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Susitna-Watana Hydroelectric Project Document
ARLIS Uniform Cover Page
Title:
Health impact assessment study, Study plan Section 15.8 : Initial study
report
SuWa 207
Author(s) – Personal:
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Prepared by NewFields
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Draft initial study report
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Series (ARLIS-assigned report number):
Susitna-Watana Hydroelectric Project document number 207
Existing numbers on document:
Published by:
[Anchorage : Alaska Energy Authority, 2014]
Date published:
February 2014
Published for:
Alaska Energy Authority
Date or date range of report:
Volume and/or Part numbers:
Study plan Section 15.8
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Draft
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viii, 83 p.
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Notes:
All reports in the Susitna-Watana Hydroelectric Project Document series include an ARLIS-
produced cover page and an ARLIS-assigned number for uniformity and citability. All reports
are posted online at http://www.arlis.org/resources/susitna-watana/
Susitna-Watana Hydroelectric Project
(FERC No. 14241)
Health Impact Assessment Study
Study Plan Section 15.8
Initial Study Report
Prepared for
Alaska Energy Authority
Prepared by
NewFields
February 2014 Draft
INITIAL STUDY REPORT HEALTH IMPACT ASSESSMENT STUDY (15.8)
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FERC Project No. 14241 Page i February 2014 Draft
TABLE OF CONTENTS
Executive Summary ................................................................................................................... viii
1. Introduction ....................................................................................................................... 1
2. Study Objectives................................................................................................................ 1
3. Study Area ......................................................................................................................... 2
4. Methods and Variances in 2013 ....................................................................................... 2
4.1. Project Overview and Issues Summary ............................................................ 3
4.1.1. Variances......................................................................................... 3
4.2. Phase 2: Baseline Data Collection .................................................................... 3
4.2.1. Variances......................................................................................... 4
5. Results ................................................................................................................................ 4
5.1. Project Overview and Issues Summary ............................................................ 4
5.1.1. HEC 1: Social Determinants of Health ........................................... 4
5.1.2. HEC2: Accidents and Injuries ........................................................ 7
5.1.3. HEC3: Exposure to Potentially Hazardous Materials ..................... 9
5.1.4. HEC4: Food, Nutrition, and Subsistence Activity ........................ 10
5.1.5. HEC5: Infectious Disease ............................................................. 12
5.1.6. HEC6: Water and Sanitation ......................................................... 13
5.1.7. HEC7: Non-communicable and Chronic Disease......................... 13
5.1.8. HEC8: Health Services Infrastructure and Capacity .................... 14
5.2. Baseline Health Conditions............................................................................. 15
5.2.1. HEC 1: Social Determinants of Health ......................................... 15
5.2.2. HEC 2: Accidents and Injuries ..................................................... 22
5.2.3. HEC 3: Exposure to Potentially Hazardous Materials .................. 24
5.2.4. HEC 4: Food, Nutrition, and Subsistence Activity ....................... 27
5.2.5. HEC 5: Infectious Diseases including STIs .................................. 28
5.2.6. HEC 6: Water and Sanitation ........................................................ 33
5.2.7. HEC 7: Chronic Non-communicable Disease .............................. 36
5.2.8. HEC 8: Health Services Infrastructure ......................................... 39
6. Discussion......................................................................................................................... 42
6.1. HEC 1: Social Determinants of Health ........................................................... 42
6.1.1. Summary ....................................................................................... 42
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6.1.2. Data Gaps ...................................................................................... 43
6.1.3. Interdependent Studies .................................................................. 43
6.2. HEC 2: Accidents and Injury .......................................................................... 43
6.2.1. Summary ....................................................................................... 43
6.2.2. Data Gaps ...................................................................................... 44
6.2.3. Interdependent Studies .................................................................. 44
6.3. HEC 3: Exposure to Potentially Hazardous Materials .................................... 44
6.3.1. Summary ....................................................................................... 44
6.3.2. Data Gaps ...................................................................................... 44
6.3.3. Interdependent Studies .................................................................. 44
6.4. HEC 4: Food, Nutrition, and Subsistence Activity ......................................... 45
6.4.1. Summary ....................................................................................... 45
6.4.2. Data Gaps ...................................................................................... 45
6.4.3. Interdependent Studies .................................................................. 45
6.5. HEC 5: Infectious Disease .............................................................................. 45
6.5.1. Summary ....................................................................................... 45
6.5.2. Data Gaps ...................................................................................... 46
6.5.3. Interdependent Studies .................................................................. 46
6.6. HEC 6: Water and Sanitation .......................................................................... 46
6.6.1. Summary ....................................................................................... 46
6.6.2. Data Gaps ...................................................................................... 47
6.6.3. Interdependent Studies .................................................................. 47
6.7. HEC 7: Chronic Disease ................................................................................. 47
6.7.1. Summary ....................................................................................... 47
6.7.2. Data Gaps ...................................................................................... 48
6.7.3. Interdependent Studies .................................................................. 48
6.8. HEC 8: Health Infrastructure and Capacity .................................................... 48
6.8.1. Summary ....................................................................................... 48
6.8.2. Data Gaps ...................................................................................... 49
6.8.3. Interdependent Studies .................................................................. 49
7. Completing the Study ..................................................................................................... 49
8. Literature Cited .............................................................................................................. 49
9. Tables ............................................................................................................................... 55
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10. Figures .............................................................................................................................. 75
LIST OF TABLES
Table 5.2-1. Social Determinants of Health Susitna-Watana Hydroelectric Study Area
Communities – Demographic Profile, 2010 Census ............................................................. 60
Table 5.2-2. Infant Deaths and Infant Mortality Rates for Mat-Su Borough and Alaska,
All Races, 2007 to 2009 ........................................................................................................ 61
Table 5.2-3. Adequacy of Prenatal Care for Females, by Race, 2009 ......................................... 62
Table 5.2-4. Infants Born to All Mothers Reporting Substance Use during Pregnancy, 2009 .... 63
Table 5.2-5. Teen Birth Rates among Alaska Natives and All Mothers, 2009 ............................ 63
Table 5.2-6. Potentially Affected Communities – Economic Indicators ..................................... 64
Table 5.2-7. Potentially Affected Communities – Education Indicators ..................................... 64
Table 5.2-8. Potentially Affected Communities – Household Characteristics ............................ 65
Table 5.2-9. Major Causes of Unintentional Injury Deaths, Mat-Su and Denali Boroughs,
Valdez-Cordova Census Area, Kenai Peninsula Borough and State of Alaska,
2007 to 2009 ......................................................................................................................... 66
Table 5.2-10. Leading Causes of Unintentional Injury Deaths among All Alaska Natives,
2005 to 2007 ......................................................................................................................... 67
Table 5.2-11. Leading Causes of Intentional Injury Deaths among All Alaska Natives,
2005 to 2007 ......................................................................................................................... 67
Table 5.2-12. Deaths due to Infectious and Parasitic Disease in the State of Alaska, Mat-Su
Borough, Valdez Cordova Census Area, Denali Borough, and the Kenai Peninsula
Borough ................................................................................................................................. 68
Table 5.2-13. Reportable Infectious Disease Cases, Alaska Natives, January 1, 2007 to
October 3, 2008 ..................................................................................................................... 69
Table 5.2-14. Water and Sanitation Service Rates by Region, 2008 ........................................... 70
Table 5.2-15. Major Cardiovascular Disease Deaths, Matanuska-Susitna Borough,
Valdez-Cordova, Denali Borough, Kenai Peninsula Borough and the State of
Alaska, 2007 to 2009 ............................................................................................................ 71
Table 5.2-16. Top Leading Causes of Death in Alaska and the Susitna Watana Study Area,
Age-adjusted Ratesa, 2007 to 2009 ....................................................................................... 72
Table 5.2-17. Cancer Deaths by Type, Matanuska-Susitna, Denali, Valdez-Cordova Census
Area, Kenai Peninsula Borough, and the State of Alaska, 2007 to 2009 ............................. 73
Table 5.2-18. Ratio of People to Providers .................................................................................. 74
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LIST OF FIGURES
Figure 5-1. HIA Study Area......................................................................................................... 75
Figure 5.2-1. Alaska Age-adjusted Suicide Rates over Time by Region 2001 – 2010. Source:
ADHSS Suicide Prevention Council 2012. .......................................................................... 76
Figure 5.2-2. Suicide Death Rates by Region. Source: Alaska Native Epidemiology Center
2009. ...................................................................................................................................... 76
Figure 5.2-3. Binge Drinking Rates by Region. Source: Alaska Native Epidemiology Center
2009. ...................................................................................................................................... 77
Figure 5.2-4. Number of Fatal Injuries in the Matanuska Susitna Borough, 2007 – 2009. Source:
Alaska Trauma Registry 2011. ............................................................................................. 77
Figure 5.2-5. Leading Causes of Non-Fatal Injury in the Matanuska Susitna Borough, 2004 –
2008. Source: Alaska Trauma Registry 2011 ...................................................................... 78
Figure 5.2-6. Non-fatal injuries by Percentage Involving Alcohol: 2004 – 2008 Matanuska
Susitna Borough, Alaska. Source: Alaska Trauma Registry 2011. .................................... 78
Figure 5.2-7. Average Annual Age-adjusted Unintentional Injury Death Rates per 100,000 by
Region, Alaska Natives, 2004 – 2007. Source: Alaska Trauma Registry 2011. ................ 79
Figure 5.2-8. Regions in Alaska Where Rabies is Enzootic Among Foxes. Source: ADHSS
SOE 2013b. ........................................................................................................................... 79
Figure 5.2-9. Chlamydia Rate per 100,000 Population, Alaska Natives Statewide, 2007. Source:
Alaska Native Epidemiology Center 2011. .......................................................................... 80
Figure 5.2-10. Gonorrhea Rate per 100,000 Population, Alaska Natives Statewide, 2007.
Source: Alaska Native Epidemiology Center 2011. ............................................................ 80
Figure 5.2-11. Average Annual Age-adjusted Heart Disease Mortality Rates per 100,000 by
Region Alaska Natives, 2004 to 2007. Source: Alaska Native Epidemiology Center 2011.
............................................................................................................................................... 81
Figure 5.2-12. Average Annual Age-adjusted Cerebrovascular Disease Mortality Rates per
100,000 by Region Alaska Natives, 2004 to 2007. Source: Alaska Native Epidemiology
Center 2011. .......................................................................................................................... 81
Figure 5.2-13. Alaska Native Age-Adjusted Cancer Death Rates. Source: Alaska Native
Epidemiology Center 2009. .................................................................................................. 82
Figure 5.2-14. Tobacco Use. Source: Alaska Native Epidemiology Center 2009. ................... 82
Figure 5.2-15. Alaska Native Chronic Obstructive Pulmonary Disease, 2004 – 2007. Source:
Alaska Native Epidemiology Center 2009. .......................................................................... 83
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LIST OF ACRONYMS, ABBREVIATIONS, AND DEFINITIONS
Abbreviation Definition
ABVS Alaska Bureau of Vital Statistics
ACR Alaska Cancer Registry
ADEC Alaska Department of Environmental Conservation
ADF&G State of Alaska, Department of Fish and Game
ADHSS Alaska Department of Health and Social Services
ADHSS BRFSS Alaska Department of Health and Social Services Behavioral Risk Factor Surveillance
System
ADHSS SOE Alaska Department of Health and Social Services, Section of Epidemiology
ADNR Alaska Department of Natural Resources
AEA Alaska Energy Authority
AFN Alaska Federation of Natives
Ahtna Ahtna, Incorporated
AI/AN American Indian and Alaska Native
AMAP Arctic monitoring and assessment program
ANC Alaska Native Corporations
ANMC Alaska Native Medical Center
ANTHC Alaska Native Tribal Health Consortium
ATR Alaska Trauma Registry
CAC Chugach Alaska Corporation
CFR Code of Federal Regulations
CHA community health aides
COPD chronic obstructive pulmonary disease
CIRI Cook Inlet Region, Inc.
CT chlamydia trachomatis
DHC Dena'ina Health Clinic
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Abbreviation Definition
DHSS Alaska Department of Health and Human Service
EPA U.S. Environmental Protection Agency
FERC Federal Energy Regulatory Commission
FASDs fetal alcohol spectrum disorders
FMD Fishery Management Plan
GC gonococcal infection
HEC Health Effects Categories
HIA Health Impact Assessment
Hib Haemophilis Influenza, type B
HIV human immunodeficiency virus
HMP Health Management Plan
ILP Integrated Licensing Process
ISR Initial Study Report
KIT Kenaitze Indian Tribe
LTBI latent TB infection
LRIs Lower Respiratory Infections
MMR measles-mumps-rubella
NCHS National Center for Health Statistics
PAC potentially affected communities
PID pelvic inflammatory disease
PWS Public Water Systems
RSP Revised Study Plan
RSV Respiratory Syncytial Virus
RTA road traffic accident
SDH Social Determinants of Health
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Abbreviation Definition
SDWA Federal Safe Drinking Water Act
SIDS sudden infant death syndrome
SPD study plan determination
STI Sexually Transmitted Infections
TB tuberculosis
TLK traditional and local knowledge
VOC volatile organic compounds
VPSO village public safety officers
WHO World Health Organization
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EXECUTIVE SUMMARY
Health Impact Assessment Study 15.8
Purpose The Health Impact Assessment (HIA) is a structured planning and decision-
making process for analyzing the potential positive and negative impacts of
the Project on the health of residents in impacted communities. The overall
goal of the HIA is to reduce potential negative health effects while
maximizing the health benefits of an action. The hallmark of a comprehensive
HIA is the collection of new data, to address critical data gaps that have been
identified during the scoping process.
Status The HIA is currently in Phas e 2: Baseline Data Collection. An analysis of
available federal/state/regional/tribal/community/household level health data
was initiated that will proceed in the next study season. Data collected by
other Project studies will be included where such studies will produce
baseline data that may inform the HIA.
Study
Components
The major components of an HIA include:
• Identify potentially affected communities (PACs) and establish a
community engagement plan.
• Identify public issues and concerns regarding how community health
might be affected during construction and operation of the Project.
• Collect baseline health data at the state, borough, or census area level,
tribal level, and PAC level, as available.
• Identify data gaps and determine the most efficient method to fill those
gaps, through community consultation and coordination with other
interdependent studies.
• Evaluate the baseline data against the Project description to initially
determine the nature and extent of potential impact pathways, both
positive and negative.
2013 Variances There were no variances to the study plan in 2013.
Steps to
Complete the
Study
As explained in the cover letter to this draft ISR, AEA’s plan for completing
this study will be included in the final ISR filed with FERC on June 3, 2014.
Highlighted
Results and
Achievements
This report designates PACs by Health Effect Category (HEC), based upon
potential impacts scoped during Phase 1 of the HIA (Overview and Issues
process). The ISR also provides an overall summary of baseline health data
collected to date, important data gaps identified, and how these gaps may be
filled by the other AEA interdependent studies.
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1. INTRODUCTION
On December 14, 2012, Alaska Energy Authority (AEA) filed with the Federal Energy
Regulatory Commission (FERC) its Revised Study Plan (RSP) for the Susitna-Watana
Hydroelectric Project No. 14241 (Project), which included 58 individual study plans (AEA
2012). Section 15.8 of the RSP described the Health Impact Assessment Study. This study
focuses on analyzing the potential positive and negative impacts of programs, projects, and
policies on the health of residents in impacted communities. RSP Section 15.8 provided goals,
objectives, and proposed methods for data collection regarding health impacts.
On February 1, 2013, FERC staff issued its study plan determination (February 1 SPD) for 44 of
the 58 studies, approving 31 studies as filed and 13 with modifications. RSP Section 15.8 was
one of the 31 studies approved with no modifications.
Following the first study season, FERC’s regulations for the Integrated Licensing Process (ILP)
require AEA to “prepare and file with the Commission an initial study report describing its
overall progress in implementing the study plan and schedule and the data collected, including an
explanation of any variance from the study plan and schedule.” (18 CFR 5.15(c)(1)) This Initial
Study Report (ISR) on the Health Impact Assessment Study has been prepared in accordance
with FERC’s ILP regulations and details AEA’s status in implementing the study, as set forth in
the RSP as approved by FERC’s February 1 SPD (referred to herein as the “Study Plan”).
2. STUDY OBJECTIVES
Health Impact Assessment (HIA) is a structured planning and decision-making process for
analyzing the potential positive and negative impacts of programs, projects, and policies on the
health of residents in impacted communities. This Study Plan uses the methods and guidelines in
the Alaska Department of Health and Human Service’s (DHSS’s) “Technical Guidance for HIA
in Alaska,” July 2011 (www.epi.hss.state.ak.us/hia/AlaskaHIAToolkit.pdf).
As set forth in the Study Plan (RSP Section 15.8.1.1), the goals and objectives of the HIA
include the following activities:
• Identify potentially affected communities (PACs) and establish a community
engagement plan (where relevant).
• Through a review of the FERC scoping meetings and ongoing community
engagement, identify public issues and concerns about how community health might
be affected during construction and operation of the Project.
• Collect baseline health data at the state level, borough, or census area level, tribal
level, and at the potentially affected community level, as possible.
• Identify data gaps and determine the most efficient method to fill those gaps, through
community consultation and coordination with other studies, such as the Subsistence
Resources Study (Study 14.5), Regional Economic Evaluation Study (Study 15.5),
Social Conditions and Public Goods and Services Study (Study 15.6), and Recreation
Resources Study (Study 12.5).
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• Evaluate the baseline data against the Project description to initially determine the
nature and extent of potential impact pathways, both positive and negative.
• Prepare an HIA baseline data report document which is transparent, scientifically
rigorous, and understandable to the public.
3. STUDY AREA
The HIA study area, established by the Study Plan (RSP Section 15.8.3) includes those
communities potentially affected by construction and operation of the Project, such as Cantwell
and communities along the Alaska Railroad corridor, as well as those communities further away
but potentially affected by the movement of workers, materials, and supplies by using the criteria
available in the Technical Guidance for HIA in Alaska (DHSS 2011). The study would also
include communities identified in the Regional Economic Evaluation Study (Study 15.5) and Air
Quality Study (Study 15.9) that would experience changes in emissions resulting from reductions
in fossil-fuel utility plant outputs as a result of the Project. In addition to the communities along
transportation corridors and those identified in these other studies, the HIA study will initially
consider all the communities being studied in the Subsistence Resources Study (Study 14.5).
Together, all these communities have been initially identified as PACs for the Project analysis to
help facilitate collecting baseline information that could be used in the analysis of Project effects.
Some sample analysis factors that could be used to evaluate a community’s possible nexus to the
Project effects the following criteria are examined:
• Close geographic proximity to the Project,
• High likelihood for worker influx,
• Intense work force recruitment potential,
• High likelihood for change in key subsistence resources,
• High likelihood for change in transportation infrastructure,
• Potential for economic change including regional staging centers, and
• Existing high level of exposure to an environmental hazard that would be potentially
exacerbated or improved by Project development.
4. METHODS AND VARIANCES IN 2013
As reflected in the study objectives, HIA is a preventive health tool that anticipates the human
health impacts of new or existing development projects, programs, or policies. The overall goal
of HIA is to minimize potential negative health effects while maximizing the health benefits of
an action. The hallmark of a comprehensive HIA is the collection of new data, in order to
address critical data gaps that have been identified during the scoping process. The HIA includes
extensive stakeholder engagement. In accordance with the Study Plan, the study team initiated
work on the HIA during the 2013 study season, as described below.
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4.1. Project Overview and Issues Summary
In 2013, the study team developed the Project overview and issues summary as provided in the
Study Plan (RSP Section 15.8.4.1) with no variances. In preparing the summary, the study team:
• Developed Project-specific criteria for establishing the PAC’s analysis framework
(PACs for health may not be the same as for other social sciences and must be
established);
• Coordinated through community engagement, other social study areas, and other
AEA licensing participant engagement programs to gather enough of the appropriate
information to meet HIA needs; and,
• Identified potential health concerns and issues related to the Project.
The result of this effort has been incorporated into this ISR, in Section 5.1 below. The report
generally follows the overall strategies and methodologies presented in the “Technical Guidance
for HIA in Alaska.”
4.1.1. Variances
In 2013, there were no variances in implementing the methodologies in the Study Plan (RSP
Section 15.8.4.1) for developing the Project Overview and Issues Summary.
4.2. Phase 2: Baseline Data Collection
In 2013, the study team initiated baseline data collection as provided in the Study Plan (RSP
Section 15.8.4.1) with no variances.
