The Need and Goals for the Guidebook

With the recent boom in shale energy development in the United States, local public health officials and other stakeholders are often seeking information and guidance on the health issues that could accompany development in their communities. In response to that need, RESOLVE’s Solutions Network consulted with a multi-stakeholder working group to create this guidebook on the community health issues that may arise as a result of shale energy development.

Our goal is for health officials, community members, and industry representatives to use this guidebook to 1) gain a basic factual understanding of the potential health issues, 2) easily access in-depth resources from a variety of perspectives, 1 and 3) learn about some options for responding to challenges. We hope that the guidebook will become a valued resource that provides a basis for stakeholders to engage in productive conversations around how to address the impacts and manage the benefits of development. To that end, we have included case examples in which companies and communities have worked together to find solutions to community concerns. This is a dynamic guidebook, to be updated as new information and case studies emerge.

RESOLVE Approach

As an independent organization with a 30-year history of bringing those with different perspectives together to solve environmental, social, and health problems, RESOLVE took a collaborative approach to this guidebook, soliciting input from local health officials, companies, and nongovernmental organizations (NGOs). We drew on a variety of different perspectives when pulling together the resources for this guide, which you can see in the bibliography organized by source type.

We recognize that some of the health issues associated with shale energy development (such as truck traffic, communicable diseases, impacts on municipal services, and managing revenues in a way that benefits community health) are common to many forms of natural resource development, including mining and conventional oil and gas development. These sectors have long confronted such health challenges; consequently, there is an existing body of information and resources for responding to them. While shale development has some unique characteristics – such as bringing oil and gas development in closer proximity to communities and residences than has been common in the past – this project draws upon these resources where they can be useful in the shale development context.

Project Background & Participants

In 2012, RESOLVE hosted a series of multi-stakeholder conversations around the process of shale development for oil and gas resources. The goal was to learn whether there could be a role for collaborative dialogue and action to address concerns and foster solutions to the challenges involved. One recommendation for useful action emerging from those conversations was the concept of creating a guidebook as a resource for local health officials.

Shell Oil Company and Talisman Energy provided initial funding for the creation of the guidebook. RESOLVE matched these resources with general support funding and has also received support from the National Association of County and City Health Officials (NACCHO).

RESOLVE asked a variety of stakeholders for input on the composition of a working group to guide the project. The working group’s mandate was to give guidance and advice to RESOLVE on the development of the guidebook. For a list of working group members and their short biographies, see Appendix B. In addition to the working group, RESOLVE recruited a group of expert advisors to give feedback on particular elements of the guidebook, drawing on their expertise in the fields of public and/or environmental health and their experience with shale development operations.

A team of RESOLVE staff, interns, and volunteers participated in and led the working group; collected the resources for the guidebook; and drafted the guidebook text. We shared the drafts with the working group and the expert advisors for feedback. We also delivered a webinar presentation to NACCHO members and invited their feedback on the draft via an online survey. After revising the document based on the NACCHO comments, we held another feedback workshop for all stakeholders and invited written comments on the draft. We made a concerted effort to take the feedback we received into account in preparing the final version.

Guidebook Organization: How to Use This Guide

The guidebook is organized both by project stage and the typical questions that community stakeholders might have. The six project stages described are initial assessment; leasing and permitting; exploratory drilling; development; production; and project closure and land restoration. Other summaries of the shale development process may differ somewhat in their organization of the project phases. We have described the project steps in this way to highlight aspects of the process that are relevant to local communities and are amenable to community-company engagement and to the implementation of certain management options, such as early planning.

The entry for each stage includes a brief description of what the company does at that stage; what the community might experience; health concerns the community might have; options for managing health-related issues, including case studies describing what others have done; and a set of selected resources. The options for addressing health concerns are organized according to those who could carry them out, including local officials, company representatives, and community leaders. Some options are often-implemented or recommended practices; others have been undertaken at some sites or by some operators; and others are suggestions for stakeholders to consider. These are not, therefore, a standardized set of best practices, but rather a menu of options to give local decision-makers a range of alternatives that might suit their particular community.

Although we have organized the guide by project stage, we recognize that some communities may be host to multiple well sites that can all be in different stages of development. We have therefore included a chart of the entire process with icons indicating the major health issues that are discussed at each stage to facilitate searching for particular topics (see Figure 1). In the website version, you can move between stages or between topics by clicking on the stage or issue area listed at the bottom of the screen. Each issue area section (e.g., “water quality”) contains the text from each stage pertaining to that issue. 

