Assessing the unintended health impacts of road transport policies and interventions: Translating research evidence for use in policy and practice

MRC Social & Public Health Sciences Unit, Glasgow, UK.
BMC Public Health (Impact Factor: 2.26). 10/2008; 8(1):339. DOI: 10.1186/1471-2458-8-339
Source: PubMed


Transport and its links to health and health inequalities suggest that it is important to assess both the direct and unintended indirect health and related impacts of transport initiatives and policies. Health Impact Assessment (HIA) provides a framework to assess the possible health impacts of interventions such as transport. Policymakers and practitioners need access to well conducted research syntheses if research evidence is to be used to inform these assessments. The predictive validity of HIA depends heavily on the use and careful interpretation of supporting empirical evidence. Reviewing and digesting the vast volume and diversity of evidence in a field such as transport is likely to be beyond the scope of most HIAs. Collaborations between HIA practitioners and specialist reviewers to develop syntheses of best available evidence applied specifically to HIA could promote the use of evidence in practice.
Best available research evidence was synthesised using the principles of systematic review. The synthesis was developed to reflect the needs of HIA practitioners and policymakers.
Aside from injury reduction measures, there is very little empirical data on the impact of road transport interventions. The possibility of impacts on a diverse range of outcomes and differential impacts across groups, make it difficult to assess overall benefit and harm. In addition, multiple mediating factors in the pathways between transport and hypothesised health impacts further complicate prospective assessment of impacts. Informed by the synthesis, a framework of questions was developed to help HIA practitioners identify the key questions which need to be considered in transport HIA.
Principles of systematic review are valuable in producing syntheses of best available evidence for use in HIA practice. Assessment of the health impacts of transport interventions is characterised by much uncertainty, competing values, and differential or conflicting impacts for different population groups at a local or wider level. These are issues pertinent to the value of HIA generally. While uncertainty needs explicit acknowledgement in HIA, there is still scope for best available evidence to inform the development of healthy public policy.

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However, hypotheses around health benefits need to be validated: There are many examples of well-intended interventions which did not produce the expected benefits, and in some cases had adverse effects. Compared to many clinical interventions, social interventions are characteristically difficult to control, and likely to be more susceptible to the effect of confounding and mediating factors. These issues increase the level of uncertainty inherent in hypotheses about the impacts of social interventions, in particular health impacts which are influenced by many factors, and further underlines the need for empirical validation. Evidence from empirical research evaluating the health impacts of social interventions needs to be used to inform and refine future policy if the potential for public policy to contribute to health improvement is to be realised. Both reviews of previous research evidence as well as the pursuit of new evidence can be used to develop the evidence base. Previous evidence needs to be reviewed rigorously and comprehensively to minimise the potential for selective interpretations which may be subject to bias; this is best done using transparent systematic review methods. New evaluations are required to provide up-to-date evidence as well as to improve the quality of evidence and plug gaps in the evidence which systematic reviews are well placed to identify. Having synthesised previous evidence and generated newly relevant evidence, it is crucial that the available evidence is made available to those in policy and practice who are most likely to use the evidence. It is necessary that the evidence is disseminated beyond academic audiences and translate the evidence or knowledge to provide syntheses of evidence which are accessible to and tailored to the needs of potential evidence-users. The use of systematic reviews, evaluations of health impacts, and knowledge transfer work has existed for many years within both the health and social policy field. However, the application of these approaches to the field of healthy public policy and the health impacts of social interventions is relatively novel. Application of conventional methods to this new area has required adapting and developing existing methods appropriately. The proposed submission The portfolio of publications selected for this submission represents a selection of the applicant’s publications since 2001. Hilary Thomson is the lead author on each of these publications which were prepared from work carried out with the Evaluation programme (original title Evaluation of the health impacts of non-health sector interventions) of research based at the Medical Research Council’s Social & Public Health Sciences Unit, Glasgow. This programme was funded by the Chief Scientist’s Office of the Scottish Government in 1999 to provide evidence on the health impacts of social interventions, and thus to inform the development of healthy public policy. This thesis presents 10 peer reviewed international publications in this field; nine of these are from high impact public health journals, and one is an example of knowledge transfer that was commissioned by the WHO. The work is presented in three key themes each of key relevance to the development of best available evidence for healthy public policy. Theme I: Systematic review Three publications are presented in this theme, each of these reports the key findings of a systematic review. Paper I reports the findings of a systematic review of the health impacts of housing improvement; Paper III reports the findings of a similar review which has been substantially updated, both methodologically and in content. Paper II presents the findings of a systematic review of the health and socio-economic impacts of urban regeneration investment in the UK since 1980. Theme II: Evaluation & generation of new evidence Four publications are presented in this theme. Paper IV and Paper V report the empirical findings of studies investigating the health impacts of local community leisure facilities, and a local programme of housing-led neighbourhood regeneration respectively. Paper VI and Paper VII present a commentary and reflection based on the author’s experience in the field on how to develop best available evidence to inform healthy public policy. These papers focus on assessing the health impacts of income supplementation interventions, such as welfare benefits, and housing and regeneration investment, however, the emerging lessons and issues have a relevance to the wider field of healthy public policy. Theme III: Knowledge transfer Three publications are presented in this theme. Each of these illustrates how my work has gone beyond reviewing and generating evidence for an academic audience, by providing accessible evidence syntheses which are accessible to and tailored to the needs of policy makers and practitioners who wish to use evidence in their work. Paper VIII and Paper IX were commissioned by the Scottish Health Impact Assessment Network and report how I developed evidence syntheses on housing improvement and transport policy. Paper X presents an evidence synthesis on housing and health commissioned by the WHO for use by European policymakers.
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