Annoyance is an adverse health effect

Malcolm S. Lock, MD., M.P.H.
(A) Medical Officer of Health
Haldimand-Norfolk Health Unit
Haldimand-Norfolk Board of Health
c/o Chair, Mr. Charlie Luke
Ms Stephana Johnston
Ontario, Canada
February 25, 2015
Dear Dr. Lock,

Re: Response to your November 20, 2014 letter to Ms Johnston

Ms Johnston has asked that I respond to your letter of November 20, 2014. She requests that a copy of this letter be provided to the Chair and the Members of the Board of Health.

Personal disclosure: I declare no potential conflicts of interest and have received no financial support with respect to the research and authorship of this commentary.

This letter is public and may be shared.

I met Ms Johnston for the first time on April 22, 2009, during the Standing Committee on General Government, Green Energy and Economy Act, 2009 hearings. I have been in touch with Ms Johnston since that time and am aware of her circumstances. In my opinion since early 2009 Ms Johnston has explored every avenue available to her, including contacting your office, to find a remedy to her circumstances which are associated with the operation of
the wind projects in her vicinity.

There is sufficient evidence that some, including Ms Johnston are negatively affected by industrial wind energy facilities. Examples of reported adverse health effects include chronic and high annoyance, chronic sleep disturbance, stress-related health impacts and reduced quality of life.1,2,3,4,5,6,7,8,9,10,11, 12 In some cases families reporting adverse health effects  have abandoned their homes, been billeted away from their homes or hired legal counsel to successfully reach a financial agreement with the wind energy developer.13

Peer reviewed and published references, testimony under oath, and/or disclosure evidence and/or witness statements, authoritative documents and other references such as those briefly
summarized in this letter have acknowledged adverse health effects.

A brief bio and summary of the peer reviewed articles and conference papers for which I am an author / co-author is provided at the end of this letter.

Assurances of Health Protection

In a communication dated pre-Green Energy and Economy Act (GEA 2009), the former Minister of Environment of Ontario, John Gerretsen states the MOE is committed to siting and operation of facilities in a manner that is protective of human health and that it is an offence to violate a condition set out in a CofA (Certificate of Approval): [excerpt]




Following the GEA coming into law, similar assurances have been given. An example is a commitment by the Premier of Ontario: [excerpt]




A search of the GEA using the term “health” indicates that the only section relating to health cites the grounds for a hearing, i.e., that engaging in the renewable energy project in accordance with the renewable energy approval will cause serious harm to human health.
During the Green Energy Act hearings, Robert Y. McMurtry, M.D., F.R.C.S.(C), F.A.C.S. presented WindVOiCe,14 the Ontario community based self-reporting survey.

The WindVOiCe survey:

“… follows the principles of Health Canada’s Canada Vigilance Programs, which encourages all consumers in Canada to self-report perceived adverse health effects from prescription and consumer products, vaccines and other. Medical and health
care practitioners are encouraged to report perceived adverse health effects to the Canada Vigilance. Consumers do not have to prove the effect, only perceive it. The pharmaceutical industry is obligated by law to submit any reported adverse health effects it receives to Health Canada (Health Canada, n.d.).”15

Based on Health Canada’s principles for reporting perceived adverse health effects, there is no requirement to prove the effect, only perceive it.

There is no federal mechanism for a similar reporting system associated with Industrial Wind Turbines (IWT)

CMOH Report of 2010

The CMOH report is cited in your correspondence with Ms Johnston. This report is dated 2010 and since its publication, the body of scientific knowledge has expanded.

During a meeting held with senior MOECC (Ministry of Environment and Climate Change) representatives16 MOECC indicated that the Environmental Sciences and Standards Division
considers and reviews the emerging studies/reports available since 2010. However, MOECC also stated it does not have evaluation criteria established for determining the application of new research relating to wind turbine noise/setback guidelines.

It has been documented, including testimony under oath, that the King report only considered “direct” effects.17 However, the reported cluster of symptoms typically involves the “indirect” pathway.

The Environmental Review Tribunal Decision of Erickson vs MOE expressed concerns: “…about the Director’s apparent lack of consideration of indirect health effects and the need for further work on the MOE’s practice of precaution…”18

Erikson v MOE also found:

“… The Tribunal has found above that “serious harm to human health” includes both direct impacts (e.g., a passer-by being injured by a falling turbine blade or a person losing hearing) or indirect impacts (e.g., a person being exposed to noise and then exhibiting stress and developing other related symptoms). This approach is consistent with both the WHO definition of health and Canadian jurisprudence on the topic.”19

Investigation of a health hazard

Your letter of November 20, 2014 comments that the installation and operations of IWTs are primarily the responsibility of the MOE and that PART III, COMMUNITY HEALTH PROTECTION Complaint re health hazard related to occupational or environmental health
directs that “in consultation with the ministry, the medical officer of health shall investigate the complaint to determine whether the health hazard exists or does not exist. R.S.O. 1990, c. H.7, s. 11 (1).”