Following the completion of the Project overview and issues process, an analysis of available
federal/state/regional/tribal/community/household level health data was initiated during the 2013
study season. Because the Study Plan contemplates that data collected by other licensing studies
will be used in this analysis, the collection of baseline data is an ongoing process as data from
these other studies become available, and the Study Plan expressly provides for the collection of
baseline data over multiple years (see RSP Sections 15.8.6, 15.8.6). For example, the study team
is using information from the Air Quality Study (Study 15.9) concerning existing and future air
quality levels, and from the socioeconomic studies (Studies 15.5 and 15.6) for population
projections and household characteristics, which have been shown to be key determinants of
health. Coordination between studies avoids unnecessary duplication of effort and community
‘survey fatigue.’
The output of the baseline data review to date, data gaps analysis, and field studies appears in
Section 5.2, below, “Baseline Community Health Data Assessment.” The information presented
in Section 5.2 will be expanded upon based on continued baseline data collection efforts in the
next study season and included in the Updated Study Report (USR).
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4.2.1. Variances
In 2013, there were no variances in implementing the methodologies in the Study Plan (RSP
Section 15.8.4.2) for collecting and analyzing baseline data.
5. RESULTS
The initial results associated with development of the HIA are presented below. Section 5.1
presents the “Project Overview and Issues Summary” required under the Study Plan (RSP
Section 15.8.4.1), and an initial “Baseline Community Health Data Assessment,” prepared from
the baseline information collected to date (RSP Section 15.8.4.2), appears in Section 5.2.
Described within these Section 5 results, PACs are identified according to each HEC with
underlying assumptions describing the potential impacts. The HIA will evaluate and consider
communities identified in the interdependent studies as potential PACs. Figure 5-1 indicates all
communities that may reflect potential impacts from a health perspective. Each community and
population is further analyzed according to potential risk.
5.1. Project Overview and Issues Summary
This Project Overview and Issues Summary presents a generalized set of the geographical, time
scale, and population boundaries of the HIA. This report, which generally follows the overall
strategies and methodologies presented in the “Technical Guidance for HIA in Alaska,”
describes the following eight HECs used to categorize the issues and concerns:
1. Social Determinants of Health (SDH),
2. Accidents and Injuries,
3. Exposure to Potentially Hazardous Materials,
4. Food, Nutrition, and Subsistence Activity,
5. Infectious Disease,
6. Water and Sanitation,
7. Non-communicable and Chronic Diseases, and
8. Health Services Infrastructure and Capacity.
5.1.1. HEC 1: Social Determinants of Health
It is widely accepted that human health is strongly influenced by a constellation of factors such
as educational opportunity, family dynamics, income and employment. Social and health
scientists often refer to these factors as “determinants” because their influence on health is so
strong. Many determinants are strongly influenced by individual factors such as genetics,
lifestyle choices and personal circumstances. Based on large project experience in Alaska, the
State HIA guidance has identified a suite of specific determinants that should be considered:
• Psychosocial issues related to drugs and alcohol
• Teenage pregnancy
• Family stress
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• Domestic violence
• Depression and anxiety
• Isolation
• Work rotations and hiring practices
• Cultural change
• Economy, employment and education
Typically, these impacts may occur with in-migration of job seekers and workers, economic
changes, project workforce management and mixing of cultural practices/ethnic groups during
construction. The causal relationship between a project and SDH for any given individual is very
complex, but some level of causality can be predicted for subgroups within a community that
share certain individual traits.
5.1.1.1. Cultural Change
Some of the most challenging health issues for Alaskans are social and cultural changes that
produce psychological distress resulting in adverse health behaviors (especially substance abuse
and addictive behaviors) followed by depression and, in some cases, suicide. Psychosocial
impacts are complex and involve a constellation of choices and causal factors. There may be
instances when a project feature potentially exacerbates or ameliorates a psychosocial issue and
the associated health outcomes. The most common negative examples are community fear that a
project will affect their subsistence foods or the fear of environmental catastrophe. Conversely,
improvements and stability in employment opportunities and income can have substantial
positive impacts on family dynamics and cultural stability.
A portion of the Subsistence Resources Study (Study 14.5) program included traditional and
local knowledge (TLK) workshops. Criteria for the TLK research are based on “consideration of
the likelihood that the community has knowledge about the Project area (proximity of
community or use area to the Susitna River watershed), as well as consideration of the presence
of long-term knowledge held by at least a portion of the community (Alaska Native population
or affiliation of a federally recognized tribe).” Inclusion criteria for investigating TLK requires:
• “Communities to be within the Susitna River watershed, or
• The study community’s use area is located within the Susitna River watershed; and at
least 50 percent of the community is Alaska Native, or is a federally recognized tribe is
affiliated with the community.”
These communities include:
• Cantwell
• Chickaloon
• Chitina
• Copper Center
• Eklutna
• Gakona
• Gulkana
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• Tyonek
• Knik
The focus of TLK research is focused on beliefs related to potential project impacts in these
communities. The HIA team is collecting specific information regarding community health
beliefs and cultural healing/medicinal practices through focused key informant health interviews
in a suite of potentially impacted communities. This work is being performed as an adjunct to the
data collected during TLK workshops. The HIA team is coordinating with the subsistence
resources and TLK study efforts.
5.1.1.2. Potential In-Migration
The influx of job seekers and workers can potentially trigger a shift away from traditional
lifestyles leading to changes in family and community cohesion. Potential changes are complex
and multi-factorial and include both positive and negative effects.
Many potential SDH impacts are tied to economic drivers. For example, in-migration of job
seekers and worker family members may result in pressure on housing supplies and prices.
Impacts can be mixed as rent-seeking activity may increase among existing owners and new
income streams may be captured. Increases in income from employment can potentially trigger
positive and negative behavioral changes at the household level, e.g., increased alcohol, and
tobacco. Conversely, improved incomes in the hands of locally sourced workers may increase
beneficial local trade store and home improvement spending. In addition, increased income can
lead to improved access to health services that may facilitate an overall improvement in health
status. Increased purchasing power at both the community and household level could potentially
trigger investments in water and sanitation services and facilities.
Although the Project labor and employment plan is currently unknown, these communities have
the potential to become labor resources for the Project and are included as PACs because of their
close proximity to the Project area and proximity to transportation modes accessing the Project
area:
• Willow (Railbelt & proximity to Project area)
• Chase (Railbelt)
• Healy (transportation route)
• Trapper Creek (transportation route & close proximity to Project area)
• Gold Creek (Railbelt & laydown yard)
• Cantwell (transportation route and potential work camp)
• Talkeetna (Railbelt & potential work camp)
• Chulitna (Railbelt)
Communities that are potential labor resources and potential targets for in-migration due to
potential port locations are:
• Seward
• Anchorage
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• Port MacKenzie
• Whittier/Portage
Other communities that are included in other Project studies such as Subsistence, etc., may also
become labor resources for the Project and will be evaluated once the Project labor plans are
fully known. In addition, communities that are not within the Project area along with the lower
48 states may also be targets for labor resources but are not considered as PACs for the Project.
During the ESHIA study periods, temporary labor camps are located at:
• Talkeetna
• Curry Camp
• Gold Creek
• Stephan Lake
• Spike Camps (Several temporary camps located along the Susitna River in various
locations)
During Project construction, work camps will be present, potentially at Cantwell, but exact
locations are not known. Management practices for work camps and the potential for interaction
between workers and community members may generate health impacts.
5.1.2. HEC2: Accidents and Injuries
HEC 2 includes impacts related to both fatal and non-fatal injury patterns for individuals and
communities. Road traffic accident (RTA) impacts are most likely to occur during peak
construction when the highest volume and frequency of transport of workers, supplies, and heavy
equipment utilization will occur. Communities and populations are potentially at increased risk
for accidents and injuries due to:
• Influx of non-resident personnel (increased traffic on roadways, rivers, air corridors)
• Increased travel distances required for successful subsistence
• Increases vehicles and heavy equipment on transportation routes due to project transport
requirements
• Project-related income and revenue potentially used for improved infrastructure and
improved subsistence equipment/technology.
Three potential alternatives for road access and transmission lines have been identified for the
Project; however, AEA has not decided which route(s) will be part of its license application to be
filed with FERC.
It is expected that bulk materials (cement, fuel, reinforcing steel, etc.) and manufactured
materials (transformers, power plants, etc.) for the dam will arrive in-state at one of four
potential ports in south central Alaska and transported to the project site by rail. The four
potential ports of entry include: the Ports of Whittier and Seward in the Valdez Cordova Census
Area; the Port of Anchorage (MOA) and Port MacKenzie in the Mat-Su borough. The Ports of
Seward and Whittier as well as the Port of Anchorage have intermodal connections via rail and
road. Port MacKenzie is connected by road; however, expansion of rail service to connect the
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port to the Alaska Railroad system is currently under construction and should be completed in
2016. As design progress and selection of a port of entry for materials is identified, the suite of
PACs may change.
The three potential transportation corridors are:
• “Denali” – North-south corridor. Pathway of transport of materials from Fairbanks to
Cantwell via Parks highway or Railroad; continuing from Cantwell to dam site via
roughly 20 miles along the Denali Highway and on to a newly built road which runs due
south for a distance of approximately 44 miles with a maximum elevation of
approximately 4,100 ft. msl.
• “Chulitna” – East-west corridor. Pathway of transport of materials from Anchorage to
Chulitna via railroad; continuing from Chulitna siding area to dam site via new gravel
corridor along north side of Susitna River. The new road would run approximately 45
miles with a maximum elevation of approximately 3,250 ft. msl.
• “Gold Creek” – East-west corridor. Pathway of transport of materials from Anchorage (or
other port) to Gold Creek via railroad; continuing from Gold Creek to dam via newly
created gravel road along the south bank of Susitna River. The new road would be
approximately 50 miles long with a maximum elevation of 3,500 ft. msl.
• Where possible, transmission lines will be co-located with the road access. A second
transmission line is likely to provide duplicity and security for the Railbelt’s Intertie.
Potential accidents and injuries related to vehicle operation from transport of Project materials on
potential road and railways include:
• Willow (Road & Rail) • Chase (Rail)
• Talkeetna (Rail) • Chulitna (Rail)
• Gold Creek (Rail) • Cantwell (Road & Rail)
• Hurricane (Road) • Railbelt corridor
• Trapper Creed (Road) • Houston (Road & Rail)
• Healy (Road – only if Fairbanks transport
route is used by the Project)
• Wasilla (Road & Rail)
• Seward (Rail) • Port Mackenzie (Road & Rail)
• Anchorage (Rail) • Whittier/Portage (Rail)
Accidents and injuries related to changing distance of travel required for successful subsistence
(increased ATV and boating accidents) include communities with potential subsistence use areas
within the Susitna Watershed:
• Healy • Cantwell • Willow
• Trapper Creek • Talkeetna • Chase
• Gold Creek • Chulitna • Hurricane
• Petersville • Susitna • Wasilla
• Eklutna • Chickaloon • Glenallen
• Gulkana • Gakona • Paxson
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• Copper Center • Tosina • Kenny Lake
• Chilitna • McCarthy
The extent of subsistence use within these areas will be obtained with Subsistence Resources
Study (Study 14.5) results.
Potential increases in alcohol use and substance abuse are also related to increased accidents and
injuries, and include these communities that are potential work camp sites:
• Talkeetna
• Gold Creek
• Chulitna
• Cantwell
• Temporary construction camp locations
RTA risk throughout the summer will be driven by the high volume of tourism traffic (including
recreational vehicles, buses, motorcycles, etc.) that typically occurs at this time throughout the
state. During the winter, road conditions can be quite treacherous and Caribou crossings are at
their highest.
5.1.3. HEC3: Exposure to Potentially Hazardous Materials
Exposure to Potentially Hazardous Materials includes Project emissions and discharges that lead
to potential exposure. Exposure pathways can include:
• Food - Quality changes in subsistence foods
• Drinking water
• Air - Respiratory exposures to fugitive dusts, criteria pollutants, volatile organic
compounds (VOCs), and other substances
• Indirect pathways, such as changing heating fuels/energy production fuels in
communities.
In general, potential exposure pathways are through food, drinking water, work, air, refuse or
debris by-products, as well as indirect pathways. Specific populations are potentially at risk due
to potential increased mercury in fish, accidental release of potentially hazardous materials, and
impacts to air quality.
Reservoir construction has the potential to lead to increased levels of mercury in fish through
release of inorganic mercury from flooded vegetation and soils (e.g. Montgomery et al. 2000;
Schetagne et al. 2000; Mailman et al. 2006). This issue is being investigated in the Mercury
Assessment and Potential for Bioaccumulation Study (Study 5.7). Communities that may
consume fish from the study area will be identified using data from the Subsistence Resources
Study.
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Depending upon the transportation route selected, potential exposure to (PM10, PM2.5) through
diesel exhaust and roadway dusts from trucking/transportation of Project materials along
transportation corridors:
• Willow (Road & Rail) • Chase (Rail)
• Talkeetna (Rail) • Chulitna (Rail)
• Gold Creek (Rail) • Cantwell (Road & Rail)
• Hurricane (Road) • Railbelt corridor
• Trapper Creed (Road) • Wasilla (Road & Rail)
• Healy (Road – only if Fairbanks transport
route is used by the Project)
• Houston (Road & Rail)
• Port Mackenzie (Road & Rail) • Seward (Rail)
• Anchorage (Rail) • Whittier/Portage (Rail)
Potential exposure to inadequate disposal of refuse and/or incineration ash and other Project
related waste materials could potentially be a concern at work camp located in:
• Cantwell (Denali corridor)
• Gold Creek (Gold Creek Corridor)
• Chulitna (Chulitna corridor)
• Talkeetna
Improvements in air quality can occur in all populations that currently rely on fossil fuels, and
that will become recipients of the energy produced by the Project.
5.1.4. HEC4: Food, Nutrition, and Subsistence Activity
HEC4 considers a project’s potential impact on diet and food security. For example, project-
driven landscape changes and associated infrastructure may affect the availability of subsistence
resources via changes to habitat utilization, and fish and wildlife migration routes. Changes in
wildlife habitat, hunting patterns, and food choices may influence the diet and cultural practices
of local communities. Because many rural Alaskans rely on mixed cash and subsistence
economy, impacts on important subsistence species can affect food security.
In addition to direct impacts, indirect project impacts to subsistence resources may occur as a
result of population influx from project workers, job seekers and/or extended family members.
For example, workers housed in open camps (where this is the case) may compete with
community members for subsistence resources via recreational hunting and fishing during time
off. Similarly, project-driven increases in total residential population (job seekers and extended
families) can facilitate competition for subsistence resources. The influx of extended family
(more mouths to feed) may result in shift from a mixed cash/subsistence based economy to one
that is predominantly cash based. A shift away from subsistence-based diet can lead to the
purchase and consumption of store-bought processed foods. On the positive side, increased
income may facilitate greater purchasing power, improved efficiency of subsistence activities
(snowmobile purchases, better rifles, etc.) and therefore, improved food security.
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Here, subsistence impacts could occur with disruption of wildlife migration pathways due to
Project-driven landscape change associated with civil engineering changes associated with
construction activities. Impacts may also occur cumulatively over time as the watershed
undergoes ecological transformation. These issues are being investigated in a series of terrestrial
and botanical resources (Studies 10.5 through 11.9).
Camp catering services, food handlers, and food supply chain are important sources of potential
positive and negative impacts to the local population. Food inflation can be triggered by a
project’s efforts to “buy or source locally”; conversely, local supplying can be a positive source
of income. Food handler/catering issues are extremely important, and a camp catered food-borne
infectious disease outbreak can rapidly spread from food handlers to camp residents and then to
distant communities via rotating staff. Similarly, rotating local employees, can “import” local
foods into the camp environment with potential adverse consequences. Here, the Project catering
plan, when available, will be evaluated to determine potential community related nutrition
impacts.
Nutritional impacts mediated by dietary choices would occur on a cumulative timescale, while an
outbreak of foodborne illness spreading to the community would be felt more acutely.
HEC 4 relies upon the Subsistence Resources Study (Study 14.5) and nutritional surveys and
considers:
• Effect on diet: how changes in habitat, hunting patterns, and food choices will influence
the diet of and cultural practices of local communities, and
• Effect on food security: Project-specific impacts that may limit or increase the
availability of foods needed by local communities to survive in a mixed cash and
subsistence economy present in rural Alaska.
Potentially affected communities from a nutrition perspective fall within the criteria developed
by the Subsistence Resources team. Criteria for inclusion require:
• The community be located within the Susitna River watershed, or
• Located outside the Susitna River watershed but previously documented subsistence use
areas that extend into the watershed, or
• A community preliminarily identified by ADF&G as requiring updated harvest
information.
There are 12 communities, noted in Table 5.5-1, for which there is no household level field work
planned by the Subsistence Resources Study (Study 14.5) because existing data is sufficient from
their (subsistence) perspective. However, these 12 communities constitute a data gap from an
HIA perspective because no data currently exists to determine food security, consumption, and
caloric intake. These data are needed to evaluate impacts to nutrition status. If data gaps are
identified following a review of the Subsistence Study results, the food consumption portion of
the ADF&G survey may be conducted in these communities by the AEA HIA team.
Changes in wildlife habitat, hunting patterns, and food choices may influence subsistence and
dietary choices. Data gaps exist with respect to location of hunting and fishing areas, type and
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number of animals harvested, and origin of hunters with use in watershed areas – these data will
be obtained from Harvest data, Subsistence Study, and Wildlife Habitat Mapping Study. These
PACs have previously documented subsistence use areas within the watershed:
• Healy • Cantwell • Eklutna
• Chickaloon • Glenallen • Gulkana
• Gakona • Paxson • Copper Center
• Tonsina • Kenny Lake • McCarthy
• Lake Louise • Skwentna •
PACs without use data (but may use watershed for subsistence) include:
• Susitna • Chase • Nelchina
• Willow • Petersville • Tolsana
• Wasilla • Chulitna • Copperville
• Talkeetna • Hurricane • Silver Springs
• Trapper Creek • Palmer
• Willow Creek • Tazlina
5.1.5. HEC5: Infectious Disease
HEC5 considers a project’s potential for influence on patterns of infectious diseases. Pathways
include:
• Influx of personnel
• Crowded or enclosed living and working conditions that may increase:
o Respiratory infections, including TB
o Skin infections
o Ecto-parasite related conditions
• Mixing populations with low and high prevalence Sexually Transmitted Infections
(STIs) due to in-migration and commercial trade can create an increased risk for
transmission of syphilis, HIV, chlamydia, and gonorrhea
Overcrowding in community homes to due influx of extended family can lead to an increase in
prevalence of respiratory infections such as influenza and TB. Vaccination coverage is often
incomplete in under populated rural settings, which can potentially lead to outbreaks of measles,
chicken pox, etc.
In 2007-08, the top Reportable Infectious diseases in Alaska were chlamydia, gonorrhea,
hepatitis C, pneumococcal pneumonia, and tuberculosis. Project-related in-migration into port
facilities, communities that will become construction camp locations, and communities that
become targets for job seekers can influence changes in the distribution of communicable
infectious diseases.
Other considerations for Project-driven impacts on patterns of infectious disease include impacts
on wildlife hosts of zoonotic disease. For example, the improper disposal of kitchen wastes could
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leads to congregation of canid hosts (e.g. red fox), facilitating outbreaks of rabies. This situation
has occurred with a large resource development project in Alaska (Ballard et al. 2001) and
presents a potential danger to Project workers as well as community residents.
Communities where HEC 5 impacts may occur will be evaluated once identified. Timescale and
geographical impacts are dependent upon incubation periods of disease, worker rotation
schedule, workers’ place of residence, and behavioral choices.
5.1.6. HEC6: Water and Sanitation
HEC6 includes changes to access, quality and quantity of water supplies. Adequate provision of
water and sanitation services is a critical public health infrastructure. Water and sanitation related
adverse health concerns for a project are largely related to community influx. For example,
population increases can lead to an overburdening of existing services and systems, generating
increases in water and fecal/oral related illnesses.
Potential pathways include:
• Lack of adequate water service is linked to the high rates of lower respiratory infections
observed in some regions, and to invasive skin infections.
• Increased demand on water and sanitation infrastructure secondary to influx of non-
resident workers.
• Revenue from the project that supports construction and improved maintenance of water
and sanitation facilities.
Communities and populations potentially affected by water and sanitation related changes due
largely to community in-migration and stress on existing infrastructure are those listed in Section
5.1.1.2.
