The CSG arena: a critical review of unconventional gas developments and best-practice health impact assessment in Queensland, Australia

Abstract

This paper compares a government-commissioned health study of coal seam gas (CSG) developments in Queensland with international best-practice health impact assessment (HIA) methodologies. A literature review was conducted of (HIA) methods and health studies of CSG development areas in Queensland. Forty-eight interviews were conducted in the Darling Downs CSG region in Queensland. One Queensland Health report was identified but failed to meet HIA international best practice because 7 of 9 key steps were omitted. Interview participants reported poor consultation by government and industry within affected communities. Lack of and poor quality health data was found to exacerbate community tensions. We recommend application of HIAs, epidemiological studies, consultation with communities and consideration of social risks of poor quality health studies.

Keywords:

• Health impact assessment
• coal seam gas
• community response
• Queensland

Introduction

There is widespread political support for exploration of unconventional gas to reduce dependency on foreign energy. Unconventional gas, previously believed too costly to access, is increasingly viewed as a viable energy source globally. Unconventional gas occurs in layers of shale (e.g. Marcellus Shale in the US), tight sands and coal seams and, compared to conventional gas typically extracted with few wells, requires many wells drilled into shale. Australian coal seam gas (CSG) is predominantly extracted in the Surat and Bowen basins in Queensland, with 40,000 wells planned. It entails drilling gas wells in grid-like patterns, depressurizing the coal seam, and potentially using hydraulic fracturing (‘fracking’) technology.

CSG developments in populated and agriculturally productive regions, such as the Darling Downs in southern Queensland, have led to complex social and land use conflicts, including vociferous contestation of emerging ‘agri-gas fields’ (de Rijke 2013c). CSG extraction in New South Wales and shale gas extraction in western and northern Australia are also scheduled.

Our paper concentrates on unconventional gas developments and associated health impact assessment (HIA) practices in Queensland. We identify best-practice HIA methodologies that we compare to the only publicly available health impact study in Queensland. We use ethnographic data to identify community perspectives on CSG development, discuss implications for CSG debates of lack of scientific information, and make recommendations.

Unconventional gas: reported concerns

Concerns with unconventional gas developments include air and water quality, human and environmental health, poor regulatory frameworks, inadequate social impact assessment, poor compliance and transparency, and poor industry disclosure of chemicals used in extraction (Schmidt 2011; Bamberger and Oswald 2012; McKenzie et al. 2012; Hamawand et al. 2013; de Rijke 2013b). US environmental health experts have highlighted absence of health professionals in extraction policy debates (Goldstein et al. 2012), while others have advocated for application of the precautionary principle because of absence of impact data (Finkel and Law 2011). Korfmacher et al. (2013) argued that a holistic public health approach to resource extraction contributes to improved impact assessment, risk management and prevention (Korfmacher et al. 2013). Others suggest availability of new extraction technologies that allow expansion of access to previously inaccessible fields has created a lag between gas developments and health studies (Steinzor et al. 2013). US public health doctors argue that political support for gas developments and declining independence of public health institutions have impeded rigorous health impact studies potentially contributing to better practice, safety and, ultimately, to greater viability of the industry (Goldstein 2013). A British public health study on shale gas extraction recommended greater investigation of health impacts (Public Health England 2013). However, a critique of this report highlighted the importance of conducting independent long-term studies that consider risks inherent in specific contexts of extraction (e.g. population density) and warned against assumptions that existence of regulatory frameworks necessarily led to health studies (Law et al. 2014).

Australian scientists are concerned about measured fugitive gas emissions in Queensland gas fields (Santos and Maher 2012), calling for baseline studies to be undertaken. The Australian Medical Association has called for monitoring, independent risk assessments (Australian Medical Association 2013a) and air quality checks (Australian Medical Association 2013b). The New South Wales Chief Scientist recommended health professionals monitor psychosocial well-being and mental health in extraction areas (O’Kane 2013). Subsequently, in a review of the CSG industry in NSW, the Chief Scientist made 16 recommendations, including creation of an independent regulator and a management plan for potential impacts (O’Kane 2014). Advocates have raised concerns about associations between poor health and CSG extraction in Queensland gas fields (Lloyd-Smith and Senjen 2011; McCarron 2013; National Toxics Network 2013).