I am aware of this provision and my understanding is that the Ministry of Environment, now known as the Ministry of Environment and Climate Change is the ministry with which a
medical officer of health consults. If a change in ministry has taken place, please let Ms Johnston and I know the correct ministry involved.

Based on your correspondence to Ms Johnston, consideration was given to whether “all legislative requirements were being adhered to by the operator and that daily operations were in compliance.”

The MOE Compliance Protocol for Wind Turbine Noise states exclusions including health effects:

“Complaints about wind turbine noise in the infrasound or ultrasound ranges (i.e. outside the normal audio range), transformer substation noise, and other issues such as shadow flicker or health effects are beyond the scope of this document.” (pg. 7)

It appears that under the HPPA, your investigation is based on correspondence received from the MOE which cites ministry reviews. There are no details or supporting data provided regarding what constituted ministry reviews. It is unclear whether complaints, correspondence, noise measurements, new evidence or other were considered. The Oxford English Dictionary defines investigation as “The action of investigating something or someone; formal or systematic examination or research”20 It is unclear whether a formal or systematic examination or research has been conducted. Based on past correspondence with other Ontario health units, it is my understanding the medical officers of health are limited in scope.21, 22 [Correspondence available on request] However, in correspondence dated September 10, 2012, the Ontario Ministry of Environment advised the suggested course of action to report a problem was to contact the Local Medical Officer of Health [excerpt]:


The above correspondence suggests that health related matters be addressed to the local medical officer of health. In the case of Ms Johnston, her adverse health complaints have not been resolved. However, in your opinion, you have discharged your obligation under HPPA section 11. (1).

If the health effects are out of scope with the compliance protocols, the MOE suggests contact with the local public health unit, and the local public health units are limited in scope, what is Ms Johnston’s recourse? What is the unique nature of a community health issue that an Ontario Medical Officer of Health is constituted to address? As well, regarding industrial wind energy what would be considered a human health hazard?

Any clarifications you could provide would be appreciated.

Responses in other jurisdictions

You may be aware that some jurisdictions have conducted an investigation to better understand the health and socio-economic impact of wind energy development.23, 24, 25

For example, the Falmouth Board of Health (Massachusetts) USA investigated neighbours who were reporting adverse health effects and in correspondence to the Massachusetts Board of Health: [note: bold face emphasis is that of the Falmouth Board of Health]

“… requests that Mass DPH immediately initiate a health assessment of the impacts of the operation of wind turbines in Falmouth. This appeal is compelled by two years of consistent and persistent complaints of health impacts during turbine operation.” 26 “

Due to the increasing intensity of the reported health impacts, the Board is considering emergency actions. To determine the appropriateness of such actions, the Board requests immediate guidance on interim measures to protect the health of affected individuals while the complete health assessment is being conducted.

We look to your Department, as that which holds the highest duty to protect the health of the citizens of the Commonwealth, to assist us in this matter.”27

Subsequently, a preliminary injunction was issued until further order of the court: [excerpt]

“1. The Town of Falmouth, its Selectmen, agents and persons acting in concert shall be restrained from operating the Wind Turbines located at the Waste Water Treatment Facility except during the hours of 7am to 7pm, every day of the week except Sunday. This schedule shall commence on November 22, 2013. Additionally, the same parties shall be restrained from operating said turbines in any fashion on the following limited dates: November 27, 2013; December 25, 2013; and January 1, 2014.28

In 2012, the Brown County Board of Health (Wisconsin) USA requested emergency financial relocation assistance: [excerpt]

“…formally requests temporary emergency financial relocation assistance from the State of Wisconsin for those Brown County families that are suffering adverse health effects and undue hardships caused by the irresponsible placement of industrial wind turbines around their homes and property. The State of Wisconsin emergency financial assistance is requested until the conditions that have caused these undue hardships are studied and resolved, allowing these families to once again return safely to their homes and property.”29

Subsequent to the above request, an investigation was conducted at the Shirley Wind Farm, Brown County, Wisconsin, USA.30 The primary conclusion states:31 [excerpt]


The Brown County Board of Health continued with its investigation and on October 14, 2014 Dr. Jay Tibbetts, member of the Brown County Board of Health states that the Brown Co. Board of Health’s meeting of 10-14-14 unanimously approved a motion to declare the Shirley Wind turbines to be a human health hazard.