Communities and populations who may experience changes to water supply and systems along
the Susitna River and Railbelt are:
• Chulitna
• Chase
• Talkeetna
• Trapper Creek
• Susitna
Impacts can occur cumulatively if there is sustained population growth.
5.1.7. HEC7: Non-communicable and Chronic Disease
HEC7 considers how a project might change patterns of chronic diseases. Pathways include:
• Nutritional changes that could eventually produce obesity, impaired glucose tolerance,
diabetes, cardiovascular disease
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• Pulmonary exposures that lead to tobacco related chronic lung disease, asthma; in-home
heat sources; local air community air quality, clinic visits for respiratory illness
• Cancer rates secondary to diet changes or environmental exposures
• Increased rates of other disorders, specific to the contaminant(s) of concern.
Negative changes in exercise and dietary habits are associated with increases in non-
communicable and chronic disease, particularly diabetes and cardiovascular diseases. It has been
observed at many industrial locations that workers often experience significant changes in
weight, i.e., rapid weight gain. There is potential that changes in diet from life in work camps
may result in adverse health outcomes (i.e. weight gain, cardiovascular disease, diabetes, etc.). A
shift from high physical activity to sedentary lifestyles may contribute to increased obesity rates,
cardiovascular disease rates and diabetes rates. Increased wages may lead to increased
expenditure on processed foods versus subsistence products. Chronic diseases such as
hypertension and diabetes were consistently cited as one of the most important health issues
during the community observation interviews. Improvements in air quality may lessen the
burden of chronic obstructive pulmonary disease (COPD) over time, particularly in areas where
baseline air quality is poor.
Using information from the Subsistence Resources Study (Study 14.5) and updated Project
description information (i.e. location of camps and employment), HEC 7 PACs will be
designated based upon their potential to experience:
• Changes in diet related to subsistence resources that may indirectly affect incidence of
chronic conditions.
• Shifts away from traditional lifestyle, life in work camps, and decreases in physical
activity that may potentially affect the communities with use areas within the Susitna
watershed.
• Construction personnel who reside in work camps are at risk for developing weight
fluctuations while on and off rotation that can lead to non-communicable diseases.
HEC 7 impacts are generally cumulative, occurring over both construction and operations and
impact PACs wherever locally sourced employees may be procured.
5.1.8. HEC8: Health Services Infrastructure and Capacity
HEC8 considers how a project may influence health services, infrastructure and capacity.
Pathways include:
• Increased revenues used to support or bolster local/regional services and infrastructure
• Increased demands on infrastructure and services by in-migration or residents injured on
the job, especially during construction phases
• Increased roadway accidents and injuries that can overwhelm local fragile medical
emergency response systems
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Increased revenue can be used to support or bolster local/regional services and infrastructure, and
may potentially affect these communities that currently support health facilities:
• Cantwell
• Healy
• Chulitna
• Gold Creek
• Talkeetna
Increased demands on health infrastructure and services by incoming non-resident workers or
residents, especially during construction phases may potentially affect these communities:
• Fairbanks
• Wasilla
• Anchorage
• Talkeetna
• Cantwell
• Chulitna
• Gold Creek
Increased demand on emergency response services will become a potential impact along
transportation routes that are listed in Section 5.1.2, Accidents and Injuries.
5.2. Baseline Health Conditions
5.2.1. HEC 1: Social Determinants of Health
Both health outcome and determinant data are used to establish baseline health status for HEC1.
An outcome is a health event that has actually occurred, while a determinant is a “setting” or
context that strongly influences health status.
Life expectancy, maternal and child health, intimate partner violence and sexual violence, oral
(dental) health, suicide rates, and substance dependence are health outcomes used as general
indicators of physical and social wellness. Family structure, economic status, educational
attainment, family stability, and cultural continuity are health determinants that are associated
with positive and negative health outcomes. Regional information is compared to information for
all Alaska Natives, Alaskans statewide, and to the U.S. population, where possible.
5.2.1.1. Life Expectancy
Life expectancy data give some indication of the overall health of a population. Current
information on life expectancy at birth is unavailable for residents of the individual PACs, but is
available for Alaska. Based on year 2000 population data, the life expectancy at birth for the
State of Alaska is 74.9 years for males and 79.7 years for females. Overall total US data are
similar, 74.0 years for males and 79.4 years for females (ADOLWD 2009). Consistent with
global life expectancy trends, Alaska has seen an increase in life expectancy since 1950;
however, both Alaska and the rest of the U.S. have seen a slower rate of increase in life
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expectancy than has been experienced by the 10 nations with the best life expectancy during this
same time period (Kulkarni et al. 2011). Life expectancy for Alaskans in 2007 increased slightly
to 75.9 years for males and 80.5 years for females. This was similar to the increase in the entire
U.S. population (to 75.6 for males and 80.8 for females) (Kulkarni et al. 2011).
Life expectancy at birth for Alaska Natives was 67.2 years for males and 73.7 years for females
in 2000 (IHS 2011). During the decade 1999–2008, the life expectancy for all Alaska Natives
(70.1 years) lagged behind both non-native Alaskans (75.6 years) and the general U.S.
population (77.8 years; NSB 2012).
The 2010 Mat-Su Borough demography has a slight predominance of males (51.7 percent).
Alaska natives are 5.5 percent of the population. The 2010 Valdez-Cordova Census Area
reported population data that were 53.4 percent males and 13.6 percent Alaska Native. In the
Kenai Peninsula Borough, 52.4 percent of the population was male and 7.4 percent was Alaska
Native. The Denali Borough had the greatest percentage of males (54.9 percent) and the lowest
percentage of Alaska Natives (3.6 percent) of the Study Area Boroughs. These populations are
similar to the 2010 State of Alaska demographics, i.e., 52 percent male and 14.8 percent Alaska
Native. Table 5.2-1 displays the demographic profile of study area communities.
5.2.1.2. Maternal and Child Health
In the United States, more than 80 percent of women will become pregnant and give birth to at
least one child in her lifetime (CDC 2010). Maternal and child health outcomes (e.g. low birth
weight) can profoundly influence youth and adult health status and can suggest current or future
challenges (or improvements) to human health (AMAP 2009). This section presents components
of maternal and child health including initiation of prenatal care, infant mortality, low-birth
weight, teen-birth rates, and substance use during pregnancy.
Infant Mortality
Infant mortality is an important indicator for population health and is influenced by living
conditions, food security, domestic conflict, socio-economic wellbeing, and access to health
services. Infant mortality can be separated into neonatal deaths, which occur during the first 28
days of life, and post-neonatal deaths, which occur from the 28th day to one year of life.
Whereas neonatal deaths are associated with the quality of prenatal and perinatal health care,
post-neonatal deaths are more closely associated with socio-economic conditions (AMAP 2009).
The Mat-Su Borough experienced a slightly lower infant mortality rate of 5.5 per 1,000 live
births compared with 6.3 per 1,000 in Alaska in 2007-2009 (Table 5.2-2). Rates were zero for
Denali and too few cases to report a rate in Valdez. In 2009, the infant mortality rate for the
United States was 6.9 per 1,000 live births (Alaska Bureau of Vital Statistics 2013). In the Kenai
Peninsula, the rate for the period 2007-2009 was 3.9 percent. The total number of infant deaths,
however was less than 20.
Low weight at birth (< 2500 grams) is multifactorial and can also be related to the health of the
mother (Marmot and Wilkinson 2006). Low birth weight is associated with an increased risk of
disability and death in infants (NCHS 2010). Low birth weight is both an indicator of the health
of the maternal population and a determinant of the health of the infant. According to the Alaska
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Bureau of Vital Statistics in 2009, 5.8 percent of all births in the Mat-Su Borough were classified
as low birth-weight babies compared to 5.9 percent in the State of Alaska. The percentage of low
birth weight babies born to Alaska Native mothers in the Mat-Su was 3.4 percent. Valdez
Cordova Census Area had the highest percentage of low birth weight babies at 8.1 percent
overall and 18.8 for babies born to Alaska Natives. In Denali, there were no low birth weight
babies born in 2009. In the Kenai Peninsula, 4.3 percent of all babies born were of low birth
weight; the rate was 3.7 percent for Alaska Natives.
Adequacy of Prenatal Care
Initiation of prenatal care during the first trimester is an important marker of improved infant
health outcomes (Krueger and Scholl 2000). Prenatal care not only identifies women at risk for
complications during delivery, but also enables screening and treatment of medical conditions
that may arise during pregnancy. Some conditions, such as preeclampsia, hemorrhage, and intra-
partum infection, may be life threatening to both the mother and developing fetus. Prenatal
appointments further allow for interventions involving behavioral risk factors associated with
poor birth outcomes, such as smoking (WHO 2005). Adequate prenatal care has been shown to
increase the likelihood of a healthy pregnancy and reduce the likelihood of adverse birth
outcomes (CDC 2010).
The Adequate Prenatal Care Utilization Index (APCNU) is a measure that combines the
initiation of prenatal care and the number of prenatal visits. A ratio of actual to recommended
visits is calculated, and if the ratio is 110 percent or greater, care is considered “adequate plus”
prenatal care. If the ratio is greater than 80 percent but less than 110 percent, care is considered
“adequate”. A ratio between 50 percent and 79 percent is considered “intermediate,” and a ratio
of less than 50 percent is considered “inadequate” (CDC 2010). The categories of “adequate”
and “adequate plus” were also combined to create the category “adequate or better” (Alaska
Native Epidemiology Center 2009).
In 2009, 73.5 percent and 54.2 percent of all pregnant women in the Mat-Su Borough, and
Valdez-Cordova Census Area (respectively) were documented via birth certificate reporting as
having received adequate or better (adequate and adequate plus) prenatal care. The percentage
for the Kenai Peninsula was higher at 69.1 for all Borough residents, and 61.7 for Alaska
Natives. These levels of performance favorably compares to the overall State of Alaska, where
nearly 57.4 percent of all pregnant women reported experiencing adequate or better prenatal care
(Table 5.2-3). Of pregnant Alaska Native women, 61.6 percent in the Mat-Su Borough, and 51.8
percent in the Valdez-Cordova Census Area received adequate or adequate plus prenatal care,
compared to 44.3 percent of all Alaska Natives in 2009. In the Denali Borough 52.4 percent of
all races received adequate or adequate plus prenatal care, which was lower than in the entire
State of Alaska. The percentage of all Alaska women receiving adequate or adequate plus care
decreased from 2007 to 2009; hence, prenatal care remains a critical issue that appears to be
experiencing some challenges (ADHSS BVS 2012).
Initiation of prenatal care during the first trimester may serve as a marker of improved infant
health outcomes (Krueger and Scholl 2000). According to the Alaska Bureau of Vital Statistics,
in 2009, 78.3 percent of all pregnant women and 71 percent of pregnant Alaska Native women in
the Matanuska-Susitna (Mat-Su) Borough made their initial prenatal visit during the first
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trimester compared with 80 percent of all pregnant women in Alaska (ADHSS BVS 2011). In
2009, 87.4 percent of all pregnant women and 85.7 percent of pregnant Alaska Native women in
the Valdez-Cordova Census Area made their initial prenatal visit during the first trimester. The
same year, 85.5 percent of all pregnant women in the Kenai Peninsula and 80.2 percent of Native
Alaska pregnant women made their initial prenatal visit during the first trimester.
Substance Use during Pregnancy
Substance use during pregnancy refers to the consumption of alcohol, tobacco, and/or drugs
during the partum period. Substance use endangers both the mother and the fetus and can lead to
premature detachment of the placenta, sudden infant death syndrome (SIDS), and developmental
problems in childhood (WHO 2005). Excessive alcohol use during pregnancy puts infants at risk
for fetal alcohol spectrum disorders (FASDs), the leading preventable cause of birth defects and
mental retardation (Healthy People 2020). During 2009, the percentage of infants born to all
mothers who reported drinking alcohol during the pregnancy in the Mat-Su Borough was 1.4
percent; in the Denali Borough 0 percent; and in the Valdez-Cordova Census Area 2.5 percent.
These levels are lower than the 3.1 percent reported for the all Alaska mothers (3.1 percent;
ADHSS BVS 2012).
Smoking during pregnancy is the single most important contributor to low birth weight (CDC
2004, Brooke 1989, Kramer 1987). In the Mat-Su Borough in 2009, 15.3 percent of infants were
born to mothers who reported smoking during pregnancy, in the Denali Borough 4.5 percent,
reported smoking during pregnancy, and in the Valdez-Cordova Census Area, 18.0 percent of
mothers reported smoking during pregnancy. In the Kenai Peninsula Borough, 14 percent
reported smoking during pregnancy. Overall, these numbers are similar to the percentage for the
State of Alaska, in which 15.6 percent of infants were born to mothers reporting smoking during
pregnancy (Alaska Bureau of Vital Statistics [ABVS] 2013). Nearly 23 percent of Alaska Native
mothers in the Mat-Su Borough reported smoking during pregnancy (Table 5.2-4).
Teen Birth Rates
Infants born to teen-age mothers (defined by Alaska Native Epidemiology Center 2009 as
women aged 15 to 19 years) are at increased risk of preterm birth, low birth weight, and death
during infancy. They are more likely to have health problems as children, drop out of school, be
incarcerated during adolescence, give birth as a teenager, and be unemployed as a young adult
(Ventura et al. 2011). Teen-age mothers are less likely to receive a high school diploma, which
may negatively impact their future health (Alaska Native Epidemiology Center 2009).
Table 5.2-5 shows that in 2009, 10.7 percent of all babies were born to 15 to 19 year olds in the
Mat-Su Borough, which was slightly higher than for all Alaskans (9.8 percent). In 2009, 8.9
percent of all babies were born to mothers 15 to 19 years old. The statewide teen pregnancy rate
for all races was 9.9 percent. In 2009, the percentage of Alaska Native teen-aged (<20 years)
mothers in the Mat-Su Borough was 17.8 percent, and in the Valdez-Cordova Census Area was
18.8 percent, which was similar to the percentage for all Alaska Natives statewide (16.1 percent;
ABVS 2013). During 2009, the teen birth rate for 15-19 year olds in the Kenai Peninsula
Borough (11 percent) was slightly higher than the rate for all Alaskans (9.8 percent). The rate for
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Alaska Natives in the Kenai Peninsula Borough (11 percent) is lower than the rate for all Kenai
Peninsula residents (13 percent) and below that for Alaska Natives statewide (16.1 percent).
5.2.1.3. Suicide
Suicide can function as a broad indicator of mental health in a population. Alaska has a rate
twice the national average, a higher rate of suicide in rural regions, and a higher incidence of
suicide among men versus women. Figure 5.2-1 displays age-adjusted suicide rates over time by
region for 2001-2010. In 2010, the age-adjusted rate was 23/100,000. The actual number of lives
lost to suicide in 2010 was 163. Alaska’s rural regions have the highest rates of suicide, because
the population of most communities is small (relative to the number of actual suicides. Alaska’s
largest metropolitan area, Anchorage-Wasilla-Palmer, has had the highest number of suicides for
several years.
From 2007-2009, there were 53 suicides in the Mat-Su Borough with an age-adjusted rate of
23.2 deaths per 100,000 people, the same rate experienced state-wide (22.8 deaths per 100,000
persons) among all races (ADHSS 2011).
In general, Alaskan Natives experience a higher suicide death rate than non-native Alaskans or
U.S. whites (Alaska Native Epidemiology Center 2009). From 2004-2007, the suicide death rate
for Alaska Natives living in the Mat-Su region was 32.6 deaths per 100,000 people, lower than
the prevalence for all Alaska Natives (43.1 per 100,000 people) but higher than the borough,
state, and the U.S. rates (Figure 5.2-2). Suicide death rates for Alaska Natives living in the
Valdez-Cordova Census Area and the Kenai Peninsula Borough were unavailable for 2004-2007.
5.2.1.4. Substance Abuse
Substance abuse influences a significant number of health outcomes, e.g., accidents and injuries,
domestic violence, mortality, etc. Substance abuse includes illegal drugs (e.g., marijuana,
cocaine), alcohol addiction, and binge drinking. According to the Alaska Native Epidemiology
Center, substance abuse for adolescents is defined as having used alcohol, marijuana or cocaine
in the past 30 days. Binge drinking is defined as having 5 or more drinks on one or more
occasion in the past 30 days. The excessive drinking measure reflects the percent of the adult
population that reports either binge drinking, defined as consuming more than 4 (women) or 5
(men) alcoholic beverages on a single occasion in the past 30 days, or heavy drinking, defined as
drinking more than 1 (women) or 2 (men) drinks per day on average (ADHSS BRFSS 2011).
The County Health Rankings report reveals that 16 percent of the residents of the Mat-Su
Borough report participation in ‘excessive drinking’ as binge and heavy drinkers, lower than the
19 percent reported for all Alaskans but twice the national benchmark of 8 percent. Data the
Valdez-Cordova Census Area and the Kenai Peninsula Borough were similar (21 percent and 18
percent). The highest level of excessive drinking for this time period was in the Denali Borough
where 27 percent of residents reported excessive drinking (Population Health Institute 2013).
Overall, Alaska Native regional data from the state’s Behavioral Risk Factor Surveillance
System (BRFSS) for 2004–2007 are shown in Figure 5.2-3. The self-reported percentages of
binge drinking are lower for the Anchorage/Mat-Su Region Alaska Natives (16 percent) than the
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binge drinking percentages for all Alaska Natives, all Alaskans and all races in the U.S. Data is
not available for Valdez-Cordova Census Area Alaska Natives or Denali Borough Alaska
Natives. In the Kenai Peninsula Region, 13.6 percent of Alaska Natives had engaged in binge
drinking during this time.
5.2.1.5. Economic Indicators
Economic status may create a powerful context for human health and improved household and
community income is associated with better health outcomes. While there are many indicators
used to assess economic status, the HIA reports median household income, employment, and the
percentage of households living below poverty levels. This information is largely dependent on
the Social Conditions and Public Goods and Services Study (Study 15.6). Information that will
be needed to complete the analysis of the direct effects of the Project includes:
• Final location of the Project components
• Duration and schedule of construction phase
• Cost of materials and supplies during construction
• Approximate cost of materials and supplies during construction that will be spent
locally, versus non-locally
• Size of total workforce, including how many workers will be hired locally versus
non-locally (data from the ADLWD on employment by occupation will be used to
estimate the percent of out-of-state workers)
• Total size of construction workforce by month, or peak number of workers and when
that peak would occur
• Summary of construction workforce by craft or discipline
• Total construction wages or average construction pay, including benefits
• Total number of workers required for operation and maintenance of the Project, and
total wages including benefits
• Approximate cost of materials, supplies, and services that will be purchased locally
versus non-locally during operations
• For trucks that would be used, estimated number and size, number of trips per day
and week to and from the Project site, travel route, and capacity of the roads on which
the trucks will be traveling
• The number of residences or businesses that could be displaced by construction of the
Project
• Number of acres of agricultural/pasture land or timberland that will be removed from
production
Median Household Income
Median household income is one important measure of economic well-being and a key
determinant of human health (Braveman et al. 2011). Median means that half of the households
have higher income and half of the households have lower income. In Alaska, income includes
all monetary sources of income including wages, the Permanent Fund Dividend, Corporation
Dividends and Public Assistance. Income does not include subsistence resources. For 2007-2011,
the estimated median household income among the PAC Boroughs was highest in the Denali
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Borough at $82,898. In the Mat-Su, Borough, Valdez Cordova Census Area, and the Kenai
Peninsula Borough, median income was $70,343, $62,238, and $59,296 respectively.
For Alaska the median income was $69, 014 and for the U.S. it was $51,425 (Table 5.2-6). Only
median income in Valdez Cordova was lower that that of the state as a whole. Income was higher
in all of the PAC boroughs as compared to the U.S. Additional economic indicators (i.e. per
capita income and poverty) are displayed in Table 5.2-6.
Educational Attainment
The level of educational attainment in a household can strongly influence a variety of health
outcomes. In one study, high school graduates have been found to live an average of six to nine
years longer than high school dropouts (Wong et al. 2002). Adults with low educational
attainment were more likely to die from cardiovascular disease, cancer, and lung disease
(Muenning 2005). Multiple possible mechanisms have been proposed to account for this trend.
Education positively impacts lifestyle choices and health-related decisions. Better-educated
people are also less likely to be employed in dangerous jobs (Muenning 2006).
