to prepare plans for the community that will serve as a guide for community development and as a basis for making decisions. These various approaches, and many variations, have been used by impacted communities. Some have resulted in near disasters. All communities that have coped effectively with health impacts even- tually developed some type of organization to prepare a community health plan that serves as a. basis for decisions. The most effec- tive plans were prepared with extensive citizen participation. These plans generally reflect a concensus of the community regarding needs and priority. Hence, they are better supported and more easily implemented than are plans prepared without involvement of the general public. Before making a decision not to develop a systematic plan, talk to officials in communities where impacts came so quickly that time was not available for.planning. Ask them for suggestions. (See References and section on "Sources of Information and Assistance") -5- ------- How to Deal With Health Impacts Kinds of Health Impacts First, we should be specific about the things we are going to consider. Our concern is the undesirable health effects assoc- iated with energy development. There are two kinds: Effects resulting from the toxins and irritants (pollution) generated by industrial processes. Effects caused by rapid growth of communities. Industrial Pollution. The control of industrial pollution is a state-level responsibility and is carried out in accordance with Federal guidelines and enforced by both Federal and state laws and regulations. Most of the industrial developments in the Region are modern and generally employ the most advanced method for pollution control. The probability of serious health hazards from industrial sources is remote. This doesn't mean, however, that dangerous pollution might not occur under some circumstances. Monitoring programs maintained by the responsible state agencies are designed to detect such hazards and to take appropriate control measures should conditions warrant. Rapid Growth. By far the most significant health effects that communities have to handle are those associated with rapid population growth. There are two types of such effects: Impacts on community environmental services. Direct, adverse effects on health of people. The types of environmental services that are most commonly affected -6- ------- include water supply, sewage disposal, solid waste disposal, and environmental sanitation. Direct adverse effects on people include increases in rates of communicable diseases, mental illness, alco- holism, drug abuse, accidents, and other problems. The lack of adequate health and medical services has been perceived as the most important direct health effect in most communities. Approaches to Cope We already have indicated in several ways, the necessity of a systematic approach in dealing with health impacts. This will be mentioned several times more before the end of these Suggestions 1 Regardless of the form it takes, some type of planning organization is essential to prepare for orderly community growth that will pre- serve the values and provide the services desired by the community. Otherwise the way is open for intuitive decisions. Such decisions often are based on inadequate information and stand a good chance of being less than the best course of action.. Simply reacting to emergencies, though sometimes necessary, may be equally undesirable. Appropriate planning, on the other hand, provides a means for making the best possible decision under prevailing circumstances. As far as health impacts are concerned, the planning process in- volves the following: Evaluating health problems and the needs for health services. Consideration of alternative ways to alleviate the problems defined and provide the services needed. Assessment of resources available, or attainable, in the community and determining further needs to carry out the alternative programs. -7- ------- Providing the resulting information in proper form to assist decision makers in selecting the most appropriate program--considering cost, community preferences, efficiency, and other factors. Assiting operating agencies with implementing programs selected by decision makers. Assisting responsible officials with evaluating effectiveness of both new and established programs. Recommending modification of programs to operating agencies and decision makers as changes are indicated. Preparing periodic analyses of health conditions and recommendations for dealing with health problems. The "decision makers" referred to may be a city council, county supervisorg, or other legally responsible governing body. "Operating agency" may be a department of local government, a vol- unteer organization, or a contractor responsible for a specific function in the community. Examples are a local health department, a mental health center, and a child day care center. Does all this seem complicated? It really isn't. If you think about the items in the above list, you probably will conclude that many of the activities are being performed already. Some of them probably are being done without adequate data that the planning process would provide. Hence the decisions that are made may not be reliable. Any community that wants to do so can develop a nlanning organization that is appropriate to meet local needs. An organi- zation consisting of only one person may be adequate for some com- munities. Others may require a large staff, depending on the size of the community and the extent of the impact. Relation of Health Problems to Other Types of Impact. Although we are considering how to deal with health-related problems in these -8- ------- Suggestions, impacted communities must deal with a wide variety of other issues. Most of the problems faced by an impacted community are interrelated. For example, health, education, recreation, and law enforcement are all interrelated. What we say about health impacts applies as well to many other problems. Some communities that have not yet developed programs to cope with health impacts already have planners who are developing programs in related areas. It is essential that planning for health programs be related to these efforts. Approaches to community planning are outlined in the Action Handbook. The steps outlined in the Handbook are generally appli- cable to most aspects of community planning, including planning to deal with health impacts. In these suggestions we are providing some additional details related to health issues. We also are em- phasizing some of the material in the Handbook by repeating it here. One point we wish to emphasize is the necessity for community involvement in planning. Citizens of the community must understand the necessity and purpose of planning. In some areas planning has been interpreted as an infringement on individual rights. Land use planning especially is suspect because it results in "telling a man what he can and cannot do with his own land." Most persons, how- ever, now appreciate the necessity of collective action and indi- vidual compromises to protect community values. Still, many com- munities prefer to "go it alone" and not get involved with other jurisdictions. Many small communities that do not have the nec- essary personnel and other resources to cope with impact situations have found this course to be very costly in the long run. Not only -9- ------- is money wasted but the community often has been stuck with avoid- able problems that will remain for a long time. However, the decision is up to the community. It is unlikely that any one can, or would try to, force the community to do any- thing contrary to the prevailing concensus. Those who may seem persuasive are simply' pointing out the consequences of various courses that may be pursued. The Health Services Task Force The Handbook indicates how a Community Impact Committee may be organized and outlines how specific issues and problems in the community may be addressed by task forces. These Suggestions are made especially for the task force concerned with health impacts. Such a task force may consider health services exclusively, or health services may be included in the work of a task force with other responsibilities. As promised in the Introduction, these Suggestions are brief. They provide a general overview of how a community may deal with health impacts. More details for operation of the Health Service Task Force are given in a compilation of formats and protocols entitled "Procedure for Evaluating Health Impacts Resulting from Energy Developments." This report is available from the Office of Energy Activities, U.S. Environmental Protection Agency, Denver. Specific Problems As indicated before, these Suggestions are not concerned with technical details. They are not step-by-step instructions. So, in commenting on how to deal with some problems we will only -10- ------- suggest sources of assistance or where detailed information can be obtained. With this in mind, let's consider each kind of health impact indicated earlier in this section. Industrial Pollution. We will have little further comments concerning this type of impact. Communities should be familiar with the monitoring programs mentioned previously and should be alert to changes that might result in increased risles to health. It is highly unlikely, however, that communities would need to deal individually with problems of industrial pollution. Health Impacts Resulting From Rapid Community Growth. As in- dicated before there are two kinds of these impacts. --Impacts on Community Environmental Services involve water supplies, waste water treatment, solid waste disposal, and envi- ronmental sanitation. Municipal services and matters relating to physical facilities usually will not be the direct responsibility of the Health Services Task Force. However, the Health Services Task Force will want to participate in planning these services. The adequacy of current services and plans that may be developed for additional service should be evaluated as to effectiveness in protecting the public health. In most states, the