Additional Resources

Have we missed an important document? The resources provided in this guidebook are not intended to constitute a comprehensive list, but rather a starting point that we can build upon as new resources emerge. If you know of useful resources or case studies that are not listed here, please let us know by contacting RESOLVE at

Health Considerations of Shale Development

What is Shale Development?

First, a word on terminology. We are using the term “shale development” to refer to the entire process of seeking and extracting oil and/or natural gas reserves from shale deposits using a combination of horizontal drilling and high-volume hydraulic fracturing techniques, often known as “fracking.” The combination of these techniques allows oil and gas operators to reach previously inaccessible “tight,” or low-permeability, geologic formations like shale deposits, allowing the trapped resources to flow into the well and up to the surface for capture.

While these techniques have been in use in the oil and gas industry for decades, they have only recently improved to the point where the exploitation of shale formations has become feasible for the industry. Originally used for natural gas, operators have adopted horizontal drilling and hydraulic fracturing techniques in oil fields, allowing both oil and natural gas production in the United States to skyrocket. 2 After becoming the world’s largest producer of natural gas in 2010, the United States took the lead in petroleum production in 2013. 3

This new oil and gas boom has also brought development to regions where extensive shale deposits – known as shale plays – are present. A 2013 Wall Street Journal analysis determined that over 15 million Americans now live within a mile of a shale well drilled since 2000. 4 Many of these communities are unfamiliar with the implications of shale development, with its potential challenges and benefits – an information gap that this guidebook aims to help fill.

A Public Health Approach to Shale Development

According to the American Public Health Association (APHA), “Public health promotes and protects the health of people and the communities where they live, learn, work and play.” 5 The focus of public health professionals is on prevention and wellness, anticipating and avoiding risks to keep people healthy. Public health practitioners hail from a range of fields, including not only government public health officials and public health physicians and nurses, but also first responders, researchers, community planners, and public policymakers.

To determine potential population health risks, practitioners and/or researchers take into account both the health effects of a particular stressor, such as air pollution or psychosocial stress, and the potential exposure of the population to that stressor. They consider possible exposure pathways, or the means through which people can be exposed to a stressor. In the case of air pollution and shale development, for example, exposure pathways include fugitive emissions of pollutants from wells and other project infrastructure or emissions from increased truck traffic, such as road dust and diesel exhaust. Furthermore, public health practitioners are concerned with impacts on vulnerable subpopulations, such as the elderly, pregnant women, children, and people with existing respiratory conditions like asthma. Finally, they might also consider the cumulative effects of a number of different stressors on a population.

When attempting to determine if there is a link between possible environmental exposures and public health risks, researchers can draw on several types of investigative methods, each with different strengths and limitations in terms of answering questions from a public health standpoint. These different study types are described below:

  • Environmental epidemiologic studies are generally observational in nature and investigate the possible links between environmental stressors and health outcomes. Environmental epidemiologic studies can be descriptive – such as case reports or studies of a disease cluster – or analytic, which involve more individually detailed data and control populations. Descriptive studies are generally considered most useful for generating hypotheses and analytic studies for testing hypotheses. Typical examples of analytic studies are cohort studies, which follow a group of people with a particular exposure over the long term to determine the consequences, and case-control studies, which study past exposures of two groups of people – those who have a particular health outcome (or case, such as breast cancer) and those who do not (control group). 6 Limitations of environmental epidemiologic studies include the difficulty of ascertaining the relationship of a health outcome to a particular exposure given the multiplicity of factors in real-world situations. In addition, given the potentially long period between exposure to a toxicant and the development of certain diseases, it can be difficult to identify and measure exposure during the most critical time periods. 7
  • Toxicology studies involve experiments using animal alternatives and animals to evaluate potential hazards of a chemical or other stressor. These studies provide indicators of potential hazards, and are used by regulatory authorities, industry, and others to assess potential hazards to humans and the environment.
  • Exposure assessments quantify the magnitude, frequency, and duration of human exposure to a contaminant in the environment. It is step 3 of the 4-step process of risk assessment and attempts to answer these questions:  “How much of the stressor are people exposed to during a specific time period? How many people are exposed?” 8 According to the U.S. Environmental Protection Agency (EPA), “Exposure assessment considers both the exposure pathway (the course an agent takes from its source to the person(s) being contacted) as well as the exposure route (means of entry of the agent into the body).” 9

In addition to these investigative methods, surveys and self-reports describe the health status of residents in areas where environmental changes are taking place. While subjective reports cannot provide reliable evidence of impacts or causality, they can serve as a useful indicator of issues for further research. 10