Health impact assessment: background

Measures to gauge public health at national and international levels grew in tandem with concerns about differential health impacts of developments on populations. Health regulation is associated with democratic principles of equity and social protection. The US National Environmental Policy Act (1969) was enacted because of consequences of DDT (the ‘Silent Spring’). The Lalonde Report (Canada) addressed environmental issues affecting population-level well-being and health outcomes (Lalonde 1974). The UK Black Report (1980) on health equity associated lower social class and occupation with poorer health. The World Health Organization policy ‘Social Determinants of Health- The Solid Facts’, emphasised the importance of social equity for good health outcomes (Marmot and Wilkinson 2003). Similarly, establishment of the International Association for Impact Assessment (1980) aimed to address potential health inequity produced by change. The Gothenburg Consensus Paper (European Centre for Health Policy 1999) and the Merseyside Guidelines for health impact assessment (Scott-Samuel et al. 2001) arose from concerns with health equity.

While aspects of the Gothenburg and Merseyside HIA approaches have been adopted by international organisations (International Finance Corporation 2009; International Council on Mining and Metals 2010), their application depends on project objectives, legal frameworks, compliance and other factors. As Lock (2000) noted, HIA is:

A means of evidence-based policy making … [employing] a combination of methods whose aim is to assess the health consequences to a population of a policy, project, or programme … [and which uses] a multidisciplinary process within which a range of evidence about the health effects of a proposal is considered in a structured framework.

A comprehensive HIA includes biological factors, prenatal conditions, behavioural factors, psychosocial environment, physical environment, socioeconomics, public services and public policy (Lock 2000). HIA ‘enhances recognition of societal determinants of health and of intersectoral responsibility for health, but pitfalls of HIA warrant critical attention’ (Krieger et al. 2003). HIA’s greatest power is indicative and suggestive rather than conclusive because it identifies key areas for investigation but is typically too short-term and methodologically constrained to offer population-level studies (the preserve of epidemiology) and to segment sample populations according to vulnerabilities that influence the health outcomes of change (social differentiation). As a first ‘gateway’ step toward broader studies, HIA is an important instrument in the ethical investigation of health effects of developments, but ideally considerations of health should be integrated into the design of SIA and SEA in order to gather health impacts in the short term. This is sometimes possible to do if there is availability of routinely gathered health data in areas under development and/or if it is possible to include a measurement instrument into the SIA or SEA.

A comprehensive HIA requires cooperation between sectors and should be integrated into cognate areas of impact: social impact assessment (SIA), environmental impact assessment (EIA) and risk assessment. Negev et al. (2012) argue that cooperation between environment and health institutions and coordination of measures provides opportunities to comprehensively address health impacts to inform policy and planning.

Recently, the Faculty of Public Health in the United Kingdom (www.fph.org.uk) issued a report emphasising the importance of structuring investigations of impacts on human health through determinants of health and well-being framework that is inclusive of the multiple factors and contexts that impact human health (Cave et al. 2017). We will discuss this new framework below.

Similarly, the oil and gas industry has recently issued a guide for HIA which highlights the importance of Strategic Health Impact Assessment (SHIA) as a tool to include health in strategic decision-making within the development process (IPIECA-IOGP 2016). While each HIA framework emphasises specific aspects of the health impact process, they all agree on the importance of standard and reproducible mechanisms for gauging human health effects of developments.

Queensland CSG health impact assessment

The Queensland Government guidelines on HIA provide a six-step approach and an assessment matrix for practitioners (Queensland Health 2003). HIA guidelines are based on social impact assessment principles and steps (Queensland Government n.d.), but enforcement procedures are unclear. Below we summarise international best-practice HIA and compare these methods with the only health study of CSG developments commissioned by the Queensland Government (in the Darling Downs). The analysis is augmented by ethnographic field data obtained in the same area.