Department of Health, or a department providing the usual services of a health department, has responsi- bility for approving the design of physical facilities and opera- tions of community environmental services. Guidance should be sought from the appropriate state agency early in the planning process. It is unwise to make commitments for consultants or -11- ------- incur other expenses until the extent of assistance available from state or Federal agencies is determined. --Direct Impacts on the Health of People will be the primary- concern cf the Health Services Task Force and will require most of its attention. Many health problems in the community, and ways to handle them, will be apparent. Other problems that may be equally important may be less obvious. Be sure to have your Health Sys- tems Agency involved in the work of the Task Force at an early • stage. This will give you an idea of what assistance is available and will suggest some ways of undertaking various tasks. The op- erating state departments that have responsibilities for specific programs also should be consulted as you undertake work on various problems. All states have offices responsible for programs in public health, mental health, alcoholism, drug abuse, and other areas related to local health problems. Look over the lists of References and "Sources of Information and Assistance" for mater- ial or contacts that may be helpful. A Special Word About Personal Health Services One of the most perplexing, often controversial, and certainly the most expensive problem that the Health Service Task Force will have to deal with is the matter of planning for personal health services. To most people, "personal health services" involve only the treatment of illness or injury. The need for personal health services is perceived as a need for physicians and hospitals. Some communities have spent a great deal of money in attempts to recruit physicians and other health personnel. By far, the -12- ------- majority of such efforts have been unsuccessful. Other communi- ties have attempted to attract physicians to the area by con- structing hospitals or providing other types of medical facili- ties. This has not worked well either. Such facilities are costly to construct and maintain. Often they prove to be inappro- priate for the needs 'of the community and do not attract the de- sired personnel. Many have been converted to other uses and essentially all of them result in a financial burden, and the com- munity is still without the desired medical service. How then does a community arrange to obtain the needed health and medical services? In the first place, the "needs'' must be defined. The instances just described--recruitment of a physician or construction of a medical facility--may be among the possible ways to provide certain medical services. They may be possible answers to a problem. But an apparent inadequate number of physicians is not the real problem. The real problem is in- adequate services. Having more physicians residing and prac- ticing in the community may be a possible solution. Certainly it is not the only solution and may not even be the best. Yet, many thousands of dollars have been wasted in pursuing a perceived so- lution to an inadequately defined problem. For many communities, the most practical way to provide personal health services is by a Physician's Assistant or a Nurse Practi ioner. Public Health Nurses and Emergency Medical Technicians also can provide many of primary medical services in small communities. This may seem in- volved, but it really isn't. As suggested before, planners and others can be of great help to a community in working out such -13- ------- problems. The protest often is heard: "But I know we need a doctor, we don't have one--or we don't have enough!" The fact is, the doctors services are needed, not necessarily that he or she be in residence and work full-time in the community. Dr. Bond Bible, Director of the Department of Rural and Community Health for the American Medical Association has clearly described the situation. "It is certain that many small communities which once had their 'own' physician will never again have one of their own. It has become clear that for some sparsely populated rural areas, solutions completely different from the traditional physician in residence must be sought. In some areas, emphasis may be needed on expanded transportation and communication capabilities, use of new allied health professionals better understanding of individ- ual health practices, and development of•emergency care and self- help methods to ensure rural health coverage. Multiple communi- ties in a logical service area will need to plan together to de- velop health care systems on an area basis so that they can at- tract appropriate health manpower working in a group to provide home, clinic, and hospital care." "Today, organizing health care systems in sparsely populated areas requires multi-institutional arrangements on a geographical basis. To accomplish this will require courage and foresight on the part of community leaders and health care professionals. Some institutions may have to change their missions or actually close down. Some must be helped to expand. Ambulatory, primary care and group practice units must be built. Rescue squads must -14- ------- have trained staffs and new equipment to handle acute emergencies until they reach the appropriate hospital. No rural community can handle it alone. Communities should plan and develop the type of health ser- vices, both personnel and facilities, that are appropriate but not excessive to meet the needs of the area. This must be done on a regional basis so that all of the needed services are avail- able to the community but not necessarily provided in facilities physically located within the community, or by personnel that re- side in the community. Arrangements should be made, however, for "local access to emergency services and services of other types that are continuously or frequently needed. Most important, mechanisms should be developed to permit ready access to the en- tire systems of health services. This is to assure that the type and level of services required are secured promptly when needed. How does a community go about making these arrangements? Get the planner to help. They know the techniques for planning regional health services and can assist in identifying the op- tions that are available to the community. The planners cannot., however, do the job for the community. They can assist with some of the technical aspects and provide information on experi- ences in other areas. The participation of citizens of the com- munity is essential to determine local needs and preferences re- garding delivery of health services. Also, the local residents . Studt, W.B., Jerold G. Sorensen, and Beverly Burge. 1976. Medicine in the Intermountain West. Olympus Publishing Company. Salt Lake City. -15- ------- are in a better position to explain the advantages and disadvan- tages of the various options to others. This process is essential for developing a consensus of what the community wants and what the citizens are willing to support and pay for. Also, seek comments from communities that have used various systems for providing health services. See how the various ones worked out. Proposals should be sought from organizations that develop rural health services for rural areas and contract to op- erate them. See the "Examples of Successes and Innovations" in a following section. -16- ------- Where to Get Help Many resources are available throughout the Rocky Mountains- Prairie Region to assist communities in developing and implement- ing plans to deal with health impacts, as well as other problems related to energy developments. A list of such resources in each state, and those that are available to all the states, is included 7 « ' with these Suggestions. In each state a number of departments and offices can pro- vide essentially all of the assistance needed by the communities. If information concerning these resources are not available in the community, contact with the appropriate representative should be made by letter or telephone. Often someone from the agency or office will be able to visit the community and explain what assis- tance is available. At least it is well to learn what is offered, even if the services are not requested. The following are some of the sources you may want to con- tact. Health Planning Agencies. Each state has a State Health Planning and Development Agency, although not necessarily with this title, and one or more Health Systems Agencies. These agen- cies are involved in a collaborative Federal-State-Local program concerned with planning, developing, and regulating health ser- vices. This program was recently organized, or reorganized, and some of the agencies are relatively new. Many currently are con- cerned with mandated tasks and are occupied with development of -17- ------- state or regional plans. Nevertheless, these agencies can assist communities in approaching health problems in ways that will be compatible with activities of other health planning organizations. Each community is part of a Health Service Area that is the responsibility of a specific Health Systems Agency. In some in- stances sub-area planning activities are under way. To assure the necessary relationship and support, communities should get in touch with their Health Systems Agency at an early stage. State Planning Office. The State Planning Office which is designated by various titles in different states, is the focal point of community planning in most states. As indicated before, planning to deal with health impacts should be done in concert with other aspects of community planning. Collaboration is es- sential for establishing priorities and orderly allocation of funds. In addition, many programs can be mutually supportive, so that sometimes two or more related problems can be solved more satisfactorily together than they could be separately. State Offices of Community Affairs. The names vary, but most states have an office that serves