“To declare the Industrial Wind Turbines at Shirley Wind Project in the Town of Glenmore, Brown County, WI. A Human Health Hazard for all people (residents, workers, visitors, and sensitive passersby) who are exposed to Infrasound/Low Frequency Noise and other emissions potentially harmful to human health.”

Inaudible sound / infrasound have been shown to have adverse effects on humans. A recent study32 conducted by Steven Cooper, acoustician from Australia merits consideration. As a result of the study design, the exhaustive infrasound (typically inaudible) measurements, the detailed diaries kept by the families, and the developer’s (Pacific Hydro) cooperation, this study has advanced the understanding of the role of infrasound and human responses associated with industrial wind turbines.

The link to the Cooper report and appendices (over 500 pages in total):

Health Canada Wind Turbine Noise and Health Study

Your letter commented on the results of the Health Canada wind turbine noise and health study1 and indicated that Ms Johnston’s reports and issues have in the most part been addressed within this Health Canada study.

To clarify, regarding the 2.1 million dollar study, it was acknowledged by Health Canada that the results will not provide a definitive answer on their own.33 As well, there was no expectation that the study would conclude ‘causality’.

Health Canada found statistically significant findings relating to wind turbine noise annoyance by subjective and objective measurements. A few examples are: [excerpts]

“WTN annoyance was found to be statistically related to several self-reporting health effects including, but not limited to, blood pressure, migraines, tinnitus, dizziness, scores on the PSQI, and perceived stress” as well as related to “measured hair
cortisol, systolic and diastolic blood pressure.”

“A statistically significant increase in annoyance was found when WTN levels exceeded 35 dBA. “ 34

The statistically significant increase in annoyance when wind turbine noise exceeded 35 dBA is relevant to Ms Johnston’s reports of adverse health.

The MOE wind turbine noise guidelines model for 40 dBA with a limit of up to 51 dBA with increased wind speed, i.e., 5 dBA more than the Health Canada findings. [excerpt of a Renewable Energy Approval]


Annoyance is an adverse health effect  

Annoyance may seem of little consequence in general parlance; however, in respect of health, the term annoyance is acknowledged by a number of authorities including Health Canada and the World Health Organization as an adverse health effect.35, 36, 37, 38. 39 Additional references regarding the effects of chronic noise annoyance are available on request.

Health Canada states:

“Health Canada considers the following noise induced endpoints as health effects: noise induced hearing loss, sleep disturbance, interference with speech comprehension, complaints, and change in percent highly annoyed (%HA).” 40

Several studies published by the World Health Organization have revealed findings related to the serious nature of annoyance. An example:

“The result confirms the thesis that for chronically strong annoyance a causal chain exists between the three steps health – strong annoyance – increased morbidity.”41 “

… confirmed, on an epidemiological level, an increased health risk from chronic noise annoyance.”42

Regarding noise induced annoyance the US Environmental Protection Agency states:

“…“annoyance” can have major consequences, primarily to one’s overall health.”43

The Canadian Medical Association Journal Blog by Krogh and McMurtry provides additional context on the significance of annoyance and the Health Canada study findings.44

In addition, a December 2010 report on low frequency noise commissioned by the Ontario Ministry of Environment comments on highly annoyed:

“The audible sound from wind turbines, at the levels experienced at typical receptor distances in Ontario, is nonetheless expected to result in a non-trivial percentage of persons being highly annoyed. As with sounds from many sources, research has shown that annoyance associated with sound from wind turbines can be expected to contribute to stress related health impacts in some persons. (bold emphasis added)

Stress symptoms associated with noise annoyance, and in particular low frequency annoyance, include sleep interference, headaches, poor concentration, mood swings…”45


With respect to the Green Energy Act, I indicated the only section relating to health cites the grounds for a hearing, i.e., that engaging in the renewable energy project in accordance with the renewable energy approval will cause serious harm to human health. [bold emphasis added]

Causality requires a high burden of proof, i.e., a high degree of scientific certainty.

The BioInitiatives (2012) summarizes and gives examples of the different levels of proof. It notes the proof of causality ranks at about 95 to 99% certainty and is rarely possible for biological system; the Precautionary Principle ranks at about the 50% medium level, consistent with civil and some administrative law; and environmental protection has a low level of certainty (10 to 30%): 46 (see Appendix III for levels of proof schema) It notes:

“The prudent approach from a public health point of view is to take preventive actions as if causation had been proven, while at the same time to continue to search for mechanisms of action.”47 “

The Precautionary Principle introduces the use of different levels of proof (or strengths of evidence) to justify actions to reduce exposure, where the level of proof chosen depends upon the nature and distribution of the costs of being wrong in acting, or not acting; the benefits of the agent or substance in question; the availability of alternatives, etc. Waiting for high levels of scientific proof of causality, or for knowledge about mechanisms of action, can be very expensive in terms of compensation, health care, job losses, reduction in public trust of scientists etc.”48 (bold emphasis added).