Table 5.2-7 compares Mat-Su Borough residents with the State of Alaska and the U.S., based on
2009 US Census data, American Communities Survey. The percent of residents over age 25 in
the State of Alaska and in the PAC Boroughs who have graduated from high school is over 90
percent. The percentage of residents with bachelor’s degrees ranged from 20.9 percent (Mat-Su)
to 24.5 in the Valdez Cordova Census Area. These levels were below that for the state as a whole
(27.2 percent) and the U.S. (28.2 percent).
Family Structure
Family stability refers to families where parents are healthy and employed; where members
experience infrequent housing changes; and family members experience infrequent divorce and
remarriage, or few separations due to immigration and job seeking.
Family stability has been shown to provide numerous benefits to children, such as more effective
child supervision and parental monitoring, less family conflict, and more family cohesion
(Robertson et al. 2008). Good parental monitoring, in particular, results in better child physical
and mental health (Proeschold 2010).
Families in the Mat-Su Borough appear to be stable compared to families in the State of Alaska
and the U.S (see Table 5.2-8).
Many of the communities in the Mat-Su Borough have families with both parents in the
household. This is not the case in the other PAC Boroughs, where the percentage of two parent
households is lower than the state (34.3 percent versus 19.7 to 28.1 percent).
Cultural Indicators
In Alaska, subsistence practices are a component of cultural identification and community
cohesion. The Alaska Federation of Natives (AFN) describes subsistence as “the hunting,
fishing, and gathering activities which traditionally constituted the economic base of life for
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Alaska's Native peoples and which continue to flourish in many areas of the state today.
Subsistence, being integral to our worldview and among the strongest remaining ties to our
ancient cultures, is as much spiritual and cultural, as it is physical (AFN 1993).”
Subsistence practices anchor the customs and traditions of many cultural groups in Alaska. These
customs and traditions encompass sharing and distribution networks, cooperative hunting,
fishing, and ceremonial activities. Participation in subsistence activities promotes transmission of
traditional knowledge from generation to generation and serves to maintain people’s connection
to the physical and biological environment. Further input will be obtained reflecting other study
area communities from the TLK workshop; subsistence study results and targeted HIA key
informant interviews.
5.2.2. HEC 2: Accidents and Injuries
HEC2 includes impacts related to both fatal and non-fatal injury patterns for individuals and
communities. Accidents and injuries are an important cause of mortality and morbidity in Alaska
(see Table 5.2-9).. The term ‘unintentional injury’ refers to causes of injury or death other than
suicide and homicide. Fatal injury information is drawn from the ABVS, while non-fatal injuries
are typically obtained from the Alaska Trauma Registry (ATR) Alcohol use is a powerful risk
factor for accidents and injuries; alcohol related injury events are reported, as are local option
laws in PACs. The presence of law enforcement or village public safety officers (VPSO)
influences safety in rural communities.
5.2.2.1. Fatal Injuries
The most recent fatal injury data available from the ADHSS Bureau of Vital Statistics is from
2009. During 2007-2009, there were 117, 1,105 and 21 fatal injuries in the Mat-Su, Denali, and
Kenai Peninsula Boroughs, and Valdez-Cordova Census Area, respectively (Figure 5.2-4). The
leading cause of non-transportation related fatalities in Mat-Su was poisoning (20.0/100,000) and
the leading cause of transportation related fatalities was motor vehicle accidents (13.7/100,000).
Unintentional poisoning is often related to alcohol overdose. The Mat-Su Borough has a higher
rate of poisoning deaths than the state as a whole (20.0 vs. 16.9/100,000) and a similar rate of
fatal motor vehicle fatalities as compared to state of Alaska as a whole (13.7 vs. 13.2/100,000).
There was only 1 death by motor vehicle in the Denali Borough, 5 in Valdez-Cordova Census
Area, and 38 motor vehicle fatalities in the Kenai Peninsula Borough. Fatal injury patterns in the
Kenai Peninsula Borough were most similar to the Mat-Su, except there were fewer poisoning
deaths and more deaths due to: falls, smoke, flame, and fire; and drowning and submersion.
5.2.2.2. Non-fatal Injury
The Alaska Trauma Registry (ATR) records non-fatal injuries that are serious enough to require
admission to a health care facility. Data available for the period 2004-2008 indicated there were
2,530 non-fatal accidents and injuries in the Mat-Su Borough with an average of 500 injuries per
year. Males accounted for almost 60 percent of these injuries. Individuals between 15-24 years of
age were the most commonly injured and accounted for 18 percent of all injuries for this period.
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The most common cause of non-fatal injury requiring hospitalization in the Mat-Su Borough
area was falls (32 percent), followed by motor vehicle accidents (17 percent), and suicide
attempts (11 percent). These three causes of injury alone accounted for 60 percent of all non-fatal
injuries during this period. Figure 5.2-5 lists the 10 most common non-fatal injuries in this region
for the period 2004-2008.
Non-fatal injury data for the Denali and Kenai Peninsula Boroughs and the Valdez-Cordova
Census Area is under request with the ATR. The most recent crude non-fatal unintentional injury
hospitalization rate by tribal health organization dates back to 2001. These data are considered
outdated and represents a data gap.
5.2.2.3. Alcohol Related Accidents and Injuries
Alcohol consumption and injury death are strongly related. In 1997, Landen reported that in the
U.S. in injury fatality cases where blood alcohol was actually recorded, more than 65 percent had
a blood alcohol concentration (BAC) of ≥80 mg/dL (≥0.08 percent). The legal limit for blood
alcohol concentrations in the majority of states, including Alaska, is 80 mg/dL (0.08 percent).
These authors also report that living in a wet village was an independent risk factor for injury
death (Landen et al. 1997).
For non-fatal injury, ATR records reveal that alcohol use was documented over in 20.6 percent
of all non-fatal injury cases for the Mat-Su Borough. See Figure 5.2-6 for a ranking of the top 10
causes of non-fatal injury by percentage involving alcohol.
5.2.2.4. Fatal Injuries Among Alaska Natives
From 2005 to 2007, the most common cause of injury among Alaska Natives statewide was
suicide, which accounted for 28.7 percent of deaths among all Alaska Natives. The leading
causes of injury for all Alaska Natives are shown in Table 5.2-10; the top 3 were suicide,
unintentional poisoning (generally via alcohol ingestion), and motor vehicle traffic accidents.
Unintentional injury deaths for Alaska Natives residing in the Interior and the Copper
River/Prince William Sound Regions were more than twice that of Alaska whites and U.S.
whites as a whole (Figure 5.2-7). Of the three regions, the Anchorage/Mat-Su region had the
lowest age-adjusted unintentional injury death rate (71.7), however this is still above that for
Alaska whites and U.S. whites as a whole (47.1 and 39.3, respectively). The Kenai Peninsula had
the highest at 76.4.
5.2.2.5. Intentional Fatal Injury and Self-Harm: Suicide and Homicide
Suicide attempts are ranked second in the most common causes of injury hospitalization for all
Alaska Natives. For leading causes of injury deaths for all Alaska Natives between 2005 and
2007, suicide ranked first, with 141 deaths (Table 5.2-11). Homicide ranked second, accounting
for 21.7 percent of all intentional injury deaths.
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5.2.3. HEC 3: Exposure to Potentially Hazardous Materials
When gathering data on exposure to potentially hazardous materials, the HIA considers and
evaluates available air, water, and soil monitoring data. Study area data from relevant
interdependent studies are pending and the HIA will assess these data as they become available.
5.2.3.1. Sources of Existing Contamination
Alaskans in rural communities have multiple possible contamination exposure sources, including
(i) industrial fuel and biomass combustion, (ii) pollution transported through the air, water or
locally bio-accumulated from global sources (e.g. atmospheric long range transport of mercury
and POPs), (iii) naturally occurring substances such as asbestos and mercury, and (iv) local
waste processes such as individual septic systems or honey pots.
Inhalation is the principal exposure pathway to airborne contaminants. Pollutants can also
dissolve in water sources or deposit on terrestrial surfaces. Contaminant bioaccumulation in
subsistence resources is a pathway for exposure to humans. This pathway is important for
Alaskans due to high consumption rates of subsistence products.
Impacts related to exposure to potentially hazardous materials include project emissions and
discharges. Potential exposure pathways include:
• Food- Quality changes in subsistence foods (risk based on analysis of foods or
modeled environmental concentrations)
• Drinking water impacts from changes to ground and/or surface water sources
• Air-Respiratory exposures to fugitive dusts, criteria pollutants, VOCs, mercury, and
other substances.
• Work-Secondary occupational exposure such as a family member’s exposure to
contaminants on a worker’s clothing.
• Indirect pathways-such as changing heating fuels/energy production fuels in
communities.
Redwood et al. (2012) examined the prevalence of self-reported lifetime exposure to nine
occupational and environmental hazards among American Indian and Alaska Native (AI/AN)
adults enrolled in the Education and Research Towards Health study in the Southwest U.S. and
Alaska. The top three hazards experienced by AI/AN people in Alaska were petroleum products,
military chemicals, and asbestos.
5.2.3.2. Air Quality
Air pollution has been shown to increase the risk of or exacerbate a number of respiratory and
cardiac conditions. The elderly, children, and those with underlying health problems are
particularly vulnerable to the effects of air pollution.
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According to the United States Environmental Protection Agency (EPA), tribes in Alaska face
unique challenges to protecting air quality and reducing health risks in their communities (EPA
2011):
• Most Tribes do not have a reservation or defined lands where they can assert
jurisdiction to address air quality issues.
• Frozen ground prevents burying waste in landfills, and many communities resort to
burning trash that creates air pollution.
• Electricity primarily comes from diesel generators that produce particulate and other
air pollutants.
• The cold climate means people spend significant time indoors in homes and buildings
where indoor air pollution can accumulate.
• Many homes have older wood stoves that can be inefficient and create air pollution.
• Dust from unpaved roads may contain pollutants that can be inhaled or deposited on
subsistence food sources.
Ware et al. (2013) conducted surveys focused on understanding the demographics, home heating
practices, indoor activities, community/outdoor activities, and air quality perceptions in rural
Alaskan communities over a two-year period. Results from these surveys showed that there is an
elevated potential for PM10/PM2.5 exposures in rural Alaska. Significant indoor air quality
concerns included mold, lack of ventilation or fresh air, and dust. Important outdoor air pollution
concerns identified were open burning/smoke, road dust, and vehicle exhaust (e.g., snow
machines, ATVs, etc.). Dadvand et al. (2013) performed an assessment to quantify the
association between maternal exposure to particulate air pollution and term birth weight and low
birth weight (LBW). The study concluded that maternal exposure to particulate pollution was
associated with LBW at term across study populations. A baseline burden of poor indoor air
quality increases susceptibility to changes in outdoor air quality.
2009 Alaska Wildfire Emissions Inventory
ADEC is responsible for statewide fire data surveillance and for preparing the annual Alaska
Enhanced Smoke Management Plan emission inventory reports. These reports summarize: fire
type, start and end dates, locations, and acreages using data provided by the Division of Forestry.
Emission factors (tons of pollutant per acre) are used for the various vegetation types with the
Division of Forestry data to estimate emissions (MACTEC 2011). The complete report
describing the 2009 Alaska Wildfire Emissions Inventory can be accessed online at:
http://fire.ak.blm.gov/content/admin/awfcg_committees/Air Quality and Smoke
Management/6_2009 AK WF EI rpt 050411.pdf.
ADEC Point Source Inventory
ADEC is required by Federal Regulations 40 CFR 51.321 to submit a statewide point-source
emission inventory to the EPA every 3 years. ADEC requires individual facilities to provide
detailed process-level emissions for criteria pollutants and information regarding stack
characteristics and location. The ADEC point source inventory can be accessed online at:
https://myalaska.state.ak.us/dec/air/airtoolsweb/EmissionInventory.aspx.
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EPA National Emission Inventory (NEI)
The NEI is principally based upon emission estimates and emission model inputs provided by
state, local, and tribal air agencies, supplemented by EPA generated data. The NEI is developed
on a 3-year cycle, with the current version based on 2008 data and commonly referred to as the
NEI2008. The majority of the NEI2008 point source inventory is based on data provided directly
from the ADEC point source inventory described above. Other NEI2008 inventory sectors (on-
road mobile, non-road mobile, and area sources) are based on data, methods, and models that
were developed primarily for use in the lower 48 states and may not be entirely representative of
the conditions in the study area. Additional information about the NEI and NEI2008 can be
found online at: http://www.epa.gov/ttn/chief/net/2008inventory.html#inventorydoc.
Alaska Rural Communities Emission Inventory
The NEI2008 for non-point sectors may not accurately estimate emissions in Alaska, especially
in rural areas. ADEC and Sierra Research, Inc., developed on-road and non-road emission
inventories representative of rural areas in Alaska for the calendar year 2005 (Sierra Research
2007). The full report that describes the Alaska Rural Communities Emission Inventory can be
accessed online at:
http://www.epa.gov/region10/pdf/tribal/wrap_alaska_communities_final_report.pdf.
In a 2010 ADEC rural dust survey distributed among 250 villages (response rate 33 percent),
most respondents reported that some residents of their communities were highly affected by dust
releases. The most frequently reported community health effects were irritation of eyes, nose,
and throat (72 percent of responses); asthma (72 percent of responses); coughing (68 percent of
responses); chronic bronchitis (56 percent of responses); shortness of breath (50 percent of
responses); emphysema (48 percent of responses); and tightness of the chest (44 percent of
responses). More dusty days occur in June, July, and August, with averages above 20 days each
month. For May, September, and October 13-19 dusty days per month is typical. The fewest
dusty days occur in winter, an average of 19 dusty days during the 6-month period from
November through April. Dust seasons vary somewhat among different regions of Alaska.
Information for specific communities is not available (ADEC 2010). A map of dust complaints
reported to ADEC throughout rural Alaska can be found at:
http://dec.alaska.gov/air/anpms/Dust/Dust_docs/web percent20map percent2012-2011
percent20(2).pdf.
5.2.3.3. Water Quality
The State of Alaska conducts surface and groundwater water quality monitoring investigations
regularly. However, the Clean Water Act mandates that each state develop a program to monitor
and report on the quality of its surface and ground waters and prepare a report describing the
status of its water quality. Alaska updates its report every two years (ADEC 2010).
EPA encourages States/Tribes to use a five-category system for classifying all water bodies (or
segments) within its boundaries regarding the waters’ status in meeting the State’s/Tribe’s water
quality standards. The categories are: all designated uses are supported, no use is threatened
(category 1); available data and/or information indicate that some, but not all, designated uses are
supported (category 2); there is insufficient available data and/or information to make a use
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support determination (category 3); available data and/or information indicate that at least one
designated use is not being supported or is threatened, but a total maximum daily load is not
needed (category 4); and, available data and/or information indicate that at least one designated
use is not being supported or is threatened, and a total maximum daily load is needed (category
5) (EPA 2011). The majority of Alaskan waters fall into category 1. There are 44 water bodies in
category 2, 304 in category 3, 33 in category 4a, 4 in 4b, 0 in 4C, and 28 in category 5.
5.2.4. HEC 4: Food, Nutrition, and Subsistence Activity
The Alaska Federation of Natives describes subsistence as “the hunting, fishing, and gathering
activities which traditionally constituted the economic base of life for Alaska's Native peoples
and which continue to flourish in many areas of the state today” (AFN 1993).
Subsistence is part of a rural economic system, called a “mixed subsistence market” economy,
wherein families invest money into small-scale, efficient technologies to harvest wild foods.
Fishing and hunting for subsistence resources provide a reliable economic base for many rural
regions. Subsistence is focused toward meeting the self-limiting needs of families and small
communities (Wolfe and Walker 1987). Participants in this mixed economy in rural Alaska
augment their subsistence production by cash employment. Cash (from commercial fishing,
trapping, and/or wages from public sector employment, construction, fire fighting, oil and gas
industry, or other services) provides the means to purchase the equipment, supplies, and gas used
in subsistence activities. The combination of traditional and commercial-wage activities provide
the economic basis for the way of life so highly valued in rural communities (Wolfe and Walker
1987).
ADF&G confirms that subsistence fishing and hunting are important sources of employment and
nutrition in almost all rural communities (ADF&G 2007). Traditional fishing, hunting, and
gathering are sources of nutrition for residents in areas of Alaska where food prices are high.
While some people earn income from employment, these and other residents rely on subsistence
to supplement their diets throughout the year. Furthermore, traditional and cultural activities
support a healthy diet and contribute to residents’ overall wellbeing. Data from the 2013
ADF&G surveys will remain a data gap in this baseline section until results become available to
the HIA team in the next study season. This section reports the results that are available.
5.2.4.1. Micronutrient Deficiencies
Vitamin D deficiency is a common problem for children and adults in Alaska, which can lead to
bone disorders such as rickets and is also associated with an increase the risk of TB, dental
caries, and autoimmune disorders. Vitamin D deficiency has been found to be common in
Alaskan children, particularly among those who are breastfed, and routine vitamin D
supplements are recommended the Alaska Division of Health and Social Services Section of
Epidemiology (ADHSS SOE 2003). Iron deficiency is also extremely common among rural
Alaskan children, particularly in the northern and southwestern regions, although the cause is not
entirely understood. It is probably not caused by a single factor (NSB 2012). Helicobacter pylori
infection has been shown to be associated with iron-deficiency anemia among school-aged
children in southwest Alaska (NSB 2012); however, observed patterns make either nutritional
deficiency or H. pylori infection unlikely to be the sole etiology of the high prevalence of anemia
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in rural Alaska (Alaska Native Epidemiology Center 2008). Among young children, persistent
prenatal conditions appear to contribute to high rates of iron-deficiency and anemia in children
up to at least age 5 years (NSB 2012). There are no reported deaths by malnutrition or other
nutritional disorders in the Mat-Su Borough, Denali Borough or the Valdez Cordova Census
Area.
5.2.4.2. Contribution of Subsistence Activities
The Mat-Su Valley has been a productive agricultural area with farms, dairies and gardens since
it was settled in the 1930s. The area has grown not only in population but also in retail services,
including grocery stores. The County Health Ranking system defines limited access to healthy
foods as “percent of population who are low-income and do not live close to a grocery store”
(Population Health Institute 2013). Among the Project Boroughs, Mat-Su and the Kenai
Peninsula Boroughs had the lowest percentage of residents with limited access to healthy food at
6 percent which was similar to that of the State of Alaska overall (8 percent). The Denali
Borough had the highest percentage of residents with limited access to healthy foods at 19
percent while 11 percent of the Valdez Cordova Census area residents had limited access.
Food Security
Food security means having enough food to fully meet basic needs at all times. At present, there
are no known acute shortages of major dietary components (e.g., proteins, carbohydrates, grains,
fruits, or vegetables) in any of the PACs. While many residents in the communities engage in
subsistence hunting, fishing, and gathering as a part of their diets, the percentage of their food
supply currently comes from subsistence activities is currently unknown.
Food costs
The University of Alaska Fairbanks (UAF), Cooperative Extension Service (CES), performs a
Food Cost Survey (FCS) every quarter. Information on the specific vegetables, fruits, grains,
carbohydrates and proteins included as well as quarterly results for the last 10 years is available
online (CES UAF 2011).
The UAF CFS reports that in March 2012 (the last quarter available) it cost a family of 4,
$157.71 to purchase the 104 items in the market basket at a grocery store in Palmer-Wasilla, $11
more than the same products cost in Anchorage. This weekly cost equates to almost $7,500 for
food over the course of a year or 11 percent of the annual median family income for Mat-Su
Borough residents.
5.2.5. HEC 5: Infectious Diseases including STIs
Reportable communicable diseases include infectious and parasitic diseases, such as
tuberculosis, septicemia, viral hepatitis, HIV, and STIs as well as influenza and pneumonia.
Communicable diseases disproportionally affect poor populations and are exacerbated by
unsanitary conditions, unsafe water, and inadequate personal hygiene. Children and adults
without proper immunization are at higher risk of contracting infections and left untreated,
chronic infections can lead to cancers, such as cervical (caused by HPV) and liver cancer
(Hepatitis B and C); (WHO 1999).
