Including health in environmental impact assessments of three mega transport projects in Sydney, Australia: A critical, institutional, analysis

This article details how health impacts came to be assessed in three mega, billion dollar, transport infrastructure projects, two road tunnels and one light rail, in Sydney Australia. The known health impacts of transport decisions include environmental, behavioural and social factors. EIA practice prioritises environmental risks, and there has been scant attention to understanding why this is persistently the case. Here we provide a critical theory lens, using critical realist methodology, to analyse empirical data collected through interviews and documents for the three cases. Our analysis focusses on EIA practice within its institutional context, building on 'new institutional' approaches to policy analysis that emphasise actors (the stakeholders involved in the EIA), structures (the 'rules of the game' that influence practice in systems), and power. We find that the various actors engaged in the EIAs principally to address particular goals that were pre-determined by the system in which they worked or belonged. Structurally, each EIA was undertaken as a compliance process relatively late in the planning process. Considering project options was not part of the ETA's purpose. Resources to undertake the EIAs were provided by those funding the projects ("the proponents") and determined the types of issues to be considered. The full range of links between transport and health were not identified. Concerning power, health impacts were considered through inter-professional technical negotiation. The inability to engage in the fundamental options driving projects meant impacted communities questioned the validity of the EIA, and the health assessment within this. Our institutional analysis provides important knowledge about how the EIAs preferenced a focus on specific health risks to the detriment of the known broader determinants that shape the health impacts of transport.