as a community advocate in dealing with other state agencies and with appropriating bod- ies. Depending on the individual states, a variety of programs are available to assist individual communities. In most in- stances, help can be provided in developing an entire local plan- ning program or in assisting with specific programs or problems. In some states, the office of community affairs has regulatory responsibilities. -18- ------- Cooperative Extension Service. Agricultural extension agents have long been involved in community activities. They are excel- lent initial contacts for information on how to get started in dealing with impact problems. Most state extension services have developed materials that may be used to inform citizens of pending problems and approaches to solutions. Extension services maintain extensive contacts and serve as good sources of information con- cerning the availability of resources from other agencies. Operating Agencies. In dealing with specific problems--such as water supplies, health facilities, and mental health services-- you may wish to get in touch with the state or regional agency that has responsibilities for these types of programs. Technical assistance often is available for helping communities in defining local problems and implementing local programs. University Institutes. State universities address a variety of issues that concern impacted communities. Review the list of "Sources of Information and Assistance" for your state to find the ones that would be helpful in your work. Health Services Organizations. Two organizations in Utah have worked with impacted communities in providing medical ser- vices. They are the Health Systems Research Institute in Salt Lake City and the Utah Valley Hospital in Provo. The programs and approaches of these organizations are somewhat different. Both are involved in providing direct medical and administrative Ser- vices in a variety of situations. Specific arrangements are tail- ored to needs of the community and resources available. You may -19- ------- wish to obtain literature (see References) from both organizations and consult with them concerning the circumstances in your com- munity. Chambers of Commerce. The local Chamber of Commerce is often an important resource in developing and carrying out plans to han- dle impacts. The principal industrial and business organizations in the community usually participate in activities of the Chamber of Commerce. Many of the essential contacts and sources of sup- port can be developed when the Chamber shares leadership in com- munity planning. -20- ------- Examples of Successes and Innovations There are many outstanding examples of successes and innova- tions in dealing with health impacts in the Rocky Mountains-Prairie Region. Some representative ones are briefly described in this section. You may wish to secure information directly concerning these programs from the sources indicated in the References and the section on "Sources of Information and Assistance." Severely Impacted Communities. Rock Springs, Green River, and Gillette, Wyoming, and Colstrip, Montana are representative of the first communities to be severely impacted by energy developments. References to articles concerning these communities are listed in References. You may wish to examine these accounts for insight as to what can happen when there is not adequate information concern- ing developments soon enough to enable effective preparation to avoid impact. Also, to review the processes used to alleviate impacts. Effective Preparation in Advance of Impact. Among others, the advance preparation that is in progress at Wheatland, Wyoming and in Mercer County, North Dakota are outstanding examples of industry-community collaboration to minimize impacts. The project near Wheatland involves the construction and operation of a 1,500 megawatt generating station by six consumer-owned electric utili- ties that developed the Missouri Basin Power Project. The commun- ity was advised of the development about two years in advance of construction. An impact alleviation task force was organized -21- ------- jointly by community leaders and industry representatives soon after the announcement. Staff members of the Missouri Basin Power Project served as advisors to the Platte County Impact Alleviation Task Force from the beginning. The Task Force was provided with the most accurate information concerning population projections and other data that would affect requirements for local services. As a result, existing and anticipated problems were identified at an early stage and plans were developed for handling them. Timely implementation of these plans assured that impacts would be mini- mal. This is not to say that no problems developed, or that the task was easy. The Wheatland (Platte County) story is an inter- esting one and is worth reviewing. Developments in Mercer County have been along similar lines. There, two primary industries are involved; Basin Electric, one of the participants in the Missouri Basin Power Project, and A.N.G. Coal Gasification Company worked cooperatively with community leaders to develop the Mercer County Task Force. Both companies have full-time impact planning coordinators. Personal Health Services. The health planners can give many local illustrations of effective arrangements for personal health services in a variety of situations. For example, the Health Systems Research Institute has worked with the city of Sundance, Wyoming in staffing and operating the local hospital. This hos- pital provides services in the nearby community of Moorcroft at a mobile clinic. At Castle Dale, Utah, the Utah Valley Hospital -22- ------- has similarily assisted the community in operating a local clinic. There are many other examples--ask the health planner. Local Planning Organizations. Examples of outstanding local planning agencies are available for every state. Ask the State Planning Office for information concerning activities that are most similar to those planned for your community. The Sheridan Area Planning Office in Sheridan, Wyoming has produced a variety of excellent community reports. These reports have provided the basis for plans that have been effective in coping with impacts. Industrial Councils. Many communities are concerned with activities of several different industries. In some instances, the industries have formed a local association that serves as a focal point of contact and cooperation with the community. The Southwest Wyoming Industrial Association, with offices in Rock Springs, is an example. Wyoming Human Services Project. This university-based pro- gram has operated in Gillette and Wheatland, Wyoming. Advanced students are trained at the University of Wyoming to work in im- pacted communities for a year after graduation. Team members work in such areas as public administration, public health, men- tal health, and social services. Half of each week is spent as a regular staff member in a human services agency. The remaining time is spent with the team working on projects related to the improvement of human services within the community. This pro- gram has resulted in development and evaluation of new planning approaches and programs to deal with impacts. -23- ------- Information Systems. Impact assessment and information sys- tems have been developed in some states. These programs develop data and provide direct local assistance. The Regional Environ- mental Assessment Program (REAP) in Bismarck, North Dakota is collecting baseline data and is monitoring and cataloging a vari- ety of information useful to impacted communities. -24- ------- References General articles about the extent of impacts and public attitudes Christiansen, B. and T.H. Clack, Jr. 1976. A western perspective on energy: a plea for national energy planning. Science 194:578-584. Gilmore, John S. 1976. Boomtowns may hinder energy development. Science 119:535-540. Gilmore, John S. and Mary K. Duff. 1975. Boomtown growth manage- ment: a case study of Rock Springs-Green River, Wyoming. Westview Press. Bolder. Gold, R. L. 1974. A comparative case study of the impact of coal development on che way of life of people in the coal areas of eastern Montana and northeastern Wyoming. Institute for Social Science Research, University of Montana. Missoula. Gold, R.L. 1977. A case study of social and socioeconomic effects of thermal power plant development at Colstrip, Montana. To be published in the Journal of the Air Pollution Control Association. Ludtke, Richard L. 1977. Human impacts of energy development. A Survey Study of Dunn, McLean, Mercer and Oliver Counties in North Dakota. Social Science Research Institute, University of North Dakota. Wataha, Paul J. Presentation of Mayor Paul J. Wataha, Rock Springs, Wyoming. The 26tn Annual Utah Economic Development Confer- ence. August 20, 1975. Salt Lake City. Mimeographed. Planning to minimize impact Bell, William. 1975. Data base book for Sheridan County. Sheri- dan Area Planning Agency. Big Horn Planning Advisory Board. 1977. Community development plan, Big Horn, Wyoming. Briscoe, Maphis, Murray and Lamont. 1977. Action handbook for small communities facing rapid growth. Prepared for the U.S. Environmental Protection Agency. Denver. (Draft) -25- ------- Holloway, Jill. Progress of the Platte County impact alleviation task force. Wheatland, Wyoming. Rapp, D.A. 1976. Western boomtowns: part I. A comparative analy- sis of state actions. Western Governors' Regional Energy Policy Office. Denver. Planning health services Call, Richard D. and Hark J. Howard. 1976. Rural health - a three-pronged approach. Clinical Medicine 83:9-13. Drumwright, Sterling. 1977. The role of the federal government in health planning for (energy) impacted communities. Mim- eographed. Health Systems Research Institute. Rural health care delivery system The new world in rural practice Community health care Query, Joy M.N. 1975. Human environment impact assessment of coal gasification in the Dunn County area of North Dakota. The health delivery system. North Dakota State University. Mim- eographed. Studt, Ward B., Jerald G. Sorensen, and Beverly Burge. 