Methods

Keyword web searches of international best-practice guidelines for HIA and actual HIAs of CSG developments in Queensland were conducted. Keywords included ‘coal seam gas’, ‘Queensland’ and ‘health’ using the Google search engine. We excluded reports not commissioned by the Queensland Government such as by advocacy groups and media releases. Four documents were found: Queensland Government guidelines for HIA; a report by the Darling Downs Public Health Unit (DDPHU) examining reported health complaints related to CSG; a report on health effects of CSG in the Darling Downs by a consultant commissioned by Queensland Health, and another longer report focusing on risk assessment of health complaints and environmental monitoring data in the same area commissioned by Queensland Health. This latter report incorporated both the DDPHU and privately commissioned reports, which in effect left only one document to examine and compare against international HIA best-practice. Further, we conducted 48 interviews with cattle, crop, and cotton farmers with and without CSG infrastructure on their land, town and gas field residents, anti-CSG activists, businesspeople, government representatives, and Aboriginal people. These interviews were done within the scope of ethnographic research on impacts of CSG within local communities. Recruitment was achieved by purposive and snowball sampling. Topics included personal biographies, land and water use, attitudes to, and personal experiences of, CSG developments, and views on community dynamics and future scenarios. Responses were audio-recorded, transcribed and thematically coded (Ezzy 2002). Ethical clearance was obtained from the Human Ethics Office, The University of Queensland.

Results

Health impact assessment best-practice

HIA is methodologically similar to social impact assessment (SIA) and includes an iterative process: screening, scoping, identification and assessment of impacts, decision-making and recommendations, evaluation, monitoring and follow-up. In recent times consideration for health has also been included in strategic impact assessment (SEA) after the European Directive 2001/42/EC on SEA and the Protocol on Strategic Environmental Assessment. According to these agreements, health is to be considered alongside biodiversity, fauna, flora, soil, water, air, climactic factors, material heritage, landscape and populations. However, as Fischer et al. (2010) found in their evaluation of eight SEAs, consideration of health varied with regard to terms of reference and methodologies used to gauge health impact. The authors suggest ‘a more consistent consideration of health aspects in SEA could be facilitated by SEA which acts as an integrative tool for consistency between plans of different sectors and levels of decision-making’ (Fischer et al. 2010, 207). While, there are very good best practice frameworks for including health in impact assessments, their application varies across geographical regions and development sectors, including mining. For example, a working group of North American HIA practitioners suggest a list of minimal elements in HIA as best-practice (Bhatia et al. 2010) which are valuable but not enforceable.

While various industries have HIA frameworks, three key documents are accepted as blueprints in the extractive industries sector. The first two documents serve as prescriptions for HIA in all sectors, while the third document specifically relates to the mining sector.

The Gothenburg Consensus paper (European Centre for Health Policy 1999) (Figure 1) proposed guidelines based on democracy, equity, sustainable development, ethical use of evidence, evidence-based methods, community voices, evidence-based decision-making and mitigation of negative effects of change. This approach was augmented by the Merseyside guidelines (see Figure 2). The International Council on Mining and Minerals (ICCM) derived their current HIA framework from both Gothenburg and Merseyside approaches, while the Gothenburg framework has been more influential in this framework in terms of providing philosophical orientations (International Association for Impact Assessment 2006) (Figure 3).

Figure 1. Gothenburg HIA framework.

(Source: European Centre for Health Policy (27)).

Figure 2. Merseyside guidelines (HIA stages).

(Source: Scott-Samuel, Birley (28)).

Figure 3. ICMM framework.

While these three frameworks set standards for HIA, in practice health impacts are often assessed within legislated EIAs. To this end, and in consideration of recent changes to the European Union EIA Directive that prescribes inclusion of ‘human health’ in EIAs, the Faculty of Public Health (FPH) in the United Kingdom issued a report proposing a multiple-level framework to gauge health impacts of developments. The authors emphasise a methodology that includes standard health outcome measures (e.g. on respiratory health or mental health) rather the currently used noise levels or air quality that are, in fact, the putative environmental determinants of health outcomes. The FPH framework is illustrated in Figure 4.

