The work environment impact assessment: a methodologic framework for evaluating health-based interventions.
BACKGROUND: A new conceptual framework is needed to evaluate health-based interventions based on the premise that like the environment, workplaces are complex ecologies. The proposed Work Environment Impact Assessment (WEIA) is analogous to Environmental Impact Assessment (EIA), a concept and method developed 30 years ago in the environmental policy arena to evaluate potential consequences of human activity for the natural environment. WEIA entails identifying and evaluating both intended and unintended consequences, or outcomes, associated with a particular intervention. Because the workplace is a complex ecology, changes in one aspect may lead to changes in other aspects. WEIA calls for a systematic and comprehensive approach to the total work environment. METHODS: To illustrate the utility of WEIA we use this approach to evaluate an intervention to reduce the public's exposure to the pesticide Alar, which had been used on apples until it was withdrawn from the market in 1989. RESULTS: While this intervention did indeed reduce the public's exposure to Alar, it also led to other unintended consequences, namely new ergonomic hazards for apple pickers, increased stress levels in the orchards for both pickers and growers, as well as new worker, and perhaps public, exposure to potent neurotoxins. CONCLUSIONS: The goal of using WEIA is not to engage in a risk-risk debate that stalls worthwhile interventions. Rather, we propose that by conducting a Work Environment Impact Assessment, all possible positive and negative "ripple" effects stemming from an intervention can be considered, so that the intervention can be designed to achieve maximum benefit.