1976. Medicine in the intermountain west. Olympus Publishing Co. Salt Lake City. Uhlmann, Julie M. 1977. The delivery of human services in Wyoming boomtowns. Manuscript. University of Wyoming, Laramie. Financing for impacted communities Briscoe, Maphis, Murray and Lamont. 1974. Oil shale tax lead time study. Prepared for regional development and land use planning subcommittee of the Governor's Committee on Oil Shale Environmental Problems. Denver. Bronden, Leonard D. et al. 1977. Financial strategies for allev- iation of socioeconomic impacts in seven western states. Western Governors' Regional Energy Policy Office. Dorow, Norbert et al. North Dakota's state and local taxes and coal development. Cooperative Extension Service. North Dakota State University. Johnson, Maxine C. and Randle V. White. 1976. Coal development, population growth, and local government finance: a handbook for local officials. Prepared for Montana Energy Advisory Council and Custer National Forest, USDA. Montana Bureau of Business and Economic Research, University of Montana. Missoula. -26- ------- Examples of community plans Clearmont City Council and Citizens of Clearmont. 1976. Clear- mont comprehensive plan. Clearmont, Montana. Dayton Town Council and the Citizens of Dayton. 1976. Dayton comprehensive plan. Dayton, Montana. Dempsey, John and Associates. 1975. Comprehensive plan update, City of Rock Springs, Wyoming. Platte County Joint Planning Office. 1976. Wheatland impact area comprehensive plan. Sheridan City Planning Commission. 1977. Community development plan, Sheridan, Wyoming. Sheridan County Planning Commission. 1977. A comprehensive plan for Sheridan County, Wyoming. Story Planning Advisory Board. 1977. Community development plan, Story, Wyoming. Slide-tape series Environmental Protection Agency. Health effects associated with energy developments. Office of Energy Activiites, Denver, Colorado. (Contact Mr. N.L. Hammer, Environmental Protec- tion Agency, Office of Energy Activities, 1860 Lincoln Street, Denver, Colorado 80203.) North Dakota Cooperative Extension Service. The following three sets are available: 1. Prime Farmland 2. Extension's Community Development Program 3. Coal Development and its Impact on the community of Washburn, North Dakota. (Contact Mr. Don H. Peterson, Area Resource Development Agent, County Extension Office, Washburn, North Dakota 58577.) Utah Valley Hospital. Health care for rural America, a unique pre- scription. (Contact Mr. Mark Howard, Director of Rural Health, Utah Valley Hospital, Provo, Utah 84601. Telephone 801/373-7850). -27- ------- SOURCES OF INFORMATION AND ASSISTANCE FOR COMMUNITIES IMPACTED BY ENERGY DEVELOPMENTS -28- ------- FEDERAL. REGIONAL, AND MULTISTATE AGENCIES FEDERAL U.S. Environmental Protection Agency Region VIII Office of Energy Activities 1860 Lincoln Street Denver, Colorado 80203 Telephone 303/837-3691 N.L. Hammer U.S. Department of the Interior Oil Shale Environmental Advisory Panel Room 690, Building 67 Denver Federal Center Denver, Colorado 80225 Henry 0. Ash Executive Director U.S. Department of Health, Education, and Welfare Region VIII Federal Office Building 1961 Stout Street Denver, Colorado 80202 Telephone 303/837-4461 Hilary H Conner, M.D. Regional Health Administrator Dr. Gunner Sydow, Director Division of Health Resources Development Michael Liebman, Liaison Officer National Center for Health Statistics James E. Ver Duft, Chief Health Planning Branch Ralph C. Barnes, Director Division of Prevention Dean Hungerford, Director Division of Health Service George Rold Office of Intergovernmental Affairs Federal Regional Council 1961 Stout Street Denver, Colorado 80202 Telephone- 303/837-2751 Russell W. Fitch, Representative Federal Energy Administration U.S. Department of Health, Education, and Welfare Indian Health Service Area Offices Montana and Wyoming 2727 Central Avenue Post Office Box 2143 Billings, Montana 59103 Telphonc 406/585-64 52 Richard J Anderson, Assistant Area Director Environmental Health and Engineering Programs North Dakota and South Dakota- Aberdeen Area, IHS 115 - 4th Street, S E. Aberdeen, South Dakota 57401 Telephone• 605/782-7553 Bill F. Pearson, Chief Office of Environmental Health REGIONAL COMMISSIONS Old West Regional Commission Room 306-A Fratt Building Billings, Montana 59102 Telephone- 406/245-6711 Beth Givens Information Specialist Four Corners Regional Commission 3535 East 30th Street Suite 238 Farmington, New Mexico 87401 Telephone* 505/327-9626 Carl A. Larson Executive Director MULTI-STATE OFFICES Fort Union Regional Task Forces State Capitol Bismarck, North Dakota 58505 Telephone 701/224-2916 Sheila Miedema Project Coordinator PACT Health Planning Center 90 Madison Street Suite 604 Denver, Colorado S0206 Telephone 303/320-0917 H. Sterling Drumwright Associate Director for Consultation Montana Nebraska North Dakota South Dakota Arizona Colorado New Mexico Utah Hon tana North Dakota South Dakota Wyoming Utah. Navajo Area, IHS Post Office Box G Window Rock, Arizona 86515 Telephone: 602/871-5851 Donald G. Myer, Assistant Area Director Enviormental Health and Engineering Programs Colorado: Federal Building and U.S. Courthouse 500 Gold Avenue, S.W Albuquerque, New Mexico 87101 Telephone 505/474-2155 Perry C. Brackett, Chief Office of Environmental Health ------- COLORADO STATE DEPARTMENT OF HEALTH Colorado Department of Health 4210 East 11th Avenue Denver, Colorado 80220 Telephone1 303/388-6111 Anthony Robbins, M.D. , M.P.H. Executive Director Extension 315 Thomas M. Vernon, M.D., Chief Epidemiology Section Extension 252 Robert E. Fontaine, M.D. Epidemic Intelligence Service (EIS) Officer Extension 252 Orlen J. Wiemann, Chief Milk, Food, and Drug Section Consumer Protection Extension 252 Donald J. Davids, Chief Records and Statistical Section Extension 237 (Health Information) Frank Rozich, Director Water Quality Control and Public Health Engineering Extension 325 STATE PLANNING AGENCY Division of Planning Department of Local Affairs 1313 Sherman Street, Room 520 Denver, Colorado 80203 Telephone. 303/839-2351 Philip H. Schmuck Planning Director REGIONAL PLANNING COMMISSIONS Region 1 - Sedgwick, Phillips, Yuma, Logan, Washington and Morgan Counties Northeastern Colorado Council of Governments Post Office Box 1782 Sterling, Colorado 80751 Telephone 303/522-0040 John Harrington, Executive Director Region 2 - Larimer and Weld Counties Larimer-Weld Regional Council of Governments 201 East Fourth Street, Room 201 Loveland, Colorado 80537 Telephone. 303/667-3288 Ronald Thompson, Director Region 3 - Denver, Adams, Arapahoe, Boulder, Jefferson, Douglas, Clear Creek, and Gilpin Counties Denver Regional Council of Governments 1776 South Jackson Street, Suite 200 Denver, Colorado 80210 Telephone: 303/758-5166 Robert D. Farley, Executive Director Region 4 - El Paso, Park, and Teller Counties Pikes Peak Area Council of Governments 27 East Vermijo Avenue Colorado Springs, Colorado 80903 Telephone 303/471-7080 Roland Gaw, Executive Director Region 5 - Lincoln, Elbert, Kit Carson, and Cheyenne Counties East Central Council of Governments Box 28 Stratton, Colorado 80336 Telephone 303/348-5562 Maryjo M. Downey, Director Region 6 i .Crowley, Kiowa, Otero, Bent, Prowers, and • * Baca Counties Lower Arkanasas Valley Council of Governments Bent County Courthouse Las Animas, Colorado 81054 Telephone. 303/456-0692 James N. Miles, Executive Director Region 7a - Pueblo County and City of Pueblo Pnebln Area Council of Governments One City Hall Place Pueblo, Colorado 81003 Telephone 303/5^5-0562 Region 7b - Huerfana and Las Animas Counties Huerfano-Lac Animas Area Council of Governments Room 100 - County Court House Trinidad, Colorado 81082 Telephone. 303/846-4478 Fred E. Weisbrod, Executive Director Region 8 - Sauache, Mineral, Rio Grande, Alamosa, Conejos, and Costilla Counties San Luis Valley Council of Governments Adams State College, Box 28 Alamosa, Colorado 81101 Telephone 303/589-7925 Rondall Phillips, Director Region 9 - Dolores, Montezuma, La Plata, San Juan, and Archuleta Counties San Juan Regional Commission 1911 North Main Durango, Colorado 81301 Telephone 303/259-1691 Region 10 - Gunnison, Delta, Montrose, Ouray, San Miguel, and Hindsdale Counties District 10 Regional Planning Commission 107 S. Cascade Post Office Box 341 Montrose, Colorado 81401 Telephone 303/249-9638 John J. Collier, Director Region 11 - Garfield, Moffat, Mesa, and Rio Blanco Counties Colorado West Area Council of Governments 1400 Access Road Post Office Box 351 Rifle, Colorado 81650 Telephone 303/625-1723 Steve Schmitz, Director Region 12 - Routt, Jackson, Grand, Summit, Eagle, and Pitkin Counties Northwest Colorado Council of Governments Holiday Center Building Post Office Box 739 Frisco, Colorado 80443 Telephone 303/468-5445 ------- (COLORADO CONT'D) Lee Woolsey, Director Region 13 - Lake, Chaffee, Fremont, and Cuscer Counties Upper Arkansas Area Council of Governments 6th and Mason, Box 510 Canon City, Colorado 81212 Telephone 303/275-3350 Frank Cervi, Director HEALTH PLANNING AND DEVELOPMENT AGENCY Colorado Department of Health 4210 East Eleventh Street Denver, Colorado 80220 Telephone 303/388-6111 Anthony Robbins, M.D., Director Michael K. Schonbrun, Assistant Director Office of Medical Care Regulation and Development Extension 356 HEALTH SYSTEMS AGENCIES Area I Central-Northeast Colorado Health Systems Agency, Inc 7290 Samuel Drive, Suite 316 Denver, Colorado 80222 Telephone- 303/427-5460 June H. Twinam, Executive Director Area II Southeastern Colorado Health Systems Agency, Inc. Pikes Peak Center 1715 Monterey Road Colorado Springs, Corlorado 81501 Telephone 303/475-9395 Frank Armstrong, Executive Director Area III Western Colorado Health Systems Agency, Inc. 2525 NorthSeventh Street Grand Junction, Colorado 81501 Telephone. 