Figure 4. Determinants of health and well-being (FPH, UK).

In summary, best-practice HIA guidelines encompass a range of details based on shared values, participatory approaches and development contexts. The Gothenburg and Merseyside frameworks particularly emphasise analyses of health determinants and are incorporated into the HIA protocols of governments (Health Canada 1999, Commonwealth of Australia 2001), the mining industry (International Council on Mining and Metals 2010) and international organisations. The new framework advanced by the FPH proposes a holistic multi-level determinants approach in which health status is gauged through standard health outcome measures.

HIA frameworks evolved to include six areas influencing health: biological factors (age, sex, genetic factors); personal/family circumstances and lifestyle (family structure, education, occupation, risky behaviours, transport and leisure); social environment (culture, discrimination, supports, community participation); physical environment (air, water, housing and working conditions, communications, land use, energy, local environmental features); public services (access and quality of healthcare, childcare, social services, transport, policing); public policy (economic/social/environmental/health trends, local and national priorities, policies, programmes, projects) (Scott-Samuel et al. (2001).

The Equator Principles, which refer to the IFC Sustainability Framework, stipulate that community health, safety and security must be considered in new developments (Equator Principles 2013). These approaches are accepted as international best-practice but their application and effectiveness depend on local legal frameworks. Australia is listed as a designated country by The Equator Principles Association and regarded as having ‘robust environmental and social governance, legislation systems and institutional capacity designed to protect their people and the natural environment’ (Equator Principles 2013). Whilst the Equator Principles are a voluntary framework adopted by companies within their corporate social responsibility approaches, and thus not legally enforceable, we highlight the fact that Australia is designated as a good-practice country by this network and could follow the principles more closely in its health studies. In the state of Queensland, however, the terms of reference for SIAs have recently been modified to ‘cut red-tape for major resource projects to proceed in the state’ (Seeney 2013), leading to questions about the robustness of environmental and social governance (de Rijke 2013c). Against this background of regulatory guidelines and CSG developments, we discuss the only publicly available HIA of CSG developments commissioned by the state in Queensland.

Queensland health report

The Queensland Health report was commissioned after health-related complaints by residents living close to CSG fields in the Darling Downs, and investigated three issues: known health complaints, known environmental health factors, and the likely relationship between residents’ health complaints and documented impacts of CSG extraction (Queensland Health 2013). Methods included reviews of pre-existing environmental studies, a report contracted from Medibank Health Solutions Pty Ltd on behalf of Queensland Health, a private health company operating throughout Australia, and a report from the Darling Downs Public Health Unit (see Table 1) (Hutchinson 2013) (Adam 2013). The latter two reports were initially commissioned by Queensland Health and then later incorporated into the final health report discussed herein.

Table 1. Methodology (components) of Queensland Health report compared with the ICCM Framework.

Reports analysed	Methods	Results and interpretations
Darling Downs Public Health Unit (DDPHU) report	1. Reports of health providers in the region in regard to clinical presentations of complaints of adverse reactions to CSG	Prevalence of complaints: 3.7% (calculated by comparing complaints: 34 headaches, 18 sore itchy eyes, 14 nosebleeds with total population of Wieambilla area of 1257
	2. Self-report by patients	Complaints are non-specific and have multiple causes
	3. Follow-up with patients	Lack of finding on clinical examination
	4. Mapping of households reporting symptoms relative to location of CSG wells	Low prevalence of reported symptoms
	5. Liaison with mining companies with regard to reports of health complaints	No similar patterns of symptoms reported amongst mines regarding mine employees
	Sample size: N = 56	Possibility of other environmental exposures
		Lack of information on hazard at levels that may cause health problems
The report of a medical doctor contracted by Medibank Health Solutions Pty Ltd	Clinical examination	Complaints similar to earlier DDPHU reports; did not find evidence of nosebleeds, and could not attribute reasons for other complaints; no relationship between CSG activities and health complaints
	Sample size n = 23
Air monitoring		Concentrations of analytes were too low to be associated with CSG activities
Water monitoring		No significant levels of toxins found in either dam or roof-harvested rainwater
Soil monitoring		No significant levels of toxins found in soil analysed
Noise monitoring		Possible annoyance due to low frequency noise attributed to a CSG processing facility.
Fugitive gas emissions (methane, carbon dioxide and radon)		All levels below scientifically accepted values; no relationship with health complaints