The World Health Organization comments on full scientific proof with respect to noise in general:

“In all cases, noise should be reduced to the lowest level achievable in a particular situation. Where there is a reasonable possibility that public health will be damaged, action should be taken to protect public health without awaiting full scientific proof.” 49

There are many diseases and conditions for which causality has not been determined. Examples are:

  •  The National Institutes of Health has an Undiagnosed Diseases Program that “will aim to provide answers to patients with mysterious conditions that have long eluded diagnosis.”50
  •  The National Institutes of Health is clear the cause of fibromyalgia is not known.51 11
  • A recent report that experts urge for recognition of chronic fatigue syndrome as a real disease.52 On February 10, 2015 the Institute of Medicine, released a report which “proposes new diagnostic criteria that will facilitate timely diagnosis and care…” for chronic fatigue syndrome.53

Diagnostic criteria for adverse health effects in the environs of wind turbines by McMurtry and Krogh (2014) published in the Journal of the Royal Society of Medicine supports physicians with their investigation of their patients.54 The cluster of symptoms is commonly reported world-wide.

Despite lack of causality physicians do investigate and treat. They do not require proof of causality in order to provide patient care.


In my opinion, there is sufficient scientific evidence supporting that adverse health effects are occurring in some. The evidence warrants invoking precaution.

The World Health Organization agrees it is not necessary to wait for full scientific proof:

“…where there is a reasonable possibility that public health will be damaged, action should be taken to protect public health without awaiting full scientific proof.”55

A literature review cannot be equated to an investigation. By its nature, a literature review will not have investigated those that are reporting harm.

A randomized study cannot be equated to an investigation. By its nature, a randomized study will not necessarily select affected individuals.

Ms Johnston was not selected to participate in the Health Canada study.

Therefore, an investigation of Ms Johnston’s situation would be appropriate under the HPPA.

Ms Johnston had the foresight to plan her retirement so she could live her remaining years in dignity. Now due to unbearable conditions in her home she is required to live away from it more than in it. She is intelligent, well educated and credible. I do not doubt her reports of adverse health effects. Her symptoms are consistent to those of the international community, even when a country’s national language differs and requires translation.

Ms Johnston is elderly. She did not consent to be exposed to the risk factors associated with industrial wind energy facilities. It appears she has been abandoned by the systems she expected would protect her.

I suggest that based on the authority of the HPPA, the medical officer of health could conduct an investigation of Ms Johnston’s health complaints. The investigation should include the actual data, complaints, correspondence, noise measurement and medical reports and other evidence which is on record.

Some have commented that due to a lack of remedy and a failure of the systems to accept responsibility for the care and protection of rural residents who live near wind projects, they feel like ‘lab rats” or “guinea pigs”. There may be a potential for ethical issues with respect to future research.

Regarding ethical considerations, Health Canada (2009) states:

“In order for research to be ethically acceptable, it must be scientifically sound. If research does not have sufficient scientific merit, generalizable knowledge cannot be anticipated and the reason for undertaking the research vanishes. Even a negligible risk of harm resulting from research that may not yield meaningful results is inherently unethical.” 56

I trust the information provided in this brief overview will assist with your deliberations.

Thank you for your consideration of this matter and if I can assist, please do not hesitate to contact me.

Respectively submitted,

Carmen Krogh, BScPharm

Ontario, Canada

Cell 613 312 9663

Brief Bio

I am an independent, full time volunteer and published researcher regarding health effects and industrial wind energy facilities and share information with: communities; individuals; federal, provincial and public health authorities, wind energy developers; the industry; and others. I am an author or co-author of peer reviewed articles and conference papers presented at wind turbine noise scientific conferences.

I have held senior executive positions at a teaching hospital, as a drug information researcher, a professional organization and Health Canada (PMRA). I am a former Director of Publications and Editor in Chief of the Compendium of Pharmaceuticals and Specialties (CPS), the book used by physicians, nurses, and health professionals for prescribing information in Canada.

