ABSTRACT
This chapter discusses the efforts to use the emerging practice of health impact assessment (HIA) to foster health equity in policy decisions related to the export proposals. The chapter explores efforts to evaluate the potential human health impacts of the export proposals and questions the emphasis on technical procedures that purport to definitively and/or quantitatively measure impacts of these large projects. It argues that the shortcomings of legally mandated impact assessment procedures, coupled with stakeholders' efforts to compensate for gaps in these procedures, create an environment where it is difficult to realize HIA's potential for promoting health equity in all policy decisions. As a consequence, advocacy for HIA's of coal export proposals may actually create a barrier to achieving its desired goal of elevating health and social equity concerns into the decision-making process. However, the political challenges of applying HIA to coal exports in the Pacific Northwest also demonstrate HIA's vulnerability to appropriation.