303/245-3590 David Meyer, Executive Director OFFICE OF ENERGY CONSERVATION Office of Energy Conservation 1313 Sherman, Room 718 Denver, Colorado 80203 Telephone- 303/839-2507 Buie Seawell SOURCE OF DEMOGRAPHIC DATA Colorado Department of Local Affairs Division of Planning 1313 Sherman, Room 520 Denver, Colorado 80203 Telephone 303/829-2351 Kenneth D. Prince STATE CARTOGRAPHER Louis F. Campbell Division of Planning Department of Local Affairs 1313 Sherman Street, Room 520 Denver, Colorado 80203 Telephone 303/839-2351 INDUSTRIAL ECONOMICS DIVISION Denver Research Institute University of Denver Denver, Colorado 80210 Telephone 303/753-3376 Dr. Alma Lantz, Research Psychologist COOPERATIVE EXTENSION SERVICE Colorado Extension Service Ft. Collins, Colorado 80523 ------- MONTANA STATE DEPARTMENT OF HEALTH State Department of HeaLth and Environmental Sciences CogsweLl Building Helena, Montana 59601 Arthur C. Knight, M.D., Director Telephone 406/449-2544 Martin D. Skinner, M.D., Chief Preventive Health Services Bureau Telephone. 406/449-2645 Harry F. Hull, M.D. Epidemic Intelligence Service (EIS) Officer Telephone: 406/449-2645 Vernon E. Sloulin, Chief Food and Consumer Safety Bureau Telephone: 406/449-2408 John C. Wilson, Chief Records and Statistics Bureau Telephone 406/449-2614 (Health Information) Benjamin F. Wake, Administrator Environmental Sciences Division Telephone- 406/449-3454 DEPARTMENT OF COMMUNITY AFFAIRS Capitol Scation Helena, Montana 59601 Telephone. 406/449-3757 Harold A. Fryslie, Director C.R. Draper, Administrator Research and Information Systems Division Harold M. Price, Administrator Planning Division Barbara Garrett, Administrative Officer Coal Board Department of Natural Resources and Conservation 37 South Ewing Natural Resources Building Helena, Montana 55601 Telephone 406/449-3780 John Orth, Director Robert Anderson, Administrator Energy Planning Division DISTRICT PLANNING COUNCILS District 1 - Daniels, Phillips, Roosevelt, Sheridan, and and Valley Counties High Plains Provisional Council for District One Post Office Box 836 Scobey, Montana 59203 Telephone 406/487-5026 V.C. Tousley, Administrator District 4 - Blaine, Hill, and Liberty Counties Bear Paw Development Corporation of Northern Montana Post Office Box 1549 Hill County Courthouse Havre, Montana 59501 Tony Preite, Executive Director District 6 - Fergus, Golden Valley, Judith Basin, Musselshell, Petroleum, and Wheacland Counties Central Montana District Six Council Post Office Box 302 Roundup, Montana 59072 Telephone: 406/323-2547 Ralph Gildroy, Director District 11 - Mineral, Missoula, and Ravalli Counties District Eleven Council of Governments c/o Board of County Commissioners Missoula County Courthouse Missoula, Montana 59801 Gladys Elison, Director PLANNING DIRECTORS Barbara Keneedy Miles City City-County Planning Board Powder River County Planning Board 9 South 6th, #301 Miles City, Montana 59301 Telephone: 406/232-6339 Douglas C Dean Richland County Planning Board Post Office Box 1011 Sidney, Montana 59720 Telephone. 406/482-4340 Eldon Rice Rosebud County Planning Board Route 2 Forsyth, Montana 59237 Telephone 406/356-7551 Albion M. Hettich (Bud) Tri-County Planning Board Box 199 Circle, Moncana 59215 Telephone- 406/485-2622 Jim Ashbury Dawson City-County Planning Board City Hall Glendive, Montana 59930 Telephone. 406/365-5029 Tom Eggensperger Fallon County Planning 3oard County Courthouse Baker, Montana 59313 Telephone 406/778-3603 HEALTH PLANNING AND DEVELOPMENT AGENCY State Health Planning and Resource Development Bureau 836 Front Street Helena, Montana Telephone. 406/449-3121 Wallace King, Chief HEALTH SYSTEMS AGENCY Montana Health Systems Agency 324 Fuller Avenue Helena, Montana 59601 Telephone: 406/443-5965 Ralph Gildroy, Executive Director STATE ENERGY OFFICE Energy Research and Conservation Office State Capicol Helena',- Montana 59601 Telephone- 406/449-3940 Bill Christiansen, Staff Coordinator ------- (MONTANA CONT'D) BUREAU OF BUSINESS AND ECONOMIC RESEARCH School of Business Administration University of Montana Missoula, Montana 59801 Telephone. 406/243-0211 Dr. Maxine C. Johnson, Director COOPERATIVE EXTENSION SERVICE Montana State University Bozeman, Montana 59715 Telephone¦ 406/994-0211 SOURCES OF DEMOGRAPHIC INFORMATION Department of Community Affairs Capitol Station Helena, Montana 59601 Telephone: 406/449-2896 C.R. Draper, Administrator Research and Information Systems Division ------- NORTH DAKOTA STATE DEPARTMENT OF HEALTH North Dakota Department of Health State Capitol Bismarck, North Dakota 58505 Jonathan B. Weisbuch, M.D. State Health Officer Telephone- 701/224-2372 Willis H. Van Heuvelen, Chief Environmental Health and Engineering Telephone 701/224-2371 KennethsMosser, Director Communicable Disease Control Telephone: 701/224-2376 Kenneth W. Tardif, Director Environmental Sanitation and Food Protection Telephone 701/224-2360 STATE PLANNING AND RESOURCE AGENCIES State Planning Division State Capitol, Fourth Floor Bismarck, North Dakota 58505 Telephone 701/224-2818 Austin Engle, Director Bonnie Austin Banks, Associate Planner State Board for Vocational Education State Office Building 900 East Boulevard Bismarck, North Dakota 58505 Telephone 701/224-3187 Coal Impact Information Project Cooperative Extension Service North Dakota Stace University Fargo, North Dakota 58102 Telephone: 701/237-7392 or 7393 Regional Environmental Assessment Program (REAP) 316 North Fifth Street, Room 521 Bismarck, North Dakota 58505 Telephone• 701/224-3700 Dr. A. William Johnson, Director Regional Environmental Impact Statement Office 1200 Missouri Avenue, Room 105 Bismarck, North Dakota 58501 Rebecca Lee Community Affaris Specialist REGIONAL PLANNING ORGANIZATIONS Region I - Divide McKenzie, and Williams Counties Williston Basin RC & D Law Enforcement Center 512 Fourth Avenue East Williston, North Dakota 58801 Telephone 701/572-8191 Ron Kiedrowski, Executive Director Region II - Bottineau, Burke, McHenry, Mountrail, Pierce, Renville, and Ward Counties Souris Basin Planning Council Minot State College Dakota Hall, Room 118 Minot, North Dakota 58701 Telephone: 701/839-6641 Mark Hinthorne, Executive Director Region III - Benson, Cavalier, Eddy, Ramsey, Rolette, and Towner Counties North Central Planning Council Post Office Box 651 Devils Lake, North Dakota 58301 Telephone: 701/662-8131 Region IV - Grand Forks, Nelson, Pembina, and Walsh Counties Red River RC & D Post Office Box 633 Grafton, North Dakota 53237 Telephone- 701/352-3550 Julius Wangler, Executive Director Region V - Cass, Ranson, Richland, Sergent, Steele, and Traill Counties Lake Agassiz Regional Council 319 1/2 North Fifth Street Post Office Box 428 Fargo, North Dakota 58102 Ervin Rustad, Executive Director Region VI - Barnes, Dickey, Foster, Griggs, LaMoure, Logan. Mcintosh, Stutsman, and Wells Counties South Central Dakota Regional Council 701 Third Avenue, SE Post Office Box 903 Jamestown, North Dakota 58401 Telephone¦ 701/252-8060 Larry Heisner, Executive Director Region VII - Burleigh, Emmons, Granc, Kidder, McLean, Mercer, Morton, Oliver, Sheridan and Sioux Counties Lewis and Clark 1805 RCD 801 Boundary Road Mandan, Noruh Dakota Telephone 701/663-658 7 John O'Leary, Project Director Region VIII - Adams, Billings Bowman, Dunn, Golden Valley, Hettinger, Slope, and Stark Counties Roosevelt-Custer Regional Council 19 West First Street Dickinson, North Dakota 58601 Telephone 701/227-0647 Marcoe Drem, Project Coordinator HEALTH PLANNING AND DEVELOPMENT AGENCY State Department of Health Capitol Building Bismarck, North Dakota 58505 Telephone 701/224-2894 Edward L. Sypnieski, Director and SHPDA Coordina tor Division of Health Facilities Missouri Office Building 12C0 Missouri Avenue Bismarck, North Dakota 58505 Telephone- 701/224-2352 Joe Pratschner, Director Division of Health Statistics Capitol Building Bismarck, North Dakota 58505 Telephone 701/224-2 360 Rick Blari, Director ------- (NORTH DAKOTA CONT'D) HEALTH SYSTEMS AGENCIES Western North Dakota Healch Systems Agency 209 North Seventh Street, Suite No 2 Bismarck, North Dakota 58501 Telephone- 701/223-8085 Barry Halm, Executive Director Agassiz Health Systems Agency 123 DeMers Avenue East Grand Forks, MN 56721 Telephone. 218/773-2471 Don DeMers, Executive Director Min-Dak Health Systems Agency 811 South 16th Post Office Box 915 Moorhead, MN 56560 Telephone 218/236-2 746 Bruce T Briggs, Executive Director DISTRICT HEALTH UNITS Custer District Health Unit 210 Second Avenue Northwest Post Office Box 185 Mandan, North Dakota 58554 Telephone 701/663-4243, Ext 46 Frank E. Gilchrist, Area Public Health Administrator First District Health Unit 801 11th Avenue Southwest Post Office Box 1268 Minot, North Dakota 58701 Telephone 701/852-1376 O.S Uthus, M.D., Executive Director Southwestern District Health Unit Pulver Hall, Dickinson College Post Office Box 1208 Dickinson, North Dakota 58601 Telephone. 701/227-0171 John E. Fields, Area Public Health Administrator Upper Missouri District Health Unit 210 First Avenue East Post Office Box 756 Williston, North Dakota 58801 Telephone 701/5 72-3763 Frank L. Onufray, Area Public Health Administrator Lake Region District Health Unit Kamsey County Court House Post Office Box 844 Devils Lake, North Dakota 58301 Telephone 701/662-4931 Norman Septon, Area Public Health Administrator STATE ENERGY OFFICE Governor's Office Capitol Building Bismarck, North Dakota 58501 Telephone 701/224-2200 Dr. Charles Metzger, Energy Advisor for Governor Arthur A Link SOURCES OF DEMOGRAPHIC INFORMATION State Board for Vocational Education State Office Building 900 East Boulevard Bismarck, North Dakota 58501 Telephone. 701/224-3187 Social Science Research Institute University of North Dakota University Station Grand Forks, North Dakota 58201 Regional Environmental Assessment Prop}r;im (KF.AP) 316 North Fifth Street,Room 52L Bismarck, North Dakota 58505 Telephone. 