The WestConnex M4 East EIS also assessed health using HHRA. This was very similar to NorthConnex, covering all of the previously mentioned elements with the addition of an assessment of social issues within the health section.
Nevertheless, the approaches to assessing health using HHRA in the NorthConnex and WestConnex M4 East motorway projects and in the SIA for the light rail were conducted according to current best practice for EA and can on that criterion be considered to be of good quality.
The consideration of health was most comprehensive in the WestConnex M4 East EIS, which notably was the only EIS required to have a detailed HHRA as an explicit chapter.
After such a critical HGT event, we may then move into a more quantitative kind of HHRA.
The Codex Alimentarius Commission (2011) described eight principles that are specific to risk analysis for foodborne antimicrobial resistance, several of which are generally applicable to a HHRA of environmental ARB.
Importantly, the key difference from traditional HHRA undertaken in some jurisdictions is that it is essential to include environmental processes to fully assess human risks associated with antibiotic resistance.
Based on our conceptualization of the processes important to undertake HHRA of ARB (Figure 1), most elements related to ARB development in environmental media (processes 1, 2, and 4) have been addressed above in "Hazard identification and hazard characterization." Here we focus on describing important environmental compartments for and human exposure to ARB (Figure 1, processes 3 and 6).
Important Research Gaps Affecting Progress of HHRA of Antibiotic Resistance
However, because these data are currently very limited, workshop participants evaluated alternative ways and possible experimental methods to address these data gaps for HHRA as they relate to the processes identified in Figure 1.
Defining "critical exposure levels" is therefore an important HHRA output to aid management activities, which will likely vary between and within environmental compartments, depending on the location.
We propose that environmental aspects of antibiotic-resistance development be included in the processes of any HHRA addressing ARB.