Aricles Peer reviewed

Robert Y McMurtry and Carmen ME Krogh, Diagnostic criteria for adverse health effects in the environs of wind turbines JRSM Open 2014 5:1-5 The online version of this article can be found at: DOI: 10.1177/2054270414554048 PMID: 25383200 [PubMed] PMCID: PMC4221978 s+in+the+environs+of+wind+turbines

Roy D. Jeffery, Carmen M.E. Krogh, and Brett Horner, Industrial wind turbines and adverse health effects Can J Rural Med 2014;19(1) PMID: 24398354 [PubMed – indexed for MEDLINE]

Roy D. Jeffery, Carmen Krogh, and Brett Horner, Adverse health effects of industrial wind turbines Can Fam Physician 2013; 59: 473-475 (Commentary) PMCID: PMC3653647

Roy D. Jeffery MD FCFP, Carmen Krogh, Brett Horner CMA, Adverse health effects of industrial wind turbines, Letter to editor, Can Fam Physician. 2013 Sep;59(9):921, 923-5 PMCID: PMC3771715

Carmen M.E. Krogh, Industrial Wind Turbine Development and Loss of Social Justice? Bulletin of Science Technology & Society 2011 31: 321, DOI: 10.1177/0270467611412550,

Carmen M.E. Krogh, Lorrie Gillis, Nicholas Kouwen, and Jeffery Aramini, WindVOiCe, a Self-Reporting Survey: Adverse Health Effects, Industrial Wind Turbines, and the Need for Vigilance Monitoring Bulletin of Science Technology & Society 2011 31: 334, DOI: 10.1177/0270467611412551.

Brett Horner, Roy D. Jeffery and Carmen M. E. Krogh, Literature Reviews on Wind Turbines and Health: Are They Enough? Bulletin of Science Technology & Society 2011 31: 399. DOI: 10.1177/0270467611421849

Stephen E. Ambrose, Robert W. Rand and Carmen M. E. Krogh, Wind Turbine Acoustic Investigation: Infrasound and Low-Frequency Noise–A Case Study, Bulletin of Science Technology & Society published online 17 August 2012 DOI: 10.1177/0270467612455734,

Robert W. Rand, Stephen E. Ambrose, and Carmen M. E. Krogh, Occupational Health and Industrial Wind Turbines: A Case Study, Bulletin of Science Technology & Society 2011 31: 359DOI: 10.1177/0270467611417849.

Birds and Bird Habitat: What Are the Risks From Industrial Wind Turbine Exposure? Terry Sprague, M. Elizabeth Harrington, and Carmen M. E. Krogh, DOI: 10.1177/0270467611417844

Canadian Medical Association Journal (CMAJ) Blog

Carmen Krogh, BScPharm57 and R Y McMurtry, M.D., F.R.C.S.(C), F.A.C.S.58, Health Canada and Wind Turbines: Too little too late? CMAJ • November 28, 2014

Conference papers

Krogh CME Noise and Children’s Risk Factors including Industrial Wind Energy Facilities, Paper presented at the 7th International Symposium: Global Perspectives Safety & Health in Agricultural & Rural Populations (SHARP), Saskatoon, Saskatchewan, Canada October 19- 22, 2014

Wind Turbine Facilities’ Perception: A Case Study from Canada Peter N. Cole MD, MHSc, FRCP(C) and Carmen Krogh, BScPharm 5th International Conference on Wind Turbine Noise Denver 28 – 30 August 2013 (published in proceedings but not presented) Audit report: literature reviews on wind turbine noise and health Brett Horner, Carmen ME Krogh, Roy D Jeffery Paper presented at the Wind Turbine Noise conference 2013, August 28 to 30, Denver, Colorado, USA

Trading off human health: Wind turbine noise and government policy Carmen ME Krogh, Joan Morris, Murray May, George Papadopoulos, Brett Horner, Paper presented at the Wind Turbine Noise conference 2013, August 28 to 30, Denver, Colorado, USA

Carmen ME Krogh, Roy D Jeffery, Jeff Aramini, Brett Horner, Wind turbines can harm humans: a case study, Paper presented at Inter-noise 2012, New York City, NY

Carmen ME Krogh, Roy D Jeffery, Jeff Aramini, Brett Horner, Wind turbine noise perception, pathways and effects: a case study Paper presented at Inter-noise 2012, New York City, NY

Carmen ME Krogh, Roy D Jeffery, Jeff Aramini, Brett Horner, Annoyance can represent a serious degradation of health: wind turbine noise a case study, Paper presented at Inter-noise 2012, New York City, NY

Stephen E. Ambrose, Robert W. Rand and Carmen M. E. Krogh, Falmouth, Massachusetts wind turbine infrasound and low frequency noise measurements, Invited paper presented at Inter-noise 2012 New York City, NY

Follow link for original letter and References Wind Turbines Dr Lock Letter Feb 25 2015 FINAL

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