Comparison of Queensland health report with the ICCM framework

Of the nine steps within the ICCM HIA framework, only two were adopted within the Queensland Health report. These were the fifth and sixth steps, health impact evidence gathering and analysis of health impacts. Screening, scoping, community profiling and baseline studies, stakeholder and community involvement, mitigation and enhancement measures, HIA reporting, and development of a health management plan (monitoring and evaluation) were not included.

The Queensland Health study established no association between health complaints of residents and CSG activities, however, the study did not follow HIA guidelines. The analytical framework of the report was unclear purporting to conduct a risk assessment, an evaluation of residents’ health complaints, and a review of existing health and environmental data without using established frameworks. The study was methodologically poor: the inclusion/exclusion criteria for selected reports were not disclosed; there was no participatory component to set terms of reference; with regard to the clinical data, it was unclear whether comprehensive patient histories were recorded and blood tests and/or imaging conducted on patients in either the contracted Queensland health report or the DDPHU reports included therein; results were not shared with the community for feedback; and no health strategy was developed for the target area. The report found no association between residents’ health complaints and CSG extraction activities, suggesting these may have resulted from solastalgia, a form of psychological distress related to rapid environmental change (Albrecht et al. 2007). The report did not claim to be exhaustive nor methodologically sound, but it is the only publicly available Queensland Health report about human health and CSG developments.

While this report does not state it is a HIA, its commissioning by Queensland Health, the state government health department, and the fact that it is the only publicly available study of health impacts of CSG suggests that it would have been conducted according to best practice principles. This was not the case, and the report did not adhere to any discernable best-practice health impact guidelines as expressed in various frameworks including the ones we cite because of its vague analytical framework and imprecise methodology. The Gothenburg Consensus and Merseyside Guidelines stipulate screening/scoping phases and investigation of six key areas (Table 1), which were not followed. The ICCM framework derives from both these approaches and is applied within the mining industry. Further, the Equator Principles stipulate that health impacts should be investigated using appropriate methods, which were not used in this case. Conversely, our ethnographic study captured perceptions and experiences of community members in this area, which complemented, and highlighted flaws in the Queensland Health study.

Qualitative field data

In best practice HIA, a participatory approach (Merseyside Guidelines) captures community views on health impacts of developments. Our study identified key health concerns, perceptions of disrespect from health and industry workers, and local conflict fuelled by differing views of CSG health impacts.

Health complaints have been reported since CSG operations commenced in the Wieambilla rural residential estate (Darling Downs). Residents are locally known as ‘blockies’, a derogatory term referring to migrants in search of alternative and affordable rural lifestyles. The blocks of land they purchase, between 20 and 100 acres, are marginal farming land and dwellings have minimal amenities (electricity and reliable water supply). Roads in the area, Happiness Road and Lucky Road, represent the quest for alternate lifestyles. A number of residents have physical disabilities, are unemployed and moved to Wieambilla for cheap land.

Fieldwork amongst residents identified debates concerning human health impacts of CSG and the Queensland Health study. Participatory approaches to HIA prescribe gauging residents’ views and knowledge in planning and assessment of health impacts. To inform such an approach, we describe key issues articulated by residents. It is noteworthy that the residents themselves found it necessary to set up a gas field community support group to represent health concerns of residents.

Residents expressed concern with the safety of residing close to CSG infrastructure. Reported health complaints included severe skin rashes (photographed by residents), nosebleeds, headaches and loss of sense of smell. One resident described her views as follows:

We’re asking: ‘Is CSG safe?’ Nobody’s prepared to answer that. So Queensland Health’s [response was about] walking across the road, that’s how they’ve put it: ‘Is walking across the road safe?’ What we’re asking is: ‘Is it safe to live in a gas field?’ … but nobody’s prepared to say it’s safe. … It’s not good when you’ve got bore water that burns. [Another resident] said it has a vapour, she says ‘You run the water in the bath and you let it sit and it’s got this vapour, not steam, vapour. She said … it gives you headaches.