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Reportable infectious and parasitic diseases were not among the leading cause of death among all
races in the Mat-Su, Kenai Peninsula or Denali Boroughs nor the Valdez-Cordova Census Area
Pneumonia (4 deaths), septicemia (1 death), and viral hepatitis (2 deaths) were the only causes of
death due to infectious diseases in the Valdez-Cordova Census Area between 2007 and 2009,
accounting for approximately 4.3 percent of all deaths (164) between 2007 and 2009 (Table 5.2-
12; ADHSS BVS 2013). Pneumonia (12 deaths), tuberculosis (1 death), septicemia (8 deaths),
viral hepatitis (8 deaths), and HIV (2 deaths) were the causes of death due to infectious diseases
in the Mat-Su Borough between 2007 and 2009, accounting for approximately 2.8 percent of all
deaths (1,225) between 2007 and 2009 (ADHSS BVS 2013). In the Kenai Peninsula, the leading
cause of death due to infectious disease was pneumonia (11 deaths), followed by viral hepatitis
(6 deaths), and septicemia (5). There were no deaths due to any infectious or parasitic disease in
the Denali Borough and no influenza deaths were reported during the same time period in any
borough. Over the previous decade, deaths due to diseases have remained relatively stable, while
the number of deaths due to pneumonia appears to be decreasing slightly. Age-adjusted rates of
death from communicable diseases have been similar to those experienced in the state of Alaska
since 2000 (ADHSS BVS 2013).
The Bureau of Vital Statistics does not report infectious disease data by race. Therefore, data
from the Alaska Native Epidemiology Center is used as a representation of infectious disease
burden for Alaska Natives. Overall reportable infectious disease cases for all Alaska Natives
January 2007 to October 2008 are shown in Table 5.2-13.
5.2.5.1. Respiratory Infections
Lower Respiratory Infections (LRIs) refer to infections affecting the lung tissue and air sacs,
commonly referred to as pneumonia. Pneumonia most often causes illness in children less than 5
years and older adults (>65 years). Also at higher risk are those with other medical conditions,
such as chronic liver, heart or lung disease (NAID 2011). The transmission of respiratory
infections depends on many of the same factors as other infectious diseases. In particular,
crowding, poor nutrition and underlying health problems, tobacco smoking and secondhand
smoke, inadequate water supplies, and poor ventilation and indoor air quality, increase the risk of
respiratory infections.
Immunization is one of the best defenses against respiratory diseases, and immunization rates
(with a critical coverage goal of greater than 80 percent) for both children and adults serve as
critical performance indicators. By 2 years of age, it is recommended that all children have
received 4 doses of diphtheria-tetanus-pertussis (DTP), 3 doses of polio, 1 dose of measles-
mumps-rubella (MMR), 3 doses of Hepatitis B, and 3 doses of Haemophilis Influenza, type B
(Hib) vaccines. This recommendation is referred to in shorthand as “4:3:1:3:3:1” (ADHSS 2005).
In 2011, the State Office of Epidemiology reported a significant decrease in the number of
Alaskan children vaccinated in 2009. According to an Epidemiology Bulletin, “In 2009,
completion of the 4:3:1:3:3 (“0” = Hib series, which was excluded from the 2009 analysis due to
a national shortage of this vaccine that year) standard series coverage rate in Alaska was 56.6
percent. With this coverage rate, Alaska ranked 48th in the country for 1+ MMR (85.2 percent)
and 50th for 1+ varicella (76.0 percent). Alaska also ranked in the bottom 10 percent of states for
completion of 4+ DTaP and 3+ rotavirus vaccines” (ADHSS SOE 2011).
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5.2.5.2. Influenza
Influenza, or ‘the flu,’ refers to a common systemic illness involving the upper respiratory tract,
caused by the influenza virus. People with the flu typically experience cough, fever, fatigue, and
muscle aches along with other symptoms, and they may or may not seek medical care. The
severity of the illness depends on many factors, including the strains of viruses circulating in a
given season and the underlying health condition of the person infected. Statewide, Alaska
Natives experience higher rates of serious influenza infections than non-Native Alaskans” (NSB
2012).
5.2.5.3. Bronchiolitis and Respiratory Syncytial Virus
Bronchiolitis is a common infection of the small airways, occurring most often in the winter
months. It affects infants most severely and can result in prolonged illness, hospitalization, and
even respiratory failure. The most common cause of bronchiolitis is a virus called Respiratory
Syncytial Virus (RSV). RSV infection is a major cause of illness and hospitalization in Alaska
and, in particular, among Alaska Native infants, where rates far exceed U.S. rates (NSB 2012).
5.2.5.4. Tuberculosis
In 2011, Alaska had the highest incidence of TB in the nation (9.3 per 100,000 population). In
contrast to the majority of newly identified TB cases in the U.S. which occur in the foreign-born
population, most new TB cases in Alaska are locally acquired, and occur primarily in the Alaska
Native population. Furthermore, much of Alaska’s prospective TB burden is due those who
currently have latent TB infection (LTBI), as 5–10 percent of LTBI patients progress to active
TB without therapy (ADHSS SOE 2012a).
In 2012, a total of 66 cases of TB were reported to the Alaska Tuberculosis Program. This
incidence of 9.0 cases per 100,000 population was a 1% decrease in the number of cases and a
3% decrease in the incidence of tuberculosis when compared to 2011 (ADHSS SOE 2013a).
Between 2003 and 2012, 121 foreign-born persons originating from 24 countries were diagnosed
with TB in Alaska. The Philippines was the country of origin for the majority (56%) of cases,
followed by Lao PDR (8%), the Republic of Korea (7%), Mexico (6%), and Thailand (4%;
ADHSS SOE 2013a).
5.2.5.5. Childhood Immunization Initiatives
A review of the CDC’s National Immunization Survey coverage data revealed that Alaska
ranked below the U.S. average for all standard series vaccines included in the 2009 ranking. In
response Alaska Division of Public Health is attempting to increase rates statewide by:
• Strengthening partnerships with health care providers;
• Surveying parents to determine perceived barriers to immunizations;
• Increasing educational opportunities for providers and parents;
• Using VacTrAK (Alaska’s Immunization Information System) for development and
publication of immunization coverage rates for specific communities.
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5.2.5.6. Zoonotic and Vector Borne Disease
Rabies
Between 2008 and 2012, 46 animals were involved in the 61 cases of rabies exposure in Alaska
(ADHSS SOE 2013b):
• 33 (72%) were dogs, five (11%) were bats, four (9%) were foxes, and two (4%) were
wolves.
• All of the terrestrial animals involved were living in areas of Alaska known to be
enzootic for rabies; and
• Five (11%; four dogs and one wolf) were laboratory-confirmed as being positive for
rabies.
Although rabies is currently not enzootic in the study area, Project-induced changes to the
watershed may have the potential alter the ecology of this disease. Figure 5.2-8 displays the
current regions where rabies is enzootic among fox.
West Nile Virus
To date, in Alaska there have been no recorded human or animal case of locally acquired West
Nile virus (WNV) (ADF&G 2013). Although ADF&G does expect to eventually detect the
infection in birds migrating to Alaska within the next few years, WNV is unlikely to become
permanently established in Alaska’s birds. According to the ADF&G, “Locally acquired WNV
could occur only if viremic migratory birds arrive in Alaska when the appropriate species of
mosquitoes are active and when temperatures would permit adequate amplification of virus.
With all those factors in place, virus could potentially spill over into non-migratory birds,
humans, horses, or other Alaskan animals (ADF&G 2013)..”
5.2.5.7. Sexually Transmitted Infections (STIs)
STIs among Alaska residents are disproportionately distributed by race, gender, and age.
Between 2007 and 2008, STIs comprised almost 90 percent of all Alaska Native reportable
infectious disease cases. Chlamydia trachomatis (CT) was by far the most commonly reported
infectious disease, accounting for 80 percent of all reported infectious diseases, followed by
Gonorrhea with 10-fold fewer cases. CT is a bacterium that can cause pelvic inflammatory
disease (PID), ectopic pregnancy, infertility, and preterm labor. Infants born to infected women
are at risk for neonatal conjunctivitis and pneumonia. Untreated CT infections in men can cause
epididymitis, Reiter syndrome, and infertility (Alaska Native Epidemiology Center 2009). The
Alaska Department of Health and Social Services HIV/STD Program reports on STI prevalence
data race for all Alaska Native Health Corporation regions.
Chlamydia
Alaska had the highest CT infection rate in the nation in 2010, and has consistently had the first
or second highest rate in the nation since 2000 (ADHSS SOE 2013c).
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A total of 6,026 cases of urogenital CT infection were reported to State Office of Epidemiology
in 2010; Alaska’s CT case rate was 849 per 100,000 persons (ADHSS SOE 2013c). This
represents a 13 percent increase compared to 2009 and is more than twice the 2010 US rate of
417 per 100,000 persons. Alaskan women (66 percent of cases), adolescents and young adults
(68 percent of cases); were disproportionately impacted by CT. In 2007, the CT rate reported for
Alaska Native men was about 4 times greater than the rate for Alaska white men (Figure 5.2-9).
The CT rate for Alaska Native women was about 7 times greater than for Alaska white women
(Alaska Native Epidemiology Center 2011).
CT rates were highest in the Northern region (2250 cases per 100,000 persons), followed by the
Southwest (1803 cases per 100,000 persons), the Interior (816 cases per 100,000 persons),
Anchorage/Mat Su (806 cases per 100,000 persons), and Southeast (601 cases per 100,000
persons).
It should be noted that increases in CT rates and regional differences in rates may also, in part,
reflect screening practices, availability of different diagnostic tests, consistency of reporting by
providers and laboratories, and partner identification and testing practices.
Gonorrhea
Alaska is still experiencing a gonococcal infection (GC), or gonorrhea epidemic that started in
2008 and peaked in 2010 (ADHSS SOE 2013d). GC is an STI caused by the bacterium Neisseria
gonorrhoeae, that when untreated or inadequately treated, can result in pre-term labor, PID,
ectopic pregnancy, and infertility among women; epididymitis and infertility among men; and
conjunctivitis in neonates. During 2012, Alaska’s GC infection rate was 100 cases per 100,000
persons; representing a 26 percent decrease in reported cases and a 28 percent decrease in the GC
incidence rate compared to 2011. This dramatic decline is attributed to a number of factors,
including increased community/provider awareness through educational outreach efforts, disease
intervention services, and EPT (ADHSS SOE 2013d).
Data from the Alaska Native Epidemiology Center for 2007 illustrates a much greater rate of GC
among Alaska Natives as compared to whites in both males and females (Figure 5.2-10).
Expedited Partner Therapy
In 2011 the state of Alaska initiated the expedited partner therapy pharmacy pilot project (with
funding through 2015) in effort to decrease chlamydia and gonorrhea. Under the program,
pharmacy staff provide these services:
• An assessment of known allergies and contraindications for the prescribed
medication(s), and information on adverse drug reactions;
• Referral to a health care provider for persons who have contraindications for EPT
medications or are thought to have complicated infections;
• Treatment for persons infected with CT and/or GC who have no other resource for
obtaining medications;
• Counseling on STI prevention and risk-reduction strategies; and
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• Information on STIs, including a list of local health care providers who care for
patients with STIs.
Syphilis
Syphilis is an STI cased by the bacterium Treponema pallidum. Syphilis is rare in Alaska, with
the exception of three unrelated outbreaks that occurred in 2004 and 2011-2012. Both of these
outbreaks primarily involved men who have sex with men (MSM) that were engaging in high-
risk sexual behaviors (ADHSS SOE 2012b).
Human Immunodeficiency Virus (HIV)
HIV is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. In Alaska, a
cumulative total of 1,482 cases of HIV infection were reported between January 1, 1982 and
December 31, 2012 (ADHSS SOE 2013e). A total of 51 cases of HIV infection were reported to
SOE in 2012. Of these cases, 29 (57 percent) were initially diagnosed in Alaska in 2012. In
2012, the Alaska HIV/STD Program implemented a new intervention initiative called Linkage to
Care, which serves to facilitate HIV-infected persons access medical care and provide supportive
services.
5.2.6. HEC 6: Water and Sanitation
Adequate provision of water and sanitation services is a critical public health infrastructure.
Sanitation infrastructure is provided to rural Alaskans by state and federally funded programs
that have provided service first where the greatest number of homes could be served at the lowest
cost (Hennessey et al. 2008). Providing in-home sanitation services is difficult in remote villages
where small, isolated populations live in a harsh, cold climate. These difficulties can primarily be
attributed to a combination of four factors:
• A harsh climate that results in high consumption of heating fuel and electricity and
can damage mechanical systems;
• High costs for parts and consumables resulting from a lack of external road systems;
• A limited ability to pay for sanitation services because of underemployment or
unemployment; and
• A reduced revenue base and limited labor pool because of small community
populations (Eichelberger 2010, Ritter 2007).
Although many rural village homes lack in-home water service, nearly all villages have access to
safe drinking water (ADEC 2000). Alaska village residents who live without pressurized in-
home water service typically obtain water from a community-based water point and bring it
home in 5-gallon plastic containers. Although water is available in centralized locations, some
families must travel long distances or cross rivers to obtain safe water. This distribution method
makes it difficult to obtain adequate amounts of water needed for basic consumption and hygiene
practices. Alaska homes lacking pressurized in-home water service also lack flush toilets.
Residents use outhouses or in-home waste containers commonly known as “honeybuckets” that
require manual removal to a centralized waste disposal site or lagoon (Chambers et al. 2010).
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In rural Alaska, lack of adequate water service is linked to the high rates of lower respiratory
infections observed in some regions, and to invasive skin infections. Many small, rural, primarily
Alaska Native communities lack any piped water and wastewater disposal services, and entire
regions have service rates that remain below national standards. Gessner (2008) performed a
community-level analysis including all 108 Alaskan communities with at least 15 children under
two years of age enrolled in Medicaid during 1998-2003. This study found a strong association
between modern water services in a community and outpatient LRI incidence rates among
children less than two years of age. A weaker association was found for all inpatient
(hospitalized) LRI incidence. Children living in communities with the lowest level of modern
water service had LRI incidence three- to four-fold higher than those residing in communities
with the highest levels of modern water services. This study found that a lack of modern water
service in Alaska predicted increased LRI risk among young children.
A study conducted by Hennessey et al. (2008) among Native Alaskans living in rural villages
found that regions with a lower proportion of home water service had significantly higher
hospitalization rates for pneumonia and influenza, skin or soft tissue infection, and respiratory
syncytial virus (among those younger than 5 years) than did higher-service regions. Within one
region, infants from villages with less than 10 percent of homes having water service in-home
had higher hospitalization rates for pneumonia and RSV than did infants from villages with more
than 80 percent served (Hennessey et al. 2008). Outpatient Staphylococcus aureus infections (all
ages) and skin infection hospitalizations (all ages) were higher in low-service than in high-
service villages.
5.2.6.1. Households with Water and Sewer
According to the Alaska Department of Community and Regional Affairs Community
Information Services, a housing unit is considered to have water and sewer service if it has
water/sewer pipes or closed haul services. Table 5.2-14 presents information regarding the
percentage of Alaska Native houses statewide that have indoor plumbing, obtained from the
Alaska Native Epidemiology Center. Alaska Natives in the Mat-Su Borough are part of the
Southcentral Foundation that had a regional rate of 89 percent with water and sewer service. The
Project also includes PACs in the Copper River Native Association service area, which in 2008
had a regional rate of 86 percent of the population with services.
5.2.6.2. Drinking Water in Villages
“Safe water and adequate sanitation facilities have been public health priorities for decades in
Alaska and have contributed significantly to the improvement of health in rural Alaska” (NSB
2012). ADEC Division of Environmental Health, Drinking Water Program, requires Public
Water Systems (PWS) to be in compliance with the state drinking water regulations, in
accordance with the Federal Safe Drinking Water Act (SDWA) and Amendments, for the public
health protection of the residents and visitors to the State of Alaska. Regulated contaminants are
divided into 6 categories: Bacteria/Viruses, Nitrate/Nitrites, Inorganic and Heavy Metals,
Volatile Organics, Synthetic Organics, and Other Organics. Information on water quality for
private wells and water sources is not publicly available.
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Historically, there have been high rates of diseases associated with unsafe drinking water and
lack of sanitation in Alaskan Native villages. In an attempt to address these public health
problems, state and federal agencies were funded to design and build PWS in rural Alaska. There
are now PWS in many villages that treat and distribute drinking water for public use. The water
systems in each village are subject to the regulations enacted by the EPA under the SDWA and
amendments.
There are several types of PWS configurations that may be considered for use in the villages. A
system may be a watering point, which consists of a water treatment plant, storage facility, and a
single watering point where villagers can collect water in containers. The PWS may be a piped
distribution system, which consists of a water treatment plant, storage facility, and distribution
lines that bring treated water directly to homes. A PWS may be a truck haul system, which
consists of a water treatment plant and trucks used to deliver treated water to residential holding
tanks. The type of PWS selected depends on the geographic conditions, especially the presence
of permafrost, the population served, and the economic resources of the village (Christian 2007).
When violations occur, the ADEC Drinking Water Program responds with either compliance
assistance or enforcement depending on the severity of the violations. Many villages cannot meet
the requirements of all the regulations because:
• Lack of trained operators - Many Native speaking operators cannot pass the
certification tests because they are only given in English. Often, operators are not
paid by the village for their work and adequate support for the operator may not be
available from the community.
• Lack of economic resources - Most villages have a subsistence lifestyle where there is
little or no cash economy. Villagers may have trouble paying for utility services.
Utilities have problems paying and training operators, and there is little money to pay
for water testing, treatment chemicals and supplies.
• Geographic/climate extremes – Many villages are geographically remote. Many
places in Alaska have no road system and the only access to the villages is by airplane
or helicopter. It is difficult to get replacement parts for the PWS. Fuel and electricity
to run the water treatment plant are expensive and water systems routinely freeze and
distribution lines constantly break due to very cold temperatures. It is extremely
difficult to get water samples to the lab on time, especially time dependent samples
like total coliform bacteria.
• Lack of commitment in the village – Some villagers do not like the taste of chlorine
or groundwater, which in Alaska has high levels of iron. The villagers prefer to use
their traditional water sources for drinking water and the treated water for washing
clothes (ADEC 2012).
The EPA maintains a database, “The Drinking Water Data Search in ECHO” which displays
compliance information and violations that have occurred at public water systems
(http://www.epa-echo.gov/cgi-bin/ideaotis.cgi). The database lists all sanitary surveys and site
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visits that have occurred in the past 10 years, compliance summary data, and all violations and
enforcement actions that have occurred in the previous 5 years for all PWS.
Information for this Section was taken directly from the Alaska Division of Community and
Regional Affairs: Alaska Community Database, Custom Data Queries and Alaska Community
Database Community Information Summaries (CIS)
(http://www.commerce.state.ak.us/dca/commdb/CF_CIS.htm).
5.2.7. HEC 7: Chronic Non-communicable Disease
5.2.7.1. Cardiovascular Diseases
Cardiovascular disease is a category of disorders that includes blocked or narrowed blood
vessels, e.g., coronary artery disease, other diseases of the heart, arteriosclerosis, hypertension,
and cerebrovascular disease. Like many diseases, major risk factors for heart disease are
smoking, age, diet, obesity, diabetes, high blood pressure, and cholesterol levels.
Table 5.2-15 presents the number and age-adjusted rates of death caused by major cardiovascular
diseases between 2007 and 2009 in the Mat-Su, Denali, and Kenai Peninsula Boroughs; the
Valdez-Cordova Census Area, and the State of Alaska. Diseases of the heart were the second
most common cause of death due to major cardiovascular disease in the Mat-Su (149.6 deaths
per 100,000 people) and Kenai Peninsula (172.4 deaths per 1000,000 people) Boroughs in 2009
and in Valdez-Cordova Census Area (163.2 deaths per 100,000) between 2007 and 2009. Age-
adjusted rates of death due to major cardiovascular diseases were higher in the PAC boroughs
than the State as a whole.
The most currently available data for average annual age-adjusted heart disease mortality rates
among Alaska Natives by region are shown in Figure 5.2-11. For 2004 - 2007, the rate of heart
disease mortality for Alaska Natives in the Anchorage/Mat-Su and Copper River/Prince William
Sound Region (188.7 and 217.1 deaths, respectively per 100,000 population) was higher than the
rate for all Alaska Natives and for Alaska whites and all U.S. whites. The rate of deaths from
heart disease in the Interior Region was 138.6, which was less than the rate for all Alaska
Natives, Alaska whites and U.S. whites.