701/224-3700 Dr. A. William Johnson, Director COOPERATIVE EXTENSION SERVICE North Dakota State University State University Station Fargo, North Dakota 58102 Dr. Norbert A. Dorow, Economist Public Affairs North Dakota State University Pulber Hall Dickinson, North Dakota 58601 Harry Hecht, District Director County Extension Office Weshburn, North Dakota 58577 Telephone: 701/462-3532 Don H. Peterson, Area Resource Development Agent SOCIAL SICENCE RESEARCH INSTITUTE University of North Dakota Grand Forks, North Dakota 58201 Dr. Richard L. Ludtke, Director BUREAU OF BUSINESS AND ECONOMIC RESEARCH University of North Dakota 286 Gamble Hall Grand Forks, North Dakota 58201 INDUSTRIES ANG Coal Gasification Company 304 East Rosser Bismarck, North Dakota 58501 Telephone 701/258-7440 John Clement Basin Electric Power Cooperative 1717 East Interstate Avenue Bismarck. North Dakota 58501 Telephone 701/223-0441 Robert L Valeu, Coordinator Impact Planning ------- SOUTH DAKOTA STATE DEPARTMENT OF HEALTH South Dakoia State Department of Health State Office Building ;/2 Pierre, South Dakota 57501 Edward DeAntoni, Ph.D , Secretary of Health Telephone 605/224-3361 James D. Corning, Director Communicable Disease Control and Laboratory Services Telephone 605/224-3143 Howard Hutchmgs, Chief Section of Environmental Sanitation Telephone 605/224-3141 Willifm Johnson Office of Public Health Statistics Joe Fosse Office Building Pierre, South Dakota 57501 Telephone 605/224-335 5 (Health Information) Sherman Folland, Ph D., Health Economist Health Manpower and Linkage Project STATE PLANNING AND RESOURCES AGENCIES State Planning Bureau State Capitol Building Pierre, South Dakota 57501 Telephone: 605/224-3661 Dan Bucks. Commissioner Department of Environmental Protection State Office Building Pierre, South Dakota 57501 Telephone 605/224-3351 Dr. Allyn 0. Lockner, Secretary PLANNING AND DEVELOPMENT DISTRICTS District I - Brookings, Clark, Codington, Deuel, Grant, Hamlin, Kingsbury, Lake, Miner, and Moody Counties Planning and Development District I 401 1st Avenue, Northeast Watertown, South Dakota 57201 Telephone. 605/886-7224 Lowell D. Richards, Director District II - Clay, Lincoln, McCook, Minnehaha, Turner, and Union Counties Planning and Development District II (South Eastern Council of Governments) 20S East 13th Sioux Falls, South Dakota 57102 Telephone 605/336-1297 William B. Choate, Director District III - Aurora, Bon Homme, Brule. Charles Mix, Davison, Douglas, Gregory, Hanson. Hutchinson, Jerauld, Sanborn, and Yankton Counties Planning and Development District III Yankton County Courthouse Post Office Bo:: 687 Yankton, South Dakota 57078 Telephone 605/665-4408 Herman Tushaus. Director District IV - Beadle, Brown, Day, Edmunds, Faulk, Hand, Marshall, McPherson, Spink, and Roberts Counties Planning and Development District IV 310 S. Lincoln Aberdeen, South Dakota 57401 Telphone 605/229-4740 District V - Armstrong, Buffalo, Campbell, Carson, Dewey, Haakon, Hughes, Hyde, Jones, Lyman, Mellette, Perkins, Potter, Sinn- ley, Sully, Todd, Tripp, Walworth, and Ziebach Counties Planning and Development District V 365 1/2 S. Pierre Street Post Office Box 640 Pierre, South Dakota 57501 Telephone- 6G5/224-1623 Dennis W. Potter, Director District VI - Bennett, Butte, Cuscer, Fall River, Harding, Jackson, Lawrence, Meade. Pennington, Shannon, Washabaugh, and Washington Counties Sixth District Council of Local Governments 306 East Saint Joe Post Office Box 1586 Rapid City, South Dakota 57701 Telephone 605/342-8241 Larry Finnerty, Director HEALTH PLANNING AND DFA'ELOPMENT AGENCY Edward DeAntoni, Ph D Secretary of Health Department of Health State Office Building #2 Pierre, South Dakora 57501 Telephone 605/224-3361 Donald G. Kurvmk, Director Office of State Health Planning and Development Telephone- 605/224-3693 HEALTH SYSTEMS ACENCY South Dakota Health Systems Agency, Inc. 216 East Clark Street Vermillion, South Dakota 57069 Telephone 605/624-4446 Donald Brekke, Executive Director STATE ENERGY OFFICE Office of Energy Policy State Capitol Building Pietre, South. Dakota 75701 Telephone 605/22^-3603 James Van Loan, Director John Culbertson, Deputy Director BUSINESS RESEARCH BUREAU School of Business University of South Dakota Vermillion, South Dakota 57069 COOPERATIVE EXTENSION SERVICE South Dakota State University Brookings, South Dakota 57006 SOURCE OF DEMOGRAPHIC INFORMATION Rural Sociology Department Agricultural Experiment Station South, Dakota State University Brookings, Soui_h Dakota 57006 William Bergan University of South Dakota Vermillion, South Dakota 57069 Larry Rehfeld, Director ------- UTAH STATE DEPARTMENT OF SOCIAL SERVICES Utah State Division of Health 150 West North Temple Room 474 Salt Lake City, Utah 84103 Lyman J. Olsen, M.D., M.P.H. Director of Health Telephone 801/533-6111 Taira Fukushima, M.D., M.P.H. Deputy Director of Health Room 460 Telephone 801/533-6191 E. Arnold Isaacson, M.D., M P.H. Deputy Director of Health for Community Health Services Room 440 Telephone¦ 801/533-6129 Alan G. Barbour, M.D., (EIS) Officer Epidemic Intelligence Service Room 426 Telephone S01/533-6163 Mervin R. Reid, Director Bureau of Sanitation Environmental Health Services Room 430 Telephone 801/533-6163 Lynn M. Thatcher Deputy Director of Health for Environmental Health Services Room 430 Telephone 801/533-6121 Howard M. Hurst, Director Bureau of Environmental Health Room 430 Telephone 801/533-6121 John Brockert, Director Bureau of Statistical Services Room 158 Telephone 801/533-6186 STATE PLANNING AGENCIES Office of State Planning Coordinator State Capitol Building Room 118 Salt Lake Citv. Utah 84114 Telephone. 801/533-5356 James Edwin Kee State Planning Coordinator Department of Community Affairs State Capitol Building Salt Lake Cicv, Utah 84114 Telephone: 801/533-5236 Beth S. Jarman Executive Director Division of Energy Conservation and Development 455 East ^-th South Suite 300 Salt Lake City, Utah 84111 Telephone- 533-6491 Rhead Searle, Executive Secretary Energy Conservation and Development Council MULTI-COUNTY ASSOCIATIONS OF GOVERNMENTS Bear River--Box Elder, Cache, and Rich Counties Bear River Association of Governments 160 North Main Street Room 203 Cache County Hall of Justice Logan, Utah 84321 Telephone 752-7721 Bruce King Executive Director Wasatch Fiont -- Davis, Morgan, Salt Lake, -Tooele, and Weber Counties Wasatch Front Regional Council 424 West Center Street Bountiful, Utah 84010 Telephone 801/292-4469 Will Jeffries Executive Director Mountainland -- Summit, Utah, and Wasatch Counties Mountainland Association of Governments 160 East Center Street Provo, Utah 84601 Telephone¦ 801/377-2262 Homer Chandler Executive Director Six County -- Juab, Millard, Piute, Sanpete, Sevier, and Wayne Counties Six .County Commissioners Organization Post Office Box 191 Richfield, Utah S4701 Telephone 801/896-4676 Five County -- Beaver, Garfield, Iron, Kane, and Washington Counties Five County Association of Governments Post Office Box 0 St. George, Utah 84770 Telephone- 801/673-3548 Rhead 3owman Executive Director Unitah Basin -- Daggett, Duchesne, and Unitah Counties Unitah Basin Association of Governments Post Office Box 1449 Roosevelt, Utah 84066 Telephone 801/722-4518 Clint Harrison Executive Director Energy Planning Council Unitah Counly Building Room 303 Vernal, Utah 840/8 Telephone 801/789-2300 Chuck Henderson Director Southeastern -- Carbon, Emery. Grand, and San Juan Count ies Southeastern Association of Governments Post Office Drawer A-l Price. Utah 84501 Telephone- 801/637-1396 William K. Executive Dinenart Director ------- (UTAH CONT'D) HEALTH PLANNING AND DEVELOPMENT AGENCY Department of Social Services 150 West North Temple Room 310 Salt Lake City, Utah 84103 Telephone 801/533-5331 Anthony W. Mitchell Director State Health Planning and Development Agency Office of Planning and Research - 150 West North Temple Room 333 w Salt Lake City, Utah 84103 Stewart C Smith Assistant Director University of Utah Medical Center Department of Family and Community Medicine 50 North Medical Drive Salt Lake City, Utah 94132 Telephone. 801/581-5094 Dr. Richard F.H Kirk Division of Family Practice Utah Valley Hospital 1034 North Fifth West Provo, Utah 84601 Telephone- 801/373-7850 Mark J. Howard Director of Rural Health HEALTH SYSTEMS AGENCY Utah Health Systems Agency 19 West South Temple 8th Floor Salt Lake City, Utah 84103 Telephone; 801/5 71-3476 Paul Bomboulian Director STATE ENERGY OFFICE Department of Natural Resources State of Utah State Capital Building Room 438 Salt Lake City, Utah 84114 Clifford R. Collins State Energy Coordinator SOURCE OF DEMOGRAPHIC INFORMATION Office of State Planning Coordinator State Capitol Building Room 118 Salt Lake City, Utah 84114 Telephone: 801/533-5245 James Edwin Kee State Planning Coordinator COOPERATIVE EXTENSION SERVICE Utah State University Logan, Utah 84322 Telephone: 801/752-0961 William F. Famsworth Staff Development Leader INSTITUTE OF GOVERNMENT SERVICE Brigham Young University Provo, Utah 84602 Telephone: 801/374-1211 Dr. Doyle W. Buckwalter Associate Director BUREAU OF COMMUNITY DEVELOPMENT University of Utah 1141 Annex Building Salt Lake City, Utah 84112 Telephone- 801/581-6491 Dr. Richard P. Lindsay Director HEALTH SERVICES ORGANIZATIONS Health System Research Institute 715 East 3900 South Suite 205 Salt Lake City, Utah 64107 Telephone. 801/261-1000 George F. Powell, Jr. ------- WYOMING STATE DEPARTMENT OF HEALTH Wyoming Division of Health and Medical Services Hathaway Building, Fourth Floor Cheyenne, Wyoming 92002 Lawrence J. Cohen, M.D. Administrator Telephone 307/777-7121 H.S. Parish, M.D., M.P H. Assistant State Administrator for Division of Health and Medical Services Telephone 307/777-7513 Robert L. Coffman, Director Food and General Sanitation Division Telephone: 307/7 77-7 358 Jo Ann Amen, Deputy State Registrar Vital Records Services Division of Health and Medical Services Department of Health and Social Services Cheyenne, Wyoming 82002 Telephone 307/777-7591 STATE PLANNING AND RESOURCES AGENCIES Department of Economic Planning and Development Barrett Building, Third Floor Cheyenne, Wyoming 82002 Telephone. 307/777-7284 Sherman Karcher, Director Regional Planning Office Box 228 Basin, Wyoming 82410 Telephone. 307/568-2566 Newell Sorensen, Director of Planning Laramie-Albany County Regional Planning Office Albany County Courthouse Room 402 Laramie, Wyoming 82070 Telephone- 307/742-3166 Nakul "Nick" Verma, City-County Planning Director Converse Area Planning Office Post Office Box 1303 Douglas, Wyoming 82633 Telephone: 307/358-4066 A1 Straessle, City-County Planner Department of Planning and Develcpnent City of Gillette-Campbell County Post Office Box 540 Gillette, Wyoming 82716 Joe Racine, Director Rock Springs Planning Office Rock Springs, Wyoming 82901 Telephone 307/362-6892 Department of Environmental Quality Water Quality Division Hathaway Building Cheyenne, Wyoming 82002 Telephone: 307/777-7781 William L. Garland, Administrator Wyoming Community Development Authority 139 West Second Casper, Wyoming 82602 Telephone. 