While residents and representatives of government and industry have gathered air quality samples, residents questioned their reliability because of variability in environmental conditions and lack of standardisation in industry practices. As one resident explained:

[The health professionals are] saying: ‘Oh, they’re low levels [of toxic substances], nothing to worry about’, but they’re not keeping in mind that it’s a thirty second air sample. So what is in our air? … We used to smell [unfamiliar odours] a lot. I don’t smell anything anymore. We have people here who say: ‘Can you smell that?’, and my sense of smell is gone. And with that even [another resident], he doesn’t smell as much anymore but cause he gets nosebleeds every second day so he just sets them [the air quality canisters] off; if the symptoms are bad he’ll just set it off. What I’ve been asking for all along is permanent, independent air monitoring; permanent stuff so they know that if there’s a problem, cause we’ve got the compressor station that end with all their flares and associated ponds and what not. We just found out there’s a flare the next road over. I’ve sent off emails wanting to know the locations of ponds and their flares and all that and who’s testing them cause as far as we know only the companies test it. So, depending on the wind direction which, sitting here, it can be any direction lately, yeah, the symptoms are always worse.

With regard to the health of gas workers, residents believed that their exposure was limited:

They get blood tested and then they have so much time off that they’re not living it, you know, they’re an eight-hour day. And they say the workers in the camps, well they’re not there all that time like we are and they get to go home so they’re getting that break between exposure. Like, we leave the area: we’re fine. You get that break, you come back: you get sick again

Additional to concerns about adequacy of measurements and context of exposure, informants also perceived health professionals as disrespectful, untrustworthy and lacking independence:

The other family, they had high levels of cadmium or something like that in their dam and [a health professional said]: ‘Well, you must’ve thrown batteries in your dam.’ You know just really stupid stuff. So [the CSG companies] tried to push to get their doctors to do medical testing. They did approach a family but we decided that, no, we’re not going to give CSG companies access to our children … I suppose you need a third party to do all this. So whereas you may have companies paying for it, but have a non-government organisation, one of the churches for instance, to do all this so that [the CSG companies] do not have access to that third party.

Health concerns are part of local social politics represented by tensions between industry supporters (usually long-term residents) and migrants to the residential estate built in the 1980s, and are exacerbated by contemporary disputes about CSG health concerns (de Rijke 2013a). For example, an estate resident said:

[People in town are] just blaming us for our own health impacts. [They say]: ‘It’s hygiene, blah blah blah.’

Confirming local tensions, a town supporter of CSG development argued:

What the blockies [i.e. newcomers] are doing is they’re blaming their kids breaking out in sores because of the gas game. And they’re sick. Mate, I have been sniffing gas now for 12 years, I’ve suffered no mental psychosis, I’m not breaking out in any fuckin’ sores. All the drillers, all the people that work, it is not the case that it makes you sick. Now what it is … a few of them have admitted that they just want money, big bucks to get out. So they figure if they make enough noise they can get out … they want to be able to grow their pot in peace, they wanna have their little meth labs ticking over quietly in the bush and want to get around in their unregistered car and poke around discreetly, but this has brought so much activity to their field that they’re making a big deal of it. Now as far as all the illnesses and sickness go; crap. It’s absolute crap.

Thus, health complaints reported by informants living close to CSG fields constitute a contested arena, partly informed by pre-existing social tensions between the settled population and migrants, and industry supporters and opponents.