5.2.7.2. Cerebrovascular Diseases
The age-adjusted death rate in the Mat-Su Borough for all races caused by cerebrovascular
diseases between 2007 and 2009 was 40.1 deaths per 100,000 people. In the Valdez-Cordova
Census Area for all races, the age-adjusted death rate was 80.8 deaths per 100,000 people
between 2007 and 2009. The age-adjusted death rate in the Mat-Su Borough was lower than the
state rate of 43.1 deaths per 100,000 people. The age-adjusted rate in the Valdez-Cordova
Census Area was double the age-adjusted state rate, while the rate for the Kenai Peninsula was
similar (37.0 deaths per 100,000 people). Sample sizes were too small to draw any meaningful
comparisons for the Denali Borough. Figure 5.2-12 shows average annual age-adjusted
cerebrovascular disease mortality rates by region from 2004 to 2007.
The ADHSS, Division of Public Health gathers information on the percentage of adults of all
races over 18 years of age who self-reported via the Behavioral Risk Factor Surveillance System
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(BRFSS). In response to the question: “Has a doctor, nurse, or other health professional EVER
told you had a stroke?” 2.2 percent of Mat-Su Borough residents surveyed said “Yes” while a
mean of 2.4 percent of all Alaskans said “Yes” during the 2009–2011 survey period (ADHSS
BRFSS 2013). No incidence data are available. In the Kenai Peninsula Borough, 3.3 percent of
people had been told they had a stroke as compared to 0 percent in the Denali Borough, and
2.7 percent in the Valdez Cordova Census Area.
Chronic lower respiratory diseases, including asthma, chronic obstructive pulmonary disease,
bronchitis, and emphysema, were among the top five leading causes of death in 2009 in the Mat-
Su and Kenai Peninsula Boroughs and the Valdez Cordova Census Area 2007-2009, accounting
for 22 deaths (both Boroughs) and 11 deaths, respectively. Chronic lower respiratory disease was
not among the top five leading causes of death for 2005-2009 in the Denali Borough (ABVS
2013).
5.2.7.3. Asthma
In terms of lung-related health conditions, the ADHSS, Division of Public Health (BRFSS 2013)
indicated that 16.9 percent of adults over the age of 18 answered “yes” to the following question:
“Have you ever been told by a doctor, nurse, or other health professional that you had asthma?”
The mean “yes” response for all Alaskans was 14.2 percent. The self-reported rate has increased
since the question was tabulated in 2000–2002 when the mean Alaska response was 11.4 percent
“yes,”and the “yes” response for residents of the Mat-Su Borough was 12.1 percent (BRFSS
2013). For the period of 2009-2011, the Denali Borough self-reported the lowest level of asthma
at 6 percent, while the Kenai Peninsula Borough, Mat-Su Borough and the Valdez Cordova
Census Area reported “yes” responses of 14.7, 14.0, and 10.4 percent, respectively.
5.2.7.4. Mental Health Disorders
Mental health, or behavioral health, is considered a critical component of overall health and is
linked to physical health and well-being for persons of all ages. According to the state’s BRFSS
data base, from 2009 to 2011, Mat-Su Borough residents self reported approximately three days
in the past 30 days in which their mental health was not good; 9.4 percent reported having
periods of frequent mental distress (FMD: defined as 14 or more days of poor mental health;
BRFSS 2013). In the Kenai Peninsula Borough, Denali Borough, and the Valdez Cordova
Census Area residents reported that their mental health was not good over the past 30 days for a
mean of 3.1, 2.4, and 2.8 days, respectively. Furthermore, 8.6 percent, 7.5 percent, and 8.9
percent of Kenai Peninsula Borough, Denali Borough, and Valdez Cordova Census Area
residents reported FMD, respectively. These numbers were similar to the mean of all Alaska
residents who self-reported 2.8 days in which their mental health was not good and 8.8 percent
reported having periods of frequent mental distress.
5.2.7.5. Cancer
Cancer (malignant neoplasm) was the leading cause of death in the study area between 2007 and
2009 and throughout the previous decade (Table 5.2-16). Between 2007 and 2009, cancer
accounted for 25.2 percent and 28.5 percent of all deaths in the Mat-Su and Kenai Peninsula
Boroughs, respectively. In Valdez-Cordova Census Area, cancer accounted for 21.9 percent of
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all deaths in the same time period. There were not enough cases of cancer in the Denali Borough
to be statistically reliable. The percentage of deaths due to cancer for residents of the Mat-Su and
Kenai Peninsula Boroughs and the Valdez-Cordova Census Area were similar as for Alaskans
statewide (BVS 2013).
Table 5.2-17 presents the age-adjusted rates of cancer deaths in the study area by cancer type in
2007 to 2009. This data shows that cancer death rates were similar to those experienced
statewide. Only the rate for the Kenai Peninsula Borough was higher than the statewide rate.
Lung cancer was the most common type of cancer with 47.8, 59.3 and 43.9 deaths per 100,000
persons in the Mat-Su Borough, Kenai Peninsula Borough and the Valdez-Cordova Census Area,
respectively, as compared to 55 deaths per 100,000 persons in the State of Alaska. Prostate
cancers were also common. In the Mat-Su Borough and the Kenai Peninsula Borough the rate
was 24.2 and 34.6 deaths, respectively, per 100,000 persons; as compared to the state rate of 21
deaths per 100,000 persons. There were no deaths due to prostate cancer in the Denali Borough
and a rate was not reported for the Valdez-Cordova Census Area because there were fewer than 6
cases. These rates should be interpreted with caution due to the small number of occurrences
(BVS 2013).
The Alaska Native age adjusted cancer rate deaths by region are shown in Figure 5.2-13.
Although there appears to be a difference among the regions, only the Anchorage/Mat-Su region
has a statistically significant lower rate than all other regions. The lung/bronchus cancer rates are
strongly related to the extremely high tobacco usage that occurs in Alaska Native populations.
Smoking rates among Alaska Natives are elevated versus U.S. white populations. Colon/rectal
cancer is also a leading cause of cancer death.
5.2.7.6. Physical Activity Levels
Consistent physical activity is an important indicator of future non-communicable diseases risk,
particularly cardiovascular disease risk. Moderate physical activity is defined as some activity
that causes an increase in breathing or heart rate (30 or more minutes a day, 5 or more days per
week). Vigorous physical activity is defined as some activity that causes a large increase in
breathing or heart rate (20 or more minutes a day, 3 times or more a week). In the BRFSS 2009
to 2011 data, 78.3 percent of Alaskans and 76.2 percent of residents of the Mat-Su Borough self-
reported that they participate in leisure time physical activities (BRFSS 2013). The Denali
Borough had the highest percentage of residents who self-reported participating in leisure time
physical activities at 84.5 percent, followed by Valdez Cordova Census Area (80.5 percent), and
the Kenai Peninsula Borough (78.4 percent; BRFSS 2013).
5.2.7.7. Tobacco Use
The County Health Rankings define smokers as the percentage of the adult population that
currently smokes every day or most days and has smoked at least 100 cigarettes in their lifetime
(Population Health Institute 2013). Of Alaska Native people in the Mat-Su Region 36.3 percent
were smokers from 2007 to 2009. Of Alaska Native people in the Interior region 40.6% were
smokers. This is similar to Alaska Natives Statewide (39.5%), but more than double Alaskan
Non-Natives (17.1%).
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The BRFSS report asks questions on the use of smokeless tobacco products such as chewing
tobacco, snuff, Iq-mik or Blackbull. According to the 2009 to 2011 BRFSS data, 5.5 percent of
Mat-Su Borough adults self-reported that they had used such products, very similar to the use of
smokeless tobacco products by all Alaska adults (5.2 percent; BRFSS 2013). Prevalence of usage
was highest in the Valdez Cordova Census Area (20.4 percent), followed by Denali (11.7
percent) and Kenai Peninsula (7.8 percent).
BRFSS also asks questions about people smoking cigarette, cigar, or pipes within their homes
Over 14 percent of Mat-Su adults self-reported that they or someone else had smoked in their
homes compared with just 9.9 percent of all Alaska adults (2009-2011; BRFSS 2013). The
percentage of people reporting smoking within their homes was also higher than the state in the
Kenai Peninsula Borough (12.6 percent), Valdez Cordova Census Area (15.5 percent), and
highest in the Denali Borough (17.5).
Overall regional smoking rate data for Alaska Natives is shown in Figure 5.2-14. The smoking
prevalence between 2005 and 2007 for Alaska Natives in the Anchorage/Mat-Su Region (37
percent), for Interior Region (38 percent) and Copper River/Prince William Sound Region (28
percent) which is less than the rate for all Alaska Natives (41 percent) but twice the rate of
Alaska non-Natives and all races in the United States.
5.2.7.8. Chronic Obstructive Pulmonary Disease
COPD refers to a group of lung diseases where impact to airflow within the lungs is occurring.
Main risk factors associated with COPD are tobacco smoking, indoor air pollution, outdoor air
pollution, and respiratory diseases (Mayo Clinic definition 2013).
From 2004 to 2007, the rate of COPD among Alaska Natives in the Anchorage/Mat-Su Region
was 52.2 cases per 100,000 persons, which was similar to the rate for all Alaska Natives, and
Alaska whites (Figure 5.2-15). There was no reportable data for Copper River/Prince William
Sound region at this time. The rate of COPD among Alaska Natives in the Interior Region was
35.1 cases per 100,000 persons, which was lower than the rate for all Alaska Natives and the rate
for Alaska whites. The highest rate among PAC residents occurred in the Kenai Peninsula region
(60.3 cases per 100,000 persons). The Alaska Native COPD mortality rate has increased 92
percent since 1980. The rate peaked between 1994 and 1998 and appears to be decreasing
(Alaska Native Epidemiology Center 2009).
5.2.8. HEC 8: Health Services Infrastructure
Lack of health insurance coverage is a significant barrier to accessing needed health care.
Examining insurance rates among non-elderly adults (or those ages 18-64 years) is a commonly
utilized indicator because Medicare covers the preponderance of adults aged 65 years and older
in the U.S. In 2010, the percentages of non-elderly adults lacking health insurance in the Mat-Su
Borough, Denali Borough, Kenai Peninsula Borough and Valdez-Cordova Census Area were; 21
percent, 20 percent, 24 percent and 25 percent; respectively (Population Health Institute 2013).
For Alaska as a whole, 21 percent of non-elderly adults lack health insurance, as do only 13
percent of all US residents. Alaska Natives can receive health care at Southcentral Foundation
facilities, as described below.
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Having access to care requires not only having financial coverage but also access to providers.
Primary care providers include practicing physicians specializing in general practice medicine,
family medicine, internal medicine, pediatrics, and obstetrics and gynecology. Table 5.2-18
displays the number of people per one provider for the PAC boroughs.
In 2010, the health care industry accounted for about nine percent of jobs in Alaska (Alaska
Economic Trends 2011). During the past 10 years, health care has created more new jobs than
any other sector of Alaska’s economy. According to the Alaska Department of Labor and
Workforce Development (2011) the industry added 10,000 jobs between 2001 and 2010,
outpacing all other large industries. Changes due to new legislative changes in health care that
may affect the Project area will be evaluated in the USR.
5.2.8.1. Health Service Providers
In Alaska, health services are provided by both private and public organizations for both Alaska
Natives and non-natives by hospitals, clinics, and individual providers throughout the state.
Health statistics for all borough residents are collected and analyzed by the Department of Health
and Social Services and include Alaska Natives and non-natives in the totals. The Alaska Native
Epidemiology Center maintains health statistics for all Alaska Native Tribal Regions.
5.2.8.2. Mat-Su Facilities and Services
In the Mat-Su Borough, the Sunshine Community Health Center located in Talkeetna services
the residents of Talkeetna, Trapper Creek, Willow, and Chase. Valley Hospital is located in
Palmer and is one of the closest major medical facility to the Project. The facility has 36 licensed
beds and 109 staff members who provide a full range of emergency and surgical services
(Advameg Inc. 2013). Emergency Services in the Mat-Su Borough have highway and air access
and are within 30 minutes of a higher-level satellite health care facility. Emergency service is
provided by 911 Telephone Service and volunteers. Auxiliary health care is provided by the Mat-
Su Borough Fire/EMS and by volunteer Fire/EMS/Ambulance services in some of the smaller
communities. Highway access is available at the 3 major medical facilities; and helicopter access
is available to the Mat-Su Regional Medical Center.
The Mat-Su Regional Medical Center is located mid-way between Palmer and Wasilla with 74
licensed beds, a total staff of 660, of which 92 are physicians. Services include emergency,
surgical, intensive care, medical, dental, laboratory, and pharmacy (Mat-Su Regional Medical
Center 2011).
Providence Health & Services Alaska has family medicine, behavioral health and laboratory
services available in a new building on the Parks Highway in Palmer. The clinic has 10
physicians on staff.
5.2.8.3. Denali Facilities and Services
There are three health facilities in the Denali Borough: the Cantwell Community Clinic in
Cantwell, the Canyon Urgent Care Clinic and the Interior Community Health Clinic, both in
Healy.
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The closest major medical facility to the proposed “Denali” corridor (i.e. north-south) is Banner
Memorial Hospital in Fairbanks. Fairbanks Memorial Hospital is a qualified acute care facility,
which has 162 licensed beds and offers a full array of medical services including: Behavioral
Health, Cancer Care, Diabetes, Emergency Care, Heart Care, Home Health, Long-term Care,
Maternity Services, Medical Imaging, Orthopedics, Pain Management, Pediatrics, Rehabilitation,
and Sleep Disorders.
Tanana Valley Clinic located in Fairbanks is a primary care clinic operated by Banner Health
that offers these services: health promotion classes, family practice, internal medicine, OB/GYN,
occupational medicine, pediatrics, osteopathic manipulation and sleep medicine (Banner
Hospital 2012).
5.2.8.4. Valdez-Cordova Facilities and Services
The major medical facility serving the Valdez-Cordova Census Area is the Providence Valdez
Medical Center that includes 24 hour emergency services. There are a number of private, public
and Native run health facilities throughout the census area. Health care centers in the PACs are
located in the communities: Cantwell, Chitina, Gakona, Glenallen, and Copper Center.
5.2.8.5. Kenai Peninsula Facilities and Services
Tyonek and Beluga are located on the west side of the Cook Inlet; the only access to hospital and
emergency medical service is by air. The local health center includes Tyonek Health Clinic, a
village clinic staffed by a two full time “community health aides” or (CHA). The Community
Health Aide Program (CHAP) trains community members to provide basic medical services
under distance supervision by a physician. In FY 2005, the Tyonek clinic recorded 372 patient
encounters, a number that makes up around 1.5% of all recorded CHA visits in Alaska. This is
comparable (though a little higher) to the percentage of Alaska natives statewide (estimated for
year 2010) who live in Tyonek (≈1.22%; EPA 2010).
Along with the CHA program, a number of other health professionals visit Tyonek for specific
health issues. There is a local behavioral health aide in Tyonek who provides continuing care to
disabled citizens and works with a visiting Behavioral clinician who visits the village once a
week and stays overnight. There is a rural alcohol advisor who visits the village once a week.
Women’s health clinicians visit annually to hold clinics. A dental aide or dental staff visits the
village quarterly. Ophthalmology doctors or staff visit once a year. A public health nurse visits
the village quarterly to provide such services as immunization and well-child visits. Senior
citizens are cared for with lunch deliveries to their homes, and related child and senior welfare
check-ups are undertaken by a community health representative (EPA 2010).
Emergency service is provided by volunteers and a health aide, and auxiliary health care is
provided by Tyonek Volunteer Rescue Squad.
Beluga has no State or Tribal health services. Residents often undertake travel to Anchorage for
medical services.
The eastern side of the Cook Inlet has more options for health care. Local hospitals or health
clinics include the Central Peninsula General Hospital in Soldotna. The hospital is a qualified
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acute care facility and provides critical care air ambulance service, family practice pediatrics,
neurology, oncology, continuing care, and community health education programs. The hospital
also manages the Kenai Health Center, a qualified Emergency Care Center.
5.2.8.6. Alaska Native Health Organizations
The Cook Inlet Region, Inc. (CIRI), the Chugach Alaska Corporation (CAC), and Ahtna,
Incorporated (Ahtna) are the Alaska Native Corporations, which organize and manage services
to Alaska Natives within the study area. Health services are provided via the Southcentral
Foundation to the Anchorage Service Unit. The foundation recently broke ground on the
Southcentral Valley Native Primary Care Center at the junction of Knik Goose Bay Road and the
Palmer Wasilla Highway. This new facility will replace a clinic in Wasilla.
The Alaska Native Medical Center (ANMC), in Anchorage, is owned and managed by the CIRI
Southcentral Foundation and the Alaska Native Tribal Health Consortium (ANTHC). The
medical center is the state-wide referral center and gatekeeper for specialty care for Alaska
Natives.
The Kenaitze Indian Tribe (KIT) operates the Dena’ina Health Clinic (DHC) in Kenai, which
provides primary health services to eligible Alaska Natives and American Indians. Specialty
services not available at the Clinic are referred to ANMC in Anchorage.
6. DISCUSSION
HIA baseline data collection is underway. Publicly available baseline data at the State, Borough
(for the study area only), and Regional levels have been collected and compiled in this ISR.
Additional baseline data will be included in the USR. Additional data sources include State and
ANTHC database requests and baseline information collected by interdependent studies. In
addition to baseline data gaps, there are also important gaps regarding project description that are
relevant to the HIA.
6.1. HEC 1: Social Determinants of Health
6.1.1. Summary
• Alaska Natives have a lower life expectancy than Alaskans overall.
• In the Mat-Su Borough, 51.7 percent of the population was male and 5.5 percent of the
population was Alaska Native in 2010.
• The Valdez-Cordova Census Area reported having a population that was 53.4 percent
males and 13.6 percent Alaska Native in 2010.
• In the Denali Borough, 54.9 percent of the population was male and 3.6 percent was
Alaska Native in 2010.
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6.1.2. Data Gaps
• Community level demographics.
• Community level socioeconomics.
• Alaska Native infant mortality rates.
• Alaska Native prevalence of substance use during pregnancy.
• Project description information including:
o Location of work camps and key infrastructure;
o Location of transportation corridors;
o Housing availability; and
o Employment levels and hiring practices.
6.1.3. Interdependent Studies
The HIA will be informed by the Social Conditions and Public Services Study (Study 15.6). The
HIA HEC 1 will use this study as a resource for establishing a social determinants baseline and
for assessing potential impacts. The following data will inform the HIA:
• Hiring practices and work rotations,
• Potential for cultural change;
• Housing availability/inflation;
• Economy,
• Employment, and
• Education.
6.2. HEC 2: Accidents and Injury
6.2.1. Summary
• The leading cause of unintentional injury death for the: State of Alaska; the Mat-Su and
Kenai Peninsula Boroughs and the Valdez Cordova Census Area was non-transport
accidents; poisoning was the most frequent cause specified.
• The only cause of unintentional injury death for the Denali Borough was vehicle
accident.
• The leading cause of non-transport related unintentional injury death in the Mat-Su and
Kenai Peninsula Boroughs was poisoning and this rate was higher than that of the State.
• The most common cause of non-fatal injury requiring hospitalization in the Mat-Su
Borough area was falls, followed by motor vehicle accidents, and suicide attempts, (in
combination accounting for 60%).
• The leading cause of unintentional deaths among Alaska Natives between 2007-2009 was
poisoning (i.e. alcohol).
• Unintentional injury deaths for Alaska Natives residing in the Interior and the Copper
River/Prince William Sound Regions were more than twice that of Alaska Whites and
U.S. Whites as a whole.
• The leading cause of intentional injury deaths among Alaska Natives in 2005 was suicide.
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6.2.2. Data Gaps
• Updated accident and injury data from the ATR including any data for Denali Borough
and the Valdez-Cordova Census Area.
• Crude non-fatal unintentional injury hospitalization rate by tribal health organization.
• Traffic and accident datasets from Transportation Resources Study (Study 15.7).
6.2.3. Interdependent Studies
• The HIA (HEC 2: Accidents and Injuries) will utilize traffic levels data (road, air, rail,
river) generated by the Transportation Resources Study (Study 15.7) as a resource for
establishing a traffic safety baseline in the PACs.
• Data generated by the traffic-forecasting portion of the study will inform the assessment
of Project-driven accidents and injury risk posed by changes in baseline traffic.
6.3. HEC 3: Exposure to Potentially Hazardous Materials
6.3.1. Summary
• Results from surveys (Ware et al. 2013) showed that there is elevated potential for
PM10/PM2.5 exposures in rural Alaska.
• Top indoor air quality concerns included mold, lack of ventilation or fresh air, and dust.
A baseline burden of poor indoor air quality increases susceptibility to changes in
outdoor air quality.