307/265-0603 CITY-COUNTY PLANNING AGENCIES Lincoln-Uinta Association of Governments Post Office Box 389 Kemmerer, Wyoming 83101 Telephone: 307/877-3707 Richard Jentzsch, Executive Director Cheyenne-Laramie County Regional Planning Office Post Office Box 3232 Cheyenne, Wyoming 82001 Telephone. 307/635-0186 Peter L. Innis, Director of Planning Rawlins-Carbon Countv Regional Planning Office Box 953 Rawlins, Wyoming 92301 Telephone 307/324-5613 Herb Hogue, Director of Planning Casper-Natronn County Planning Office Intermountain Building Casper, Wyoming 83601 Telephone 307/235-6503 Charles L. "Chuck" Davis, City-County Planner Sweetwater County Planning and Zoning Commission Post Office Box 791 Green River, Wyoming 82935 Telephone: 307/875-2611, Extension 270 Dennis Watt, Planning Director Platte County Joint Planning Office Post Office Box 718 Wheatland, Wyoming 822C1 Telephone 307/322-9128 David Sneesby, Planning Director Sheridan Area Planning Agency Post Office Box 652 Sheridan, Wyoming 82801 Telephone- 307/672-3426 Les Jayne, Planning Director Fremont Association of Governments 191 South Fourth Lander, Wyoming 82520 Telephone 307/332-9208 Tom Curren, Executive Director Northeast Wyoming Three County Joint Powers Board Post Office Box 743 Newcastle, Wyoming 82701 Telephone- 307/746-2433 Abbie Birmingham, Director Fremont County County Courthouse Lander, Wyoming 82520 Telephone 307/332-5371 Ron Martin, Planning Director INDUSTRIAL ORGANIZATIONS Missouri Basin Power Project Post Office Box 518 Wheatland. Wyoming 82201 Telephone. 307/322-9121 Tim Rafferty, Impact Coordinator Southwest Wyoming Industrial Association 638 Elias Rock Springs, Wyoming 82901 Telephone: 307/382-4190 Kim Briggs, Executive Director ------- (WYOMING CONT'D) HEALTH PLANNING AND DEVELOPMENT AGENCY Lawrence Cohen, M.D., Director Department of Health and Medical Services Hathaway Building, Fourth Floor Cheyenne, Wyoming 92002 Telephone: 307/7 77-7121 Lawrence Bertilson, Director Comprehensive Health Planning Hathaway Building, Fourth Floor Cheyenne, Wyoming 82002 Telephone: 307/777-7121 HEALTH SYSTEMS AGENCY Wyoming Health Systems Agency Post Office Box 106 Cheyenne, Wyoming 82001 Telephone: 307/634-2726 Richard M. Neibaur, Executive Director STATE ENERGY OFFICE Department of Economic Planning and Development Barrett Building, Third Floor Cheyenne, Wyoming 82002 Telephone- 307/77 7-7284 John Niland, Executive Director John Goodier, Chief of Mineral Division SOURCE OF DEMOGRAPHIC INFORMATION Economic Research Unit State Planning Coordinator's Office 24th and Capitol Avenue Cheyenne, Wyoming 82002 Telephone- 307/777-7504 Division of Business and Economic Research University of Wyoming Post Office Box 3295 Laramie, Wyoming 82071 Telephone- 307/766-5141 Dr. Mike Joehnk, Director WYOMING HUMAN SERVICES PROJECT University of Wyoming Merica Hall 207 Laramie, Wyoming 82071 Telephone 307/766-6318 Dr. Keith A. Miller, Project Director Gillette Human Services Project 202 Warren Ave. Post Office Box 1104 Gillette, Wyoming 82716 Telephone. 307/682-4219 JoAnn Shurigar-Wzorek Community Coordinator Platte County Human Services Project 962 Gilchrist Ave. Wheatland, Wyoming 82201 Telephone: 307/322-4480 HEALTH PLANNING RESOURCE CENTER Institute for Policy Research Post Office Box 3925 University of Wyoming Laramie, WY 82071 Telephone- 307/766-5141 Dr. George Piccagli, Director COOPERATIVE EXTENSION SERVICE College of Agriculture Post Office Box 3354 University of Wyoming Laramie, Wyoming 82071 Telephone. 307/766-3253 Josephine B. Rund, State Extension Leader Home Econonomics Sharron Kelsey, Field Director ------- APPENDIX B NARRATIVE FOR SLIDES HEALTH EFFECTS ASSOCIATED WITH ENERGY DEVELOPMENTS ------- NARRATIVE FOR SLIDES HEALTH EFFECTS ASSOCIATED WITH ENERGY DEVELOPMENTS 1. Health effects associated with energy developments are the concern of many communities in the Rocky Mountains-Prairie Region. 2. The Environmental Protection Agency's Office of Energy Activ ities in Denver, Colorado prepared this series of slides to assist communities in dealing with health problems that may occur as a result of energy developments. 3. The development of Western energy fuels is affecting an ex- tensive area of the country. 4. More than 200 communities in the states of Colorado, Montana North Dakota, South Dakota, Utah, and Wyoming already have experienced some impacts as a result of energy developments. 5. Many more communities will be involved as additional energy resources are developed. -1- ------- 6. One consequence of industrial activity has been the rapid growth of communities. Data for the state or regional populations do not always re- flect the extent of growth in the affected communities. 7. However, the impact on individual communities is tremendous-- in some communities the population has more than doubled in three or four years. 8. Rapid growth of any community, especially small ones, may quickly exceed the capacity for providing personal and govern- mental services. 9. Inadequate services may give rise to a variety of problems that adversely affect personal and community health. Poor sanita- tion, disease, mental illness, crime, and accidents are just a few examples. 10. When all available housing is occupied, newcomers make what temporary arrangements they can. 11. Inadequate water supplies and facilities for sewage disposal may result in increases of communicable diseases. 12. Accummulation of garbage and other solid wastes may harbor rats and insects. -2- ------- 13. Crowding and other adverse living conditions often result in stress. 14. The need for mental health services has increased as much as tenfold in some areas. 15. Rapid population growth also is associated with increases in crime, deliquency, alcholism, child abuse, and other anti- social behavior. 16. In fact, the list of problems and the services that may be affected is long indeed. Housing, Schools, Recreation, Medi- cal and Health Services, Law Enforcement and Public Safety, Water Supply, Sewage Disposal, Solid Waste Disposal, and Transportation are among the most prominent. 17. The principal concern in this discussion is how to avoid or eliminate undesirable health effects. One must recognize, however, that health is influenced by a variety of factors. 18. In fact, most, if not all of these services and problems, are interrelated. What we have to say about health effects applies generally to many other concerns. -3- ------- 19. In considering ways to deal with undesirable health effects, we should look at three types of information: --First, the characteristics of the communities and the way of life of the people that live in them. --Second, the types of health effects that may occur as a result of energy developments and the possible conse- quences of conditions that may develop. --Finally, we want to consider some of the things that may be done to avoid adverse conditions or to eliminate problems that already have occurred. 20. Let's look at some of the prominent characteristics of the communities that will be affected by energy developments. 21. In the first place, most of the communities are small. More than half have, or originally had, less than 1,000 residents; and more than 80 percent have, or had, population of less than 2,500. 22. Larger centers of population, over 25,000 persons, are widely scattered and the majority of communities are not within two hours driving time of a city of such size. 23. The population in most of the communities was stable or de- clining during the previous decade. -4- ------- 24. The way of life has been generally quiet. Many residents have lived in the community all of their lives and most have been satisfied with the way things are, or were. 25. Community and personal services have evolved to meet the de- sires and expectations of a stable population. The way of life in most communities reflects a strong desire to preserve the integrity of the environment and a tranquil life-style. 26. Energy developments inevitably bring changes to these com- munities . 27. There are more people. The age distribution of the population usually changes. More community environmental services are needed. The need for government services increases, and the newcomers may be accustomed to more services than have been provided in the community. -5- ------- 28. As indicated earlier, many of the changes may result in con- ditions that affect the health and well-being of both the old and new residents. For our purpose, these health effects may be considered as two types: 1. Effects attributable to the industrial processes. 2. Effects associated with the rapid growth of communities. 29. The control of pollution that may.result from industrial ac- tivities is a state and Federal responsibility. The occurrence of adverse health effects from such sources is unlikely if existing air-quality and water-quality regula- tions are enforced. 30. By far the most significant health effects that have been, or may be, experienced by energy-development impacted communi- ties are those associated with rapid population growth. These effects are of two types: 31. --Those that impact community environmental services, and- 32. --those that have direct adverse effects on people. 33. The community environmental services that are affected most often include water supplies, 34. sewage disposal, 35. and solid waste disposal. -6- ------- 36. Direct adverse health effects on people include: --increase in rates of mental illness, --increase in alcholism and drug abuse, --increase in accidents, and —lack of adequate health and medical service. 37. Let's now consider ways to avoid or to reduce some of these objectionable health effects. 38. Examination of some impacted communities reveals that many problems have been dealt with satisfactorily. 