Advancing health integration in environmental impact assessments: lessons from the Free State Province, South Africa

Abstract

Environmental impact assessments (EIAs) are central to sustainable development, yet the integration of community health within these processes remains inconsistent across South Africa. This study critically examines how health dimensions are incorporated into EIA practice in the Free State Province, identifying procedural and institutional gaps that limit the consideration of community well-being. Using a mixed-methods design grounded in the social determinants of health (SDH) framework, the research analysed 343 environmental authorisations issued between 2010/11 and 2014/15, and interviews with 15 environmental assessment practitioners (EAPs). Quantitative document analysis assessed the frequency and specificity of health-related content, while qualitative data explored perceptions of public participation and institutional coordination. Findings reveal that only a minority of EIAs explicitly incorporated community health risks, with references largely confined to pollution and occupational safety, rather than broader determinants such as water quality, cumulative exposures, or healthcare access. Public participation was found to be procedurally adequate but substantively weak: approximately 40% of community submissions raised health issues, yet few were reflected in final authorisations. Barriers included technical language, limited feedback loops, and minimal cross-sectoral collaboration between environmental and health authorities. These shortcomings mirror patterns observed in comparable low- and middle-income countries such as Kenya, Ghana, and Zambia, where fragmented mandates and inadequate guidance impede health integration.

The study concludes that without systematic incorporation of health impact assessment (HIA) within the EIA framework, community health will remain marginalised in environmental governance. It recommends institutionalising provincial HIA screening tools, multilingual public engagement mechanisms, and interdepartmental accountability structures. Implementing these reforms would strengthen the legitimacy and equity of EIAs, aligning South Africa’s environmental management system with the WHO (2024) and the World Bank (2024) guidance on health-inclusive sustainable development.