• Top outdoor air pollution concerns identified were open burning/smoke, road dust, and
vehicle exhaust (e.g., snow machines, ATVs, etc.).
• The HIA does not have any Project area or community level data to examine at this time.
6.3.2. Data Gaps
• Community baseline data for air quality.
• Project baseline data for air, water, and soil.
• Project forecast and modeling data for air, water, and soil.
6.3.3. Interdependent Studies
Once available, data from the following interdependent studies will be examined under HEC3:
• Baseline Water Quality Study (Study 5.5);
• Mercury Assessment and Potential for Bioaccumulation Study (Study 5.7); and
• Air Quality Study (Study 15.9).
The HIA HEC3 Exposure to Potentially Hazardous Materials will utilize baseline data collected
via these interdependent studies to establish a baseline of current levels of contaminants of
human health concern present in fish and in water. These data will be compared to human health
risk based screening levels. Similarly, the HIA will utilize data generated by the modeling
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exercise portion of these studies in order to assess potential project impacts on contaminant
levels in fish and water.
The HIA HEC3 Exposure to Potentially Hazardous Materials will utilize baseline data collected
via the Water Quality Monitoring Study (Study 5.5) to locate domestic wells including private
(homeowner) wells. In the risk assessment portion of the HIA, the HIA will use the groundwater
vulnerability assessment in order to determine potential Project impacts on water availability for
domestic well water users.
The HIA HEC3 Exposure to Potentially Hazardous Materials will also utilize baseline emissions
data collected by the Air Quality and Transportation Studies (Studies 15.7 and 15.9) as a
resource for determining baseline air quality in the PACs. Data generated by the future air
emissions portion of the by Air Quality Study (Study 15.9) will inform the assessment of Project-
driven risks to human health due to potential change in air quality.
6.4. HEC 4: Food, Nutrition, and Subsistence Activity
6.4.1. Summary
• Fishing and hunting for subsistence resources provide a reliable economic base for many
rural regions. Subsistence is focused toward meeting the self-limiting needs of families
and small communities (Wolfe and Walker 1987).
• While many residents in the communities engage in subsistence hunting, fishing, and
gathering as a part of their diets, it is not yet known what percent of their food supply
currently comes from subsistence activities.
• There are no community level data to examine at this time.
6.4.2. Data Gaps
• Some results of the TLK surveys are not yet available.
• Subsistence surveys and harvest data and analysis have not been completed and are not
yet available.
6.4.3. Interdependent Studies
• The HIA HEC4 Food, Nutrition, and Subsistence will use the Subsistence Resources
Study (Study 14.5) to identify subsistence resources currently used in Project area and as
a resource to evaluate potential project impacts on identified subsistence uses in the
PACs.
6.5. HEC 5: Infectious Disease
6.5.1. Summary
• Communicable diseases disproportionally affect poor populations and are exacerbated by
unsanitary conditions, unsafe water, and inadequate personal hygiene.
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• Reportable communicable diseases were not among the leading cause of death among all
races in either the Mat-Su, Denali, or Kenai Peninsula Boroughs nor the Valdez-Cordova
Census Area.
• Over the previous decade, deaths due to infectious and parasitic diseases have remained
relatively stable, while the numbers of deaths due to pneumonia appear to be slightly
decreasing.
• In 2011, Alaska had the highest incidence of TB in the nation and in contrast to the
majority of newly identified TB cases in the U.S. which occur in the foreign-born
population, most new TB cases in Alaska are locally-acquired, and occur primarily in the
Alaska Native population.
• STIs among Alaska residents are disproportionately distributed by race, gender, and age.
o Between 2007 and 2008, STIs comprised nearly 90 percent of all Alaska Native
reportable infectious disease cases.
o CT the most commonly reported infectious disease, accounting for 80 percent of
all reported infectious diseases, followed by Gonorrhea.
6.5.2. Data Gaps
• Primary data sets from the BVS for the census area does not include years 2010 to 2013.
• Data from the Alaska Native Epidemiology Center do not include years 2007 to 2013.
• There is no information available at this time on admission codes for medical facilities in
the Interior Region.
• Location of Project work camps and major infrastructure are unknown which has
implications for the potential HEC 5 impacts due to population influx.
6.5.3. Interdependent Studies
• The HIA team does not anticipate receiving data from interdependent studies that would
address existing data gaps; however pending database requests may able to address some
of baseline data gaps.
• Communities potentially at risk for Project-driven changes in infectious disease
prevalence will be identified once Project design, facilities, transportation routes,
workforce plan are known.
6.6. HEC 6: Water and Sanitation
6.6.1. Summary
• Sanitation operations in rural Alaska are expensive and complex; small, economically
limited communities have limited financial and technical capacity to support these
operations.
• Many small, rural, primarily Alaska Native communities lack any piped water and
wastewater disposal services, and entire regions have service rates that remain below
national standards.
• In rural Alaska, lack of adequate water service is linked to the high rates of lower
respiratory infections observed in some regions, and to invasive skin infections.
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• There are approximately 220 Alaska Native villages that have a PWS. A significant
number of these PWSs are on the EPA’s Significant Non-Complier List due to
noncompliance with the Drinking Water Regulations, mostly due to the village’s lack of
technical, managerial and financial capacity to properly run the water treatment plant.
6.6.2. Data Gaps
• The most current regional water and sanitation data collected by Native health service
organizations are from 2008 and may not reflect current conditions.
• Community level water and sanitation service rates are unknown.
• Households to be included in the “Potential Impacts to Shallow Groundwater Users”
portion of the Groundwater Monitoring Study are currently unknown.
• Location of Project work camps and major infrastructure are unknown which has
implications for the potential overburdening of existing services due to population influx.
• Communities that may consume fish from the Study area.
6.6.3. Interdependent Studies
The HIA team is coordinating with the Groundwater Study (Study 7.5) lead to collect
information regarding potential impacts to shallow groundwater users (i.e. private well users) in
the Project area. The ground water study team sampled wells in 2013 in the following areas:
• Whiskers Slough
• Gold Creek
• Curry
The Groundwater Study team will be providing results in the next study season that will help
determine which, if any, private well owners may need to be contacted for inclusion in the
assessment.
6.7. HEC 7: Chronic Disease
6.7.1. Summary
• Major cardiovascular diseases age-adjusted mortality rates are higher in the Mat-Su and
Kenai Peninsula Borough and the Valdez-Cordova Census Area than the state as a whole.
The rate of deaths from heart disease in the Interior Region was less than the rate for all
Alaska Natives, Alaska whites and U.S. whites.
• Cancer was the leading cause of death in the study area between 2007 and 2009, and
throughout the previous decade.
• Lung/bronchus cancer rates are strongly related to the extremely high tobacco usage that
occurs in Alaska Native populations.
o Smoking rates in Alaska Natives are elevated versus U.S. white populations.
• Colon/rectal cancer is also a leading cause of cancer death among Alaska Natives.
• The rate of COPD among Alaska Natives in the Anchorage/Mat-Su Region was similar
to the rate for all Alaska Natives, and Alaska whites. The rate of COPD among Alaska
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Natives in the Interior Region was lower than for all Alaska Natives and for Alaska
whites.
6.7.2. Data Gaps
• Community level burden of chronic disease is unknown.
• Since the initial drafting of this report updated BRFSS data for Alaska Natives by
Borough has become publicly available (2009-2011). The USR will include this updated
data for chronic disease and risk factors among Alaska Natives:
o Cerebrovascular disease
o Cardiovascular disease
o Cancer
o Mental health
o Asthma
o COPD
o Substance use
• Diabetes prevalence among Alaska Natives and Alaska Whites.
• Communities that may be sources of employment for the Project are currently unknown.
6.7.3. Interdependent Studies
• The HIA team may receive data from the Social Goods and Public Services Study (Study
15.6) and/or further Project description materials that would inform which local
communities may serve as Project employment bases.
• The HIA will likely obtain anecdotal information regarding the burden of chronic disease
in some of the PACs via the key informant interviews.
6.8. HEC 8: Health Infrastructure and Capacity
6.8.1. Summary
• Health services are provided by both private and public organizations for both Alaska
Natives and non-natives by hospitals, clinics, and individual providers throughout
Alaska.
• Valley Hospital in Palmer and is the closest major medical facility to the Project.
o The facility has 36 licensed beds and 109 staff members who provide a full range
of emergency and surgical services.
o Emergency services in the Mat-Su Borough have highway and air access and are
within 30 minutes of a higher-level satellite health care facility
• The closest major medical facility to the proposed “Denali” corridor (i.e. north-south) is
Banner Memorial Hospital in Fairbanks.
• The major medical facility serving the Valdez-Cordova Census Area is the Providence
Valdez Medical Center that includes 24 hour emergency services.
• Tyonek and Beluga are located on the west side of the Cook Inlet; the only access to
hospital and emergency medical service is by air. Local health clinics include Tyonek
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Health Clinic, a village clinic staffed by two fulltime “community health aides” or
(CHA).
• Alaska Native Corporations which organize and manage services to Alaska Natives
within the Study area include:
o CIRI
o CAC
o Ahtna
6.8.2. Data Gaps
• Services and capabilities of health facilities in the Denali Borough PACs as well as true
ratio of people to providers for the Borough are unknown.
• Services and capabilities of health facilities in the Valdez-Cordova Census Area PACs
are unknown.
6.8.3. Interdependent Studies
• The HIA team does not anticipate receiving data relevant to HEC 8 from any of the other
Project studies.
• Identified gaps will be filled through community observations conducted in coordination
with ADF&G survey work, and telephone interviews with health management
organizations and local health care practitioners.
7. COMPLETING THE STUDY
[As explained in the cover letter to this draft ISR, AEA’s plan for completing this study will be
included in the final ISR filed with FERC on June 3, 2014.]
8. LITERATURE CITED
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ADHSS SOE. 2012a. (Alaska Department of Health and Social Services, Section of
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ADHSS SOE. 2012b. (Alaska Department of Health and Social Services, Section of
Epidemiology). Syphilis Outbreak - Alaska–2011-2012. Bulletin No. 4, February 21,
2012. http://www.epi.alaska.gov/bulletins/docs/b2012_04.pdf
ADHSS SOE. 2013a. (Alaska Department of Health and Social Services, Section of
Epidemiology). Tuberculosis in Alaska 2012 Annual Report.
ADHSS SOE. 2013b. (Alaska Department of Health and Social Services, Section of
Epidemiology). Alaska Rabies Post-Exposure Prophylaxis: 2008–2012 Data Summary
and Policy Change Bulletin No. 19, July 15, 2013.
http://www.epi.alaska.gov/bulletins/docs/b2013_19.pdf
ADHSS SOE. 2013c. (Alaska Department of Health and Social Services, Section of
Epidemiology.) New Pharmacy Services for Expedited Partner Therapy for Chlamydia
and Gonorrhea. Bulletin No. 8, March 12, 2013.
ADHSS SOE. 2013d. (Alaska Department of Health and Social Services, Section of
Epidemiology). Gonococcal Infection – Alaska, 2012 and January-March 2013 Bulletin
No. 16, June 11, 2013.
ADHSS SOE. 2013e. (Alaska Department of Health and Social Services, Section of
Epidemiology). Summary of HIV Infection Alaska- 1982-2012. Bulletin No. 10 Apri1, 1,
2013. http://www.epi.alaska.gov/bulletins/docs/b2013_10.pdf
ADHSS SPC. 2010. (Alaska Department of Health and Social Services Suicide Prevention
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Christian C. 2007. Building Drinking Water Capacity in Native Alaskan Villages 2006-2007.
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9. TABLES
Table 4.4-1. Health Effects Categories
Health Effects Category Pathway Description
Social Determinants of Health (SDH) This is a broad category that considers how living conditions and social situations
influence the health of individuals and communities.
Accidents and Injuries This category includes impacts related to both fatal and non-fatal injury patterns for
individuals and communities.
Exposure to Potentially Hazardous Materials This category includes project emissions and discharges that lead to potential
exposure.
Food, Nutrition, and Subsistence Activity This section depends on the subsistence analysis and nutritional surveys and the
effect on diet and food security.
Infectious Disease This category includes the project’s influence on patterns of infectious disease.
Water and Sanitation This category includes the changes to access, quantity and quality of water supplies.
Non-communicable and Chronic Diseases This category considers how the project might change patterns of chronic diseases.
Health Services Infrastructure and Capacity This category considers how the project will influence health services infrastructure
and capacity.
ADHSS Technical Guidance for Health Impact Assessment (HIA) in Alaska, 2011
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Table 4.5-1. HIA - Food Security, Nutrition Surveys and TLK Participation
Number Community ADF&G Surveys HIA Data Gap Communities1
Community in Watershed Use Area in Watershed
1 Beluga X x
2 Cantwell X x
3 Chase X X No data
4 Chickaloon X x
5 Chistochina X
6 Chitina X
7 Copper Center X
8 Copperville X No data
9 Denali Hwy Households X X No data
10 Eklutna X x
11 Gakona X x
12 Glennallen X x
13 Gulkana X x
14 Healy X x
15 Kenny Lake X x
16 Lake Louise X X x
17 McCarthy X x
18 McKinley Park X x
19 Mendeltna X X No data
20 Mentasta Lake X
21 Nabesna X
22 Nelchina X No data
23 Parks Hwy Households (Chulitna, Gold Creek,
Hurricane/Broad Pass)
X No data
24 Paxson X x
25 Petersville X X No data
26 Skwentna X X x
27 Slana X
28 Susitna X X No data
29 Talkeetna X X No data
30 Tazlina X No data
31 Tolsona X No data
32 Tonsina X x
33 Trapper Creek X X No data
34 Tyonek X x
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Number Community ADF&G Surveys HIA Data Gap Communities1
Community in Watershed Use Area in Watershed
35 Wasilla X No data
36 Western Susitna Basin X x
37 Willow X X No data
Note:
1 For these communities there is no household level field work planned by the Subsistence Resources Study
(Study 14.5) because existing data is sufficient.
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Table 4.5-2 Overview of Potential Health Impacts Associated With The Susitna-Watana Hydroelectric Project
Health Effects Category General Potential Impact
Social Determinants of Health (SDH) Shift away from traditional lifestyle may cause familial and social discord, exacerbate
generational gaps, which can lead to increased rates of domestic violence, mental
illness, and suicide rates.
Wages in the hands of locally sourced workers may increase spending on alcohol and
drugs of abuse.
In-migration of job seekers and worker family members may result in housing price
inflation and housing shortages.
Increased income can improve access to health services that may facilitate an overall
improvement in health status.
Increased purchasing power can in some cases allow families improved access to
water and sanitation facilities.
Accidents and Injuries The Project will operate vehicles that have the potential to interact with and potentially
impact the PACs: (i) Road and rail traffic accidents (injury and possible fatality); and (ii)
Releases/spills associated with road and rail traffic accidents. The primary potential
sources for road and rail traffic are the project site, port, local materials sources and
railroad headings.
Geographically, the likelihood of an RTA will be greatest in the proposed roadway
access corridors, particularly on north-south access corridor.
Seasonal risks include increased tourism traffic during the summer and dangerous road
conditions in the winter.
Exposure to Potentially Hazardous Materials Reservoir construction can elevate levels of methyl mercury in fish tissue by three- to
five-fold after flooding.
As described in HEC2, transportation of Project hazardous materials on roadways,
railways and waterways (e.g. fuel and waste materials) can result in an inadvertent
release of potentially hazardous materials.
The Project may improve local air quality by decreasing reliance on coal and diesel
generators for electricity.
Food, Nutrition, and Subsistence
Activity
Project driven landscape changes and associated infrastructure may affect the
availability of subsistence resources via changes to habitat utilization, and fish and
wildlife migration routes. Changes in wildlife habitat, hunting patterns, and food choices
may influence the diet and cultural practices of local communities.
In addition to direct impacts, indirect Project impacts to subsistence resources may
occur as a result of population influx.
Increased income may facilitate greater purchasing power and improved food security.
Shift away from subsistence based diet may lead to purchase and consumption of less
healthy foods
Infectious Disease The presence of temporary “open” construction camps near communities could
increase sexually transmitted infection rates and related diseases.
International and domestic migrant workers could import bacterial and viral diseases
endemic in other parts of the world or the contiguous 48 states. Improper disposal of
kitchen wastes leads to congregation of wildlife (e.g. red fox), facilitating zoonotic
outbreaks.
Overcrowding in community homes to due influx of extended family leads to an increase
in prevalence of respiratory infections such as influenza and TB.
Water and Sanitation Overburdening existing services and systems due to community influx can lead to
increases in water-born illness rates.
Revenue from the project may support construction/maintenance of water and
sanitation facilities that may create a positive impact.
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Health Effects Category General Potential Impact
Non-communicable and Chronic Diseases Increased smoking at work camps may transmit to home environment.
Changes in diet from life in work camps may result in adverse health outcomes (i.e.
weight gain, cardiovascular disease, diabetes, etc.)
Shift from high physical activity to sedentary lifestyles may contribute to increased
obesity rates, cardiovascular disease rates and diabetes rates.)
Improvement in air quality may lessen the burden of Chronic obstructive pulmonary
disease (COPD).
Health Services Infrastructure and Capacity
Health care workers obtain jobs at project, which may reduce availability of local health
care personnel.
Workforce influx may increase demand on local health care infrastructure and services
and reduce access for current residents. Increased revenues could be used to support
or bolster local/regional health services
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Table 5.2-1. Social Determinants of Health Susitna-Watana Hydroelectric Study Area Communities – Demographic
Profile, 2010 Census
Location Total Population Median Age Percent Male Percent Alaska Native
State of Alaska 710,231 33.8 52.0 14.8
Denali Borough 1,826 NA 54.9 3.6
Cantwell 219 42.7 58.4 15.5
Healy 1,021 40.1 53.5 2.1
Mat-Su Borough 88,995 34.8 51.7 5.5
Chase 34 52.0 64.7 0.0
Chickaloon 272 48.8 52.2 6.3
Eklutna ND ND ND ND
Houston 1,912 35.4 53.5 6.7
Lake Louise 46 60.0 69.6 2.2
Skwentna 37 52.8 59.5 0.0
Susitna 18 58.0 55.6 0.0
Talkeetna 876 45.4 51.7 3.7
Trapper Creek 481 48.0 52.6 6.4
Valdez-Cordova Census Area 9,636 39.8 53.4 13.6
Chistochina 93 43.5 51.6 53.8
Chitina 126 28.0 48.4 19.8
Copperville ND ND ND ND
Copper Center 328 35.3 51.8 48.5
Gakona 218 40.7 52.3 19.7
Glennallen 483 35.8 50.7 7.7
Gulkana 119 26.3 51.3 76.5
Kenny Lake 355 44.5 52.4 8.2
McCarthy 28 48.0 71.4 0.0
Mendeltna 39 54.8 59.0 0.0
Nelchina 59 55.3 49.2 8.5
Paxson 40 54.0 67.5 0.0
Tazlina 297 38.5 50.2 33.7
Tolsona 30 52.3 53.3 0.0
Tonsina 78 49.3 56.4 9.0
Whittier/Portage 220 48 56.8 5.5
Kenai Peninsula Borough 55,400 40.6 52.4 7.4
Beluga 20 55.5 70.0 10.0
Tyonek 171 33.6 56.1 88.3
2010 Census SF1: Profile of General Population and Housing Characteristics
ND = Not Determined
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Table 5.2-2. Infant Deaths and Infant Mortality Rates for Mat-Su Borough and Alaska, All Races, 2007 to 2009
Infant Deaths
Mat-Su Borough Denali Borough* Valdez-Cordova
Census Area* Kenai Peninsula Borough State of
Alaska
Number of deaths Rate per 1,000 live births Number of deaths Rate per 1,000 live births Number of deaths
Rate per 1,000 live births
Number of deaths
Rate per 1,000 live births
Rate per 1,000 live births
Neonatal (infants
less than 28
days of age)
6 1.6 0 0 2 ** 3 ** 2.6
Postneonatal
(infants 28 days
to 1 year of age)
15 3.9 0 0 3 ** 5 ** 3.6
Total Infant
Deaths 21 5.5 0 0 5 ** 8 3.9a 6.3
**Rates based on fewer than 6 occurrences are not reported
*Data is for the period 2005-2009
aRates based on fewer than 20 occurrences are statistically unreliable and should be used with caution.