39. For example: --Timely expansions have been made of water supplies and sewage disposal systems, 40. --sanitational services have been developed, 41. --health facilities have been provided and staffed. 42. There are, however, many communities that still face substan- tial problems and, some that have not been as successful as other communities in solving their problems. Why the difference in the effectiveness of response by various communities? -7- ------- 43. In one word, the answer is PLANNING. 44. When the first communties were affected by the current surge in energy developments, there simply was not enough time or resources for adequate advance planning. Officials and the general population had little alternative to reacting in the way that seemed best to handle emergencies or problems that appeared to be most urgent. 45. There was much uncertainty in the early days. Sometimes, communities were not aware of impending industrial activity far enough in advance to do much about it. 46. Data on schedules for construction, size of work forces, and anticipated number of permanent residents often were inaccu- rate or not available. 47. Few of the smaller communities had the trained personnel to do the planning. Sometimes community leaders lacked the knowledge or will to take appropriate actions. State and regional organizations in some areas, were not suf- ficiently developed to provide needed consultation and other assistance to the communities. Planning money was difficult to come by, especially "front end" money. -8- ------- 48. For whatever reasons, either lack of planning or wrong deci- sions resulted in costly problems for some communities. --Permanent sewage treatment facilities were built to service temporary residents. The "permanent" residents now must pay the bonded indebtedness. --Installations of more costly water distribution sys- tems than were necessary to accommodate temporary pop- ulation have been made. --Hospitals and clinics, built to attract doctors, or for other reasons, are inappropriate for the needs of the community and cannot be staffed. Still, they must be paid for even though they can't be used effectively. --Some communities have spent large sums in attempts to recruit physicians when having a physician in residence was not the best way to provide the needed services. -9- ------- 49. Adequate community planning to cope with the adverse health effects associated with energy developments depends upon several factors: 50. -- 1. Notification of plans for industrial developments far enough in advance so necessary planning can be accom- plished and necessary actions taken. 51. --2. Initiation of planning in the communities early enough to allow time for appropriate arrangements before im- pacts develop. 52. --3. Development of an organization with the necessary ex- pertise and experience to deal with both technical and social aspects of problems. 53. --4. Preparation of a plan based on objective evaluation of problems, consideration of available alternatives, and practicality of timely implementation. 54. --5. And, obviously the plan must be implemented in time to accomplish its purpose. 55. All of this may seem overwhelming to some communities. There are many questions: --Who is going to do it? --Is help available? --How to get started? --What is the first step? -10- ------- The most important thing to remember is that the planning must be a community process. Although the elected officials are required to make many of the decisions, the general public must contribute ideas and express preferences. In all probability some technical assistance from outside the community will be needed. Still, the citizens of the community must indicate what they want and understand the things the professional planners do. The plans produced will be useless unless they are what the community needs, and unless local people can carry them out. -11- ------- 57. So, the first task is either to organize a Community Impact Committee, or to augment the existing local planning organi- zation. The Community Impact Committee should include representatives of the various organizations and publics concerned with the consequences.of energy development. For example: elected officials, professional organizations, volunteer agencies, industrial organizations, farming and ranching interest, and many others should be involved in work of the Committee. Also, inclusions of persons from outside the community may be desirable. For example: representatives from Federal, state, or regional planning agencies, and technical experts should be included. 58. At a very early stage the Committee should determine what assistance is available from state and regional agencies. Although the names of the agencies vary among the various states, every state in the Rocky Mountians-Prairie Region has an energy office, a state planning office, a department of local affairs, an agricultural extension.,service, and others-, depending on the specific state. -12- ------- 59. In addition, every state has operating departments concerned with health, transportation, sanitation, public safety, and other areas. 60. In many states, various university departments have special programs for communities impacted by energy developments. 61. Joint planning agencies have been organized at the sub-state level. 62. With regard to health planning, each state has a State Health Planning and Development Agency and each area of the state is served by a Health Systems Agency that has the responsibility for health planning. 63. Although the extent of assistance varies among the states, there is a great deal of specialized help and counsel avail- able for the asking. 64. The Community Impact Committee will probably want to organize into a series of task forces or work groups depending on local needs and desires. For example: various communities have developed groups con- cerned with health services, emergency medical services, rec- reation, law enforcement, ana communtiy environmental services. -13- ------- 65. As work progresses, work groups may be formed to gather data, conduct surveys, and perform other basic tasks to support work of other task forces. In some communities special surveys have been conducted to determine specific desires or perceived needs of the citizens. 66. In organizing the Committee and the individual work groups, advice and guidance should be sought from the professional planners and the responsible state and regional agencies that have been over the ground before. 67. Fortunately, a great many examples are available from which ideas can be obtained as to various ways to proceed, and, in some cases, ways not to proceed. 68. The planning procedures must be tailored for each individual area. The process really isn't complicated as long as we remember that mistakes, and often expensive ones, may be made if the planning group simply votes on "solutions" before the problem is defined and objectives are established. Ask the. planners! They can give a lot of examples to illus-< trate that decisions based on results.of orderly planning are easier to live with than are intuitive actions. -14- ------- 69. For instance, the proper location of health and medical facil- ities is a very complex matter. The specific needs of the community must be taken into ac- count. The scope of services required to meet these needs must be determined. Then the type of facility in which these services should be provided can be decided. Ask the health planners before investing a lot of money in a facility that may not be necessary--and won't do the desired j ob anyway. 70. Health and medical services must be planned on a regional basis. This assures that adequate services are available and acces- sible to persons who need them. And equally important, the providers of health services-- physicians, nurses, physicians assistants, pharmacists, and the rest of the team--have access to the needed supportive services. 71. Efficient health services can be provided only by a team--not just an individual. Much money and effort have been spent in attempting to recruit personnel without planning for other essential components of the system. -15- ------- 72. Experienced organizations are available to plan the medical and other personnel requirements based on the defined needs of a community. 73. Such needs must be met effectively--to the satisfaction of the residents--without excessive, unnecessary costs. The main consideration is to provide the needed health ser- vices in a manner that is practiced and acceptable in each community. 74. The process of planning health services, and making other provisions to cope with impacts is not easy. But it can be done effectively through cooperation of the community, in- dustry, and governmental agencies. 75. To summarize: - Communities must be aware of firm schedules for energy developments far enough in advance to make adequate preparations. 76. - Community planning must be initiated as soon as plans for energy developments are definite. 77. - A community impact committee must promptly be organized. This committee must include representatives of all in- terests, the general public, and technical experts. -16- ------- 78. - Plans to avoid impacts must be developed. 79. - And action must be taken before undesirable conditions develop. 80. When a community becomes aware that rapid population growth will occur, organization for community planning should begin at once. The first step is to get in touch with the state and regional planning offices. If information is needed regarding these offices, write or call the Office of Energy Activities, U.S. Environmental Pro- tection Agency, Denver, Colorado 80203. 81. The end. Grateful acknowledgement is made for slides provided by the fol- lowing : Basin Electric Power Cooperative. Slides 40 and 76 Maricopa County Department of Health Services, Slide 35 Utah Valley Hospital. Slides 65, 74, and 77 -17- ------- R8 190 COPLEY INTERNATIONAL CORPORATION Economic Research • Marketing Research • Environmental Research • Management Services 7817 HERSCHEL AVENUE LA JOLLA, CALIFORNIA 92O37 ------- |