Recent Literature on Public Health Risks & Shale Development

In three recent reviews of the existing research on the public health risks of shale development, researchers concluded that there is a “compelling need” for more research with regard to the human health impacts of drilling operations and the level of human exposure to potential stressors. 11 12 13 In a December 2014 review of the scientific literature published in Reviews on Environmental Health, the authors found that the chemicals used in shale development and found near well sites can present risks to human reproduction and development and there is an urgent need for studies to determine actual exposures. The Inter-Environmental Health Sciences Core Center Working Group on Unconventional Natural Gas Drilling Operations, funded by the National Institute of Environmental Health Sciences (NIEHS), recommended that research be conducted on a number of topics, including on potential local air and water quality impacts (see Air Quality and Water Quality). The Working Group also urged that affected communities be engaged in the design and implementation of the studies (community-based participatory research, or CBPR). The authors of the three reviews emphasized the need for 1) gathering baseline data before shale development activities begin and 2) conducting comprehensive epidemiologic studies in order to answer key questions on potential public health impacts. 

Health Issues Addressed in This Guidebook

This guidebook is focused on the potential health effects of shale development for local communities. We have made an effort to be comprehensive in our discussion of the relevant health issues, including both the positive and negative impacts. The icons below represent the following topic areas covered in the guidebook: 





Air quality, including health effects and the potential exposure pathways of fugitive emissions; diesel-powered trucks and machinery; venting and flaring; evaporation pits; dehydration units; compressor stations; silica sand; and road dust.




Water quality, including the composition of fracturing fluids; the components of produced water; and the potential exposure pathways of seismic testing, spills, leaks, groundwater contamination, wastewater disposal, and orphaned wells.




Water quantity, including sourcing, U.S. water law, and regulation and permitting.




Safety issues for local communities – meaning threats to physical safety, such as injuries and death – including the potential for blowouts (i.e., sudden, uncontrolled releases of gases or fluids), explosions, chemical spills, fires, exposure to high levels of airborne chemicals, vehicular accidents, and induced seismicity.




 Diseases, including communicable diseases and mental health impacts.





Health-related quality of life, including the effects of economic and social changes; impacts on local infrastructure and services; and changes in the physical environment such as noise, lighting, and the viewshed (see Box 1).


Limitations in Scope

Given our focus on local communities and health officials, we have mentioned – but not detailed – health concerns for workers at shale development sites, as worker-related health and safety issues fall under the purview of the federal Occupational Safety and Health Administration (OSHA) and the National Institute for Safety and Health (NIOSH) at the Centers for Disease Control and Prevention (CDC). We have also not addressed issues that are national or international in scope, such as energy policy and climate change.

Finally, we have reviewed many different types of sources with the goal of conveying the health considerations that may arise with shale development. These health issues will not occur in every case and will depend on a variety of factors, including – but not limited to – the size and character of the community; the geography of the site; the stage and scale of development; and the relationship between the community, the industry, and local officials. We have therefore not attempted to describe the likelihood of the occurrence of a particular health effect, but rather to describe the range of possible effects to allow readers to take them into account when considering potential impacts in their own communities. 



Some of the impacts of shale development that are most salient to local communities are those in the area of health-related quality of life (HRQOL or, for the purposes of this guidebook, “quality of life”). The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being, not merely the absence of disease . . .” 14 Well-being and quality of life must therefore be considered in a discussion of individual and community health. According to the U.S. Centers for Disease Control and Prevention (CDC), HRQOL is “an individual’s or group’s perceived physical and mental health over time.” This multidimensional concept has been shown to be an important predictor of health outcomes. HRQOL data can be used to determine health needs and guide interventions. 15 In order to measure quality of life, the WHO has identified the six domains in Table 1 below as important to assess. 16

Table 1. Domains of Health-Related Quality of Life 

Domain   Facets incorporated within domains
    Overall Quality of Life and General Health
1. Physical health   Energy and fatigue
Pain and discomfort
Sleep and rest
2. Psychological   Bodily image and appearance
Negative feelings
Positive feelings
Thinking, learning, memory and concentration
3.  Level of Independence   Mobility
Activities of daily living
Dependence on medicinal substances and medical aids
Work capacity
4.  Social relationships   Personal relationships
Social support
Sexual activity
5. Environment   Financial resources
Freedom, physical safety and security
Health and social care:  accessibility and quality
Home environment
Opportunities for acquiring new information and skills
Participation in and opportunities for recreation/leisure
Physical environment (pollution/noise/traffic/climate)
6. Spirituality / Religion / Personal Beliefs   Spirituality / Religion / Personal Beliefs

Shale development projects have the potential to affect many, if not all, of these domains. Given the potential impacts on the economy, infrastructure, and physical environment of a community, these projects can influence the “environment” domain in particular. The aspects of HRQOL that we have focused on in this guidebook are social relationships; financial resources and opportunities for acquiring new information and skills (economic impacts); and the physical environment, including pollution, noise, traffic, lighting, and viewshed alterations. In this guidebook,the HRQOL concept is used as a framework for organizing these types of positive and negative community impacts and considering their potential relation to health.   