Alaska Bureau of Vital Statistics 2013
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Table 5.2-3. Adequacy of Prenatal Care for Females, by Race, 2009
Adequacy of Prenatal Care (APNCU Index)
ALL RACES WHITE ALASKA NATIVE
Births (No.) Percent (%) Births (No.) Percent (%) Births (No.) Percent (%)
State of Alaska
Adequate or better 5,568 59.5 3,671 67.8 1,253 44.3
Adequate plus 1,993 21.3 1,326 24.5 409 14.5
Adequate 3,575 38.2 2,345 43.3 844 29.8
Intermediate 2,178 23.3 1,148 21.2 797 28.2
Inadequate 1,605 17.2 602 11.1 780 27.6
Mat-Su Borough
Adequate or better 777 73.5 686 75.3 61 61.6
Adequate plus 333 31.5 304 33.3 19 19.2
Adequate 444 42.0 384 42.0 42 42.4
Intermediate 140 13.2 112 12.3 21 21.2
Inadequate 141 13.3 114 12.5 17 17.2
Denali Borough
Adequate or better 11 52.4 ** ** ** **
Adequate plus 3 14.3 ** ** ** **
Adequate 8 38.1 ** ** ** **
Intermediate 6 28.6 ** ** ** **
Inadequate 4 19.0 ** ** ** **
Valdez-Cordova Borough
Adequate or better 52 54.2 34 54 14 51.8
Adequate plus 17 17.7 11 17.5 5 18.5
Adequate 35 36.5 23 36.5 9 33.3
Intermediate 28 29.2 17 27.0 9 33.3
Inadequate 16 16.7 12 19.0 4 14.8
Kenai Peninsula Borough
Adequate or better 461 69.1 398 70 50 61.7
Adequate plus 142 21.3 125 22.0 12 14.8
Adequate 319 47.8 273 48.0 38 46.9
Intermediate 146 21.9 122 21.4 21 25.9
Inadequate 61 9.1 49 8.6 10 12.3
Alaska Bureau of Vital Statistics 2013
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Table 5.2-4. Infants Born to All Mothers Reporting Substance Use during Pregnancy, 2009
Reported drinking Reported smoking
Alaska Births (No.) 340 1,744
Percent (%) 3.1 15.6
Mat-Su Borough Births (No.) 18 196
Percent (%) 1.4 15.3
Denali Borough Births (No.) 0 1
Percent (%) 0 4.5
Valdez-Cordova Census Area Births (No.) 3 22
Percent (%) 2.5 18.0
Kenai Peninsula Borough Births (No.) 16 96
Percent (%) 2.3 14
Alaska Bureau of Vital Statistics 2013
Table 5.2-5. Teen Birth Rates among Alaska Natives and All Mothers, 2009
Births to Alaska
Native mothers < 20
years (%)
Births to all mothers < 20 years (%)
Alaska 16.1 9.9
Mat-Su Borough 17.8 10.8
Denali Borough ** 3.8
Valdez-Cordova Census Area 18.8 8.9
Kenai Peninsula Borough 11 13
Alaska Bureau of Vital Statistics 2013
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Table 5.2-6. Potentially Affected Communities – Economic Indicators
Borough/Census Area Median Household Income (2007-2011) ($)
Per Capita Income (2007-2011) ($)
Percent of People below Poverty Limit (2007-2011)
Percent Unemployed (July 2013)
United States 51,425 27,041 14.3 7.7
State of Alaska 69,014 31,944 9.5 5.9
Mat-Su Borough 66,052 24,906 9.7 6.7
Kenai Peninsula Borough 59,296 30,256 21.0 6.2
Denali Borough 82,898 38,804 9.1 3.6
Valdez Cordova Census
Area 62,238 31,029 6.7 5.9
U.S. Bureau of Labor Statistics 2013. Not seasonally adjusted
2011 American Community Survey 2007-2011 5-year estimates
AK Dept of Labor and Workforce Development 2013
Table 5.2-7. Potentially Affected Communities – Education Indicators
Borough/Census Area
Educational attainment persons 25 years and older
High School Drop-out rate Literacy Rate High School Grads or more (%) Bachelor’s degree or higher (%)
United States 85.4 28.2 4.1 85.5
State of Alaska 91.4 27.2 7.3 91.0
Mat-Su Borough 92.3 20.9 NA 92.0a
Kenai Peninsula Borough 92.4 23.1 4.6 92
Denali Borough 90.8 24.2 NA NA
Valdez Cordova Census
Area 91.6 24.5 NA NA
NA: Data not available
Educational Attainment: 2007-2011 American Community Survey 5-Year Estimates
National Center for Education Statistics, Public School Graduates and Dropouts 2007-2008, 2009 American
Community Survey 3-Year Estimates
a 2003 National Assessment of Adult Literacy
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Table 5.2-8. Potentially Affected Communities – Household Characteristics
Borough/Census Area Number of Households
Average Household Size
Percent of Family Households
Female Households, No Husband Present
(Percent of Family Households)
Two-Parent Households
with own Children
Present under 18 Years
(Percent of Family Households)
United States 116,716,292 2.6 66.4 19.7 30.4
State of Alaska 258,058 2.7 66.2 16.2 34.3
Mat-Su Borough 31,824 2.8 70.9 12.3 36.9
Denali Borough 806 2.22 56.3 3.0 21.5
Valdez Cordova Census
Area 3,966 2.38 60.9 8.2 19.7
Kenai Peninsula Borough 19,826 2.65 7.7 28.1 28.1
US Census 2010 (http://live.laborstats.alaska.gov/cen/dparea.cfm)
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?fpt=table
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Table 5.2-9. Major Causes of Unintentional Injury Deaths, Mat-Su and Denali Boroughs, Valdez-Cordova Census Area, Kenai Peninsula Borough and State of Alaska,
2007 to 2009
Cause of Death
Mat-Su Borough Denali Borough Valdez-Cordova Census Area Kenai Peninsula Borough State of Alaska
Deaths
Age-
Adjusted
Ratea
Deaths
Age-
Adjusted
Ratea
Deaths
Age-
Adjusted
Ratea
Deaths
Age-
Adjusted
Ratea
Deaths
Age-
Adjusted
Ratea
Unintentional Injuries 117 50.4 1 ** 21 77.1 105 70.4 1,025 55.3
Transport accidents 41 16.8 0 0 9 32.3d 45 28.8 310 15.5
Motor vehicle accidents 33 13.7 1 ** 5 ** 38 24.4 262 13.2
Snow machineb 3 ** 0 0 0 0 3 ** 48 2.5
ATVc 4 ** 0 0 0 0 2 ** 21 1
Water transport 0 0 0 0 3 ** 1 ** 16 8d
Air transport 7 2.8 0 0 1 ** 6 3.7* 27 1.3
Other transport accidents 1 ** 0 0 0 0 0 0 4 **
Non-transport accidents 76 33.6 1 ** 12 44.8d 60 41.6 715 39.8
Falls 5 ** 0 0 1 ** 8 6.9* 73 5.6
Accidental discharge of firearms 0 0 0 0 0 0 0 0 6 3d
Drowning and submersion 3 ** 0 0 3 ** 7 5.3* 74 3.6
Smoke, fire and flame 3 ** 0 0 2 ** 8 5.2* 39 1.9
Poisoning 49 20 0 0 2 ** 20 13.1 348 16.9
a Age-Adjusted rates are per 100,000 U.S. year 2000 standard population
b Deaths to an operator or passenger related to the use of a snow machine
c Deaths to an operator or passenger related to the use of an ATV
d Rates based on fewer than 20 occurrences are statistically unreliable and should be used with caution
**Rates based on fewer than 6 occurrences are not reported
Alaska Bureau of Vital Statistics 2013
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Table 5.2-10. Leading Causes of Unintentional Injury Deaths among All Alaska Natives, 2005 to 2007
Cause Rank Number of Deaths Percent of Total
Unintentional poisoning 1 61 19.6
Motor vehicle traffic 2 46 14.7
Drowning 3 41 13.1
Natural/environmental 4 39 12.5
ATV/Snowmachine 5 27 8.7
Other Transport (Boat, etc.) 6 27 8.7
Suffocation 7 19 6.1
Fire/Flame 8 15 4.8
Fall 9 7 2.2
Pedestrian (Other) 10 6 1.9
Firearm 11 3 1.0
Other 9 2.9
Not Specified 12 3.8
Total 312 100
Alaska Native Epidemiology Center 2009
Table 5.2-11. Leading Causes of Intentional Injury Deaths among All Alaska Natives, 2005 to 2007
Cause Rank Number of Deaths Percent of Total
Suicide 1 141 78.3
Homicide 2 39 21.7
Total 180 100
Alaska Native Epidemiology Center 2009
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Table 5.2-12. Deaths due to Infectious and Parasitic Disease in the State of Alaska, Mat-Su Borough, Valdez Cordova
Census Area, Denali Borough, and the Kenai Peninsula Borough
Cause of Death
Alaska
Age-
adjusted rate
Mat-Su Borough
Age-
adjusted rate
Valdez-Cordova Census Area
Age-
adjusted rate
Denali Borough
Age-
adjusted rate
Kenai Peninsula Borough
Age-
adjusted rate
INFECTIOUS AND PARASITIC DISEASE (A00-B99) 14.1 11.6 ** 0 15.2
Tuberculosis (A16-A19) 6* ** 0 0 0.0
Septicemia (A40-A41) 6.3 6.3* ** 0 **
Viral Hepatitis (B15-B19) 2.9 2.7* ** 0 2.8*
HIV Disease (B20-B24) 1.2 ** 0 0 **
All Other Infectious Disease 3.1 ** 0 0 7.7*
INFLUENZA AND PNEUMONIA (J10-J18) 12.5 ** ** 0 6.9*
Influenza (J10-J11) 7* 0 0 0 0
Pneumonia (J12-J18) 11.8 10.4* ** 0 6.9*
Alaska Bureau of Vital Statistics
a Age-Adjusted rates are per 100,000 U.S. year 2000 standard population.
*Rates based on fewer than 20 occurrences are statistically unreliable and should be used with caution.
**Rates based on fewer than 6 occurrences are not reported.
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Table 5.2-13. Reportable Infectious Disease Cases, Alaska Natives, January 1, 2007 to October 3, 2008
Infectious Disease Cases Percent of Total
Chlamydia 4,103 79.3
Gonorrhea 476 9.2
Hepatitis C 198 3.8
Pneumococcal invasive 135 2.6
Tuberculosis, Pulmonary 52 1.0
Chlamydia, PID 37 0.7
Pertussis 32 0.6
Salmonella 25 0.5
GAS invasive disease 24 0.5
GBS invasive disease 18 0.3
Chicken Pox 15 0.3
Botulism, Foodborne 13 0.3
Campylobacter 12 0.2
Gonorrhea, PID 9 0.2
Invasive H Flu, Not Meningitis 7 0.1
Giardia 5 0.1
Hepatitis B 3 0.1
Meningitis, Haemophilus 3 0.1
Other Infectious Diseases 10 0.2
Total 5,177 100.0
Alaska Native Epidemiology Center 2009
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Table 5.2-14. Water and Sanitation Service Rates by Region, 2008
Regional Health Corporation
2008 Housing Units with Pipes or Close Haul 2008 Total Housing Units Percent Served
Aleutian Pribilof Islands Association 271 324 84
Arctic Slope Native Association 462 491 94
Bristol Bay Area Health Corporation 1364 1572 87
Chugachmuit 179 189 95
Copper River Native Association 343 397 86
Eastern Aleutian Tribes 507 541 94
Kodiak Area Native Association 349 356 98
Maniilaq Association 865 1140 76
Norton Sound Health Corporation 970 1509 64
Southcentral Foundation 212 238 89
Southeast Alaska Regional Health Consortium 2288 2329 98
Tanana Chiefs Conference 1150 1930 60
Yukon-Kuskokwim Health Corporation 2753 4760 58
Independent 1437 1556 92
Total 13,150 17,332 76
Alaska Native Epidemiology Center 2011
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Table 5.2-15. Major Cardiovascular Disease Deaths, Matanuska -Susitna Borough, Valdez-Cordova, Denali Borough, Kenai Peninsula Borough and the State of Alaska,
2007 to 2009
Cause of Death
Denali Borough Mat-Su Borough Valdez-Cordova Census Area Kenai Peninsula Borough State of Alaska
Deaths
Age-Adjusted
Ratea Deaths
Age-Adjusted
Ratea Deaths
Age-Adjusted
Ratea Deaths
Age-Adjusted
Ratea Deaths
Age-Adjusted
Ratea
Major Cardiovascular Diseases 6 426.8* 306 219.4 45 235.2 285 224.6 2567 204.9
Heart disease 3 ** 233 163.2 31 145.3 220 172.4 1945 151.2
Ischemic heart disease 2 ** 132 89.4 19 89.6* 145 111.0 1152 87.6
Acute myocardial infarction 0 0 29 18.1 6 25.4* 22 18.0 232 19.2
Atherosclerotic cardiovascular disease 1 ** 41 20.7 10 51.5* 77 55.0 484 31.0
All other ischemic heart
disease 1 ** 62 50.7 3 ** 46 38.0 436 37.5
All other heart disease 1 ** 101 73.8 12 55.8 75 61.4 793 63.5
Cerebrovascular disease 3 ** 49 40.1 12 80.8* 44 37.0 488 43.1
All other cardiovascular diseases 0 0 24 16.2 2 ** 22 15.2 134 10.7
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Table 5.2-16. Top Leading Causes of Death in Alaska and the Susitna Watana Study Area, Age-adjusted Ratesa, 2007 to 2009
Cause of Death (ICD-10 Codes)
State of Alaska Denali Borough Mat-Su Borough Kenai Peninsula Borough Valdez-Cordova Census Area
Rank
Age-Adjusted
Rate Rank
Age-Adjusted
Rate Rank
Age-Adjusted
Rate Rank
Age-Adjusted
Rate Rank
Age-Adjusted
Rate
Malignant Neoplasms (C00-C97) 1 184 1 ** 1 174.9 1 228.5 1 157.0
Diseases of the Heart (I00-I09, I11, I13, I20-I51) 2 155.9 2 ** 2 149.6 2 151.2 2 145.3
Unintentional Injuries (V01-X59, Y85-Y86) 3 54 2 ** 3 42 3 74.7 3 77.1
Chronic Lower Respiratory Diseases (J40-J47) 4 49.2 - - 4 44.1 4 46.7 5 71.5*
Cerebrovascular Diseases (I60-I69) 5 40.6 2 ** - ** 5 34.4* 4 80.8*
Intentional Self-Harm (Suicide) (X60-X84, Y87.0) 6 22.7 - 5 21.3* - - - -
Diabetes (E10-E14) 7 21.3 - - - - - - -
Chronic Liver Disease and Cirrhosis (K70, K73-K74) 8 11.7 - - - -5 - 20.0 - -
Influenza and Pneumonia (J10-J18) 9 12.5 - - - - - - - -
Alaska Bureau of Vital Statistics
a Age-Adjusted rates are per 100,000 U.S. year 2000 standard population.
*Rates based on fewer than 20 occurrences are statistically unreliable and should be used with caution.
**Rates based on fewer than 6 occurrences are not reported.
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Table 5.2-17. Cancer Deaths by Type, Matanuska-Susitna, Denali, Valdez-Cordova Census Area, Kenai Peninsula Borough, and the State of Alaska, 2007 to 2009
Cause of Death
Denali Borough Mat-Su Borough Valdez-Cordova Census Area Kenai Peninsula Borough State of Alaska
Deaths Age-Adjusted Ratea Deaths Age-Adjusted Ratea Deaths Age-Adjusted Ratea Deaths Age-Adjusted Ratea Deaths Age-Adjusted Ratea
Malignant Neoplasms 1 ** 301 175.3 36 157.0 285 200.5 2583 182.8
Colon, rectum and anus 0 0 25 13.6 2 ** 26 19.5 236 17.5
Liver and intrahepatic bile ducts 0 0 8 4.2c 1 ** 11 5.8* 94 5.7
Lung 1 ** 82 47.8 10 43.9 82 59.3 770 55.0
Breast b 0 0 20 22.5 1 ** 29 39.5 187 24.0
Prostate b 0 0 14 24.2c 2 ** 16 34.6* 104 21.0
Lymphoid & hematopoietic 0 0 27 13.6 4 ** 17 12.7* 209 15.5
Non-Hodgkin’s lymphoma 0 0 8 3.4c 0 0.0 9 6.6* 83 6.3
Leukemia 0 0 14 8.1c 3 ** 6 4.4* 88 6.4
All other lymphoid &
hematopoietic 0 0 5 ** 1 ** 2 ** 38 2.8
All other malignant neoplasms 0 0 125 73.9 16 66.1 104 68.9 983 67.6
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Table 5.2-18. Ratio of People to Providers
Location Number of People Per One
Primary Care Provider
United States 1,067 to 1
Alaska 1,206 to 1
Matanuska-Susitna Borough 1,293 to 1
Denali Borough 1,835 to 0
Valdez-Cordova Census Area 1,384 to 1
Kenai Peninsula Borough 1,235 to 1
Population Health Institute 2013
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10. FIGURES
Figure 5-1. HIA Study Area
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Figure 5.2-1. Alaska Age-adjusted Suicide Rates over Time by Region 2001 – 2010. Source: ADHSS Suicide
Prevention Council 2012.
Figure 5.2-2. Suicide Death Rates by Region. Source: Alaska Native Epidemiology Center 2009.
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Figure 5.2-3. Binge Drinking Rates by Region. Source: Alaska Native Epidemiology Center 2009.
Figure 5.2-4. Number of Fatal Injuries in the Matanuska Susitna Borough, 2007 – 2009. Source: Alaska
Trauma Registry 2011.
0 20 40 60
Smoke, fire and flame
Drowning and submersion
Snow machine
ATV
Falls
Air transport
Motor vehicle accidents
Poisoning
Total Number of Fatal Injuries (N=117)
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Figure 5.2-5. Leading Causes of Non-Fatal Injury in the Matanuska Susitna Borough, 2004 – 2008. Source:
Alaska Trauma Registry 2011
Figure 5.2-6. Non-fatal injuries by Percentage Involving Alcohol: 2004 – 2008 Matanuska Susitna Borough,
Alaska. Source: Alaska Trauma Registry 2011.
0 100 200 300 400 500 600 700 800 900
Machinery
Poisoning
Struck by object
Cut
Assault
Snow machine
ATV
Suicide attempt
Motor Vehicle accident
Falls
Total Number of Non-Fatal Injuries
0 10 20 30 40 50 60 70
Struck by object
Machinery
Falls
Cut
Snow machine
Poisoning
ATV
Motor vehicle accidents
Assault
Attempted suicide
% of Non-Fatal Injuries Involving Alcohol
(N=2,530)
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Figure 5.2-7. Average Annual Age-adjusted Unintentional Injury Death Rates per 100,000 by Region, Alaska
Natives, 2004 – 2007. Source: Alaska Trauma Registry 2011.
Figure 5.2-8. Regions in Alaska Where Rabies is Enzootic Among Foxes. Source: ADHSS SOE 2013b.
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Figure 5.2-9. Chlamydia Rate per 100,000 Population, Alaska Natives Statewide, 2007. Source: Alaska
Native Epidemiology Center 2011.
Figure 5.2-10. Gonorrhea Rate per 100,000 Population, Alaska Natives Statewide, 2007. Source: Alaska
Native Epidemiology Center 2011.
979
249
3,068
418
0
500
1000
1500
2000
2500
3000
3500
Alaska Natives Alaska Whites Alaska Natives Alaska Whites
Males Females
155
28
300
29
0
50
100
150
200
250
300
350
Alaska Natives Alaska Whites Alaska Natives Alaska Whites
Males Females
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Figure 5.2-11. Average Annual Age-adjusted Heart Disease Mortality Rates per 100,000 by Region Alaska
Natives, 2004 to 2007. Source: Alaska Native Epidemiology Center 2011.
Figure 5.2-12. Average Annual Age-adjusted Cerebrovascular Disease Mortality Rates per 100,000 by
Region Alaska Natives, 2004 to 2007. Source: Alaska Native Epidemiology Center 2011.
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Figure 5.2-13. Alaska Native Age-Adjusted Cancer Death Rates. Source: Alaska Native Epidemiology
Center 2009.
Figure 5.2-14. Tobacco Use. Source: Alaska Native Epidemiology Center 2009.
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Figure 5.2-15. Alaska Native Chronic Obstructive Pulmonary Disease, 2004 – 2007. Source: Alaska Native
Epidemiology Center 2009.