Discussion and recommendations

Health experts have expressed concerns about health impacts of unconventional gas developments in populated regions; however, these are energy resources welcomed by governments as alternatives to foreign fuel dependency (Finkel and Law 2011; Goldstein et al. 2012; Coram et al. 2014). Australia has substantial deposits of CSG, political will to facilitate extraction, and a ready resources industry. Despite the existence of international guidelines, HIAs of extractive industries are not systematically undertaken, resulting in lack of studies using best-practice methodologies and lack of baseline and impact data. As Watterson and Dinan (2016) highlight, standards for HIA vary across projects, regions and regulatory frameworks and are not free of politics. However, the core values of gauging health impact on affected populations remain central to the health impact process and must be translated through the various available HIA frameworks into practice. Frameworks such as SEAs suggest an iterative approach, which is compatible with the ethnographic approach we use in this paper.

The Australian Medical Association has called for better data on CSG health impacts. Currently HIA is not required for resource development approval and health-related studies, when conducted, may be subsumed under environmental or social impact assessments. While the Equator Principles designate Australia as a country with good legal frameworks related to social and environmental governance, these are not applied. The Darling Downs study here reviewed is characterised by poor methodology and should alert health professionals to the paucity of CSG health-related environmental and health data. The study illustrates the lack of regulatory initiative to enforce best-practice collection of baseline data. In Queensland, CSG extraction areas tend to be rural, have specific demographics not necessarily reflective of the general Australian population, and poor pre-existing health care infrastructure that complicate delivery of care and gathering of data. In light of our analysis of government approaches to health in a Queensland CSG arena, we highlight the following issues for consideration by governments, civil society groups and extractive industries:

(1)	Scientific rigour: we have identified a lack of knowledge of CSG-related science, and a lack of studies of health effects that consequently affect local perceptions and experiences of the industry. As we noted, poor knowledge fuels anxiety and exacerbates tensions within communities. As a first step, disclosure of chemicals used in CSG development and facilitation of scientific studies would fill current knowledge gaps. Baseline scientific studies are required;
(2)	Adoption of best-practice HIA methods: Comprehensive HIAs enable industry and governments to fulfil obligations to affected populations through consultation, identification of stakeholder concerns, data-gathering, harm mitigation and redress. Current governance regimes have allowed significant gaps in data to exist. Governments stand to benefit economically from CSG developments; however, poor data can lead to actual or perceived conflicts of interest. HIA is part of democratic processes in which consultation and equity are valued, supporting transparency and better disclosure of conflicts of interest. Importantly, HIA enables stakeholders to create a platform to articulate needs and perceptions and experiences of impact;
(3)	Epidemiological studies: investigation of patterns of illness and disease, and relationships between CSG-related chemical compounds and the health profiles of affected populations are needed. These studies will enable international comparisons of results and contribute to empirically rigorous data-driven policy;
(4)	Mixed-methods studies that identify and explain differential health impacts within affected population could identify specific vulnerabilities that highlight potential levels of risk and adversity within populations exposed to CSG developments. Doing so would permit comprehensive analyses and potentially more effective ways to mitigate harm and compensate for health problems;
(5)	The politics of CSG-related health: this arena is characterised by multiplicity of views depending on residence, experience, social networks, economic interests and potentially pre-existing health conditions and vulnerabilities. Diversified populations entail differential impacts.
(6)	The risk of not knowing: Beyond health impacts of CSG developments, studies must also consider the psychological impact of both environmental change and of poor knowledge of the processes by which that change occurs. While some residents in proximity to CSG infrastructure report substantial psychological stress, often framed as solastalgia (Queensland Health 2013) (Albrecht et al. 2007), physiological complaints also require urgent attention. Stresses and anxieties of lack of knowledge can precipitate poor decision-making such as the panic selling of land. A lack of knowledge can also contribute to entrenching views on all sides that do not maximise best outcomes for all. Community tensions in CSG development areas should not obscure the need to investigate health complaints using appropriate methods. If the Queensland Health report is an indication of investigative standards, significant improvements are required to enhance scientific rigour and rapport between investigators and residents. HIA provides a participatory framework to address outstanding issues that will otherwise continue to haunt CSG proponents, affected populations and the broader public. Doctors can participate by collecting clinical data in CSG-affected areas, advocating for better impact assessment, and collaborating in research on CSG and human health.

Disclosure statement

No potential conflict of interest was reported by the authors.