General Resources on Community Health & Shale Development

Shale Development

  • Frackmap is a mapping tool hosted by Harvard University that includes the locations of U.S. shale plays and permitted wells. Other data layers, such as the principal aquifers in the U.S., can be displayed and/or uploaded into the tool.
  • The Geological Society of America website has “critical issue” pages dedicated to an overview of the shale development process, its history, and some potential environmental issues, including water quality, water use, and induced seismicity.
  • National Energy Technology Laboratory, “Modern Shale Gas Development in the United States: An Update” (September 2013), prepared for the U.S. Department of Energy. This update to the 2009 “Modern Shale Gas Development in the United States:  A Primer,” contains an overview of U.S. natural gas resources, the technology used to develop shale gas, and the existing regulatory framework; it also describes some potential environmental and community impacts, including water quality, water quantity, air quality, and induced seismicity.

Public Health

Figure 1. Shale Development Timeline and Listing of Topics Discussed

Continue to Stage One: Initial Assessment ➤


  1. With the goal of presenting a variety of perspectives, RESOLVE has included information and references from perspectives that may not reflect the perspectives of other stakeholders involved in this project. Therefore, support for or participation in the development of the guidebook does not constitute a blanket endorsement of all resources cited herein.
  2. Geological Society of America, “GSA Critical Issue:  Hydraulic Fracturing,” 8, accessed December 10, 2014.
  3. Grant Smith, “U.S. Seen as Biggest Oil Producer After Overtaking Saudi Arabia,” Bloomberg News (July 4, 2014)
  4. Russell Gold and Tom McGinty, “Energy Boom Puts Wells in America’s Backyards,” The Wall Street (October 25, 2013).
  5. American Public Health Association, “What Is Public Health?” accessed December 8, 2014.
  6. National Research Council, Environmental Epidemiology, Volume 2: Use of the Gray Literature and Other Data in Environmental Epidemiology (Washington, DC:  National Academies Press, 1997), 13-19. 
  7. The Breast Cancer Fund, “Environmental Epidemiological Studies” (accessed 8/15/15).
  8. U.S. Environmental Protection Agency, “Step 3: Exposure Assessment,” last updated 7/31/12.
  9. U.S. Environmental Protection Agency, “Step 3: Exposure Assessment,” last updated 7/31/12.
  10. Vera Bonnet, Shale Extraction and Public Health: A Resource Guide (2013), Shale and Public Health Committee, League of Women Voters of Pennsylvania, pp. 2-3.
  11. John L. Adgate, Bernard D. Goldstein, and Lisa M. McKenzie, “Potential Public Health Hazards, Exposures and Health Effects from Unconventional Natural Gas Development,” Environmental Science and Technology (February 10, 2014).
  12. Trevor M. Penning, Patrick N. Breysse, Kathleen Gray, Marilyn Howarth, and Beizhan Yan, “Environmental Health Research Recommendations from the Inter-Environmental Health Sciences Core Center Working Group on Unconventional Natural Gas Drilling Operations,” Environmental Health Perspectives (July 18, 2014).
  13. Ellen Webb et al., “Developmental and Reproductive Effects of Chemicals Associated with Unconventional Oil and Natural Gas Operations,”  Reviews on Environmental Health, Volume 29, Issue 4, Pages 307–318, December 5, 2014
  14. Programme on Mental Health, World Health Organization Division of Mental Health and Prevention of Substance Abuse, WHOQOL Measuring Quality of Life (WHO/MSA/MNH/PSF/97.4, 1997)
  15. Centers for Disease Control and Prevention, “Health-Related Quality of Life:  HRQOL Concepts,” last modified March 17, 2011.
  16. Programme on Mental Health, World Health Organization Division of Mental Health and Prevention of Substance Abuse, WHOQOL Measuring Quality of Life (WHO/MSA/MNH/PSF/97.4, 1997), pp. 3-4